Donald M. Quinlan

Impact of perfectionism and need for approval on the brief treatment of depression: The National Institute of Mental Health Treatment of Depression Collaborative Research Program revisited.

Patients in the National Institute of Mental Health Treatment of Depression Collaborative Research Program (TDCRP) were administered at intake with the Dysfunctional Attitude Scale (DAS; A. N. Weissman & A. T. Beck, 1978). Factor analyses of the DAS in the TDCRP data as well as in several independent samples reveal two primary factors: an interpersonal factor, Need for Approval, and a self-critical factor, Perfectionism. This study explored the hypotheses that these factors, assessed prior to treatment, would have differential interactions with the two forms of psychotherapy evaluated in the TDCRP as well as differential relationships to various outcome measures (depression, clinical functioning, and social adjustment). DAS Perfectionism had consistently significant negative relationships with all the outcome measures in all four treatment conditions. Contrary to expectations, however, there were no significant interactions between the two DAS factors and the four types of brief treatment (cognitive-behavioral therapy, interpersonal therapy, imipramine, and placebo).

Psychosocial benefits of a cancer support group

Many clinicians use group support to reduce the psychosocial difficulties of persons with cancer. This study compared the long‐term benefits of a thematic counseling model used both as a structure for group support and for counseling patients individually. The thematic model included eight counseling sessions focused on information about cancer and positive health strategies such as progressive relaxation, diet, and exercise. The psychosocial status of women newly diagnosed with gynecologic cancer was assessed before the counseling, immediately after counseling, and again 6 months later. The women who participated in thematic counseling were significantly less depressed and less anxious and had more knowledge of their illness, better relationships with care givers, fewer sexual difficulties, and more participation in leisure activities. Data confirmed the model to be equally helpful whether it was used as a structure for individual counseling or more cost‐effective group counseling. This model is easily adaptable to the needs of persons with other forms of cancer.

Interpersonal and self-critical dysphoria and behavioral problems in adolescents

Clinical evidence suggests that various problem behaviors in adolescence can be expressions of dysphoria that have not reached threshold for the diagnosis of depressive disorders. Formulations of two major types of dysphoria distinguish between disruptions of interpersonal relatedness (e.g., feelings of loss or abandonment) and diminished self-esteem (e.g., feelings of self-criticism, failure, or guilt). Adolescents in a suburban high school were given the Achenbach Youth Self-Report, the Adolescent Depressive Experiences Questionnaire, and the Community Epidemiological Survey of Depression for Children (CES-DC). Even after level of depressive symptoms (CES-DC) was partialled out in hierarchical multiple regressions, interpersonal dysphoria significantly accounted for additional variance in predicting internalizing disorders, while self-critical dysphoria added significantly to the explained variance of both internalizing and externalizing disorders, specifically delinquency and aggression in both males and females.

Executive Function Impairments in High IQ Adults With ADHD

Objectives: To demonstrate that high IQ adults diagnosed with ADHD suffer from executive function (EF) impairments that: a) can be identified with a combination of standardized measures and self-report data; and b) occur more commonly in this group than in the general population. Method: 157 ADHD adults with IQ ≥ 120 were assessed with 8 normed measures of EF— 3 index scores from standardized tests of memory and cognitive abilities, and 5 subscales of a normed self-report measure of EF impairments in daily life. Results: 73% of subjects were significantly impaired on ≥ 5 of these 8 EF markers. On all 8 measures, incidence of these impairments was significantly greater than in the general population. Conclusion: High IQ adults with ADHD tend to suffer EF impairments that can be assessed with these measures; incidence of such impairments in this group is significantly higher than in the general population. (J. of Att. Dis. 2009; 13(2) 161-167)

Assessment of short-term verbal memory impairments in adolescents and adults with ADHD:

The purpose of this study was to determine whether a brief measure of verbal memory can assess short-term verbal memory impairments relative to verbal abilities in adolescents and adults with Attention-Deficit/Hyperactivity Disorder (ADHD) and to ascertain whether significant differences between short-term verbal memory and verbal abilities are more common among persons with ADHD than in the general population. One hundred seventy-six adolescents and adults diagnosed with ADHD (DSM-IV criteria) were assessed with a measure of short-term verbal memory. The short-term verbal memory score of each subject was compared with the verbal abilities on two measures. Percentages of ADHD subjects with “significant discrepancy” between verbal IQ and short-term verbal memory were compared with the standardization sample for the verbal memory measure. A majority of adolescents and adults diagnosed with ADHD demonstrated significant discrepancy between performance on the short-term verbal memory measure and verbal IQ. The percentage of ADHD subjects with a significant discrepancy between these two measures greatly exceeded the percentage of persons in the general population showing such a discrepancy. This brief measure of short-term verbal memory may be a useful measure to include in a comprehensive assessment for ADHD symptoms in adolescents and adults. Replication in other groups of ADHD patients is needed to test the generalizability of the findings.

