Richard J. Shaw, M.D.

All Publications

• Treatment of Psychological Distress in Parents of Premature Infants: PTSD in the NICU edited by Shaw, R. J., Horwitz, S. M. American Psychiatric Association Publishing. 2020
• Clinical Manual of Pediatric Consultation-Liaison Psychiatry Shaw, R. J., DeMaso, D. R. Washington, DC: American Psychiatric Association Publishing. 2020
• Textbook of Pediatric Psychosomatic Medicine Washington DC: American Psychiatric Publishing, Inc. Shaw RJ, DeMaso DR 2010
• Clinical Manual of Pediatric Psychosomatic Medicine: Mental Health Consultation with Physically Ill Children and Adolescents Washington DC: American Psychiatric Publishing, Inc. Shaw RJ, DeMaso DR 2006
• Improving parental mental health in the perinatal period: A review and analysis of quality improvement initiatives. Seminars in perinatology Perazzo, S. I., Hoge, M. K., Shaw, R. J., Gillispie-Bell, V., Soghier, L. 2024: 151906

  Abstract

  Parental mental health is an essential sixth vital sign that, when taken into consideration, allows clinicians to improve clinical outcomes for both parents and infants. Although standards exist for screening, referral, and treatment for perinatal mood and anxiety disorders (PMADs), they are not reliably done in practice, and even when addressed, interventions are often minimal in scope. Quality improvement methodology can accelerate the implementation of interventions to address PMADs, but hurdles exist, and systems are not well designed, particularly in pediatric inpatient facilities. In this article, we review the effect of PMADs on parents and their infants and identify quality improvement interventions that can increase screening and referral to treatment of parents experiencing PMADs.

  View details for DOI 10.1016/j.semperi.2024.151906

  View details for PubMedID 38664078

• Mental Health Symptoms of Parents Following Prenatal Diagnoses Tiller-Ormord, J., Friedberg, R. D., Shaw, R. J., McConnell, L., Cordova, M., Wong, M., Smith, C. M. OXFORD UNIV PRESS INC. 2024: 152

  View details for Web of Science ID 001271423400311

• Preterm infant mental health in the neonatal intensive care unit: A review of research on NICU parent-infant interactions and maternal sensitivity. Infant mental health journal Hartzell, G., Shaw, R. J., Givrad, S. 2023

  Abstract

  Caregiving relationships in the postnatal period are critical to an infant's development. Preterm infants and their parents face unique challenges in this regard, with infants experiencing separation from parents, uncomfortable procedures, and increased biologic vulnerability, and parents facing difficulties assuming caregiver roles and increased risk for psychological distress. To better understand the NICU parent-infant relationship, we conducted a review of the literature and identified 52 studies comparing observed maternal, infant, and dyadic interaction behavior in preterm dyads with full-term dyads. Eighteen of 40 studies on maternal behavior found less favorable behavior, including decreased sensitivity and more intrusiveness in mothers of preterm infants, seven studies found the opposite, four studies found mixed results, and 11 studies found no differences. Seventeen of 25 studies on infant behavior found less responsiveness in preterm infants, two studies found the opposite, and the remainder found no difference. Eighteen out of 14 studies on dyad-specific behavior reported less synchrony in preterm dyads and the remainder found no differences. We identify confounding factors that may explain variations in results, present an approach to interpret existing data by framing differences in maternal behavior as potentially adaptive in the context of prematurity, and suggest future areas for exploration.

  View details for DOI 10.1002/imhj.22086

  View details for PubMedID 37815538

• COMPETENCIES AND TRAINING NEEDS ASSESSMENT IN PEDIATRIC CONSULTATION-LIAISON PSYCHIATRY Shaw, R. ELSEVIER SCIENCE INC. 2023: S10

  View details for DOI 10.1016/j.jaac.2023.07.160

  View details for Web of Science ID 001098830400028

• Stress Symptoms Among Children and Their Parents After ICU Hospitalization. Journal of intensive care medicine Daughtrey, H. R., Lee, J., Boothroyd, D. B., Burnside, G. M., Shaw, R. J., Anand, K. J., Sanders, L. M. 2023: 8850666231201836

  Abstract

  Objective: Child survival after intensive care unit (ICU) hospitalization has increased, yet many children experience acute stress that may precipitate mental/behavioral health comorbidities. Parents report stress after their child's hospitalization. Little is known about the individual and family characteristics that may moderate intergenerational relationships of acute stress. Design: Following ICU admission at a large academic medical center, a prospective cross-sectional cohort study assessed the associations between intergenerational characteristics and acute stress among children and families. Patients: Parent-child dyads (N = 88) were recruited from the pediatric ICU and pediatric cardiovascular ICU (CVICU) following ICU discharge. Eligible children were between 8 and 18 years old with ICU stays longer than 24 hours. Children with developmental delays were excluded. Caregivers were proficient in English or Spanish. Surveys were collected before hospital discharge. Measurements/Main Results: The primary outcome was "child stress" defined as a score≥17, measured by the Children's Revised Impact of Events Scale (CRIES-8). "Parent stress" was defined as an elevated composite score on the Stanford Acute Stress Reaction Questionnaire. We used validated scales to assess the child's clinical and family social characteristics. Acute stress was identified in 34 (39.8%) children and 50 (56.8%) parents. In multivariate linear regression analyses adjusting for social characteristics, parent stress was associated with increased risk of child stress (adjusted odds ratio 2.58, 95% confidence interval 0.69, 4.46, p < .01). In unadjusted analyses, Hispanic ethnicity was associated with greater child stress. In adjusted analyses, race, income, ICU length of stay, and language were not associated with child stress and did not moderate the parent-child stress relationship. Conclusions: Parent stress is closely correlated with child stress during ICU hospitalization. Hispanic ethnicity may be associated with increased risk for child stress, but further studies are required to define the roles of other social and clinical measures.

  View details for DOI 10.1177/08850666231201836

  View details for PubMedID 37743757

• Neurodevelopmental, Mental Health, and Parenting Issues in Preterm Infants. Children (Basel, Switzerland) Shaw, R. J., Givrad, S., Poe, C., Loi, E. C., Hoge, M. K., Scala, M. 2023; 10 (9)

  Abstract

  The World Health Organization in its recommendations for the care of preterm infants has drawn attention to the need to address issues related to family involvement and support, including education, counseling, discharge preparation, and peer support. A failure to address these issues may translate into poor outcomes that extend across the lifespan. In this paper, we review the often far-reaching impact of preterm birth on the health and wellbeing of the parents and highlight the ways in which psychological stress may have a negative long-term impact on the parent-child interaction, attachment, and the styles of parenting. This paper addresses the following topics: (1) neurodevelopmental outcomes in preterm infants, including cognitive, sensory, and motor difficulties, (2) long-term mental health issues in premature infants that include elevated rates of anxiety and depressive disorders, autism, and somatization, which may affect social relationships and quality of life, (3) adverse mental health outcomes for parents that include elevated rates of depression, anxiety, and symptoms of post-traumatic stress, as well as increased rates of substance abuse, and relationship strain, (4) negative impacts on the parent-infant relationship, potentially mediated by maternal sensitivity, parent child-interactions, and attachment, and (5) impact on the parenting behaviors, including patterns of overprotective parenting, and development of Vulnerable Child Syndrome. Greater awareness of these issues has led to the development of programs in neonatal mental health and developmental care with some data suggesting benefits in terms of shorter lengths of stay and decreased health care costs.

