Penelope Krener

Asymmetrical visual-spatial attentional performance in ADHD: Evidence for a right hemispheric deficit

This study was designed to confirm the presence of a lateralizing deficit in visual-spatial attention in children with ADHD, to further characterize the nature of this deficit and to specify the likely hemispheric locus of dysfunction. Two versions of the covert orienting of attention procedure which evaluated separately endogenous and exogenous cuing effects were administered to 20 unmedicated children aged 9-12 with ADHD and 20 matched controls. Both groups also underwent thorough psychiatric assessment and testing using the TOVA and the Wisconsin Card Sorting Task (WCST). Children with ADHD showed an asymmetrical performance deficit characterized by a loss of costs on controlled (endogenous) attentional orienting to invalidly cured left visual field targets. The degree of cost asymmetry correlated negatively with the number of categories sorted on the WCST. It was concluded that unmedicated children with ADHD show an asymmetrical performance deficit on the covert orienting procedure characterized by a disruption of right hemispheric attentional mechanisms. This deficit may be related to diminished right hemispheric frontal-striatal catecholamine activity.

Abnormal processing of irrelevant information in attention deficit hyperactivity disorder

The presence of a selective attention deficit in children with attention deficit hyperactivity disorder (ADHD) was investigated by administering a trial-by-trial version of the Stroop Color-Naming Task to children, aged 9-12, with ADHD (n = 19) and age-matched normal control children (n = 19). Performance was evaluated on both interference and facilitation components of the task. On the standard version of the task, with equal numbers of color words and neutral words, children with ADHD showed increased Stroop interference (prolongation of color-naming times by color-incongruent stimuli) but normal amounts of facilitation (speeding of color naming by color-congruent stimuli). This finding suggests that children with ADHD show increased disruption of color-naming performance by task-irrelevant information, probably secondary to decreased attentional control over the interference process. In contrast to findings of studies in adults, both groups of children failed to use an attentional strategy to reduce interference when they were administered blocks of trials that varied their expectancy for color word trials. This precluded a direct test of the diminished control hypothesis. There were no significant correlations between abnormal Stroop performance and impairment on the Continuous Performance Test or the Wisconsin Card Sorting Test or measures of IQ or reading performance. The implications of these findings for our understanding of information-processing deficits in children with ADHD and of the neurobiological underpinnings of these deficits are discussed.

Mood changes and affective disorder in the bulimic binge—Purge cycle

Mood changes over the bulimic binge–purge cycle were studied in retrospective questionnaire reports of patients, 16 with and 34 without concurrent affective disorder. Moods clearly differed over phases. Mood reports depicted the period between the binge and purge as most unpleasant, with low energy/excitement and security/relief and high panic/helplessness and guilt/disgust/anger. Feelings after the purge were relatively calm and pleasurable, with low panic/helplessness and excitement/energy and high security/relief. Patients with affective disorder did not differ from those without affective disorder in their mood changes during the cycle.

Effect of Concentration Problems on the Malleability of Children's Aggressive and Shy Behaviors

OBJECTIVE Previous research has demonstrated the central role of early childhood concentration problems in the development of aggression and other maladaptive behaviors. The present study investigated the moderating effect of concentration problems on the impact of a classroom-based preventive intervention directed at aggressive and shy behaviors in an epidemiologically defined sample of 1,084 urban first-grade children. METHOD Concentration problems, aggressive behavior, and shy behavior were assessed by a structured teacher interview (the Teacher Observation of Classroom Adaptation-Revised) in the fall and spring of first grade. RESULTS Children with high ratings on concentration problems in the fall had higher levels of teacher-rated aggressive and shy behavior in the spring than did children without such problems. The intervention reduced aggressive and shy behavior in children regardless of fall concentration level. Boys, but not girls, in the intervention condition with high concentration problems had higher levels of spring aggression than those without such problems, but they also showed the greatest reductions in aggressive behavior from fall to spring. CONCLUSIONS These results suggest that aggressive behavior is malleable in children with concentration problems, provide further evidence on the etiological significance of concentration problems for the development of maladaptive behavior, and highlight the importance of directly targeting concentration problems to maximize preventive intervention impact.

Bulimia and borderline personality disorder

Female patients with bulimia or atypical eating disorder (n = 31) were compared on dimensions of psychiatric symptomatology (SCL-90) and measures of eating problems (Eating Disorder inventory, Diagnostic Survey for Eating Disorders) with 10 similar patients who were also diagnosed as having borderline personality disorder. In addition to greater symptom severity and higher levels of distress (p < .05), the borderline subgroup scored higher on SCL-90 scales for interpersonal sensitivity, phobic anxiety, paranoid ideation, and depression (p < .05), with no differences on the scales for bulimia and body-related concerns. The borderline subgroup of eating disorder patients did not differ on any SCL-90 scales from another comparison group of borderline patients without eating disorder (n = 32). The differential self-perceptions of the borderline subgroup may have implications for the formation of a therapeutic relationship.

