Semi-structured Diagnostic Interview Research Articles

Evaluation of the 6‐item Identify Chronic Migraine screener in a large medical group

ObjectiveTo evaluate the sensitivity and specificity of the 6‐item Identify Chronic Migraine screener (ID‐CM[6]), designed to improve the detection of chronic migraine (CM).BackgroundCM is often undertreated and underdiagnosed. Survey‐based studies have found that approximately 75–80% of people meeting criteria for CM do not report having received an accurate diagnosis.MethodsThis study used claims data of patients enrolled in a large medical group who had at least one medical claim with an International Classification of Diseases 9th/10th revision diagnostic code for migraine in the 12‐month prescreening period. The Identify Chronic Migraine survey was administered by e‐mail, in‐person, or over the telephone to all enrolled patients. A Semi‐Structured Diagnostic Interview (SSDI) was administered by telephone by a trained physician. The ID‐CM(6) and SSDI classifications of CM status were compared to evaluate sensitivity and specificity of the ID‐CM(6) screening tool.ResultsThe analysis of the ID‐CM(6) screening tool included 109 patients, with 65/109 (59.6%) positive for CM based on the SSDI. The mean (standard deviation) age of the patient sample was 49 (15) years and 100/109 (91.7%) were female. Using the SSDI as the diagnostic gold standard, the ID‐CM(6) had a sensitivity of 70.8% (46/65) and a specificity of 93.2% (41/44).ConclusionThe ID‐CM(6) demonstrated acceptable sensitivity and good specificity in determining CM status. The results of this analysis support the real‐world utility of the ID‐CM(6) as a simple and useful tool to identify patients with CM.

Reliability and Validity of Preschool Feelings Checklist.

The Preschool Feelings Checklist (PFC) is a 16-item parent report measure of depressive symptoms in young children. However, data on its reliability and validity are limited. We examined the internal consistency and convergent, discriminant, and predictive validity of the PFC in an unselected community sample of 490 3-year old children. Child psychopathology was assessed using semi-structured diagnostic interviews conducted with a parent at ages 3 and 6 (the Preschool Age Psychiatric Assessment) and with the child and a parent at ages 9, 12, and 15 (the Kiddie Schedule for the Affective Disorders and Schizophrenia, Present and Lifetime Version). The PFC exhibited good internal consistency. It was concurrently associated with depression, as well as a wide range of other psychiatric disorders and functional impairment. Similarly, the PFC at 3years independently predicted depression and a range of other disorders and global functioning in subsequent assessments later in childhood and in adolescence. Finally, the PFC outperformed the longer Child Behavior Checklist in predicting diagnoses and functioning. Results support the concurrent and predictive validity of the PFC in preschoolers. However, it also exhibited concurrent and predictive associations with a number of other disorders, suggesting that it indexes a broad transdiagnostic liability for psychopathology and impairment.

"Less stress": a pilot study on a cognitive behavioral treatment program for anxiety in children with autism spectrum disorders.

Background:Comorbid anxiety disorders are prevalent in children with autism spectrum disorders (ASD), but only a minority receives adequate treatment for anxiety. Cognitive behavioral therapy (CBT) has been shown to be effective in treating anxiety disorders. The objectives of the present pilot study were to test the feasibility of the CBT program “Less stress” for comorbid anxiety disorders in children with ASD and explore whether an improvement in diagnostic outcomes for anxiety disorders and symptoms of anxiety was found after treatment.Methods:Participants were ten children diagnosed with ASD and anxiety disorders (eight boys, mean age = 9.5 years, range 8 - 12 years). The “Less Stress” program includes three months of weekly treatment sessions followed by three monthly booster sessions. Five therapists participated. A standardized semi-structured diagnostic interview with the mothers was used to assess comorbid disorders. Child anxiety symptoms were measured with the Revised Child Anxiety and Depression Scale (RCADS).Results:The therapists found the manual easy to use but adaptations were necessary, particularly shorter sessions due to frequent (n = 7) comorbid Attention-Deficit/Hyperactivity Disorder. The participants found the program useful and the parents noted that they had learned methods they could continue using after the end of the program.Eight of ten children completed the treatment. Seven of the eight completers benefited from the program. Five of those seven children were free from all anxiety disorders, while two had fewer anxiety disorders. On a group level, a significant mean reduction of anxiety symptoms (RCADS) was found after treatment.Conclusion:The therapists found the “Less stress” program to be a feasible intervention in a sample of children with ASD and comorbid anxiety. The significant reduction of anxiety after treatment is promising, but a replication in a larger and more rigorous study is needed to investigate the effectiveness of the intervention.

