Biomedical subjects

Hans Steiner

Publications and source records attributed to Hans Steiner.

At least 37 records · Page 2Linked to original sources

PubMed2003

Pre-adjudicative and adjudicative competence in juveniles and young adults.

There are several different types of legal competence, such as competence to waive Miranda rights, competence to confess, and competence to stand trial. Although it can be surmised that many of the underlying factors that influence the different legal competencies are similar, little research has been conducted to empirically test this hypothesis. In the present study, juveniles' and young adults' understanding and appreciation of their Miranda rights and their ability to stand trial were measured. Age, suggestibility, average grades in school, and frequency of previous police involvement were also examined as possible factors that influence both types of legal knowledge. Results indicated that Miranda competence and adjudicative competence are indeed strongly related, especially for juveniles. Also, age and suggestibility were found to predict Miranda competence, whereas suggestibility and average school grades predicted competence to stand trial. Patterns of findings often diverged for juveniles and young adults. Implications for legal policy are discussed.

Adolescent↗

PubMed2003

Risk and protective factors for juvenile eating disorders.

Eating disorders are prevalent and complicated disorders which are difficult to treat. Unicausal and main effects models are not likely to do justice to the complexity of psychopathology encountered, as one considers etiology and pathogenesis. Risk and protection can arise out of several domains: biological, psychological and social. Risk and protective factors aggregate in specific developmental phases and interact to produce adverse outcomes. Temperamental factors, eating dysregulation, attachment, deficient self regulation and sociocultural ideals of health and beauty all contribute to pathogenesis. Applying the insights of developmental psychopathology to these disorders has considerable potential to lead to early and preventive interventions. Reviewing the current literature from this perspective and updating a similar discussion from 8 years ago, we witness a continued accumulation of quality empirical data. Compared to previous reviews, the field's attention has shifted to psychosocial/cultural domains relevant to eating, away from biological risk. In the aggregate, these data make possible the increasing differentiation of eating disorders from other psychopathology, and the specific pathways in which anorexia and bulimia may develop. Understanding of risk and vulnerability still outweighs our knowledge of protective factors and resilience. While an ideal study would be longitudinal, such studies are still extremely difficult to conduct and costly, thus, forcing us to further our understanding from lagged designs, cross-sectional data and case control studies. While these have many limitations, they do seem to produce an increasingly coherent account of the development of these disorders and prepare us for more targeted and longitudinal study of high risk populations.

Adolescent↗

PubMed2003

Temperament characteristics of child and adolescent bipolar offspring.

BACKGROUND: We wished to characterize temperament of children at high risk for bipolar disorder (BD). METHODS: We collected data from the Dimensions of Temperament-Revised (DOTS-R) from 53 biological offspring of at least one parent with BD. RESULTS: Overall, our cohort differed from population means for the DOTS-R, having decreased Activity Level-General scores, and increased Approach, and Rhythmicity-Sleep scores. Offspring with psychiatric disorders differed from those without in having decreased Flexibility, Mood, and Task Orientation scores. Temperament profiles for diagnostic categories of BD and attention-deficit/hyperactivity disorder were performed in a descriptive manner. LIMITATIONS: Self- or parent-report of temperament was used rather than clinical observation. Temperament characterization was cross-sectional and retrospective rather than prospective and may overlap with clinical diagnoses. CONCLUSIONS: Assessment of temperament may be useful in characterizing bipolar offspring. Decreased flexibility and task orientation, and presence of negative moods may be correlated with development of psychopathology.

Adolescent↗

PubMed2003

Dissociative symptoms in posttraumatic stress disorder: diagnosis and treatment.

This article explores the complex relationship between dissociation and psychiatric trauma. Dissociation is described as a defense reaction, a risk factor for the development of posttraumatic stress disorder, and as a set of syndromal disturbances. The authors discuss various models proposed for the relationship between these. They outline developmental considerations in diagnosis and treatment and end by discussing further needed research.

Adolescent↗

PubMed2003

Psychopharmacologic strategies for the treatment of aggression in juveniles.

