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The consequences of Conduct Disorder for males who develop schizophrenia: associations with criminality, aggressive behavior, substance use, and psychiatric services.

Men with schizophrenia are at increased risk, as compared to the general population, for criminal offending and to have displayed Conduct Disorder (CD) before age 15. The present study examined the consequences of CD among a sample of 248 men with schizophrenia or schizo-affective disorder, aged, on average, 39 years old. Participants were intensively assessed at discharge from the hospital and four times during the subsequent two-year period. CD was associated with criminality and substance misuse among first-degree male relatives and substance misuse among female relatives. In childhood and adolescence, CD was associated with poor academic performance, substance abuse, and physical abuse. In adulthood, the diagnosis of CD and each CD symptom were associated with increased non-violent and violent criminal offending, after adjusting for life-time diagnoses of substance misuse disorders. CD was not associated with homicide. CD was associated with life-time diagnoses of alcohol and drug abuse and/or dependence. During the 24 month follow-up period, CD and the number of CD symptoms were associated with aggressive behavior, controlling for life-time diagnoses of substance use disorders, substance misuse measured objectively and subjectively, medication compliance, and obligatory care. CD was associated with an earlier age at onset of schizophrenia and at first admission to hospital, and with length of time spent in hospital. During the two-year follow-up period, neither the diagnosis of CD nor the number of CD symptoms was associated with levels of positive and negative symptoms assessed five times, compliance with medication, substance use, or readmission. The results are interpreted to suggest that CD is a distinct co-morbid disorder that runs parallel to the course of schizophrenia.

Adult↗

Behavioral effects of the beta-carboline derivatives ZK 93423 and ZK 91296 in squirrel monkeys: comparison with lorazepam and suriclone.

Behavioral effects of the beta-carboline derivatives ZK 93423 (6-benzyloxy-4-methoxymethyl-beta-carboline-3-carboxylic acid ethyl ester) and ZK 91296 (5-benzyloxy-4-methoxymethyl-beta-carboline-3-carboxylic acid ethyl ester) were compared with those of lorazepam and suriclone in squirrel monkeys. Two groups of monkeys were trained to respond under a fixed-interval schedule of food presentation. In one group, responding was suppressed (punished) by superimposing a fixed-ratio schedule of response-produced electric shock. Dose-effect curves were determined for all drugs by administering single doses i.m. 15 min before the start of the fixed-interval schedule. Low and intermediate doses of ZK 93423 (0.03-0.3 mg/kg), ZK 91296 (0.3-10.0 mg/kg), lorazepam (0.03-0.3 mg/kg) and suriclone (0.003-0.03 mg/kg) produced dose-related increases in the rates of both suppressed and nonsuppressed responding. The increases in response rates normally produced by maximally effective doses of ZK 93423, ZK 91296, lorazepam or suriclone were eliminated when the drugs were given in combination with the benzodiazepine antagonist Ro 15-1788. Although many beta-carboline derivatives have been found to act as "inverse agonists" at benzodiazepine recognition sites, the present results show that ZK 93423 and ZK 91296 have clear benzodiazepine-like (agonist) effects on schedule-controlled behavior in squirrel monkeys.

Animals↗

Comparison of the stimulus properties of ethanol and the Ca2+ channel antagonist nimodipine in rats.

A variety of L-type Ca2+ channel antagonists, including the dihydropyridine derivative nimodipine, have been shown to be effective in reducing ethanol intake and preference in animal models of alcoholism. The behavioral mechanism involved in the anti-alcohol effects of nimodipine are, however, not clear yet. The aim of the present study was to investigate the possibility that the effects of nimodipine on ethanol intake are based on stimulus substitution. Therefore, rats were trained to discriminate ethanol (12.5% w/v, 1000 mg/kg i.p.) from saline in a two-lever food-reinforced drug discrimination procedure (dose range of ethanol tested: 125-1000 mg/kg i.p., ED50 value: 488 mg/kg). In cross-generalization tests with nimodipine (0.15-15 mg/kg i.p.), stimulus substitution was not noted. In addition, a cross-familiarization conditioned taste aversion paradigm was utilized. In rats, 1000 mg/kg i.p. ethanol was used as the reference drug producing a conditioned taste aversion. Effects of preexposure to ethanol (500-1500 mg/kg i.p.) and nimodipine (7.5-30 mg/kg i.p.) on the magnitude of the ethanol-induced conditioned taste aversion were investigated as an index for stimulus similarity between preexposure and reference drug. Preexposure to both ethanol and nimodipine prevented the development of a conditioned taste aversion. Contrary to the drug discrimination results, these latter findings suggest that there may be similarities between the stimulus properties of nimodipine and ethanol. Moreover, the apparent discrepancy between the results obtained in drug discrimination and cross-familiarization conditioned taste aversion suggests that different stimulus properties of ethanol control behavior in both procedures. The finding that, under particular conditions, ethanol and nimodipine appear to share common stimulus properties needs to be further evaluated, as this may be related to the reported anti-alcohol effects of nimodipine and other Ca2+ channel antagonists.