A brief session-by-session measure of eating disorder psychopathology for children and adolescents: Development and psychometric properties of the Eating Disorder-15 for Youth (ED-15-Y).

Despite evidence supporting the use of measures to track ongoing progress and outcome in treatment, there is a relative absence of measures that are appropriate for this purpose in youth with eating disorders. This study examined the psychometric properties of the Eating Disorder-15 for Youth (ED-15-Y) scale, including its ability to detect short-term change in symptomatology. Youth (N = 203) ages 8-18 years completed self-report questionnaires and semi-structured diagnostic interviews upon initial presentation for an outpatient eating disorders assessment at an academic medical center. The ED-15-Y demonstrated excellent reliability (internal consistency, split-half reliability) and high sensitivity to change early in treatment (change from sessions 1 to 8, adjusting for baseline score). Further, these data demonstrate that the ED-15-Y has excellent convergent validity, being highly correlated with a well-tested, longer measure of eating disorders psychopathology-the Eating Disorders Examination-Questionnaire (EDE-Q). These data also support good discriminant and concurrent validity, differentiating between youth without an eating disorder or with ARFID and youth with eating disorders involving weight and shape concerns (e.g., anorexia nervosa, bulimia nervosa). The ED-15-Y may be a useful tool to briefly assess eating disorder psychopathology in youth as young as 8 years old. Its sensitivity to change very early in treatment suggests that it has the potential to be used as a routine outcome measure in the context of treatment.

Therapygenetics: how is effectiveness of psychotherapy related to genotype?

Effectiveness of psychotherapy and of clinico-psychological interventions depends on different factors: skills and characteristics of a specialist; diagnosis and extent of severity of symptoms; social and personal peculiarities of patient/client; parameters of psychotherapeutic contact. Therapygenetics is a trend of applied research at the interface of molecular genetics and psychotherapy, which considers molecular-genetic predictors of success/failure of psychotherapeutic interventions.
 The aim of the article is analysis and summarization of the current research works in the field of therapygenetics, substantiation of their theoretical and practical significance for psychiatry, psychotherapy and clinical psychology, discussion of the existing limitations and requirements to the design of the respective applied research works. By the moment, contra-dictory, but at the same promising positions in therapygenetics can be outlined. In the given article the results of therapygenetic research performed mostly in accordance with methods of identification of candidate genes, are systematized. Gene-environment correlations in psycho-therapy of anxiety and depressive disorders in children and adults are described. Scarce studies of genetic predictors of effectiveness of psychotherapy in posttraumatic stress-related disorders are summarized. While planning a therapygenetic study, the following methodological, methodical and organizational aspects should be taken into consideration: sufficient representativeness of an experimental sample both from the point of view of socio-demographic characteristics and from the point of view of the diagnosis and used therapy; existence of the control group; use of assessment scales and semi-structured diagnostic interviews for assessment of functioning of respondents; universalization of protocols of assessment of the results of application of methods of psychotherapy; use of polygenomic search for associations; observance of confidentiality and provision of respondents with minimally effective ways of rendering psychological assistance.

Personality Disorder and Physical Health Comorbidities: A Link With Bone Health?

