Jousting with straw men: comment on Westen, Novotny, and Thompson-Brenner (2004).

Empirically supported treatments (ESTs) do not cure every patient, and the randomized trial is not a flawless methodology. Upon these often-noted and widely accepted points, D. Westen, C.

Identifying and selecting the common elements of evidence based interventions: a distillation and matching model.

A model is proposed whereby the intervention literature can be empirically factored or distilled to derive profiles from evidence-based approaches. The profiles can then be matched to individual clients based on consideration of their target problems, as well as demographic and contextual factors. Application of the model is illustrated by an analysis of the youth treatment literature.

The therapy process observational coding system-alliance scale: measure characteristics and prediction of outcome in usual clinical practice.

The authors describe psychometric characteristics of the new Therapy Process Observational Coding System-Alliance scale (TPOCS-A; B. D. McLeod, 2001) and illustrate its use in the study of treatment as usual.

Youth psychotherapy outcome research: a review and critique of the evidence base.

Over the past four decades, researchers have produced extensive evidence on psychotherapy for youth mental health problems and disorders. The evidence often has been evaluated through narrative reviews and through meta-analyses assessing the magnitude of treatment effects, but methodological analysis addressing the character and quality of the evidence base itself is an important complement, needed to place treatment effects in perspective and to suggest directions for future research. We carried out such an analysis, focusing on all the methodologically acceptable published randomized trials our search identified involving treatment of anxiety, depression, ADHD and related conditions, and conduct-related problems and disorders.

Youth versus parent working alliance in usual clinical care: distinctive associations with retention, satisfaction, and treatment outcome.

We investigated associations between both youth-therapist and parent-therapist alliances and retention, satisfaction, and symptom improvement among 65 youth and their parents receiving usual community-based outpatient mental health services. Parent (but not youth) alliance was significantly related to more frequent family participation, less frequent cancellations and no-shows, and greater therapist concurrence with termination decision. In contrast, youth (but not parent) alliance was significantly related to both youth and parent reports of symptom improvement.

Cognitive-behavioral therapy for depression in adolescents with inflammatory bowel disease: a pilot study.

Objective: To evaluate the safety and feasibility of cognitive-behavioral therapy (CBT) for depression in physically ill adolescents.

Method: In an open trial, 11 adolescents (12-17 years) with inflammatory bowel disease and either major or minor depression underwent 12 sessions of a manual-based CBT enhanced by social skills, physical illness narrative, and family psychoeducation components. Standardized instruments assessed pre- to posttreatment changes in depression, physical health, global psychological functioning, and social functioning.

Empirically tested psychotherapies for youth internalizing and externalizing problems and disorders.

This article is a review of specific psychotherapies that have been supported in clinical trials. Treatments that showed significant effects in studies published over a period of 4 decades were identified, with the goal of complementing the overall picture of treatment benefit provided in narrative reviews and meta-analyses with a detailing of the specific interventions that have shown significant effects. The article focuses on treatments for four broad clusters of problems and disorders that account for a very large proportion of youth mental health referrals: anxiety, depression, attention-deficit/hyperactivity, and conduct.

Effects of sweet and bitter gustatory stimuli in anorexia nervosa on EEG frequency spectra.

The possible differences in processing gustatory stimuli in anorexic patients compared to healthy control subjects was investigated by electrophysiological methods. The electroencephalogram (EEG) was recorded in outpatients treated with anorexia nervosa (AN) and age-matched controls after exposure to sweet (milk chocolate) and bitter (black tea) taste stimuli. Power spectrum analysis was performed on EEG epochs recorded in the above conditions.

Using dissertations to examine potential bias in child and adolescent clinical trials.

The major youth psychotherapy meta-analyses have relied on published studies, which may have led to biased effect size estimates. To examine this possibility, the authors compared 121 dissertations with 134 published studies and found the following: (a) few differences on individual methodological variables, but, overall, stronger methodology in dissertations; (b) no differences in the steps taken to ensure treatment integrity; and (c) a mean dissertation effect size less than half that of published studies. The effect size difference remained robust across tests controlling for all reliable method differences.

