Continuum Of Severity Research Articles

Latent profiles of patients with borderline pathology based on the alternative DSM-5 model for personality disorders

BackgroundThere have been multiple attempts to try to parse out heterogeneity within borderline pathology by identifying patient subtypes; thus far, these works have yielded few consistent results. Recent developments in the operationalization of borderline pathology may provide new opportunities to identify clinically and conceptually meaningful subgroups of patients. The Alternative DSM-5 Model for Personality Disorders (AMPD) offers a categorical-dimensional operationalization of Borderline personality disorder (BPD) that has yet to be tested for identification of patient subgroups. The purpose of the present study is to test whether the combination of the Criterion A elements (pertaining to level of severity) and the seven pathological facets from Criterion B that define BPD in the AMPD can yield meaningful patient profiles.MethodsA total of 211 outpatients from a specialized PD treatment program (133 women, Mage = 33.66, SD = 10.97) were selected based on the presence of at least moderate borderline pathology according to cutoffs recently proposed for the Borderline Symptom List-23. Valid Criterion A (Self and Interpersonal Functioning Scale) and B (Personality Inventory for DSM-5 Faceted Brief Form) self-reports were administered to measure elements and facets that define BPD in the AMPD model; these variables were used as indicators in a latent profile analysis (LPA).ResultsThe optimal solution generated by LPA yielded four distinct profiles: (a) Borderline traits; (b) Moderate pathology with Impulsivity; (c) Moderate pathology with Identity problems and Depressivity; and (d) Severe pathology. Clinically meaningful distinctions emerged among profiles on AMPD indicators and external variables relevant to PD, especially aggression and impulsivity.ConclusionsProfiles reflected both the “severity” and “style” components imbedded within Criterion A and B of the AMPD, as they were mainly distinguished by a continuum of severity but also by some meaningful qualitative differences that may have important clinical implications for treatment planning and contracting. Results also suggest that the four Criterion A elements have independent value to identify important differences in patients with borderline pathology. They also highlight that some Criterion B facets that define BPD in the AMPD may be especially important to identify subgroups of patients, mainly Impulsivity and Depressivity.

Altered temporal, but intact spatial, features of transient network dynamics in psychosis

Contemporary models of psychosis suggest that a continuum of severity of psychotic symptoms exists, with subthreshold psychotic experiences (PEs) potentially reflecting some genetic and environmental risk factors shared with clinical psychosis. Thus, identifying abnormalities in brain activity that manifest across this continuum can shed new light on the pathophysiology of psychosis. Here, we investigated the moment-to-moment engagement of brain networks (“states”) in individuals with schizophrenia (SCZ) and PEs and identified features of these states that are associated with psychosis-spectrum symptoms. Transient brain states were defined by clustering “single snapshots” of blood oxygen level-dependent images, based on spatial similarity of the images. We found that individuals with SCZ (n = 35) demonstrated reduced recruitment of three brain states compared to demographically matched healthy controls (n = 35). Of these three illness-related states, one specific state, involving primarily the visual and salience networks, also occurred at a lower rate in individuals with persistent PEs (n = 22), compared to demographically matched healthy youth (n = 22). Moreover, the occurrence rate of this marker brain state was negatively correlated with the severity of PEs (r = −0.26, p = 0.003, n = 130). In contrast, the spatial map of this state appeared to be unaffected in the SCZ or PE groups. Thus, reduced engagement of a brain state involving the visual and salience networks was demonstrated across the psychosis continuum, suggesting that early disruptions of perceptual and affective function may underlie some of the core symptoms of the illness.

