Difficulties in emotional regulation and substance use disorders: a controlled family study of bipolar adolescents

Anxiety and Disruptive Behavior Symptoms and Disorders in Preschool-Age Offspring of Parents With and Without Bipolar Disorder: Associations With Parental Comorbidity

OBJECTIVE

We examined the relative contribution of parental bipolar disorder (BPD) and psychiatric comorbidities (disruptive behavior disorders [DBD] and anxiety disorders) in predicting psychiatric symptoms and disorders in 2-5-year-old offspring.

METHODS

Participants were 60 families with a parent with BPD and 78 offspring and 70 comparison families in which neither parent had a mood disorder and 91 offspring. Parent and offspring diagnoses and symptoms were assessed using standardized diagnostic interviews and measures, with offspring assessors masked to parental diagnoses.

RESULTS

Offspring of parents with BPD had significant elevations in behavioral, mood and anxiety disorders and symptoms. Both parental BPD and DBD contributed to elevations in child disruptive behavioral symptoms, whereas child anxiety symptoms were more strongly predicted by comorbid parental anxiety. Parental BPD was a stronger predictor than comorbid DBD of child DBDs.

CONCLUSION

Some of the elevated risk for disorders in preschoolers is accounted for by parental comorbidity.

Associations between cannabis use, opioid misuse and severe psychological distress in adolescents: A cross-sectional school-based study

BACKGROUND

Cannabis use and nonmedical use of prescription opioids are consumed by a small to moderate number of adolescents. However, little is known about their combined influence on mental health in this age group. This study examined the association between cannabis use, nonmedical use of prescription opioids, or both with serious psychological distress among adolescents and tested if sex could moderate these associations.

METHODS

We based our analyses on cross-sectional data from the 2019 Ontario Student Drug Use and Health Survey, a provincially representative sample of students in grades 7 through 12 (aged 11-20 years or older) across Ontario, Canada (n= 7097; mean age: 15.2 ± 1.2 years). Logistic regression analyses were adjusted for important covariates.

RESULTS

We found that 20.5% reported cannabis use only, 5.8% reported opioid use only, and 5% reported both cannabis and opioid use. Cannabis use only (odds ratio [OR]:1.91; 95% confidence interval [CI]:1.53-2.37), opioid use only (OR: 2.21; 95% CI: 1.63-3.00), and both cannabis and opioid use (OR: 3.24; 95% CI: 2.25-4.66) were associated with greater odds of serious psychological distress after adjustment for covariates. Associations were similar for males and females.

CONCLUSION

The use of both cannabis and opioids is significantly associated with serious psychological distress among adolescents. Adolescents who use both cannabis and opioids represent a small and vulnerable group that should be targeted in future interventions against mental health problems. Health professionals should consider screening for polysubstance use, especially when working with adolescents who use cannabis.

Problematic online anime (animation) use: It's relationship with viewers' satisfaction with life, emotions, and emotion regulation

Although there are numerous studies on problematic technology use, such as problematic video game use and problematic smartphone use, little is known about problematic online anime use. However, problematic online anime use warrants further examination because of anime's popularity and commercial importance. Furthermore, how emotion strategies and emotions (such as pleasure and arousal) invoked upon watching the online anime are associated with problematic online anime use is not examined in previous studies. To bridge these literature gaps and to contribute to the fields of emotion regulation and media psychology, this study adopts the emotion regulation theory and considers the relationships among viewers' satisfaction with life, feelings of pleasure and arousal arising from watching a particular online anime, cognitive emotion regulation strategies activated because of anime viewing, and potential to exhibit problematic behavior related to online anime use, which is operationalized as viewers' inability to control or reduce watching online anime. Data was collected from viewers who have watched the popular romantic comedy anime Kaguya-sama: Love Is War online via a major online discussion board in Taiwan through the purposive sampling method. Data analysis on the 190 online questionnaire returns (mostly from males and students) through the partial least squares analysis reveals that the emotion regulation theory can be used to examine viewers' perceptions of anime. In the online anime context, the emotion regulation strategy most likely to be invoked is positive refocusing (mean value of 3.68, measured through a 5-point Likert scale) which is in line with how people typically watch anime for immersion and escapism. Satisfaction with life demonstrates its robustness and flexibility in invoking the positive refocusing (path coefficient = 0.17) and refocus on planning (path coefficient = 0.13) strategies. It also lowers the adoption of the maladaptive strategy of catastrophizing (path coefficient = -0.18). While catastrophizing strategy (path coefficient = 0.31) and arousal (path coefficient = 0.24) add to problematic online anime use, pleasure (path coefficient = -0.27) lowers problematic online anime use. Thus, when viewers keep magnifying the severity of a bad situation they are in while watching online anime, instead of making them better, could lead them to the undesirable outcome of problematic online anime use. Although this study has provided several interesting insights, this study has only considered Kaguya-sama: Love Is War and used survey respondents' perception of their extent of problematic online anime use. To increase generalization, future studies could consider other types of anime and alternative means to measure problematic use, such as frequency of online anime viewing.

Personality and emotion dysregulation profiles predict differential engagement in a wide range of health-risk behaviors

OBJECTIVE

Health-risk behaviors have an unclear etiology and college students have elevated risk for engagement. Emotion dysregulation and several personality dimensions have been implicated in health-risk behaviors, but these constructs have rarely been studied together. Further, it is unknown if different types of health-risk behaviors have distinct etiologies.

PARTICIPANTS

2077 college students completed a cross-sectional survey.