  View details for DOI 10.3390/children10091565

  View details for PubMedID 37761526

  View details for PubMedCentralID PMC10528009

• Group trauma focused cognitive behavior therapy for parents of premature infants compared to individual therapy intervention. Early human development Shaw, R. J., Moreyra, A., Simon, S., Wharton, E., Dowtin, L. L., Armer, E., Goldman, L. W., Borkovi, T., Neri, E., Jo, B., Hintz, S., Van Meurs, K., Horwitz, S. M. 2023; 181: 105773

  Abstract

  The current study compares results of a group-based intervention developed to reduce symptoms of posttraumatic stress, depression, and anxiety in parents of premature infants with a prior study using an individual version of the treatment manual.26 mothers of preterm infants (25-34 weeks' gestational age; >600 g) received 6 sessions of trauma-focused cognitive behavior therapy (CBT). Outcomes were compared with those of a previously published RCT, which tested an individual therapy based on the same model in a group of 62 mothers. Results were also compared across in-person and telehealth treatment.From baseline to follow up, the individual intervention showed greater improvement in trauma symptoms assessed with the Davidson Trauma Scale (d = 0.48, p = 0.016), although both conditions showed clinically significant improvement. Similar patterns were found for maternal depression and anxiety. In-person treatment was found to be superior to telehealth treatment administered during the COVID-19 pandemic, although the difference was not significant.Group-based trauma focused CBT is an effective treatment modality for parents of premature infants with symptoms of psychological distress but not as effective as individual therapy using the same treatment model.

  View details for DOI 10.1016/j.earlhumdev.2023.105773

  View details for PubMedID 37119727

• Maternal mental health and engagement in developmental care activities with preterm infants in the NICU. Journal of perinatology : official journal of the California Perinatal Association Dubner, S. E., Morales, M. C., Marchman, V. A., Shaw, R. J., Travis, K. E., Scala, M. 2023

  Abstract

  To examine associations between maternal mental health and involvement in developmental care in the NICU.Mothers of infants born <32 weeks gestation (n = 135) were approached to complete mental health screening questionnaires at two weeks after admission. Mothers who completed screening (n = 55) were further classified as with (n = 19) and without (n = 36) elevated scores. Mothers' frequency, rate, and duration of developmental care activities were documented in the electronic health record.35% of screened mothers scored above the cutoff for clinical concern on ≥1 measure. No significant differences between the 3 groups were identified for rates, frequency, or amount of all developmental care, kangaroo care, and swaddled holding.Elevated scores on maternal mental health questionnaires did not relate to developmental care. Maternal developmental care engagement may not indicate mental health status. Universal screening for psychological distress is required to accurately detect symptoms in mothers of hospitalized preterm infants.

  View details for DOI 10.1038/s41372-023-01661-0

  View details for PubMedID 37046070

  View details for PubMedCentralID 8552262

• The psychosocial organ transplant assessment: A call to action. Pediatric transplantation Shaw, R. J. 2022: e14453

  View details for DOI 10.1111/petr.14453

  View details for PubMedID 36518027

• Group Psychotherapy for Parents of Youth with Pediatric Acute-Onset Neuropsychiatric Syndrome. Journal of clinical psychology in medical settings Ellerkamp, H., Thienemann, M., Tinero, J., Shaw, R., Dowtin, L. L., Frankovich, J., Borkovi, T. C. 2022

  Abstract

  Parents of children with diagnoses of Pediatric Acute-onset Neuropsychiatric Syndrome (PANS) and Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal Infections (PANDAS) may experience significant psychological distress related to their child's severe and relapsing illness and challenges with the traumatic nature of its treatment. No manualized or studied psychological interventions specifically for parents of youth with PANS have existed prior to this study. In this pilot study, we assessed the feasibility, satisfaction, and treatment fidelity of a brief 9-session group therapy intervention for parents based on principles of trauma-focused cognitive behavior therapy (CBT). We hypothesized that, if initially elevated, symptoms of depression, anxiety, and trauma would decrease and participants' utilization of positive coping mechanisms would increase post-intervention. We adapted an existing evidence-based group intervention developed for parents of children with premature infants to target sources of stress and coping in parents of children with PANS. Ten parents participated in the study. The 9-session intervention used a combination of techniques that included cognitive restructuring, coping skills, self-care, and a trauma narrative to address psychological stress, trust, grief, and unwanted emotions. Outcome measures included parental symptoms of anxiety, depression, and posttraumatic stress disorder (PTSD), as well as rating of parental satisfaction with the intervention. The treatment was feasible and deliverable with high fidelity. The intervention was rated as useful and satisfactory by parents (overall average usefulness of 4.54 and satisfaction of 4.71 out of 5.0). Elevated symptoms of PTSD and depression decreased with large effect sizes (Cohen's d = 1.42 and Cohen's d = 1.38, respectively). Participating parents demonstrated significantly more active coping and acceptance behaviors and stances. A brief 9-session group therapy intervention based on principles of trauma-focused CBT was found to be effective in reducing symptoms of psychological distress in parents of children with PANS.

  View details for DOI 10.1007/s10880-022-09926-0

  View details for PubMedID 36480109

• Post-Traumatic Stress Disorder in pediatric Implantable Cardioverter Defibrillator patients and their parents. Heart rhythm Schneider, L. M., Wong, J. J., Adams, R., Bates, B., Chen, S., Ceresnak, S. R., Danovsky, M., Hanisch, D., Motonaga, K. S., Restrepo, M., Shaw, R. J., Sears, S. F., Trela, A., Dubin, A. M., Hood, K. K. 2022

  Abstract

  An ICD in the pediatric patient (and the precipitating events that led to ICD placement) can be traumatic for patients and their families and may lead to PTSD.This study aimed to estimate the prevalence of PTSD in pediatric ICD patients and their parents and identify the factors associated with PTSD incidence.Pediatric participants with an ICD ages 8-21 years and parents of youth ages 0-21 years completed surveys that included demographics and PTSD measures. Pediatric participants completed additional psychosocial measures, such as anxiety and depression self-report questionnaires.Fifty youth (30% female) and 43 parents (70% female) completed the measures. Six youth (12%) met the screening criteria for a likely PTSD diagnosis, while 20 parents (47%) met the cutoff for PTSD on the screening measure. Children with PTSD were more likely to have had a secondary prevention ICD (83% vs 17%, p=0.021), meet the clinical cutoff for depression (67% vs 16%, p=.005), and had higher shock anxiety (31.7 vs 17.9, p=0.003) than children without PTSD. Female gender (57% vs 23%, p=0.043) and patient depression (31% vs 5%, p=.042) were associated with PTSD among parents.Parents were found to be more likely to meet the criteria for PTSD than youth. Among youth, PTSD was associated with medical and psychosocial factors whereas PTSD among parents was associated with being female and child depression. Clinic based screenings and management planning of emotional functioning are warranted to address psychological distress in patients and parents.

