Child and adolescent predictors of smoking involvement in emerging adulthood.

OBJECTIVE: This study examined the differential relationship of externalizing behavior, internalizing behavior, social context, and their interactions to three developmental indicators of smoking involvement: onset (age), amount of smoking, and dependence symptomatology. METHOD: Participants (n = 504, 73% male) from a high-risk community-based longitudinal study were followed from age 12-14 to young adulthood (18-20). Smoking involvement was conceptualized as a process involving differences in (a) age of onset of smoking, (b) amount of smoking at age 18-20, and (c) level of nicotine dependence symptomatology at age 18-20. Survival analysis was used to predict onset of smoking, regression for smoking level, and zero-inflated Poisson regression for nicotine dependence. RESULTS: Externalizing (teacher report) and internalizing behavior (youth self-report), prior to the onset of smoking, predicted different components of smoking and nicotine dependence in young adulthood. Parental smoking predicted all levels of smoking involvement. Peer smoking was related to early onset of smoking, but not higher levels of smoking involvement. Externalizing and internalizing behavior interacted to predict nicotine dependence level, with higher levels of internalizing behavior predicting higher levels of dependence symptoms, even at low levels of externalizing behavior. CONCLUSIONS: Externalizing and internalizing behavior and social context are independent and interacting risk factors that come into play at different points in the developmental process occurring between smoking onset and dependence. This study provides important information for theoretical models of smoking progression and shows that different types of risk should be targeted for prevention at different points in smoking progression. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Relationship between emotional processing, drinking severity and relapse in adults treated for alcohol dependence in Poland.

AIMS: Growing data reveals deficits in perception, understanding and regulation of emotions in alcohol dependence (AD). The study objective was to explore the relationships between emotional processing, drinking history and relapse in a clinical sample of alcohol-dependent patients. METHODS: A group of 80 inpatients entering an alcohol treatment program in Warsaw, Poland was recruited and assessed at baseline and follow-up after 12 months. Baseline information about demographics, psychopathological symptoms, personality and severity of alcohol problems was obtained. The Schutte Self-Report Emotional Intelligence (EI) Test and Toronto Alexithymia Scale (TAS) were utilized for emotional processing assessment. Follow-up information contained data on drinking alcohol during the last month. RESULTS: At baseline assessment, the duration of alcohol drinking was associated with lower ability to utilize emotions. Patients reporting more difficulties with describing feelings drank more during their last episode of heavy drinking, and had a longer duration of intensive alcohol use. A longer duration of the last episode of heavy drinking was associated with more problems identifying and regulating emotions. Poor utilization of emotions and high severity of depressive symptoms contributed to higher rates of drinking at follow-up. CONCLUSIONS: These results underline the importance of systematic identification of discrete emotional problems and dynamics related to AD. This knowledge has implications for treatment. Psychotherapeutic interventions to improve emotional skills could be utilized in treatment of alcohol-dependent patients.

Theory of mind among young adult children from alcoholic families.

OBJECTIVE: Given the evidence that several cognitive and emotional functions are impaired in adult alcohol-dependent patients and the possibility that some of these deficits are transmitted to their children, the objective of the present study was to test the hypothesis that the perception of complex mental states would be reduced in young adults from families with a positive family history of alcohol dependence. It was also anticipated that social-perceptual deficits would confer unique predictive ability beyond that shared with other cognitive risk factors for alcohol dependence and/or substance use risk. METHOD: Data from 301 youth ages 18-21 years, recruited from an ongoing community longitudinal study of alcoholic and matched control families, were analyzed. Family history of alcohol dependence as well as alcohol-dependence diagnosis in the youth was based on diagnostic criteria in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. A substance use risk factor measured early problem alcohol/other drug use. The perception of mental states was measured with the computerized version of the Reading the Mind in the Eyes Test (RMET). RESULTS: Children of alcohol-dependent parents did not show impairment in the mental states perception task, nor did social perception skills predict alcohol dependence in the youth. Correlational analysis performed between RMET and the substance use risk factor showed no significant association between the variables. CONCLUSIONS: The study results do not confirm the hypothesis that behaviorally measured social perception impairment is more prevalent in the children of alcohol-dependent parents. In addition, social-perceptual deficits were not a unique marker of either alcohol dependence or high risk for alcohol dependence in this young adult sample.

Effects of sleep restriction and exercise deprivation on somatic symptoms and mood in healthy adults.