We examined whether personality disorders (PDs) (any, cluster A/B/C) were associated with bone mineral density (BMD) in a population-based sample of Australian women (n = 696). Personality and mood disorders were assessed using semi-structured diagnostic interviews. BMD was measured at the spine, hip, and total body using dual-energy x-ray absorptiometry (GE-Lunar Prodigy). Anthropometrics, medication use, physical conditions, and lifestyle factors were documented. The association between PDs (any, cluster A/B/C) and BMD (spine/hip/total body) was examined with multiple linear regression models. The best models were identified by backward elimination including age, weight, physical activity, smoking status, alcohol consumption, dietary calcium intake, mood disorders, physical multimorbidity, socioeconomic status, and medications affecting bone. The variables were retained in the model if p < 0.05. All potential interactions in final models were tested. Those with cluster A PD, compared to those without, had 6.7% lower hip BMD [age, weight adjusted mean 0.853 (95% CI 0.803–0.903) vs. 0.910 (95% CI 0.901–0.919) g/cm2, p = 0.027] and 3.4% lower total body BMD [age, weight, smoking, alcohol, calcium adjusted mean 1.102 (95% CI 1.064–1.140) vs. 1.139 (95% CI 1.128–1.150) g/cm2, p = 0.056]. No associations were observed between cluster B/C PDs and hip/total body BMD or between any of the PD clusters and spine BMD. To our knowledge, this study is the first to investigate the bone health of women with PD in a population-based sample. Given the paucity of literature, replication and longitudinal research including the examination of underlying mechanisms and sex differences are warranted.

Association of Borderline Personality Disorder Criteria With Suicide Attempts

Borderline personality disorder (BPD) has been identified as a strong risk factor for suicidal behavior, including suicide attempts. Delineating specific features that increase risk could inform interventions. To examine factors associated with prospectively observed suicide attempts among participants in the Collaborative Longitudinal Study of Personality Disorders (CLPS), over 10 years of follow-up, with a focus on BPD and BPD criteria. The CLPS is a multisite, naturalistic, prospective study of adult participants with 4 personality disorders (PDs) and a comparison group of adults with major depressive disorder and minimal PD features. Participants were all treatment-seeking and recruited from inpatient, partial, and outpatient treatment settings across New York, New York, Boston, Massachusetts, New Haven, Connecticut, and Providence, Rhode Island. A total of 733 participants were recruited at baseline, with 701 completing at least 1 follow-up assessment. The cohorts were recruited from September 1996 through April 1998 and September 2001 through August 2002. Data for this study using this follow-up sample (N = 701) were analyzed between March 2019 and August 2020. Participants were assessed annually using semistructured diagnostic interviews and a variety of self-report measures for up to 10 years. Multiple logistic regression analyses were used to examine baseline demographic and clinical risk factors, including BPD and individual BPD criteria, of suicide attempt assessed over 10 years of prospective follow-up. Of the 701 participants, 447 (64%) identified as female, 488 (70%) as White, 527 (75%) as single, 433 (62%) were unemployed, and 512 (73%) reported at least some college education. Of all disorders, BPD emerged as the most robust factor associated with prospectively observed suicide attempt(s) (odds ratio [OR], 4.18; 95% CI, 2.68-6.52), even after controlling for significant demographic (sex, employment, and education) and clinical (childhood sexual abuse, alcohol use disorder, substance use disorder, and posttraumatic stress disorder) factors. Among BPD criteria, identity disturbance (OR, 2.21; 95% CI, 1.37-3.56), chronic feelings of emptiness (OR, 1.63; 95% CI, 1.03-2.57), and frantic efforts to avoid abandonment (OR, 1.93; 95% CI, 1.17-3.16) emerged as significant independent factors associated with suicide attempt(s) over follow-up, when covarying for other significant factors and BPD criteria. In the multisite, longitudinal study of adults with personality disorders, identity disturbance, chronic feelings of emptiness, and frantic efforts to avoid abandonment were significantly associated with suicide attempts. Identity disturbance, chronic feelings of emptiness, and frantic efforts to avoid abandonment may be clinically overlooked features of BPD in context of suicide risk assessment. In light of the high rates of BPD diagnostic remission, our findings suggest that these criteria should be independently assessed and targeted for further study as suicide risk factors.

Familial aggregation of anxiety disorder subtypes and anxious temperament in the NIMH Family Study of Affective Spectrum Disorders