After Incest: Secondary Prevention?

The course and outcome of therapy for 22 girls, victims of incest, referred to a child psychiatry clinic are reviewed. Obstacles to carrying out successful psychotherapy are found to include economic, procedural, social, counter-transference-related and intrapsychic factors. Diagnostic features of post-traumatic stress disorder were observed in our patients with an associated pattern of pseudomature coping behavior concealing underlying severe symptomatology. The sobering findings of the study point to an intensive treatment approach.

Impact of the diagnosis of AIDS on hospital care of an infant.

Detailed analysis of caretaker response to the first infant newly diagnosed with AIDS at a university hospital was done by review of nursing notes for three periods: before diagnosis of AIDS, after diagnosis, and after psychiatric consultation. Five consultation questions were posed, and the findings on investigation of these questions are discussed. It was found that the percentage of time that PRN medication was given dropped after diagnosis of AIDS but rose above the initial level after the consultation. The number of times per shift the nurse touched the baby (TLCs) was not found to be associated with use of PRN medication; rather it was explained by which nurse was caring for the child. This study focuses on variations in nursing care of one infant to illustrate how variation in caretaker response can amplify the range of perturbations of the infants behavioral response. It is speculated that caretakers of patients with AIDS may normally have feelings considered unacceptable in medical settings, including fear, blaming the patient, or a wish to avoid the patient. Such feelings are more difficult to tolerate in the care of children or infants and are superimposed upon the familiar stains associated with the care of chronically ill or dying pediatric patients.

Psychiatric Liaison to Liver Transplant Recipients

Child psychiatric consultants perform psychiatric assessment and liaison among various clinical services. Execution of these familiar roles for pediatric liver transplantation recipients exposes unfamiliar and difficult bioethical problems. Administrative problems arise if the recipients suitability is too narrowly evaluated. Assessment may be time-limited. The intensive care unit environment and the VIP characteristics of child transplantation patients may distort observations and constrain opportunities for preventive preoperative psychologic management. Unnecessary psychiatric complications may ensue, which imperil the transplantation surgery. The primary caretakers may have an extraordinary emotional investment, so liaison is pressured. Three cases are presented to illustrate these points. Medical ethical perspectives and the limitations of medical training to prepare physicians to perceive them are indicated. That these limitations also affect the psychiatrist is acknowledged, and a clinical research approach is suggested.

Gender Differences in Career Paths in Psychiatry

Although psychiatry has one of the highest proportions of women entering its residency programs, women have not assumed a proportionate amount of academic or research leadership positions in the field. This literature review identifies three general groups of models that explain disparities between men’s and women’s careers, but these do not fully account for observed differences in psychiatric practice and academic progression of women in psychiatry. Gender differences in career paths in psychiatry are not only affected by individual traits and choices, but also by economic factors. Theories based on organizational discrimination, and systems and market factors are also reviewed. No single explanatory model accounts for disparities between the careers of men and those of women. Because psychiatric practice patterns may be broadly distributed across labor sectors, more diverse career patterns are possible in psychiatry than in more constrained and traditional fields. Research on gender differences in psychiatry careers must consider not only the individual work style and choice, but also the position of individuals within the organization and the position of those organizations across the labor market.

Relation of family factor to treatment outcome for bulimic patients.

The psychotherapy of 25 normal weight bulimic adolescent and late adolescent women (age 15-32 years, mean = 21 years), was reviewed to evaluate developmental and diagnostic precursors and the outcome of psychoanalytically oriented long-term therapy (mean = 33 sessions). Psychotherapy outcome was scored in these categories: bingeing and purging; food obsession; school/work satisfaction; equilibration with family of origin, and achievement of heterosexual closeness. On factor analysis, all factors loaded highly and a global outcome score was derived which was used as the dependent variable in a step-wise regression analysis with 18 family factors as independent variables. To identify family patterns that predicted degree of improvement, a multiple regression analysis was performed. Results indicated that family variables associated with maternal warmth explained an appreciable proportion of the variance in outcome. Such a finding is consistent with the formulation that patients with benign archaic maternal representations were better able than their counterparts with less benign maternal images to form a positive transference and better working alliance with the (female) therapist.