Latin American Trans-ancestry INitiative for OCD genomics (LATINO): Study protocol

Obsessive-compulsive disorder (OCD) is a debilitating psychiatric disorder. Worldwide, its prevalence is ~2% and its etiology is mostly unknown. Identifying biological factors contributing to OCD will elucidate underlying mechanisms and might contribute to improved treatment outcomes. Genomic studies of OCD are beginning to reveal long-sought risk loci, but >95% of the cases currently in analysis are of homogenous European ancestry. If not addressed, this Eurocentric bias will result in OCD genomic findings being more accurate for individuals of European ancestry than other ancestries, thereby contributing to health disparities in potential future applications of genomics. In this study protocol paper, we describe the Latin American Trans-ancestry INitiative for OCD genomics (LATINO, https://www.latinostudy.org). LATINO is a new network of investigators from across Latin America, the United States, and Canada who have begun to collect DNA and clinical data from 5000 richly phenotyped OCD cases of Latin American ancestry in a culturally sensitive and ethical manner. In this project, we will utilize trans-ancestry genomic analyses to accelerate the identification of OCD risk loci, fine-map putative causal variants, and improve the performance of polygenic risk scores in diverse populations. We will also capitalize on rich clinical data to examine the genetics of treatment response, biologically plausible OCD subtypes, and symptom dimensions. Additionally, LATINO will help elucidate the diversity of the clinical presentations of OCD across cultures through various trainings developed and offered in collaboration with Latin American investigators. We believe this study will advance the important goal of global mental health discovery and equity.

A - 2 The Effect of English Language Fluency, Acculturation, and Length of Stay in the U.S. on Cognitive Functioning in Mexican Americans

OBJECTIVE

Evidence suggests that Hispanic and Latino individuals perform worse on some measures of cognitive functioning than non-Hispanic White individuals. Given this finding, several possible explanations have been posited, including differences in English fluency and acculturation. The purpose of this study was to investigate the effect of English fluency and acculturation on older Mexican American individuals' cognitive testing performance.

METHOD

Participants (M age = 63.44; 66.1% female) were Mexican American (n = 899) community members participating in the Health and Aging Brain Study: Health Disparities study. Information gathered included demographic information, attained education level, language use/fluency, acculturation level, and estimated premorbid functioning (reading score) in addition to cognitive functioning performance (MMSE).

RESULTS

Controlling for education and estimated premorbid functioning, both longer stay in the U.S. (β = 1.12, p = 0.006) and more acculturation (β = 1.00, p = 0.035) significantly predicted better cognitive testing performance. Furthermore, after controlling for education and estimated premorbid functioning, using English as a primary language resulted in significantly better testing performance than using Spanish as a primary language and being English fluent (p = 0.006) or non-fluent (p < 0.001). English fluent individuals that used Spanish as their primary language performed significantly better (p < 0.001) than those that were not English fluent and used Spanish as their primary language.

CONCLUSION

Our findings suggest that factors associated with U.S. acculturation, including stay in the U.S. and English fluency, influence cognitive testing performance. Additional cultural considerations and adaptions may be needed for current neuropsychology measures, such as cognitive testing instruments.

H - 08 Differences in the Predictive Validity of Social Determinants of Health and all-Cause Dementia Risk in Hispanic Americans

OBJECTIVE

Hispanics and Latinos are one of the fastest growing ethnic groups in the U.S. This fact, coupled by their increased risk of developing a dementia, underscores the importance of research investigating methods to ameliorate this risk. The purpose of this study was to investigate if common social determinants of health (SDOH) associated with dementia risk were similarly predictive of cognitive decline with Mexican American clients compared to non-Hispanic White clients.

METHOD

Participants (M age = 65.98; 61.5% female) were non-Hispanic White (n = 1063) and Mexican American (n = 1061) community members participating in the Health and Aging Brain Study: Health Disparities study. The majority (77.9%) of participants were determined by diagnostic consensus to have normal cognition. Information gathered included SDOH factors-income, attained education level, social support, and physical exercise-in addition to information relating to informant-reported cognitive and functional impairment (CDR).