BackgroundEvidence from family and twin studies suggests that mood and anxiety disorders, and related temperamental factors may share common etiologic factors. We examine the familial aggregation and coaggregation of anxiety disorder subtypes and anxiety-related temperamental traits, and their association with mood disorders. MethodsA total of 477 probands and 549 first-degree adult relatives from a large community based family study of affective spectrum disorders completed semi-structured diagnostic interviews and self-reported assessments of temperamental traits including: negative affectivity on the ‘Positive and Negative Affect Schedule’ (PANAS), neuroticism anxiety on the ‘Zuckerman-Kuhlman Personality Questionnaire’ (ZKPQ), and anxiety sensitivity on the ‘Anxiety Sensitivity Index’ (ASI). ResultsThe anxiety-related temperamental traits of negative affectivity, neuroticism anxiety and anxiety sensitivity had significant familial specificity, even after controlling for comorbid mood and anxiety disorders in probands and relatives. Yet, these traits in probands did not predict anxiety disorders in relatives. Although some anxiety subtypes were familial, there were no longer familial links between anxiety disorder subtypes (generalized anxiety disorder, social anxiety or panic disorder) after controlling for mood disorder subtypes in probands and relatives. LimitationsCross-sectional interviews were used to estimate disorders, and self-report measures were used for temperamental traits. ConclusionsThese results confirm previous research regarding familial overlap between anxiety subtypes and mood disorders, however their shared liability cannot be fully explained by anxiety-related temperamental traits. These findings suggest that anxiety-related temperamental traits may indicate a vulnerability for mood and anxiety disorders or a potential consequence of these conditions.

Glutamatergic Correlates of Bipolar Symptoms in Adolescents.

Objectives: Prior studies demonstrate elevated cortical glutamate (Glu) in patients with bipolar disorder (BD). Studies assessing neurochemistry in early stages of bipolar illness before the emergence of manic symptoms are lacking. This study aimed to examine neurochemical correlates measured by proton magnetic resonance spectroscopy (1H-MRS) and a dimensional measure of bipolarity in a sample of depressed adolescents. Methods: Adolescent participants (aged 13-21 years) underwent a semistructured diagnostic interview and clinical assessment, which included the General Behavior Inventory Parent Version (P-GBI), a 73-item, parent-rated assessment of symptoms and behaviors. 1H-MRS scans of a left dorsolateral prefrontal cortex (L-DLPFC) voxel (8 cm3) were collected using a two-dimensional J-averaged sequence to assess N-acetylaspartate (NAA), Glu, Glx (glutamate + glutamine), and NAA/Glx concentrations. We used generalized linear models to assess the relationships between P-GBI scores and metabolite levels in L-DLPFC. Results: Thirty-six participants (17 healthy controls, 19 depressed) underwent 1H-MRS scans and clinical evaluation with the P-GBI. There was a significant negative relationship between P-GBI score and L-DLPFC NAA/Glx in the whole sample. However, the magnitude of the effect was small and statistical significance was lost after correcting for multiple comparisons. Conclusions: These preliminary results suggest that NAA/Glx may have utility as a marker of bipolar traits in healthy and depressed adolescents. If replicated, 1H-MRS measures of glutamatergic metabolism anomalies might have a role in identifying depressed adolescents at risk for mixed symptom presentations or BD. Identifying bipolarity in the early stages of the disease would have a significant impact on treatment planning and prognosis. Further longitudinal studies should examine neurochemical correlates of mood state during the developmental emergence of BD.

مقایسه اثربخشی درمان رفتاری بارکلی، خانواده درمانی ساختاری مینوچین و نوروفیدبک بر اضطراب کودکان مبتلا به اختلال نقص توجه – بیش فعالی

Background &amp; objective: Due to the consequences of attention deficit - hyperactivity disorder, various therapy approach have been formed. This research aimed to investigate a comparative study between Barkley behavioral therapy, Minuchin structural family therapy and neuro-feedback on anxiety among children suffering from attention deficit – hyperactivity disorder. Methods: This study was a quasi - experimental pretest-posttest with a control group. The study population consisted of all primary school student in Karaj in 2018. By using cluster sampling method, 400 students selected and screening conducted for hyperactivity and anxiety. The sample consisted of 40 (10 for each group) students and their mothers were selected by as an available and randomly recruits to each of groups. Instruments for gathering data were semi-structured diagnostic interview (K-SADS), short diagnostic scale for hyperactivity and attention deficit disorder (Caners, 1999) and multidimensional child anxiety scale (March et al., 1997). Then, the participants in the experimental groups (Three groups) participated in Barkley behavioral therapy (9 sessions of 90 min), Minuchin structural family therapy (8 sessions of 90 min) and neuro-feedback (25 sessions of 30 min), while the control group did not receive any intervention. Then, the data were analyzed using SPSS.v21 software and statistical tests such as MANCOVA and ANCOVA. Data analysig was performed with SPSS.v16 and significant levels of all tests set on 0.05. Results: The results indicate that Barkley behavioral therapy, Minuchin structural family therapy and neuro-feedback have significant impact on anxiety among children suffering from attention deficit – hyperactivity disorder, generally (P &lt; 0.01). Furthermore, post-hoc test revealed that the efficacy of therapies on anxiety of experiment groups is different (P &lt; 0.01). Three months follow-up results represent resistance of therapies (P &gt; 0.01). Conclusion: So, using of these therapies for reduction of anxiety among children suffering from attention deficit – hyperactivity disorder. Key words: Barkley behavioral therapy, Minuchin structural family therapy, neuro-feedback, anxiety, attention deficit – hyperactivity disorder

