Evaluation of an Intensive Program for Children With Co-occurring Medical and Emotional Disorders.

The study objective was to assess clinical outcomes and cost avoidance of an intensive day treatment program for children with co-occurring chronic medical disease and emotional problems. Intensive day treatment programs for this population are uncommon, and their effectiveness has not been previously reported. A total of 175 children were enrolled during the 3-year study period.

Refinement of the Reflective Function Questionnaire for Youth (RFQY) Scale B Using Item Response Theory.

We conducted item response theory analyses to refine the Reflective Function Questionnaire for Youth (RFQY) Scale B. Data from a non-clinical sample of young people ( = 737; aged 18-25 years) was used to derive a shortened version of the RFQY. Results were replicated in a clinical sample of inpatient adolescents ( = 467; aged 12-17 year), resulting in a five-item measure, thereafter named the RFQY-5.

The new landscape of medication adherence improvement: where population health science meets precision medicine.

Despite the known health and economic benefits of medications, nonadherence remains a significant, yet entirely preventable public health burden. Over decades, there have been numerous research studies evaluating health interventions and policy efforts aimed at improving adherence, yet no universal or consistently high impact solutions have been identified. At present, new challenges and opportunities in policy and the movement toward value-based care should foster an environment that appreciates adherence as a mechanism to improve health outcomes and control costs (eg, fewer hospitalizations, reduced health care utilization).

Differential relations of executive functioning to borderline personality disorder presentations in adolescents.

Borderline personality disorder (BPD) in adolescents is highly complex and heterogeneous. Within the disorder, research has suggested the existence of at least two subgroups: one with predominantly internalizing psychopathology features and one with predominantly externalizing psychopathology features. One process that may differentiate these groups is executive functioning (EF), given that poor EF is linked to externalizing psychopathology.

Paradoxical Effects of Intranasal Oxytocin on Trust in Inpatient and Community Adolescents.

Research suggests that oxytocin, a neuropeptide implicated in attachment, is a promising clinical tool because it increases affiliation and attachment behaviors, which are reduced in a range of psychiatric disorders. Oxytocin has been recommended as a psychiatric treatment for adolescents, but this remains largely unstudied. Skepticism is warranted, based on mixed findings in adults and absence of data across development.

Predictors of Length of Stay in a Psychiatric Adolescent Treatment Program.

Understanding predictors of adolescent inpatient length of stay (LOS) is important in informing treatment outcomes for this age group. The current literature on adolescent LOS remains limited and has been characterized by methodological limitations. In the study described here, we examined a wide range of predictors for LOS in a psychiatric unit for adolescents (N=285), including severity of disorder (previous hospitalizations, self-harm, cognitive impairment and thought disorder, severe depression, history of trauma), types of psychotropic medication, and diagnoses.

An Examination of Incentive Strategies to Increase Participation in Outcomes Research for an Adolescent Inpatient Unit.

Tracking adolescent outcomes after inpatient hospitalization is important in informing clinical care for this age group, as inpatient care is one of the most expensive treatment modalities. This study examined 4 incentive strategies used to maintain adolescent participation in follow-up research (at 6, 12, and 18 mo) after their discharge from the hospital (N=267). A generalized estimation equation approach was taken to investigate whether different incentive strategies predicted adolescent completion of the follow-up assessments at each time point.

First empirical evaluation of the link between attachment, social cognition and borderline features in adolescents.

Objective: Several developmental models of borderline personality disorder (BPD) emphasize the role of disrupted interpersonal relationships or insecure attachment. As yet, attachment quality and the mechanisms by which insecure attachment relates to borderline features in adolescents have not been investigated. In this study, we used a multiple mediational approach to examine the cross-sectional interplay between attachment, social cognition (in particular hypermentalizing), emotion dysregulation, and borderline features in adolescence, controlling for internalizing and externalizing symptoms.

Taking stock of medication wastage: Unused medications in US households.

Background: Despite the potential deleterious impact on patient safety, environmental safety and health care expenditures, the extent of unused prescription medications in US households and reasons for nonuse remain unknown.

Objective: To estimate the extent, type and cost of unused medications and the reasons for their nonuse among US households.

Methods: A cross-sectional, observational two-phased study was conducted using a convenience sample in Southern California.

Psychiatric comorbidity in hospitalized adolescents with borderline personality disorder.

Objective: The goal of this study was to carry out the first comprehensive assessment of psychiatric comorbidity in adolescents (aged 12-17 years) with DSM-IV criteria for borderline personality disorder (BPD) compared to a psychiatric comparison group without BPD. Complex comorbidity (a hallmark feature of adult BPD and defined as having any mood or anxiety disorder plus a disorder of impulsivity) was also examined as a distinguishing feature of adolescent BPD.

Method: Consecutively admitted patients (October 2008 to October 2012) to an inpatient psychiatric hospital received parental consent and gave assent for participation in the study (N = 418), with the final sample after exclusions consisting of 335 adolescent inpatients.

The measurement of reflective function in adolescents with and without borderline traits.

Reflective function refers to the capacity to reflect on the mind of self and others in the context of the attachment relationship. Reflective function (and its conceptual neighbor, mentalizing) has been shown to be an important correlate of a variety of disorders, including borderline personality disorder (BPD). The current study examined the construct validity of the Reflective Function Questionnaire for Youths (RFQY) in an inpatient sample of adolescents.

Hypermentalizing in adolescent inpatients: treatment effects and association with borderline traits.

Sharp et al. (2011) recently demonstrated that in adolescents with borderline traits the loss of mentalization is more apparent in the emergence of unusual alternative strategies (excessive theory of mind or hypermentalizing) than in the loss of the capacity per se (no mentalizing or undermentalizing). This suggests that hypermentalizing could be a worthwhile social-cognitive treatment target in adolescents with borderline traits.

