Psychiatric Treatment and Management of Psychiatric Comorbidities of Movement Disorders.

Pediatric movement disorders may present with psychiatric symptoms at many points during the course of the disease. For the relatively common pediatric movement disorder, Tourette syndrome, psychiatric comorbidities are well-described and treatment is well-studied. Managing these comorbidities may be more effective than improving the movements themselves. For more uncommon movement disorders, such as juvenile-onset Huntington disease, treatment of psychiatric comorbidities is not well-characterized, and best-practice recommendations are not available. For the least common movement disorders, such as childhood neurodegeneration with brain iron accumulation, psychiatric features may be nonspecific so that underlying diagnosis may be apparent only after recognition of other symptoms. However, psychiatric medication, psychotherapy, and psychosocial support for these disorders may prove helpful to many children and adolescents.

Six In Vivo Assessments of Compulsive Behavior: A Validation Study Using the Obsessive-Compulsive Inventory-Revised.

Due to the complex and heterogeneous nature of obsessive-compulsive disorder (OCD), movement toward multimodal assessment has become necessary to more precisely understand the nature of the disorder and interrelations between symptom clusters. Thus, the present study utilized large undergraduate samples (total N = 800) to test the validity of six in vivo assessments of OC symptoms (i.e., one ordering/arranging task, two contamination fear/washing tasks, and three checking tasks). Associations between task-specific variables and self-reported symptom scores (as measured by the Obsessive-Compulsive Inventory-Revised [OCI-R]) were examined. The majority of the in vivo task variables (those presented in Studies 1-4) exhibited significant relationships with the corresponding OCI-R symptom subscale (i.e., ordering, washing, checking). However, many of the task variables demonstrated relationships with other OCI-R symptom subscales, as well. Some evidence for discriminant validity was found, as task variables were generally unrelated to past-week symptoms of depression or anxiety. While continued research is necessary to further establish the validity and utility of the tasks discussed in the current article, findings have implications for improving future empirical examination of OC symptoms.

Intolerance of uncertainty in body dysmorphic disorder.

Intolerance of uncertainty (IU) is a transdiagnostic construct associated with several anxiety and related disorders. Three studies were conducted to explore the potential relationship between IU and body dysmorphic disorder (BDD). Study 1 revealed a positive relationship between IU and BDD symptoms above symptoms of anxiety and depression in an unselected student sample (N=88). Study 2 demonstrated a similar relationship between IU and BDD symptoms above negative affectivity and intolerance of ambiguity in a community sample (N=116). Study 3 found that a clinical BDD sample (N=23) reported greater IU than healthy controls (N=20), though this relationship was accounted for by symptoms of anxiety and depression. Greater IU predicted functional impairment in the clinical sample above BDD symptoms and past-week anxiety and depression. The observed relationship between IU and BDD symptoms provides preliminary support for the relevance of IU to this population.

An Initial Test of Reconsolidation in Disgust-Related Learning and Extinction.

This study examines whether the spacing of a single unreinforced retrieval trial relative to extinction learning allows for "rewriting" the original disgust association, thereby preventing the return of disgust using a paradigm that employs disgust-relevant unconditioned stimuli (US). During conditioning, disgusting US were paired with a color square that served as the conditioned stimuli (CS). Participants (n = 54) then returned to the lab 24 hours later and received a "reactivation" intervention which consisted of one unpaired presentation of the CS+. Participants were then randomized to receive extinction trials either 10 min (Group A) or 6 hours (Group B) after reactivation. A third control group (Group C) did not receive the reactivation manipulation before extinction. Participants returned 24 hours later for additional extinction trials and at a 1-month follow-up for disgust reinstatement. Although the paradigm resulted in participants evaluating the CS+ as significantly more unpleasant after being associated with a disgust-relevant US, extinction learning within the reconsolidation window did not influence self-reported reduction or return of disgust. However, there was some evidence suggesting that those who received reactivation (Groups A and B), regardless of timing, evaluated the CS+ as less unpleasant after extinction relative to acquisition, whereas this pattern was not observed among those who did not receive reactivation (Group C). The implications of these findings for anxiety-related disorders in which disgust has been implicated will be discussed.

Trait hostility and hostile interpretation biases in daily smokers: associations with reasons for smoking, motivation to quit, and early smoking lapse.

Hostility has emerged as an important predictor of smoking cessation difficulties, though the mechanisms underlying the hostility and smoking relationship are poorly understood. Further, research has yet to explore relations between hostile interpretation biases and different aspects of smoking behavior. In the present study, current daily smokers (N = 106) were administered measures of smoking characteristics, smoking motivation, reasons for quitting, hostility, and hostile interpretation bias. Neither trait hostility nor hostile interpretation bias were uniquely associated with motivation to quit, reasons for quitting, nicotine dependence, or problematic symptoms following past cessation attempts. However, hostility and hostile interpretation biases were uniquely associated with different reasons for smoking. Additionally, greater hostile interpretation bias (but not hostility) was uniquely associated with early relapse following past cessation attempts. The current findings add uniquely to the growing, but still relatively small, literature on hostility and smoking and implicate hostile interpretation bias as a potential treatment target in smoking cessation interventions.

Multiple facets of problematic anger among regular smokers: exploring associations with smoking motives and cessation difficulties.

