Examining relations between psychopathology and psychopathy dimensions among adolescent female and male offenders

Aim: This study was performed to investigate relations between psychopathology and psychopathy in adolescent female and male detainees. Method: We examined 91 male and 123 female adolescent detainees (aged 14–19) for psychopathology -using the Youth Self Report, the Overt Aggression Scale-Modified and a Conduct Disorder Self Report Scale- and for psychopathic dimensions using the psychopathy checklist youth version (PCL:YV). Based on a linear regression analysis we compared the specific associations between psychopathology and psychopathy in both male and female delinquent juveniles. Results: Our results revealed higher scores for externalizing behavior and psychopathic dimensions in delinquent males, and higher internalizing problem scores in delinquent females. Furthermore, we found a positive relationship between suicidal behavior and the psychopathy total score as well as the affective, the lifestyle and the antisocial dimension only in girls. No association was found for suicidal behavior in boys. Regarding anxious-depressive behavior, we found a negative relation to the psychopathy total score and to the affective psychopathy factor for the boys. Conclusion: Expectedly, the population of incarcerated adolescents exhibited a high prevalence of psychopathology. At the same time our results referred to meaningful gender-related differences with respect to associations with psychopathy. The gender-related differences in psychopathological symptoms could indicate varied subtypes of psychopathy in boys and girls

Lisinopril or Coreg CR in Reducing Cardiotoxicity in Women with Breast Cancer Receiving Trastuzumab: A Rationale and Design of a Randomized Clinical Trial

Background—Trastuzumab (TZB) is an established therapy for HER2 positive breast cancer. The use of TZB is commonly associated with cardiotoxicity manifesting as asymptomatic decrease in left ventricular ejection fraction (LVEF) or overt heart failure. Several studies demonstrated favorable effects of angiotensin converting enzyme (ACE) inhibitors and beta blockers (BB) in the prevention of chemotherapy-induced cardiotoxicity. We hypothesize that patients, randomized to receive an ACE inhibitor or a beta-blocker during trastuzumab therapy for breast cancer, will maintain a higher LVEF than patients randomized to placebo. Methods and Results—We designed a prospective, multicenter, randomized, phase II placebo-controlled clinical trial to evaluate the effects of an ACE inhibitor (lisinopril) and a β-blocker (carvedilol phosphate-extended release) on cardiotoxicity in patients with breast cancer who are receiving adjuvant or neoadjuvant TZB therapy. The primary objectives include 1) comparison of incidence of cardiotoxicity and 2) comparison of LVEF as a continuous variable in between the arms. Cardiotoxicity was defined as an absolute decrease in LVEF from baseline of ≥ 10% at follow-up or an absolute decrease of ≥ 5% in LVEF from baseline for individuals with \u3c 50% LVEF at follow-up. The target accrual is 468 participants, representing patients both with and without anthracycline exposure. The enrollment is completed. The trial is co-sponsored by University of South Florida and National Cancer Institute. The LVEF is being evaluated by echocardiography or multigated acquisition scan. Conclusions—If we can demonstrate that the use of an ACE inhibitor or a BB can reduce the degree of TZB-induced cardiotoxicity it is hoped that patients will receive complete and uninterrupted TZB therapy for breast cancer without compromising cardiac function

Attachment Representation and Emotion Recognition Ability in Children with ADHD and Their Parents: A Study Protocol

Background: Few studies in clinical attachment research to date have examined children with an attention-deficit/hyperactivity disorder (ADHD) diagnosis. This is surprising for two reasons: first, there are a number of parallels between the behaviors of children with an insecure and disorganized attachment and the behaviors of children with an ADHD diagnosis. Second, secure attachment has a positive effect on the development of skills in areas in which children with ADHD demonstrate problems (e.g., attention span, impulse control). There are currently no findings on whether or not and how insecure and disorganized attachment and ADHD affect children's emotion recognition ability. Methods: This is a cross-sectional study, part exploratory and part hypothesis-driven in the context of basic research. A clinical sample of 5- to 10-year-old children with an ADHD diagnosis and their parents is to be compared to a non-clinical unaffected control group. Over a period of 3 years, 80 subjects and their parents are to be recruited in each group for participation in the study. Discussion: This study is the first to examine links between attachment, emotion recognition ability, and ADHD. It is also the first to include not just children with ADHD but also their mothers and fathers in its design. The findings should help reduce the research gap and generate more knowledge for family interventions in the case of ADHD

Reduction of Non-Suicidal Self-Injury (NSSI) in Adolescents with Borderline Personality Organization Treated with TFP-A

