Showing papers in "Annual Review of Clinical Psychology in 2008"

Ecological Momentary Assessment

Abstract: Assessment in clinical psychology typically relies on global retrospective self-reports collected at research or clinic visits, which are limited by recall bias and are not well suited to address how behavior changes over time and across contexts. Ecological momentary assessment (EMA) involves repeated sampling of subjects’ current behaviors and experiences in real time, in subjects’ natural environments. EMA aims to minimize recall bias, maximize ecological validity, and allow study of microprocesses that influence behavior in real-world contexts. EMA studies assess particular events in subjects’ lives or assess subjects at periodic intervals, often by random time sampling, using technologies ranging from written diaries and telephones to electronic diaries and physiological sensors. We discuss the rationale for EMA, EMA designs, methodological and practical issues, and comparisons of EMA and recall data. EMA holds unique promise to advance the science and practice of clinical psychology by shedding ligh...

Psychopathy as a clinical and empirical construct.

Abstract: In this review, we focus on two major influences on current conceptualizations of psychopathy: one clinical, with its origins largely in the early case studies of Cleckley, and the other empirical, the result of widespread use of the Hare Psychopathy Checklist-Revised (PCL-R) for assessment purposes. Some investigators assert that the PCL-R, ostensibly based on Cleckley’s work, has “drifted” from the construct described in his Clinical Profile. We evaluate this profile, note its basis in an unrepresentative sample of patients, and suggest that its literal and uncritical acceptance by the research community has become problematical. We also argue that the idea of construct “drift” is irrelevant to current conceptualizations of psychopathy, which are better informed by the extensive empirical research on the integration of structural, genetic, developmental, personality, and neurobiological research findings than by rigid adherence to early clinical formulations. We offer some suggestions for future research on psychopathy.

Disorders of childhood and adolescence: gender and psychopathology.

Abstract: Early-onset disorders (e.g., conduct problems, autism) show a marked male preponderance, whereas adolescent-onset disorders (e.g., depression, anxiety) show a marked female preponderance. A developmental psychopathology framework provides a means to investigate complex gender-related etiologies of these different disorders. This review focuses on biological and environmental factors implicated in the development of conduct problems and depression in boys and girls. Boys and girls showed certain differences in types, rates, comorbidities, antecedents, correlates, and trajectories of these problems. Origins of male and female preponderant problems are likely to be rooted, in part, in biological, physical, cognitive, and social-emotional differences in boys and girls that can precede the expression of clinical problems. These male-like and female-like characteristics are considered regarding conduct problems and depression to explore how they inform biological and environmental theories about gender and psyc...

Stress and the hypothalamic pituitary adrenal axis in the developmental course of schizophrenia.

Abstract: Diathesis-stress models of schizophrenia and other psychotic disorders have dominated theorizing about etiology for over three decades. More recently, with advances in our understanding of the biological processes mediating the effects of stress, these models have incorporated mechanisms to account for the adverse impact of stress on brain function. This review examines recent scientific findings on the role of the hypothalamic-pituitary-adrenal (HPA) axis, one of the primary neural systems triggered by stress exposure, in the expression of vulnerability for schizophrenia. The results indicate that psychotic disorders are associated with elevated baseline and challenge-induced HPA activity, that antipsychotic medications reduce HPA activation, and that agents that augment stress hormone (cortisol) release exacerbate psychotic symptoms. The cumulative findings are discussed in light of a neural diathesis-stress model that postulates that cortisol has the potential to increase activity of dopamine pathways that have been implicated in schizophrenia and other psychotic disorders.

Behavioral Disinhibition and the Development of Early-Onset Addiction: Common and Specific Influences

Abstract: Research on substance use disorders is often compartmentalized, focused on understanding addiction to one substance or substance class at a time. Although this approach has contributed significantly to knowledge about addictions, early-onset substance use disorders appear to share common etiology with each other and with other disorders, traits, behaviors, and endophenotypes associated with behavioral disinhibition. We propose that a common genetic liability to behavioral disinhibition underlies the co-occurrence of these externalizing attributes. This liability is expressed in part through brain mechanisms related to cognitive control, impulsivity, and sensitivity to reward, all of which are maturing during adolescence. During this important transitional period, problem behaviors emerge, including the initiation of substance use. Exposure to various environmental risks further amplifies the risk associated with the common liability, increasing the likelihood of addiction generally. Specific environmental and genetic factors ultimately contribute to the differentiation among externalizing disorders.

