10,271 research outputs found

    The Role of Neurocognitive Tests in the Assessment of Adult Attention-Deficit/Hyperactivity Disorder

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    Despite widespread recognition that attention-deficit/hyperactivity disorder (ADHD) is a lifelong neurodevelopmental disorder, optimal methods of diagnosis among adults remain elusive. Substantial overlap between ADHD symptoms and cognitive symptoms of other mental health conditions, such as depression and anxiety, and concerns about validity in symptom reporting have made the use of neuropsychological tests in ADHD diagnostic assessment appealing. However, past work exploring the potential diagnostic utility of neuropsychological tests among adults has often relied on a relatively small subset of tests, has failed to include symptom and performance validity measures, and often does not include comparison groups of participants with commonly comorbid disorders, such as depression. The current study examined the utility of an extensive neuropsychological measure battery for diagnosing ADHD among adults. Two hundred forty-six participants (109 ADHD, 52 depressed, 85 nondisordered controls) completed a multistage screening and assessment process, which included a clinical interview, self, and informant report on behavior rating scales, performance and symptom validity measures, and an extensive neuropsychological testing battery. Results indicated that measures of working memory, sustained attention, response speed, and variability best discriminated ADHD and non-ADHD participants. While single test measures provided performed poorly in identifying ADHD participants, analyses revealed that a combined approach using self and informant symptom ratings, positive family history of ADHD, and a reaction time (RT) variability measure correctly classified 87% of cases. Findings suggest that neuropsychological test measures used in conjunction with other clinical assessments may enhance prediction of adult ADHD diagnoses

    The unified protocol for transdiagnostic treatment of emotional disorders compared with diagnosis-specific protocols for anxiety disorders a randomized clinical trial

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    IMPORTANCE: Transdiagnostic interventions have been developed to address barriers to the dissemination of evidence-based psychological treatments, but only a few preliminary studies have compared these approaches with existing evidence-based psychological treatments. OBJECTIVE: To determine whether the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (UP) is at least as efficacious as single-disorder protocols (SDPs) in the treatment of anxiety disorders. DESIGN, SETTING, AND PARTICIPANTS: From June 23, 2011, to March 5, 2015, a total of 223 patients at an outpatient treatment center with a principal diagnosis of panic disorder with or without agoraphobia, generalized anxiety disorder, obsessive-compulsive disorder, or social anxiety disorder were randomly assigned by principal diagnosis to the UP, an SDP, or a waitlist control condition. Patients received up to 16 sessions of the UP or an SDP for 16 to 21 weeks. Outcomes were assessed at baseline, after treatment, and at 6-month follow-up. Analysis in this equivalence trial was based on intention to treat. INTERVENTIONS: The UP or SDPs. MAIN OUTCOMES AND MEASURES: Blinded evaluations of principal diagnosis clinical severity rating were used to evaluate an a priori hypothesis of equivalence between the UP and SDPs. RESULTS: Among the 223 patients (124 women and 99 men; mean [SD] age, 31.1 [11.0] years), 88 were randomized to receive the UP, 91 to receive an SDP, and 44 to the waitlist control condition. Patients were more likely to complete treatment with the UP than with SDPs (odds ratio, 3.11; 95% CI, 1.44-6.74). Both the UP (Cohen d, −0.93; 95% CI, −1.29 to −0.57) and SDPs (Cohen d, −1.08; 95% CI, −1.43 to −0.73) were superior to the waitlist control condition at acute outcome. Reductions in clinical severity rating from baseline to the end of treatment (ÎČ, 0.25; 95% CI, −0.26 to 0.75) and from baseline to the 6-month follow-up (ÎČ, 0.16; 95% CI, −0.39 to 0.70) indicated statistical equivalence between the UP and SDPs. CONCLUSIONS AND RELEVANCE: The UP produces symptom reduction equivalent to criterion standard evidence-based psychological treatments for anxiety disorders with less attrition. Thus, it may be possible to use 1 protocol instead of multiple SDPs to more efficiently treat the most commonly occurring anxiety and depressive disorders.This study was funded by grant R01 MH090053 from the National Institute of Mental Health. (R01 MH090053 - National Institute of Mental Health)First author draf

    Psychometrics in Practice at RCEC

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    A broad range of topics is dealt with in this volume: from combining the psychometric generalizability and item response theories to the ideas for an integrated formative use of data-driven decision making, assessment for learning and diagnostic testing. A number of chapters pay attention to computerized (adaptive) and classification testing. Other chapters treat the quality of testing in a general sense, but for topics like maintaining standards or the testing of writing ability, the quality of testing is dealt with more specifically.\ud All authors are connected to RCEC as researchers. They present one of their current research topics and provide some insight into the focus of RCEC. The selection of the topics and the editing intends that the book should be of special interest to educational researchers, psychometricians and practitioners in educational assessment

