186 research outputs found

    A Multicenter Examination and Strategic Revisions of the Yale Global Tic Severity Scale

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    Objective To examine the internal consistency and distribution of the Yale Global Tic Severity Scale (YGTSS) scores to inform modification of the measure. Methods This cross-sectional study included 617 participants with a tic disorder (516 children and 101 adults), who completed an age-appropriate diagnostic interview and the YGTSS to evaluate tic symptom severity. The distributions of scores on YGTSS dimensions were evaluated for normality and skewness. For dimensions that were skewed across motor and phonic tics, a modified Delphi consensus process was used to revise selected anchor points. Results Children and adults had similar clinical characteristics, including tic symptom severity. All participants were examined together. Strong internal consistency was identified for the YGTSS Motor Tic score (α = 0.80), YGTSS Phonic Tic score (α = 0.87), and YGTSS Total Tic score (α = 0.82). The YGTSS Total Tic and Impairment scores exhibited relatively normal distributions. Several subscales and individual item scales departed from a normal distribution. Higher scores were more often used on the Motor Tic Number, Frequency, and Intensity dimensions and the Phonic Tic Frequency dimension. By contrast, lower scores were more often used on Motor Tic Complexity and Interference, and Phonic Tic Number, Intensity, Complexity, and Interference. Conclusions The YGTSS exhibits good internal consistency across children and adults. The parallel findings across Motor and Phonic Frequency, Complexity, and Interference dimensions prompted minor revisions to the anchor point description to promote use of the full range of scores in each dimension. Specific minor revisions to the YGTSS Phonic Tic Symptom Checklist were also proposed

    Development And Preliminary Psychometric Evaluation of the Children\u27s Saving Inventory

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    This study reports on the development and initial psychometric properties of the Children\u27s Saving Inventory (CSI), a parent-rated measure designed to assess child hoarding behaviors. Subjects included 123 children and adolescents diagnosed with primary Obsessive-Compulsive Disorder (OCD) and their parents. Trained clinicians administered the Children\u27s Yale-Brown Obsessive-Compulsive Scale (CY-BOCS), items assessing Family Accommodation and the Clinical Global Impressions-Severity index. Parents completed the CSI, Child Obsessive-Compulsive Impact Scale (COIS)-Parent Version and Child Behavior Checklist. Youth completed the COIS-Child Version, Obsessive-Compulsive Inventory Child Version (OCI-CV), Multidimensional Anxiety Scale for Children, and Children\u27s Depression Inventory-Short Form. A four factor solution was identified; factors were named Discarding, Clutter, Acquisition, and Distress/Impairment. Internal consistency for the CSI Total and factor scores were good. One-week test-retest reliability (n = 31) from a random subsample was excellent. Known groups validity was supported vis-Ă -vis higher CSI scores for those endorsing hoarding on the CY-BOCS Symptom Checklist. Convergent and discriminant validity was evidenced by weak relationships with OCI-CV Checking and Contamination factors but strong relationships with the OCI-CV Hoarding factor and with hoarding obsession/compulsions on the CY-BOCS. These findings provide initial support for the reliability and validity of the CSI for the assessment of hoarding behaviors among youth with OCD. Future studies are needed to extend these findings to non-OCD samples of youth

    D-cycloserine augmentation of exposure-based cognitive behavior therapy for anxiety, obsessive-compulsive, and posttraumatic stress disorders: a systematic review and meta-analysis of individual participant data

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    Importance: Whether and under which conditions D-cycloserine (DCS) augments the effects of exposure-based cognitive behavior therapy for anxiety, obsessive-compulsive, and posttraumatic stress disorders is unclear. Objective: To clarify whether DCS is superior to placebo in augmenting the effects of cognitive behavior therapy for anxiety, obsessive-compulsive, and posttraumatic stress disorders and to evaluate whether antidepressants interact with DCS and the effect of potential moderating variables. Data Sources: PubMed, EMBASE, and PsycINFO were searched from inception to February 10, 2016. Reference lists of previous reviews and meta-analyses and reports of randomized clinical trials were also checked. Study Selection: Studies were eligible for inclusion if they were (1) double-blind randomized clinical trials of DCS as an augmentation strategy for exposure-based cognitive behavior therapy and (2) conducted in humans diagnosed as having specific phobia, social anxiety disorder, panic disorder with or without agoraphobia, obsessive-compulsive disorder, or posttraumatic stress disorder. Data Extraction and Synthesis: Raw data were obtained from the authors and quality controlled. Data were ranked to ensure a consistent metric across studies (score range, 0-100). We used a 3-level multilevel model nesting repeated measures of outcomes within participants, who were nested within studies. Results: Individual participant data were obtained for 21 of 22 eligible trials, representing 1047 of 1073 eligible participants. When controlling for antidepressant use, participants receiving DCS showed greater improvement from pretreatment to posttreatment (mean difference, -3.62; 95% CI, -0.81 to -6.43; P = .01; d = -0.25) but not from pretreatment to midtreatment (mean difference, -1.66; 95% CI, -4.92 to 1.60; P = .32; d = -0.14) or from pretreatment to follow-up (mean difference, -2.98, 95% CI, -5.99 to 0.03; P = .05; d = -0.19). Additional analyses showed that participants assigned to DCS were associated with lower symptom severity than those assigned to placebo at posttreatment and at follow-up. Antidepressants did not moderate the effects of DCS. None of the prespecified patient-level or study-level moderators was associated with outcomes. Conclusions and Relevance: D-cycloserine is associated with a small augmentation effect on exposure-based therapy. This effect is not moderated by the concurrent use of antidepressants. Further research is needed to identify patient and/or therapy characteristics associated with DCS response.2018-05-0