METHODS

Latent profile analysis discerned classes of participants from emotion dysregulation and personality dimensions. Differential engagement in self-injury, suicidality, disordered eating, substance misuse, and unprotected sex was evaluated across classes.

RESULTS

Three classes were identified, which were primarily distinguished by emotion dysregulation, urgency, and neuroticism. Health-risk behaviors generally increased across classes with increasing emotion-related constructs. Self-injury and suicidality demonstrated different patterns than other health-risk behaviors.

CONCLUSIONS

Results elucidate heterogeneity in health-risk behavior engagement. Focusing on emotional difficulties may be more important for reducing self-injury and suicidality than disordered eating, substance misuse, and risky sex.

Prevalence of Dual Diagnoses among Children and Adolescents with Mental Health Conditions

BACKGROUND

The World Health Organisation defines dual diagnosis as the co-occurrence in the same individual of a psychoactive substance use disorder and another psychiatric disorder. Children and adolescents with dual diagnoses represent a significant public health burden in social and financial terms.

AIMS

The objective of the present paper is to provide a review of studies dealing with dual diagnoses and their prevalence among children and adolescents whose primary treatment involves psychiatric conditions.

METHODS

The PRISMA was used to conduct a systematic search. Articles published between January 2010 and May 2022 were searched for analysis.

RESULTS

Eight articles were eventually found eligible for the final content analysis. The analysis of the articles identified the prevalence of dual diagnoses among children and adolescents treated primarily for psychiatric conditions, the gender-specific occurrence of dual diagnoses, methods used to diagnose psychiatric and substance use disorders, types of psychiatric diagnoses involved in dual diagnoses, and prevalence differences contingent on the type of service provision as the main thematic areas. The prevalence of dual diagnoses among the target population ranged from 18.3% to 54% (mean 32.7%). Boys were more likely to experience dual diagnoses and affective disorders were the most frequent psychiatric diagnoses.

CONCLUSION

The importance of the issue and the high prevalence of dual diagnoses make it imperative that this type of research is pursued.

Further Evidence of an Association Between a Positive Child Behavior Checklist-Bipolar Profile and a Diagnosis of Pediatric Bipolar Disorder: A Meta-Analysis

Background

Previous research has found that a unique profile of the Child Behavior Checklist comprising of aggregate elevations of the Attention, Anxiety/Depression and Aggression scales (A-A-A profile, CBCL-Bipolar (BP) profile, CBCL-Dysregulation profile (DP); henceforth CBCL-BP/DP profile) is associated with a clinical diagnosis of pediatric bipolar (BP) disorder.

Objective

The main aim of the study is to evaluate the strength of the association between the CBCL-BP/DP profile and the clinical diagnosis of pediatric BP disorder through a meta-analysis.

Methods

A literature search was performed to identify studies that examined the association between a positive CBCL-BP/DP profile and a clinical diagnosis of pediatric BP disorder. The meta-analyses first examined studies assessing the rates of a positive CBCL-BP/DP profile in youth with BP disorder versus those with 1) ADHD, anxiety/depression, or disruptive behavior disorders (DBDs), and 2) non-bipolar controls. The second analysis evaluated studies examining the rates of pediatric BP disorder in youth with and without a positive CBCL-BP/DP profile.

Results

Eighteen articles met our inclusion and exclusion criteria, and fifteen articles had adequate data for meta-analysis. Results showed that BP youth were at significantly increased odds of having a positive CBCL-BP/DP profile compared to those with other psychiatric disorders (i.e., ADHD, anxiety/depression, or DBDs) (pooled OR=4.34, 95% CI=2.82, 8.27; p<0.001) and healthy control groups (pooled OR=34.77, 95% CI=2.87, 420.95; p=0.005). Further, meta-analysis results showed that youth with a positive CBCL-BP/DP profile were at significantly increased odds of having a BP disorder diagnosis compared to those without (pooled OR=4.25, 95% CI=2.12, 8.52; p<0.001).

Conclusion

Our systematic review and meta-analysis of the extant literature provides strong support for the association between the CBCL-BP/DP profile and pediatric BP disorder.

A Pilot Study of a Tablet-Based Emotion Regulation Intervention for Early Adolescents

OBJECTIVE

This study examined the feasibility, acceptability, and preliminary outcomes of internet-based Talking About Risk and Adolescent Choices (iTRAC), a tablet intervention designed to promote emotion regulation (ER) skills among middle schoolers as a strategy for reducing risk behaviors.

METHODS

Adolescents (12-14 years) were recruited from 3 urban US schools for advisory groups (n = 15), acceptability testing (n = 11), and pilot testing (n = 85). Youth advisory boards and expert panels tailored content, resulting in an animated intervention of instructional videos, games, and activities designed to teach ER strategies to young adolescents. Eighty-five adolescents were randomized to the 4-module digital iTRAC intervention or a wait-list control group. Adolescents and 1 parent completed baseline and 3-month follow-up questionnaires examining ER attitudes and behaviors; adolescents also completed behavioral tasks related to distress tolerance.

RESULTS

Among those randomized to iTRAC, 88% completed all modules. Moderate effect sizes ( d ≥ 0.36) were found from baseline to follow-up on adolescents' beliefs in the controllability of emotions, awareness of emotions, self-efficacy for managing emotions, perceived access to ER strategies, and use of ER strategies. Parent measures of adolescent regulation showed mixed results.