  View details for DOI 10.1016/j.hrthm.2022.06.025

  View details for PubMedID 35772698

• Training Needs Assessment Survey in Pediatric Consultation-Liaison Psychiatry. Academic psychiatry : the journal of the American Association of Directors of Psychiatric Residency Training and the Association for Academic Psychiatry Meadows, A. L., Brahmbhatt, K., Shaw, R. J., Lee, J., Malas, N., Fuchs, D. C., Kurtz, B. P., Mooneyham, G., Gangopadhyay, M., Plioplys, S., Pao, M. 1800

  Abstract

  OBJECTIVE: Despite growing recognition of how curriculum modules can benefit child and adolescent psychiatry (CAP) training, there are few standardized teaching resources for pediatric consultation-liaison psychiatry (PCLP). A Special Interest Group (SIG) of the American Academy of Child and Adolescent Psychiatry Physically Ill Child Committee (PICC) conducted a needs assessment to establish interest in, and availability of, a library of online, self-paced learning modules specific to PCLP.METHOD: An email needs assessment survey was distributed to the PICC listserv in the fall of 2019 with four core areas of inquiry: (1) clinical service description, (2) teaching barriers, (3) interest in curriculum resources, and (4) interest in evaluation resources.RESULTS: Respondents were representative of typical academic PCLP programs. The response rate was 28% (n = 39). Programs endorsed barriers to teaching including high service obligations and limited protected teaching time. All respondents indicated that they would utilize high-quality, online learning modules. Psychiatric complications of medical illness, catatonia, and delirium were identified as priority topics in the care of pediatric patients with comorbid medical conditions.CONCLUSIONS: There are currently no published educational studies regarding the training needs for PCLP programs, even among tertiary care academic facilities. This training needs assessment is the first step in establishing a national PCLP training curriculum. New paradigms to develop standardized curriculum resources for PCLP are needed.

  View details for DOI 10.1007/s40596-022-01587-3

  View details for PubMedID 35089540

• Adaptations Made to Pediatric Consultation-Liaison Psychiatry Service Delivery During the Early Months of the COVID-19 Pandemic: A North American Multisite Survey JOURNAL OF THE ACADEMY OF CONSULTATION-LIAISON PSYCHIATRY Brahmbhatt, K., Mournet, A. M., Malas, N., DeSouza, C., Greenblatt, J., Afzal, K., Giles, L. L., Charoensook, J., Feuer, V., Raza, H., Mooneyham, G. C., Pergjika, A., Schlesinger, A., Chapman, A., Strain, A., Gandhi, B., Johnson, K., Mroczkowski, M. M., Ibeziako, P., Graham, R., Yoon, Y., Plioplys, S., Fuchs, C., Shaw, R. J., Pao, M. 2021; 62 (5): 511-521

  View details for Web of Science ID 000702643600005

• Parental Stress and Mental Health Symptoms in the NICU: Recognition and Interventions. NeoReviews Bernardo, J., Rent, S., Arias-Shah, A., Hoge, M. K., Shaw, R. J. 2021; 22 (8): e496-e505

  Abstract

  Parental experiences in the NICU are often characterized by psychological stress and anxiety following the birth of a critically ill or premature infant. Such stress can have a negative impact on parents and their vulnerable infants during NICU hospitalization as well as after discharge. These infants are also at increased risk for adverse developmental, cognitive, academic, and mental health outcomes. Identifying parents at risk for psychological distress is important and feasible with the use of well-validated screening instruments. Screening for psychological distress is essential for identifying families in need of referral for psychological support and resources. Numerous interventions have been implemented in the NICU to support parents. These include staff-based support such as wellness rounds and education in developmental care as well as parental-based support that includes cognitive behavioral therapy and home visitation programs. Comprehensive interventions should use a multidisciplinary approach that involves not only NICU staff but also key stakeholders such as social workers, spiritual/religious representatives, specialists in developmental care, and psychiatrists/psychologists to help support families and facilitate the transition to the home. Future efforts should include raising awareness of the psychological stresses of NICU parents and encouraging the development of programs to provide parents with psychological support.

  View details for DOI 10.1542/neo.22-8-e496

  View details for PubMedID 34341157

• Catatonia in a 6-year-old Patient Following Disseminated Group A Streptococcus Infection. Innovations in clinical neuroscience Cawkwell, P. B., Mayor, I. D., Shaw, R. J. 2021; 18 (1-3): 17-20

  Abstract

  Pediatric catatonia is a complex entity that is easily missed in the hospital setting and seldom reported in the literature. Here, we present the case of a 6-year-old previously healthy female patient who was initially thought to have intractable delirium secondary to disseminated Group A streptococcus (GAS) infection. Careful examination, utilization of the Pediatric Catatonia Rating Scale, and lorazepam challenge were key to elucidating the diagnosis. While GAS is most often associated with pediatric acute-onset neuropsychiatric syndrome (PANS) in the child and adolescent population, we reviewed the limited literature to suggest a mechanism by which it can lead to catatonia. Further systematic study of catatonia in the pediatric population is warranted to better understand pathogenesis and long-term neuropsychiatric outcomes.

  View details for PubMedID 34150358

• Vulnerable child syndrome in the neonatal intensive care unit: A review and a new preventative intervention with feasibility and parental satisfaction data. Early human development Hoge, M. K., Heyne, E., Nicholson, T. D., Acosta, D., Mir, I., Brown, L. S., Shaw, R. J., Chalak, L., Heyne, R. 2020: 105283

  Abstract

  Vulnerable Child Syndrome (VCS) occurs in the setting in which a child recovers from a life-threatening illness, as result of which the parent develops heightened parental perceptions of child vulnerability (PPCV). This leads to a pattern of overprotective parenting which may result in adverse neurodevelopmental and behavioral outcomes in the child over time. Parents of premature infants have been shown to be at increased risk of developing raised PPCV while their infants may develop symptoms of VCS. The PreVNT trial is a randomized controlled trial designed to test the efficacy of a 5-session manualized Cognitive Behavioral Therapy (CBT) intervention to reduce PPCV. Results of a pilot study of parents of premature infants (n=41) demonstrate that the intervention can be delivered with high ratings of treatment fidelity and with a completion rate of 100% during the NICU admission, and 78% at 6months post term. Ratings of parental satisfaction ranged between 4.9 and 5 out of 5 demonstrating high satisfaction with the intervention. Pilot feasibility and maternal satisfaction data are presented for a group of 22 intervention families, which suggest a CBT model for understanding VCS is feasible and deemed helpful by parents. This review is gauged to summarize risk of VCS development, diagnosis of VCS, and effective treatments for VCS through Cognitive Behavioral Therapy. We also present a paradigm shift in a therapeutic approach by introducing the PreVNT Trial. Given that VCS can interfere with the long-term outcomes of both infant and family, it is important to understand VCS and address its involvement in NICU and post NICU discharge care. Further research is needed in this area.

