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Postpartum depression (PPD) affects up to 1 in 8 women. The early postpartum period is characterized by a downward physiological shift from relatively elevated levels of sex steroids during pregnancy to diminished levels after parturition. Sex steroids influence functional brain connectivity in healthy non-puerperal subjects. This study tests the hypothesis that PPD is associated with attenuation of resting-state functional connectivity (rs-fc) within corticolimbic regions implicated in depression and alterations in neuroactive steroid concentrations as compared to healthy postpartum women. Subjects (n = 32) were prospectively evaluated during pregnancy and in the postpartum with repeated plasma neuroactive steroid measurements and mood and psychosocial assessments. Healthy comparison subjects (HCS) and medication-free subjects with unipolar PPD (PPD) were examined using functional magnetic resonance imaging (fMRI) within 9 weeks of delivery. We performed rs-fc analysis with seeds placed in the anterior cingulate cortex (ACC), and bilateral amygdala (AMYG), hippocampi (HIPP) and dorsolateral prefrontal cortices (DLPFCs). Postpartum rs-fc and perinatal neuroactive steroid plasma concentrations, quantified by liquid chromatography/mass spectrometry, were compared between groups. PPD subjects showed attenuation of connectivity for each of the tested regions (i.e. ACC, AMYG, HIPP and DLPFC) and between corticocortical and corticolimbic regions vs. HCS. Perinatal concentrations of pregnanolone, allopregnanolone and pregnenolone were not different between groups. This is the first report of a disruption in the rs-fc patterns in medication-free subjects with PPD. This disruption may contribute to the development of PPD, at a time of falling neuroactive steroid concentrations.

OBJECTIVE: The relatively modest benefit of vasomotor symptom relief in clinical trials of isoflavones may reflect once-daily dosing and low percentages of participants who are able to metabolize daidzein into equol, a potentially more biologically active isoflavone. This pilot study examined whether symptom reduction was greater with more frequent administration and with higher daily doses. In addition, we explored possible effect modification by equol producer status.

METHODS: We randomized 130 perimenopausal (no menses in the past 3 mo) and postmenopausal (≥12 mo of amenorrhea) women with a mean of five or more moderate/severe hot flashes per day to treatment arms with varying total daily isoflavone doses and dosing frequency, separately for equol producers and nonproducers. Participants recorded the daily frequency and severity of hot flashes. Analyses compared mean daily hot flash intensity scores (sum of hot flashes weighted by severity) by total daily dose and by dosing frequency. Dose- and frequency-related differences were also compared for equol producers and nonproducers.

RESULTS: Hot flash intensity scores were lowest in women randomized to the highest total daily dose (100-200 mg) and in women randomized to the highest dosing frequency (twice daily to thrice daily), with greater benefits on nighttime scores than on daytime scores. Dose- and frequency-related differences were somewhat larger in equol producers than in nonproducers.

CONCLUSIONS: These results suggest that a twice-daily to thrice-daily dosing frequency may improve the benefit of isoflavones for vasomotor symptom relief, particularly in equol producers and for nighttime symptoms. Larger studies are needed to confirm these findings.

Biederman and colleagues reported that a CBCL profile identified youngsters who were diagnosed with bipolar disorder. Some studies found that this CBCL profile does not reliably identify children who present with bipolar disorder, but nonetheless this CBCL does identify youngsters with severe dysfunction. However, the nature of the impairment of youngsters who fit this profile is unclear. The goal of this study was to describe the clinical characteristics of youngsters who fit this CBCL profile. The sample included 310 youngsters referred to an outpatient psychopharmacology clinic. There were 55 youngsters who fit the CBCL profile. These youngsters were compared to 255 youngsters who did not fit the CBCL profile. Measures included the CBCL, standardized measures of aggression and ADHD symptoms, youngsters’ self-reported depression, DSM-IV diagnoses, and child and adolescent psychiatrists’ ratings of impairment and functioning. Compared to youngsters who did not fit the CBCL bipolar disorder profile, youngsters who fit the profile had significantly higher scores on all but one CBCL scale and significantly higher levels of aggression. Youngsters who fit the CBCL profile also had greater psychosocial impairment and more DSM-IV diagnoses than youngsters who did not fit the profile. Youngsters who fit the CBCL profile exhibit severe dysregulation across multiple domains of functioning including attention, affective, and behavioral dysregulation that are not easily nor efficiently captured by extant DSM-IV diagnoses. These youngsters are not uncommon and comprise slightly less than 1 in 5 referrals to a child psychiatry clinic.