CONCLUSION

A digital intervention to enhance ER skills for youth in early adolescence was feasible and demonstrated promising indicators of impact on emotional competence. Increasing adolescents' awareness of and access to ER strategies could reduce decisions driven by transient emotions, which in turn may reduce engagement in risk behaviors and resultant negative health outcomes. This brief tablet-based intervention has the potential to be self-administered and used to increase emotional competency.

The Impact of Pharmacotherapy of Childhood-Onset Psychiatric Disorders on the Development of Substance Use Disorders

Background and Objective: Child- and adolescent-onset psychopathology is known to increase the risk for developing substance use and substance use disorders (SUDs). While pharmacotherapy is effective in treating pediatric psychiatric disorders, the impact of medication on the ultimate risk to develop SUDs in these youth remains unclear. Methods: We conducted a Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) systematic review of peer-reviewed literature published on PubMed through November 2021, examining pharmacological treatments of psychiatric disorders in adolescents and young adults and their effect on substance use, misuse, and use disorder development. Results: Our search terms yielded 21 studies examining the impact of pharmacotherapy and later SUD in attention-deficit/hyperactivity disorder (ADHD), two studies on Major Depressive Disorder, and three studies on psychotic disorders. The majority of these studies reported reductions in SUD (N = 14 sides) followed by no effects (N = 10) and enhanced rates of SUD (N = 2). Studies in ADHD also reported that earlier-onset and longer-duration treatment was associated with the largest risk reduction for later SUD. Conclusions: Overall, pharmacological treatments for psychiatric disorders appear to mitigate the development of SUD, especially when treatment is initiated early and for longer durations. More studies on the development of SUD linked to the effects of psychotherapy alone and in combination with medication, medication initiation and duration, adequacy of treatment, non-ADHD disorders, and psychiatric comorbidity are necessary.

Association between problematic internet use and behavioral/emotional problems among Chinese adolescents: the mediating role of sleep disorders

Background

Studies that focus on the relationships of problematic Internet use (PIU), sleep disorders, and behavioral/emotional problems were limited. This study aimed to explore (1) the relationship between PIU and behavioral/emotional problems among Chinese adolescents and (2) whether sleep disorders mediate the relationship between PIU and behavioral/emotional problems.

Methods

A total of 1,976 adolescents were recruited by cluster sampling from ten secondary schools in Guangzhou between January and April 2019, and 1,956 of them provided valid information (response rate: 98.9% ). Among them, 50.8% were males and the mean age was 13.6±1.5 years, ranging from 11 to 18 years. Data on behavioral/emotional problems, sleep disorders, and PIU were collected using a self-reported questionnaire. Linear regression models and mediation analyses were performed.

Results

Of the participants, 14.5% (284/1,956) reported moderate to severe PIU, and their average score for total difficulties was significantly higher than the score for average users (14.9±5.5 Vs 9.8±4.7). After adjusting for controlled variables, PIU was further proven to be positively related to elevated levels of behavioral/emotional problems (unstandardized β = 0.16, p < 0.05). In addition, sleep disorders partially mediated the forgoing associations.

Conclusions

Adolescents with problematic Internet habits were at higher risk of developing behavioral and emotional problems than their normal-use peers, and sleep disorders partially mediated the effect. Close attention and effective guidance for adolescents with PIU and behavioral/emotional problems were recommended for parents and schools.

Emotional Dysregulation in Children and Adolescents With Psychiatric Disorders. A Narrative Review

Background: Emotional dysregulation (ED) is a transdiagnostic construct defined as the inability to regulate the intensity and quality of emotions (such as, fear, anger, sadness), in order to generate an appropriate emotional response, to handle excitability, mood instability, and emotional overreactivity, and to come down to an emotional baseline. Because ED has not been defined as a clinical entity, and because ED plays a major role in child and adolescent psychopathology, we decided to summarize current knowledge on this topic based on a narrative review of the current literature. Methods: This narrative review is based on a literature search of peer-reviewed journals. We searched the databases ERIC, PsycARTICLES, PsycINFO and PSYNDEX on June 2, 2020 for peer reviewed articles published between 2000 and 2020 in English language for the preschool, school, and adolescent age (2-17 years) using the following search terms: "emotional dysregulation" OR "affect dysregulation," retrieving 943 articles. Results: The results of the literature search are presented in the following sections: the relationship between ED and psychiatric disorders (ADHD, Mood Disorders, Psychological Trauma, Posttraumatic Stress Disorder, Non-suicidal Self-Injury, Eating Disorders, Oppositional Defiant Disorder, Conduct Disorder, Disruptive Disruptive Mood Dysregulation Disorder, Personality Disorders, Substance Use Disorder, Developmental Disorders, Autism Spectrum Disorder, Psychosis and Schizophrenia, and Gaming Disorder), prevention, and treatment of ED. Conclusion: Basic conditions of ED are genetic disposition, the experience of trauma, especially sexual or physical abuse, emotional neglect in childhood or adolescence, and personal stress. ED is a complex construct and a comprehensive concept, aggravating a number of various mental disorders. Differential treatment is mandatory for individual and social functioning.