Clinical and genetic differences between bipolar disorder type 1 and 2 in multiplex families

The two major subtypes of bipolar disorder (BD), BD-I and BD-II, are distinguished based on the presence of manic or hypomanic episodes. Historically, BD-II was perceived as a less severe form of BD-I. Recent research has challenged this concept of a severity continuum. Studies in large samples of unrelated patients have described clinical and genetic differences between the subtypes. Besides an increased schizophrenia polygenic risk load in BD-I, these studies also observed an increased depression risk load in BD-II patients. The present study assessed whether such clinical and genetic differences are also found in BD patients from multiplex families, which exhibit reduced genetic and environmental heterogeneity. Comparing 252 BD-I and 75 BD-II patients from the Andalusian Bipolar Family (ABiF) study, the clinical course, symptoms during depressive and manic episodes, and psychiatric comorbidities were analyzed. Furthermore, polygenic risk scores (PRS) for BD, schizophrenia, and depression were assessed. BD-I patients not only suffered from more severe symptoms during manic episodes but also more frequently showed incapacity during depressive episodes. A higher BD PRS was significantly associated with suicidal ideation. Moreover, BD-I cases exhibited lower depression PRS. In line with a severity continuum from BD-II to BD-I, our results link BD-I to a more pronounced clinical presentation in both mania and depression and indicate that the polygenic risk load of BD predisposes to more severe disorder characteristics. Nevertheless, our results suggest that the genetic risk burden for depression also shapes disorder presentation and increases the likelihood of BD-II subtype development.

Cognitive heterogeneity in the offspring of patients with schizophrenia or bipolar disorder: a cluster analysis across family risk

BackgroundNeurocognitive impairment is considered to lie on a continuum of severity across schizophrenia (SZ) and bipolar disorder (BP), possibly reflecting a gradient of neurodevelopmental load. Cluster analyses have identified different levels of impairment across the two disorders, from none to widespread and severe. We for the first time used this approach to examine cognitive function pooling together children and adolescents at familial risk of SZ or BP. Methods220 participants, 49 offspring of individuals with schizophrenia (SZO), 90 offspring of individuals with bipolar disorder (BPO) and 81 offspring of healthy control parents (HC), aged 6 to 17 years, underwent a comprehensive clinical and cognitive assessment. Cognitive measures were used to group SZO and BPO using K-means clustering. Cognitive performance within each of the clusters was compared to that of HC and clinical variables were compared between clusters. ResultsWe identified three cognitive subgroups: a moderate impairment group, a mild impairment group, and a cognitively intact group. Both SZO and BPO were represented in each of the clusters, yet not evenly, with a larger proportion of the SZO in the moderately impaired cluster, but also a subgroup of BPO showing moderate cognitive dysfunction. LimitationsParticipants have yet to reach the age of onset for the examined disorders. ConclusionsThe findings point to a range of neurodevelopmental loadings across youth at familial risk of both SZ and BP. They have therefore important implications for the stratification of cognitive functioning and the possibility to tailor interventions to individual levels of impairment.

Pregnant women misusing opioids: Depression, anxiety, stress, and neonatal opioid withdrawal syndrome

• Pregnant women misusing opioids report significant depression, anxiety, and stress. • Symptoms are higher compared to women with other medically high-risk pregnancies. • High maternal anxiety and low stress predict neonatal opioid withdrawal syndrome. Diagnoses of anxiety and depressive disorders are prevalent among women who misuse opioids during pregnancy and have been linked to the development of neonatal opioid withdrawal syndrome (NOWS) in infants. The role of stress in NOWS, however, has not been studied, despite its relationship to anxiety and depression. Moreover, anxiety and depression have only been assessed at the level of diagnoses, limiting our understanding of the effects of symptoms along a continuum of severity on opioid misuse in pregnancy and NOWS. We first compared symptoms of anxiety, depression, and stress assessed along a continuum in women who misused opioids during pregnancy ( n = 53) who chose to receive medication assisted treatment (MAT) or to detoxify from opioids, and women with high-risk pregnancies for medical reasons unrelated to drug use ( n = 37). We then examined whether depression, anxiety, and stress symptoms during pregnancy predicted NOWS. Findings revealed significantly higher depression, anxiety, and stress among pregnant women who misused opioids than among the comparison group. Furthermore, results indicated that higher anxious symptoms as hypothesized (but not depressive symptoms), and lower stress symptoms contributed to a greater likelihood of infants developing NOWS after delivery beyond the type of treatment (i.e., MAT or tapering/detoxification) they received for opioid use. The present study used a small sample size and had some measurement limitations. Findings suggest important opportunities for effective integrated psychological and medical interventions for pregnant women misusing opioids to improve their own health and that of their infants.