D8/17 and CD19 expression on lymphocytes of patients with acute rheumatic fever and Tourette's disorder.

D8/17, an alloantigen found on B lymphocytes, has been reported to be elevated in patients susceptible to rheumatic fever and may be associated with autoimmune types of neuropsychiatric disorders. The pediatric-autoimmune-neuropsychiatric-disorders-associated-with-streptococci model is a putative model of pathogenesis for a group of children whose symptoms of obsessive-compulsive disorder and Tourette's disorder (TD) are abrupt and may be triggered by an infection with group A streptococci. As a test of this model, we have examined D8/17 levels on the B cells of patients with TD and acute rheumatic fever (ARF) along with those on the B cells of normal controls by flow cytometry.

Parent-child interactions in relation to critical and emotionally overinvolved expressed emotion (EE): is EE a proxy for behavior?

Expressed emotion measures, encompassing dimensions of criticism (CRIT), and emotional overinvolvement (EOI) are increasingly being used to assess the parent-child relationship in child clinical populations, despite the lack of studies assessing their validity. We examined the correspondence between CRIT, EOI, and parent-child interactions as observed by neutral coders in a sample of 252 clinic-referred children and adolescents, ages 7-17 years. We found support for the validity of the CRIT code, with high critical parents showing more antagonism, negativity, disgust, harshness, and less responsiveness, compared to parents who scored in the low or borderline ranges.

Nonlinear and linear EEG complexity changes caused by gustatory stimuli in anorexia nervosa.

The objective of the present study was to investigate the effects of pleasant and unpleasant gustatory stimuli on nonlinear and linear complexity measures of the EEG in healthy controls and in anorexia nervosa (AN) patients. The subjects were exposed to unpleasant (bitter tea) and pleasant (chocolate) gustatory stimuli for 2 min. Multichannel EEG was recorded and the dimensional complexity (point-correlation dimension) and Omega complexity were calculated from the EEG epochs corresponding to the above taste conditions.

Surfactant protein A, an innate immune factor, is expressed in the vaginal mucosa and is present in vaginal lavage fluid.

Surfactant protein A (SP-A), first identified as a component of the lung surfactant system, is now recognized to be an important contributor to host defence mechanisms. SP-A can facilitate phagocytosis by opsonizing bacteria, fungi and viruses, stimulate the oxidative burst by phagocytes and modulate pro-inflammatory cytokine production by phagocytic cells. SP-A can also provide a link between innate and adaptive immune responses by promoting differentiation and chemotaxis of dendritic cells.

Reported maltreatment among clinic-referred children: implications for presenting problems, treatment attrition, and long-term outcomes.

Objective: To examine the treatment implications of a reported history of maltreatment in a sample of 343 children referred to Los Angeles area mental health clinics for emotional and behavioral problems.

Method: Child Protective Service records identified 161 of the 343 families as having a documented history of maltreatment. Parent reports of child behavior problems were obtained following clinic intake and at 2-year follow-up, and attrition was assessed via medical records.

Youth with anxiety disorders in research and service clinics: examining client differences and similarities.

Compared 2 groups of children with anxiety disorders: those treated in a university-based research clinic (RC) and those treated in community-based service clinics (SCs). A widely endorsed goal in intervention research is to disseminate evidence-based treatments from RCs to SCs. Attaining this goal requires an understanding of the similarities and differences between clients in these 2 settings.

Class I alcohol dehydrogenase is highly expressed in normal human mammary epithelium but not in invasive breast cancer: implications for breast carcinogenesis.

Detoxification of ethanol can contribute to oxidative cellular and DNA damage and, thereby, to carcinogenesis. The potential relevance of this to breast carcinogenesis is suggested by evidence that alcohol consumption is a risk factor for breast cancer. It is, however, not known whether ethanol can be metabolized in breast parenchyma.

Syndromal structure of psychopathology in children of Thailand and the United States.