    Evidence-Based Assessment of Child Obsessive Compulsive Disorder: Recommendations for Clinical Practice and Treatment Research

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    Obsessive-compulsive disorder (OCD) presents heterogeneously and can be difficult to assess in youth. This review focuses on research-supported assessment approaches for OCD in childhood. Content areas include pre-visit screening, diagnostic establishment, differential diagnosis, assessment of comorbid psychiatric conditions, tracking symptom severity, determining psychosocial functioning, and evaluating clinical improvement. Throughout this review, similarities and differences between assessment approaches geared towards clinical and research settings are discussed

    Correlates of comorbid anxiety and externalizing disorders in childhood obsessive compulsive disorder

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    The present study examines the influence of diagnostic comorbidity on the demographic, psychiatric, and functional status of youth with a primary diagnosis of obsessive compulsive disorder (OCD). Two hundred and fifteen children (ages 5–17) referred to a university-based OCD specialty clinic were compared based on DSM-IV diagnostic profile: OCD without comorbid anxiety or externalizing disorder, OCD plus anxiety disorder, and OCD plus externalizing disorder. No age or gender differences were found across groups. Higher OCD severity was found for the OCD + ANX group, while the OCD + EXT group reported greater functional impairment than the other two groups. Lower family cohesion was reported by the OCD + EXT group compared to the OCD group and the OCD + ANX group reported higher family conflict compared to the OCD + EXT group. The OCD + ANX group had significantly lower rates of tic disorders while rates of depressive disorders did not differ among the three groups. The presence of comorbid anxiety and externalizing psychopathology are associated with greater symptom severity and functional and family impairment and underscores the importance of a better understanding of the relationship of OCD characteristics and associated disorders. Results and clinical implications are further discussed

    Multi-Scale Action Effectiveness Research in the Lower Columbia River and Estuary, 2011 - FINAL ANNUAL REPORT

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    The study reported here was conducted by researchers at Pacific Northwest National Laboratory (PNNL), the Oregon Department of Fish and Wildlife (ODFW), the University of Washington (UW), and the National Marine Fisheries Service (NMFS) for the U.S. Army Corps of Engineers, Portland District (USACE). This research project was initiated in 2007 by the Bonneville Power Administration to investigate critical uncertainties regarding juvenile salmon ecology in shallow tidal freshwater habitats of the lower Columbia River. However, as part of the Washington Memorandum of Agreement, the project was transferred to the USACE in 2010. In transferring from BPA to the USACE, the focus of the tidal freshwater research project shifted from fundamental ecology toward the effectiveness of restoration in the Lower Columbia River and estuary (LCRE). The research is conducted within the Action Agencies Columbia Estuary Ecosystem Restoration Program (CEERP). Data reported herein spans the time period May 2010 to September 2011

    Robust changes and sources of uncertainty in the projected hydrological regimes of Swiss catchments

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    Projections of discharge are key for future water resources management. These projections are subject to uncertainties, which are difficult to handle in the decision process on adaptation strategies. Uncertainties arise from different sources such as the emission scenarios, the climate models and their post-processing, the hydrological models and natural variability. Here we present a detailed and quantitative uncertainty assessment, based on recent climate scenarios for Switzerland (CH2011 data set) and covering catchments representative for mid-latitude alpine areas. This study relies on a particularly wide range of discharge projections resulting from the factorial combination of 3 emission scenarios, 10 to 20 regional climate models, 2 post-processing methods and 3 hydrological models of different complexity. This enabled us to decompose the uncertainty in the ensemble of projections using analyses of variance (ANOVA). We applied the same modeling setup to 6 catchments to assess the influence of catchment characteristics on the projected streamflow and focused on changes in the annual discharge cycle. The uncertainties captured by our setup originate mainly from the climate models and natural climate variability, but the choice of emission scenario plays a large role by the end of the century. The respective contribution of the different sources of uncertainty varied strongly among the catchments. The discharge changes were compared to the estimated natural decadal variability, which revealed that a climate change signal emerges even under the lowest emission scenario (RCP2.6) by the end of the century. Limiting emissions to RCP2.6 levels would nevertheless reduce the largest regime changes at the end of the 21st century by approximately a factor of two, in comparison to impacts projected for the high emission scenario SRES A2. We finally show that robust regime changes emerge despite the projection uncertainty. These changes are significant and are consistent across a wide range of scenarios and catchments. We propose their identification as a way to aid decision-making under uncertainty
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