Maladaptive aggression in youth is one of the most common and troublesome reasons for referrals to child psychiatrists. It has a complex relationship with psychopathology. There are several syndromes, which are primary disturbances of clustered maladaptive aggression, most notably oppositional defiant disorder and conduct disorder. However, problems with aggression also appear in a wide range of other disturbances, such as bipolar disorder, posttraumatic stress disorder, and mood disorders. Additionally, aggression is normative, serves an adaptive purpose and can be situationally induced. These complexities need to be carefully addressed before targeting maladaptive aggression psychopharmacologically. We summarize the literature on the psychopharmacology of maladaptive aggression in youth, focusing on disorders without cognitive impairment. We delineate the subtypes of aggression which are most likely to respond to medication (reactive-affective-defensive-impulsive in their acute and chronic form) and conclude with a discussion of specific medication strategies which are supported by controlled clinical trials and clinical experience.

Adolescent↗

PubMed2003

The stress response in anorexia nervosa.

Patients with eating disorders have been found to have problems with Interoceptive Awareness. This study seeks to examine this issue in an experimental paradigm. In the present study, we investigated the hypothesis that, in addition to lowering a body's autonomic stress response, a state of starvation also lowers the psychological stress response. Results indicated that those with anorexia nervosa showed a muted physiology, but they did not show a complete denial of negative emotion. No relation was seen, however, between their affective and physiological responses to a stress task, which contrasted results found for the controls.

Adaptation, Psychological↗

PubMed2003

Defenses in school age children: children's versus parents' report.

We tested a questionnaire assessing defenses in school age children and compared the results with their mothers' reports of the same. Thirty-four children (56% male, mean age 8.5) completed the Response Evaluation Measure for Youth (REM-Y) twice over three weeks. Simultaneously, mothers completed the parent version of this measure (REM-P) about their children. In these questionnaires, factor 1 defenses (less adaptive; broken down into intrapersonal and interpersonal defenses) are assessed separately from factor 2, or more adaptive, defenses. Only lower level, interpersonal defenses, such as acting out, were recognized by mothers in their children. The children's intrapersonal defenses, along with factor 2 reactions, were reported less by mothers than by children.

Child↗

PubMed2003

Predicting adolescents' global functioning from personality typologies.

This study examined the utility of three personality typologies in predicting global functioning in a non-clinic sample of adolescents. Participants were 140 students from middle class suburban public high schools (74 girls; mean age = 16.0 +/- 1.2; 70.7% Caucasian, 11.4% African American, 7.1% Asian, 7.1% Hispanic, and 3.6% other) who completed psychometrically sound standardized measures of personality. They were combined into three four quadrant personality typologies. Global Assessment of Functioning (GAF) ratings were based on clinical interviews utilizing DSM criteria and were obtained by raters blind to self-report results. All three systems overlapped modestly but significantly. Each model detected significant GAF differences among quadrants. There was no gender difference in representation among the quadrants of the three systems. Results suggest that compared with unitary dimensions of personality, typologies concurrently utilizing two dimensions of personality functioning better capture individual differences on a complex psychological construct such as global functioning. Further research is warranted to examine the utility of these typological systems in predicting global functioning across a variety of clinical and nonclinical adolescent populations, and to determine how other aspects of global functioning may influence or interact with personality typologies.

Adolescent↗

PubMed2003

The College Health Related Information Survey (C.h.R.I.s.-73): a screen for college student athletes.

OBJECTIVE: To assess the reliability and discriminate validity of a new screening instrument for college student athletes. METHOD: 518 Stanford University students completed the proposed instrument (College Health Related Information Survey-CHRIS-73), which was based on the Juvenile Wellness and Health Survey (JWHS-76) but re-designed to assess mental health domains relevant to college athletes. RESULTS: Factor analysis yielded four factors: mental health problems, eating problems, risk behaviors, and performance pressure. Factors were internally consistent, reasonably independent, and clearly discriminated between athletes and non-athletes, and males and females. CONCLUSIONS: This study supports the CHRIS-73 as a useful screen for assessing mental health problems among college student athletes.

Adult↗

PubMed2003

A cluster-analytic investigation of MMPI profiles of serious male and female juvenile offenders.