Evaluating maternal psychopathology biases in reports of child temperament: An investigation of measurement invariance.

Parent reports of child temperament, especially those of mothers', are frequently used in research and clinical practice, but there are concerns that maternal characteristics, including a history of psychopathology, might bias reports on these measures. However, whether maternal reports of youth temperament show structural differences based on mothers' psychiatric history is unclear. We therefore conducted tests of measurement invariance to examine whether maternal psychopathology was associated with structural aspects of child temperament as a means of evaluating potential biases related to mothers' mental disorder history. From 2 community-based studies of child temperament, 935 mothers completed the Child Behavior Questionnaire (CBQ) and semistructured diagnostic interviews that assessed their own lifetime history of depressive symptoms, anxiety, and substance use disorders. Mothers also completed a measure of depressive symptoms concurrent to their completion of the CBQ. We found little evidence that mothers' current depressive symptoms or history of depressive symptoms, anxiety, or substance use disorders were associated with the structure of their reports of child temperament. Thus, there is little empirical support for systematic biases in reports of youth temperament as indexed by psychometric modeling. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Late-onset depression is associated to age-related central auditory processing disorder in an older population in Southern Italy.

The association between late-life depression (LLD) and age-related hearing loss (ARHL) was suggested by preliminary studies, but reliance on LLD subtypes may introduce significant bias. We examined the association between ARHL and LLD according to the age of onset (early-onset depression (EOD) and late-onset depression (LOD)). We investigated the association between ARHL and LLD diagnosed according to the Semi-structured Clinical Diagnostic Interview for DSM-IV-TR in 1749 Italian community-dwelling older subjects from the population-based GreatAGE Study, Southern Italy. Peripheral ARHL was assessed as a pure tone average (PTA) threshold > 40dB hearing level in the better ear- and age-related CAPD as a score of < 50% to the Synthetic Sentences Identification with Ipsilateral Competitive Message (SSI-ICM) test. LLD amounted at 10.29% of the sample, subdivided in LOD (6.21%) and EOD (4.08%). Age-related CAPD tended to be higher in LOD (28.91%) than in EOD (19.05%). After accounting for covariates, LOD was tendentially associated to age-related CAPD, but not to peripheral ARHL. This trend was confirmed by the linear models in which LOD was significantly associated to worsen SSI-ICM percentages (odds ratio 2.38, 95% confidence interval 1.32-4.30, p = 0.004), but not to PTA values. In a fully adjusted model of LOD, the effect of the association between CAPD and LOD was explained by social dysfunction. LLD was not associated to peripheral ARHL. Age-related CAPD was associated to LOD, a form of depression with cognitive dysfunction hallmark. The ARHL assessment may be an important opportunity to prevent depressive disorders in later life, particularly for LOD.

PSYCHIATRIC COMORBIDITY AND SLEEP PROBLEMS IN CHILDREN AND ADOLESCENTS WITH ATTENTION DEFICIT HYPERACTIVITY DISORDER IN RELATION TO ATTENTION DEFICIT HYPERACTIVITY DISORDER PRESENTATION, AGE AND GENDER