RESULTS

Although higher levels of social support and income were related to less cognitive and functional impairment across participants, more physical exercise (β = -0.09, p = 0.006) was only predictive of less impairment for non-Hispanic White participants. Further, more attained education level (β = -0.08, p = 0.018) was only predictive of less impairment for Mexican American individuals.

CONCLUSION

Our findings suggest that some SDOHs, specifically exercise and educational level, differentially predict cognitive and functional impairment between Mexican American and non-Hispanic White individuals. Future studies should investigate aspects of these variables (e.g., quality of education, type of exercise, etc.) that best protect from cognitive and functional impairment.

Measurement invariance of commonly used psychosis-screening scales in U.S. Spanish- and English-speaking Hispanic participants

Two of the most commonly used psychosis screening measures are the Prodromal Questionnaire-Brief (PQ-B) and the Youth Psychosis at Risk Questionnaire-Brief (YPARQ-B). Both scales have considerable support for the reliability and validity of their scores for use with English- and Spanish-speaking participants, with measurement equivalence established across a subset of demographic characteristics. However, measurement invariance has not been examined across several important demographic variables, including native language, language of the scales used with Hispanic participants, education, occupation, income, birth country, and generation status. In the present study, (N = 1,191) measurement invariance was examined for each of these variables across three samples (ns = 505, 714, and 126). The PQ-B total scores and YPARQ-B were found to demonstrate configural and scalar invariance, while PQ-B Distress scores displayed configural, metric, and scalar invariance across most tested demographic variables. Psychosis scores were associated with social determinants of health (SDoH) including major and everyday experiences of discrimination, food insecurity, financial insecurity, acculturation, and ethnic identity. The associations between psychosis and SDoH were mostly consistent across groups. Compared to White-non-Hispanic participants, Hispanic participants had higher scores on all psychosis measures and tended to have higher scores on discrimination, food and housing insecurity, affirmation aspects of ethnic identity, and acculturative stress. Despite differences in psychosis levels, the groups did not differ in history of treatment. Overall, these results provide strong evidence that the PQ-B and YPARQ provide equivalent, nonbiased, valid, and reliable scores in Hispanic and Non-Hispanic participants in both English and Spanish. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Latin American Trans-ancestry INitiative for OCD genomics (LATINO): Study Protocol

Obsessive-compulsive disorder (OCD) is a debilitating psychiatric disorder. Worldwide, its prevalence is ~2% and its etiology is mostly unknown. Identifying biological factors contributing to OCD will elucidate underlying mechanisms and might contribute to improved treatment outcomes. Genomic studies of OCD are beginning to reveal long-sought risk loci, but >95% of the cases currently in analysis are of homogenous European ancestry. If not addressed, this Eurocentric bias will result in OCD genomic findings being more accurate for individuals of European ancestry than other ancestries, thereby contributing to health disparities in potential future applications of genomics. In this study protocol paper, we describe the Latin American Trans-ancestry INitiative for OCD genomics (LATINO, www.latinostudy.org). LATINO is a new network of investigators from across Latin America, the United States, and Canada who have begun to collect DNA and clinical data from 5,000 richly-phenotyped OCD cases of Latin American ancestry in a culturally sensitive and ethical manner. In this project, we will utilize trans-ancestry genomic analyses to accelerate the identification of OCD risk loci, fine-map putative causal variants, and improve the performance of polygenic risk scores in diverse populations. We will also capitalize on rich clinical data to examine the genetics of treatment response, biologically plausible OCD subtypes, and symptom dimensions. Additionally, LATINO will help elucidate the diversity of the clinical presentations of OCD across cultures through various trainings developed and offered in collaboration with Latin American investigators. We believe this study will advance the important goal of global mental health discovery and equity.