OBJECTIVE: To use cluster analysis to identify psychological profiles and related mental health symptoms among male and female juvenile offenders. METHOD: Juvenile offenders (N = 141) incarcerated in the California Youth Authority completed the Minnesota Multiphasic Personality Inventory (MMPI) and the Massachusetts Youth Screening Instrument-Version 2 (MAYSI-2). RESULTS: MMPI cluster analysis revealed four distinct profiles: two for male and two for female juvenile offenders. Among males, we identified one Normative cluster with no clinically elevated scores. A second male cluster, labeled Disorganized, exhibited clinical elevations on scales 8 (Schizophrenia), 6 (Paranoia), 4 (Psychopathic Deviate), and 7 (Psychasthenia). Among females, two clinically elevated profiles emerged. One Impulsive-Antisocial cluster consisted of clinical elevations on scale 4 (Psychopathic Deviate), which has been consistently associated with delinquent and antisocial behavior. The second cluster, labeled Irritable-Isolated, produced elevations on MMPI scales 4 (Psychopathic Deviate), 8 (Schizophrenia), 6 (Paranoia), and 7 (Psychasthenia). There were no significant sex, ethnicity, or offense differences across clusters, but the clusters exhibit distinct psychiatric profiles (MMPI) and mental health symptoms (MAYSI-2). CONCLUSIONS: The findings indicate that not only do female offenders have more acute mental health symptoms and psychological disturbances than male offenders, they exhibit qualitatively distinct psychiatric profiles. Results reinforce the need for assessment of mental health symptoms for male and female juvenile offenders as well as sex-appropriate treatments.

Adolescent↗

PubMed2003

Pathways to dissociation: intrafamilial versus extrafamilial trauma in juvenile delinquents.

Dissociation is postulated to occur as a function of particular types of child abuse or chronic abuse. Additionally, there is an ongoing controversy examining the perpetrator's relationship to the victim in the development of dissociation. In this study, reports of traumatic events experienced both in the family environment and in the community were used to examine the relationship between dissociative disorder as defined by DSM-IV (pathological dissociation), and dissociation as a defense mechanism. The first objective was to identify whether the site of the trauma or the quantity of trauma correlated more significantly with symptoms of dissociation. The second objective was to explore a potential correlation between topics that participants choose to disclose during a standardized Stress Inducing Speech Task (SIST), and symptoms of dissociation. The third objective was to examine the relationship between the age of occurrence, the duration of trauma, and symptoms of dissociation. Fifty-two delinquent juveniles completed measures (including the SCID-D, REM-71, CTQ, CTI, SIST) assessing traumatic experiences, psychopathological dissociation, and dissociation as defense mechanism. Blind raters scored the SIST for intrafamilial and extrafamilial trauma. The perpetrator's relationship to the victim, site of the trauma, quantity of the trauma, age of occurrence, and duration of the trauma were analyzed by descriptive statistics and Pearson partial correlations. Significant correlations were found between symptoms of pathological dissociation and intrafamilial trauma. Significant correlations were not found between extrafamilial trauma and pathological dissociation and dissociation as defense mechanism. All these correlations held constant the chronicity of traumas reported. The results obtained in this study through blind and independent assessment suggest that special trauma characteristics (i.e., childhood trauma perpetrated by a family member) rather than sheer cumulative effects of trauma may have greater implications for the development of pathological dissociation. The relationships to dissociation as a defense were much weaker.

Adolescent↗

PubMed2003

High school student athletes: associations between intensity of participation and health factors.

This paper addresses and compares the impact of organized, more intensive sports participation with lower intensity participation among high school student-athletes. Subjects included 770 high school students who reported being active in organized school sports. Mental health, physical health, and coping skills were assessed as indicated by factor scores derived from the Juvenile Wellness and Health Survey (JWHS-76). Results indicate that compared to students who were less active, competitive sports participation was associated with fewer mental health problems, fewer total risks, and fewer eating and dietary problems for both girls and boys. These results provide initial support for the association between youth participation in competitive sports and mental health.

Adaptation, Psychological↗

PubMed2003

Divalproex monotherapy in the treatment of bipolar offspring with mood and behavioral disorders and at least mild affective symptoms.