  View details for DOI 10.1016/j.earlhumdev.2020.105283

  View details for PubMedID 33514479

• Best practice guidelines on parental mental health in the neonatal intensive care unit: The importance and impact on infant health and developmental outcomes. Early human development Hoge, M. K., Shaw, R. J. 2020: 105277

  View details for DOI 10.1016/j.earlhumdev.2020.105277

  View details for PubMedID 33485725

• Prevention of posttraumatic stress disorder in mothers of preterm infants using trauma-focused group therapy: Manual development and evaluation. Early human development Simon, S., Moreyra, A., Wharton, E., Dowtin, L. L., Borkovi, T. C., Armer, E., Shaw, R. J. 2020: 105282

  Abstract

  BACKGROUND: Preterm birth has been associated with a number of adverse maternal psychological outcomes.AIMS: The current study aims to develop and evaluate the feasibility of a trauma-focused group intervention that is designed to reduce maternal symptoms of anxiety, depression, and posttraumatic stress in a sample of mothers of preterm infants hospitalized in a neonatal intensive care unit (NICU).STUDY DESIGN: The study was a one-group pre-/post quasi-experimental design. Participants received a 6-session intervention targeting parental trauma.SUBJECTS: English-speaking mothers (N=19) greater than 18years of age of infants 23-34weeks gestational age hospitalized in the NICU at Lucile Packard Children's Hospital Stanford.OUTCOME MEASURES: Beck Anxiety Inventory (BAI), Beck Depression Inventory, Second Edition (BDI-II), Davidson Trauma Scale (DTS).RESULTS: Results from the study indicate that the intervention is feasible, able to be implemented with a high degree of fidelity, is rated as highly satisfactory by participants, and leads to statistically significant reductions in symptoms of anxiety, depression, and posttraumatic stress at 6-week and 6-month follow-ups.CONCLUSIONS: Though encouraging, these findings are preliminary, and future studies should strive to reproduce these findings with a larger sample size and a comparison group.

  View details for DOI 10.1016/j.earlhumdev.2020.105282

  View details for PubMedID 33248796

• Selective Serotonin Reuptake Inhibitors and Tardive Dyskinesia: A Case Report of Escitalopram Use in a Cardiac and Liver Transplant Patient. Journal of clinical psychopharmacology Fischer, A., Connor, A. T., Machenzie, K. M., Shaw, R. J. 2020; 40 (6): 626–27

  View details for DOI 10.1097/JCP.0000000000001285

  View details for PubMedID 33136924

• CLINICIAN AWARENESS OF PARENTING CONCERNS IN PATIENTS WITH CANCER Williams, P., Artusio, D. A., Haruno, L. S., Benedict, C., Shaw, R., Ach, E. L., Rauch, P. K., Schapira, L. OXFORD UNIV PRESS INC. 2020: S29

  View details for Web of Science ID 000546262400062

• An exploratory assessment of pediatric patient and parent needs after implantable cardioverter defibrillator implant. Pacing and clinical electrophysiology : PACE Schneider, L. M., Wong, J. J., Trela, A. n., Hanisch, D. n., Shaw, R. J., Sears, S. F., Motonaga, K. S., Ceresnak, S. R., Hood, K. K., Dubin, A. M. 2020

  Abstract

  Placement of an ICD is often accompanied by psychological adjustment issues in pediatric patients and their parents. While anxiety, depression, and lowered QOL have been seen in these patients, no studies have investigated patient or parent reported needs. This exploratory study describes the needs of pediatric ICD patients and parents and assesses whether patient factors of age, gender, depression, and anxiety are associated with specific needs.ICD patients ages 8-21 and their parents completed a needs analysis survey assessing various domains of functioning. Patients also completed self-reported measures of depression and anxiety.Thirty-two patients (28% female) and their parents (72% mothers) completed the survey. Patients' most frequently endorsed needs involved educational issues: understanding their cardiac event/diagnosis (34%), medications (34%), and how the ICD would change their lifestyle (31%). Parents' most frequently endorsed needs involved family issues; almost half of parents (47%) were concerned about their children's frustration with their overprotectiveness and 28% were concerned with their child feeling depressed or anxious. Patients who reported feeling overprotected (12.1 ± 3.4 vs 17.4 ± 3.5 years, p = .001) were significantly younger than those who did not. Experiencing peer issues was more frequently endorsed by females than males (33% of females vs 4% of males, p = .026).ICD patients and parents endorsed markedly different needs. Patients focused on understanding their ICD, while parents were more focused on their children's emotional needs. Novel ways of educating patients about their device and clinic based screenings of emotional functioning may serve to meet these needs. This article is protected by copyright. All rights reserved.

  View details for DOI 10.1111/pace.13876

  View details for PubMedID 31971265

• A Previously Healthy Adolescent With Acute Psychosis and Severe Hyperhidrosis. Pediatrics Rosenblatt, T. n., Ort, K. n., Shaw, R. n., Levy, R. J., Chen, C. n., Niemi, A. n., Hoang, K. n. 2020

  Abstract

  A previously healthy 15-year-old boy presented with 3 months of progressive psychosis, insomnia, back and groin pain, and hyperhidrosis. On examination, the patient was disheveled, agitated, and soaked with sweat, with systolic blood pressure in the 160s and heart rate in the 130s. Aside from occasional auditory and visual hallucinations, his neurologic examination was normal. The patient was admitted for an extensive workup, including MRI of the brain and spine and lumbar puncture, which were normal. Through collaboration with various pediatric specialists, including psychiatry and neurology, a rare diagnosis was ultimately unveiled.

  View details for DOI 10.1542/peds.2019-3786

  View details for PubMedID 32444380

• Implementing a standardized screening protocol for parental depression, anxiety, and PTSD symptoms in the Neonatal Intensive Care Unit. Early human development Moreyra, A. n., Dowtin, L. L., Ocampo, M. n., Perez, E. n., Borkovi, T. C., Wharton, E. n., Simon, S. n., Armer, E. G., Shaw, R. J. 2020: 105279

  Abstract

  The aim of this paper is to describe the development of a standardized screening program for parents of infants in the Neonatal Intensive Care Unit (NICU) and to assess its implementation. The standardized screening protocol assessed parental mental health symptoms including depression, anxiety and trauma. Screening began at 14 days post NICU admission and was implemented as part of routine medical care for all caregivers with infants admitted to the NICU at two weeks of age. Screenings were facilitated by pediatric social workers and psychology postdoctoral fellows and included review of critical self-harm items. A total of 158 parents ages 18-42 years (mean = 31.04) were eligible for screening, with 150 completed screenings. Positive screens on any of the three measures resulted in a mental health referral. Approximately 27% of parents had a positive screen that resulted in a mental health referral. The standardized screening protocol was found to be feasible, widely accepted, and effective in establishing referrals for in house mental health services. This model can be used as an example to help other NICUs implement their own universal screening protocols.

  View details for DOI 10.1016/j.earlhumdev.2020.105279

  View details for PubMedID 33339676

• Beyond the First Wave: Consequences of COVID-19 on High-Risk Infants and Families. American journal of perinatology Lemmon, M. E., Chapman, I. n., Malcolm, W. n., Kelley, K. n., Shaw, R. J., Milazzo, A. n., Cotten, C. M., Hintz, S. R. 2020

  Abstract

  The novel coronavirus disease 2019 (COVID-19) pandemic is affecting care for high-risk newborns in ways that will likely be sustained beyond the initial pandemic response. These novel challenges present an urgent imperative to understand how COVID-19 impacts parent, family, and infant outcomes. We highlight three areas that warrant targeted attention: (1) inpatient care: visitation policies, developmental care, and communication practices; (2) outpatient care: high-risk infant follow-up and early intervention programs; and (3) parent psychosocial distress: mental health, social support, and financial toxicity. Changes to care delivery in these areas provide an opportunity to identify and implement novel strategies to provide family-centered care during COVID-19 and beyond. KEY POINTS: · The COVID-19 pandemic is influencing care delivery for high-risk newborns and their families.. · Rapid changes to care delivery are likely to be sustained beyond the initial pandemic response.. · We have an urgent imperative to understand how COVID-19 impacts infant, parent, and family outcomes..

