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Cervin M, McGuire JF, D'Souza JM, De Nadai AS, Aspvall K, Goodman WK, Andrén P, Schneider SC, Geller DA, Mataix-Cols D, Storch EA. Efficacy and acceptability of cognitive-behavioral therapy and serotonin reuptake inhibitors for pediatric obsessive-compulsive disorder: a network meta-analysis. J Child Psychol Psychiatry 2024; 65:594-609. [PMID: 38171647 DOI: 10.1111/jcpp.13934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/08/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND Cognitive-behavioral therapy (CBT) and serotonin reuptake inhibitors (SRIs) are recommended treatments for pediatric obsessive-compulsive disorder (OCD), but their relative efficacy and acceptability have not been comprehensively examined. Further, it remains unclear whether the efficacy of in-person CBT is conserved when delivered in other formats, such as over telephone/webcam or as Internet-delivered CBT (ICBT). METHODS PubMed, PsycINFO, trial registries, and previous systematic reviews were searched for randomized controlled trials (RCTs) comparing CBT (in-person, webcam/telephone-delivered, or ICBT) or SRIs with control conditions or each other. Network meta-analyses were conducted to examine efficacy (post-treatment Children's Yale-Brown Obsessive Compulsive Scale) and acceptability (treatment discontinuation). Confidence in effect estimates was evaluated with CINeMA (Confidence in Network Meta-Analysis). RESULTS Thirty eligible RCTs and 35 contrasts comprising 2,057 youth with OCD were identified. In-person CBT was significantly more efficacious than ICBT, waitlist, relaxation training, and pill placebo (MD range: 3.95-11.10; CINeMA estimate of confidence: moderate) but did not differ significantly from CBT delivered via webcam/telephone (MD: 0.85 [-2.51, 4.21]; moderate), SRIs (MD: 3.07 [-0.07, 6.20]; low), or the combination of in-person CBT and SRIs (MD: -1.20 [-5.29, 2.91]; low). SRIs were significantly more efficacious than pill placebo (MD: 4.59 [2.70, 6.48]; low) and waitlist (MD: 8.03 [4.24, 11.82]; moderate). No significant differences for acceptability emerged, but confidence in estimates was low. CONCLUSIONS In-person CBT and SRIs produce clear benefits compared to waitlist and pill placebo and should be integral parts of the clinical management of pediatric OCD, with in-person CBT overall having a stronger evidence base. The combination of in-person CBT and SRIs may be most efficacious, but few studies hinder firm conclusions. The efficacy of CBT appears conserved when delivered via webcam/telephone, while more trials evaluating ICBT are needed.
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Affiliation(s)
| | | | | | | | - Kristina Aspvall
- Karolinska Institutet and Stockholm Health Care Services, Stockholm, Sweden
| | | | - Per Andrén
- Lund University, Lund, Sweden
- Karolinska Institutet and Stockholm Health Care Services, Stockholm, Sweden
| | | | | | - David Mataix-Cols
- Lund University, Lund, Sweden
- Karolinska Institutet and Stockholm Health Care Services, Stockholm, Sweden
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2
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Hicks MM, Mouton-Odum S, Patyk KC, Zamora RJ, De Nadai AS. Latent class analysis of emotions experienced during compulsive hair-pulling episodes. J Behav Ther Exp Psychiatry 2023; 81:101882. [PMID: 37331096 DOI: 10.1016/j.jbtep.2023.101882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 04/11/2023] [Accepted: 05/23/2023] [Indexed: 06/20/2023]
Abstract
BACKGROUND AND OBJECTIVES Reasons for compulsive hair pulling are heterogeneous and not fully understood. Given that many people who experience compulsive hair pulling do not respond to treatment, identifying subgroups can inform potential mechanisms and treatment design. METHODS We sought to identify empirical subgroups among participants in an online treatment program for trichotillomania (N = 1728). A latent class analysis was used to identify patterns of emotions associated with compulsive hair-pulling episodes. RESULTS Six classes of participants were found which reflected three predominant themes. One theme reflected expected patterns, where emotional changes were seen following pulling. Two other themes were more surprising, where one reflected high overall emotional activation that did not show consistent change in response to pulling, and another showed low emotional activation overall. These results suggest that there are multiple types of hair-pulling and a sizeable group of people may benefit from treatment adjustments. LIMITATIONS Participants did not receive semi-structured diagnostic assessment. A majority of participants were Caucasian, and future research would benefit from increased participant diversity. Emotions associated with compulsive hair-pulling were measured across an entire treatment program, but the relationship between specific intervention components and change in specific emotions was not systematically collected. CONCLUSIONS While previous research has addressed overall phenomenology and comorbidity, the present study is the first to identify empirical subgroups of people who experience compulsive hair-pulling at the level of individual pulling episodes. Identified participant classes had distinguishing features that can aid in personalizing treatment to individual symptom presentations.
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Affiliation(s)
- Macy M Hicks
- Psychology Department, Texas State University, San Marcos, TX, USA.
| | - Suzanne Mouton-Odum
- Psychiatry and Behavioral Sciences, Baylor College of Medicine; Psychology Houston, PC, Director, Houston, TX, USA
| | | | - Ryan J Zamora
- McLean Hospital, Harvard Medical School, Belmont, MA, USA
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3
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Gunzler DD, De Nadai AS, Miller D, Ontaneda D, Briggs FB. Long-term trajectories of ambulatory impairment in multiple sclerosis. Mult Scler 2023; 29:1282-1295. [PMID: 37503861 PMCID: PMC10528275 DOI: 10.1177/13524585231187521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
BACKGROUND Ambulatory impairment is a common and complex manifestation of multiple sclerosis (MS), and longitudinal patterns are not well understood. OBJECTIVE To characterize longitudinal walking speed trajectories in a general MS patient population and in those with early disease (⩽ 5 years from onset), identify subgroups with similar patterns, and examine associations with individual attributes. METHODS Using a retrospective cohort study design, latent class growth analysis was applied to longitudinal timed 25-foot walk (T25-FW) data from 7683 MS patients, to determine T25-FW trajectories. Associations were evaluated between trajectory assignment and individual attributes. Analyses were repeated for 2591 patients with early disease. RESULTS In the general patient population, six trajectories were discerned, ranging from very minimal to very high impairment at baseline, with variability in impairment accrual. The clusters with moderate to very high walking impairment were associated with being female, older and Black American, longer symptom duration, progressive course, and depressive symptoms. In the early disease subset, eight trajectories were discerned that included two subgroups that rapidly accrued impairment. CONCLUSION We identified novel subgroups of MS patients will distinct long-term T25-FW trajectories. These results underscore that socially disadvantaged and economically marginalized MS patients are the most vulnerable for severe ambulatory impairment.
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Affiliation(s)
- Douglas D. Gunzler
- Department of Population and Quantitative Health Sciences,
Case Western Reserve University School of Medicine, Cleveland, OH, USA
- Center for Health Care Research and Policy, School of
Medicine, Case Western Reserve University, Cleveland, OH, USA
| | | | - Deborah Miller
- The Mellen Center for Multiple Sclerosis and Research,
Department of Neurology, Neurological Institute, Cleveland Clinic Foundation,
Cleveland, OH, USA
- Cleveland Clinic Lerner College of Medicine of Case
Western Reserve University, Cleveland, OH, USA
| | - Daniel Ontaneda
- The Mellen Center for Multiple Sclerosis and Research,
Department of Neurology, Neurological Institute, Cleveland Clinic Foundation,
Cleveland, OH, USA
- Cleveland Clinic Lerner College of Medicine of Case
Western Reserve University, Cleveland, OH, USA
| | - Farren B.S. Briggs
- Department of Population and Quantitative Health Sciences,
Case Western Reserve University School of Medicine, Cleveland, OH, USA
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Gutierrez CI, Arteaga K, Schepis TS, De Nadai AS. Posttraumatic stress disorder in diverse populations: Testing for assessment bias in a nationally representative sample. Psychol Trauma 2023:2023-70686-001. [PMID: 37166918 DOI: 10.1037/tra0001492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
OBJECTIVE A growing body of research has emerged to characterize differences in posttraumatic stress disorder (PTSD) symptom presentations in individuals from diverse racial and ethnic groups. However, less research has examined if these observed differences can be attributed to bias within PTSD assessments. Knowledge about potential bias in PTSD assessment is essential for interpreting group differences. If PTSD assessments do not perform similarly across diverse demographic groups, then observed differences may be artificial products of inaccurate measurement, new assessments could be required for individuals from different demographic groups, and we would be unable to accurately detect PTSD treatment effects in patients from diverse groups. METHOD We evaluated PTSD assessment bias through tests of measurement invariance for the semistructured, clinician-administered AUDADIS-5 diagnostic assessment of participants in the National Epidemiologic Survey on Alcohol and Related Conditions-III. Participants included those who reported having experienced at least one potentially traumatic event in their lifetime (N = 23,936). Measurement invariance was assessed for participants who identified from several demographic groups (Asian, Native Hawaiian, or Pacific Islander; Hispanic; American Indian/Alaskan Native; and Black) compared to participants who identified as White (non-Hispanic). RESULTS Overall, PTSD assessment was largely invariant across groups, while small amounts of measurement invariance were detected that can inform future research and clinical adaptations. CONCLUSIONS This work validates prior research that relies on a common conceptualization of PTSD, and it provides several paths for future improvement in research and clinical practice. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Carolina I Gutierrez
- Department of Psychiatry & Behavioral Sciences, University of Texas Health Science Center at San Antonio
| | | | - Ty S Schepis
- Department of Psychology, Texas State University
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5
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De Nadai AS, Fitzgerald KD, Norman LJ, Russman Block SR, Mannella KA, Himle JA, Taylor SF. Defining brain-based OCD patient profiles using task-based fMRI and unsupervised machine learning. Neuropsychopharmacology 2023; 48:402-409. [PMID: 35681047 PMCID: PMC9751092 DOI: 10.1038/s41386-022-01353-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 05/16/2022] [Accepted: 05/23/2022] [Indexed: 12/26/2022]
Abstract
While much research has highlighted phenotypic heterogeneity in obsessive compulsive disorder (OCD), less work has focused on heterogeneity in neural activity. Conventional neuroimaging approaches rely on group averages that assume homogenous patient populations. If subgroups are present, these approaches can increase variability and can lead to discrepancies in the literature. They can also obscure differences between various subgroups. To address this issue, we used unsupervised machine learning to identify subgroup clusters of patients with OCD who were assessed by task-based fMRI. We predominantly focused on activation of cognitive control and performance monitoring neurocircuits, including three large-scale brain networks that have been implicated in OCD (the frontoparietal network, cingulo-opercular network, and default mode network). Participants were patients with OCD (n = 128) that included both adults (ages 24-45) and adolescents (ages 12-17), as well as unaffected controls (n = 64). Neural assessments included tests of cognitive interference and error processing. We found three patient clusters, reflecting a "normative" cluster that shared a brain activation pattern with unaffected controls (65.9% of clinical participants), as well as an "interference hyperactivity" cluster (15.2% of clinical participants) and an "error hyperactivity" cluster (18.9% of clinical participants). We also related these clusters to demographic and clinical correlates. After post-hoc correction for false discovery rates, the interference hyperactivity cluster showed significantly longer reaction times than the other patient clusters, but no other between-cluster differences in covariates were detected. These findings increase precision in patient characterization, reframe prior neurobehavioral research in OCD, and provide a starting point for neuroimaging-guided treatment selection.
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Affiliation(s)
| | - Kate D Fitzgerald
- Department of Psychiatry, Columbia University, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
| | - Luke J Norman
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | | | | | - Joseph A Himle
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
- School of Social Work, University of Michigan, Ann Arbor, MI, USA
| | - Stephan F Taylor
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
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6
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De Nadai AS, Quast T, Little TB, Westerberg K, Patyk KC, Monahan MF, Storch EA, Gregory ST. Intervention cost-effectiveness for pediatric anxiety and OCD: A systematic review and integrated database model. J Affect Disord 2022; 298:110-118. [PMID: 34728286 DOI: 10.1016/j.jad.2021.10.127] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 09/30/2021] [Accepted: 10/20/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND While multiple treatments for pediatric anxiety and obsessive compulsive disorder (OCD) are efficacious, little is known about their cost-effectiveness. In response, we sought to provide relevant information through systematic review and cost-effectiveness simulation. METHODS We evaluated the cost-effectiveness of treatment for pediatric anxiety and OCD in two ways. First, we conducted a systematic review following PRISMA guidelines. Second, we evaluated cost-effectiveness for antidepressant medication, cognitive behavioral therapy, and their combination via a simulation that integrated information from the Truven MarketScan database and the NIMH National Database for Clinical Trials Related to Mental Illness. RESULTS Both systematic review and simulation found antidepressant medication and cognitive behavioral therapy to be cost-effective for pediatric anxiety and OCD. Antidepressant medication was the least costly approach, and cognitive behavioral therapy provided additional cost-effectiveness, especially for OCD. LIMITATIONS During systematic review, relatively few articles provided information about both costs and effectiveness. While there was a notable margin of error to support multiple interventions as cost-effective, limited prior research decreased precision of point estimates and comparisons between interventions. CONCLUSIONS Both antidepressant medication and cognitive behavioral therapy were found to be cost-effective for pediatric anxiety and OCD. Results supported investment from third party payers, who serve as critical gatekeepers that can increase treatment dissemination. However, more precise information would better inform the exact amount of investment needed, especially with regard to selection decisions between active interventions. Cost-effectiveness research would benefit from systematic collection of data on treatment costs and quality of life in future clinical trials.