BACKGROUND: Offspring of parents with bipolar disorder, by virtue of their high-risk status for developing bipolar disorder, merit an investigation of the efficacy of treatment with mood stabilizers. Behavioral and mood difficulties in this population may represent prodromal forms of bipolar disorder. We studied the efficacy of divalproex in treating child and adolescent bipolar offspring with mood or behavioral disorders who did not yet meet criteria for bipolar I or II disorder. METHOD: We studied 24 children aged 6-18 years (mean = 11.3 years; 17 boys/7 girls) with at least 1 biological parent with bipolar disorder. Participants were diagnosed by the Washington University in St. Louis Kiddie Schedule for Affective Disorders and Schizophrenia with at least 1 of the following DSM-IV disorders: major depressive disorder, dysthymic disorder, cyclothymic disorder, or attention-deficit/hyperactivity disorder. Subjects all had at least moderate affective symptoms (28-item Hamilton Rating Scale for Depression or Young Mania Rating Scale score > 12). After a 2-week washout period, subjects were treated with divalproex for 12 weeks, titrated to achieve serum levels of 50-120 micro g/mL (mean final dose = 821 mg/day; mean final serum level = 79.0 micro g/mL). RESULTS: One subject discontinued after 2 weeks due to continuation of symptoms. Of the remaining 23 subjects, 18 (78%) were considered responders by primary outcome criteria ("very much improved" or "much improved" on the Clinical Global Impressions-Improvement scale). Divalproex was well tolerated with no discontinuations due to adverse effects. CONCLUSION: Bipolar offspring with mood or behavioral disorders and at least mild affective symptoms may respond to divalproex treatment. Our study was limited by the open treatment, lack of a placebo group, and the heterogeneous nature of the sample. Controlled studies are warranted in the use of divalproex in symptomatic bipolar offspring.

Adolescent↗

PubMed2003

Divalproex sodium for the treatment of conduct disorder: a randomized controlled clinical trial.

BACKGROUND: New treatments for conduct disorder are sorely needed. We aimed to test the efficacy of divalproex sodium for the treatment of conduct disorder. METHOD: Seventy-one youths with conduct disorder according to DSM-IV criteria were enrolled in a randomized, controlled, 7-week clinical trial. Subjects were all adolescent males with at least 1 crime conviction. Subjects were randomized into high- and low-dose conditions and were openly managed by a clinical team. Subjects and independent outcome raters were blinded to condition. Clinical Global Impressions-Severity of Illness (CGI-S) and CGI-Improvement (CGI-I) ratings, Weinberger Adjustment Inventory ratings, and staff ratings of behavioral privilege were used to assess outcome. RESULTS: Intent-to-treat analyses showed significant associations between assignment to the high-dose condition and ratings on the CGI-S (p =.02) and CGI-I (p =.0008). Self-reported weekly impulse control was significantly better in the high-dose condition (p <.05), and association between improvement in self-restraint and treatment condition was of borderline statistical significance (p <.06). Parallel analyses comparing outcome by blood drug level achieved strengthened the results, as expected. CONCLUSION: This preliminary study in a most difficult population suggests a role for divalproex sodium in the treatment of conduct disorder. Divalproex sodium improved self-reported impulse control and self-restraint, variables shown to be predictive of criminal recidivism. Studies are needed of longer-term impact and side-effect profiles. This is one of few controlled psychopharmacologic studies of conduct disorder.

Adolescent↗

PubMed2002

Coping styles as correlates of health in high school students.

PURPOSE: To study a large, population-based sample of adolescents with the goal of expanding our knowledge base about the relationship of coping and health outcomes. METHOD: We examined 1769 nonclinical, high school students (48% girls, mean age 16 years, predominantly white) using one class period to establish a link between coping styles, health problems, and health risk behaviors. Instruments employed included the Coping Response Inventory - Youth form (abbreviated version) and the Juvenile Wellness and Health Survey. ANCOVAs were used to test the main effects of coping typology, gender, and their interaction on the five health domains. RESULTS: Findings were consistent with previous research and showed that approach coping correlated negatively with indicators of health problems and health risk behaviors, while avoidance coping correlated positively with these domains. The presence of both forms of coping mitigated the negative effects of avoidance coping. CONCLUSION: As early as mid-adolescence, habitual coping styles appear to be associated with significant health outcomes. In screening nonclinical samples the clinician can rely on habitual coping styles as indicators of potential health problems.

Adaptation, Psychological↗

PubMed2002

Boys' and girls' responses to stress: affect and heart rate during a speech task.