  View details for DOI 10.1055/s-0040-1715839

  View details for PubMedID 32911555

• Core Competencies for Pediatric Consultation-Liaison Psychiatry in Child and Adolescent Psychiatry Fellowship Training. Psychosomatics Shaw, R. J., Rackley, S. n., Walker, A. n., Fuchs, D. C., Meadows, A. n., Dalope, K. n., Pao, M. n. 2019

  Abstract

  Learners developing competency-based skills, attitudes, and knowledge through the achievement of defined milestones is a core feature of competency-based medical education. In 2017, a special interest study group of the American Academy of Child and Adolescent Psychiatry convened a panel of specialists to describe pediatric consultation-liaison psychiatry (CLP) best educational practices during child and adolescent psychiatry fellowship.The objective of this project was to develop a national consensus on pediatric CLP competencies to help guide training in this specialty.An expert working group developed a list of candidate competences based on previously established educational outcomes for CLP (formerly Psychosomatic Medicine), child and adolescent psychiatry, and general psychiatry. A survey was distributed to members of the American Academy of Child and Adolescent Psychiatry Physically Ill Child Committee to determine child and adolescent psychiatry fellowship educational needs on pediatric CLP services and generate consensus regarding pediatric CLP competencies.Most survey respondents were supportive of the need for a national consensus on core competencies for pediatric CLP. Consensus from a panel of experts in the field of pediatric CLP generated a list of proposed core competencies that track the Accreditation Council for Graduate Medical Education's six core competencies.Consistent learning outcomes provide the foundation for further development of tools to support training in pediatric CLP. There is a need to develop further tools including outcome assessment instruments and self-directed learning materials that can be used to support lifelong learning.

  View details for DOI 10.1016/j.psym.2019.04.006

  View details for PubMedID 31248613

• Sibling-Controlled Study of Parental Bonding, Coping, and Urgent Health-Care Use in Families With Children With Nonepileptic Seizures JOURNAL OF PEDIATRIC PSYCHOLOGY Bursch, B., Forgey, M., Emerson, N. D., Siddarth, P., Weisbrot, D. M., Shaw, R. J., Doss, J., Falcone, T., Hinman, K., LaFrance, W., Laptook, R., Willis, M. D., Deggelman, E. L., Caplan, R., Plioplys, S. 2018; 43 (10): 1128–37

  Abstract

  Pediatric psychogenic nonepileptic seizures (PNES) is a functional somatic symptom condition with significant health-care service burden. While both family and individual factors play an important role in the development and maintenance of PNES, little is known about what predicts urgent health-care use in families with children who have PNES. The aim of the current study was to explore whether child coping and parental bonding styles influence the decision to seek urgent medical care in these families.Data were analyzed from youth of age 8-18 years, 47 with PNES, and their 25 sibling controls. Parents provided the number of youth emergency room visits and hospitalizations in the preceding year. Youth completed a questionnaire about their coping styles and a measure about their mothers' and fathers' bonding styles. Using a mixed model with family as a random effect, we regressed urgent health-care use on participant type (youth with PNES or sibling), parental bonding style, and youth coping style, controlling for number of child prescription medications.Higher urgent health-care use was associated with having PNES, coping via monitoring, and perceiving one's father to be rejecting and overprotective. Lower urgent health-care use was associated with coping via venting and with perceiving one's mother to be caring and overprotective.This study provides preliminary empirical support for family-based clinical efforts to reduce child urgent health-care use by enhancing effective child coping skills and improving parental response to child impairment and distress in families with youth with PNES.

  View details for PubMedID 29992307

• Management of Pediatric Delirium in Pediatric Cardiac Intensive Care Patients: An International Survey of Current Practices PEDIATRIC CRITICAL CARE MEDICINE Staveski, S. L., Pickler, R. H., Lin, L., Shaw, R. J., Meinzen-Derr, J., Redington, A., Curley, M. Q. 2018; 19 (6): 538–43

  Abstract

  The purpose of this study was to describe how pediatric cardiac intensive care clinicians assess and manage delirium in patients following cardiac surgery.Descriptive self-report survey.A web-based survey of pediatric cardiac intensive care clinicians who are members of the Pediatric Cardiac Intensive Care Society.Pediatric cardiac intensive care clinicians (physicians and nurses).None.One-hundred seventy-three clinicians practicing in 71 different institutions located in 13 countries completed the survey. Respondents described their clinical impression of the occurrence of delirium to be approximately 25%. Most respondents (75%) reported that their ICU does not routinely screen for delirium. Over half of the respondents (61%) have never attended a lecture on delirium. The majority of respondents (86%) were not satisfied with current delirium screening, diagnosis, and management practices. Promotion of day/night cycle, exposure to natural light, deintensification of care, sleep hygiene, and reorientation to prevent or manage delirium were among nonpharmacologic interventions reported along with the use of anxiolytic, antipsychotic, and medications for insomnia.Clinicians responding to the survey reported a range of delirium assessment and management practices in postoperative pediatric cardiac surgery patients. Study results highlight the need for improvement in delirium education for pediatric cardiac intensive care clinicians as well as the need for systematic evaluation of current delirium assessment and management practices.

  View details for PubMedID 29863637

• Clinical Management of Pediatric Acute-Onset Neuropsychiatric Syndrome: Part I-Psychiatric and Behavioral Interventions. Journal of child and adolescent psychopharmacology Thienemann, M., Murphy, T., Leckman, J., Shaw, R., Williams, K., Kapphahn, C., Frankovich, J., Geller, D., Bernstein, G., Chang, K., Elia, J., Swedo, S. 2017; 27 (7): 566-573

  Abstract

  This article outlines the consensus guidelines for symptomatic treatment for children with Pediatric Acute-Onset Neuropsychiatric Syndrome (PANS) and Pediatric Autoimmune Neuropsychiatric Syndrome Associated with Streptococcal Infection (PANDAS).Extant literature on behavioral, psychotherapeutic, and psychopharmacologic treatments for PANS and PANDAS was reviewed. Members of the PANS Research Consortium pooled their clinical experiences to find agreement on treatment of PANS and PANDAS symptoms.Current guidelines result from consensus among the Consortium members.While underlying infectious and inflammatory processes in PANS and PANDAS patients are treated, psychiatric and behavioral symptoms need simultaneous treatment to decrease suffering and improve adherence to therapeutic intervention. Psychological, behavioral, and psychopharmacologic interventions tailored to each child's presentation can provide symptom improvement and improve functioning during both the acute and chronic stages of illness. In general, typical evidence-based interventions are appropriate for the varied symptoms of PANS and PANDAS. Individual differences in expected response to psychotropic medication may require marked reduction of initial treatment dose. Antimicrobials and immunomodulatory therapies may be indicated, as discussed in Parts 2 and 3 of this guideline series.