Objective: This study aimed to investigate psychiatric comorbidity and sleep problems and their relationships with ADHD presentation, age and gender in a clinical sample of children and adolescents with ADHD. Material and Method: One hundred fifty-four subjects aged 6-17 were included in the study. A semi-structured diagnostic interview was conducted to screen psychiatric disorders. The Child Depression Inventory (CDI), Screen for Child Anxiety Related Emotional Disorders (SCARED) and Children’s Sleep Habits Questionnaire (CSHQ) were used to investigate internalizing difficulties and sleep problems. Results: Overall high rates of comorbid disorders (78%) and sleep problems (97%) were found. ADHD-C was significantly more frequent in males and ADHD-I was more frequent in females (p&lt;0.001). While oppositional defiant disorder (ODD), enuresis and encopresis were more frequent in subjects with ADHD-C (p&lt;0.05), generalized anxiety (GAD) and social anxiety (SAD) disorders were more frequent in subjects with ADHD-I (p&lt;0.05). Females, compared to males, had more frequent diagnoses of depression (p=0.021) and SAD (p=0.03). The majority of subjects (96.7%) scored above the cut off score of 41 in CSHQ (50.51±5.86). The ADHD-C group had significantly higher CSHQ total scores than the ADHD-I group (p&lt;0.05). There was a significant positive correlation between CSHQ total scores and the number of lifetime comorbid diagnoses (p=0.006), self-reported anxiety (p=0.009) and depressive (p=0.004) symptoms. Conclusion: Comorbidity and sleep problems may be common in young people with ADHD and may have complex reciprocal relations with several factors including ADHD presentation, age, and gender.

Religious Hallucinations and Religious Delusions among Older Adults in Treatment for Psychoses in the Netherlands

Background. Although religious delusions (RDs) are common in geriatric psychiatry, we know little about their frequency and content. Our study examines the prevalence and content of religious hallucinations (RHs) and RDs and how they relate to the diagnosis and the patients’ denominational background and other aspects of religiousness. Methods. Semi-structured diagnostic interviews were conducted with inpatients and outpatients (N = 155, mean age 76.5) at a geriatric psychiatry department in the Netherlands. We used the Schedules for Clinical Assessment in Neuropsychiatry 2.1. Results. The prevalences of RHs and RDs were 19% and 32%, respectively. RHs were mostly auditory. There was no statistically significant difference between the prevalence of RHs in schizophrenia (17.5%) and in psychotic depression (9.4%). Compared to non-affiliated patients and mainline Protestants, RDs were significantly more prevalent in raised and current strict Protestants, especially in those with psychotic depression. RHs were more prevalent in Evangelical (e.g., Pentecostal) and strict Protestant patients. The presence of RDs was associated with several measures of religiousness (e.g., dogmatism, religious coping). Conclusions. Religion is likely to act as a symptom-formation factor for psychotic symptoms in strict Protestant older adults. More detailed research might lead to a fuller understanding of how strict religious beliefs may affect the content of psychotic symptoms and unintentionally add a component of existential suffering. It is important for mental health professionals, especially the predominantly secular professionals in the Netherlands, to recognize and address religious themes.

Validity of the Korean Version of DIVA-5: A Semi-Structured Diagnostic Interview for Adult ADHD.

BackgroundThis study was to assess the validity of the Korean version of the semi-structured Diagnostic Interview for Adult ADHD, third edition (DIVA-5). The secondary aim was to compare sociodemographic and psychiatric comorbidities in adult patients with and without a diagnosis of ADHD.MethodsA total of 279 participants were recruited from nine psychiatric outpatient clinics in Korea. All participants were administered the Mini-International Neuropsychiatric Interview (MINI) Plus v.5.0.0, the Adult ADHD Self-Report Scale v1.1 (ASRS-v1.1) Symptom Checklist, and DIVA-5. Diagnosis concordance between two board-certified psychiatrists and DIVA-5 were analysed.ResultsThe DIVA-5 showed a diagnostic accuracy of 92%, a sensitivity of 91.30%, and a specificity of 93.62%. Significant clinical and demographic differences between ADHD and control groups were found.ConclusionThe Korean version of DIVA-5 is a reliable tool for assessing and diagnosing ADHD in adult Korean populations.