OBJECTIVES: Exposure to acute 'stressors' (e.g. infections, pain, trauma) often results in altered sleep habits and reductions in routine activity. In some individuals, these behavioural responses to acute stressors may contribute to the development of chronic somatic symptoms such as widespread pain, fatigue, memory difficulties and mood disturbances, much like those associated with 'functional somatic syndromes' (FSS) such as fibromyalgia or chronic fatigue syndrome. METHODS: Eighty-seven healthy young adults who reported sleeping between 7 and 9 hours nightly and exercising regularly were randomised to one of four groups: exercise cessation, sleep restriction (6 hours nightly), both, or neither. Symptoms of pain, fatigue, cognitive dysfunction and negative mood were measured before and after the 10-day restriction period. RESULTS: Sleep restriction was a potent contributor to the development of somatic symptoms. Exercise cessation was less influential leading only to fatigue. There were no significant interactions between exercise cessation and sleep restriction, except that males were much more likely to develop somatic symptoms when deprived of both sleep and exercise than one or the other. Women were generally much more likely to develop somatic symptoms than men. CONCLUSIONS: This study supports previous research suggesting that both sleep and exercise are critical in 'preventing' somatic symptoms among some individuals. Furthermore, to our knowledge, this is the first time there is data to suggest that women are much more sensitive to decrements in routine sleep and exercise than are men.

Executive function in chronic pain patients and healthy controls: different cortical activation during response inhibition in fibromyalgia.

UNLABELLED: The primary symptom of fibromyalgia (FM) is chronic, widespread pain; however, patients report additional symptoms including decreased concentration and memory. Performance-based deficits are seen mainly in tests of working memory and executive function. Neural correlates of executive function were investigated in 18 FM patients and 14 age-matched healthy controls during a simple Go/No-Go task (response inhibition) while they underwent functional magnetic resonance imaging (fMRI). Performance was not different between FM and healthy control, in either reaction time or accuracy. However, fMRI revealed that FM patients had lower activation in the right premotor cortex, supplementary motor area, midcingulate cortex, putamen and, after controlling for anxiety, in the right insular cortex and right inferior frontal gyrus. A hyperactivation in FM patients was seen in the right inferior temporal gyrus/fusiform gyrus. Despite the same reaction times and accuracy, FM patients show less brain activation in cortical structures in the inhibition network (specifically in areas involved in response selection/motor preparation) and the attention network along with increased activation in brain areas not normally part of the inhibition network. We hypothesize that response inhibition and pain perception may rely on partially overlapping networks, and that in chronic pain patients, resources taken up by pain processing may not be available for executive functioning tasks such as response inhibition. Compensatory cortical plasticity may be required to achieve performance on a par with control groups. PERSPECTIVE: Neural activation (fMRI) during response inhibition was measured in fibromyalgia patients and controls. FM patients show lower activation in the inhibition and attention networks and increased activation in other areas. Inhibition and pain perception may use overlapping networks: resources taken up by pain processing may be unavailable for other processes.

Content and criterion validity of the preliminary core dataset for clinical trials in fibromyalgia syndrome.

OBJECTIVE: Increasing research interest and emerging new therapies for treatment of fibromyalgia (FM) have led to a need to develop a consensus on a core set of outcome measures that should be assessed and reported in all clinical trials, to facilitate interpretation of the data and understanding of the disease. This aligns with the key objective of the Outcome Measures in Rheumatology (OMERACT) initiative to improve outcome measurement through a data driven, interactive consensus process. METHODS: Through patient focus groups and Delphi processes, working groups at previous OMERACT meetings identified potential domains to be included in the core data set. A systematic review has shown that instruments measuring these domains are available and are at least moderately sensitive to change. Most instruments have been validated in multiple languages. This pooled analysis study aims to develop the core data set by analyzing data from 10 randomized controlled trials (RCT) in FM. RESULTS: Results from this study provide support for the inclusion of the following in the core data set: pain, tenderness, fatigue, sleep, patient global assessment, and multidimensional function/health related quality of life. Construct validity was demonstrated with outcome instruments showing convergent and divergent validity. Content and criterion validity were confirmed by multivariate analysis showing R square values between 0.4 and 0.6. Low R square value is associated with studies in which one or more domains were not assessed. CONCLUSION: The core data set was supported by high consensus among attendees at OMERACT 9. Establishing an international standard for RCT in FM should facilitate future metaanalyses and indirect comparisons.

Fibromyalgia syndrome module at OMERACT 9: domain construct.