  View details for DOI 10.1089/cap.2016.0145

  View details for PubMedID 28722481

  View details for PubMedCentralID PMC5610394

• Clinical Management of Pediatric Acute-Onset Neuropsychiatric Syndrome: Part II-Use of Immunomodulatory Therapies. Journal of child and adolescent psychopharmacology Frankovich, J., Swedo, S., Murphy, T., Dale, R. C., Agalliu, D., Williams, K., Daines, M., Hornig, M., Chugani, H., Sanger, T., Muscal, E., Pasternack, M., Cooperstock, M., Gans, H., Zhang, Y., Cunningham, M., Bernstein, G., Bromberg, R., Willett, T., Brown, K., Farhadian, B., Chang, K., Geller, D., Hernandez, J., Sherr, J., Shaw, R., Latimer, E., Leckman, J., Thienemann, M. 2017; 27 (7): 574-593

  Abstract

  Introduction: Pediatric Acute-onset Neuropsychiatric Syndrome (PANS) is a clinically heterogeneous disorder with a number of different etiologies and disease mechanisms. Inflammatory and postinfectious autoimmune presentations of PANS occur frequently, with some clinical series documenting immune abnormalities in 75%-80% of patients. Thus, comprehensive treatment protocols must include immunological interventions, but their use should be reserved only for PANS cases in which the symptoms represent underlying neuroinflammation or postinfectious autoimmunity, as seen in the PANDAS subgroup (Pediatric Autoimmune Neuropsychiatric Disorders associated with Streptococcal infections). Methods: The PANS Research Consortium (PRC) immunomodulatory task force is comprised of immunologists, rheumatologists, neurologists, infectious disease experts, general pediatricians, psychiatrists, nurse practitioners, and basic scientists with expertise in neuroimmunology and PANS-related animal models. Preliminary treatment guidelines were created in the Spring of 2014 at the National Institute of Health and refined over the ensuing 2 years over conference calls and a shared web-based document. Seven pediatric mental health practitioners, with expertise in diagnosing and monitoring patients with PANS, were consulted to create categories in disease severity and critically review final recommendations. All authors played a role in creating these guidelines. The views of all authors were incorporated and all authors gave final approval of these guidelines. Results: Separate guidelines were created for the use of immunomodulatory therapies in PANS patients with (1) mild, (2) moderate-to-severe, and (3) extreme/life-threatening severity. For mildly impairing PANS, the most appropriate therapy may be "tincture of time" combined with cognitive behavioral therapy and other supportive therapies. If symptoms persist, nonsteroidal anti-inflammatory drugs and/or short oral corticosteroid bursts are recommended. For moderate-to-severe PANS, oral or intravenous corticosteroids may be sufficient. However, intravenous immunoglobulin (IVIG) is often the preferred treatment for these patients by most PRC members. For more severe or chronic presentations, prolonged corticosteroid courses (with taper) or repeated high-dose corticosteroids may be indicated. For PANS with extreme and life-threatening impairment, therapeutic plasma exchange is the first-line therapy given either alone or in combination with IVIG, high-dose intravenous corticosteroids, and/or rituximab. Conclusions: These recommendations will help guide the use of anti-inflammatory and immunomodulatory therapy in the treatment of PANS.

  View details for DOI 10.1089/cap.2016.0148

  View details for PubMedID 36358107

• Risk factors for learning problems in youth with psychogenic non-epileptic seizures. Epilepsy & behavior Doss, J., Caplan, R., Siddarth, P., Bursch, B., Falcone, T., Forgey, M., Hinman, K., Curt LaFrance, W., Laptook, R., Shaw, R., Weisbrot, D., Willis, M., Plioplys, S. 2017; 70: 135-139

  Abstract

  This study examined the risk factors for learning problems (LP) in pediatric psychogenic non-epileptic seizures (PNES) and their specificity by comparing psychopathology, medical, cognitive/linguistic/achievement, bullying history, and parent education variables between subjects with PNES with and without LP and between subjects with PNES and siblings with LP.55 subjects with PNES and 35 siblings, aged 8-18years, underwent cognitive, linguistic, and achievement testing, and completed somatization and anxiety sensitivity questionnaires. A semi-structured psychiatric interview about the child was administered to each subject and parent. Child self-report and/or parent report provided information on the presence/absence of LP. Parents also provided each subject's medical, psychiatric, family, and bullying history information.Sixty percent (33/55) of the PNES and 49% (17/35) of the sibling subjects had LP. A multivariable logistic regression demonstrated that bullying and impaired formulation of a sentence using a stimulus picture and stimulus word were significantly associated with increased likelihood of LP in the PNES youth. In terms of the specificity of the LP risk factors, a similar analysis comparing LP in the youth with PNES and sibling groups identified anxiety disorder diagnoses and bullying as the significant risk factors associated with LP in the PNES youth.These findings emphasize the need to assess youth with PNES for LP, particularly if they have experienced bullying, have linguistic deficits, and meet criteria for anxiety disorder diagnoses.

  View details for DOI 10.1016/j.yebeh.2017.03.016

  View details for PubMedID 28427021

• Clinical Management of Pediatric Acute-onset Neuropsychiatric Syndrome (PANS): Part II – Use of Immunomodulatory Therapies Journal of Child and Adolescent Psychopharmacology Frankovich, J., Swedo, S., Murphy, T., Dale, R. C., Agalliu, D., Williams, K., Daines, M., Hornig, M., Chugani, H., Sanger, T., Muscal, E., Pasternack, M., Cooperstock, M., Gans, H., Zhang, Y., Cunningham, M., Bernstein, G., Bromberg, R., Willett, T., Brown, K., Farhadian, B., Chang, K., Geller, D., Hernandez, J., Sherr, J., et al 2017; 27 (7): 574-593

  View details for DOI 10.1089/cap.2016.0148

• Practice Patterns Revisited in Pediatric Psychosomatic Medicine PSYCHOSOMATICS Shaw, R. J., Pao, M., Holland, J. E., Demaso, D. R. 2016; 57 (6): 576-585

  Abstract

  Given the heightened focus on the implementation of integrated care and population health management strategies, there is a critical need for an analysis of pediatric psychosomatic medicine (PPM) programs.The goal was to survey current practice patterns in academic PPM programs in North America regarding their service composition, clinical consultation services, changes in service demand, funding, and major challenges so as to inform and support advocacy efforts on behalf of children in their need for responsive and effective PPM services.With a 52.5% survey response rate from 122 child and adolescent psychiatry programs in North America, the demand for PPM services was reported to have significantly increased over the past decade as seen in the described expansion in clinical consultation services and the reported higher patient acuity, as well as new responsibilities in the care of youth with psychiatric illnesses who require boarding on medical inpatient services. Although an increased willingness by hospital administrators to fund PPM services was apparent, adequate funding remained a core issue. Although the value of research is well recognized, few programs are engaged in systematic PPM investigation.This survey provides evidence that the current field of PPM appears to be in an increasingly stronger position within academic medical centers. It is just as apparent today, as it has been in the past, that there is a need to communicate at local, regional, and national levels that PPM is an essential behavioral health service.

  View details for Web of Science ID 000388064200004

  View details for PubMedID 27393387

• Risk factors for comorbid psychopathology in youth with psychogenic nonepileptic seizures SEIZURE-EUROPEAN JOURNAL OF EPILEPSY Plioplys, S., Doss, J., Siddarth, P., Bursch, B., Falcone, T., Forgey, M., Hinman, K., LaFrance, W. C., Laptook, R., Shaw, R. J., Weisbrot, D. M., Willis, M. D., Caplan, R. 2016; 38: 32-37

  Abstract

  To examine the risk factors for internalizing (anxiety, depression) and posttraumatic stress (PTSD) disorders, somatization, and anxiety sensitivity (AS) in youth with psychogenic non-epileptic seizures (PNES).55 probands with PNES and 35 siblings, aged 8-18 years, underwent a psychiatric interview, cognitive and language testing, and completed somatization and AS questionnaires. Parents provided the subjects' medical, psychiatric, family, and adversity history information.The risk factors for the probands' internalizing disorders (girls, older age of PNES onset), somatization (older age, epilepsy), and anxiety sensitivity (girls, adversities) differed from their siblings. The risk factors in the siblings, however, were similar to the general pediatric population. Proband depression was unrelated to the study's risk variables while PTSD was significantly associated with female gender and lower Full Scale IQ.Knowledge about the specificity of the risk factors for comorbid psychopathology in youth with PNES might facilitate their early identification and treatment.