    Elucidating the efficacy and response to social cognitive training in recent-onset psychosis

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    Neurocognitive deficits are one of the core features of psychosis spectrum disorders (PSD), and they are predictive of poor functional outcome and negative symptoms many years later (Green, Kern, Braff, Mintz, 2000). Neurocognitive interventions (NCIs) have emerged in the last two decades as a strong potential supplementary treatment option to improve cognitive deficits and drop in functioning affecting patients with PSD. Social cognitive training (SCT) involving e.g., facial stimuli, has gained considerably more attention in recent studies than computerized NCIs, that use basic visual or auditory stimuli. This is due to the complex character of social cognition (SC) that draws on multiple brain structures involved in behaviors and perception beyond default cognitive function. SC is also tightly interlinked with psychosocial functioning. Although they are cost-effective and quite independent of clinical staff, such technological approaches as SCT are currently not integrated into routine clinical practice. Recent studies have mapped the effects of SCT in task-based studies on multiple brain regions such as the amygdala, putamen, medial prefrontal cortex, and postcentral gyrus (Ramsay MacDonald III, 2015). Yet, the degree to which alterations in brain function are associated with response to such interventions is still poorly understood. Importantly, resting-state functional connectivity (rsFC) may be a viable neuromarker as it has shown greater sensitivity in distinguishing patients from healthy controls (HC) across neuroimaging studies, and is relatively easy to administer especially in patients with acute symptoms (Kambeitz et al., 2015). In this dissertation, we employed 1) a univariate statistical approach to elucidate the efficacy of a 10-hour SCT in improving cognition, symptoms, functioning and the restoration of rsFC in patients undergoing SCT as compared to the treatment as usual (TAU) group, and 2) multivariate methods. In particular, we used a Support Vector Machine (SVM) approach to neuromonitor the recovery of rsFC in the SCT group compared to TAU. We also investigated the potential utility of rsFC as a baseline (T0) neuromarker viable of predicting role functioning approximately 2 months later. First, current findings suggest a 10-hour SCT has the capability of improving role functioning in recent-onset psychosis (ROP) patients. Second, we have shown intervention-specific rsFC changes within parts of default mode and social cognitive network. Moreover, patients with worse SC performance at T0 showed greater rsFC changes following the intervention, suggestive of a greater degree of rsFC restoration potential in patients with worse social cognitive deficits. Third, when referring to neuromonitoring results, it is important to state that only greater transition from ROP to ?HC-like? SVM decision scores, based on the resting-state modality, was paralleled by intervention specific significantly greater improvement in global cognition and attention. Finally, we were able to show the early prediction of good versus poor role functioning is feasible at the individual subject level using a rsFC-based linear SVM classifier with a Balanced Accuracy (BAC) of 74 %. This dissertation sheds light on the effects and feasibility of a relatively short computerized SCT, and the potential utility of multivariate pattern analysis (MVPA) for better clinical stratification of predicted treatment response based on rsFC neuromarkers

    Neurocognitive impairment is associated with lower health literacy among persons living with HIV infection.

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    This study sought to determine the effects of HIV-associated neurocognitive disorders (HAND) on health literacy, which encompasses the ability to access, understand, appraise, and apply health-related information. Participants included 56 HIV seropositive individuals, 24 of whom met Frascati criteria for HAND, and 24 seronegative subjects who were comparable on age, education, ethnicity, and oral word reading. Each participant was administered a brief battery of well-validated measures of health literacy, including the Expanded Numeracy Scale (ENS), Newest Vital Sign (NVS), Rapid Estimate of Adult Literacy in Medicine (REALM), and Brief Health Literacy Screen (BHLS). Results revealed significant omnibus differences on the ENS and NVS, which were driven by poorer performance in the HAND group. There were no significant differences on the REALM or the BHLS by HAND status. Among individuals with HAND, lower scores on the NVS were associated with greater severity of neurocognitive dysfunction (e.g., working memory and verbal fluency) and self-reported dependence in activities of daily living. These preliminary findings suggest that HAND hinders both fundamental (i.e., basic knowledge, such as numeracy) and critical (i.e., comprehension and application of healthcare information) health literacy capacities, and therefore may be an important factor in the prevalence of health illiteracy. Health literacy-focused intervention may play an important role in the treatment and health trajectories among persons living with HIV infection