INTRODUCTION: Research has implicated problematic anger in multiple smoking outcomes, including nicotine dependence and difficulties with cessation. However, the mechanisms underlying the role of anger in smoking behavior and cessation difficulties remain unclear. The current study examined associations between different facets of anger with smoking motives, problematic symptoms during past quit attempts, reasons for quitting, and perceived barriers to cessation. METHODS: Current smokers (N = 93) were administered measures assessing the relevant constructs. RESULTS: After controlling for gender and negative affectivity, greater trait anger was uniquely related to more severe symptoms during past cessation attempts, perceived internal and external barriers to cessation, social influence reasons for quitting, and negative affect reduction and sensorimotor smoking motivations. CONCLUSIONS: These findings add uniquely to the literature on anger and smoking and suggest anger plays a role in everyday smoking behavior. Smokers with problematic anger might benefit from treatment focused on reducing anger and improving interpersonal functioning. Reducing trait anger may help reduce problematic symptoms during quitting, making relapse less likely.

Intolerance of uncertainty and obsessive-compulsive symptom expression.

BACKGROUND AND OBJECTIVES: Research suggests a relationship between intolerance of uncertainty (IU) and obsessive-compulsive disorder (OCD), though this has been limited to self-report measures of OCD symptoms. The current investigation examined the relationship between IU and multiple symptom domains of OCD using self-report and in vivo assessments of OC symptoms. METHODS: Five separate studies are presented in which undergraduate students (N=603) were administered a self-report measure of IU and tasks related to either ordering and arranging, checking, washing, contamination avoidance, or neutralization. RESULTS: Intolerance of uncertainty was found to be significantly related to each self-report measure of the OCD symptom domains (ps < .01). Further, IU was predictive of performance on all in vivo tasks (ps < .05) except one concerning neutralizing/harm-related obsessions. LIMITATIONS: This study relied on an unselected sample and was correlational in design. CONCLUSIONS: The current study demonstrates that IU is related to multiple OC symptom dimensions. Future experimental research is warranted to evaluate the causal role of IU in OCD.

A multi-modal investigation of the roles of distress tolerance and emotional reactivity in obsessive-compulsive symptoms.

Emerging evidence implicates important roles of poor distress tolerance and heightened emotional reactivity in obsessive-compulsive disorder. To date, investigations have relied mostly on self-report measures, and we sought to extend the literature by examining the relationship between OC symptoms and distress tolerance, as well as emotional reactivity, using three laboratory assessments. Nonclinical participants (N=167) viewed emotional films associated with four different negative emotions and also completed mirror tracing and handgrip persistence tasks. Greater obsessions scores were predictive of poorer emotional tolerance for a sad film and shorter persistence on the mirror tracing task. Among men only, obsessions were negatively correlated with persistence on the handgrip task. Associations between increased emotional reactivity and washing symptoms also emerged. These findings provide further evidence for the role of poor distress tolerance in obsessions and suggest heightened emotional reactivity may play a role in compulsive washing.

The Three Domains of Disgust Scale: factor structure, psychometric properties, and conceptual limitations.

This investigation examined the measurement properties of the Three Domains of Disgust Scale (TDDS). Principal components analysis in Study 1 (n = 206) revealed three factors of Pathogen, Sexual, and Moral Disgust that demonstrated excellent reliability, including test-retest over 12 weeks. Confirmatory factor analyses in Study 2 (n = 406) supported the three factors. Supportive evidence for the validity of the Pathogen and Sexual Disgust subscales was found in Study 1 and Study 2 with strong associations with disgust/contamination and weak associations with negative affect. However, the validity of the Moral Disgust subscale was limited. Study 3 (n = 200) showed that the TDDS subscales differentially related to personality traits. Study 4 (n = 47) provided evidence for the validity of the TDDS subscales in relation to multiple indices of disgust/contamination aversion in a select sample. Study 5 (n = 70) further highlighted limitations of the Moral Disgust subscale given the lack of a theoretically consistent association with moral attitudes. Lastly, Study 6 (n = 178) showed that responses on the Moral Disgust scale were more intense when anger was the response option compared with when disgust was the response option. The implications of these findings for the assessment of disgust are discussed.

Attentional bias toward threat in contamination fear: overt components and behavioral correlates.

Recent research suggests that an attentional bias toward threat may play a causal role in obsessive-compulsive disorder (OCD) with contamination concerns. However, the attentional components involved in this bias, as well as its behavioral correlates, remain unclear. In the present study, eye movements were recorded in individuals high and low in contamination fear (HCF, LCF, respectively) during 30-s exposures to stimulus arrays containing contamination threat, general threat, pleasant, and neutral images. HCF individuals oriented gaze toward contamination threat more often than LCF individuals in initial fixations, and this bias mediated group differences in responding to a behavioral challenge in a public restroom. No group differences were found in the maintenance of gaze on contamination threat, both in terms of initial gaze encounters, as well as gaze duration over time. However, the HCF group made shorter fixations on contamination threat relative to other image types. The implications of these findings for further delineating the nature and function of attentional biases in contamination-based OCD are discussed.

Orienting and maintenance of gaze in contamination fear: Biases for disgust and fear cues.

The present study examines the extent to which attentional biases in contamination fear commonly observed in obsessive-compulsive disorder (OCD) are specific to disgust or fear cues, as well as the components of attention involved. Eye tracking was used to provide greater sensitivity and specificity than afforded by traditional reaction time measures of attention. Participants high (HCF; n = 23) and low (LCF; n = 25) in contamination fear were presented with disgusted, fearful, or happy faces paired with neutral faces for 3 s trials. Evidence of both vigilance and maintenance-based biases for threat was found. The high group oriented attention to fearful faces but not disgusted faces compared to the low group. However, the high group maintained attention on both disgusted and fearful expressions compared to the low group, a pattern consistent across the 3 s trials. The implications of these findings for conceptualizing emotional factors that moderate attentional biases in contamination-based OCD are discussed.