Cognitive Subtyping in Schizophrenia: A Latent Profile Analysis.

Cognitive dysfunction is a core feature of schizophrenia. The subtyping of cognitive performance in schizophrenia may aid the refinement of disease heterogeneity. The literature on cognitive subtyping in schizophrenia, however, is limited by variable methodologies and neuropsychological tasks, lack of validation, and paucity of studies examining longitudinal stability of profiles. It is also unclear if cognitive profiles represent a single linear severity continuum or unique cognitive subtypes. Cognitive performance measured with the Brief Assessment of Cognition in Schizophrenia was analyzed in schizophrenia patients (n = 767). Healthy controls (n = 1012) were included as reference group. Latent profile analysis was performed in a schizophrenia discovery cohort (n = 659) and replicated in an independent cohort (n = 108). Longitudinal stability of cognitive profiles was evaluated with latent transition analysis in a 10-week follow-up cohort. Confirmatory factor analysis (CFA) was carried out to investigate if cognitive profiles represent a unidimensional structure. A 4-profile solution was obtained from the discovery cohort and replicated in an independent cohort. It comprised of a "less-impaired" cognitive subtype, 2 subtypes with "intermediate cognitive impairment" differentiated by executive function performance, and a "globally impaired" cognitive subtype. This solution showed relative stability across time. CFA revealed that cognitive profiles are better explained by distinct meaningful profiles than a severity linear continuum. Associations between profiles and negative symptoms were observed. The subtyping of schizophrenia patients based on cognitive performance and its associations with symptomatology may aid phenotype refinement, mapping of specific biological mechanisms, and tailored clinical treatments.

Plasma levels of CGRP and expression of specific microRNAs in blood cells of episodic and chronic migraine subjects: towards the identification of a panel of peripheral biomarkers of migraine?

BackgroundMigraine can manifest with an episodic or a chronic pattern in a continuum of disease severity. Multiple factors are associated with the progression of the pattern from episodic to chronic. One of the most consistently reported factors is the overuse of medications (MO) for the acute treatment of migraine attacks. The mechanisms through which MO facilitates the transformation of episodic migraine (EM) into chronic migraine (CM) are elusive. In order to provide insights into these mechanisms, the present study aims to identify possible peripheral biomarkers associated with the two forms of migraine, and with the presence of MO.MethodsWe evaluated the plasma levels of calcitonin gene-related peptide (CGRP) and the expression of miR-34a-5p and miR-382-5p in peripheral blood mononuclear cells of subjects with EM (n = 27) or CM-MO (n = 28). Subjects in the CM-MO group were also tested 2 months after an in-hospital detoxification protocol.ResultsCGRP, miR-382-5p, and miR-34a-5p levels were significantly higher in CM-MO subjects when compared to EM patients (p = 0.003 for all comparisons). After correcting for age, sex, and disease duration, miRNAs expression was still significantly associated with migraine phenotype (EM vs. CM-MO: p = 0.014 for miR-382-5p, p = 0.038 for miR-34a-5p), while CGRP levels were not (p = 0.115). CGRP plasma levels significantly and positively correlated with miR-382-5p (Spearman’s rho: 0.491, p = 0.001) and miR-34a-5p (Spearman’s rho: 0.303, p =0.025) in the overall population. In the CM-MO group, detoxification significantly decreased CGRP levels and miRNAs expression (p = 0.001). When comparing responders and non-responders to the detoxification, the former group (n = 23) showed significantly higher levels of CGRP at baseline, and significantly lower expression of miR-382-5p after the detoxification.ConclusionsOur findings identify a potential panel of peripheral markers associated with migraine subtypes and disease severity. CGRP levels as well as miRNAs expression were influenced by MO, and modulated by detoxification in subjects with CM-MO.Trial registrationThe study protocol was registered at www.clinicaltrials.gov (NCT04473976).