Posttraumatic stress disorder in daily life among World Trade Center responders: Temporal symptom cascades

BACKGROUND

Posttraumatic stress disorder (PTSD) symptoms are common in the immediate aftermath of a trauma, but it is their persistence over time that leads to a diagnosis. This pattern highlights the critical role of symptom maintenance to understanding and treating the disorder. Relatively few studies have explored whether PTSD symptoms may be interacting or triggering one another to worsen and maintain the disorder, a dynamic we refer to as "symptom cascades." Additionally, little work has tested in real-time how other maintenance factors, such as stress, contribute to such events in daily life.

METHODS

The present study in a group (N = 202) of World Trade Center (WTC) responders oversampled for PTSD tested day-to-day temporal associations among PTSD symptom dimensions (i.e., intrusions, avoidance, numbing, and hyperarousal) and stress across one week.

RESULTS

Longitudinal models found hyperarousal on a given day predicted increased PTSD symptoms the next day, with the effect sizes almost double compared to other symptom dimensions or daily stress. Intrusions, in contrast, showed little prospective predictive effects, but instead were most susceptible to the effects from other symptoms the day before. Avoidance and numbing showed weaker bidirectional effects.

LIMITATIONS

Findings are from a unique population and based on naturalistic observation.

CONCLUSIONS

Results are consistent with the idea of symptom cascades, they underscore hyperarousal's strong role in forecasting short-term increases in PTSD (even more than stress per se) and they raise the prospect of highly specific ecological momentary interventions to potentially disrupt PTSD maintenance in daily life.

Inviting ASPPB to address systemic bias and racism: Reply to Turner et al. (2021)

Turner et al. (2021) subtly relapse in conceptualizing the Examination for Professional Practice in Psychology (Part 2-Skills) exam as a competency evaluation despite Association of State and Provincial Psychology Boards' (ASPPB) prior concession that Part 2 measures only the knowledge of skills (not skill competency). They do not address the purpose of redundant evaluation or the other concerns raised in Callahan et al. (2020). Instead, Turner et al. remain narrowly focused on defense of content validity and a reliance on outdated standards that fail to meet contemporary expectations for assessment of health care professionals. The adopted processes and procedures, albeit time consuming and effortful, are known to be methodologically inadequate. ASPPB's methods demonstrably foster linguistic biases and systemic racism that constricts licensure of diverse individuals as psychologists. Specific suggestions are offered, and ASPPB is urged to take drastic corrective action. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

The enhanced examination for professional practice in psychology: A viable approach?

Health disciplines have increasingly required competency-based evaluations as a licensure prerequisite. In keeping with this trend, the Association of State and Provincial Psychology Boards (ASPPB) has begun to develop a second part to the Examination for Professional Practice in Psychology (EPPP). The resulting 2-part examination is collectively referred to as the Enhanced EPPP. Part 1 of the Enhanced EPPP, which consists of the current exam, is designed to be an assessment of knowledge. Part 2 of the Enhanced EPPP is newly developed and intended to address the need for a competency-based evaluation. To date, ASPPB has addressed some standard facets of validity for the EPPP Part 2, but not others. In addition, the EPPP Part 2 has yet to be subjected to a broader validation process, in which the suitability of the test for its intended purpose is evaluated. Implementation of the EPPP Part 2 before validation could have negative consequences for those seeking to enter the profession and for the general public (e.g., potential restriction of diversity in the psychology workforce). For jurisdictions implementing the EPPP Part 2, failure to gather and report the evidence required for use of a test in a forensic context may also open the door for legal challenges. We end with suggestions for feasible research that could significantly enhance the validation process for the EPPP Part 2 and offer jurisdictions concrete suggestions of features to look for in determining whether and when to implement the Enhanced EPPP. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Long-term Changes in Cognitive Functioning in Individuals With Psychotic Disorders: Findings From the Suffolk County Mental Health Project

IMPORTANCE

It remains uncertain whether people with psychotic disorders experience progressive cognitive decline or normal cognitive aging after first hospitalization. This information is essential for prognostication in clinical settings, deployment of cognitive remediation, and public health policy.