PURPOSE: To examine gender differences in heart rate and reports of negative and positive affect among adolescents during a speech task. METHODS: Subjects were 133 adolescents, 73 girls and 60 boys, ages 14-18 years. Subjects were randomly assigned to speak for 10 minutes and asked either to free associate or to describe the most stressful event in their lives. Their heart rate was assessed at baseline and at 5 and 10 minutes after the task began. Self-ratings of negative and positive affect were assessed at baseline and at 10 minutes after the beginning of the task. Data were analyzed by Student's t-tests for independent samples, analyses of covariance, and Spearman rank-order correlation coefficients. RESULTS: Girls rated their negative affect significantly higher at baseline in comparison to boys. In addition, girls had a higher baseline heart rate. However, boys' increase in heart rate 5 minutes into the speech task was significantly greater than that of girls. Also, the free association task elicited significantly greater increases in heart rate compared to a task in which the adolescent described his or her most stressful life event. However, the stressful event task elicited greater negative and less positive affect. Significant relationships between change in heart rate and ratings of post-task affect were found among girls but not among boys, suggesting that the girls' ratings of their affect are more congruent with their physiological reactions to a stressful speech task. CONCLUSIONS: These results suggest that gender and task differences must be considered in assessing adolescents' stress.

Adolescent↗

PubMed2002

Violence exposure, posttraumatic stress, and personality in juvenile delinquents.

OBJECTIVE: To assess posttraumatic stress and its relationship to comorbid psychopathology, violence exposure, and personality traits in Russian male juvenile delinquents. METHOD: Posttraumatic stress and comorbid psychopathology were assessed by a semistructured psychiatric interview (Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version) in 370 delinquent youths during winter-spring of 1999. In addition, violence exposure, personality, and psychopathology were assessed by self-reports. RESULTS: Most delinquents reported some degree of posttraumatic stress: 156 subjects (42%) fulfilled partial criteria and 87 (25%) fulfilled full DSM-IV criteria for posttraumatic stress disorder (PTSD). Violence-related experiences (witnessing and victimization) were the most common types of trauma. Higher levels of posttraumatic stress were accompanied by higher rates of comorbid psychopathology, with the most striking differences occurring between the groups with full versus partial PTSD criteria. Violence exposure was related to temperamental behavior activation (novelty seeking), whereas PTSD symptom scores were predominantly related to behavior inhibition and poor coping (high harm avoidance and low self-directedness). CONCLUSIONS: Similar to findings from American samples, Russian juvenile delinquents represent a severely traumatized population, mainly due to high levels of violence exposure. Those with full PTSD are the most severely traumatized and have highest rates of psychopathology, as compared to those with no or partial PTSD, and they require the most clinical attention and rehabilitation. Both exposure to violence and levels of posttraumatic stress are related to personality traits, which influence degree of exposure and individual perception of stress. The latter should be considered in individualized approaches to rehabilitation.

Adolescent↗

PubMedDate not supplied

Characterization of children of bipolar parents by parent report CBCL.

In past research the Child Behavior Checklist (CBCL) has differentiated among various diagnostic categories for children and adolescents. However, research has not been conducted on whether the CBCL differentiates among diagnostic categories for children at high risk for development of psychopathology. This study compares four diagnostic groups [bipolar disorder (BD), attention/deficit-hyperactivity disorder (ADHD), Depressed/Anxious and No Diagnosis] within a cohort of 58 children of bipolar parents to determine whether their CBCL scores will replicate the scores of children not at high risk for bipolar disorder. The cohort of children of bipolar parents received elevated scores on the CBCL scales in comparison with non-clinical populations. In addition, the CBCL distinguished between children of bipolar parents with and without clinical disorders. Finally the BD group differed from the ADHD group only on the Aggressive Behaviors, Withdrawn and Anxious/Depressed subscales of the CBCL. Therefore the CBCL did not discriminate between the BD and ADHD groups as it had in previous studies of children with BD and unspecified family history. It is possible that this discrepancy is due to a group of children of bipolar parents with ADHD who are currently prodromal for bipolar disorder and therefore received higher scores on the CBCL based on prodromal symptomatology. A longitudinal follow-up of this cohort is necessary to ascertain whether this is the case.

Adolescent↗