The objective of the module was to (1) establish a core domain set for fibromyalgia (FM) assessment in clinical trials and practice, (2) review outcome measure performance characteristics, (3) discuss development of a responder index for assessment of FM in clinical trials, (4) review objective markers, (5) review the domain of cognitive dysfunction, and (6) establish a research agenda for outcomes research. Presentations at the module included: (1) Results of univariate and multivariate analysis of 10 FM clinical trials of 4 drugs, mapping key domains identified in previous patient focus group: Delphi exercises and a clinician/researcher Delphi exercise, and breakout discussions to vote on possible essential domains and reliable measures; (2) Updates regarding outcome measure status; (3) Update on objective markers to measure FM disease state; and (4) Review of the issue of cognitive dysfunction (dyscognition) in FM. Consensus was reached as follows: (1) Greater than 70% of OMERACT participants agreed that pain, tenderness, fatigue, patient global, multidimensional function and sleep disturbance domains should be measured in all FM clinical trials; dyscognition and depression should be measured in some trials; and stiffness, anxiety, functional imaging, and cerebrospinal fluid biomarkers were identified as domains of research interest. (2) FM domain outcome measures have generally proven to be reliable, discriminative, and feasible. More sophisticated and comprehensive measures are in development, as is a responder index for FM. (3) Increasing numbers of objective markers are being developed for FM assessment. (4) Cognitive dysfunction assessment by self-assessed and applied outcome measures is being developed. In conclusion, a multidimensional symptom core set is proposed for evaluation of FM in clinical trials. Research on improved measures of single domains and composite measures is ongoing.

Review of cognitive dysfunction in fibromyalgia: a convergence on working memory and attentional control impairments.

Clinical and laboratory evidence confirm that dyscognition is a real and troubling symptom in fibromyalgia (FM), and that the cognitive mechanisms most affected in FM are working memory, episodic memory, and semantic memory. Recent evidence provides further convergence on specific difficulty with attentional control. Dyscognition in FM cannot be attributed solely to concomitant psychiatric conditions such as depression and poor sleep, but does seem to be related to the level of pain. This article presents recent contributions regarding the etiology of the cognitive dysfunction, its impact on patients, and highlights the need for further research on this facet of FM.

Effects of alcoholism severity and smoking on executive neurocognitive function.

AIMS: Neurocognitive deficits in chronic alcoholic men are well documented. Impairments include memory, visual-spatial processing, problem solving and executive function. The cause of impairment could include direct effects of alcohol toxicity, pre-existing cognitive deficits that predispose towards substance abuse, comorbid psychiatric disorders and abuse of substances other than alcohol. Cigarette smoking occurs at higher rates in alcoholism and has been linked to poor cognitive performance, yet the effects of smoking on cognitive function in alcoholism are often ignored. We examined whether chronic alcoholism and chronic smoking have effects on executive function. METHODS: Alcoholism and smoking were examined in a community-recruited sample of alcoholic and non-alcoholic men (n = 240) using standard neuropsychological and reaction-time measures of executive function. Alcoholism was measured as the average level of alcoholism diagnoses across the study duration (12 years). Smoking was measured in pack-years. RESULTS: Both alcoholism and smoking were correlated negatively with a composite executive function score. For component measures, alcoholism was correlated negatively with a broad range of measures, whereas smoking was correlated negatively with measures that emphasize response speed. In regression analyses, both smoking and alcoholism were significant predictors of executive function composite. However, when IQ is included in the regression analyses, alcoholism severity is no longer significant. CONCLUSIONS: Both smoking and alcoholism were related to executive function. However, the effect of alcoholism was not independent of IQ, suggesting a generalized effect, perhaps affecting a wide range of cognitive abilities of which executive function is a component. On the other hand, the effect of smoking on measures relying on response speed were independent of IQ, suggesting a more specific processing speed deficit associated with chronic smoking.

Trajectories of childhood aggression and inattention/hyperactivity: differential effects on substance abuse in adolescence.

OBJECTIVE: Aggression and hyperactivity/inattention each are linked to risk of alcohol use disorder (AUD), but their unique contributions remain ambiguous. The present study disaggregated these two domains developmentally and examined the relation between childhood behavior trajectories and adolescent substance use. METHOD: A total of 335 children of alcoholic and nonalcoholic fathers were studied prospectively. Parallel process latent trajectory class analysis was developed with behavioral ratings by parents and teachers of aggression and inattention/hyperactivity across ages 7 to 16. Membership in the four latent classes was used as a predictor for problem adolescence alcohol use and substance onset. RESULTS: Youths in the four latent trajectory classes differed in number of alcohol problems at age 16: healthy class (39% of sample, mean 2.1 alcohol-related problems), inattentive/hyperactive but not aggressive (33%; mean 2.7 problems), aggressive but not inattentive/hyperactive (4%, mean 5.0 problems), and comorbid (24%; mean 4.0 problems). Survival analysis revealed that the aggressive, comorbid, and inattentive/hyperactive classes had significantly earlier onsets of drinking, drunkenness, and marijuana use than the healthy class. Illicit drug use was also significantly increased in the comorbid, aggressive, and inattentive/hyperactive classes compared to the healthy class. CONCLUSIONS: Three levels of behavioral risk of substance abuse exist, the highest having trajectories of increased aggressive and inattentive/hyperactive problems throughout childhood, the next involving only an increased inattentive/hyperactive behavioral trajectory, and the lowest involving those with neither type of problem. Children with both inattention/hyperactivity and aggression have the greatest need for childhood intervention to prevent substance abuse in adolescence.