Analysis of Variance↗

Measurement characteristics of weight concern and dieting measures in 8-10-year-old African-American girls from GEMS pilot studies.

BACKGROUND: Reliability and validity were established for weight concern measures completed by 8-10-year-old African-American girls participating in a pilot obesity prevention program. METHODS: Two hundred ten girls and parents participated in the program. Girls completed subscales of the McKnight Risk Factor Survey (MRFS) and body silhouette ratings, had height, weight, and body fat measured, wore accelerometers for 3 days, and completed two dietary recalls. Principal components analysis, internal consistency, and test-retest reliability were computed for weight concerns and body image measures along with convergent validity with body mass index (BMI), percent body fat (PBF), physical activity, and dietary intake. RESULTS: A Moderate Weight Control Behaviors (MWCB) subscale was derived from the MRFS. Overconcern with Weight and Shape (OWS) was a stand-alone scale. Internal consistency estimates for the scales were substantial ranging from 0.71 to 0.84. Test-retest reliabilities were moderate (0.45-0.58). OWS, MWCB, body silhouette rating, and body size discrepancy were positively associated with BMI and PBF. The "like to look" silhouette rating was negatively associated with PBF. CONCLUSIONS: Weight concern measures had reasonable levels of internal consistency and promising validity, but only moderate test-retest reliability among preadolescent African-American girls. Refinement and further validation of weight concern measures in this population are warranted.

Black or African American↗

The impact of cochlear implants on young deaf children: new methods to assess cognitive and behavioral development.

Much evidence suggests that, early in life, auditory input and communication are essential for the normal development of language, cognition, and behavior. Thus, deaf children, who experience significant disruptions in auditory input, are likely to show delays not only in the production of oral language but in other important aspects of development such as visual attention and behavioral control. Cochlear implants have shown tremendous promise in restoring auditory information to deaf children and concomitant improvements in speech recognition and production. However, little is known about how cochlear implants affect psychological variables. In this multisite trial, we assess the effects of cochlear implants on a range of developmental outcomes, including visual attention, problem-solving skills, symbolic play, and social adjustment. Measuring these constructs in young children, primarily younger than 2 years, has presented a number of unique challenges. In this article, we describe the methods used to assess these variables in young children and present preliminary findings comparing joint attention and symbolic play skills in a small sample of age-matched deaf and hearing children. As expected, deaf children performed more poorly than hearing children on measures of attention and symbolic play. As auditory input is restored via a cochlear implant, we predict that significant improvements in these variables will be observed.

Attention↗

Age-related changes in neutral sphingomyelin-specific phospholipase C activity in striatum, hippocampus, and frontal cortex: implication for sensitivity to stress and inflammation.

UNLABELLED: Previous studies show the enrichment of mammalian brain with neutral sphingomyelin-specific phospholipase C (ceramide-phosphocholine phosphodiesterase, EC 3.1.4.12; N-Sase), a key enzyme of sphingolipid metabolism and sphingolipid-induced signaling. OBJECTIVE: The objective of this study was to evaluate the membrane-associated and cytosolic N-Sase activities in the brain regions associated with behavior (striatum, hippocampus, and frontal cortex). RESULTS: Results showed higher membrane-associated N-Sase activity as compared to the N-Sase activity in the cytosolic fractions of all the evaluated brain regions. In the hippocampus, the N-Sase activity was significantly higher than in the striatum and cortex. In addition, age-related changes in the hippocampal N-Sase activities were profoundly higher than in the respective fractions isolated from the striatum and cortex. Age-related decreases in the hippocampal and striatal cytosolic N-Sase activities were accompanied by increases in the membrane N-Sase activities in those brain regions. There was a significant increase in the cortical membrane-associated N-Sase activity with age; however, to a much lesser extend than in other brain regions. The increase in the hippocampal membrane-associated N-Sase activity was accompanied by a higher expression of the inflammatory marker, interleukin-1 beta (IL-1 beta), with age. One of the important findings of the present study is the region-specific expression of heat shock protein 70 (hsp70). Frontal cortex showed lower hsp70 expression in both young and old age groups as compared to the striatal and hippocampal hsp70 levels which can contribute to the recently reported higher cortical sensitivity to oxidative stress. CONCLUSION: In conclusion (a) our results, for the first time to our knowledge, demonstrated the association between the N-Sase activity and the stress/inflammatory markers expression in the brain regions controlling behavior; (b) these findings suggest the role of N-Sase as a contributor to the increased stress and inflammatory sensitivity among the brain regions with age.