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Affiliation(s)
| | - Troy Quast
- University of South Florida, 13201 Bruce B. Downs Blvd., Tampa, FL 33620, USA
| | - Tara B Little
- Texas State University, 601 University Drive, UAC 253L, San Marcos, TX 78666, USA
| | - Kaitlyn Westerberg
- Texas State University, 601 University Drive, UAC 253L, San Marcos, TX 78666, USA
| | - Kevin C Patyk
- Texas State University, 601 University Drive, UAC 253L, San Marcos, TX 78666, USA
| | - Maureen F Monahan
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, 1051 Riverside Drive, New York, NY 10032, USA; New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, USA
| | - Eric A Storch
- Baylor College of Medicine, 1977 Butler Blvd, Houston, TX 77030, USA
| | - Sean T Gregory
- Baylor College of Medicine, 1977 Butler Blvd, Houston, TX 77030, USA; Magellan Health, 6303 Cowboys Way, Frisco, TX 75034, USA
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7
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Affiliation(s)
| | - Yueqin Hu
- Department of Psychology, Beijing Normal University, Beijing, China
| | - Wesley K Thompson
- Population Neuroscience and Genetics Lab, University of California, San Diego, La Jolla
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8
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Stern ER, Eng GK, De Nadai AS, Iosifescu DV, Tobe RH, Collins KA. Imbalance between default mode and sensorimotor connectivity is associated with perseverative thinking in obsessive-compulsive disorder. Transl Psychiatry 2022; 12:19. [PMID: 35022398 PMCID: PMC8755709 DOI: 10.1038/s41398-022-01780-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 12/07/2021] [Accepted: 12/20/2021] [Indexed: 11/09/2022] Open
Abstract
Obsessive-compulsive disorder (OCD) is highly heterogeneous. Although perseverative negative thinking (PT) is a feature of OCD, little is known about its neural mechanisms or relationship to clinical heterogeneity in the disorder. In a sample of 85 OCD patients, we investigated the relationships between self-reported PT, clinical symptom subtypes, and resting-state functional connectivity measures of local and global connectivity. Results indicated that PT scores were highly variable within the OCD sample, with greater PT relating to higher severity of the "unacceptable thoughts" symptom dimension. PT was positively related to local connectivity in subgenual anterior cingulate cortex (ACC), pregenual ACC, and the temporal poles-areas that are part of, or closely linked to, the default mode network (DMN)-and negatively related to local connectivity in sensorimotor cortex. While the majority of patients showed higher local connectivity strengths in sensorimotor compared to DMN regions, OCD patients with higher PT scores had less of an imbalance between sensorimotor and DMN connectivity than those with lower PT scores, with healthy controls exhibiting an intermediate pattern. Clinically, this imbalance was related to both the "unacceptable thoughts" and "symmetry/not-just-right-experiences" symptom dimensions, but in opposite directions. These effects remained significant after accounting for variance related to psychiatric comorbidity and medication use in the OCD sample, and no significant relationships were found between PT and global connectivity. These data indicate that PT is related to symptom and neural variability in OCD. Future work may wish to target this circuity when developing personalized interventions for patients with these symptoms.
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Affiliation(s)
- Emily R. Stern
- grid.240324.30000 0001 2109 4251Department of Psychiatry, New York University Grossman School of Medicine, New York, NY USA ,grid.250263.00000 0001 2189 4777Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY USA
| | - Goi Khia Eng
- grid.240324.30000 0001 2109 4251Department of Psychiatry, New York University Grossman School of Medicine, New York, NY USA ,grid.250263.00000 0001 2189 4777Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY USA
| | - Alessandro S. De Nadai
- grid.264772.20000 0001 0682 245XDepartment of Psychology, Texas State University, San Marcos, TX USA
| | - Dan V. Iosifescu
- grid.240324.30000 0001 2109 4251Department of Psychiatry, New York University Grossman School of Medicine, New York, NY USA ,grid.250263.00000 0001 2189 4777Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY USA
| | - Russell H. Tobe
- grid.250263.00000 0001 2189 4777Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY USA
| | - Katherine A. Collins
- grid.250263.00000 0001 2189 4777Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY USA
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9
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van den Heuvel OA, Boedhoe PS, Bertolin S, Bruin WB, Francks C, Ivanov I, Jahanshad N, Kong X, Kwon JS, O'Neill J, Paus T, Patel Y, Piras F, Schmaal L, Soriano‐Mas C, Spalletta G, van Wingen GA, Yun J, Vriend C, Simpson HB, van Rooij D, Hoexter MQ, Hoogman M, Buitelaar JK, Arnold P, Beucke JC, Benedetti F, Bollettini I, Bose A, Brennan BP, De Nadai AS, Fitzgerald K, Gruner P, Grünblatt E, Hirano Y, Huyser C, James A, Koch K, Kvale G, Lazaro L, Lochner C, Marsh R, Mataix‐Cols D, Morgado P, Nakamae T, Nakao T, Narayanaswamy JC, Nurmi E, Pittenger C, Reddy YJ, Sato JR, Soreni N, Stewart SE, Taylor SF, Tolin D, Thomopoulos SI, Veltman DJ, Venkatasubramanian G, Walitza S, Wang Z, Thompson PM, Stein DJ. An overview of the first 5 years of the ENIGMA obsessive-compulsive disorder working group: The power of worldwide collaboration. Hum Brain Mapp 2022; 43:23-36. [PMID: 32154629 PMCID: PMC8675414 DOI: 10.1002/hbm.24972] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Revised: 02/12/2020] [Accepted: 02/16/2020] [Indexed: 01/12/2023] Open
Abstract
Neuroimaging has played an important part in advancing our understanding of the neurobiology of obsessive-compulsive disorder (OCD). At the same time, neuroimaging studies of OCD have had notable limitations, including reliance on relatively small samples. International collaborative efforts to increase statistical power by combining samples from across sites have been bolstered by the ENIGMA consortium; this provides specific technical expertise for conducting multi-site analyses, as well as access to a collaborative community of neuroimaging scientists. In this article, we outline the background to, development of, and initial findings from ENIGMA's OCD working group, which currently consists of 47 samples from 34 institutes in 15 countries on 5 continents, with a total sample of 2,323 OCD patients and 2,325 healthy controls. Initial work has focused on studies of cortical thickness and subcortical volumes, structural connectivity, and brain lateralization in children, adolescents and adults with OCD, also including the study on the commonalities and distinctions across different neurodevelopment disorders. Additional work is ongoing, employing machine learning techniques. Findings to date have contributed to the development of neurobiological models of OCD, have provided an important model of global scientific collaboration, and have had a number of clinical implications. Importantly, our work has shed new light on questions about whether structural and functional alterations found in OCD reflect neurodevelopmental changes, effects of the disease process, or medication impacts. We conclude with a summary of ongoing work by ENIGMA-OCD, and a consideration of future directions for neuroimaging research on OCD within and beyond ENIGMA.
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Affiliation(s)
- Odile A. van den Heuvel
- Department of Psychiatry, Department of Anatomy & Neurosciences, Amsterdam NeuroscienceAmsterdam UMC, Vrije Universiteit AmsterdamAmsterdamThe Netherlands
- Bergen Center for Brain PlasticityHaukeland University HospitalBergenNorway
| | - Premika S.W. Boedhoe
- Department of Psychiatry, Department of Anatomy & Neurosciences, Amsterdam NeuroscienceAmsterdam UMC, Vrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Sara Bertolin
- Department of PsychiatryBellvitge University Hospital, Bellvitge Biomedical Research Institute‐IDIBELLBarcelonaSpain
| | - Willem B. Bruin
- Department of Psychiatry, Amsterdam NeuroscienceAmsterdam UMC, University of AmsterdamAmsterdamThe Netherlands
| | - Clyde Francks
- Department of Language & GeneticsMax Planck Institute for PsycholinguisticsNijmegenThe Netherlands
- Donders Institute for Brain, Cognition and BehaviourRadboud UniversityNijmegenThe Netherlands
| | - Iliyan Ivanov
- Icahn School of Medicine at Mount SinaiNew YorkNew York
| | - Neda Jahanshad
- Keck USC School of MedicineImaging Genetics Center, Mark & Mary Stevens Institute for Neuroimaging & InformaticsMarina del ReyCalifornia
| | - Xiang‐Zhen Kong
- Department of Language & GeneticsMax Planck Institute for PsycholinguisticsNijmegenThe Netherlands
| | - Jun Soo Kwon
- Department of PsychiatrySeoul National University College of MedicineSeoulSouth Korea
- Department of Brain & Cognitive SciencesSeoul National University College of Natural SciencesSeoulSouth Korea
| | - Joseph O'Neill
- Division of Child & Adolescent PsychiatryUCLA Jane & Terry Semel Institute For NeuroscienceLos AngelesCalifornia
| | - Tomas Paus
- Holland Bloorview Kids Rehabilitation HospitalBloorview Research InstituteTorontoOntarioCanada
| | - Yash Patel
- Holland Bloorview Kids Rehabilitation HospitalBloorview Research InstituteTorontoOntarioCanada
| | - Fabrizio Piras
- Laboratory of NeuropsychiatryIRCCS Santa Lucia FoundationRomeItaly
| | - Lianne Schmaal
- Orygen, The National Centre of Excellence in Youth Mental HealthParkvilleAustralia
- Centre for Youth Mental Health, The University of MelbourneMelbourneAustralia
| | - Carles Soriano‐Mas
- Department of PsychiatryBellvitge University Hospital, Bellvitge Biomedical Research Institute‐IDIBELLBarcelonaSpain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM)BarcelonaSpain
- Department of Psychobiology and Methodology in Health SciencesUniversitat Autònoma de BarcelonaBarcelonaSpain
| | - Gianfranco Spalletta
- Laboratory of NeuropsychiatryIRCCS Santa Lucia FoundationRomeItaly
- Division of Neuropsychiatry, Menninger Department of Psychiatry and Behavioral SciencesBaylor College of MedicineHoustonTexsas
| | - Guido A. van Wingen
- Department of Psychiatry, Amsterdam NeuroscienceAmsterdam UMC, University of AmsterdamAmsterdamThe Netherlands
| | - Je‐Yeon Yun
- Seoul National University HospitalSeoulRepublic of Korea
- Yeongeon Student Support Center, Seoul National University College of MedicineSeoulRepublic of Korea
| | - Chris Vriend
- Department of Psychiatry, Department of Anatomy & Neurosciences, Amsterdam NeuroscienceAmsterdam UMC, Vrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - H. Blair Simpson
- Center for OC and Related Disorders at the New York State Psychiatric Institute and Columbia University Irving Medical CenterNew YorkNew York
| | - Daan van Rooij
- Donders Institute for Brain, Cognition and BehaviourRadboud UniversityNijmegenThe Netherlands
| | - Marcelo Q. Hoexter
- Departamento e Instituto de Psiquiatria do Hospital das Clinicas, IPQ HCFMUSP, Faculdade de MedicinaUniversidade de São PauloSão PauloBrazil
| | - Martine Hoogman
- Donders Institute for Brain, Cognition and BehaviourRadboud UniversityNijmegenThe Netherlands
- Department of Human GeneticsRadboud University Medical CenterNijmegenThe Netherlands
| | - Jan K. Buitelaar
- Donders Institute for Brain, Cognition and BehaviourRadboud UniversityNijmegenThe Netherlands
| | - Paul Arnold
- Mathison Centre for Mental Health Research & Education and Department of PsychiatryCumming School of Medicine, University of CalgaryCalgaryAlbertaCanada
| | - Jan C. Beucke
- Humboldt‐Universität zu BerlinDepartment of PsychologyBerlinGermany
- Karolinska InstitutetDepartment of Clinical NeuroscienceStockholmSweden
| | - Francesco Benedetti
- Department of Psychiatry and Clinical PsychobiologyScientific Institute OspedaleMilanItaly
| | - Irene Bollettini
- Department of Psychiatry and Clinical PsychobiologyScientific Institute OspedaleMilanItaly
| | - Anushree Bose
- Obsessive‐Compulsive Disorder (OCD) Clinic Department of PsychiatryNational Institute of Mental Health and NeurosciencesBangaloreIndia
| | | | | | - Kate Fitzgerald
- Department of PsychiatryUniversity of Michigan Medical SchoolAnn ArborMichigan
| | | | - Edna Grünblatt
- Department of Child and Adolescent Psychiatry and PsychotherapyUniversity Hospital of Psychiatry, University of ZurichZurichSwitzerland
- Neuroscience Center ZurichUniversity of Zurich and ETH ZurichZurichSwitzerland
- Zurich Center for Integrative Human PhysiologyUniversity of ZurichZurichSwitzerland
| | - Yoshiyuki Hirano
- Research Center for Child Mental DevelopmentChiba UniversityChibaJapan
| | - Chaim Huyser
- De Bascule, academic center child and adolescent psychiatryAmsterdamThe Netherlands
| | - Anthony James
- Department of PsychiatryUniversity of OxfordOxfordUK
| | - Kathrin Koch
- Department of Neuroradiology, School of MedicineKlinikum Rechts der Isar, Technical University of MunichMunichGermany
| | - Gerd Kvale
- Bergen Center for Brain PlasticityHaukeland University HospitalBergenNorway
| | - Luisa Lazaro
- Department of Child and Adolescent Psychiatry and Psychology, IDIBAPS, CIBERSAM, Department of MedicineFaculty of BarcelonaBarcelonaSpain
| | - Christine Lochner
- SAMRC Unit on Risk & Resilience in Mental Disorders, Department of PsychiatryStellenbosch UniversityMatielandSouth Africa
| | - Rachel Marsh
- Center for OC and Related Disorders at the New York State Psychiatric Institute and Columbia University Irving Medical CenterNew YorkNew York
| | - David Mataix‐Cols
- Department of Psychiatry and Clinical PsychobiologyScientific Institute OspedaleMilanItaly
| | - Pedro Morgado
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of MinhoBragaPortugal
- ICVS/3B's, PT Government Associate LaboratoryBraga/GuimarãesPortugal
- Clinical Academic Center–BragaBragaPortugal
| | - Takashi Nakamae
- Department of PsychiatryGraduate School of Medical Science, Kyoto Prefectural University of MedicineKyotoJapan
| | - Tomohiro Nakao
- Department of Neuropsychiatry, Graduate School of Medical SciencesKyushu UniversityKyushuJapan
| | - Janardhanan C. Narayanaswamy
- Obsessive‐Compulsive Disorder (OCD) Clinic Department of PsychiatryNational Institute of Mental Health and NeurosciencesBangaloreIndia
| | - Erika Nurmi