Emotional Dysregulation in Preschool Age Predicts Later Media Use and Gaming Disorder Symptoms in Childhood

Background: The aim of this study was to evaluate the role of early Emotional Dysregulation (ED) at preschool age as a risk factor or predictor of later media use behavior and Gaming Disorder (GD) in school age. Methods: 80 patients (63.7% male; mean age = 4.2, SD = 1.23) who had attended a special outpatient program for preschoolers at measuring point time t1 were contacted at measuring point time t2 (mean age = 9.2, SD = 2.03). At t1, the comprehensive clinical assessment comprised Child Behavior Checklist-Dysregulation Profile (CBCL-DP). At t2, parents completed a questionnaire on their children's media availability, usage times, and GD. Results: ED predicts a more intense use of digital media in the future. The daily average screen-use time at t2 varies significantly between the groups (148 min for children with ED at t1 and 85 min for children without ED at t1). The intensity of media use can be considered a significant predictor for the presence of a GD in dimensional assessment. When GD is classified categorically, according to the DSM-5 criteria, there is no significant correlation between ED and later GD diagnosis, neither between screen-use time and GD diagnosis. However, at dimensional level, preschool children with ED show significantly higher GD symptom scores at 9 years of age. Conclusion: ED at preschool age is strongly associated with time spent video gaming and GD symptoms 5 years later. Our results strongly indicate that emotion dysregulation in preschool children is a risk factor for later problematic video game playing behavior. This strengthens the concept of ED in the etiology of media use and provides potential targets for early GD prevention.

Work addiction and personality: A meta-analytic study

BACKGROUND

During the past three decades, research interest in work addiction has increased significantly. Most definitions concerning work addiction have specifically contained personality-related elements. However, the results of empirical studies concerning personality and work addiction are both few and mixed. The aim of the present study was to explore the role of personality in the background of work addiction.

METHODS

The present study systematically reviewed and empirically carried out a meta-analysis on all the published studies examining the association between personality variables and work addiction (n = 28).

RESULTS

The results of the meta-analysis indicated that perfectionism, global and performance-based self-esteem, and negative affect had the strongest and most robust associations as personality risk factors of work addiction. Among the Big Five traits, extraversion, conscientiousness, and intellect/imaginations showed positive relationships with work addiction. However, these associations were weak.

CONCLUSIONS

Based on the meta-analysis, personality appears to explain only a small amount of the variance of work addiction and further studies are needed to assess the interaction between individual and environmental factors.

Prediction of attempted suicide in men and women with crack-cocaine use disorder in Brazil

Background

Suicide is a severe health problem, with high rates in individuals with addiction. Considering the lack of studies exploring suicide predictors in this population, we aimed to investigate factors associated with attempted suicide in inpatients diagnosed with cocaine use disorder using two analytical approaches.

Methods

This is a cross-sectional study using a secondary database with 247 men and 442 women hospitalized for cocaine use disorder. Clinical assessment included the Addiction Severity Index, the Childhood Trauma Questionnaire, and the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, totalling 58 variables. Descriptive Poisson regression and predictive Random Forest algorithm were used complementarily to estimate prevalence ratios and to build prediction models, respectively. All analyses were stratified by gender.

Results

The prevalence of attempted suicide was 34% for men and 50% for women. In both genders, depression (PR_M = 1.56, PR_W = 1.27) and hallucinations (PR_M = 1.80, PR_W = 1.39) were factors associated with attempted suicide. Other specific factors were found for men and women, such as childhood trauma, aggression, and drug use severity. The men's predictive model had prediction statistics of AUC = 0.68, Acc. = 0.66, Sens. = 0.82, Spec. = 0.50, PPV = 0.47 and NPV = 0.84. This model identified several variables as important predictors, mainly related to drug use severity. The women's model had higher predictive power (AUC = 0.73 and all other statistics were equal to 0.71) and was parsimonious.

Conclusions

Our findings indicate that attempted suicide is associated with depression, hallucinations and childhood trauma in both genders. Also, it suggests that severity of drug use may be a moderator between predictors and suicide among men, while psychiatric issues shown to be more important for women.

Smile judgment in substance use disorders and its relationship to interpersonal and emotional functioning: An eye-tracking investigation

The current study explored the judgments individuals with Substance Use Disorders (SUDs) make regarding the authenticity of enjoyment smiles and masking smiles containing traces of negative emotions. Accuracy at identifying the masked negative emotions were also examined. Eye-movements were recorded to observe relationships between attentional processes and smile judgment. Additionally, the relationships between smile judgment, emotion dysregulation, and interpersonal problems were investigated. Twenty individuals with SUDs and twenty individuals matched on gender/age participated in the smile judgment task. Results indicated that individuals with SUDs were no different in their categorization of smiles. However, the results showed that individuals with SUDs were significantly more likely to report the presence of negative emotions in the expressions. They were also more often incorrect in their identification of the masked emotions. No link was observed between smile judgment and attentional processes. Emotional and interpersonal functioning were related more to the ability to distinguish smile authenticity than the ability to identify masked emotions.

The link between bipolarity and substance use: A controlled clinic based study

OBJECTIVES

Because of high rates of co-occurrence, common familial risk, and phenotypic similarities, we conjectured that substance use and bipolar disorder might have a common substrate of origin in bipolarity and that they might lie on a continuum of bipolarity. Thus it was aimed to investigate the association between bipolarity and substance use through a controlled, clinic based study.

METHODS

Cross sectional assessment and comparison of bipolarity as trait in four groups, namely the substance use disorder (SUD), bipolar disorder (BPAD), dual diagnosis (DD), and the healthy control (HC) groups. Bipolar spectrum diagnostic scale (BSDS) was used. The quality of life in these four groups was also assessed using WHOQOL-Bref scale.