Aging↗

Structure and functions of internal working models of attachment and their role for emotion regulation.

The concept of organization in the service of adaptation has been applied to attachment theory (Sroufe & Waters, 1977) as well as to a variety of life sciences (Ryan, Kuhi & Deci, 1997). Internal working models (IWMs) are postulated as providing organizing structure to the attachment behavior system controlling attachment behaviors toward caregivers and, with increasing age, autonomous individual adaptation. While many theoretical specifications have been suggested on that topic (e.g. Bretherton, 1987, 1990; Bretherton & Munholland, 1999; Main, Kaplan & Cassidy, 1985; Sroufe & Fleeson, 1986), empirical studies focusing directly on the structure or functions of internal working models are rare. Knowledge about the structure and functioning of IWMs could add to the understanding of the developmental influences of the attachment organization across the life-span. In this paper two topics will be addressed shortly and related to an empirical investigation concerning the relationship between attachment representations during late adolescence and emotion regulation patterns: (1) structure and functions of IWMs in terms of information-processing and emotion and behavior regulation; and (2) the transfer from IWMs of self-with-attachment figures to adaptive personality structures based on autonomous self-regulation.

Adaptation, Psychological↗

Hospitalization of adolescents for psychiatric and substance abuse treatment. Legal and ethical issues.

It has been estimated that as many as 12%-15% of the nations 63 million children are in need of mental health treatment. We have a responsibility to do everything we can to see to it that these children receive the services they need. Unfortunately, there is mounting evidence that a significant proportion of our health care resources are being misspent on the unnecessary and inappropriate hospitalization of children and youths in psychiatric and substance abuse treatment programs. More alarming is the evidence of poor quality programs, abusive practices, and greed. The intense competition to capture a "share of the market" and turn a profit or keep a nonprofit hospital from closing its doors is contributing to unprofessional and unethical advertising and public relations practices. In the end these practices will reflect poorly on the broader mental health and health care community. Hopefully, the stakeholders in the system will recognize these problems and assume a leadership role in turning the situation around. If not, we can expect intervention from forces outside the system (e.g., courts, elected public officials, public interest groups, the business community, and child advocates).

Adolescent↗

Comparison of effortful and noneffortful swallows in healthy middle-aged and older adults.

OBJECTIVE: To assess the effects of effortful swallowing, a common compensatory strategy for dysphagia, on the bolus and swallowing mechanism of middle-aged and older men and women. DESIGN: Case-controlled design in which subjects completed both the intervention technique and the control behavior. SETTING: A university hospital. PARTICIPANTS: Sixty-four healthy men and women between 45 and 93 years of age from the community. INTERVENTIONS: Participants swallowed 3-mL thin liquid boluses both normally and using the effortful swallow strategy. MAIN OUTCOMES MEASURES: The biomechanics and bolus flow patterns of swallows were analyzed from videofluoroscopic and simultaneous oral pressure data. RESULTS: Subjects at all ages generated significantly increased oral pressures at each sensor location using the effortful swallow (p = .0001), with the pressure increase greater for the middle-aged subjects compared with older subjects. Several durational measures were significantly longer with the effortful swallow including: hyoid maximum anterior excursion (p < .04), laryngeal vestibule closure (p < .0001), and duration of the upper esophageal sphincter opening (p =.0001). The hyoid bone moved further in the superior direction with the effortful swallow (p = .002). There was a trend of decreased oral residue with the effortful swallow (p = .06). CONCLUSION: Biomechanical and bolus flow aspects of swallowing changed when healthy individuals performed effortful swallows with 3-mL boluses.