Are the syndromes of child psychopathology similar across cultures? Yes, in most comparisons of Western cultures. Here the authors compared Thailand and the United States, Eastern and Western cultures differing markedly in racial/ethnic composition, religious-philosophical traditions, and beliefs and practices regarding children. Exploratory factor analysis and a useful kappa approach were used to compare Child Behavior Checklist factor structure in Thai and American children aged 6 to 11.

Clinical resistance of recurrent Candida albicans vulvovaginitis to fluconazole in the presence and absence of in vitro resistance.

Objective: To determine if failure of recurrent Candida albicans vulvovaginitis to respond clinically to fluconazole is related to in vitro mycologic resistance.

Study Design: We compared clinical response to fluconazole with culture and sensitivity data in all cases of recurrent C albicans vulvovaginitis referred to our clinic over an 18-month period.

Results: Of 52 patients referred to us with recurring vulvovaginitis, 10 were C albicans culture positive.

Child, parent, and therapist (dis)agreement on target problems in outpatient therapy: the therapist's dilemma and its implications.

A minimal requirement for success in child psychotherapy is arguably that child, parent, and therapist agree about which problems to address. How often is this the case? Following clinic intake, the authors asked 315 children, parents, and therapists, separately, to identify target problems. More than 3/4 of child-parent-therapist triads began treatment without consensus on a single problem; nearly half failed to agree on even I broad problem domain (e.

Applying Treatment Outcome Research in Clinical Practice: Techniques for Adapting Interventions to the Real World.

Despite the growing literature on empirically supported therapies, these interventions are rarely used in clinical settings. Although researchers lament the poor transfer of techniques from controlled trials to clinics, little has been written to guide the adaptation of manualised treatments for real-life clinical practice. The goal of this paper is to provide suggestions for the clinical use of research-tested treatments, with specific examples from the treatment of child depressive disorders.

Correlates of expressed emotion in mothers of clinically-referred youth: an examination of the five-minute speech sample.

Background: Most studies applying the adult-derived 'expressed emotion' (EE) measure to children have combined criticism (CRIT) and emotional overinvolvement (EOI). Yet, some of the parent behaviors coded as EOI and shown to have negative implications for parents and their adult children (e.g.

[Right prefrontal cerebral hemispheric activation by symmetrical carotid sinus baroreceptor stimulation].

This study was performed to test the hypothesis of greater right hemispheric involvement in the processing of signals related to baroreceptor stimuli. Carotis sinus baroreceptors were stimulated by rhythmically decreasing air pressure in a neck chamber, and as a control the thorax was stimulated in a similar manner. Changes in regional cerebral blood flow (rCBF) were measured by positron emission tomography (PET).

[Spatial standardization of [15O]-butanol PET images using T1-weighted MRI data].

Population averaged brain activation studies require the spatial standardization of the individual perfusion PET images. This procedure is usually supported by T1-weighted MRI images. The authors developed a segmentation technique to improve the automatized transformation of the individual MRI images into Talairach space.

Development of the Therapy Procedures Checklist: a therapist-report measure of technique use in child and adolescent treatment.

Evaluated the psychometric properties of the Therapy Procedures Checklist (TPC). The TPC was developed to assess therapists' reports of the techniques they employ when working with child and adolescent clients. TPC items encompass the 3 most common therapeutic models for youth: psychodynamic, cognitive, and behavioral.

Expression of a retinol dehydrogenase (hRoDH-4), a member of the retinol/steroid dehydrogenase family implicated in retinoic acid biosynthesis, in normal and neoplastic endometria.

Objective: Retinoic acid plays an essential role in epithelial differentiation, and retinoid homeostasis is disrupted in cancers of epithelial origin. The goal of this study was to determine whether hRoDH-4, an enzyme that can catalyze the first and rate-limiting step in retinoic acid biosynthesis, is expressed in normal endometrium and, if so, whether its expression is altered in endometrial cancer.

Study Design: Proliferative, secretory, hyperplastic, and neoplastic endometria were examined by immunocytochemistry for hRoDH-4 protein and by reverse transcriptase-polymerase chain reaction for the hRoDH-4 transcript.