The entry for nonsuicidal self-injury (NSI) disorder in the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) provides a criterion-based definition of clinically relevant NSI. NSI disorder is currently classified in the DSM-5 as a condition requiring further study. The present study aimed to examine the reliability, validity, and clinical utility of a self-report measure of NSI disorder, the Alexian Brothers Assessment of Self-Injury (ABASI). The sample included 511 patients admitted to an acute care treatment program designed to treat NSI. Patients were administered the ABASI as part of a clinical assessment and routine outcome evaluation. The sample included a broad age range, as well as sufficient numbers of males and Hispanics to examine sociodemographic differences. The ABASI demonstrated adequate internal consistency and test-retest reliability, and the factor structure reflects NSI disorder criteria. Among patients being treated for NSI, 74% met criteria for NSI disorder. No differences in the rate of NSI disorder were observed by sex, ethnicity, or age. Although NSI disorder is associated with a worse presentation of self-injurious behavior, NSI disorder provides limited clinical utility as a dichotomous diagnosis, at least when compared with common NSI characteristics such as number of methods of NSI and the urge to self-injure. Instead, findings support a dimensional approach to NSI disorder. Analyses of specific symptoms of NSI disorder indicate concerns with Criterion B as currently defined by the DSM-5. Recommendations for a more parsimonious revision of NSI disorder are discussed. (PsycINFO Database Record (c) 2014 APA, all rights reserved).
Cognitive functioning affects health. This study assessed cognitive functioning among participants in the Northwestern Juvenile Project, a stratified random sample of 1,829 newly detained juveniles (10 to 18 years old) from Cook County, Illinois. The study examined receptive vocabulary, oral reading, arithmetic computation skills, and general intellectual abilities. The sample exhibited impaired overall intellectual functioning and deficits in all areas. Males performed more poorly than females. More than three quarters of males showed below average overall intellectual functioning, and 9 in 10 had below average receptive vocabulary skills. Hispanic and African American males performed more poorly than non-Hispanic White males. The multiple systems that serve delinquent youth--correctional, health, legal, and rehabilitative--must collaborate to tailor needed services to the cognitive level of youth in the juvenile justice system.
We use longitudinal multilevel modeling to test how exposure to community violence and cognitive and behavioral factors contribute to the development of aggressive and prosocial behaviors. Specifically, we examine predictors of self-, peer-, and teacher-reported aggressive and prosocial behavior among 266 urban, African American early adolescents. We examine lagged, within-person, between-person, and protective effects across 2 years. In general, results suggest that higher levels of violence exposure and aggressive beliefs are associated with more aggressive and less prosocial peer-reported behavior, whereas greater self-efficacy to resolve conflict peacefully is associated with less aggression across reporters and more teacher-reported prosocial behavior. Greater knowledge and violence prevention skills are associated with fewer aggressive and more prosocial teacher-reported behaviors. Results also suggest that greater self-efficacy and lower impulsivity have protective effects for youth reporting higher levels of exposure to community violence, in terms of teacher-reported aggressive behavior and peer-reported prosocial behavior. Differences among reporters and models are discussed, as well as implications for intervention.
AIM: To review the diagnosis and the pharmacologic and psychosocial interventions for pediatric bipolar disorder (PBD). METHODS: A comprehensive literature review of studies discussing the diagnosis and treatment of PBD was conducted. RESULTS: A context for understanding controversies and difficulties in the diagnosis of PBD is provided. An evidence-based assessment protocol for PBD is reviewed. The evidence for the following three categories of pharmacologic interventions are reviewed: Lithium, antiepileptics, and second generation antipsychotics. Algorithms for medication decisions are briefly reviewed. Existing psychosocial treatments and the evidence for those treatments are also reviewed. CONCLUSION: Despite recent developments in understanding the phenomenology of PBD and in identifying pharmacologic and psychosocial interventions, critical gaps remain.
The misdiagnosis of pediatric bipolar disorder (PBD) has become a major public health concern. Would available evidence-based assessment (EBA) strategies help improve diagnostic accuracy, and are clinicians willing to consider these strategies in practice? The purpose of the present study was to document the extent to which using an EBA decision tool--a probability nomogram--improves the interpretation of family history and test data by clinicians and to examine the acceptability of the nomogram technique to clinicians. Over 600 clinicians across the US and Canada attending continuing education seminars were trained to use the nomogram. Participants estimated the probability that a youth in a clinical vignette had bipolar disorder, first using clinical judgment and then using the nomogram. Brief training of clinicians (less than 30 minutes) in using the nomogram for assessing PBD improved diagnostic accuracy, consistency, and agreement. The majority of clinicians endorsed using the nomogram in practice. EBA decision aids, such as the nomogram, may lead to a significant decrease in overdiagnosis and help clinicians detect true cases of PBD.
This study examines sudden gains (SGs), or rapid improvements in symptoms, among adults in treatment for depression in a partial hospitalization program (PHP). This study identifies the proportion of people who experience SGs in a PHP, when SGs occur in treatment, and the association of SGs with outcomes at the end of treatment.
The purpose of this study was to evaluate the psychometric properties of a measure, the Alexian Brothers Urge to Self-Injure Scale (ABUSI). The ABUSI was designed to assess the severity of the urge to engage in non-suicidal self-injury. Non-suicidal self-injury is the deliberate damage of body tissue that is not sanctioned by society and is devoid of an active intent to die. Participants included 386 adolescent and adult patients (90.7% female, 86.3% non-Hispanic white) admitted to a psychiatric facility for the treatment of non-suicidal self-injury. Patients were administered the ABUSI as well as measures of the frequency of self-injury, quality of life and satisfaction, functional impairment, and suicidal ideation at admission and discharge as part of routine clinical assessment. Results provide preliminary support for the reliability and validity of the ABUSI as a measure of the intensity of the urge to self-injure. Specifically, the ABUSI demonstrated adequate internal consistency, test-retest reliability, sensitivity to change, and convergent, predictive, and incremental validity. Findings suggest the ABUSI is a promising tool for both clinical assessment and research.
Psychiatric disorders are prevalent among incarcerated juveniles. Most juveniles eventually return to their communities, where they become the responsibility of the community mental health system. However, no large-scale study has examined psychiatric disorders after youth leave detention.
Non-suicidal self-injury (NSSI) among adolescents is gaining increasing attention in both clinical and scientific arenas. The lifetime prevalence of NSSI is estimated to vary between 7.5% to 8% for preadolescents, increasing to between 12% and 23% for adolescents. Despite the prevalence and the increasing interest in NSSI, few psychotherapeutic treatments have been designed specifically for NSSI, and no treatments have been evaluated specifically for the treatment of NSSI among adolescents. Consequently, child and adolescent clinicians are left with little evidence-based guidance for treating this challenging population. To provide some guidance, evaluations of treatments for adults with NSSI and for adolescents with related conditions, such as deliberate self-harm and borderline personality disorder, are reviewed. Clinical guidelines and resources are also discussed to assist with the gaps in the knowledge base for treatment of NSSI among adolescents.
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