Age Factors↗

[Health locus of control and health related risk behavior--an analysis of locus of control patterns].

In this study we related health locus of control beliefs to risk-behavior (little physical exercise, overweight and smoking) in a sample of n = 956 persons, First, we used a correlative method and later we analysed health locus of control patterns. The sample is divided in eight different health locus of control beliefs patterns by the three dimensions (internal, social external and fatalistic external). The hypothesis that some subgroups have a different risk-behavior can't supported. Only the subgroup with high internal and high social external health locus of control showed in tendency lower risk-behavior. Finally we discuss different possibilities for the interpretation of the results.

Adult↗

The functional properties of the light-sensitive neurons of the posterior parietal cortex studied in waking monkeys: foveal sparing and opponent vector organization.

We describe in this paper the results of a new study of the inferior parietal lobule in 10 waking monkeys combining the methods of behavioral control, visual stimulation, and single neuron analysis. In this study, 1682 neurons were identified; 804 were studied in detail. Neurons insensitive to visual stimuli comprise the fixation, oculomotor, and projection-manipulation classes thought to be involved in initiatives toward action. The largest group of the light-sensitive (LS) neurons were activated from large and frequently bilateral response areas that excluded the foveal region; we term this foveal sparing. The remaining cells subtended areas including the fovea, when tested with large stimuli (6 degrees X 6 degrees), but only 8 of 216 cells studied in detail responded to the small fixation target light. We propose that a dynamic central neural process associated with the acts of fixation and visual attention suppresses responses to foveal stimuli. Parietal LS neurons are sensitive to stimulus movement and direction over a wide range of velocities. The vectors point either inward toward the center or outward toward the perimeter of the visual field, and for neurons with bilateral response areas, the vectors commonly point in opposite directions in the two half-fields; we term this opponent vector organization. The functional properties of area 7 LS neurons are such that they could signal motion in the immediate surround and the apparent motion accompanying head movements and forward locomotion. We surmise that they contribute to a central neural image of immediately surrounding space and to the perceptual constancy of that space obtaining during bodily movement. These properties are suitable for the attraction of gaze and attention to objects and events in the peripheral visual fields. It is this system, together with the classes of parietal neurons concerned with action initiatives, whose destruction is thought to account for the hemi-inattention and neglect of the parietal lobe syndrome in primates.

Animals↗

Behavioral Self-Control Program for Windows: results of a controlled clinical trial.

Forty nonalcoholic heavy drinkers were randomly assigned to receive a computer-based version of behavioral self-control training either immediately after pretreatment assessment or after a 10-week waiting period. Results at each of 3 follow-ups strongly support the study hypotheses. Participants in the immediate treatment group significantly reduced their drinking relative to their pretreatment levels and relative to those in the delayed treatment condition at the initial follow-up, 10 weeks after the pretreatment assessment. The delayed group did not change their drinking behaviors during this period of time. However, they significantly reduced their drinking by the second follow-up conducted after they received training. At the 12-month follow-up, participants maintained the gains they had achieved during treatment. There were no interactions involving participant ethnicity or gender. Although use of other drugs was not specifically addressed, such use did not increase, and there was some evidence of a decline.

Adult↗

Trends in adherence to a revised risk management program designed to decrease or eliminate isotretinoin-exposed pregnancies: evaluation of the accutane SMART program.

OBJECTIVE: To review adherence to selected procedures outlined in the System to Manage Accutane-Related Teratogenicity (SMART) program during the first year of implementation vs the procedures in effect in the year prior to initiation of the SMART program. DESIGN: Observational. SETTING: A novel pharmacy compliance survey and an ongoing, voluntary survey. PATIENTS: Female recipients of isotretinoin. INTERVENTION: In April 2002, Hoffmann-La Roche Inc, Nutley, NJ, manufacturer of Accutane brand isotretinoin and at that time the sole source of isotretinoin, revised earlier guidelines and instituted the SMART risk management program, which included the use of qualification stickers to affix to all prescriptions for Accutane to indicate, among other things, a negative pregnancy test just before the prescription was written. The goal of the SMART program was to decrease or eliminate isotretinoin-exposed pregnancies. MAIN OUTCOME MEASURES: Use and completion of prescription qualification stickers; changes in pretherapy pregnancy testing and birth control use. RESULTS: The results of the pharmacy compliance survey indicated high (>90%) use of prescription qualification stickers. Results of the patient survey suggested that 9% of prescription qualification stickers within the observed user cohort were issued without a pregnancy test. Furthermore, the pregnancy rate for patients participating in the survey was similar to that reported for cohorts recruited before the SMART program. CONCLUSIONS: The usefulness of the results derived from 2 surveys designed to evaluate the SMART program is limited by the lack of reliability and validity of the survey instruments and by questionable generalizability to all female recipients of isotretinoin. The presence of a qualification sticker may not have an impact on pregnancy testing or compliance with effective birth control behavior as outlined in the SMART program.