OBJECTIVE

To examine long-term cognitive changes in individuals with psychotic disorders and to compare age-related differences in cognitive performance between people with psychotic disorders and matched control individuals (ie, individuals who had never had psychotic disorders).

DESIGN, SETTING, AND PARTICIPANTS

The Suffolk County Mental Health Project is an inception cohort study of first-admission patients with psychosis. Cognitive functioning was assessed 2 and 20 years later. Patients were recruited from the 12 inpatient facilities of Suffolk County, New York. At year 20, the control group was recruited by random digit dialing and matched to the clinical cohort on zip code and demographics. Data were collected between September 1991 and July 2015. Analysis began January 2016.

MAIN OUTCOMES AND MEASURES

Change in cognitive functioning in 6 domains: verbal knowledge (Wechsler Adult Intelligence Scale-Revised vocabulary test), verbal declarative memory (Verbal Paired Associates test I and II), visual declarative memory (Visual Reproduction test I and II), attention and processing speed (Symbol Digit Modalities Test-written and oral; Trail Making Test [TMT]-A), abstraction-executive function (Trenerry Stroop Color Word Test; TMT-B), and verbal fluency (Controlled Oral Word Association Test).

RESULTS

A total of 705 participants were included in the analyses (mean [SD] age at year 20, 49.4 [10.1] years): 445 individuals (63.1%) had psychotic disorders (211 with schizophrenia spectrum [138 (65%) male]; 164 with affective psychoses [76 (46%) male]; 70 with other psychoses [43 (61%) male]); and 260 individuals (36.9%) in the control group (50.5 [9.0] years; 134 [51.5%] male). Cognition in individuals with a psychotic disorder declined on all but 2 tests (average decline: d = 0.31; range, 0.17-0.54; all P < .001). Cognitive declines were associated with worsening vocational functioning (Visual Reproduction test II: r = 0.20; Symbol Digit Modalities Test-written: r = 0.25; Stroop: r = 0.24; P < .009) and worsening negative symptoms (avolition: Symbol Digit Modalities Test-written: r = -0.24; TMT-A: r = -0.21; Stroop: r = -0.21; all P < .009; inexpressivity: Stroop: r = -0.22; P < .009). Compared with control individuals, people with psychotic disrders showed age-dependent deficits in verbal knowledge, fluency, and abstraction-executive function (vocabulary: β = -0.32; Controlled Oral Word Association Test: β = -0.32; TMT-B: β = 0.23; all P < .05), with the largest gap among participants 50 years or older.

CONCLUSIONS AND RELEVANCE

In individuals with psychotic disorders, most cognitive functions declined over 2 decades after first hospitalization. Observed declines were clinically significant. Some declines were larger than expected due to normal aging, suggesting that cognitive aging in some domains may be accelerated in this population. If confirmed, these findings would highlight cognition as an important target for research and treatment during later phases of psychotic illness.

Integrating the Hierarchical Taxonomy of Psychopathology (HiTOP) into clinical practice

OBJECTIVE

Diagnosis is a cornerstone of clinical practice for mental health care providers, yet traditional diagnostic systems have well-known shortcomings, including inadequate reliability, high comorbidity, and marked within-diagnosis heterogeneity. The Hierarchical Taxonomy of Psychopathology (HiTOP) is a data-driven, hierarchically based alternative to traditional classifications that conceptualizes psychopathology as a set of dimensions organized into increasingly broad, transdiagnostic spectra. Prior work has shown that using a dimensional approach improves reliability and validity, but translating a model like HiTOP into a workable system that is useful for health care providers remains a major challenge.

METHOD

The present work outlines the HiTOP model and describes the core principles to guide its integration into clinical practice.