Cranial CT scans in eating disorder patients and controls

Abstract Computed tomography (CT) scans of 21 patients with eating disorders were compared with those of 14 nonpsychotic controls. Of 14 patients with anorexia nervosa, 8 had cerebral ventricular enlargement, and 4 of these also had cortical sulcal atrophy, both by global assessment as compared with none of the controls. Ventricular brain ratio (VBR) and third ventricular measurements were also significantly increased in anorectics in comparison with 5 bulimic patients or controls. CT abnormalities were significantly correlated with rate of and degree of weight loss from premorbid weight but not with loss from estimated minimal healthy weight. Of any clinical features of anorexia, only hypothermia correlated with CT scan abnormality. Review of other reports of CT abnormalities in anorectics and implications for further investigation are discussed.

Anorexia nervosa as a defense against anaclitic depression

This paper atempts a developmental understanding of the anaclitic depression which frequently underlies anorexia nervosa. Familial lapses in transactional boundaries are viewed as leading to a maternal overinvolvement or unavailability during the practicing subphase of the separation-in-dividuation process. The future anorectic is consequently arrested at a sensorimotor level of self and object representations with no ability to evoke a representation of the object in its absence. Such individuals remain vulnerable to separation experiences and the sense of depression, loss, and helplessness which accompany these experiences. Much anorectic symptomology can then be looked at as a defense against such experiences and the potential loss of self-other boundaries which accompany them.

Abnormal liver enyzmes in outpatients with eating disorders

OBJECTIVE This study was undertaken to screen a large series of outpatients with anorexia or bulimia for liver enzyme abnormalities, examining their frequency and their clinical correlates. METHOD Eight hundred seventy-nine eating-disordered outpatients presenting at a suburban clinic constituted the subject population. Serum glutamic oxalacetic transaminase, serum glutamic pyruvate transaminase, and gamma glutamyl transpeptidase (SGOT, SGPT, and GGTP, respectively) were drawn at intake. Medical charts were reviewed to obtain further clinical data on all patients with an enzyme elevation. RESULTS Liver enzymes were abnormally high in 36 patients (4.1%). Elevated SGPT was the most frequent enzyme abnormality and was correlated with lower current and past weight and body mass index (BMI). DISCUSSION Hepatic dysfunction in eating-disordered outpatients is neither specific nor common. Low weight alone can cause liver damage, yet elevated liver chemistries in patients with anorexia and especially bulima are often not due to their eating disorder.

Using computational patients to evaluate illness mechanisms in schizophrenia.

BACKGROUND Various malfunctions involving working memory, semantics, prediction error, and dopamine neuromodulation have been hypothesized to cause disorganized speech and delusions in schizophrenia. Computational models may provide insights into why some mechanisms are unlikely, suggest alternative mechanisms, and tie together explanations of seemingly disparate symptoms and experimental findings. METHODS Eight corresponding illness mechanisms were simulated in DISCERN, an artificial neural network model of narrative understanding and recall. For this study, DISCERN learned sets of autobiographical and impersonal crime stories with associated emotion coding. In addition, 20 healthy control subjects and 37 patients with schizophrenia or schizoaffective disorder matched for age, gender, and parental education were studied using a delayed story recall task. A goodness-of-fit analysis was performed to determine the mechanism best reproducing narrative breakdown profiles generated by healthy control subjects and patients with schizophrenia. Evidence of delusion-like narratives was sought in simulations best matching the narrative breakdown profile of patients. RESULTS All mechanisms were equivalent in matching the narrative breakdown profile of healthy control subjects. However, exaggerated prediction-error signaling during consolidation of episodic memories, termed hyperlearning, was statistically superior to other mechanisms in matching the narrative breakdown profile of patients. These simulations also systematically confused autobiographical agents with impersonal crime story agents to model fixed, self-referential delusions. CONCLUSIONS Findings suggest that exaggerated prediction-error signaling in schizophrenia intermingles and corrupts narrative memories when incorporated into long-term storage, thereby disrupting narrative language and producing fixed delusional narratives. If further validated by clinical studies, these computational patients could provide a platform for developing and testing novel treatments.

Three domains of classroom environment: Factor analysis of the Classroom Environment Scale

The study reports the results of a factor analysis of the Classroom Environment Scale using a sample of 229 classrooms with 3,480 students. A six-factor solution accounting for 51% of the variance was found. These factors, consistent with the general conception of environments underlying the development of the scale, fall into three domains: personal development dimensions, system maintenance dimensions, and relationship dimensions. In classrooms, these domains are evident in the friendship and authority aspects of the teacher role and in student-student relationships. An analysis of their relationship to locale of classroom (urban, suburban, and rural), sex of teacher, and size of class revealed relationships of each of these external variables to aspects of the classroom environment. The relationship of the factor structure to the general conception of environments and to the original 9-dimension scale is also discussed. The assessment of social environments has recently come of age as a major conceptual and empirical research task. In spite of Barkers (1970) long-standing interest, only recently have psychologists devoted effort in this direction. One significant methodological approach which has proliferated in recent years is that of assessing the environment through the pooled perceptions of members of the particular setting (e.g., Moos, 1974; Stern, 1970). While individuals do,