Fibromyalgia and cognition.

Patients with fibromyalgia frequently complain of cognitive problems or "fibrofog." The existence of these symptoms has been confirmed by studies of the incidence of cognitive problems in fibromyalgia patients and by the results of objective tests of metamemory, working memory, semantic memory, everyday attention, task switching, and selective attention. The results of these tests show that fibromyalgia patients have impairments in working, episodic, and semantic memory that mimic about 20 years of aging. These patients have particular difficulty with memory when tasks are complex and their attention is divided. Cognitive symptoms in these patients may be exacerbated by the presence of depression, anxiety, sleep problems, endocrine disturbances, and pain, but the relationship of these factors to cognitive problems in fibromyalgia patients is unclear. Standardized tests and treatment have not yet been established for cognitive problems in fibromyalgia patients.

A psychophysical study of auditory and pressure sensitivity in patients with fibromyalgia and healthy controls.

UNLABELLED: Fibromyalgia (FM) is characterized by widespread tenderness. Studies have also reported that persons with FM are sensitive to other stimuli, such as auditory tones. We hypothesized that subjects with FM would display greater sensitivity to both pressure and auditory tones and report greater sensitivity to sounds encountered in daily activities. FM subjects (n = 30) and healthy control subjects (n = 28) were administered auditory tones and pressure using the same psychophysical methods to deliver the stimuli and a common way of scaling responses. Subjects were also administered a self-report questionnaire regarding sensitivity to everyday sounds. Participants with FM displayed significantly greater sensitivity to all levels of auditory stimulation (Ps < .05). The magnitude of difference between FM patients' lowered auditory sensitivity (relative to control subjects) was similar to that seen with pressure, and pressure and auditory ratings were significantly correlated in both control subjects and subjects with FM. FM patients also were more sensitive to everyday sounds (t = 8.65, P < .001). These findings support that FM is associated with a global central nervous system augmentation in sensory processing. Further research is needed to examine the neural substrates associated with this abnormality and its role in the etiology and maintenance of FM. PERSPECTIVE: Muscle tenderness is the hallmark of FM, but the findings of this study and others suggest that persons with FM display sensitivity to a number of sensory stimuli. These findings suggest that FM is associated with a global central nervous system augmentation of sensory information. These findings may also help to explain why persons with FM display a number of comorbid physical symptoms other than pain.

Multidisciplinary care and stepwise treatment for fibromyalgia.

Fibromyalgia is a common musculoskeletal pain condition associated with chronic widespread pain, tenderness at various points on the body, fatigue, sleep abnormalities, and common comorbidity with psychiatric and medical disorders. Research into pharmacologic remedies for fibromyalgia has demonstrated efficacy for a variety of agents, but pharmacology is only one piece of the puzzle when it comes to successful management of fibromyalgia. Sensitive and appropriate methods of diagnosis and an integrated treatment plan including proper patient education, aerobic exercise, and cognitive-behavioral therapy have been shown effective in alleviating fibromyalgic symptoms. The development of a comprehensive, multidisciplinary disease management strategy is a difficult but essential challenge facing clinicians treating patients with fibromyalgia.

Evaluating and diagnosing fibromyalgia and comorbid psychiatric disorders.

Fibromyalgia is a common and disabling chronic pain syndrome that is often accompanied by other chronic pain and/or psychiatric comorbidities, which impact fibromyalgia course and outcome. Although a primary care provider will likely take the lead in caring for patients with fibromyalgia, psychiatrists and other mental health professionals may play a role in the diagnosis, evaluation, and management of fibromyalgia. Psychiatrists' familiarity with many of the pharmacologic and nonpharmacologic treatments that are currently being used for fibromyalgia make them valuable partners in the multidisciplinary team of clinicians addressing fibromyalgia and its comorbidities. In this activity, experts on fibromyalgia discuss the nature of the syndrome and its diagnosis and evaluation.