  View details for DOI 10.1016/j.seizure.2016.03.012

  View details for Web of Science ID 000377834400007

  View details for PubMedID 27085102

• Emotional expressiveness and avoidance in narratives of unaccompanied refugee minors. European journal of psychotraumatology Huemer, J., Nelson, K., Karnik, N., Völkl-Kernstock, S., Seidel, S., Ebner, N., Ryst, E., Friedrich, M., Shaw, R. J., Realubit, C., Steiner, H., Skala, K. 2016; 7: 29163-?

  Abstract

  The aim of this study was to examine a cohort of unaccompanied refugee minors (URMs) by means of psycholinguistic methods in order to obtain a more subtle picture of their degree of traumatization.Twenty-eight participants were included in the Stress-Inducing Speech Task (SIST) consisting of a free association (FA) and a stress (STR) condition. Narratives were examined by means of (1) quantitative parameters (word count); (2) psycholinguistic variables (temporal junctures, TJs), narrative structure, referential activity (RA)-a measure of emotional expressivity; and (3) content analysis ratings.Word count was significantly lower than in age-matched norms. In the FA condition, TJs were lower, but in the STR condition, rates were comparable. RA was significantly higher in both conditions. Content analysis ratings showed that the experiences described by these youths were potentially traumatic in nature.This pattern of narrative shows a mixture of fulfilling the task demand, while containing an emotionally charged narrative. Narrative structure was absent in the FA condition, but preserved in the STR condition, as URMs struggled with the description of non-normative events. This indicates that these youths have not yet emotionally dealt with and fully integrated their trauma experiences.

  View details for DOI 10.3402/ejpt.v7.29163

  View details for PubMedID 26955827

  View details for PubMedCentralID PMC4783431

• Does she think she’s supported? Maternal perceptions of their experiences in the neonatal intensive care Patient Experience Journal Lilo, E. A., Shaw, R. J., Corcoran, J., Storfer-Isser, A., Horwitz, S. M. 2016; 3 (1): 15-24
• Adolescent Defense Style as Correlate of Problem Behavior. Zeitschrift fu¨r Kinder- und Jugendpsychiatrie und Psychotherapie Huemer, J., Shaw, R. J., Prunas, A., Hall, R., Gross, J., Steiner, H. 2015; 43 (5): 345-350

  Abstract

  Adolescent problem behaviors are often the visible results of intrapsychic distress. Defensive reactions are the unconscious means of managing intrapsychic distress. This cross-sectional study examines the strength of defensive style as measured by self-report on the Response Evaluation Measure (REM-71) relative to age, sex, and SES, as a correlate of internalizing and externalizing problem behaviors, as assessed by the Youth Self Report (YSR).A sample of 1,487 students from two suburban high schools completed self-report measures of defense style, self-esteem, and internalizing and externalizing problem behaviors. Demographic variables (age, sex, and SES) were included as covariates.Mature and immature defense style correlated as expected with problem behaviors. Demographic variables contributed minimally to the variance in the outcome variable.Defense style, as assessed by the REM-71, is a significant correlate of clinically elevated internalizing and externalizing problem behaviors in youth as in adults. This study adds to the convergent validity of the REM-71.

  View details for DOI 10.1024/1422-4917/a000368

  View details for PubMedID 26373385

• A Model for the Development of Mothers' Perceived Vulnerability of Preterm Infants JOURNAL OF DEVELOPMENTAL AND BEHAVIORAL PEDIATRICS Horwitz, S. M., Storfer-Isser, A., Kerker, B. D., Lilo, E., Leibovitz, A., St John, N., Shaw, R. J. 2015; 36 (5): 371-380

  Abstract

  Some mothers of preterm infants continue to view them as vulnerable after their health has improved. These exaggerated perceptions of vulnerability lead to poor parent-child interactions and, subsequently, to adverse child outcomes. However, there is no theoretical model to explain why these exaggerated perceptions develop in only some mother-child dyads.Data for this study come from a randomized trial of an intervention to reduce distress in mothers of preterm infants. A total of 105 mothers older than 18 years of infants aged 25-34 weeks, weighing >600 g and with clinically significant anxiety, depression, or trauma symptoms, were recruited and randomized. Women were assessed at baseline, after intervention, and at 6 months after birth. The outcome for these analyses was perceptions of infant vulnerability as measured by the Vulnerable Baby Scale (VBS) at 6 months after birth. A theoretical model developed from the extant literature was tested using the MacArthur Mediator-Moderator Approach.A dysfunctional coping style, high depression, anxiety, or trauma symptoms in response to the preterm birth, and low social support were related to 6-month VBS scores. Maternal response to trauma was directly related to VBS, and an important precursor of maternal response to trauma was a dysfunctional coping style.This model suggests that maternal responses to trauma are critical in the formation of exaggerated perceptions of vulnerability as are dysfunctional coping styles and low social support. Women with these characteristics should be targeted for intervention to prevent poor parenting practices that result from exaggerated perceptions of vulnerability.

  View details for DOI 10.1097/DBP.0000000000000173

  View details for Web of Science ID 000356248100009

  View details for PubMedID 25961903

  View details for PubMedCentralID PMC4456223

• DOES AN INTERVENTION TO REDUCE MATERNAL ANXIETY, DEPRESSION AND TRAUMA ALSO IMPROVE MOTHERS' PERCEPTIONS OF THEIR PRETERM INFANTS' VULNERABILITY? INFANT MENTAL HEALTH JOURNAL Horwitz, S. M., Leibovitz, A., Lilo, E., Jo, B., DeBattista, A., St John, N., Shaw, R. J. 2015; 36 (1): 42-52

  Abstract

  To determine if an intervention to reduce maternal distress and address maternal perceptions of infants' vulnerability also reduces perceptions of vulnerability, 105 mothers of premature infants (25- to 34-weeks' gestational age; >600 g) with depression, anxiety, or trauma were randomized to a six- or nine-session intervention or a comparison condition. The outcome was changes in a measure of perception of infant vulnerability between 4 to 5 weeks' and 6 months' postdelivery, the Vulnerability Baby Scale (VBS; B. Forsyth, S. Horwitz, J. Leventhal, & J. Burger, 1996; N. Kerruish, K. Settle, P. Campbell-Stokes, & B. Taylor, 2005). High scores on the VBS were indicative of high levels of perceived infant vulnerability. The perceptions of infants' vulnerability showed significant declines, with no differences across groups or in rate of change. Mothers reporting prior trauma at entry to the study showed much lower perceptions of infants' vulnerability scores under the intervention, Cohen's d = -0.86, p = .01. Given that women with prior trauma are very likely to view their premature infants as vulnerable, this intervention may have important implications for subsequent parenting behaviors and child development.