This study examined whether stressful events occurred during the week preceding admission to an inpatient psychiatric unit in a sample of 97 adults with serious mental illness. The study also examined whether patients who had been readmitted within 30 days reported different stressful events than patients who had lived in the community for at least 6 months prior to admission. A structured interview was developed to obtain information about depressive and psychotic symptoms, stressful events, substance use, and aggressive and disruptive behaviors. Suicide risk was the most common reason for hospitalization (65%). Between 25% and 38% of patients reported interpersonal problems with family members or people outside their family, and about 50% reported financial problems immediately before hospitalization. Comparison of patients who had been readmitted within 30 days with patients who had been living in the community for at least 6 months since their last hospitalization found few differences between these groups. Results indicate that most patients were admitted to an inpatient psychiatric unit because of suicide risk, and interpersonal events seemed to precipitate hospital admission for these patients. (PsycINFO Database Record (c) 2012 APA, all rights reserved)

We examined the relationship of gender and different forms of abuse experience on internalizing symptoms, externalizing symptoms, and IQ in a sample of 397 youngsters who were admitted to a residential treatment program. Three types of abuse experience were examined in this study: sexual abuse only, physical abuse only, and both sexual and physical abuse. Results indicate that girls exhibited higher levels of internalizing and externalizing symptoms even though abuse experience was accounted for in the analyses. Moreover, youngsters who had experienced sexual abuse (but not physical abuse) exhibited higher levels of internalizing and externalizing symptoms than youngsters who had not been abused. Implications for developing individualized interventions based on gender and abuse experience in residential treatment programs is discussed.

Comorbid oppositional defiant disorder (ODD) and conduct disorder (CD) are common in clinically referred children and adolescents with attention-deficit/hyperactivity disorder (ADHD). Early recognition and treatment of co-occurring ADHD and ODD and/or CD is important because comorbidity influences symptom severity, prognosis, and treatment. Research on treatment supports the importance of behavior therapies for ODD and multimodal psychosocial interventions delivered simultaneously and intensively for CD with adjunctive medication for ADHD symptoms. Clinical trials are beginning to show that stimulants and atomoxetine are effective for ADHD and ODD symptoms when the disorders occur together. It is presently unclear if ODD in the absence of ADHD responds to pharmacotherapy. More research is needed examining the effects of commonly prescribed ADHD medications on CD symptoms. Research suggests a high prevalence of lifetime comorbidity with ODD in clinically referred patients with ADHD.

PURPOSE: This study examined whether psychological variables were associated with posttraumatic stress disorder (PTSD) symptoms 3 to 6 months after myocardial infarction.

METHODS: The sample included 52 patients with myocardial infarction. A structured interview was used to obtain information about PTSD symptoms, quality of life, and ratings of perceived control, danger, and predictability, as well as information about stressful events that occurred during hospitalization.

RESULTS: Four patients (7.7%) met criteria for the diagnosis of PTSD. Elevated PTSD scores were associated with poorer quality of life (r = -0.32 to -0.79). Lower perceived control was associated with higher PTSD symptom scores (r = -0.30 to -0.52). Finally, PTSD scores were significantly correlated with the number of times patients were readmitted to the hospital (r = 0.35-0.57).

CONCLUSIONS: Approximately 8% of patients experienced PTSD 3 to 6 months following MI. Increasing levels of PTSD symptoms were correlated with poorer quality of life. Perceived lack of control during the MI and multiple hospitalizations may be related to the severity of PTSD symptoms.

Objective: Healthy People 2020 is a set of objectives with 10-year targets to guide national health promotion and disease prevention efforts. Public health professionals may have limited time to identify relevant research articles on public health strategies. NLM recognized the need to reduce the time and increase the precision of finding research to support evidence-based actions to achieve HP2020 objectives.

Methods: NLM collaborated with the HHS Office of Disease Prevention and Health Promotion to develop pre-formulated search strategies ─ structured evidence queries (SEQs) ─ of PubMed to make research evidence related to HP2020 objectives easier to find. The queries were developed by librarians, working in consultation with subject matter experts in public health. The PubMed search strategies are organized by HP2020 topic areas on the HP2020 SEQ website that is supported by NLM with assistance of the collaboration, Partners in Information Access for the Public Health Workforce. The website also provides search queries for the Healthy People 2020 Leading Health Indicators, a subset of high-priority health issues that represent significant threats to the public’s health. Information to help users learn more about PubMed, obtain full-text copies of articles, and find additional resources for public health practice are provided on the site.