Classification of gastrointestinal symptom patterns in young adults

BackgroundThe purpose of this study was to identify common gastrointestinal (GI) symptom groups using the Patient-Reported Outcomes Measurement Information System - GI symptom scales (PROMIS-GI) within a large sample of young adults. An attempt was made to relate the emergent groups to the Rome IV disorders of gut-brain interaction symptom domains. The PROMIS-GI is a freely available, adaptable, normatively referenced symptom measurement system that is applicable to many health assessment situations.MethodsParticipants were 956 introductory psychology students between the ages of 18 and 25 who completed the PROMIS-GI as part of ongoing research monitoring physical and psychological health of students at a major southeastern university. GI symptom groups were determined using a latent class analysis (LCA) approach. These GI symptom groups were then compared on key psychosocial factors including self-reported mood, anxiety, and health related quality of life (HRQoL) using MANOVA.ResultsThree groups were identified based on GI symptom elevations: Normal (n = 649), Mild (n = 257), and Moderate (n = 50). Self-reported anxiety, depression, and bodily pain levels were significantly higher in the Mild and Moderate GI symptom groups, and they indicated significantly lower work functioning, and general health ratings compared to participants in the normal group.ConclusionsApproximately a third of young adults surveyed were experiencing at least one GI symptom of a severity greater than normative levels. Both the Mild and Moderate GI groups demonstrated a similar configuration of symptoms with significantly the higher levels of pain, gas/bloating, and nausea/vomiting compared to the Normal group. The configuration of symptoms did not map discretely onto the Rome IV diagnostic categories for Bowel Disorders, such as IBS with predominant Diarrhea or Functional Constipation as might be expected. Rather, the emergent groups suggest that Bowel Disorders occur on a continuum of severity across multiple symptom areas. Mild to moderate GI symptoms appear to emerge at much earlier ages and are more frequent than previously documented. It is recommended that health service providers evaluate individual patterns of “GI health” when young adults present with anxiety and depression, and conversely, they should assess anxiety and depression when they present with GI complaints.

The performance of DSM-5 alcohol use disorder and quantity-frequency of alcohol consumption criteria: An item response theory analysis

BackgroundMaladaptive patterns of drinking are central to the development of AUD. However, no DSM-5 criteria ask about patterns of alcohol use, such as 5+/4+ binge drinking. It is important to examine whether such an item would improve the diagnostic utility of the DSM-5 instrument. MethodUsing a large representative sample of the US population, we used item response theory (IRT) methodology to examine the threshold, discrimination, and information value and differential criterion functioning of DSM-5 AUD criteria, along with a 5+/4+ drinking pattern criterion assessed at various levels of frequency. ResultsThe best fit drinking pattern criterion (defined at 5+/4+ drinking at least once a week in the past year) tapped the milder end of that continuum, which was similar to the criterion of drinking in larger amounts or for longer than intended. The new DSM-5 craving criterion was associated with mid-level values of threshold and discrimination. The AUD criteria with the addition of the 5+/4+ drinking pattern criterion demonstrated invariance across important subgroups of the population. ConclusionsAmong the criteria with the lowest level of threshold, the drinking pattern criterion has demonstrated its utility of the DSM-5 classification by identifying clinically significant but milder AUD cases. Along with its relationship to AUD relapse, the new craving criterion tapped the moderate levels of threshold and discrimination and thus, argues for its continued inclusion in the DSM-5 AUD formulation. Study results showed that DSM-5 AUD criteria and the 5+/4+ drinking pattern criterion formed a unidimensional continuum of AUD severity.