    Neural Alterations Influencing Skilled Reading In Adhd: A Task-Based Fmri Study

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    Attention-Deficit/Hyperactivity Disorder (ADHD) is a heterogeneous, neurodevelopmental disorder which co-occurs often with Reading Disability (RD). ADHD with and without RD consistently have higher inattentive ratings compared with typically developing controls, with co-occurring ADHD and RD (ADHD/+RD) also demonstrating impaired phonological processing. Accordingly, inattention has been associated with greater phonological impairment, though neither the neural correlates of the co-occurring disorders nor the association are well understood from a functional neuroimaging perspective. The goal was to assess to what extent ADHD/+RD differ from ADHD without RD (ADHD/-RD) and typically developing controls (TDC) in functional activation of attention- and reading-related areas during various tasks. The general hypothesis was that ADHD/+RD would show more extensive alterations in attention-related areas and unique alterations in reading-related areas compared with the other two groups. The results indicated differences between ADHD/+RD and ADHD/-RD in attention processing; ADHD/-RD showed greater activation of frontoparietal areas for digit and word rhyming continuous performance fMRI tasks. Additionally, though some dysfunction was observed in decoding-related areas in ADHD/+RD relative to TDC, the results showed greater evidence of other cognitive impairments influencing decoding abilities across the ADHD/+RD and ADHD/-RD. Once the groups were re-characterized to reflect relative reading abilities in decoding and word recognition, specific cognitive and functional activation profiles surfaced for three groups: Balanced, Decoders, and Sight Readers. Two findings contribute to a better understanding of ADHD and RD. First, the functional activation differences between the ADHD subgroups suggest that RD needs to be characterized specifically in ADHD neuroimaging studies and that non-linguistic stimuli should be used to mitigate RD-related confounds in ADHD studies. Second, the role of cognitive impairments, including the level of inattention, on phonology requires clarification from a neuroimaging perspective. Lastly, the novel Reading Tendency Index provides an estimation of an individual\u27s preferred strategy for single word reading without the influence of variable processing speeds. The Index corresponds with predictable neural activations and has implications for instructional and remediation practices

    Integrating the Hierarchical Taxonomy of Psychopathology (HiTOP) Into Clinical Practice

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    Objective: Diagnosis is a cornerstone of clinical practice for mental health care providers, yet traditional diagnostic systems have well-known shortcomings, including inadequate reliability, high comorbidity, and marked within-diagnosis heterogeneity. The Hierarchical Taxonomy of Psychopathology (HiTOP) is a data-driven, hierarchically based alternative to traditional classifications that conceptualizes psychopathology as a set of dimensions organized into increasingly broad, transdiagnostic spectra. Prior work has shown that using a dimensional approach improves reliability and validity, but translating a model like HiTOP into a workable system that is useful for health care providers remains a major challenge. / Method: The present work outlines the HiTOP model and describes the core principles to guide its integration into clinical practice. Results: Potential advantages and limitations of the HiTOP model for clinical utility are reviewed, including with respect to case conceptualization and treatment planning. A HiTOP approach to practice is illustrated and contrasted with an approach based on traditional nosology. Common barriers to using HiTOP in real-world health care settings and solutions to these barriers are discussed. / Conclusions: HiTOP represents a viable alternative to classifying mental illness that can be integrated into practice today, although research is needed to further establish its utility

    Effect of Race and Sex on Primary Care Physicians' Diagnosis and Treatment of Late-Life Depression

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    To examine primary care physician (PCP) contributions toward racial and sex differences in the diagnosis and treatment of late-life depression. Design : Survey using a computerized instrument incorporating video interviews and text, with volunteer PCPs randomly assigned to one of four standardized video vignettes of an elderly patient depicting late-life depression. Vignettes differed only in the patient/actor's race (white/African-American) or sex. Setting : American Academy of Family Physicians meeting, San Diego, California, 2002. Participants : One hundred seventy-eight U.S.-practicing postresidency PCPs who were asked to participate in a clinical decision-making study. Measurements : The computerized survey instrument assessed PCPs' diagnoses, first-line treatment and management recommendations, and judgment of personal characteristics/behaviors for the patients in the vignettes. Results : Eighty-five percent of all PCPs correctly diagnosed the elderly patient(s) with major depression. There were no significant differences in the diagnosis of depression, treatment recommendations, or PCP assessment of most patient characteristics by the race or sex of the patient/actor in the vignette, but PCP characteristics, most notably the location of medical school training (U.S. vs international), affected the likelihood of a depression diagnosis and treatment recommendations. Conclusion : Given standardized symptom-pictures, PCPs are just as likely to diagnose and treat depression in African-American as in white older people, suggesting that bias based simply on apparent patient race is not a likely explanation for the lower rates of depression diagnosis and treatment in older African Americans. PCPs who have trained at international medical schools may benefit from targeted training initiatives on the diagnosis and treatment of late-life depression.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/65962/1/j.1532-5415.2005.53255.x.pd
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