RESULTS

The mean Bipolar spectrum diagnostic scale (BSDS) score in SUD was 11.0 ± 5.3 which was more than that of HC (6.2 ± 3.9) and lesser than that in BPAD (18.4 ± 4.2) and DD (20.6 ± 3.6). Differences among all four groups were statistically significant. SUD group was found to have significantly higher score than healthy control. The BSDS score of DD and BPAD groups were higher than those of SUD but the difference between BPAD and DD was non-significant.

DISCUSSION

The results showed a potential association between substance dependence and bipolarity. Mood dysregulation appears to be the link between the two. The gradient of bipolarity detected by BSDS screener suggests a continuum model between substance use and bipolar disorder. However, this is a clinic based study and only male patients have been taken for study.

Accelerating the Pace of Science: Improving Parenting Practices in Parents with Opioid Use Disorder

A public health emergency exists in the United States as a result of rising overdose deaths related to Opioid Use Disorder (OUD). With the rise of OUD has also come an increase in the number of children exposed to parents who suffer from an OUD. There is a pressing need for parenting interventions for individuals with OUD to provide safe environments for the children being reared in the face of this epidemic. Research on parenting with an OUD is sparse, but it is impractical to move linearly from basic research to program development and implementation given the urgent need for intervention - a trajectory that prior research has established takes approximately 17 years. We have created an outline of strategies that can be used to accelerate the pace of science so that parenting practices are more immediately improved for this population. First, we summarize what is already known about OUD and parenting to characterize mechanisms that existing interventions have targeted and optimal settings for the wide dissemination of implementable interventions. Next, we identify existing interventions that either specifically target parents with OUD or mechanisms specific to parents with OUD. We describe four different approaches for accelerating the pace of science to improve the lives of parents with OUD and their children. By doing so, we hope to provide a roadmap for future researchers and practitioners to deliver more timely evidence-based interventions to address the additional burden placed on families and communities due to the rise in OUD in the United States.

The relationship between attention deficit hyperactivity disorder, bipolarity and mixed features in major depressive patients: Evidence from the BRIDGE-II-Mix Study

OBJECTIVE

This study primarily focused on the relationship between comorbid attention deficit-hyperactivity disorder (ADHD), mixed features and bipolarity in major depressive patients.

METHODS

The sample comprised 2777 patients with Major Depressive Episode (MDE) enrolled in a multicentre, multinational study originally designed to assess different definitions of mixed depression. Socio-demographic, familial and clinical characteristics were compared in patients with (ADHD + ) and without (ADHD-) comorbid ADHD.

RESULTS

Sixty-one patients (2.2%) met criteria for ADHD. ADHD was associated with a higher number of (hypo)manic symptoms during depression. Mixed depression was more represented in ADHD + patients than in ADHD- using both DSM-5 and experimental criteria. Differences were maintained after removing overlapping symptoms between (hypo)mania and ADHD. ADHD in MDE was also associated with a variety of clinical and course features such as onset before the age of 20, first-degree family history of (hypo)mania, past history of antidepressant-induced (hypo)manic switches, higher number of depressive and affective episodes, atypical depressive features, higher rates of bipolarity specifier, psychiatric comorbidities with eating, anxiety and borderline personality disorders.

LIMITATIONS

The study was primarily designed to address mixed features in ADHD, with slightly reduced sensitivity to the diagnosis of ADHD. Other possible diagnostic biases due to heterogeneity of participating clinicians.

CONCLUSIONS

In a sample of major depressive patients, the comorbid diagnosis of current ADHD is associated with bipolar diathesis, mixed features, multiple psychiatric comorbidity and a more unstable course. Further prospective studies are necessary to confirm the possible mediating role of temperamental mood instability and emotional dysregulation in such a complex clinical presentation.

The Effects of Trait Emotional Intelligence on Adolescent Substance Use: Findings From a Hungarian Representative Survey

Previous research has emphasized the importance of emotions in the development of adult and adolescent substance use. There is substantial evidence for deficits in emotional processing among teenagers with substance use, but few studies have investigated the association between emotional intelligence and adolescent substance use. The aim of the present study was to examine the relationship between the use of tobacco, alcohol, and illicit drugs and level of emotional intelligence among adolescents. A representative sample of high school students participated in the study (N = 2,380). Substance use patterns were assessed using data from the European School Survey Project on Alcohol and Other Drugs (ESPAD) Survey, and emotional intelligence was assessed with the Bar-On Emotional Quotient Inventory Youth Version. Self-esteem and depressive symptomatology were also assessed to compare their effects on the frequency of substance use with the effect of emotional intelligence. Results demonstrated that greater difficulty in stress management and empathy predicted a higher frequency of tobacco, alcohol, and cannabis use. However, the level of emotional intelligence showed only a weak relationship to substance use habits. Latent profile analyses supported the hypothesis that different emotional patterns and problems underlie different types of psychoactive substances. Using a multiple linear regression model, the present study found that although emotional intelligence is not a key factor underlying substance use habits, it has an individual effect on substance use beyond depressive tendencies and self-esteem. These results can be applied to both drug prevention programs and interventions in substance abuse treatment.