- Department of Psychiatry and Biobehavioral SciencesUniversity of CaliforniaLos AngelesCalifornia
| | | | | | - João R. Sato
- Center of Mathematics, Computing and CognitionUniversidade Federal do ABCSanto AndréBrazil
| | - Noam Soreni
- Pediatric OCD Consultation Service, Anxiety Treatment and Research CenterMcMaster UniversityHamiltonOntarioCanada
| | - S. Evelyn Stewart
- Department of PsychiatryUniversity of British ColumbiaVancouverBritish ColumbiaCanada
- BC Mental Health and Addictions Research InstituteVancouverBritish ColumbiaCanada
- BC Children's HospitalVancouverBritish ColumbiaCanada
| | - Stephan F. Taylor
- Department of PsychiatryUniversity of Michigan Medical SchoolAnn ArborMichigan
| | - David Tolin
- Anxiety Disorders Center, The Institute of LivingHartfordConnecticut
| | - Sophia I. Thomopoulos
- Keck USC School of MedicineImaging Genetics Center, Mark & Mary Stevens Institute for Neuroimaging & InformaticsMarina del ReyCalifornia
| | - Dick J. Veltman
- Department of Psychiatry, Department of Anatomy & Neurosciences, Amsterdam NeuroscienceAmsterdam UMC, Vrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Ganesan Venkatasubramanian
- Obsessive‐Compulsive Disorder (OCD) Clinic Department of PsychiatryNational Institute of Mental Health and NeurosciencesBangaloreIndia
| | - Susanne Walitza
- Department of PsychiatryUniversity of Michigan Medical SchoolAnn ArborMichigan
| | - Zhen Wang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of MedicineShanghaiChina
- Institute of Psychological and Behavioral Science, Shanghai Jiao Tong UniversityShanghaiChina
| | - Paul M. Thompson
- Keck USC School of MedicineImaging Genetics Center, Mark & Mary Stevens Institute for Neuroimaging & InformaticsMarina del ReyCalifornia
| | - Dan J. Stein
- SAMRC Unit on Risk & Resilience in Mental Disorders, Department of Psychiatry & Neuroscience InstituteUniversity of Cape TownCape TownSouth Africa
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10
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Ramsey KA, De Nadai AS, Espil FM, Ricketts E, Stiede JT, Schild J, Specht MW, Woods DW, Bennet S, Walkup JT, Chang S, Piacentini J, McGuire JF. Urge intolerance predicts tic severity and impairment among adults with Tourette syndrome and chronic tic disorders. Front Psychiatry 2022; 13:929413. [PMID: 36032236 PMCID: PMC9399515 DOI: 10.3389/fpsyt.2022.929413] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 07/11/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Individuals with Tourette Syndrome and Persistent Tic Disorders (collectively TS) often experience premonitory urges-aversive physical sensations that precede tics and are temporarily relieved by tic expression. The relationship between tics and premonitory urges plays a key role in the neurobehavioral treatment model of TS, which underlies first-line treatments such as the Comprehensive Behavioral Intervention for Tics (CBIT). Despite the efficacy of CBIT and related behavioral therapies, less than 40% of adults with TS respond to these treatments. Further examination of the relationship between premonitory urges, tic severity, and tic impairment can provide new insights into therapeutic targets to optimize behavioral treatment outcomes. This study examined whether urge intolerance-difficulty tolerating premonitory urges-predicted tic severity and tic-related impairment among adults with TS. METHODS Participants were 80 adults with TS. Assessments characterized premonitory urge, distress tolerance, tic severity, and tic impairment. We used structural equation modeling (SEM) to examine the construct of urge intolerance-comprised of premonitory urge ratings and distress tolerance ratings. We first evaluated a measurement model of urge intolerance through bifactor modeling, including tests of the incremental value of subfactors that reflect premonitory urge severity and distress tolerance within the model. We then evaluated a structural model where we predicted clinician-rated tic severity and tic impairment by the latent variable of urge intolerance established in our measurement model. RESULTS Analyses supported a bifactor measurement model of urge intolerance among adults with TS. Consistent with theoretical models, higher levels of urge intolerance predicted greater levels of clinician-rated tic severity and tic impairment. CONCLUSION This investigation supports the construct of urge intolerance among adults with TS and distinguishes it from subcomponents of urge severity and distress tolerance. Given its predictive relationship with tic severity and tic impairment, urge intolerance represents a promising treatment target to improve therapeutic outcomes in adults with TS.
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Affiliation(s)
- Kesley A Ramsey
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Center for OCD, Anxiety, and Related Disorders for Children (COACH), Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | | | - Flint M Espil
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States
| | - Emily Ricketts
- Division of Child and Adolescent Psychiatry, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, United States
| | - Jordan T Stiede
- Department of Psychology, Behavior Therapy and Research Lab, Marquette University, Milwaukee, WI, United States
| | - Jennifer Schild
- Department of Psychology, Choices Youth Psychopathology Lab, Suffolk University, Boston, MA, United States
| | - Matthew W Specht
- Department of Psychiatry, Weill-Cornell Medicine, New York, NY, United States
| | - Douglas W Woods
- Department of Psychology, Behavior Therapy and Research Lab, Marquette University, Milwaukee, WI, United States
| | - Shannon Bennet
- Department of Psychiatry, Weill-Cornell Medicine, New York, NY, United States
| | - John T Walkup
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Susanna Chang
- Division of Child and Adolescent Psychiatry, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, United States
| | - John Piacentini
- Division of Child and Adolescent Psychiatry, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, United States
| | - Joseph F McGuire
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Center for OCD, Anxiety, and Related Disorders for Children (COACH), Johns Hopkins University School of Medicine, Baltimore, MD, United States
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11
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Abramovitch A, De Nadai AS, Geller DA. Neurocognitive endophenotypes in pediatric OCD probands, their unaffected parents and siblings. Prog Neuropsychopharmacol Biol Psychiatry 2021; 110:110283. [PMID: 33609605 PMCID: PMC8222154 DOI: 10.1016/j.pnpbp.2021.110283] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 01/28/2021] [Accepted: 02/10/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Limited extant research on neurocognitive endophenotypes in obsessive-compulsive disorder (OCD) show inconsistent results. Limitations of this body of literature include small sample sizes, strict exclusion criteria, lack of objective standard normalized test scores, and significant lack of studies utilizing pediatric probands. This study aimed to address these limitations. METHODS A large carefully screened cohort of pediatric OCD (n = 102), their unaffected siblings (n = 78), and parents (n = 164), completed a neuropsychological battery. To compare participants at different ages and developmental stages, standard scores were computed using test norms. Cluster-robust regression with sample size-adjusted sandwich estimates of variance, and interclass correlations were computed. False Discovery Rate procedures were employed to correct for multiplicity. RESULTS Probands, siblings and parents demonstrated deficient task performance (Z < -0.5) on the 'number of trials to complete first category' on the Wisconsin Card Sorting Test, and on the Stroop color naming trials. Compared to test norms, the three groups exhibited medium to large effect sizes on these outcome measures. No other meaningful familial trends were found. CONCLUSIONS OCD probands, their unaffected siblings and parents exhibited deficiencies in specific subdomains of cognitive flexibility and inhibitory control, namely, initial concept formation and proactive control, which may be valid candidate neurocognitive endophenotypes of OCD. No other meaningful familial effect has been found on other functions, including other executive function indices such as perseverations and interference control. These results highlight the need to carefully examine individual outcomes from executive function tests instead of the tendency to focus largely on major outcome measures.
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Affiliation(s)
- Amitai Abramovitch
- Department of Psychology, Texas State University, San Marcos, TX, USA; Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA.
| | | | - Daniel A Geller
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
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12
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De Nadai AS, Etherton JL. Beyond Efficacy and Effectiveness: Clinical Efficiency Is Necessary for Dissemination. J Cogn Psychother 2021; 35:221-231. [PMID: 34362861 DOI: 10.1891/jcpsy-d-20-00034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Nearly all patients interact with critical gatekeepers-insurance companies or centralized healthcare systems. For mental health dissemination efforts to be successful, these gatekeepers must refer patients to evidence-based care. To make these referral decisions, they require evidence about the amount of resources expended to achieve therapeutic gains. Without this information, a bottleneck to widespread dissemination of evidence-based care will remain. To address this need for information, we introduce a new perspective, clinical efficiency. This approach directly ties resource usage to clinical outcomes. We highlight how cost-effectiveness approaches and other strategies can address clinical efficiency, and we also introduce a related new metric, the incremental time efficiency ratio (ITER). The ITER is particularly useful for quantifying the benefits of low-intensity and concentrated interventions, as well as stepped-care approaches. Given that stakeholders are increasingly requiring information on resource utilization, the ITER is a metric that can be estimated for past and future clinical trials. As a result, the ITER can allow researchers to better communicate desirable aspects of treatment, and an increased focus on clinical efficiency can improve our ability to deliver high-quality treatment to more patients in need.
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13
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Abstract
Nearly all patients interact with critical gatekeepers-insurance companies or centralized healthcare systems. For mental health dissemination efforts to be successful, these gatekeepers must refer patients to evidence-based care. To make these referral decisions, they require evidence about the amount of resources expended to achieve therapeutic gains. Without this information, a bottleneck to widespread dissemination of evidence-based care will remain. To address this need for information, we introduce a new perspective, clinical efficiency. This approach directly ties resource usage to clinical outcomes. We highlight how cost-effectiveness approaches and other strategies can address clinical efficiency, and we also introduce a related new metric, the incremental time efficiency ratio (ITER). The ITER is particularly useful for quantifying the benefits of low-intensity and concentrated interventions, as well as stepped-care approaches. Given that stakeholders are increasingly requiring information on resource utilization, the ITER is a metric that can be estimated for past and future clinical trials. As a result, the ITER can allow researchers to better communicate desirable aspects of treatment, and an increased focus on clinical efficiency can improve our ability to deliver high-quality treatment to more patients in need.
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14
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Briggs FBS, Conway DS, De Nadai AS, Ontaneda D, Gunzler DD. Integrating patient-reported outcomes and quantitative timed tasks to identify relapsing remitting multiple sclerosis patient subgroups: a latent profile analysis. Mult Scler Relat Disord 2021; 51:102912. [PMID: 33773274 DOI: 10.1016/j.msard.2021.102912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 02/28/2021] [Accepted: 03/13/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Multiple sclerosis (MS) patients experience wide-ranging symptoms with varied severity, and approaches that integrate patient-reported outcomes and objective quantitative measures will present opportunities for advancing clinical profiling. The primary objective of the current study was to conduct exploratory data analysis using latent variable modeling to empirically identify clusters of relapsing remitting (RR) MS patients with shared impairment patterns across three patient-reported outcomes and two timed task measures. METHODS Latent profile analyses and impairment data for 2,012 RRMS patients identified distinct patient clusters using timed task measures of upper and lower limb performance, and patient-reported outcomes measuring quality of life, depression symptom severity, and perceived global disability. Multinomial logistic regression models were used to characterize associations between socio-demographic attributes and assignment to the patient clusters. RESULTS There were 6 distinct clusters of RRMS patients that differed by symptom patterns, and by their socio-demographic attributes. Most notable were were no differences in age, sex, or disease duration between the least and most impaired classes, representing 14% and 4% of patients, respectively. Patients in the most impaired class were much more likely to be Black American, have a history of smoking, have a higher body mass index, and be of lower socioeconomic status than the least impaired class. There were positive relationships between age and classification to clusters of increasing moderately severe impairment but not the most severe clusters. CONCLUSION We present a framework for discerning phenotypic impairment clusters in RRMS. The results demonstrate opportunities for advancing clinical profiling, which is necessary for optimizing personalized MS care models and clinical research.
