Atypical and Severe Nonsuicidal Self-Injury as an Indicator of Severe Psychopathology: Findings From a Sample of High-Risk Community Mental Health Clients

This study examined whether atypical/severe nonsuicidal self-injury (NSSI; e.g., foreign body ingestion, cutting necessitating sutures) serves as a marker of severe psychopathology among 467 adult community mental health clients (n = 33 with an atypical/severe NSSI history). Information regarding psychiatric risk indicators was extracted from participants’ psychiatric records. Generalized linear models with negative binomial distribution and log link function, as well as chi-square tests, were used to address study aims. Clients with a lifetime atypical/severe NSSI history met criteria for a significantly greater number of psychiatric risk indicators than clients with a lifetime history of common NSSI only; however, these clients were not significantly more likely to report recent suicidal actions. Individuals with an atypical/severe NSSI history may demonstrate more severe psychopathology than those with a history of common NSSI only. Thus, it may be clinically useful to consider individuals with an atypical/severe NSSI history as a high-risk subgroup

Posttraumatic stress disorder-like symptoms 1 week to 3 months after myocardial infarction

In DSM-IV, the revised criteria for PTSD allow for “being exposed to a life-threatening illness,” to now meet the criterion of exposure to an extreme stressor. The present study examined psychosocial adjustment, particularly PTSD symptoms, in 45 cardiac patients 1 week to 3 months after they experienced their first MI. Identification of potential participants proceeded via review of records of patients on the coronary care unit at the University of Massachusetts Medical Center. The results indicated that most patients reported low levels of distress. Using Foa and co-workers’ (1993) PTSD Symptom Scale, 9% of the patients met DSM-III-R criteria for PTSD

Relationship of goal setting, self-efficacy, and self-evaluation in dysphoric and socially anxious women

This study examined the relation between goal setting and self-efficacy and self-evaluation of interpersonal performance. Twelve dysphoric, 12 socially anxious, and 12 normal undergraduate women participated in videotaped interactions with normal female partners. Measures of goal setting and self-efficacy were obtained prior to the interactions and each member of the dyad evaluated her performance, as well as her partner\u27s performance, immediately after the interaction. Objective observers also rated each partner\u27s performance. The groups did not differ in personal goals or evaluations of their own performance. Observer ratings did not indicate differences in social competence among the three groups. When self-efficacy was considered, dysphoric and socially anxious subjects had larger discrepancies between their goals and efficacy ratings than normal subjects. Although dysphoric and socially anxious individuals did not set perfectionistic goals, they did set higher goals than they believed they could achieve

Posttraumatic stress disorder following myocardial infarction or cardiac surgery

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

Posttraumatic Stress Disorder and Heart Disease

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)

Attention-deficit/hyperactivity disorder and comorbid oppositional defiant disorder or conduct disorder

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

ADHD with comorbid oppositional defiant disorder or conduct disorder: discrete or nondistinct disruptive behavior disorders

OBJECTIVE: In children with ADHD who have comorbid disruptive behavior diagnoses distinctions between oppositional defiant disorder (ODD) and conduct disorder (CD) remain unclear. The authors investigate differences between ODD and CD in a large clinical sample of children with ADHD. METHOD: Consecutively referred and systematically assessed male children and adolescents with either ADHD (n = 65), ADHD with ODD (n = 85), or ADHD with CD (n = 50) were compared using structured diagnostic interviews and parent, teacher, and clinician rating scales. RESULTS: In children with ADHD, significant differences emerged between ODD and CD in the domains of delinquency, overt aggression, and ADHD symptom severity; ADHD with CD was most severe, followed by ADHD with ODD, and ADHD had the least severe symptoms. Distinctions between ADHD with CD and the other two groups were found for parenting, treatment history, and school variables. CONCLUSION: Within the limits of a cross-sectional methodology, results support clinically meaningful distinctions between ODD and CD in children with ADHD

Symptoms of posttraumatic stress disorder following myocardial infarction and coronary artery bypass surgery

Psychosocial adjustment, particularly posttraumatic stress disorder (PTSD) symptoms, was assessed in a sample of 50 men 6-12 months after initial myocardial infarction (MI) or coronary artery bypass (CABG) surgery. Mean scores on the adjustment measures indicated relatively low levels of distress for the entire group. However, a small number of patients reported clinically significant elevations in anxiety, depression, anger, and ruminative thinking. Using DSM-III-R criteria, four patients met the criteria for PTSD on a self-report checklist. Four patients met the criteria for major depressive disorder on the Inventory to Diagnose Depression. Overall, the findings suggest that posttraumatic stress disorder-like reactions may be an unrecognized problem for some men who sustain an MI or undergo CABG surgery. These traumatic reactions are highly correlated with emotional distress, including depression, generalized anxiety, and anger

Self-reported depression in patients with coronary heart disease

BACKGROUND: Assessing depression in cardiac patients is challenging because somatic symptoms of depression may be the result of physical illness. This study examined self-reported symptoms of depression in patients with cardiovascular disease. METHOD: Three hundred six patients with cardiovascular disease completed the Inventory to Diagnose Depression (IDD), which is a self-report depression scale. RESULTS: Practically all patients reported some symptoms on the IDD, but only a small number had scores in the range suggestive of depression. Somatic symptoms did not contribute disproportionately to depression scores but affective and cognitive symptoms were stronger indicators of depression in these patients. Factor analysis identified one factor that represented a general syndrome of depression. CONCLUSIONS: The results suggest that the IDD has promise as a measure to screen for depression in cardiac patients