Results: The Healthy People 2020 Structured Evidence Queries website, http://phpartners.org/hp2020, launched in June 2011. As of the end of 2012, structured evidence queries were formulated for 268 health objectives in 24 Healthy People 2020 topic areas, with the expectation of full coverage by May 2013. The SEQs are also integrated with the HHS HealthyPeople.gov website. The PubMed search strategies were designed to return a manageable number of relevant citations for busy public health professionals to review. Users retrieve the most recent research articles indexed for MEDLINE on Healthy People objectives each time a SEQ is selected and run in PubMed. The search strategies can be modified to address particular practice and research needs. The website includes FAQs on how to modify and save searches, obtain copies of articles, and receive assistance from the National Network of Libraries of Medicine. Additional resources on public health topics are available from the Partners in Information Access for the Public Health Workforce website, http://PHPartners.org.

Conclusions: The HP2020 SEQs provide peer-reviewed research evidence to support national objectives for improving the health of all Americans. The resource is the outcome of an effective partnership between librarians, public health professionals, and subject experts.

This study examined predictors of readmission to a general hospital psychiatric unit that provided acute inpatient care. Participants were 370 patients admitted to the inpatient unit over a 15-month period. During this period, 105 (28%) patients were readmitted to the unit. Readmitted patients were compared to patients who were not readmitted on (a) symptom improvement during hospitalization, (b) psychosocial and clinical variables, and (c) length of hospitalization. The readmitted patients presented with levels of psychological symptoms similar to those of patients who were not readmitted. Moreover, readmitted patients and patients who were not readmitted reported comparable relief in symptom severity during hospitalization. Readmitted patients were more likely to have at least one previous psychiatric hospitalization, be unemployed, be participating in day treatment, and receiving medicare and social security disability insurance. Rehospitalization is a significant problem and the patients' self-reported symptomatology is not a major determinant of readmission for inpatient treatment.

Our objective was to investigate the relationship between a lifetime history of traumatic stress, defined as physical and/or sexual abuse and aggression and psychosocial functioning in a sample of clinically referred and nonclinically referred children and adolescents. This is a retrospective case comparison study. Three groups of children were identified, assessed, matched for age, and partially matched for gender. Children clinically referred to residential treatment with a history of abuse (N = 29) were compared with children clinically referred to residential treatment without a history of abuse (N = 29), and a nonclinical group of children residing in the community (N = 29). Variables investigating specific types of aggression, IQ, and psychopathology were assessed across the three groups. Clinically referred children scored worse on all measures compared with nonclinical community children. Clinically referred abused children scored higher on measures of aggression and significantly higher on measures of reactive aggression and verbal aggression than clinically referred nonabused children. Clinically referred abused children had significantly lower verbal IQ scores than clinically referred nonabused children, but no difference in psychopathology. Results support the importance of assessing specific types of aggression in samples of traumatized youths. Verbal information processing may be especially vulnerable in abused children and adolescents and enhance vulnerability to aggressive responding.

Studies of youths in residential treatment that utilize systematic assessments and validated measures are rare. We examined psychopathology, family characteristics, occurrence of physical or sexual abuse, types of aggressive behavior, hyperactive/impulsive behavior, medical and neurological problems, and self-reported drug and alcohol use in 397 youth who were assessed using reliable measures and consecutively treated in a residential treatment center. Results indicate high rates of internalizing and externalizing psychopathology, aggressive behavior, and consistent gender differences, with girls having higher levels of internalizing and externalizing psychopathology and aggressive behavior. The sample was characterized by high rates of medical problems including asthma, seizures, and obesity, as well as evidence of extensive family dysfunction, including high rates of parental alcohol use, violence, and physical or sexual abuse. Residential treatment needs to progress beyond the one size fits all approach and develop more specific and empirically proven treatments for the specific needs of this population.

BACKGROUND: Because of continuing controversy over distinguishing juvenile bipolar disorder (JBD) from disruptive behavior disorders (DBDs) in the clinical setting, we investigated whether referred children with a DBD and a negative mood component could be differentiated from those diagnosed with JBD. The distinction is important because treatments differ.

METHODS: In this single-site sample, 96 children with non-attention-deficit/hyperactivity DBD and depression were compared with 27 JBD children and 187 psychiatric comparison children on measures assessing behavior, functional impairment, symptom severity, psychopathology, and comorbid psychiatric diagnosis.

RESULTS: Few differences were found between children with DBD and depression and those with JBD on measures of conduct problems, oppositionality, aggression, hostility, and psychopathology. More functional impairment was found in the JBD group who also had higher rates of comorbid posttraumatic stress disorder (PTSD), substance use disorders, and suicidality than the other groups.