Neural correlates of impaired self-regulation in male youths with autism spectrum disorder: A voxel-based morphometry study

Although recent studies revealed impaired self-regulation (dysregulation) in autism spectrum disorder (ASD), neural correlates of dysregulation and its impacts on autistic neuroanatomy remain unclear. Voxel-based morphometry was applied on structural MRI images in 81 ASD and 61 typically developing (TD) boys aged 7-17years. Dysregulation was defined by the sum of T-scores of Attention, Aggression, and Anxiety/Depression subscales in the Child Behavior Checklist>180. There were 53 and 28 boys in the ASD+Dysregulation and ASD-Dysregulation groups, respectively. First, we compared regional gray matter (GM) volume for ASD and TD. Second, we investigated regional GM volumetric differences among the ASD+Dysregulation, ASD-Dysregulation and TD groups. Lastly, shared and distinct neurostructural correlates of dysregulation were investigated in the ASD and TD groups. The ASD-TD difference on neuroanatomy no longer existed after controlling the dysregulation severity. ASD+Dysregulation had larger regional GM volumes in the right fusiform gyrus, and smaller GM volumes in the anterior prefrontal cortex than ASD-Dysregulation and TD, respectively. ASD+Dysregulation had smaller GM volumes in the left lateral occipital/superior parietal cortex than TD boys. No GM difference was identified between ASD-Dysregulation and TD. ASD and TD had a shared association between GM volumes in the orbitofrontal cortex and dysregulation levels. Our findings suggest that atypical neuroanatomy associated with ASD might partially reflect a disproportionate level of impaired self-regulation. Categorical and dimensional considerations of dysregulation should be implemented in future ASD studies.

No differences in manic-like behaviors between voluntary ethanol and water drinking in Lateral Hypothalamic Kindled (LHK) alcohol preferring rats

This study investigates phenotypic differences of manic-like behaviors during voluntary ethanol (vs. water) intake in alcohol preferring (P) rats, using the lateral hypothalamus kindled (LHK) rat mania model. Alcohol preferring (P) rats exhibited classic manic-like behaviors during kindling and the post-kindling intervals in all coded behaviors (p < 0.0001), lending further validity to the lateral hypothalamus kindled rat as a useful model to study mania. However, there was no significant phenotypic difference between alcohol and water drinking alcohol preferring (P) rats.

Six months methylphenidate treatment improves emotion dysregulation in adolescents with attention deficit/hyperactivity disorder: a prospective study

PURPOSE

Individuals with attention deficit/hyperactivity disorder (ADHD) may suffer from emotional dysregulation (ED), although this symptom is not listed among the diagnostic criteria. Methylphenidate (MPH) is useful in reducing emotional symptoms in ADHD. The aim of the present study was to determine both psychosocial risk factors and presence of ED in adolescents with ADHD before and after MPH treatment.

PARTICIPANTS AND METHODS

Eighty-two patients aged 12-18 years with ADHD were included as participants. The Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children - Present and Lifetime, the Difficulties in Emotion Regulation Scale (DERS), sociodemographic form, and the Inventory of Statements About Self-Injury were administered. Results were compared before and after 6 months MPH treatment.

RESULTS

A significant improvement was detected on DERS for impulsivity (15.9±6.8 initial vs 14.2±6.5 final test, p<0.01) and total score (88.4±23.3 initial vs 82.4±2.7 final test, p<0.05) across all patients taking MPH regardless of subtype and sex. Despite treatment, a significant difference remained for impulsivity, strategies, and total score in patients with comorbid oppositional defiant disorder (ODD) compared with those without ODD, but no difference was detected for conduct disorder comorbidity. In patients who self-harm, scores for goals, impulsivity, strategies, clarity, and total score were higher before treatment: furthermore, impulsivity and total score remained high after treatment. In maltreated patients, goals, impulsivity, strategies, and total scores were significantly higher before treatment; however, their symptoms were ameliorated after treatment with MPH.

CONCLUSION

Individuals with severe ED may "self-medicate" by smoking and/or self-harming. MPH led to significant improvements in ED possibly owing, in part, to a decrease in impulsivity, so that individuals felt more able to supervise their emotions and engage in goal-directed behaviors. ED should be considered particularly in patients with additional psychosocial factors and ODD comorbidity, and included in the treatment plan.

Emotional Regulation in Young Adults with Internet Gaming Disorder

People diagnosed with Internet gaming disorder (IGD) have been frequently reported to experience depression, anxiety, and hostility. Emotional regulation contributes to these mood symptoms. This study evaluated emotional regulation in subjects with IGD and examined relationships between emotional regulation, depression, anxiety, and hostility in young adults with IGD. We recruited 87 people with IGD and a control group of 87 people without a history of IGD. All participants underwent a diagnostic interview based on the IGD criteria of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, and they completed a questionnaire on emotional regulation, depression, anxiety, and hostility. We found that subjects with IGD were less likely to practice cognitive reappraisal and were more likely to suppress their emotions. Linear regression revealed the higher cognitive reappraisal and lower expressive suppression associated with depression, anxiety, and hostility among subjects with IGD. The emotional regulation strategies that characterize those with IGD could be contributing factors to the depression and hostility tendencies of these people. When treating patients with IGD, in addition to providing appropriate interventions to relieve depression and hostility, practitioners should effectively assess emotional regulation strategies and provide emotional regulation therapy to prevent a vicious cycle of negative emotions.