Clinical and neuroimaging correlates of cardiorespiratory fitness in adolescents with bipolar disorder

Cardiovascular disease (CVD) is exceedingly prevalent, and occurs prematurely in individuals with bipolar disorder (BD). Cardiorespiratory fitness (CRF), arguably the most important modifiable CVD risk factor, is also associated with brain structure and function. There is a gap in knowledge regarding CRF in BD, particularly in relation to brain structure. Adolescents with BD (n=54) and healthy controls (HC; n=53) completed semi-structured diagnostic interviews, self-report questionnaires, and 20 minutes of cardiorespiratory exercise at 60-80% of estimated maximum heart rate (HR) on a bicycle ergometer. Average power (watts/kg) within this HR range served as a previously validated proxy for CRF. Brain magnetic resonance imaging (MRI) structural analysis was done using FreeSurfer. Analyses controlled for age and sex. CRF was significantly lower in BD vs HC (0.91±0.32 vs 1.01±0.30, p=0.03, F=4.66, df=1, η2 =0.04). Within BD, greater depression symptoms were associated with lower CRF (P=.02), and greater physical activity (PA) was associated with greater CRF (P<.001). In multivariable analyses, there were significant main effects of diagnosis (HC>BD; P=.03) and sex (M>F; P<.001) on power. Significant predictors of power within BD included male sex (P=.02) and PA (P=.002) but not depression symptoms (P=.29). Significant diagnosis by CRF interaction effects was found in frontal, parietal, and occipital cortical regions. CRF was reduced among adolescents with BD, particularly women, related in part to depression symptoms and inactivity and was differentially associated with regional brain structure. Studies seeking to improve CRF as a means of reducing psychiatric symptoms of BD are warranted.

\u201cSince his birth, I\u2019ve always been old\u201d the experience of being parents to children displaying disruptive behavior problems: a qualitative study

BackgroundBeing parents of children who display disruptive behavior problems (DBP) can pose several challenges. Interventions for children with DBP are primarily outpatient group parent training (PT) programs. The purpose of this study was to explore how parents of children with disruptive behavior problems, diagnosed with oppositional defiant disorder (ODD), describe the difficulties they face in their family and parenting situations.MethodsNineteen parents of children aged 3 to 8 years who had searched for help and signed up for a parent training program provided by Child and Adolescent Mental Health Service participated in the study. Semi-structured diagnostic interviews and a modified background interview adapted for the purpose of the study were conducted before parents entered the program. All children included in the study met the DSM criteria for ODD. The interviews were audiotaped and transcribed. Thematic analysis was used to examine, identify, and report patterns of meaning in the data. The analysis was conducted inductively using a contextual approach.ResultsParents described their own vulnerability, how they were affected by the parent-child interaction, and the challenges they perceived in their parenting practices. The study contributes to an understanding of the complexity that parents of children with ODD perceive in everyday life.ConclusionsThe parents in the study highlight the need to address parents’ own mental health problems, parental alliance, capacity for emotion regulation, perceived helplessness as parents, lack of parental strategies, sense of isolation, and absence of supportive social networks. All these factors could be important when tailoring interventions aimed to help and support parents of children who display DBP, and specifically ODD.

How common are depression and anxiety in adolescents with chronic fatigue syndrome (CFS) and how should we screen for these mental health co-morbidities? A clinical cohort study

Adolescents with Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (CFS/ME) appear to be more likely to experience anxiety and/or depression using Patient Reported Outcome Measures (PROMs). However, we do not know how accurate these are at detecting problems in this patient group given the primary symptom of fatigue. We aimed to accurately determine the prevalence of anxiety/depression using gold-standard diagnostic interviews and evaluate the accuracy of PROMs measuring mood disorders in this patient group. We conducted a cross-sectional epidemiological study in a specialist tertiary paediatric CFS/ME service, England. The participants were164 12–18-year olds with clinician confirmed CFS/ME and their parents. The measures were a semi-structured diagnostic interview, the Kiddie Schedule for Affective Disorders and Schizophrenia, K-SADS, and questionnaires (Revised Children’s Anxiety and Depression Scale, RCADS; Spence Children’s Anxiety Scale, SCAS; Hospital Anxiety and Depression Scale, HADS). Parents completed the RCADS-P. 35% met the criteria for at least one common mental health problem. 20% had major depressive disorder, and 27% an anxiety disorder, with social anxiety and generalised anxiety being the most common. There was high co-morbidity, with 61% of those who were depressed also having at least one anxiety disorder. The questionnaires were moderately accurate (AUC > 0.7) at detecting clinically significant anxiety/depression, although only the RCADS-anxiety reached the predefined 0.8 sensitivity, 0.7 specificity target. Mental health problems are particularly common amongst adolescents with CFS/ME. Most screening tools were not sufficiently accurate in detecting clinically significant anxiety and depression, so these should be used with care in combination with thorough psychological/psychiatric assessment.