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Affiliation(s)
- Farren B S Briggs
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, OH, USA.
| | - Devon S Conway
- The Mellen Center for Multiple Sclerosis and Research, Department of Neurology, Neurological Institute, Cleveland Clinic Foundation, Cleveland, OH, USA; Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA
| | | | - Daniel Ontaneda
- The Mellen Center for Multiple Sclerosis and Research, Department of Neurology, Neurological Institute, Cleveland Clinic Foundation, Cleveland, OH, USA; Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA
| | - Douglas D Gunzler
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, OH, USA; Center for Health Care Research and Policy, School of Medicine, Case Western Reserve University, Cleveland, OH, USA
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15
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Oberle CD, De Nadai AS, Madrid AL. Orthorexia Nervosa Inventory (ONI): development and validation of a new measure of orthorexic symptomatology. Eat Weight Disord 2021; 26:609-622. [PMID: 32279201 DOI: 10.1007/s40519-020-00896-6] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 03/28/2020] [Indexed: 12/11/2022] Open
Abstract
PURPOSE To overcome the problems associated with existing measures of orthorexia, we assessed the reliability and validity of a new measure: the Orthorexia Nervosa Inventory (ONI). METHOD An online survey was completed by 847 people recruited from undergraduate nutrition and psychology courses and from advertisements in Facebook and Instagram targeting both healthy eaters (with keywords such as "clean eating" and "healthy eating") and normal eaters (with keywords such as "delicious food" and "desserts"). RESULTS Exploratory factor analysis revealed three factors with 9 items assessing behaviors and preoccupation with healthy eating, 10 items assessing physical and psychosocial impairments, and 5 items assessing emotional distress. With this sample, all scales demonstrated good internal consistency (Cronbach's α = 0.88-0.90) and 2-week test-retest reliability (r = 0.86- 0.87). Consistent with past research, ONI scores were significantly greater among vegetarians and vegans, and among those with higher levels of disordered eating, general obsessive-compulsive tendencies, and compulsive exercise. Additionally, whereas ONI scores did not significantly differ between men and women, the scores were negatively correlated with body mass index. CONCLUSION The ONI is the first orthorexia measure to include items assessing physical impairments that researchers and clinicians agree comprise a key component of the disorder. Additionally, at least for the current sample, the ONI is a reliable measure with expected correlations based on the past research. LEVEL OF EVIDENCE Level V, descriptive cross-sectional study.
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Affiliation(s)
- Crystal D Oberle
- Department of Psychology, Texas State University, 601 University Dr., San Marcos, TX, 78666, USA.
| | - Alessandro S De Nadai
- Department of Psychology, Texas State University, 601 University Dr., San Marcos, TX, 78666, USA
| | - Aspen L Madrid
- Department of Psychology, Texas State University, 601 University Dr., San Marcos, TX, 78666, USA
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16
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Rech M, Weinzimmer S, Geller D, McGuire JF, Schneider SC, Patyk KC, De Nadai AS, Cepeda SC, Small BJ, Murphy TK, Wilhelm S, Storch EA. Symptom Trajectories of Early Responders and Remitters among Youth with OCD. J Obsessive Compuls Relat Disord 2020; 27:100580. [PMID: 35990243 PMCID: PMC9390966 DOI: 10.1016/j.jocrd.2020.100580] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJECTIVES This study examined the phenomenology and predictors of early response and remission among youth with obsessive-compulsive disorder (OCD) receiving cognitive-behavioral therapy (CBT). METHODS One hundred and thirty-nine youth with a current primary diagnosis of OCD participated in this study. Participants received 10 sessions of CBT augmented by either placebo or d-cycloserine (DCS) as part of a randomized double-blind multi-site clinical trial. Early response and remission status were determined by clinician-rated global symptom improvement (CGI-I) and severity (CGI-S), respectively. RESULTS At the mid-treatment assessment, 45.3% of youth were early responders, and 28.1% were early remitters. At post-treatment assessment, 79.1% of youth were responders and 67.6% were remitters. Early response predicted a higher likelihood of post-treatment response and remission; early remission significantly predicted a higher likelihood of post-treatment remission. Bivariate logistic regressions showed that early response was predicted by lower baseline clinician-rated global severity (CGI-S) and lower depression severity; however, only depression severity remained a significant predictor in the multivariable logistic regression model. Furthermore, bivariate logistic regressions showed that early remission was predicted by lower baseline clinician-rated global severity (CGI-S), lower depression severity, and lower obsessive-compulsive symptom severity (CY-BOCS); however, only global severity remained a significant predictor in the multivariable logistic regression model. CONCLUSIONS Lower OCD and depression symptom severity predicted a greater likelihood of early treatment response and remission to CBT. Findings suggest that low OCD and depression symptom severity could serve as baseline characteristics to identify potential candidates for lower-intensity initial interventions in a stepped care approach. The modest predictive value of the variables examined suggests that additional factors could add to prediction of treatment response and remission.
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Affiliation(s)
- Megan Rech
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas
| | - Saira Weinzimmer
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas
| | - Daniel Geller
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Joseph F McGuire
- Division of Child and Adolescent Psychiatry, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Sophie C Schneider
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas
| | - Kevin C Patyk
- Department of Psychology, Texas State University, San Marcos, Texas
| | | | - Sandra C Cepeda
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas
| | - Brent J Small
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas
- University of South Florida School of Aging Studies, Tampa, Florida
| | - Tanya K Murphy
- Department of Pediatrics, University of South Florida, Tampa, Florida
| | - Sabine Wilhelm
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Eric A Storch
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas
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17
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Storch EA, Schneider SC, De Nadai AS, Selles RR, McBride NM, Grebe SC, Bergez KC, Ramirez A, Viana AG, Lewin AB. A Pilot Study of Family-Based Exposure-Focused Treatment for Youth with Autism Spectrum Disorder and Anxiety. Child Psychiatry Hum Dev 2020; 51:209-219. [PMID: 31493105 DOI: 10.1007/s10578-019-00923-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Anxiety is a common and impairing condition in youth with autism spectrum disorders (ASD). Evidence supports the use of cognitive behavioral therapy for treating anxiety in this population; however, available treatment protocols may be difficult to implement outside of research settings. The present study examined the efficacy of family-based exposure-focused treatment (FET) compared to a treatment as usual (TAU) control in 32 youth aged 6-17 years with ASD and co-occurring anxiety. Fourteen youth were randomized to FET, which included 12 face-to-face weekly therapy sessions lasing 45-55 min, while 18 youth completed the TAU control where engagement in psychotherapy or pharmacotherapy was at the discretion of the families. Results strongly supported FET with a 79% (versus 0% in TAU) response rate, 86% (versus 0% in TAU) remission in primary anxiety diagnosis, and large between-group effects on clinician-rated anxiety severity and most parent-rated domains of anxiety-related impairment. Among treatment responders, 2-month follow-up supported maintenance of gains. Overall, the study supported FET as a relatively brief intervention for the treatment of anxiety in youth with ASD, although further research is needed to replicate these findings and compare FET outcomes to more comprehensive interventions.
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Affiliation(s)
- Eric A Storch
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, One Baylor Plaza MS:350, Houston, TX, 77030, USA.
| | - Sophie C Schneider
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, One Baylor Plaza MS:350, Houston, TX, 77030, USA
| | | | - Robert R Selles
- University of British Columbia and BC Children's Hospital, Vancouver, BC, Canada
| | - Nicole M McBride
- Department of Family and Preventive Medicine, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Stacey C Grebe
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, One Baylor Plaza MS:350, Houston, TX, 77030, USA
| | - Katherine C Bergez
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, One Baylor Plaza MS:350, Houston, TX, 77030, USA
| | - Ana Ramirez
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, One Baylor Plaza MS:350, Houston, TX, 77030, USA
| | - Andres G Viana
- Department of Psychology, University of Houston, Houston, TX, USA.,Texas Institute of Measurement, Evaluation, and Statistics, University of Houston, Houston, TX, USA
| | - Adam B Lewin
- Department of Pediatrics, Rothman Center for Neuropsychiatry, University of South Florida, Saint Petersburg, FL, USA
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18
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Storch EA, Cepeda SL, Lee E, Goodman SL, Robinson AD, De Nadai AS, Schneider SC, Sheth SA, Torgerson L, Lázaro-Muñoz G. Parental Attitudes Toward Deep Brain Stimulation in Adolescents with Treatment-Resistant Conditions. J Child Adolesc Psychopharmacol 2020; 30:97-103. [PMID: 31697591 PMCID: PMC7047254 DOI: 10.1089/cap.2019.0134] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Objective: To examine parent's perceptions of deep brain stimulation (DBS) and whether DBS is perceived to be a viable and safe treatment for their adolescent child presenting with a severe, treatment-resistant neurological or psychiatric condition. Method: Two hundred and seventy-nine parents completed an online survey using Amazon Mechanical Turk (MTurk). Participants were presented with five vignette scenarios involving adolescents with severe, treatment-resistant neurological or psychiatric conditions: Rett syndrome, autism spectrum disorder, epilepsy, obsessive-compulsive disorder, and Tourette syndrome. Parents were then asked to evaluate each scenario and rate overall acceptability of using DBS to improve their child's core symptoms. Data were collected over a period of 2 weeks in the month of October 2018. Results: We found that parents reported favorable impressions of DBS regardless of the target condition, especially when greater improvement could be assured and when their child had the capacity to assist in the treatment decision-making. Parents indicated some reluctance to use DBS when possible safety concerns were present. Familiarity with DBS was directly associated with attitudes. Conclusions: The findings highlight an overall parental willingness to consider DBS as a treatment option for key symptoms of neurological and psychiatric conditions in adolescents.
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Affiliation(s)
- Eric A. Storch
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas
- Address correspondence to: Eric A. Storch, PhD, Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, 1977 Butler Blvd, Suite 4–400, Houston, TX 77030
| | - Sandra L. Cepeda
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas
| | - Eric Lee
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas
| | - Sarah L.V. Goodman
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas
| | | | | | - Sophie C. Schneider
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas
| | - Sameer A. Sheth
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
| | - Laura Torgerson
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, Texas
| | - Gabriel Lázaro-Muñoz
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, Texas
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19
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De Nadai AS, Little TB, McCabe SE, Schepis TS. Diverse diagnostic profiles associated with prescription opioid use disorder in a nationwide sample: One crisis, multiple needs. J Consult Clin Psychol 2019; 87:849-858. [PMID: 31556662 DOI: 10.1037/ccp0000429] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE The opioid crisis has had devastating effects on individuals and communities, and it has rapidly increased in severity. However, we still lack nationally representative information on the diversity of comorbidity patterns among prescription opioid use disorder (P-OUD), other substance use disorders (SUDs), and psychopathology using the newest edition of the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5; American Psychiatric Association, 2013). This impedes planning for multiple aspects of intervention, including society-wide allocation of treatment resources, program design at individual treatment centers, and personalized care to individual patients. METHOD To address this critical gap in information, we evaluated clinical profiles of American adults via latent class analysis in a large, recently collected epidemiological dataset that uses structured diagnostic assessment for DSM-5 psychopathology (National Epidemiologic Survey on Alcohol and Related Conditions-III; N = 36,309). Variables considered for profiles included lifetime diagnosis for multiple SUDs, various externalizing and internalizing conditions, and demographic variables. We then associated clinical profiles with demographic variables and functional impairment. RESULTS Comorbid psychopathology and other SUDs were common in latent classes with elevated and very high rates of P-OUD. To illustrate, alcohol use disorder rates were greater than 45%, and posttraumatic stress disorder rates were greater than 28% in classes with higher P-OUD rates. Higher P-OUD rates were associated with White/non-Hispanic and American Indian/Alaska Native populations. Relationships between P-OUD rates and functional impairment were inconsistent. CONCLUSION Many current treatment delivery systems are not designed to accommodate the heterogeneous profiles associated with high P-OUD rates. We provide specific suggestions for improvements to the mental health service system, individual clinical care programs, and future research approaches. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Affiliation(s)
| | | | - Sean E McCabe
- Center for the Study of Drugs, Alcohol, Smoking and Health, School of Nursing, University of Michigan
| | - Ty S Schepis
- Department of Psychology, Texas State University
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20
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Gregory ST, Kay B, Smith J, Hall K, De Nadai AS, Quast T, Riemann BC, Storch EA. Treatment-Refractory Obsessive-Compulsive Disorder in Adults: A Cost-Effectiveness Analysis of Treatment Strategies. J Clin Psychiatry 2019; 79. [PMID: 29419948 DOI: 10.4088/jcp.17m11552] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Accepted: 07/27/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE This study sought to assess the cost-effectiveness of 7 treatment strategies for treatment-refractory obsessive-compulsive disorder (OCD) in adults. METHODS A model was developed to evaluate treatment alternatives for adults (18-64 years old) that consisted of 2 parts: a decision analytic model and a Markov model. The decision analytic model stratified 7 outpatient treatment strategies, and the Markov model accumulated benefits and costs across the life expectancy of a simulated cohort of individuals. The model was parameterized with probabilistic and deterministic parameters from the literature and an outcomes database to perform a Monte Carlo simulation of a hypothetical cohort of 100,000 adults with OCD to estimate net health benefits (NHBs), costs, and incremental cost-effectiveness ratio (ICER) for each treatment strategy. OCD was considered treatment refractory in adults with an OCD diagnosis who failed first-line therapies. Encounters took place from 2012 to 2015, and the analyses were performed from November 2016 to February 2017. RESULTS Partial hospitalization with step-down to intensive outpatient treatment was the most cost-effective of the 7 strategies, with an estimated ICER of $7,983 and mean (SD) NHB of 10.96 (0.53) quality-adjusted life-years (QALYs) remaining. This result was 2.2 QALYs greater than that of the trial-based antidepressant and cognitive-behavioral therapy (ADM + CBT) strategy. Three additional ADM + CBT strategies were estimated not to be statistically significantly different from each other. These 4 ADM + CBT strategies outperformed both pharmacotherapy-only strategies. CONCLUSIONS Treatment strategies that include higher-intensity CBT, with effectiveness outcomes that approached efficacy estimates, were superior to real-world CBT strategies. However, given the limited availability of high-quality CBT, especially through use of commercial insurance networks, specialized treatment programs offer greater effectiveness than real-world therapies in achieving wellness for this severe patient population.