The moderating role of regulatory emotional self-efficacy on smoking craving: An ecological momentary assessment study

Emotion is presumed as a major reason for smoking, but this hypothesis needs support from data with high ecological validity. Regulatory emotional self-efficacy (RESE) is key for emotion regulation, therefore RESE is likely to moderate the relationship between emotional states and smoking. The present study used the ecological momentary assessment (EMA) to record the levels of pleasure, arousal, and smoking craving in 33 male current smokers' daily lives, and examined the moderating effect of RESE in the prediction relationship between emotion and craving. The results showed that either end of the pleasure dimension, namely the high positive or high negative affect, predicted higher smoking craving. A similar pattern was also discovered in the arousal dimension, in which either of the activation and deactivation ends predicted higher smoking craving. Moreover, the prediction of negative affect on smoking craving was weakened by higher RESE, especially by the higher self-efficacy in managing negative emotions. In conclusion, smoking craving is closely related with immediate emotional states, and RESE reveals promising value in the reduction of smoking behavior. We discuss the possibility of expanding the RESE frame.

Suicidal Behavior in Juvenile Delinquents: The Role of ADHD and Other Comorbid Psychiatric Disorders

This study evaluated the role of psychiatric morbidity in relation to a history of suicidal behavior, with a particular focus on attention-deficit/hyperactivity disorder (ADHD). Suicidality and psychiatric diagnoses were assessed in 370 incarcerated male juvenile delinquents from Northern Russia using the semi-structured K-SADS-PL psychiatric interview. A lifetime history of suicidal ideation only (24.7 %) and suicidal ideation with suicide attempts (15.7 %) was common. Binary logistic regression analysis was used to assess the role of ADHD and other psychiatric disorders in suicidal ideation and suicide attempts. A history of suicidal ideation and of suicide attempts were associated with higher rates of psychiatric morbidity and with the number of comorbid psychiatric disorders. An ADHD diagnosis was associated with an increased risk for both suicidal ideation and for suicide attempts. The comorbidity of ADHD with drug dependence further increased the risk for suicidal ideation, while ADHD and alcohol dependence comorbidity increased the risk for suicide attempts. Our findings highlight the importance of adequately detecting and treating psychiatric disorders in vulnerable youths, especially when they are comorbid with ADHD.

Normative development of the Child Behavior Checklist Dysregulation Profile from early childhood to adolescence: Associations with personality pathology

The Dysregulation Profile (DP) is a broad indicator of concurrent affective, behavioral, and cognitive dysregulation, often measured with the anxious/depressed, aggressive behavior, and attention problems syndrome scales of the Child Behavior Checklist. Despite an expanding body of research on the DP, knowledge of the normative developmental course of the DP from early childhood to adolescence is lacking. Furthermore, although we know that the DP longitudinally predicts personality pathology, no research yet has examined whether next to the DP in early childhood, the rate of change of the DP across development predicts personality pathology. Therefore, using cohort-sequential latent growth modeling in a population-based sample (N = 668), we examined the normative developmental course of mother-reported DP from ages 4 to 17 years and its associations with a wide range of adolescent-reported personality pathology dimensions 3 years later. The results showed that the DP follows a nonlinear developmental course with a peak in early adolescence. The initial level of the DP at age 4 and, to a lesser extent, the rate of change in the DP predicted a range of personality pathology dimensions in late adolescence. The findings suggest that the DP is a broad developmental precursor of personality pathology in late adolescence.

Alcohol use disorders are associated with increased affective lability in bipolar disorder

BACKGROUND

Affective dysregulation is a core feature of bipolar disorder (BD), and inter-episodic affect lability is associated with more severe outcomes including comorbidity. Rates of daily tobacco smoking and substance use disorders in BD are high. Knowledge regarding relationships between affective lability and abuse of the most commonly used substances such as tobacco, alcohol and cannabis in BD is limited.

METHODS

We investigated whether dimensions of inter-episodic affective lability as measured with the Affective Lability Scale - short form (ALS-SF) were associated with lifetime daily tobacco use or alcohol (AUD) or cannabis use disorders (CUD) in a sample of 372 French and Norwegian patients with BD I and II.

RESULTS

ALS-SF total score and all sub-dimensions (anxiety-depression, depression-elation and anger) were significantly associated with AUD, while only the depression-elation sub-dimension was associated with CUD, after controlling for possible confounders such as gender, age at interview, age at illness onset, BD subtype, duration of illness and other substance use disorders. Daily tobacco smoking was not significantly associated with affective lability.

LIMITATIONS

Data for recent substance use or psychiatric comorbidities such as personality or hyperkinetic disorders were not available, and could have mediated the relationships.

CONCLUSION

AUD is associated with several dimensions of inter-episodic affective lability in BD, while CUD is associated with increased oscillations between depression and elation only. Increased affective lability may partly explain the increased illness severity of patients with BD and AUD or CUD. Affective lability should be treated in order to prevent these comorbidities.

Further Evidence for Smoking and Substance Use Disorders in Youth With Bipolar Disorder and Comorbid Conduct Disorder

OBJECTIVE

Bipolar disorder (BPD) is a highly morbid disorder increasingly recognized in adolescents. The aim of this study was to examine the relative risk for substance use disorders (SUDs; alcohol or drug abuse or dependence) and cigarette smoking in adolescents with BPD.

METHODS

We evaluated the relative risk for SUDs and cigarette smoking in a case-controlled, 5-year prospective follow-up of adolescents with (n = 105, mean ± SD baseline age = 13.6 ± 2.5 years) and without ("controls"; n = 98, baseline age = 13.7 ± 2.1 years) BPD. Seventy-three percent of subjects were retained at follow-up (BPD: n = 68; controls: n = 81; 73% reascertainment). Our main outcomes were assessed by blinded structured interviews for DSM-IV criteria.