Modern approaches to conceptualizing and measuring human life stress.

Abstract: The idea that adverse life circumstances and negative life events contribute to disorder and disease has long been held. Advances in conceptualizing and defining these conditions under the common label of life stress have led to progress in measuring both the environmental and individual response characteristics that may promote disorder and disease. In general, a substantial and growing research literature supports the basic premise that life stress plays an important role in the development of many psychological and physical problems. Recent research, too, strongly suggests that interest in life stress in relation to health and disease will accelerate over the coming years. Yet debates and controversies remain concerning how to best conceptualize and measure life stress, which presents distinctive challenges for advancing the field. The present review examines the major issues pertaining to these debates, controversies, and challenges, for they will be crucial to resolve if progress is to be made in und...

Stigma as related to mental disorders.

Abstract: Individuals with mental illness receive harsh stigmatization, resulting in decreased life opportunities and a loss of independent functioning over and above the impairments related to mental disorders themselves. We begin our review with a multidisciplinary discussion of mechanisms underlying the strong propensity to devalue individuals displaying both deviant behavior and the label of mental illness. Featured is the high potential for internalization of negative perceptions on the part of those with mental disorders—i.e., self-stigmatization. We next focus on several issues of conceptual and practical relevance: (a) stigma against less severe forms of mental disorder; (b) the role of perceptions of dangerousness related to mental illness; (c) reconciliation of behavioral research with investigations of explicit and implicit attitudes; (d) evolutionary models and their testability; (e) attributional accounts of the causes of mental illness, especially to personal control versus biogenetic factors; and (f)...

Cost-Effective Early Childhood Development Programs from Preschool to Third Grade

Abstract: Although findings on the positive effects of early childhood development programs have been widely disseminated, less attention has been given to program impacts across the entire period of early childhood. This review summarizes evidence on the effects and cost-effectiveness of programs and services from ages 3 to 9. The major focus is preschool programs for 3- and 4-year-olds, full-day kindergarten, school-age programs including reduced class sizes, and preschool-to-third-grade interventions. Participation in preschool programs was found to have relatively large and enduring effects on school achievement and child well-being. High-quality programs for children at risk produce strong economic returns ranging from about $4 per dollar invested to over $10 per dollar invested. Relative to half-day kindergarten, the positive effects of full-day kindergarten have been found to be relatively small and generally do not last for more than a year. Although no formal economic analyses have been conducted, the economic return per dollar invested would be expected to be close to zero. Among early-school-age programs, preschool plus school-age interventions (PK-3) for children at risk are linked to higher levels of school performance into adolescence. The Child-Parent Center PK-3 Program shows a return of $6 to $9 per dollar invested. Class-size reductions show evidence of positive effects, with economic returns of roughly $3 per dollar invested. The causal mechanisms of long-term effects are discussed. Key principles to promote intervention effectiveness are offered.

Should binge eating disorder be included in the DSM-V? A critical review of the state of the evidence.

Abstract: Binge eating disorder (BED) was introduced in 1994 as a provisional eating disorder diagnosis. The core symptom is recurrent binge eating in the absence of inappropriate compensatory behaviors and/or extreme dietary restraint. This review examines the status of the literature on BED according to five criteria that have been proposed to determine whether BED warrants inclusion in the psychiatric nosology as a distinct eating disorder. We conclude that each of these criteria was met. There is a commonly accepted definition of and assessment approach to BED. The clinical utility and validity of BED have been established, and BED is distinguishable from both bulimia nervosa and obesity. BED should be included in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders.