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Affiliation(s)
- Sean T Gregory
- Department of Politics and International Affairs, Northern Arizona University, 5 E McConnell Dr, Flagstaff, AZ 86011 .,Department of Politics and International Affairs, College of Social and Behavioral Sciences, Northern Arizona University, Flagstaff, Arizona, USA
| | - Brian Kay
- Rogers Memorial Hospital, Oconomowoc, Wisconsin, USA
| | - Joseph Smith
- Department of Health Policy & Management, College of Public Health, University of South Florida, Tampa, Florida, USA
| | - Kristin Hall
- Department of Health Policy & Management, College of Public Health, University of South Florida, Tampa, Florida, USA
| | - Alessandro S De Nadai
- Department of Psychology, University of South Florida, Tampa, Florida, USA.,Department of Psychiatry, University of Mississippi Medical Center, Jackson, Mississippi, USA.,Department of Psychology, Texas State University, San Marcos, Texas, USA
| | - Troy Quast
- Department of Health Policy & Management, College of Public Health, University of South Florida, Tampa, Florida, USA
| | | | - Eric A Storch
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, USA
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Karver MS, De Nadai AS, Monahan M, Shirk SR. Meta-analysis of the prospective relation between alliance and outcome in child and adolescent psychotherapy. Psychotherapy (Chic) 2018; 55:341-355. [DOI: 10.1037/pst0000176] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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De Nadai AS. Reconciling stakeholder interests in the era of open data. Bull Menninger Clin 2018; 82:253-259. [PMID: 30179044 DOI: 10.1521/bumc.2018.82.3.253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
While there is great enthusiasm about new data sharing initiatives in mental health research, some concerns have recently been expressed that reflect tension between those who generate data and those who engage in secondary data analysis. While many aspects of data sharing have been considered, some of this tension has not been fully addressed. If this tension continues to go unresolved, enthusiasm for data sharing initiatives may be hindered. The author suggests solutions to these issues after carefully considering respective stakeholder interests (including those of patients, researchers, and funding agencies).
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Ung D, De Nadai AS, McBride NM, Haney B, Huszar P, Hart D, Tauriello S, Glenn S, Cepeda S, Petti EA, Winesett SP, Storch EA. The Association Between Quality of Life and Clinical Characteristics Youth with Headaches. Children's Health Care 2018. [DOI: 10.1080/02739615.2018.1425872] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- Danielle Ung
- Department of Pediatrics, University of South Florida, Tampa, Florida
| | | | - Nicole M McBride
- Department of Pediatrics, University of South Florida, Tampa, Florida
| | - Brandon Haney
- Department of Pediatrics, University of South Florida, Tampa, Florida
| | - Peter Huszar
- Department of Neurology, Johns Hopkins All Children’s Hospital, Saint Petersburg, Florida
| | - Dennis Hart
- Department of Neurology, Johns Hopkins All Children’s Hospital, Saint Petersburg, Florida
| | - Sara Tauriello
- Department of Pediatrics, University of South Florida, Tampa, Florida
| | - Shannon Glenn
- Department of Pediatrics, University of South Florida, Tampa, Florida
| | - Sandra Cepeda
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas
| | - Erin A Petti
- Department of Neurology, Johns Hopkins All Children’s Hospital, Saint Petersburg, Florida
| | - S. Parrish Winesett
- Department of Neurology, Johns Hopkins All Children’s Hospital, Saint Petersburg, Florida
| | - Eric A. Storch
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas
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Etherton JL, Osborne R, Stephenson K, Grace M, Jones C, De Nadai AS. Bayesian analysis of multimethod ego-depletion studies favours the null hypothesis. Br J Soc Psychol 2018; 57:367-385. [DOI: 10.1111/bjso.12236] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 12/08/2017] [Indexed: 11/28/2022]
Affiliation(s)
| | | | | | | | - Chas Jones
- Texas State University; San Marcos TX USA
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Bozzay ML, O'Leary KN, De Nadai AS, Gryglewicz K, Romero G, Karver MS. Adolescent Depression: Differential Symptom Presentations in Deaf and Hard-of-Hearing Youth Using the Patient Health Questionnaire-9. J Deaf Stud Deaf Educ 2017; 22:195-203. [PMID: 28426888 DOI: 10.1093/deafed/enw099] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 12/12/2016] [Indexed: 06/07/2023]
Abstract
The present study examined differences in symptom presentation in screening for pediatric depression via evaluation of the Patient Health Questionnaire-9 (PHQ-9). In particular, we examined whether PHQ-9 items function differentially among deaf and hard-of-hearing (DHH; n = 75) and hearing (n = 75) youth based on participants recruited from crisis assessment services. Multiple indicators multiple causes models were used to examine whether items of the PHQ-9 functioned differently between groups as well as whether there were group differences in the mean severity of depressive symptoms. Results indicate that DHH youth were more likely to endorse psychosomatic items, and less likely to endorse an affective item. These findings indicate that the PHQ-9 functions differently when used with DHH youth. Implications of these findings are discussed, including both for future work with the PHQ-9 and with regard to the conceptualization of depression across hearing groups.
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Abstract
This study evaluated the psychometric properties of the Child Disgust Scale (CDS) among 457 youth (ages 8-17, M = 14.77 ± 1.98 years) initiating residential treatment for obsessive-compulsive disorder and anxiety disorders. Confirmatory factor analysis supported a bifactor model with two distinct factors of Disgust Avoidance and Disgust Affect, in addition to an overall General Disgust factor. Strong internal consistency was observed for the CDS total and factor scores. In addition, CDS scores demonstrated generally modest and positive correlations with child-reported obsessive-compulsive and anxiety symptoms, weaker correlations with parent-reported anxiety and child-rated impairment, and non-significant correlations with parent-rated impairment. Findings suggest that the CDS displays strong psychometric properties and is developmentally appropriate for use in pediatric clinical populations with obsessive-compulsive and anxiety disorders.
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Affiliation(s)
- Joshua M Nadeau
- Department of Pediatrics, University of South Florida, Tampa, FL, USA.
- Rogers Memorial Hospital, Tampa, FL, USA.
| | - Alessandro S De Nadai
- Department of Pediatrics, University of South Florida, Tampa, FL, USA
- Department of Psychology, University of South Florida, Tampa, FL, USA
| | | | - Bunmi O Olatunji
- Rogers Memorial Hospital, Tampa, FL, USA
- Department of Psychology, Vanderbilt University, Nashville, TN, USA
| | | | | | - Brian Kay
- Rogers Memorial Hospital, Tampa, FL, USA
| | | | - Eric A Storch
- Department of Pediatrics, University of South Florida, Tampa, FL, USA
- Rogers Memorial Hospital, Tampa, FL, USA
- Department of Psychology, University of South Florida, Tampa, FL, USA
- Department of Health Policy and Management, University of South Florida, Tampa, FL, USA
- Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa, FL, USA
- All Children's Hospital - Johns Hopkins Medicine, St. Petersburg, FL, USA
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Storch EA, Nadeau JM, De Nadai AS, Cepeda SL, Riemann BC, Seibell P, Kay B. Symptom correspondence between clinicians and patients on the Yale-Brown Obsessive Compulsive Scale. Compr Psychiatry 2017; 73:105-110. [PMID: 27930951 DOI: 10.1016/j.comppsych.2016.11.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 11/19/2016] [Accepted: 11/25/2016] [Indexed: 12/30/2022] Open
Abstract
The present study examined concordance between the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) and its self-report version (Y-BOCS-SR), as well as theoretically derived moderators. Sixty-seven adults (ages 18-67) with obsessive-compulsive disorder (OCD) were administered the Y-BOCS prior to completing self-report measures. The Y-BOCS-SR generated lower scores relative to the clinician-administered Y-BOCS (5.3 points lower). Strong correspondence was shown between the Y-BOCS and Y-BOCS-SR; however, many items exhibited fair to moderate agreement, particularly the resistance and control against obsessions/compulsions items. Depression significantly moderated correspondence such that Y-BOCS-SR scores significantly predicted Y-BOCS scores in the presence of low and average depression levels in our sample, but not for patients with high levels of depression relative to the rest of our sample; gender, generalized anxiety and obsessionality did not significantly impact agreement. Synthesizing the present data, the Y-BOCS-SR demonstrates modest agreement with the Y-BOCS and may underestimate clinical severity especially for those with high levels of depression.
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Affiliation(s)
- Eric A Storch
- Department of Pediatrics, University of South Florida, St. Petersburg, FL, USA; Department of Health Management and Policy, University of South Florida, Tampa, FL, USA; Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa, FL, USA; Department of Psychology, University of South Florida, Tampa, FL, USA; Rogers Behavioral Health - Tampa Bay, Tampa, FL, USA; All Children's Hospital-Johns Hopkins Medicine, St. Petersburg, FL, USA.
| | - Joshua M Nadeau
- Department of Pediatrics, University of South Florida, St. Petersburg, FL, USA; Rogers Behavioral Health - Tampa Bay, Tampa, FL, USA
| | | | - Sandra L Cepeda
- Department of Pediatrics, University of South Florida, St. Petersburg, FL, USA
| | | | - Philip Seibell
- OCD and Anxiety Psychiatry of Westchester, P.C., Hawthorne, NY, USA
| | - Brian Kay
- Rogers Memorial Hospital, Oconomowoc, WI, USA
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De Nadai AS, Karver MS, Murphy TK, Cavitt MA, Alvaro JL, Bengtson M, Stock S, Rakhshani AC, Storch EA. Common Factors in Pediatric Psychiatry: A Review of Essential and Adjunctive Mechanisms of Treatment Outcome. J Child Adolesc Psychopharmacol 2017; 27:10-18. [PMID: 27128785 PMCID: PMC5326981 DOI: 10.1089/cap.2015.0263] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE The purpose of this article is to review the literature on hypothesized behavioral correlates of pharmacotherapy treatment response. A particular focus is placed on what have been referred to as "common factors" across mental health treatments, including medication adherence, therapeutic alliance, motivation for behavior change, and expectancies for positive treatment outcomes. These understudied factors may provide unique explanations for mechanisms of symptom change, patient risk as a result of protocol deviation, and attenuated treatment outcomes. METHOD A literature search was conducted to evaluate the relationship between treatment processes in pediatric psychiatry and medication adherence, therapeutic alliance, motivation for behavior change, and expectancies for positive treatment outcomes. RESULTS Substantial variability and room for improvement was identified for each common factor. Behavioral protocols have already been developed to address many aspects of common factors in pediatric psychiatric treatment, but are not yet a part of many practice parameters. CONCLUSION Interventions to improve common factors can be used immediately in tandem with psychopharmacological interventions to provide increased symptom relief and reduce patient risk. Furthermore, incorporating instruction in common factors interventions can positively affect training of future providers and enhance understanding of the mechanisms of effect of medications. An increased focus on common factors, with a particular emphasis on quantifying the magnitude and mechanisms of their effects on psychopharmacological interventions stand to benefit child patients, their families, treatment providers, training facilities, and pharmaceutical manufacturers.