Abnormalities, Drug-Induced↗

Pica and elevated blood lead level in autistic and atypical children.

Children with severely atypical development often display pica, habitual mouthing, and odd food preferences as symptoms from the first year of life. Such children can ingest dangerous amounts of lead even in environments that are usually considered safe. Mean blood lead concentration was notably higher in 18 autistic children than in 16 nonautistic psychotic children or in ten normal siblings. Fifteen (44%) of the psychotic children (autistic and nonautistic) had blood lead levels greater than two standard deviations above the mean for normal controls. Behavioral and neurological sequelae of elevated blood lead level may be obscured in severely disorganized children. Screening for blood lead should be part of the medical care of these vulnerable children with pica.

Adolescent↗

Parental psychopathology, parenting styles, and the risk of social phobia in offspring: a prospective-longitudinal community study.

BACKGROUND: This article examines the associations between DSM-IV social phobia and parental psychopathology, parenting style, and characteristics of family functioning in a representative community sample of adolescents. METHODS: Findings are based on baseline and first follow-up data of 1047 adolescents aged 14 to 17 years at baseline (response rate, 74.3%), and independent diagnostic interviews with one of their parents. Diagnostic assessments in parents and adolescents were based on the DSM-IV algorithms of the Munich-Composite International Diagnostic Interview. Parenting style (rejection, emotional warmth, and overprotection) was assessed by the Questionnaire of Recalled Parental Rearing Behavior, and family functioning (problem solving, communication, roles, affective responsiveness, affective involvement, and behavioral control) was assessed by the McMaster Family Assessment Device. RESULTS: There was a strong association between parental social phobia and social phobia among offspring (odds ratio [OR], 4.7; 95% confidence interval [CI], 1.6-13.5). Other forms of parental psychopathology also were associated with social phobia in adolescents (depression: OR, 3.6; 95% CI, 1.4-9.1; any anxiety disorder other than social phobia: OR, 3.5; 95% CI, 1.4-8.8; and any alcohol use disorder: OR, 3.0; 95% CI, 1.1-7.8). Parenting style, specifically parental overprotection (OR, 1.4; 95% CI, 1.0-1.9) and rejection (OR, 1.4; 95% CI, 1.1-1.9), was found to be associated with social phobia in respondents. Family functioning was not associated with respondents' social phobia. CONCLUSIONS: Data suggest that parental psychopathology, particularly social phobia and depression, and perceived parenting style (overprotection and rejection) are both associated with the development of social phobia in youth.

Adolescent↗

Body dissatisfaction among Chinese undergraduates and its implications for eating disorders in Hong Kong.

OBJECTIVES: To study the body dissatisfaction of Chinese undergraduates and its implications for eating disorders in Hong Kong. METHOD: A large sample of 1,581 subjects completed a "Body Dissatisfaction Questionnaire" (BDQ) which included 25 items about various body parts and questions on body indices, body shape dissatisfaction, and dieting. RESULTS: Whereas male subjects wanted to be taller and stronger in their upper body, the majority of female subjects felt fat in their lower body and were cognitively inclined to weigh less even though they were not obese. They desired a slimming of the stomach, thighs, waist and hip, but not the breasts. Body dissatisfaction was substantially intensified in females who reported a history of dieting in the previous year. Factor analysis of the BDQ affirmed the gender specificity and multidimensionality of body dissatisfaction. DISCUSSION: The typically "Western" pattern of body dissatisfaction has overshadowed the traditional Chinese notions of female beauty based on the face and other nontruncal features. In the context of a rapidly urbanizing Chinese society, this will predispose more females to weight control behavior and eating disorders.

Adolescent↗