Behavioural activation for the treatment of low-income, African American adolescents with major depressive disorder: a case series.

Behavioural activation (BA) is a psychosocial treatment that has shown promise in the treatment of adults suffering from major depressive disorder (MDD). Recent studies have shown that BA may also be effective for treating depressed adolescents. There are no studies that have reported on the BA treatment of depressed and low-income African American adolescents; thus, the current study reports on the effectiveness of a version of BA adapted for the treatment of African American adolescents who were diagnosed with MDD (n = 3). Participants were allowed to attend a maximum of 17 sessions of weekly psychotherapy. Based on results taken from structured interviews, two of the three participants no longer met criteria for MDD at the end of treatment, and the severity of clinician-rated depressive symptoms and impairment decreased for all participants at post-treatment assessment. Additionally, all participants and their caregivers reported satisfaction with treatment. Implications of these findings, study limitations and suggestions for future directions are discussed.

The therapeutic alliance in the cognitive behavioral treatment of pediatric obsessive-compulsive disorder.

Although cognitive-behavioral therapy (CBT) for pediatric obsessive-compulsive disorder (OCD) is considered a first-line treatment, not all youth have a positive treatment response, suggesting need for investigating factors that may enhance or reduce treatment effects. Few studies have investigated predictors of treatment response in pediatric OCD, and there is an absence of studies examining the influence of treatment process variables (e.g., therapeutic alliance [TA]) on treatment outcome. Using a multiple-informant and multiple-time point design, the current study examined the role of the TA in family-based CBT for pediatric OCD. Analyses examined (1) the predictive value of the TA on OCD symptom reduction and (2) whether changes in the TA over time predict treatment response. Findings indicated that (1) stronger child-rated, parent-rated, and therapist-rated TAs were predictive of better treatment outcome and (2) larger and more positive early alliance shifts (as rated by changes in child-rated TA between sessions 1 and 5) were predictive of better treatment outcome. Implications for the treatment of youth with OCD within family-based CBT are discussed.

Trichotillomania: A current review.

This review provides a broad and thorough synthesis of the Trichotillomania (TTM) literature as a resource for health professionals seeking the most current and complete information available. For the treatment provider, up to date information can help inform assessment, treatment, or referral decisions. For the student, this review provides a general overview and broad background information necessary to better understand hair-pulling and associated problems. For the researcher, information can help inform study planning. Prevalence, gender distributions, comorbidities, subtypes, and phenomenological characteristics are presented. Etiological theories are reviewed, and assessment and treatment options are offered. The validity of current DSM requirements is discussed and psychological and psychiatric treatment options are presented and evaluated for their strength of recommendation. Challenges to research and treatment are presented and directions for future research are suggested.

Quality of life in children and adolescents with obsessive-compulsive disorder: base rates, parent-child agreement, and clinical correlates.

The presence of obsessive-compulsive disorder (OCD) has been linked to decreased quality of life (QoL) among adults, yet little is known about the impact of OCD on QoL in pediatric patients. Sixty-two youth with OCD and their parent(s) were administered the Children's Yale-Brown Obsessive Compulsive Scale following a clinical interview. Children completed the Pediatric Quality of Life Inventory and parents completed the Pediatric Quality of Life Parent Proxy Inventory and Child Behavior Checklist. QoL scores for OCD patients were significantly lower than for healthy controls, but similar to QoL in a general psychiatric sample on the majority of domains. Parent-child agreement on QoL was moderate to strong across age groups. Results indicate that, in youth with OCD, QoL is reduced relative to healthy controls, related to OCD symptom severity per parent-report, and are strongly predicted by the presence of comorbid externalizing and internalizing symptoms.

Anxiety disorders in youth.

Anxiety disorders are one of the most prevalent categories of childhood and adolescent psychopathology. Due to their distressing, time-consuming, and/or debilitating nature, impairments in academic, social, and family functioning are often substantial. This article reviews the nature, etiology, assessment, and treatment of anxiety disorders in youth. We conclude by reviewing implications for nurses involved in the care of youth with anxiety disorders.

Clinical predictors of response to cognitive-behavioral therapy for obsessive-compulsive disorder.

This paper reviews predictors of treatment response in open and controlled trials of cognitive-behavioral therapy for obsessive-compulsive disorder (OCD). We focus on demographic characteristics, aspects of OCD symptoms, comorbidity, family factors, cognitive influences, and treatment-specific characteristics as predictor variables. Although inconsistent findings characterize much of the literature, several relatively consistent and salient predictors have emerged, including symptom severity, symptom subtype, severe depression, the presence of comorbid personality disorders, family dysfunction, and the therapeutic alliance. Implications of findings and recommendations for future research are discussed.

Assessment of obsessive-compulsive disorder: a review.

Obsessive-compulsive disorder (OCD) affects approximately 2-3% of the adult population and is considered a debilitating and costly disorder, with associated impairments spanning the social, occupational, and familial domains. Although effective treatments of OCD exist, many individuals who suffer from OCD go undiagnosed or misdiagnosed, preventing them from obtaining appropriate treatment. As a result, making improvements to the assessment and diagnosis of OCD remains an important area of focus for research and clinical practice. This paper provides a critical review of instruments used in the assessment and diagnosis of OCD as well as a review of adjunctive measures used to assess associated symptoms. Types of instruments reviewed include diagnostic interviews, self-report questionnaires, family-report questionnaires, and clinician-administered inventories. Discussion of each instrument includes information regarding the pragmatics of administration and the psychometric properties of each instrument, as well as an evaluation of each instrument's strengths and weaknesses. We conclude by providing a synthesis of the literature and highlighting directions for future research.

The Adolescent Coping Process Interview: measuring temporal and affective components of adolescent responses to peer stress.

The way in which adolescents cope with stressors in their lives has been established as an important correlate of adjustment. While most theoretical models of coping entail unfolding transactions between coping strategies and emotional arousal, the majority of coping measures tap only trait-level coping styles, ignoring both temporal and affective components of the coping process. The current study fills this gap by establishing the psychometric properties of a newly developed measure, the Adolescent Coping Process Interview (ACPI), that is more in line with transactional and developmental models of coping. Results indicate that the ACPI displays good psychometric properties, captures significant intra-individual variability in coping over the process, and points to emotional arousal as informing several coping-adjustment relationships. Moreover, the ACPI and similar approaches may help promote the development of more adaptive patterns of coping in adolescents by helping to identify specific points within the coping process at which to intervene.

Pediatric obsessive-compulsive disorder: a guide to assessment and treatment.

Obsessive-compulsive disorder (OCD) is an anxiety disorder characterized by recurrent or persistent thoughts, impulses, or images that are experienced as intrusive or distressing (obsessions), and repetitive behaviors or mental acts (compulsions) often performed in response to an obsession. Recent epidemiological studies have found lifetime prevalence of pediatric OCD to be approximately 1-4% in the USA. OCD begins before the age of 18 years for as many as 80% of cases and follows a chronic, unremitting course. Due to the distressing, time-consuming, and debilitating nature of OCD, impairments in academic, social, and family functioning are often substantial. Despite the relatively high prevalence rate of OCD, dissemination about effective assessment and treatment has lagged. Increasing the awareness of OCD symptoms and its treatment among nurses and other health professionals will enhance identification of children presenting with unrecognized or untreated symptoms of OCD and will stimulate appropriate referrals for treatment to improve children's psychological functioning and overall quality of life. This paper reviews the nature, etiology, assessment, and treatment of OCD, highlighting clinical implications for nurses involved in mental health care.