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Affiliation(s)
- Alessandro S. De Nadai
- Department of Pediatrics, Rothman Center for Pediatric Neuropsychiatry, University of South Florida Morsani College of Medicine, Tampa, Florida
- Department of Psychiatry, University of South Florida, Tampa, Florida
- Department of Psychology, University of South Florida, Tampa, Florida
| | - Marc S. Karver
- Department of Psychology, University of South Florida, Tampa, Florida
| | - Tanya K. Murphy
- Department of Pediatrics, Rothman Center for Pediatric Neuropsychiatry, University of South Florida Morsani College of Medicine, Tampa, Florida
- Department of Psychiatry, University of South Florida, Tampa, Florida
| | - Mark A. Cavitt
- Department of Psychiatry, University of South Florida, Tampa, Florida
- All Children's Hospital—Johns Hopkins Medicine, St. Petersburg, Florida
| | - Jeffrey L. Alvaro
- Department of Psychiatry, University of South Florida, Tampa, Florida
- All Children's Hospital—Johns Hopkins Medicine, St. Petersburg, Florida
| | | | - Saundra Stock
- Department of Psychiatry, University of South Florida, Tampa, Florida
| | | | - Eric A. Storch
- Department of Pediatrics, Rothman Center for Pediatric Neuropsychiatry, University of South Florida Morsani College of Medicine, Tampa, Florida
- Department of Psychiatry, University of South Florida, Tampa, Florida
- Department of Psychology, University of South Florida, Tampa, Florida
- All Children's Hospital—Johns Hopkins Medicine, St. Petersburg, Florida
- Rogers Behavioral Health—Tampa Bay, Tampa, Florida
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Hayes O, Wu MS, De Nadai AS, Storch EA. Orthorexia Nervosa: An Examination of the Prevalence, Correlates, and Associated Impairment in a University Sample. J Cogn Psychother 2017; 31:124-135. [DOI: 10.1891/0889-8391.31.2.124] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Orthorexia nervosa is characterized by an obsession with eating “pure” or “healthy” foods. Despite emergent interest, few studies have been published about orthorexia to date. This study examined the phenomenology, correlates, and associated impairment of orthorexia in 404 undergraduate students. A battery of self-report questionnaires assessed orthorexia symptoms, related functional impairment, disordered eating, perfectionism, obsessive-compulsive symptoms, appearance anxiety, fear of negative evaluation, anxiety, and depressive symptoms. In total, 35.4% of participants endorsed elevated orthorexia symptoms, with primary concerns related to guilt associated with dietary transgressions and experiencing control when eating in a desired manner. Orthorexia symptoms demonstrated small to medium correlations with associated impairment variables, perfectionism, disordered eating, appearance anxiety, and obsessive-compulsive symptoms. Mean differences were observed across all variables (except depressive symptoms) between individuals elevated and not elevated on orthorexia symptoms. Collectively, this study suggests a relatively high frequency of orthorexia symptoms using current methods (which have significant limitations) and demonstrate fairly modest associations with psychological symptomology.
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Smith JL, De Nadai AS, Storch EA, Langland-Orban B, Pracht E, Petrila J. Correlates of Length of Stay and Boarding in Florida Emergency Departments for Patients With Psychiatric Diagnoses. Psychiatr Serv 2016; 67:1169-1174. [PMID: 27364809 PMCID: PMC6176481 DOI: 10.1176/appi.ps.201500283] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Length of stay (LOS) and boarding in the emergency department (ED) for psychiatric patients have been the subject of concern, given the problems with crowding and excessive wait times in EDs. This investigation examined correlates of LOS and boarding in Florida EDs for patients presenting with psychiatric complaints from 2010 to 2013. METHODS Utilizing the Florida ED discharge database, the authors examined the association of LOS and boarding with hospital and encounter factors for adult patients presenting with a primary psychiatric diagnosis (N=597,541). RESULTS The mean LOS was 7.77 hours. Anxiety disorders were the most frequent psychiatric complaint and were associated with the lowest mean LOS compared with other diagnoses (p<.05). Patient encounters resulting in a presentation of intentional self-harm and suicidality or schizophrenia were associated with significantly longer stays compared with other psychiatric diagnoses. Commercial insurance was associated with the shortest average LOS. African Americans, Hispanics, and patients age 45 and older were associated with a longer average LOS. Smaller hospital size, for-profit ownership, and rural designation were associated with a shorter average LOS. Teaching status was not associated with LOS. Furthermore, 73% of encounters resulting in transfers qualified as episodes of boarding (a stay of more than six or more hours in the ED). CONCLUSIONS Extended LOS was endemic for psychiatric patients in Florida EDs.
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Affiliation(s)
- Joseph L Smith
- With the exception of Mr. De Nadai, the authors are with the Department of Health Policy and Management, University of South Florida, Tampa (e-mail: ). Dr. Storch is also with Rogers Behavioral Health-Tampa Bay. Mr. De Nadai is with the Department of Psychology, University of South Florida, Tampa
| | - Alessandro S De Nadai
- With the exception of Mr. De Nadai, the authors are with the Department of Health Policy and Management, University of South Florida, Tampa (e-mail: ). Dr. Storch is also with Rogers Behavioral Health-Tampa Bay. Mr. De Nadai is with the Department of Psychology, University of South Florida, Tampa
| | - Eric A Storch
- With the exception of Mr. De Nadai, the authors are with the Department of Health Policy and Management, University of South Florida, Tampa (e-mail: ). Dr. Storch is also with Rogers Behavioral Health-Tampa Bay. Mr. De Nadai is with the Department of Psychology, University of South Florida, Tampa
| | - Barbara Langland-Orban
- With the exception of Mr. De Nadai, the authors are with the Department of Health Policy and Management, University of South Florida, Tampa (e-mail: ). Dr. Storch is also with Rogers Behavioral Health-Tampa Bay. Mr. De Nadai is with the Department of Psychology, University of South Florida, Tampa
| | - Etienne Pracht
- With the exception of Mr. De Nadai, the authors are with the Department of Health Policy and Management, University of South Florida, Tampa (e-mail: ). Dr. Storch is also with Rogers Behavioral Health-Tampa Bay. Mr. De Nadai is with the Department of Psychology, University of South Florida, Tampa
| | - John Petrila
- With the exception of Mr. De Nadai, the authors are with the Department of Health Policy and Management, University of South Florida, Tampa (e-mail: ). Dr. Storch is also with Rogers Behavioral Health-Tampa Bay. Mr. De Nadai is with the Department of Psychology, University of South Florida, Tampa
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Houghton DC, Capriotti MR, De Nadai AS, Compton SN, Twohig MP, Neal-Barnett AM, Saunders SM, Franklin ME, Woods DW. Defining treatment response in trichotillomania: a signal detection analysis. J Anxiety Disord 2015; 36:44-51. [PMID: 26422605 PMCID: PMC4658278 DOI: 10.1016/j.janxdis.2015.09.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Revised: 09/07/2015] [Accepted: 09/14/2015] [Indexed: 12/25/2022]
Abstract
The Massachusetts General Hospital Hairpulling Scale (MGH-HPS) and the NIMH Trichotillomania Severity Scale (NIMH-TSS) are two widely used measures of trichotillomania severity. Despite their popular use, currently no empirically-supported guidelines exist to determine the degrees of change on these scales that best indicate treatment response. Determination of such criteria could aid in clinical decision-making by defining clinically significant treatment response/recovery and producing accurate power analyses for use in clinical trials research. Adults with trichotillomania (N=69) participated in a randomized controlled trial of psychotherapy and were assessed before and after treatment. Response status was measured via the Clinical Global Impressions-Improvement Scale, and remission status was measured via the Clinical Global Impressions-Severity Scale. For treatment response, a 45% reduction or 7-point raw score change on the MGH-HPS was the best indicator of clinically significant treatment response, and on the NIMH-TSS, a 30-40% reduction or 6-point raw score difference was most effective cutoff. For disorder remission, a 55-60% reduction or 7-point raw score change on the MGH-HPS was the best predictor, and on the NIMH-TSS, a 65% reduction or 6-point raw score change was the best indicator of disorder remission. Implications of these findings are discussed.
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Affiliation(s)
- David C. Houghton
- Texas A&M University – Department of Psychology, 4235 TAMU, College Station, TX, 77843, USA, D.C.H.
| | - Matthew R. Capriotti
- University of California San Francisco – Department of Psychiatry, 401 Parnassus Ave., Box 0984, San Francisco, CA, 94143, USA,
| | - Alessandro S. De Nadai
- University of South Florida – Department of Psychology, 4202 East Fowler Ave., PCD4118G, Tampa, FL, 33620, USA,
| | - Scott N. Compton
- Duke University School of Medicine – Department of Psychiatry and Behavioral Sciences, 2213 Elba St., Durham, NC, 27705, USA,
| | - Michael P. Twohig
- Utah State University – Department of Psychology, 2810 Old Main Hill, Logan, UT, 84322, USA,
| | - Angela M. Neal-Barnett
- Kent State University – Department of Psychological Sciences, 600 Hilltop Drive, Kent, OH, 44242, USA,
| | - Stephen M. Saunders
- Marquette University – Department of Psychology, 317 Cramer Hall, Milwaukee, WI, 53233, USA,
| | - Martin E. Franklin
- University of Pennsylvania School of Medicine – Department of Psychiatry, 3535 Market St., Philadelphia, PA, 19104, USA,
| | - Douglas W. Woods
- Texas A&M University – Department of Psychology, 4235 TAMU, College Station, TX, 77843, USA, D.C.H. ,D.W.W. , D.W.W. phone: 1-(979)845-2540, D.W.W. fax: 1-(979)-845-4727
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Storch EA, De Nadai AS, do Rosário MC, Shavitt RG, Torres AR, Ferrão YA, Miguel EC, Lewin AB, Fontenelle LF. Defining clinical severity in adults with obsessive-compulsive disorder. Compr Psychiatry 2015; 63:30-5. [PMID: 26555489 PMCID: PMC4643407 DOI: 10.1016/j.comppsych.2015.08.007] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 07/17/2015] [Accepted: 08/12/2015] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE The Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) is the most commonly used instrument to assess the clinical severity of obsessive-compulsive symptoms. Treatment determinations are often based on Y-BOCS score thresholds. However, these benchmarks are not empirically based, which may result in non-evidence based treatment decisions. Accordingly, the present study sought to derive empirically-based benchmarks for defining obsessive-compulsive symptom severity. METHOD Nine hundred fifty-four adult patients with obsessive-compulsive disorder (OCD), recruited through the Brazilian Research Consortium on Obsessive-Compulsive Spectrum Disorders, were evaluated by experienced clinicians using a structured clinical interview, the Y-BOCS, and the Clinical Global Impressions-Severity scale (CGI-Severity). RESULTS Similar to results in treatment-seeking children with OCD, our findings demonstrated convergence between the Y-BOCS and global OCD severity assessed by the CGI-Severity (Nagelkerke R(2)=.48). Y-BOCS scores of 0-13 corresponded with 'mild symptoms' (CGI-Severity=0-2), 14-25 with 'moderate symptoms' (CGI-Severity=3), 26-34 with 'moderate-severe symptoms' (CGI-Severity=4) and 35-40 with 'severe symptoms' (CGI-Severity=5-6). Neither age nor ethnicity was associated with Y-BOCS scores, but females demonstrated more severe obsessive-compulsive symptoms than males (d=.34). Time spent on obsessions/compulsions, interference, distress, resistance, and control were significantly related to global OCD severity although the symptom resistance item pairing demonstrated a less robust relationship relative to other components of the Y-BOCS. CONCLUSIONS These data provide empirically-based benchmarks on the Y-BOCS for defining the clinical severity of treatment seeking adults with OCD, which can be used for normative comparisons in the clinic and for future research.
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Affiliation(s)
- Eric A. Storch
- Department of Pediatrics, University of South Florida,Department of Health Policy & Management, University of South Florida,Rogers Behavioral Health – Tampa Bay,All Children’s Hospital - Johns Hopkins Medicine
| | | | | | - Roseli G. Shavitt
- Department of Psychiatry, University of São Paulo Medical School, Brazil
| | - Albina R. Torres
- Department of Neurology, Psychology and Psychiatry, Botucatu Medical School, Univ Estadual Paulista, Brazil
| | - Ygor A. Ferrão
- Department of Psychiatry, Health Sciences Federal University of Porto Alegre, Brazil
| | | | - Adam B. Lewin
- Department of Pediatrics, University of South Florida,All Children’s Hospital - Johns Hopkins Medicine
| | - Leonardo F. Fontenelle
- Anxiety and Obsessive-Compulsive Spectrum Research Program, Institute of Psychiatry, Federal University of Rio de Janeiro & D’Or Institute for Research and Education, Brazil
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Johnco CJ, De Nadai AS, Lewin AB, Ehrenreich-May J, Wood JJ, Storch EA. Erratum to: Defining Treatment Response and Symptom Remission for Anxiety Disorders in Pediatric Autism Spectrum Disorders Using the Pediatric Anxiety Rating Scale. J Autism Dev Disord 2015; 45:3243. [DOI: 10.1007/s10803-015-2554-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Johnco C, Salloum A, De Nadai AS, McBride N, Crawford EA, Lewin AB, Storch EA. Incidence, clinical correlates and treatment effect of rage in anxious children. Psychiatry Res 2015; 229:63-9. [PMID: 26235476 PMCID: PMC4561508 DOI: 10.1016/j.psychres.2015.07.071] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Revised: 07/10/2015] [Accepted: 07/27/2015] [Indexed: 10/23/2022]
Abstract
Episodic rage represents an important and underappreciated clinical feature in pediatric anxiety. This study examined the incidence and clinical correlates of rage in children with anxiety disorders. Change in rage during treatment for anxiety was also examined. Participants consisted of 107 children diagnosed with an anxiety disorder and their parents. Participants completed structured clinical interviews and questionnaire measures to assess rage, anxiety, functional impairment, family accommodation and caregiver strain, as well as the quality of the child's relationship with family and peers. Rage was a common feature amongst children with anxiety disorders. Rage was associated with a more severe clinical profile, including increased anxiety severity, functional impairment, family accommodation and caregiver strain, as well as poorer relationships with parents, siblings, extended family and peers. Rage was more common in children with separation anxiety, comorbid anxiety, attention deficit/hyperactivity disorder and behavioral disorders, but not depressive symptoms. Rage predicted higher levels of functional impairment, beyond the effect of anxiety severity. Rage severity reduced over treatment in line with changes in anxiety symptoms. Findings suggest that rage is a marker of greater psychopathology in anxious youth. Standard cognitive behavioral treatment for anxiety appears to reduce rage without adjunctive treatment.