Visual function and cognitive aging: differential role of contrast sensitivity in verbal versus spatial tasks.

Cognitive and sensory function are correlated in older adults. Sensory function may provide an index of neurological integrity (common-cause hypothesis). Declining sensory input may also directly impair cognition (direct-cause hypothesis). Accordingly, sensory function should more strongly predict cognitive performance and should account for more age-related variability in tasks with higher sensory demands. In a cross-sectional adult life span sample, visual contrast sensitivity was a better predictor and accounted for more of the age-related variability in high sensory-demand tasks, compared with low sensory-demand tasks, consistent with the direct-cause hypothesis. The results suggest a direct role for sensory function in cognitive aging when task conditions place heavy demands on sensory processing.

Childhood and adolescent resiliency, regulation, and executive functioning in relation to adolescent problems and competence in a high-risk sample.

This study first examined the respective relations of resiliency and reactive control with executive functioning. It then examined the relationship of these different domains to the development of academic and social outcomes, and to the emergence of internalizing and externalizing problem behavior in adolescence. Resiliency and reactive control were assessed from preschool to adolescence in a high-risk sample of boys and girls (n = 498) and then linked to component operations of neuropsychological executive functioning (i.e., response inhibition, interference control, fluency, working memory/set-shifting, planning, and alertness), assessed in early and late adolescence. Consistent, linear relations were found between resiliency and executive functions (average r = .17). A curvilinear relationship was observed between reactive control and resiliency, such that resiliency was weaker when reactive control was either very high or very low. In multivariate, multilevel models, executive functions contributed to academic competence, whereas resiliency and interference control jointly predicted social competence. Low resiliency, low reactive control, and poor response inhibition uniquely and additively predicted internalizing problem behavior, whereas low reactive control and poor response inhibition uniquely predicted externalizing problem behavior. Results are discussed in relation to recent trait models of regulation and the scaffolded development of competence and problems in childhood and adolescence.

Cognitive dysfunction in fibromyalgia and chronic fatigue syndrome: new trends and future directions.

Fibromyalgia (FM) and chronic fatigue syndrome (CFS) patients often have memory and cognitive complaints. Objective cognitive testing demonstrates long-term and working memory impairments. In addition, CFS patients have slow information-processing, and FM patients have impaired control of attention, perhaps due to chronic pain. Neuroimaging studies demonstrate cerebral abnormalities and a pattern of increased neural recruitment during cognitive tasks. Future work should focus on the specific neurocognitive systems involved in cognitive dysfunction in each syndrome.

Behavioral control and resiliency in the onset of alcohol and illicit drug use: a prospective study from preschool to adolescence.

The developmental trajectories of behavioral control and resiliency from early childhood to adolescence and their effects on early onset of substance use were examined. Behavioral control is the tendency to express or contain one's impulses and behaviors. Resiliency is the ability to adapt flexibly one's characteristic level of control in response to the environment. Study participants were 514 children of alcoholics and matched controls from a longitudinal community sample (Time 1 age in years: M=4.32, SD=0.89). Children with slower rates of increase in behavioral control were more likely to use alcohol and other drugs in adolescence. Children with higher initial levels of resiliency were less likely to begin using alcohol.

Poor response inhibition as a predictor of problem drinking and illicit drug use in adolescents at risk for alcoholism and other substance use disorders.

OBJECTIVE: To evaluate the predictive power of executive functions, in particular, response inhibition, in relation to alcohol-related problems and illicit drug use in adolescence. METHOD: A total of 498 children from 275 families from a longitudinal high-risk study completed executive function measures in early and late adolescence and lifetime drinking and drug-related ratings at multiple time points including late adolescence (ages 15-17). Multi-informant measures of attention-deficit/hyperactivity disorder and conduct disorder were obtained in early childhood (ages 3-5), middle childhood, and adolescence. RESULTS: In multilevel models, poor response inhibition predicted aggregate alcohol-related problems, the number of illicit drugs used, and comorbid alcohol and drug use (but not the number of drug-related problems), independently of IQ, parental alcoholism and antisocial personality disorder, child attention-deficit/hyperactivity disorder and conduct symptoms, or age. Multivariate models explained 8% to 20% of residual variance in outcome scores. The incremental predictive power of response inhibition was modest, explaining about 1% of the variance in most outcomes, but more than 9% of the residual variance in problem outcomes within the highest risk families. Other measured executive functions did not independently predict substance use onset. CONCLUSION: Models of alcoholism and other drug risks that invoke executive functions may benefit from specifying response inhibition as an incremental component.