RESULTS

Potential advantages and limitations of the HiTOP model for clinical utility are reviewed, including with respect to case conceptualization and treatment planning. A HiTOP approach to practice is illustrated and contrasted with an approach based on traditional nosology. Common barriers to using HiTOP in real-world health care settings and solutions to these barriers are discussed.

CONCLUSIONS

HiTOP represents a viable alternative to classifying mental illness that can be integrated into practice today, although research is needed to further establish its utility. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

When Hindsight Is Not 20/20: Ecological Momentary Assessment of PTSD Symptoms Versus Retrospective Report

Assessment of posttraumatic stress disorder (PTSD) has relied almost exclusively on retrospective memory of symptoms, sometimes over long intervals. This approach creates potential for recall bias and obscures the extent to which symptoms fluctuate. The aim of the present study was to examine the discrepancy between retrospective self-reporting of PTSD symptoms and ecological momentary assessment (EMA), which captures symptoms closer to when they occur. The study also sought to estimate the degree to which PTSD symptoms vary or are stable in the short-term. World Trade Center responders ( N = 202) oversampled for current PTSD (19.3% met criteria in past month) were assessed three times a day for 7 consecutive days. Retrospective assessment of past week symptoms at the end of the reporting period were compared with daily EMA reports. There was correspondence between two approaches, but retrospective reports most closely reflected symptom severity on the worst day of the reporting period rather than average severity across the week. Symptoms varied significantly, even within the span of hours. Findings support intervention research efforts focused on exploiting significant, short-term variability of PTSD symptoms, and suggest that traditional assessments most reflect the worst day of symptoms over a given period of recall.

Perceptions of Change after a Trauma and Perceived Posttraumatic Growth: A Prospective Examination

Recent research has distinguished between actual posttraumatic growth (PTG) and perceived PTG. We used a prospective research design to measure both actual and perceived PTG in an attempt to replicate and extend previous findings. We examined college students (N = 64) who experienced a traumatic event between the start (Time 1) and end (Time 2) of a semester. We included three measures of change from pre- to post-trauma: (1) Actual PTG (change scores in measures of PTG domains), (2) perceived general growth (Time 2 ratings of functioning at Time 1 subtracted from actual ratings given at Time 1), and (3) perceived PTG (self-reports of PTG on the posttraumatic growth inventory). The results revealed perceived general growth and actual PTG were significantly correlated, suggesting that participants' perceptions of change were accurate. However, perceived PTG was not significantly related to either actual PTG or perceived general growth. Further, increases in actual PTG and perceived general growth were significantly related to decreases in distress and unrelated to coping. By contrast, higher levels of perceived PTG were significantly related to increases in distress and higher levels of avoidance coping. Our results suggest perceived PTG may be more of a coping process than an accurate recall of posttraumatic change.

The impact of accommodating client preference in psychotherapy: A meta-analysis

Client preferences in psychotherapy reflect specific conditions and activities that clients desire in their treatment, with increasing evidence pointing to preference accommodation as facilitating psychotherapy outcomes. This updated meta-analysis establishes the magnitude of the effect of client preference accommodation in psychotherapy. Based on data from 53 studies and over 16,000 clients, preference accommodation was associated with fewer treatment dropouts (OR = 1.79) and more positive treatment outcomes (d = 0.28) than providing client with a nonpreferred treatment or psychotherapy condition. The preference effect was moderated by study design, timing and type of outcome measurement, and client diagnosis. It was not moderated by year of publication, treatment duration, preference type, treatment options, client age, client gender, client ethnicity, or client years of education. The authors provide a case example of preference accommodation and practice recommendations for working with client preferences.