Pediatric Bipolar Disorder

Abstract: In the past decade, interest in and research on pediatric bipolar disorder (BD) has increased substantially. Prevalence rates of the disorder have doubled in outpatient settings, while twice as many research articles on pediatric BD were published in the past five years as in the prior decade. This review focuses on recent developments in the study of pediatric BD. We examine current research on the diagnostic boundaries of BD in youths, in particular the issues of episodicity and irritability, and provide assessment guidelines. We review data elucidating the pathophysiology of pediatric BD, with a focus on how these results may inform diagnosis. Finally, we discuss treatment approaches for pediatric BD, particularly psychotherapeutic interventions. Throughout the review, we pay particular attention to youths with severe chronic irritability, hyperarousal, and hyperreactivity, who reflect the population in whom the diagnosis of BD is most debated.

Pharmacotherapy of mood disorders.

Abstract: The mood disorders-primarily major depressive disorder and bipolar affective disorder-constitute one of the world's greatest public health problems and are associated with significant reductions in productivity, health, and longevity. In addition, people who suffer from these common illnesses, along with their families and loved ones, experience an incalculable toll on quality of life. Dating to the introduction of the first effective therapies for mood disorders in the late 1950s and 1960s, various types of pharmacotherapy have become a mainstay for the management of mood disorders, particularly more severe, chronic, and recurrent forms of depression and most forms of bipolar disorder. This review examines recent developments in the pharmacotherapy of both forms of mood disorder, comparing the newer antidepressants such as the selective serotonin reuptake inhibitors and serotonin norepinephrine reuptake inhibitors with their predecessors (the monoamine oxidase inhibitors and tricyclic antidepressants) and likewise comparing the older standard for management of bipolar disorder, lithium, with newer classes of medications, such as a selected group of anticonvulsants and the atypical antipsychotics. Although these newer classes of medications have generally improved upon the earlier treatments in terms of better tolerability and safety, there are no universally effective pharmacologic treatments for mood disorders, and careful medical management of these medications is still warranted.

Psychosocial and biobehavioral factors and their interplay in coronary heart disease.

Abstract: Recent epidemiological research has confirmed that psychosocial factors are associated with increased risk of developing coronary heart disease (CHD), a major cause of death and disability worldwide. This association is probably mediated by changes in health risk behaviors and neuroendocrine and autonomic functions that affect metabolic, hemostatic, inflammatory, and cardiovascular functions that are the proximal agents in CHD pathogenesis over time as well as the precipitation of acute disease events. Recent developments in genomics have now made it possible to begin the process of identifying specific genetic variants that act either independently or via moderation of the impact of exposures to stressful environmental situations to increase the expression of these health-damaging psychosocial factors and the accompanying behavioral and physiological changes that lead to disease. It will be possible ultimately to use the knowledge emerging from research on gene x environment interactions that affect expr...

The Behavioral Genetics of Personality Disorder

Abstract: Behavioral genetics research has opened a new window on understanding personality disorder. The earliest studies were focused on establishing the relative contributions of genes and the environment in these disorders. Although these studies provided solid evidence of the importance of genetic and environmental influences on personality disorder and showed that all aspects of personality disorder are subject to genetic influence, heritability studies are limited because they are not helpful in explicating causal mechanisms. More recent research has focused on the relative contributions of the covariation of personality disorder diagnoses and traits, which allows one to examine etiological relationships. These developments are leading to major changes in ideas about what constitutes the environment and nature of the interplay between genes and environment. The present review examines major themes in this growing body of research in the context of current issues in the personality disorders.

The empirical status of psychodynamic therapies.

Abstract: The goal of the current review is to examine the evidence for the efficacy of dynamic psychotherapy, primarily focusing on studies that meet the rigorous criteria proposed by Chambless & Hollon (1998). We examine whether any progress has been made over the past decade in evaluating the efficacy of dynamic psychotherapy using well-controlled randomized designs. Over the past decade, multiple studies have been published supporting the efficacy of dynamic psychotherapy for the treatment of specific mental disorders. Dynamic psychotherapy should now be included as a possibly efficacious treatment for panic disorder and borderline personality disorder, as well as the original designation of possibly efficacious in the treatment of opiate dependence. In the context of medication usage, dynamic psychotherapy should be considered efficacious in the treatment of major depressive disorder (MDD). Studies suggest that dynamic psychotherapy has great promise as a monotherapy for MDD and alcohol dependence and thus should be evaluated further.