Bottom-up and top-down approaches to understanding oppositional defiant disorder symptoms during early childhood: a mixed method study

BackgroundChildren with clinical levels of conduct problems are at high risk of developing mental health problems such as persistent antisocial behavior or emotional problems in adolescence. Serious conduct problems in childhood also predict poor functioning across other areas of life in early adulthood such as overweight, heavy drinking, social isolation and not in employment or education. It is important to capture those children who are most at risk, early in their development. The Diagnostic and Statistical Manual of Mental Disorders (DSM–5) is commonly used in clinical settings, to identify children with conduct problems such as oppositional defiant disorder (ODD).This paper presents a cross-sectional study in a clinical setting, and describes behaviors in 3- to 8-year-olds with ODD. Our aim was to investigate whether there were problematic behaviors that were not captured by the diagnosis of ODD, using two different methods: a clinical approach (bottom-up) and the nosology for the diagnosis of ODD (top-down).MethodFifty-seven children with clinical levels of ODD participated in the study. The mothers were interviewed with both open questions and with a semi-structured diagnostic interview K-SADS. The data was analyzed using a mixed method, convergent, parallel qualitative/quantitative (QUAL + QUAN) design. For QUAL analysis qualitative content analysis was used, and for QUAN analysis associations between the two data sets, and ages-groups and gender were compared using Chi-square test.ResultsIn the top-down approach, the ODD criteria helped to identify and separate commonly occurring oppositional behavior from conduct problems, but in the bottom-up approach, the accepted diagnostic criteria did not capture the entire range of problematic behaviors-especially those behaviors that constitute a risk for antisocial behavior.ConclusionsThe present study shows a gap between the diagnoses of ODD and conduct disorder (CD) in younger children. Antisocial behaviors manifest in preschool and early school years are not always sufficiently alarming to meet the diagnosis of CD, nor are they caught in their entirety by the ODD diagnostic tool. One way to verify suspicion of early antisocial behavior in preschool children would be to specify in the ODD diagnosis if there also is subclinical CD.

Optimizing screening for depression, anxiety disorders, and post-traumatic stress disorder in inpatient addiction treatment: A preliminary investigation

ObjectiveSubstance use disorders (SUD) are frequently comorbid with other psychiatric conditions, but a comprehensive diagnostic assessment is often not feasible clinically. Efficient psychometrically-validated screening tools exist for commonly comorbid conditions, but cutoff accuracies have typically not been evaluated in addiction treatment settings. This study examined the performance of several widely-used screening measures in relation to diagnostic status from a clinical interview to identify and validate cutoff scores in an inpatient SUD treatment setting. MethodParticipants were 99 patients in a large residential SUD treatment program in Ontario, Canada. Participants completed a screening battery, including the Patient Health Questionnaire – 9 (PHQ-9), Generalized Anxiety Disorder – 7 (GAD-7), and Post-Traumatic Stress Disorder Checklist-5 (PCL-5), and underwent a semi-structured diagnostic clinical interview. Receiver operating characteristic curves were used to determine optimal cutoff scores on the screening tool against the interview-based diagnosis. ResultsArea under the curve (AUC) was statistically significant for all screens and were as follows: PHQ-9 = 0.70 (95% CI = 0.59–0.80), GAD-7 = 0.74 (95% CI = 0.63–0.84), and PCL-5 = 0.79 (95% CI = 0.66–0.91). The optimal accuracy cutoff scores based on sensitivity and specificity were: PHQ-9 ≥ 16, GAD-7 ≥ 9, the PCL-5 ≥ 42. ConclusionsIn general, the candidate screeners performed acceptably in this population. However, the optimal cutoff scores were notably higher than existing guidelines for depression and PTSD, potentially due to the general elevations in negative affectivity among individuals initiating SUD treatment. Further validation of these cutoff values is warranted. Public health significanceThis study provides modified screening cutoff scores for major depression, anxiety disorders, and post-traumatic stress disorder in addiction treatment settings.