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Affiliation(s)
- Carly Johnco
- Department of Pediatrics, University of South Florida, USA.
| | | | | | - Nicole McBride
- Department of Pediatrics, University of South Florida, USA
| | | | - Adam B Lewin
- Department of Pediatrics, University of South Florida, USA; Department of Psychology, University of South Florida, USA; Department of Psychiatry & Behavioral Neurosciences, University of South Florida, USA
| | - Eric A Storch
- Department of Pediatrics, University of South Florida, USA; Department of Psychology, University of South Florida, USA; Department of Psychiatry & Behavioral Neurosciences, University of South Florida, USA; Rogers Behavioral Health - Tampa Bay, USA; All Children's Hospital-Johns Hopkins Medicine, USA; Department of Health Policy and Management, University of South Florida, USA
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Storch EA, Lewin AB, Collier AB, Arnold E, De Nadai AS, Dane BF, Nadeau JM, Mutch PJ, Murphy TK. A randomized controlled trial of cognitive-behavioral therapy versus treatment as usual for adolescents with autism spectrum disorders and comorbid anxiety. Depress Anxiety 2015; 32:174-81. [PMID: 25424398 PMCID: PMC4346416 DOI: 10.1002/da.22332] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Revised: 08/22/2014] [Accepted: 10/10/2014] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE Examine the efficacy of a personalized, modular cognitive-behavioral therapy (CBT) protocol among early adolescents with high-functioning autism spectrum disorders (ASDs) and co-occurring anxiety relative to treatment as usual (TAU). METHOD Thirty-one children (11-16 years) with ASD and clinically significant anxiety were randomly assigned to receive 16 weekly CBT sessions or an equivalent duration of TAU. Participants were assessed by blinded raters at screening, posttreatment, and 1-month follow-up. RESULTS Youth randomized to CBT demonstrated superior improvement across primary outcomes relative to those receiving TAU. Eleven of 16 adolescents randomized to CBT were treatment responders, versus 4 of 15 in the TAU condition. Gains were maintained at 1-month follow-up for CBT responders. CONCLUSIONS These data extend findings of the promising effects of CBT in anxious youth with ASD to early adolescents.
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Affiliation(s)
- Eric A. Storch
- Department of Pediatrics, University of South Florida
- Department of Psychiatry & Behavioral Neurosciences, University of South Florida
- Rogers Behavioral Health – Tampa Bay
- All Children’s Hospital - Johns Hopkins Medicine
| | - Adam B. Lewin
- Department of Pediatrics, University of South Florida
- Department of Psychiatry & Behavioral Neurosciences, University of South Florida
| | | | - Elysse Arnold
- Department of Pediatrics, University of South Florida
| | | | | | | | - P. Jane Mutch
- Department of Pediatrics, University of South Florida
| | - Tanya K. Murphy
- Department of Pediatrics, University of South Florida
- Department of Psychiatry & Behavioral Neurosciences, University of South Florida
- All Children’s Hospital - Johns Hopkins Medicine
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Whiteside SPH, McKay D, De Nadai AS, Tiede MS, Ale CM, Storch EA. A baseline controlled examination of a 5-day intensive treatment for pediatric obsessive-compulsive disorder. Psychiatry Res 2014; 220:441-6. [PMID: 25070176 DOI: 10.1016/j.psychres.2014.07.006] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Revised: 06/30/2014] [Accepted: 07/06/2014] [Indexed: 01/22/2023]
Abstract
This study extends support for a 5-day intensive exposure and response prevention (ERP) treatment protocol for pediatric obsessive compulsive disorder (OCD). Twenty-two children with OCD received ERP treatment twice daily for 5 days. The treatment also emphasized teaching children and parents how to conduct ERP independently after they returned home. Symptoms were assessed at four time-points: Baseline, 4 weeks later at pre-treatment, one week after the intensive treatment 5-day treatment, and at 3 month follow-up. Changes on the primary outcome measure, clinician severity ratings on the Anxiety Disorders Interview Schedule for Children, and secondary measures, indicated that OCD symptoms remained stable from the evaluation to baseline and improved significantly from baseline to follow-up. Moreover, parental accommodation of OCD decreased significantly from baseline to post-treatment and from post-treatment to follow-up. These data suggest that the 5-day intervention demonstrates efficacy in reducing OCD symptoms and may initiate change in parent accommodation that continues to improve after the family returns home.
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Affiliation(s)
| | - Dean McKay
- Department of Psychology, Fordham University, Bronx, NY, USA
| | - Alessandro S De Nadai
- Departments of Pediatrics and Psychiatry & Behavioral Neurosciences, University of South Florida, St. Petersburg, FL, USA
| | - Michael S Tiede
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - Chelsea M Ale
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - Eric A Storch
- Departments of Pediatrics and Psychiatry & Behavioral Neurosciences, University of South Florida, St. Petersburg, FL, USA; Rogers Behavioral Health - Tampa Bay, Tampa, FL, USA; All Children׳s Hospital - Johns Hopkins Medicine, St. Petersburg, FL, USA
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37
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Arnold EB, De Nadai AS, Lewin AB, Geffken GR, Reid A, McNamara JP, Storch EA. Does cognitive-behavioral therapy response in youth with obsessive-compulsive disorder differ if treatment ends during summer? Ann Clin Psychiatry 2014; 26:299-300. [PMID: 25401717 PMCID: PMC4349577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Affiliation(s)
- Elysse B Arnold
- Department of Pediatrics, Rothman Center for Neuropsychiatry, University of South Florida, St. Petersburg, FL, USA. E-mail:
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Lewin AB, Park JM, Jones AM, Crawford EA, De Nadai AS, Menzel J, Arnold EB, Murphy TK, Storch EA. Family-based exposure and response prevention therapy for preschool-aged children with obsessive-compulsive disorder: A pilot randomized controlled trial. Behav Res Ther 2014; 56:30-8. [DOI: 10.1016/j.brat.2014.02.001] [Citation(s) in RCA: 82] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Revised: 02/10/2014] [Accepted: 02/11/2014] [Indexed: 01/19/2023]
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Storch EA, De Nadai AS, Jacob ML, Lewin AB, Muroff J, Eisen J, Abramowitz JS, Geller DA, Murphy TK. Phenomenology and correlates of insight in pediatric obsessive-compulsive disorder. Compr Psychiatry 2014; 55:613-20. [PMID: 24238933 DOI: 10.1016/j.comppsych.2013.09.014] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Revised: 08/30/2013] [Accepted: 09/18/2013] [Indexed: 10/26/2022] Open
Abstract
Obsessive-compulsive disorder (OCD) is marked by the presence of obsessions and/or compulsions that cause significant interference in an individual's life. Insight regarding symptoms in youth with OCD may affect accurate assessment, acceptance and motivation for treatment, tolerance of negative valence states (i.e., fear) and treatment outcome, so assessment of this construct and associated clinical characteristics is important. Accordingly, the current study sought to expand the literature on symptom insight by examining multi-informant ratings of insight from children, parents, and clinicians simultaneously and its relationship to varied clinical characteristics. One-hundred and ten treatment-seeking youth with a primary diagnosis of OCD, aged 6-17, participated in the study along with a parent/guardian. The nature of symptom conviction, fixity of ideas, and perceptions about the cause of the problems were important indicators in assessing child insight and resulted in a comprehensive, psychometrically-sound measure of insight. Insight was generally not strongly associated with clinical characteristics. Poor insight was moderately associated with less resistance of obsessive-compulsive symptoms, increased externalizing symptoms, and ordering symptoms. Overall, this study contributes further information into the nature and correlates of insight in youth with OCD, and provides a psychometrically sound approach for its assessment.
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Affiliation(s)
- Eric A Storch
- Department of Pediatrics, University of South Florida, St. Petersburg, FL; Department of Psychiatry and Behavioral Neurosciences, University of South Florida, St. Petersburg, FL; Department of Psychology, University of South Florida, St. Petersburg, FL.
| | - Alessandro S De Nadai
- Department of Pediatrics, University of South Florida, St. Petersburg, FL; Department of Psychology, University of South Florida, St. Petersburg, FL
| | - Marni L Jacob
- Department of Pediatrics, University of South Florida, St. Petersburg, FL
| | - Adam B Lewin
- Department of Pediatrics, University of South Florida, St. Petersburg, FL; Department of Psychiatry and Behavioral Neurosciences, University of South Florida, St. Petersburg, FL
| | - Jordana Muroff
- Department of Social Work, Boston University, Boston, MA
| | - Jane Eisen
- Department of Psychiatry and Human Behavior, Brown University, Providence, RI
| | | | - Daniel A Geller
- Department of Psychiatry, Massachusetts General Hospital Boston, MA
| | - Tanya K Murphy
- Department of Pediatrics, University of South Florida, St. Petersburg, FL; Department of Psychiatry and Behavioral Neurosciences, University of South Florida, St. Petersburg, FL
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Ung D, Arnold EB, De Nadai AS, Lewin AB, Phares V, Murphy TK, Storch EA. Inter-rater Reliability of the Anxiety Disorders Interview Schedule for DSM-IV in High-Functioning Youth with Autism Spectrum Disorder. J Dev Phys Disabil 2014; 26:53-65. [PMID: 24683302 PMCID: PMC3964621 DOI: 10.1007/s10882-013-9343-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
The present study examined inter-rater agreement on the Anxiety Disorder Interview Schedule DSM-IV Child and Parent Interview (ADIS-IV-C/P) in high-functioning youth with autism spectrum disorder and if age and ASD diagnosis moderated agreement. Diagnoses established for 70 7 to 16-year-old youth with ASD during a live administration of the ADIS-IV-C/P were compared to diagnoses identified by a second rater after listening to audiotaped recordings of the interviews. Clinician-to-clinician agreement on individual parent and child reports was excellent (k=1.00). Inter-rater agreement on principal diagnoses (k=0.91), individual anxiety diagnoses (k=0.85-0.97), and other comorbid diagnoses (i.e., major depressive disorder, dysthymia, oppositional defiant disorder) (k=0.89-1.00) were excellent; agreement did not differ as a function of ASD diagnosis or age. Results suggest good to excellent inter-rater agreement for disorders assessed by the ADIS-IV-C/P.
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Affiliation(s)
| | | | | | - Adam B. Lewin
- University of South Florida, St. Petersburg, FL, USA
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41
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Lewin AB, Piacentini J, De Nadai AS, Jones AM, Peris TS, Geffken GR, Geller DA, Nadeau JM, Murphy TK, Storch EA. Defining clinical severity in pediatric obsessive-compulsive disorder. Psychol Assess 2014; 26:679-84. [DOI: 10.1037/a0035174] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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42
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McGuire JF, Small BJ, Lewin AB, Murphy TK, De Nadai AS, Phares V, Geffken G, Storch EA. Dysregulation in pediatric obsessive compulsive disorder. Psychiatry Res 2013; 209:589-95. [PMID: 23623154 DOI: 10.1016/j.psychres.2013.04.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2012] [Revised: 01/31/2013] [Accepted: 04/04/2013] [Indexed: 10/26/2022]
Abstract
Although obsessive compulsive disorder (OCD) and common co-occurring conditions share deficits in self-regulatory abilities, there has been minimal examination of impaired self-regulation (dysregulation) in youth with OCD. This study examined the association of dysregulation with symptom severity, impairment, and treatment outcome in pediatric OCD. Clinicians assessed obsessive-compulsive severity, family accommodation and global severity in 144 youth with OCD. Youth completed self-report severity ratings of anxiety and depressive symptoms. Parents completed the Child Behavior Checklist (CBCL), and both children and parents completed parallel ratings of obsessive-compulsive impairment. Ninety-seven youth received cognitive behavioral therapy (CBT) and were re-assessed after treatment. Dysregulation was assessed using the CBCL-Dysregulation Profile. Before treatment, dysregulated youth exhibited greater obsessive-compulsive symptom severity, depressive mood, family accommodation, and impairment than non-dysregulated youth. The magnitude of dysregulation directly predicted child-rated impairment, parent-rated impairment, and family accommodation, beyond obsessive-compulsive severity. The magnitude of pretreatment dysregulation predicted treatment discontinuation but not treatment response. Obsessive-compulsive symptom severity and dysregulation level significantly decreased after CBT. Dysregulated youth with OCD presented as more clinically severe than their non-dysregulated counterparts, and may require more individualized interventions to reduce dysregulated behavior to prevent CBT attrition. For treatment completers, CBT was associated with a decrease in dysregulation level.
