Alex Cogswell

Behavioral Approach System and Behavioral Inhibition System sensitivities and bipolar spectrum disorders: prospective prediction of bipolar mood episodes

OBJECTIVES Research has found that bipolar spectrum disorders are associated with Behavioral Approach System (BAS) hypersensitivity and both unipolar and bipolar depression are associated with high Behavioral Inhibition System (BIS) sensitivity, but prospective studies of these relationships are lacking. We tested whether BAS and BIS sensitivities prospectively predicted the time to new onsets of major depressive and hypomanic and manic episodes in bipolar spectrum individuals. METHODS We followed 136 bipolar II or cyclothymic and 157 demographically matched normal control individuals prospectively for an average of 33 months. Participants completed the BIS/BAS scales and symptom measures at Time 1 and semi-structured diagnostic interviews every four months of follow-up. RESULTS The bipolar spectrum group exhibited higher Time 1 BAS, but not BIS, scores than the normal controls, controlling for Time 1 symptoms. Among bipolar spectrum participants, high BAS sensitivity prospectively predicted a shorter time to onset of hypomanic and manic episodes, whereas high BIS sensitivity predicted less survival time to major depressive episodes, controlling for initial symptoms. CONCLUSIONS Consistent with the BAS hypersensitivity model of bipolar disorder, a highly responsive BAS provides vulnerability to onsets of (hypo)manic episodes. In addition, a highly sensitive BIS increases risk for major depressive episodes.

Repetitive Thought in Psychopathology: The Relation of Rumination and Worry to Depression and Anxiety Symptoms

The relation between repetitive thought and depression and anxiety symptoms was examined in an undergraduate sample. Individuals completed self-report measures of rumination, worry, depression, and anxiety as well as other related constructs including private self-consciousness, looming maladaptive style, cognitive style, cognitive content, and future outlook. Regression analyses and tests for significant differences between partial correlations were utilized to assess the study hypotheses. The results indicated that rumination and worry overlap in their association with depression and anxiety symptoms, and that rumination may be an especially important component of this overlap. Secondary analyses demonstrated that rumination and worry are two distinct constructs, as their patterns of associations with related constructs were different.

Vitamin D and Depressive Symptoms in Children with Cystic Fibrosis

BACKGROUND Vitamin D deficiency has been hypothesized to play a role in the development of depression. Hypovitaminosis D is almost universal in patients with cystic fibrosis (CF). No studies to date have explored associations between serum concentrations of 25-hydroxyvitamin D (25(OH)D), a standard measure of vitamin D, and depression in patients with CF. OBJECTIVE This pilot study aimed to explore the relationship between 25(OH)D and the presence of depressive symptoms among youth with CF. METHODS A cross-sectional study was conducted at an ambulatory Cystic Fibrosis Center clinic. Serum 25(OH)D and Childrens Depression Inventory (CDI) scores were analyzed from 38 youths with CF ages 7-17 years. Child depressive symptoms were measured using the CDI, with scores above 12 indicating a significant level of depressive symptoms. Serum 25(OH)D concentration were measured using the liaison 25 OH vitamin D assay. Insufficient vitamin D status was defined as a circulating 25(OH)D concentration less than 30 ng/mL. RESULTS Insufficient vitamin D levels were found in 59% of patients; 28% of patients had significant levels of depressive symptoms on the CDI (scores >12). Serum 25(OH)D was negatively associated with CDI scores (r = -0.55; p < 0.001), and the group of patients with insufficient 25(OH)D levels indeed reported significantly more depressive symptoms (t = 4.26; p < 0.001). CONCLUSIONS 25(OH)D insufficiency was associated with depressive symptoms in this cohort of youth with CF. Future rigorous studies investigating vitamin D and depression in CF are warranted with larger sample sizes using confirmatory methods to diagnose depressive disorders.

Explicit rejection of an implicit dichotomy: integrating two approaches to assessing dependency.

The field of personality theory and assessment is characterized by a long-standing divide between proponents of self-report and indirect approaches to assessment. This article reviews the increasing convergence between the two sides, using recent writings on interpersonal dependency as an example domain. The assumptions of the self-report approach to personality assessment are contrasted with those of the indirect, and research using both types of assessments is reviewed. Also considered is the importance of recognizing dissociations between a particular individuals scores on self-report and indirect measures of a given component of self-concept, and the possible implications of such dissociations. It is argued that the convergence between two traditionally disparate approaches is likely to develop, in light of hypotheses, data and conclusions that bear notable similarity.

Assessing dependency using self-report and indirect measures: examining the significance of discrepancies.

The present study addressed convergence between self-report and indirect approaches to assessing dependency. We were moderately successful in validating an implicit measure, which was found to be reliable, orthogonal to 2 self-report instruments, and predictive of external criteria. This study also examined discrepancies between scores on self-report and implicit measures, and has implications for their significance. The possibility that discrepancies themselves are pathological was not supported, although discrepancies were associated with particular personality profiles. Finally, this study offered additional evidence for the relation between dependency and depressive symptomatology and identified implicit dependency as contributing unique variance in predicting past major depression.

Description of a multi-university education and collaborative care child psychiatry access program: New York State's CAP PC

OBJECTIVE Although, child mental health problems are widespread, few get adequate treatment, and there is a severe shortage of child psychiatrists. To address this public health need many states have adopted collaborative care programs to assist primary care to better assess and manage pediatric mental health concerns. This report adds to the small literature on collaborative care programs and describes one large program that covers most of New York state. PROGRAM DESCRIPTION CAP PC, a component program of New York States Office of Mental Health (OMH) Project TEACH, has provided education and consultation support to primary care providers covering most of New York state since 2010. The program is uniquely a five medical school collaboration with hubs at each that share one toll free number and work together to provide education and consultation support services to PCPs. METHODS The program developed a clinical communications record to track information about all consultations which forms the basis of much of this report. 2-week surveys following consultations, annual surveys, and pre- and post-educational program evaluations have also been used to measure the success of the program. RESULTS CAP PC has grown over the 6years of the program and has provided 8013 phone consultations to over 1500 PCPs. The program synergistically provided 17,523 CME credits of educational programming to 1200 PCPs. PCP users of the program report very high levels of satisfaction and self reported growth in confidence. CONCLUSIONS CAP PC demonstrates that large-scale collaborative consultation models for primary care are feasible to implement, popular with PCPs, and can be sustained. The program supports increased access to child mental health services in primary care and provides child psychiatric expertise for patients who would otherwise have none.