Impaired control in heavy drinking and its association with alcohol craving and alcohol use disorder severity

Introduction. Impaired control over drinking has been frequently cited in diverse theoretical descriptions regarding harmful alcohol use and is considered a DSM criterion for alcohol use disorder. Differences in the frequency of endorsement of impaired control have been viewed as a reflection of the severity of the problem. Moreover, it has been posited that the ability to place a limit on alcohol consumption may be mediated through enhanced craving. Objective. In this study, we addressed the relationship between impaired control, self-reported craving, and alcohol dependence severity among heavy drinkers. Method. We conducted a latent class analysis of impaired control dimensions (perceived control, failed control, and attempted control) of 208 heavy drinkers. To determine whether the identified classes could represent different forms of severity of the disorder, the best-fit model was contrasted with scores on the Alcohol Dependence Scale. Furthermore, we assessed the relationship between impaired control criteria (using the Impaired Control Scale [ICS]) with alcohol craving. Results. We identified a three-class solution based on impaired control severity. A graded increase of the craving scores and alcohol severity among the three classes was also identified. Only the ICS items comprising perceived control and partially those related to failed control, but not those evaluating attempted control, distinguished the gradient among the latent classes. Discussion and conclusion. This study provides further support of the proposal of a unidimensional continuum of severity among heavy drinkers and strengthens the theoretical relationship between impaired control and alcohol craving.

766-P: Factors Related to Subjective Cognitive Symptoms in People with Type 2 Diabetes: A Quantile Regression Analysis

Objectives: Early cognitive impairment is common in people with type 2 diabetes (T2DM). Subjective cognitive symptoms (SCS) have been associated with higher risks for early dementia and mild cognitive impairment and may be an early indication of further cognitive decline. Our goal was to identify factors related to SCS in people with T2DM to facilitate early screening for cognitive impairment in this population. Methods: A convenience sample of 115 adults with T2D was included. The cognitive symptom subscale of the Diabetes Symptom Checklist-Revised was used. Potential factors were measured using the Patient-Reported Outcomes Measurement Information System including depression, fatigue, and sleep. Data were analyzed using quantile regression which accounts for non-normal distribution of the dependent variable. Quantile regression was useful to examine the relationships along the continuum of SCS severity that may be missed in traditional linear regression. Results: The mean age of the participants was 58.64 (SD 8.64), and 53.9% were females. The mean score of the cognitive symptom subscale was 1.45 (SD 1.14, range 0 to 5). Using quantile regression, we found that increased sleep impairment (r = .02), sleep disruption (r = .02 to .05), and body mass index (r = .02) were significantly associated with increased SCS when the participants’ cognitive symptoms were in the lower quantiles (from .05 to .30). In contrast, increased depressive symptoms (r = .05 to .07) and fatigue (r = .04 to .06) were significantly associated with increased SCS in the higher quantiles of cognitive symptoms (from .70 to .95). Conclusions: In adults with T2DM, the level of SCS is differentially associated with common diabetes factors and should be considered when screening and intervening for cognitive impairment. Sleep and weight should be considered for patients reporting fewer cognitive symptoms, whereas depression and fatigue should be considered for patients reporting more cognitive symptoms. Disclosure M. Kim: None. C.G. Park: None. B. Zhu: None. C. Fritschi: None. Funding National Institute for Nursing Research (K99R00NR012219); University of Illinois at Chicago College of Nursing