This study examines whether transference-focused psychotherapy for adolescents (TFP-A) in a dayclinic setting increases the capability to regulate affects and decreases self-destructive behavior in adolescents with borderline personality organization in comparison to treatment as usual (TAU). A total of 120 adolescents consecutively presenting to the dayclinic were allocated to either TFP-A or MU. 'they were assessed for aggression, irritability, depression, self-harm, internalizing behavior and pathological personality traits at baseline and after twelve weeks. TFP-A was more effective than TAU in reducing self-harm. Aggression and irritability was improved within the treatment group. These results can be explained by an improvement in affect regulation through a treatment with TFP- A in a dayclinic setting. Further research is necessary in order to assess whether TFP-A reduces self-harm, aggressive behavior and irritability from a long-term perspective and whether these exploratory results can be replicated in independent samples

Emotional dysregulation and trauma predicting psychopathy dimensions in female and male juvenile offenders

Background: Psychopathy is a specific syndrome that predicts future violent and aggressive behavior in adults. Studies in youth and adults have demonstrated a strong association between early traumatic incidents and later dissocial behavior. Moreover, the impact of personality pathology and emotional dysregulation on aggressive and violent behavior is well established. However, few studies have addressed the relationship between early traumatization and psychopathic traits in adolescents. Method: The present study examined associations between both general dimensions of personality pathology and early traumatic experiences and the dimensions of psychopathy in 170 male and 171 female adolescent detainees. Results: Analyses revealed associations between physical abuse, emotional dysregulation and psychopathic traits in delinquent boys but not in delinquent girls. Conclusion: Hypothesized relationships between trauma, personality pathology could only be confirmed in the lifestyle and antisocial, but not in the core affective and interpersonal facets of psychopathy

Transference Focused Psychotherapy for Borderline-Adolescents in a Day Clinic Treatment Program

This paper focuses on the concept of transference focused psychotherapy (TFP) modified for juvenile borderline patients. Adolescents with borderline developmental personality disorder (bpd) have an essential deficit in their personality structure that leads to oscillations in their self-esteem and in a split perception of the world. They suffer from a variety of symptoms and severe impairments on their own and their families' quality of life. Their fragmented perception of themselves and others make relationships almost unbearable for them. Relationships are mostly marked by severe anxiety of resentment and rejection. For these patients this causes intolerable trouble at school where every day conflicts take place. Self-mutilation and suicidal thoughts often seem the only way out. By now, there is an agreement that an early specialized assessment and treatment is necessary in order to stop the typical consequences of their self-mutilative and dysfunctional behavior. Still, in contrast to adult age, empirical evidence is missing which proves the effectiveness of treating adolescent borderline patients. In this paper we present a research project on the effectiveness of transference focused psychotherapy with adolescent borderline patients (TFP-A) in a day clinic setting, combining TFP with group skills training as known from dialectic behavior therapy (DBT). Furthermore, we give first results on analyzing the effectiveness of our day clinic treatment program based on TFP-A, focusing on improving core symptoms such as affective problems, aggressive behavior against self and others and interpersonal problems

Identity Diffusion Among Adolescents - Validation of the Inventory of Personality Organization in a Clinical Adolescent Sample (IPO-A)

The main objective of the current study was to analyze the psychometric properties of the German version of the Inventory of Personality Organization for Adolescents (IPO-A). The instrument consisting of 91 items is based on the theoretical structural model by Kernberg and investigates the severity of identity diffusion, reality testing and defense mechanisms in order to determine the level of personality organization. The factor structure, the internal consistency and the convergent validity was measured among 144 inpatients aged between 13 and 18 years drawn from the Child and Adolescent Psychiatry of the University Clinic of Cologne. The investigation revealed a five factor structure: identity diffusion, reality testing, defense mechanisms, aggression and instability of goals. Moreover, testing the psychometric properties of the instrument showed a high internal consistency and meaningful significant correlations with well-validated youth self-report instruments assessing personality pathology and psychopathology. Thus, the results indicate that the IPO-A can be considered to be a reliable instrument that measures personality organization and identity diffusion in adolescents with personality disorders

Differenzierung zwischen Identitätskrise und Identitätsdiffusion und ihre Bedeutung für die Behandlung

The differentiation between an identity crisis, a transient phenomenon that usually results (after resolution) in a well-integrated identity with flexible and adaptive functioning, and an identity diffusion that is viewed as a basis for subsequent personality pathology, has a major impact on the selection of a treatment method. A new treatment method (Adolescent Identity Treatment, AIT), a modification of Transference Focused Psychotherapy, was developed to treat adolescents with identity diffusion in order to improve their relationships with friends, parents, and teachers and to help them acquire positive self-esteem, clarify life goals and establish a stable identity. In a case study we describe the basic approaches of AIT in assessment and treatment