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Affiliation(s)
- Joseph F McGuire
- Department of Psychology, University of South Florida, Tampa, FL, USA; Department of Pediatrics, University of South Florida, Tampa, FL, USA.
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43
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Storch EA, Goddard AW, Grant JE, De Nadai AS, Goodman WK, Mutch PJ, Medlock C, Odlaug B, McDougle CJ, Murphy TK. Double-blind, placebo-controlled, pilot trial of paliperidone augmentation in serotonin reuptake inhibitor-resistant obsessive-compulsive disorder. J Clin Psychiatry 2013; 74:e527-32. [PMID: 23842022 DOI: 10.4088/jcp.12m08278] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2012] [Accepted: 02/11/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE This pilot study explored the efficacy and tolerability of paliperidone augmentation of serotonin reuptake inhibitors (SRIs) in adults with treatment-resistant obsessive-compulsive disorder (OCD). METHOD Thirty-four patients aged 24-67 years (mean = 43.7 years, SD = 11.4) who met DSM-IV criteria for OCD and remained symptomatic following 2 or more past adequate SRI trials (including their current medication) were enrolled from May 2008 to March 2012. Participants were treated for 8 weeks in a double-blind study with either paliperidone (up to 9 mg/d) or matching placebo in addition to their SRI. Blinded raters conducted outcome assessments. The primary outcome, obsessive-compulsive symptom severity, was assessed using the Yale-Brown Obsessive Compulsive Scale (YBOCS). Secondary outcomes included the Clinical Global Impressions-Severity of Illness and -Improvement scales. RESULTS Paliperidone administration resulted in significant baseline-to-posttreatment reductions in obsessive-compulsive symptoms as measured by the YBOCS (P < .01, d = 0.66), although placebo administration also resulted in medium-sized, trend-level significant YBOCS changes (P = .05, d = 0.53). In exploratory analyses examining between-group differences, tests for paliperidone superiority relative to placebo were not significant (P = .14, d = 0.34); however, a numerical trend toward significant between-group differences was found, with a reduction of 7.98 points on the YBOCS for the paliperidone group compared to a reduction of 4.02 points for the placebo group. Paliperidone was generally well tolerated and not associated with significant weight gain (mean [SD] weight: paliperidone, pretreatment 84.70 [27.08] kg, posttreatment 84.84 [18.99] kg; vs placebo, pretreatment 77.50 [25.33] kg, posttreatment 77.43 [19.90] kg; P = .21). CONCLUSIONS These results suggest that paliperidone augmentation is well tolerated and has potential efficacy in the short-term treatment of some patients with SRI-resistant OCD. Well-powered, randomized, controlled studies are necessary to more definitively address the efficacy of this treatment strategy. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT00632229.
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Affiliation(s)
- Eric A Storch
- Department of Pediatrics, Rothman Center for Neuropsychiatry, University of South Florida, Box 7523, 880 6th St South, St Petersburg, FL 33701, USA.
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Morgan J, Caporino NE, De Nadai AS, Truax T, Lewin AB, Jung L, Park JM, Khan YA, Murphy TK, Storch EA. Preliminary Predictors of Within-Session Adherence to Exposure and Response Prevention in Pediatric Obsessive–Compulsive Disorder. Child Youth Care Forum 2013. [DOI: 10.1007/s10566-013-9196-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Jones AM, De Nadai AS, Arnold EB, McGuire JF, Lewin AB, Murphy TK, Storch EA. Psychometric properties of the obsessive compulsive inventory: child version in children and adolescents with obsessive-compulsive disorder. Child Psychiatry Hum Dev 2013; 44:137-51. [PMID: 22711294 DOI: 10.1007/s10578-012-0315-0] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The psychometric properties of the Obsessive Compulsive Inventory-Child Version (OCI-CV) were examined in ninety-six youth with a primary/co-primary diagnosis of obsessive-compulsive disorder (OCD). A confirmatory factor analysis revealed an acceptable model of fit with factors consisting of doubting/checking, obsessing, hoarding, washing, ordering, and neutralizing. The internal consistency of the OCI-CV total score was good, while internal consistency for subscale scores ranged from poor to good. The OCI-CV was modestly correlated with obsessive-compulsive symptom severity on the Children's Yale-Brown Obsessive Compulsive Scale (CY-BOCS) Severity Scale, as well as with clinician-reported OCD severity. All OCI-CV subscales significantly correlated with the corresponding CY-BOCS Symptom Checklist dimension. The OCI-CV significantly correlated with child-reported depressive symptoms and OCD-related functional impairment, but was not significantly correlated with parent-reported irritability or clinician-reported overall functioning. Taken together, these data suggest the psychometric properties of the OCI-CV are adequate for assessing obsessive-compulsive symptom presence among youth with OCD.
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Affiliation(s)
- Anna M Jones
- Department of Pediatrics, University of South Florida Morsani College of Medicine, Tampa, FL, USA
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46
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Storch EA, Arnold EB, Lewin AB, Nadeau JM, Jones AM, De Nadai AS, Jane Mutch P, Selles RR, Ung D, Murphy TK. The effect of cognitive-behavioral therapy versus treatment as usual for anxiety in children with autism spectrum disorders: a randomized, controlled trial. J Am Acad Child Adolesc Psychiatry 2013; 52:132-142.e2. [PMID: 23357440 DOI: 10.1016/j.jaac.2012.11.007] [Citation(s) in RCA: 139] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2012] [Revised: 11/09/2012] [Accepted: 11/16/2012] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To examine the efficacy of a modular cognitive-behavioral therapy (CBT) protocol relative to treatment as usual (TAU) among children with high-functioning autism spectrum disorders (ASD) and clinically significant anxiety. METHOD A total of 45 children (7-11 years of age) with high-functioning ASD and clinically significant anxiety were randomized to receive 16 sessions of weekly CBT or TAU for an equivalent duration. After screening, assessments were conducted at baseline, post-treatment, and 3-month follow-up. Raters were blind to treatment condition. RESULTS Youth receiving CBT showed substantial improvement relative to TAU on primary anxiety outcomes. Of 24 children randomized to the CBT arm, 18 (75%) were treatment responders, versus only 3 of 21 children (14%) in the TAU arm. Gains were generally maintained at 3-month follow-up for CBT responders. CONCLUSIONS Relative to usual care, CBT adapted for anxious youth with high-functioning ASD demonstrates large effects in reducing anxiety symptoms. This study contributes to the growing literature supporting adapted CBT approaches for treating anxiety in youth with ASD.
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Affiliation(s)
- Eric A Storch
- Department of Pediatrics, Rothman Center for Neuropsychiatry, University of South Florida, St. Petersburg, FL 33701, USA.
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Lewin AB, Peris TS, De Nadai AS, McCracken JT, Piacentini J. Agreement between therapists, parents, patients, and independent evaluators on clinical improvement in pediatric obsessive-compulsive disorder. J Consult Clin Psychol 2012; 80:1103-7. [PMID: 22963592 DOI: 10.1037/a0029991] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Independent evaluators (IE) are used widely in clinical trials to make unbiased determinations of treatment response. By virtue of being kept blind to treatment condition, however, IEs are also kept unaware of many pertinent clinical details that are relevant for decisions about clinical improvement. In this study, agreement among raters (children, parents, therapists, and IEs) about treatment response over the course of a 14-week clinical trial for pediatric obsessive-compulsive disorder (OCD) was examined in order to determine the utility of nonblind clinician and patient ratings of treatment response. METHOD Participants were 71 youth (mean age = 12.2 years; 63.4% female) with a primary diagnosis of OCD and their parents participating in a psychotherapy trial. IEs provided response ratings (Clinician's Global Impressions-Improvement Scale; CGI-I) at Weeks 4, 8, and 14, and therapists, children, and parents completed independent CGI-I ratings at Weeks 2, 4, 8, and 14. RESULTS Nonlinear mixed models revealed differences in rating parties, with therapists and IEs slower to rate treatment improvement compared with children and parents, and growth curve models suggested that therapists and IEs produced generally consistent ratings. In addition, no evidence was found for an Evaluator × Treatment interaction, indicating that raters displayed these differences consistently across both active and placebo conditions. CONCLUSIONS Youth and parents may be able to provide accurate ratings of global improvement; nonblinded treating clinicians (with training in research-oriented assessment) can offer global improvement ratings commensurate with blinded IEs. Findings suggest that alternatives (or additions) to the blinded-IE model may be appropriate for assessing global improvement, especially with the growing emphasis on dissemination and effectiveness trials.
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Affiliation(s)
- Adam B Lewin
- University of South Florida College of Medicine.
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Storch EA, Ehrenreich May J, Wood JJ, Jones AM, De Nadai AS, Lewin AB, Arnold EB, Murphy TK. Multiple informant agreement on the anxiety disorders interview schedule in youth with autism spectrum disorders. J Child Adolesc Psychopharmacol 2012; 22:292-9. [PMID: 22856332 PMCID: PMC3422049 DOI: 10.1089/cap.2011.0114] [Citation(s) in RCA: 77] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The purpose of this study was to examine child, parent, and clinician's consensus agreement on the Anxiety Disorders Interview Schedule, Child and Parent versions (ADIS-C/P) in a sample of children and adolescents with autism spectrum disorders (ASD). METHOD Youth with ASD (n=85; age range=7-17 years) and their parents were each administered the ADIS-C/P by a trained clinician. Consensus diagnoses were determined in a clinical conference using best estimate procedures that incorporated all available information. RESULTS Children and youth with ASD diagnoses generally showed poor diagnostic agreement with parents and clinical consensus, whereas parents showed good-to-excellent diagnostic agreement with clinical consensus diagnoses. Diagnostic agreement between parents and consensus was moderated by the specific ASD diagnosis. Otherwise, the pattern of relationships did not systematically differ as a function of age or externalizing comorbidity. CONCLUSIONS These data suggest that parent and youth agreement regarding the presence of clinical levels of anxiety is markedly poor among youth with ASD. Additionally, clinicians are likely to base their diagnostic impressions on parent report, placing minimal emphasis on child report.
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Affiliation(s)
- Eric A. Storch
- Department of Pediatrics, University of South Florida, St. Petersburg, Florida.,Department of Psychiatry, University of South Florida, St. Petersburg, Florida.,Department of Psychology, University of South Florida, St. Petersburg, Florida
| | | | - Jeffrey J. Wood
- Departments of Education and Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, California
| | - Anna M. Jones
- Department of Pediatrics, University of South Florida, St. Petersburg, Florida
| | | | - Adam B. Lewin
- Department of Pediatrics, University of South Florida, St. Petersburg, Florida.,Department of Psychiatry, University of South Florida, St. Petersburg, Florida
| | - Elysse B. Arnold
- Department of Pediatrics, University of South Florida, St. Petersburg, Florida
| | - Tanya K. Murphy
- Department of Pediatrics, University of South Florida, St. Petersburg, Florida.,Department of Psychiatry, University of South Florida, St. Petersburg, Florida
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Dempsey LE, Karver MS, Labouliere C, Zesiewicz TA, De Nadai AS. Self-Perceived Burden as a Mediator of Depression Symptoms Amongst Individuals Living With a Movement Disorder. J Clin Psychol 2012; 68:1149-60. [DOI: 10.1002/jclp.21901] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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50
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Storch EA, Jones AM, Lack CW, Ale CM, Sulkowski ML, Lewin AB, De Nadai AS, Murphy TK. Rage attacks in pediatric obsessive-compulsive disorder: phenomenology and clinical correlates. J Am Acad Child Adolesc Psychiatry 2012; 51:582-92. [PMID: 22632618 DOI: 10.1016/j.jaac.2012.02.016] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2011] [Revised: 02/13/2012] [Accepted: 02/24/2012] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Rage attacks have been documented in youth with varied psychiatric disorders, but few data have been reported on the clinical characteristics and correlates of rage attacks among children with obsessive-compulsive disorder (OCD). METHOD Participants were 86 children (ages 6-16 years) with a primary diagnosis of OCD. Patients and their primary caregiver were administered clinician-rated measures of obsessive-compulsive severity and rage severity. Children completed the Center for Epidemiologic Studies Depression Scale and the Child Sheehan Disability Scale-Child, whereas parents completed the Rage Attacks Questionnaire, Aberrant Behavior Checklist-Irritability Scale, Children's Affective Lability Scale, and Child Sheehan Disability Scale-Parent. RESULTS Rage was common among youth with OCD and was associated with varied clinical characteristics. Rage severity accounted for functional impairment beyond the influence of obsessive-compulsive symptom severity; however, these relations were explained by the impact of family accommodation. CONCLUSIONS These data suggest that rage attacks are relatively common, have a negative impact on illness presentation, and contribute to functional impairment above and beyond obsessive-compulsive symptom severity. Rage may contribute to family accommodation of symptoms, which may further affect obsessive-compulsive symptom severity and impairment.
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Affiliation(s)
- Eric A Storch
- University of South Florida, 800 6th Street South, St. Petersburg, FL 33701, USA.
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