M115. COGNITIVE FUNCTION IN BIPOLAR AND SCHIZOPHRENIA OFFSPRING: FINDINGS ACROSS THE NEURODEVELOPMENTAL CONTINUUM

BackgroundNeurocognitive impairment is considered to lie on a continuum of severity across schizophrenia (SZ) and bipolar disorder (BP), possibly reflecting a continuum of neurodevelopmental load. Due to the known heterogeneity, performance patterns across both disorders have been examined using clustering approaches, which previously identified subgroups with different levels of impairment, from none to widespread and severe. We, for the first time, used this approach to examine cognitive function in children and youth at familial risk of developing SZ and BP, in order to investigate cognitive profiles earlier on in the neurodevelopmental pathway.Methods220 participants, 49 offspring of individuals with schizophrenia (SZO), 90 offspring of individuals with bipolar disorder (BPO) and 81 healthy controls (HC), underwent a comprehensive cognitive assessment. Measures of attention, verbal memory, visual memory, executive function, working memory, and processing speed were used to group high-risk offspring. The k-means clustering with elbow method was used to determine the optimal number of clusters. High-risk offspring were then each assigned to a specific cluster. Cognitive performance within each of the clusters was compared to that of HC in order to describe the distribution of impairments across different cognitive domains and their severity. Between–cluster comparisons were then performed in terms of clinical and functioning variables.ResultsThree cognitive subgroups were identified for high-risk offspring: a global impairment group (19.5%) with severe impairments across most cognitive domains, a selective impairment group (46%) with moderate deficits across specific domains, and a cognitively intact group (34.5%) with performance comparable to that of healthy controls. Both SZO and BPO were represented in each of the three clusters. However a larger proportion of the SZO (30.6%) than of the BPO (13.3%) were characterised by widespread cognitive dysfunction, whereas BPO (41.1%) were more frequently cognitively spared relative to SZO (22.4%). Individuals in the global cognitive impairment group displayed significantly poorer clinical and functioning measures relative to the other two clusters.DiscussionThree cognitive subgroups were identified in BP and SZ offspring, a global impairment group, a selective impairment group and a cognitively intact group. The clustering pattern identified overlaps with that previously observed after illness onset.Findings are in line with the known heterogeneity in cognitive impairment across SZ and BP and can contribute to elucidate the timeframe of its emergence.Using cognitive function as a proxy measure of neurodevelopmental load, the findings point to a gradient in individuals at genetic risk of SZ and BP. They have therefore important implications for the understanding of potentially different neurodevelopmental trajectories within SZ and BP, hence for patient stratification in research and clinical practice.

What works and what does not work in Alzheimer's disease? From interventions on risk factors to anti-amyloid trials.

Alzheimer's disease (AD) is a progressive neurodegenerative disorder with no approved disease-modifying therapy (DMT). In this review, we summarize the various past approaches taken in an attempt to find treatments capable of altering the long-term course for individuals with AD, including: translating epidemiological observations into potential treatment options; seeking a single-treatment approach across the continuum of AD severity; utilizing biomarkers for assessing target engagement; using biomarkers as early surrogates of clinical efficacy; and enriching study populations to demonstrate adequate placebo decline during the limited duration of clinical trials. Although targeting the amyloid-β (Aβ) pathway has been central to the search for an effective DMT, to date, trials of anti-Aβ monoclonal antibodies have failed to consistently demonstrate significant clinical efficacy. Key learnings from these anti-Aβ trials, as well as the trials that came before them, have shifted the focus within clinical development programs to identifying target populations thought most likely to benefit from treatments (i.e., individuals at an earlier stage of disease). Other learnings include strategies to increase the likelihood of showing measurable improvements within the clinical trial setting by better predicting decline in placebo participants, as well as developing measures to quantify the needed treatment exposure (e.g., higher doses). Given the complexity associated with AD pathology and progression, treatments targeting non-amyloid AD pathologies in combination with anti-amyloid therapies may offer an alternative for the successful development of DMTs.

Functional Somatic Syndromes (FSS) in Children and Adolescents

Abstract. Unspecific somatic health complaints and symptoms are common in children and adolescents, varying on a continuum of severity. When persistent and impairing, they are often referred to as functional somatic syndromes (FSS). The overarching objective of this paper is to provide an overview of the pediatric literature in relation to conceptual, assessment, and treatment issues for youth presenting with FSS. Clinical recommendations are outlined including addressing potential feasibility and barrier issues for families presenting to medical and mental health services. Assessment and treatment issues are further discussed in context of two recent psychotherapy trials conducted with children and older age adolescents (aged from 7 to 19 years). Finally, we address ongoing research gaps in this field with view to strengthen the evidence base in the assessment and treatment of youth presenting with FSS.