  View details for DOI 10.1002/imhj.21484

  View details for Web of Science ID 000348421800006

  View details for PubMedID 25452159

• A multisite controlled study of risk factors in pediatric psychogenic nonepileptic seizures EPILEPSIA Plioplys, S., Doss, J., Siddarth, P., Bursch, B., Falcone, T., Forgey, M., Hinman, K., LaFrance, W. C., Laptook, R., Shaw, R. J., Weisbrot, D. M., Willis, M. D., Caplan, R. 2014; 55 (11): 1739-1747

  Abstract

  Psychogenic nonepileptic seizures (PNES) in youth are symptoms of a difficult to diagnose and treat conversion disorder. PNES is associated with high medical and psychiatric morbidity, but specific PNES risk factors in the pediatric population are not known. We examined if youth with PNES have a distinct biopsychosocial risk factor profile compared to their siblings and if the interrelationships between these risk factors differentiate the PNES probands from the sibling group.This multisite study included 55 youth with a confirmed diagnosis of PNES (age range 8.6-18.4 years) and their 35 sibling controls (age range 8.6-18.1 years). A video EEG and psychiatric assessment confirmed the PNES diagnosis. Parents reported on each child's past and present medical/epilepsy, psychiatric, family, and educational history. Each child underwent a structured psychiatric interview, standardized cognitive and academic achievement testing, and completed self-report coping, daily stress, adversities, and parental bonding questionnaires.Compared to their siblings, the PNES probands had significantly more lifetime comorbid medical, neurological (including epilepsy), and psychiatric problems; used more medications and intensive medical services; had more higher anxiety sensitivity, practiced solitary emotional coping, and experienced more lifetime adversities. A principal components analysis of these variables identified a somatopsychiatric, adversity, epilepsy, and cognitive component. The somatopsychiatric and adversity components differentiated the probands from the siblings, and were highly significant predictors of PNES with odds ratios of 15.1 (95% CI [3.4, 67.3], and 9.5 (95% CI [2.0, 45.7]), respectively. The epilepsy and cognitive components did not differentiate between the PNES and sibling groups.These findings highlight the complex biopsychosocial and distinct vulnerability profile of pediatric PNES. They also underscore the need for screening the interrelated risk factors included in the somatopsychiatric and adversity components and subsequent mental health referral for confirmation of the diagnosis and treatment of youth with PNES.

  View details for DOI 10.1111/epi.12773

  View details for Web of Science ID 000345227400015

• Defensive functioning and psychopathology: a study with the REM-71 COMPREHENSIVE PSYCHIATRY Prunas, A., Preti, E., Huemer, J., Shaw, R. J., Steiner, H. 2014; 55 (7): 1696-1702

  Abstract

  The aim of the present study is to explore the association between defensive functioning (as assessed through the REM-71) and psychiatric symptoms in a large sample from the community, and the moderating role of age and gender on that association. Furthermore, we explored the concurrent validity of REM-71 as compared with "caseness" (SCL-90-R).The REM-71 was administered together with SCL-90-R to a community sample of 1,060 Italian high-school and university students (mean age=19.01±3.85 years; 66.7% females).Factor 1 defenses were by far the primary contributors to the predictor synthetic variable (i.e. association between defenses and psychopathology). Gender proved to moderate the association between immature defenses and symptoms. Using ROC analysis, we derived a cut-off score for Factor 1 defenses.Our results support the adoption of the REM-71 as a useful instrument for the assessment of defensive array and psychopathological liability in adolescents and adults.

  View details for DOI 10.1016/j.comppsych.2014.06.008

  View details for Web of Science ID 000342121800032

• Prevention of traumatic stress in mothers of preterms: 6-month outcomes. Pediatrics Shaw, R. J., St John, N., Lilo, E., Jo, B., Benitz, W., Stevenson, D. K., Horwitz, S. M. 2014; 134 (2): e481-8

  View details for DOI 10.1542/peds.2014-0529

  View details for PubMedID 25049338

• Screening for Symptoms of Postpartum Traumatic Stress in a Sample of Mothers with Preterm Infants ISSUES IN MENTAL HEALTH NURSING Shaw, R. J., Lilo, E. A., Storfer-Isser, A., Ball, M. B., Proud, M. S., Vierhaus, N. S., Huntsberry, A., Mitchell, K., Adams, M. M., Horwitz, S. M. 2014; 35 (3): 198-206

  Abstract

  There are no established screening criteria to help identify mothers of premature infants who are at risk for symptoms of emotional distress. The current study, using data obtained from recruitment and screening in preparation for a randomized controlled trial, aimed to identify potential risk factors associated with symptoms of depression, anxiety and posttraumatic stress in a sample of mothers with premature infants hospitalized in a neonatal intensive care unit. One hundred, thirty-five mothers of preterm infants born at 26-34 weeks of gestation completed three self-report measures: the Stanford Acute Stress Reaction Questionnaire, the Beck Depression Inventory (2nd ed.), and the Beck Anxiety Inventory to determine their eligibility for inclusion in a treatment intervention study based on clinical cut-off scores for each measure. Maternal sociodemographic measures, including race, ethnicity, age, maternal pregnancy history, and measures of infant medical severity were not helpful in differentiating mothers who screened positive on one or more of the measures from those who screened negative. Programs to screen parents of premature infants for the presence of symptoms of posttraumatic stress, anxiety, and depression will need to adopt universal screening rather than profiling of potential high risk parents based on their sociodemographic characteristics or measures of their infant's medical severity.

  View details for DOI 10.3109/01612840.2013.853332

  View details for Web of Science ID 000353212800007

  View details for PubMedID 24597585

  View details for PubMedCentralID PMC3950960

• Prevention of traumatic stress in mothers with preterm infants: a randomized controlled trial. Pediatrics Shaw, R. J., St John, N., Lilo, E. A., Jo, B., Benitz, W., Stevenson, D. K., Horwitz, S. M. 2013; 132 (4): e886-94

  Abstract

  The current study evaluates a treatment intervention developed with the goal of reducing symptoms of posttraumatic stress, depression, and anxiety in parents of premature infants.A total of 105 mothers of preterm infants (25-34 weeks' gestational age; >600 g) were randomized to receive a 6-session intervention developed to target parental trauma as well as facilitate infant redefinition (n = 62) or to an active comparison group (n = 43). Mothers in the intervention group received a combination of trauma-focused treatments, including psychoeducation, cognitive restructuring, progressive muscle relaxation, and development of their trauma narrative. The intervention also incorporated material targeting infant redefinition, defined as the process of changing the mother's negative perceptions of her infant and the parenting experience.Mothers in the intervention group reported a greater reduction in both trauma symptoms (Cohen's d = 0.41, P = .023) and depression (Cohen's d = 0.59, P < .001) compared with the comparison group. Patients under both conditions improved significantly in terms of anxiety, with no differences between groups. Results of the moderator analysis showed that mothers with higher ratings of baseline NICU stress benefited more from the intervention compared with mothers who had lower ratings (P = .036).This short, highly manualized intervention for mothers of preterm infants statistically significantly reduced symptoms of trauma and depression. The intervention is feasible, can be delivered with fidelity, and has high ratings of maternal satisfaction. Given that improvements in mothers' distress may lead to improved infant outcomes, this intervention has the potential for a high public health impact.

  View details for DOI 10.1542/peds.2013-1331

  View details for PubMedID 23999956

• