Quality Measures for Managing Prescription of Antipsychotic Medication Among Youths: Factors Associated With Health Plan Performance.

OBJECTIVE: This study examined the performance of health plans on two HEDIS measures: metabolic monitoring of children and adolescents prescribed an antipsychotic and use of first-line psychosocial care for children and adolescents prescribed an antipsychotic for a nonindicated use. Plan characteristics and other contextual factors that may be associated with health plan performance were examined to identify potential strategies for improving care. METHODS: The study population included 279 commercial and 169 Medicaid health plans that voluntarily submitted data for care provided in 2016. Bivariate associations between performance on the two measures and each plan characteristic (eligible population size, region, profit status, model type, and operating in a state with legislation on prior authorization for antipsychotics) were examined. Main-effects multivariable linear regression models were used to examine the combined association of plan characteristics with each measure. RESULTS: Performance rates on both measures were comparable for commercial and Medicaid plans. Among commercial plans, not-for-profit plans outperformed for-profit plans on both measures. Commercial and Medicaid plans in the North performed significantly better on the metabolic monitoring measure. Commercial plans in the South and Medicaid plans in the West performed significantly worse on the first-line psychosocial care measure. Plans operating in states requiring prior authorization performed significantly better on the metabolic monitoring measure. CONCLUSIONS: This study identified key plan characteristics and other contextual factors associated with health plan performance on quality measures related to pediatric antipsychotic prescribing. Findings suggest that quality measures, in conjunction with policies such as prior authorization, can encourage better care delivery to vulnerable populations.

Alcohol effects on response inhibition: Variability across tasks and individuals.

Considerable research has investigated the acute effects of alcohol on response inhibition, but a number of issues remain unresolved. Given that most studies use only a single laboratory task to assess inhibition, it is often difficult to determine whether alcohol's effects are task specific or generalize across measures of the same construct. Moreover, relatively few studies have directly compared effects of alcohol under ascending and descending blood alcohol concentrations (BACs), and those that have often failed to disentangle BAC limb effects from the effects of repeated testing. This study was intended to provide a test of alcohol's effects on behavioral inhibition using multiple laboratory measures in a relatively large sample and comparing effects under ascending and descending BAC. Young adults (N = 216) completed three commonly used inhibition tasks (Stroop, antisaccade, and stop-signal) at baseline and again 1-3 weeks later under one of three beverage conditions (alcohol, placebo or control) and one of two BAC limb conditions (ascending/descending or descending only). Findings indicated considerable specificity in alcohol's effects. Relative to control and placebo conditions, antisaccade performance suffered under both ascending and descending BAC and stop-signal reaction time (RT) suffered only under descending BAC. The Stroop RT interference effect was not affected by alcohol, though alcohol did impair response accuracy on incongruent Stroop trials. Baseline performance moderated effects of alcohol on both antisaccade accuracy and Stroop interference, suggesting the importance of individual differences. The current findings suggest that more specificity is required in characterizing acute effects of alcohol on inhibitory control. (PsycINFO Database Record

Acute alcohol effects on set-shifting and its moderation by baseline individual differences: a latent variable analysis.

AIMS: To compare the acute effects of alcohol on set-shifting task performance (relative to sober baseline performance) during ascending and descending limb breath alcohol concentration (BrAC), as well as possible moderation of these effects by baseline individual differences. DESIGN: Shifting performance was tested during an initial baseline and a subsequent drinking session, during which participants were assigned randomly to one of three beverage conditions (alcohol, placebo or control) and one of two BrAC limb conditions [ascending and descending (A/D) or descending-only (D-only)]. SETTING: A human experimental laboratory on the University of Missouri campus in Columbia, MO, USA. PARTICIPANTS: A total of 222 moderate-drinking adults (ages 21-30 years) recruited from Columbia, MO and tested between 2010 and 2013. MEASUREMENTS: The outcome measure was performance on set-shifting tasks under the different beverage and limb conditions. Shifting performance assessed at baseline was a key moderator. FINDINGS: Although performance improved across sessions, this improvement was reduced in the alcohol compared with no-alcohol groups (post-drink latent mean comparison across groups, all Ps ≤ 0.05), and this effect was more pronounced in individuals with lower pre-drink performance (comparison of pre- to post-drink path coefficients across groups, all Ps ≤ 0.05). In the alcohol group, performance was better on descending compared with ascending limb (P ≤ 0.001), but descending limb performance did not differ across the A/D and D-only groups. CONCLUSIONS: Practising tasks before drinking moderates the acute effects of alcohol on the ability to switch between tasks. Greater impairment in shifting ability on descending compared with ascending breath alcohol concentration is not related to task practice.

Is set shifting really impaired in trait anxiety? Only when switching away from an effortfully established task set.

The current study investigated whether trait anxiety was systematically related to task-set shifting performance, using a task-switching paradigm in which 1 task was more attentionally demanding than the other. Specifically, taking advantage of a well-established phenomenon known as asymmetric switch costs, we tested the hypothesis that the association between trait anxiety and task-set shifting is most clearly observed when individuals must switch away from a more attentionally demanding task for which it was necessary to effortfully establish an appropriate task set. Ninety-one young adults completed an asymmetric switching task and trait-level mood questionnaires. Results indicated that higher levels of trait anxiety were systematically associated with greater asymmetry in reaction time (RT) switch costs. Specifically, the RT costs for switching from the more attentionally demanding task to the less demanding task were significantly greater with higher levels of trait anxiety, whereas the RT costs for switching in the opposite direction were not significantly associated with trait anxiety levels. Further analyses indicated that these associations were not attributable to comorbid dysphoria or worry. These results suggest that levels of trait anxiety may not be related to general set-shifting ability per se, but, rather, that anxiety-specific effects may primarily be restricted to when one must efficiently switch away from (or let go of) an effortfully established task set. (PsycINFO Database Record

Stability and change in executive function abilities from late adolescence to early adulthood: A longitudinal twin study.

Executive functions (EFs)-the higher level cognitive abilities that enable us to control our own thoughts and actions-continue to develop into early adulthood, yet no longitudinal study has examined their stability during the important life transition from late adolescence to young adulthood. In this twin study (total N = 840 individuals from 424 families), we examined the stability of individual differences in 3 EF components across a 6-year period, from approximately age 17 years (Wave 1) to 23 years (Wave 2). Specifically, we address the following questions: (a) How stable are individual differences in multiple EFs across this time period? and (b) What (genetic and/or environmental) influences affect stability and change in EFs? Results indicated that individual differences in EFs are quite stable across this 6-year period (phenotypic latent variable correlations ranged from 0.86 to 1.0). However, there was evidence for change, particularly in the factor common to multiple EFs (Common EF). Multivariate twin models suggested that stability was due almost entirely to high genetic correlations across time; there was no new genetic variance at Wave 2. Change in Common EF was due to small but significant nonshared environmental influences at Wave 2 (15%). The results suggest that individual differences in EFs are quite heritable and stable by late adolescence, yet are still sensitive to environmental influences.

Toward a comprehensive understanding of executive cognitive function in implicit racial bias.

Although performance on laboratory-based implicit bias tasks often is interpreted strictly in terms of the strength of automatic associations, recent evidence suggests that such tasks are influenced by higher-order cognitive control processes, so-called executive functions (EFs). However, extant work in this area has been limited by failure to account for the unity and diversity of EFs, focus on only a single measure of bias and/or EF, and relatively small sample sizes. The current study sought to comprehensively model the relation between individual differences in EFs and the expression of racial bias in 3 commonly used laboratory measures. Participants (N = 485) completed a battery of EF tasks (Session 1) and 3 racial bias tasks (Session 2), along with numerous individual difference questionnaires. The main findings were as follows: (a) measures of implicit bias were only weakly intercorrelated; (b) EF and estimates of automatic processes both predicted implicit bias and also interacted, such that the relation between automatic processes and bias expression was reduced at higher levels of EF; (c) specific facets of EF were differentially associated with overall task performance and controlled processing estimates across different bias tasks; (d) EF did not moderate associations between implicit and explicit measures of bias; and (e) external, but not internal, motivation to control prejudice depended on EF to reduce bias expression. Findings are discussed in terms of the importance of global and specific EF abilities in determining expression of implicit racial bias.

Interaction between family history of alcoholism and Locus of Control in the opioid regulation of impulsive responding under the influence of alcohol.

BACKGROUND: Naltrexone (NTX) is an opioid antagonist indicated for the treatment of alcoholism, which is not universally effective. Thus, identifying individual predictors of NTX's behavioral effects is critical to optimizing its therapeutic use. Moreover, given the high rate of relapse during treatment for alcoholism, understanding NTX's behavioral effects when combined with moderate ethanol intake is important. Our previous study of abstinent alcoholics and control subjects showed that a more internal Locus of Control score predicted increased impulsive choice on NTX (Mitchell et al., 2007, Neuropsychopharmacology 32:439-449). Here, we tested whether this predictive relationship remains in the context of moderate alcohol intake. METHODS: In this study, we tested the effect of acute NTX (50 mg) on impulsive choice, motor inhibition, and attentional bias after ingestion of moderate ethanol (∼0.3 g/kg, n = 30 subjects). Subjects included those recruited from a pool of ∼1,200 UC Berkeley undergraduates on the basis of scores on the Barratt Impulsiveness Scale (BIS). RESULTS: Impulsive choice was positively correlated with breath alcohol concentration in placebo sessions. Locus of Control was again the sole predictor of NTX's effect on decision making among subjects with a family history of alcoholism. We also found a weak interaction between BIS scores and NTX's effect on impulsive choice. CONCLUSIONS: Our results reinforce the predictive relationship between Locus of Control and NTX's effect on decision making in those with a family history of alcoholism, suggesting a possible biological basis to this relationship.

When mental inflexibility facilitates executive control: beneficial side effects of ruminative tendencies on goal maintenance.

Although previous research suggests that depressive ruminators tend to become stuck in a particular mind-set, this mental inflexibility may not always be disadvantageous; in some cases, it may facilitate active maintenance of a single task goal in the face of distraction. To evaluate this hypothesis, we tested 98 college students, who differed in ruminative tendencies and dysphoria levels, on two executive-control tasks. One task emphasized fast-paced shifting between goals (letter naming), and one emphasized active goal maintenance (modified Stroop). Higher ruminative tendencies predicted more errors on the goal-shifting task but fewer errors on the goal-maintenance task; these results demonstrated that ruminative tendencies have both detrimental and beneficial effects. Moreover, although ruminative tendencies and dysphoria levels were moderately correlated (r = .42), higher dysphoria levels predicted more errors on the goal-maintenance task; this finding indicates that rumination and dysphoria can have opposing effects on executive control. Overall, these results suggest that depressive rumination reflects a trait associated with more stability (goal maintenance) than flexibility (goal shifting).

Reversal learning in Parkinson's disease depends on medication status and outcome valence.

We investigated the role of dopamine in distinct forms of reversal shifting by comparing two groups of patients with mild Parkinson's disease (PD), one ON and one OFF their normal dopaminergic medication. In accordance with our previous work, patients ON medication exhibited impaired reversal shifting relative to patients OFF medication. The present results extend previous studies by showing that the medication-induced deficit on reversal shifting was restricted to conditions where reversals were signaled by unexpected punishment. By contrast, patients ON medication performed as well as patients OFF medication and controls when the reversal was signaled by unexpected reward. The medication-induced deficit was particularly pronounced in patients on the dopamine D3 receptor agonist pramipexole. These data indicate that dopaminergic medication in PD impairs reversal shifting depending on the motivational valence of unexpected outcomes.