Crime and income trajectories preceding lethal and non-lethal violence

PurposeThis study analyzes the pathways leading to violent offending. We examine whether the lethality of a violent crime could be predicted based on individuals' prior history of violent crime and income, and whether the trajectories of lethal offenders are distinguishable from the pathways of non-lethal offenders. MethodsWe use a sample of police-reported violent crimes committed in Finland in 2010–2011 (N = 26,303) and contrast the pathways to homicide with the trajectories leading to petty assault, assault, aggravated assault, and attempted homicide. Group-based trajectory modeling is applied for identifying individuals with similar trajectories, and multilevel modeling is used for estimating the mean trajectories for offenders of differing severity. ResultsResults indicate that homicide offenders display a clear escalation in the frequency of violent offending and a slight decrease in income prior to the offense, but the pathways to homicide largely resemble the pathways to aggravated assault and attempted homicide. ConclusionsThe lethality of violent offending cannot be predicted from the offender's crime and income. The greatest divide in the violence severity continuum is between offenders of assaults and offenders of aggravated assaults, with the latter group largely resembling offenders of completed and attempted homicides.

Self-Blame Mediates the Link between Childhood Neglect Experiences and Internalizing Symptoms in Low-Risk Adolescents

Childhood neglect is the most common type of maltreatment, ranging from minor isolated incidents to consistent failures in emotional/physical caregiving. It has been associated with developmental impairments and considered a risk factor for the emergence of psychopathology, particularly internalizing disorders. This study aimed to explore individual differences in response to the continuum of severity of neglect in community adolescents, as well as the role of specific cognitive emotion regulation strategies (CERSs) as mediators between childhood neglect and current internalizing symptoms. Low-risk adolescents (12–19 years old; M age 15.88 years; N = 123; 64 Females) completed questionnaires assessing these experiences. We employed a regression model and a simple mediation analyses. Findings indicate a positive association between childhood neglect, internalizing behaviors, and the adoption of self-blame as CERS. Moreover, the use of self-blame in response to everyday stress partially mediated the relationship between neglect and internalizing behaviors (effect size: .28). Findings support the hypothesis that even in a low risk sample, neglect is associated with internalizing symptoms, and highlight the importance of assessing individual differences in the experience of neglect. Moreover, the mediation effect of the CERSs of self-blame might serve as a potential target for psychotherapeutic interventions aimed at reducing internalizing symptoms.

Heat-Related Illness Among Latinx Child Farmworkers in North Carolina: A Mixed-Methods Study.

Children as young as ten are legally hired for farm work. In North Carolina, many of these hired children are Latinx; they often work long hours during hot and humid summer conditions. Heat-related illness occurs along a continuum of severity ranging from heat cramps and rashes to heat exhaustion and heat stroke, which can be fatal. The literature on the negative health effects of occupational heat exposure is growing; however, few studies have examined this exposure and health outcomes among child agricultural workers. To understand Latinx child farmworkers' experiences of working in heat, we conducted in-depth interviews (n = 30). To estimate the prevalence of heat-related illness symptoms and associated factors, we conducted survey interviews (n = 165). Heat-related illness is common among these child farmworkers. While children often understand the dangers of working in heat, work organization often prevents their taking precautions. Formal workplace protections to prevent heat-related illness are limited.

GAY AND GRAY X: RED RIBBON REDUX: THE CHALLENGES OF LONG-TERM SURVIVAL WITH HIV

In 2016, the CDC found that nearly half of the individuals living with HIV in the United States were 50 years-old or older. Although new infections occur in older adults, the overwhelming majority of those who are over 50 and living with HIV became infected when much younger and did not expect to survive long-term. Although antiretroviral therapy (ART) has made a very positive impact on the course of HIV illness and promotes longevity, HIV is well known to exert deleterious effects on the nervous system. Approximately 50% of those living with HIV can be diagnosed with HIV Associated Neurocognitive Disorder (HAND) which is comprised of several syndromes that occur along a continuum of cognitive impairment severity. The growing number of older adults living with HIV mandates that both primary care providers and geriatric specialists understand the long-term consequences of HIV infection. In addition to HAND, these individuals may be impacted by the “triple stigma,” resulting from having three characteristics: older, gay and HIV-infected. The fact that many older adults living with HIV have fragile social networks that may not sustain their needs as they grow older makes life for these individuals even more difficult. Older adults living with HIV identify a number of barriers when accessing support including inability to disclose HIV status, the irrational fear others may have of HIV/AIDS, not wanting to be a burden, no available family members and death of friends from AIDS. Unfortunately, older adults living with HIV can fall between the cracks of the aging and the HIV services systems. The 63-year-old gay man who became infected with HIV when in his 20s and who is the subject of a case presentation highlights many of these issues. In addition to living with HIV, he has obsessive compulsive disorder, generalized anxiety disorder and lost his partner and many of his friends to AIDS-related illnesses. Although research is limited, age-contextualized interventions may combat stigma, help this individuals overcome barriers to health care, and improve both the physical and mental health of HIV+ older adults.