RESULTS

Maturing adolescents with BPD, compared to controls, were more likely to endorse higher rates of SUD (49% vs 26%; hazard ratio [HR] = 2.0; 95% confidence interval (CI), 1.1-3.6; P = .02) and cigarette smoking (49% vs 17%; HR = 2.9; 95% CI, 1.4-6.1; P = .004), as well as earlier onset of SUD (14.9 ± 2.6 [SD] years vs 16.5 ± 1.6 [SD] years; t = 2.6; P = .01). Subjects with conduct disorder (CD) were more likely to have SUD and nicotine dependence than subjects with BPD alone or controls (all P values < .05). When we added conduct disorder to the model with socioeconomic status and parental SUD, all associations lost significance (all P values > .05). Subjects with the persistence of a BPD diagnosis were also more likely to endorse cigarette smoking and SUD in comparison to those who lost a BPD diagnosis or controls at follow-up.

CONCLUSIONS

The results provide further evidence that adolescents with BPD, particularly those with comorbid CD, are significantly more likely to endorse cigarette smoking and SUDs when compared to their non-mood disordered peers. These findings indicate that youth with BPD should be carefully monitored for comorbid CD and the development of cigarette smoking and SUDs.

Adolescent's respiratory sinus arrhythmia is associated with smoking rate five years later

INTRODUCTION

Vulnerability factors like respiratory sinus arrhythmia (RSA) may help identify adolescents at risk for nicotine dependence. We examined if resting RSA and the acute effects of smoking on RSA was associated with cigarette smoking five years later among adolescents at high risk for smoking escalation and nicotine dependence.

METHODS

Sixty-nine adolescents participated in a baseline laboratory session- RSA was collected before and after smoking a single cigarette ad libitum. Participants were then followed for five years.

RESULTS

Lower pre-smoke resting RSA was related to higher past month smoking rate five years later, even after controlling for baseline smoking rate and other relevant covariates including gender, race/ethnicity, age of initiated use, and frequency of exercise at baseline (p=0.018). Exploratory analyses suggested resting RSA is an independent predictor of increased cigarette rate beyond other baseline predictors.

CONCLUSIONS

Low resting RSA may be a vulnerability factor, helping to identify adolescents at risk for cigarette escalation.

Adolescent Substance Use and Comorbid Psychopathology: Emotion Regulation Deficits as a Transdiagnostic Risk Factor

Rates of substance use and comorbid psychopathology peak during adolescence, highlighting the need to identify transdiagnostic risk processes that cut across conditions and elucidate early embedded risk factors for comorbidity across development. The current review highlights emotion regulation deficits as a core transdiagnostic risk factor underlying the development of substance use, addiction, and comorbid psychopathology in adolescence. We present the dual systems model of neurological development to highlight adolescence as a critical period of increased risk for emotion regulation difficulties, corresponding risk behaviors, and psychopathology. We describe malfunction in the neurobiological regulation system underlying the relationship between emotion regulation and risk for addiction and comorbidity. We pull from two established developmental theories including both the externalizing pathway and the internalizing pathway to substance use disorders, which together highlight how early embedded risk in the form of emotion regulation deficits can explain mechanisms underlying the development of addiction and comorbid psychiatric disorders.

Adolescent Substance Use & Psychopathology: Interactive Effects of Cortisol Reactivity and Emotion Regulation

How are emotional processes associated with the increased rates of substance use and psychological disorders commonly observed during adolescence? An index of emotion-related physiological arousal-cortisol reactivity-and subjective emotion regulation have both been independently linked to substance use and psychological difficulties among youth. The current study (N = 134 adolescents) sought to elucidate the interactive effects of cortisol reactivity following a stressful parent-child interaction task and self-reported emotion regulation ability on adolescents' substance use and externalizing and internalizing behavior problems. Results revealed that adolescents with low levels of cortisol reactivity and high emotion regulation difficulties were more likely to use substances, and also had the highest parent-reported symptoms of oppositional defiant disorder. With respect to internalizing symptoms, high emotion-related physiological reactivity coupled with high emotion regulation difficulties were associated with higher self-reported major depression symptoms among youth. Findings reveal that different profiles of HPA axis arousal and emotion regulation are associated with substance use and symptoms of psychopathology among adolescents.

Does adolescent's exposure to parental intimate partner conflict and violence predict psychological distress and substance use in young adulthood? A longitudinal study

Little is known about the extent to which parental conflict and violence differentially impact on offspring mental health and substance use. Using data from a longitudinal birth cohort study this paper examines: whether offspring exposure to parental intimate partner violence (involving physical violence which may include conflicts and/or disagreements) or parental intimate partner conflict (conflicting interactions and disagreements only) are associated with offspring depression, anxiety and substance use in early adulthood (at age 21); and whether these associations are independent of maternal background, depression and anxiety and substance use. Data (n=2,126 women and children) were taken from a large-scale Australian birth-cohort study, the Mater University of Queensland Study of Pregnancy (MUSP). IPC and IPV were measured at the 14-year follow-up. Offspring mental health outcomes--depression, anxiety and substance use--were assessed at the 21-year follow-up using the Composite International Diagnostic Interview (CIDI). Offspring of women experiencing IPV at the 14-year follow-up were more likely to manifest anxiety, nicotine, alcohol and cannabis disorders by the 21-year follow-up. These associations remained after adjustment for maternal anxiety, depression, and other potential confounders. Unlike males who experience anxiety disorders after exposure to IPV, females experience depressive and alcohol use disorders. IPV predicts offspring increased levels of substance abuse and dependence in young adulthood. Gender differences suggest differential impact.