CONCLUSIONS: These results do not support the specificity of aggression as a defining criterion for JBD and clinicians assessing such patients also should consider complex DBDs with an associated depressive component in the differential diagnosis. Children with JBD must be specifically assessed for comorbid developmental trauma, substance abuse, and suicidality. The association between JBD and PTSD needs further investigation in clinical research.

This chapter focuses on the residential treatment of self-injury and related problems in adolescents.

Although traumatic events, such as combat and physical or sexual assault, are most often associated with posttraumatic stress disorder (PTSD; Kessler, Sonnega, Bromet, Hughes, & Nelson, 1995), a growing body of research indicates that PTSD can occur in individuals with a wide range of life-threatening illnesses (Buckley, Green, & Schnurr, 2004; Tedstone & Tarrier, 2003). The prevalence of PTSD for such medical conditions as myocardial infarction (MI), HIV, or cancer is lower than the prevalence associated with traumatic stressors such as combat or sexual assault, but PTSD can develop in a significant percentage of individuals who experience a life-threatening illness (Tedstone & Tarrier, 2003). In this chapter, we review research on the occurrence of PTSD in adults with cardiac disease. Investigators have been interested in this issue because, for some individuals, the onset of an acute cardiac event shares many features of traumatic events, such as combat or sexual assault. We begin by presenting a description of PTSD and then review research on its occurrence in adults with cardiac disease. This research focuses largely on individuals who have experienced an MI or undergone coronary artery bypass graft surgery (CABG). There have also been a few reports of PTSD in individuals who have survived cardiac arrest. We then examine findings regarding the course of PTSD and risk factors for its development, and we close with a discussion of future research directions and implications for clinical practice. (PsycINFO Database Record (c) 2013 APA, all rights reserved)

Approximately 15% of patients who have had a myocardial infarction (MI) or coronary artery bypass graft surgery are likely to develop Posttraumatic Stress Disorder (PTSD) in the year after the cardiac event and there is substantial evidence linking PTSD with marked distress and poor quality of life. There is some evidence that PTSD is associated with adverse medical outcomes in cardiac patients. Because of the negative impact on quality of life, screening cardiac patients for PTSD is warranted. When PTSD is identified, there are several treatment options, including psychotherapy and pharmacotherapy, particularly with selective serotonin reuptake inhibitors (SSRIs).

The present study explored the role of behavioral self-control techniques in these self-initiated efforts to alleviate depression. Specifically, this study focused on the differences between people who had successfully coped with depression on their own and those who had not.

This paper discusses some of the problems associated with research on depression. Research issues such as subject selection, multimodal assessment, and psychiatric diagnosis are discussed. The relative merits of alternative research methodologies, such as single-case, group, and correlational field designs, are also considered. Finally, some suggestions for the synthesis of research methodologies are offered.

The increasing involvement of psychologists in the treatment of chronic pain has led to the emergence of psychologists as directors of multidisciplinary pain treatment programs. Although the role of pain unit director offers many opportunities to psychologists, several potential problems exist. Relationships with physicians must be carefully addressed; adequate administrative support must be secured; and the requisite clinical privileges must be sanctioned. Without such interprofessional and administrative groundwork, psychologists will have difficulty functioning within a medically dominated health care system. (16 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)

Explored the relationship among the MMPI, the Beck Depression Inventory, and the pain dimensions from the McGill Pain Questionnaire. The instruments were administered to 30 male VA patients with histories of pain for longer than 3 months. Multiple regression analyses that investigated the relationship between depression and the pain measures found no statistically significant correlations. Additionally, the MMPI subscales were not related significantly to the sensory-discriminative pain scores, the cognitive-evaluative pain scores, the present pain intensity scores, the percent of body area in pain, or the total number of pain words endorsed. In contrast, the MMPI subscales were related significantly to the motivational-affective pain dimension and the miscellaneous pain dimension. In the motivational-affective analysis, a significant positive correlation was found for the PT subscale, but a significant negative correlation was found for the Sc subscale. In the miscellaneous pain analysis, a significant positive correlation was found for the Hs subscale. The results are interpreted in the context of cognitive-behavioral conceptualizations of chronic pain.

Recent research has emphasized the importance of interpersonal problems with depression. It has been hypothesized that deficits in interpersonal problem-solving skills may account for many of these problems. Three studies that examined the relationship between problem-solving skills and depression are reported. Problem-solving skills among children, adolescents, and adults were assessed by the Means-Ends Problem Solving Test. Contrary to prediction, there were no differences in problem-solving skills between depressed and nondepressed groups; these findings were consistent across each age group. The external validity of such paper-and-pencil measures of problem solving is questioned; it is suggested that future research focus on how depressed individuals solve real-life problems.