Identifying unstable and empty phenotypes of borderline personality through factor mixture modeling in a large nonclinical sample.

Borderline personality disorder (BPD) is serious, prevalent, and symptomatically heterogeneous. Identifying distinct phenotypes of BPD features promises useful diagnostic and treatment implications. Although a series of subtyping studies exist, only two have examined BPD symptom configurations while taking into account BPD severity. We used factor mixture modeling to identify discrete subtypes of BPD features, simultaneously considering symptom severity, in the largest nonclinical young adult sample to date. Undergraduates (N = 20,010; 63.86% women; Mage = 18.75, SD = 1.73) completed the McLean Screening Instrument for BPD, which was condensed to measure the 9 Diagnostic and Statistical Manual of Mental Disorders BPD criteria dichotomously. We used a model comparison approach to determine the optimal latent factor and class structure of BPD symptoms and validated classes via BPD-relevant constructs. The sample consisted of three subtypes: Asymptomatic (70%), Unstable (19%), and Empty (11%). The Unstable and Empty classes displayed elevated BPD symptomatology along a single continuum of BPD severity. Individuals in the Empty class displayed the highest levels of emptiness and dissociation, emotional distress, and attachment avoidance, whereas individuals in the Unstable class displayed a high frequency of reckless and self-damaging behaviors. Our results suggest the importance of a hybrid dimensional/categorical conceptualization of BPD as displayed in a nonclinical sample. Unstable and Empty classes may be associated with different treatment targets for subthreshold BPD presentations. The findings are discussed in terms of their clinical implications regarding diagnosis, treatment, and theoretical conceptualization of BPD. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Transdiagnostic neurocognitive subgroups and functional course in young people with emerging mental disorders: a cohort study.

Neurocognitive impairments robustly predict functional outcome. However, heterogeneity in neurocognition is common within diagnostic groups, and data-driven analyses reveal homogeneous neurocognitive subgroups cutting across diagnostic boundaries. To determine whether data-driven neurocognitive subgroups of young people with emerging mental disorders are associated with 3-year functional course. Model-based cluster analysis was applied to neurocognitive test scores across nine domains from 629 young people accessing mental health clinics. Cluster groups were compared on demographic, clinical and substance-use measures. Mixed-effects models explored associations between cluster-group membership and socio-occupational functioning (using the Social and Occupational Functioning Assessment Scale) over 3 years, adjusted for gender, premorbid IQ, level of education, depressive, positive, negative and manic symptoms, and diagnosis of a primary psychotic disorder. Cluster analysis of neurocognitive test scores derived three subgroups described as 'normal range' (n = 243, 38.6%), 'intermediate impairment' (n = 252, 40.1%), and 'global impairment' (n = 134, 21.3%). The major mental disorder categories (depressive, anxiety, bipolar, psychotic and other) were represented in each neurocognitive subgroup. The global impairment subgroup had lower functioning for 3 years of follow-up; however, neither the global impairment (B = 0.26, 95% CI -0.67 to 1.20; P = 0.581) or intermediate impairment (B = 0.46, 95% CI -0.26 to 1.19; P = 0.211) subgroups differed from the normal range subgroup in their rate of change in functioning over time. Neurocognitive impairment may follow a continuum of severity across the major syndrome-based mental disorders, with data-driven neurocognitive subgroups predictive of functional course. Of note, the global impairment subgroup had longstanding functional impairment despite continuing engagement with clinical services.