Factor Structure of the CVLT-II Short Form: Evidence From a Trauma-Exposed Sample

The current study sought to investigate the factor structure of the California Verbal Learning Test-Second Edition (CVLT-II) Short Form in a trauma-exposed sample. We used confirmatory factor analysis to test four competing models proposed by Donders in a study investigating the CVLT-II Standard Form. Consistent with Donders, a four-factor model consisting of Attention Span, Learning Efficiency, Delayed Memory, and Inaccurate Memory was supported. These results confirm the latent structure of the CVLT-II holds for the CVLT-II in its Short Form as well as in a trauma-exposed sample. Findings are particularly important, given previous research indicating attention span and learning efficiency may underpin memory complaints in trauma-exposed individuals.

Supervisor Allegiance as a Critical Construct: A Brief Communication

Allegiance, long regarded as a significant variable in psychotherapy and psychotherapy research, has been ignored in the psychotherapy supervision literature. It is our contention that allegiance is similarly significant for psychotherapy supervision. In this brief communication, we define supervisor allegiance, consider its impact on supervision outcome, and highlight its role in the contextual supervision relationship model (a trans-theoretical model of the supervisory relationship).

The Case of the Tumbling Tumbleweed

Thus far, the literature in psychotherapy research on the relationship between specific factors and treatment outcome has focused on discrete, well-defined disorders. In contrast, this case study reviews a man who presents with a complex diagnostic picture. As a result, the student clinician drew from the literature examining the role of common factors, specifically of a supportive nature, in psychotherapy outcome. The client exhibited features from a variety of both Axis I and Axis II ailments, including alcohol dependence, sexual masochism, paraphilias, and borderline personality disorder. The challenges of case conceptualizing and treating an individual exhibiting multiple comorbid conditions are presented.

Treating Depression and Compensatory Narcissistic Personality Style in a Man With Chronic Lyme Disease

The following case study illustrates a client-centered, cognitive-behavioral approach to the psychological treatment of Mr. M, a 41-year-old male diagnosed with chronic Lyme disease, a mood disorder from Lyme disease, and narcissistic personality disorder. Mr. M's personality difficulties are conceptualized as representing compensatory narcissism, a strategic way of coping with feelings of insecurity. The goals of treatment included positively integrating Mr. M's chronic illness into his identity, decreasing depressive symptoms, and improving his interpersonal skills. Treatment was successful in decreasing both Mr. M's depressive symptoms and his narcissistic orientation to thinking and interacting with others.

Demographically Corrected Norms

Since the United States Supreme Court ruling in 2002 on the Atkins v. Virginia case, which determined that executing an individual with mental retardation violates the Eighth Amendment, the potential motivation to malinger mental retardation by individuals charged in potential death penalty cases has emerged. The following case illustrates some of the challenges that emerge in such an evaluation, with particular attention on the impact of inequitable standardization for demographically adjusted norms.

Comparative study of group treatments for posttraumatic stress disorder

Presented herein is a comparative study of group treatments for posttraumatic stress disorder (PTSD). In this study, an emerging intervention, memory specificity training (MeST), was compared with cognitive processing therapy (CPT) using standardized outcome measures of target symptoms (i.e., anxiety and depression from client perspective; memory specificity from independent rater perspective) and global functioning (independent rater perspective), as well as a process measure of expectancy (client perspective). Clients were assessed on 3 separate occasions: at baseline, posttreatment, and 3 months posttreatment. Adherence and treatment fidelity (independent rater perspective) were monitored throughout the course of both treatment conditions. Improvement in PTSD symptoms, depressive symptoms, and global functioning were similar between MeST and CPT; an increase in ability to specify memories upon retrieval was also similar between MeST and CPT. Positive reliable change was observed in both groups on all outcome measures. With respect to the primary target of PTSD symptoms, 88% of participants in both treatment groups moved into the functional distribution by posttreatment and maintained these gains at follow-up. Notably, compared with CPT, MeST required only half the dosage (i.e., number of sessions) to accomplish these gains. Illustrative vignettes from client-therapist exchanges are provided, and results are discussed in terms of the potential mechanisms of action. Implications for both clinical practice and clinical research are also included. (PsycINFO Database Record