Teaching medication adherence in US colleges and schools of pharmacy.

Objective: To determine and describe the nature and extent of medication adherence education in US colleges and schools of pharmacy.

Methods: A mixed-methods research study was conducted that included a national survey of pharmacy faculty members, a national survey of pharmacy students, and phone interviews of 3 faculty members and 6 preceptors.

Results: The majority of faculty members and students agreed that background concepts in medication adherence are well covered in pharmacy curricula.

Borderline personality disorder in adolescents: evidence in support of the Childhood Interview for DSM-IV Borderline Personality Disorder in a sample of adolescent inpatients.

Empirical evidence is increasing in support of the validity of the construct of borderline personality disorder (BPD) in adolescence. There is growing consensus that the early identification and treatment of emerging borderline traits may be an important focus. However, few diagnostic (questionnaire- or interview-based) measures specifically developed or adapted for adolescents and children exist.

The relationship between the youth psychopathic traits inventory and psychopathology in a U.S. community sample of male youth.

The Youth Psychopathic Traits Inventory (YPI) is a self-report measure of juvenile psychopathic traits. Validity data for this measure are limited, especially for nonreferred samples. This report investigated the concurrent validity of the YPI by assessing 171 nonreferred male youth (M age = 12.

"Better the devil you know": a preliminary study of the differential modulating effects of reputation on reward processing for boys with and without externalizing behavior problems.

Very little is known about the neurobiological correlates of reward processing during social decision-making in the developing brain and whether prior social and moral information (reputations) modulates reward responses in youth as has been demonstrated in adults. Moreover, although externalizing behavior problems in youth are associated with deficits in reward processing and social cognition, a real-life social interaction paradigm using functional neuroimaging (fMRI) has not yet been applied to probe reward processing in such youth. Functional neuroimaging was used to examine the neural correlates of reward-related decision-making during a trust task in two samples of age-matched 11 to 16-year-old boys: with (n = 10) and without (n = 10) externalizing behavior problems.

The criterion validity of the Borderline Personality Features Scale for Children in an adolescent inpatient setting.

The purpose of the current study was to examine the criterion validity of the Borderline Personality Features Scale for Children (BPFS-C) by assessing the performance of the self-report and a newly developed parent report version of the measure (BPFS-P) in detecting a borderline personality disorder (BPD) diagnosis in adolescent inpatients. This study also examined parent-child agreement and the internal consistency of the BPFS subscales. An inpatient sample of adolescents (n = 51) ranging from ages 12-18 completed the BPFS and were administered the Child Interview for DSM-IV Borderline Personality Disorder (CI-BPD) by trained clinical research staff.

Theory of mind and emotion regulation difficulties in adolescents with borderline traits.

Objective: Dysfunctions in both emotion regulation and social cognition (understanding behavior in mental state terms, theory of mind or mentalizing) have been proposed as explanations for disturbances of interpersonal behavior in borderline personality disorder (BPD). This study aimed to examine mentalizing in adolescents with emerging BPD from a dimensional and categorical point of view, controlling for gender, age, Axis I and Axis II symptoms, and to explore the mediating role of emotion regulation in the relation between theory of mind and borderline traits.

Method: The newly developed Movie for the Assessment of Social Cognition (MASC) was administered alongside self-report measures of emotion regulation and psychopathology to 111 adolescent inpatients between the ages of 12 to 17 (mean age = 15.

Get them before they get you: trust, trustworthiness, and social cognition in boys with and without externalizing behavior problems.

Economic exchange games have rarely been applied to examine psychopathology in youth. In the current study we adapted a trust game to investigate the relations between externalizing behavior problems, trust, and trustworthiness. We were particularly interested in the differential modulating impact of "known identity" (vs.

The role of child and parental mentalizing for the development of conduct problems over time.

The current study aimed to investigate the role of parental and child mentalizing in the development of conduct problems over time in a community sample of 7- to 11-year-olds (N = 659). To measure child mentalizing, children were asked to complete a social vignettes task at baseline as a measure of distorted mentalizing. Parents (primarily mothers) were asked to complete the same task, guessing their child's responses in the social scenarios as a measure of maternal mentalizing.

The cross-informant concordance and concurrent validity of the Borderline Personality Features Scale for Children in a community sample of boys.

The Borderline Personality Disorder Features Scale for Children (BPFSC) is currently the only dimensional measure specifically developed to assess borderline features in children and adolescents. Few studies have investigated this measure for its concurrent validity and concordance between youth self-report and parent-report versions. To this end, the current study had two aims: (1) to investigate the cross-informant concordance (youth self-report vs.

The development of a mentalization-based outcomes and research protocol for an adolescent inpatient unit.

The authors describe the development of a theory-driven assessment and research protocol at the Adolescent Treatment Program of The Menninger Clinic. First, the theoretical framework behind a mentalization-based model for assessment and treatment is described. Next, the process whereby measures were selected to operationalize key components of the mentalization-based model is discussed, including a brief discussion of each measure and assessment procedure.

Narcissism, self-esteem, and conduct problems: evidence from a British community sample of 7-11 year olds.

The aim of the current report was to investigate the relationship between narcissism, self-esteem and conduct problems in a British community sample of pre-adolescent and young adolescent children (n = 659; 7-11 year olds). We demonstrated that narcissism is associated with conduct problems, but no evidence for an interaction between low self-esteem and high narcissism in the prediction of conduct problems was found. Whilst low self-esteem was associated with teacher-reported (but not parent-reported) conduct problems at the bivariate level of analyses, multi-variate analyses showed that self-esteem yielded no significant effects, neither independently, nor in interaction with narcissism for either parent- or teacher reported conduct problems.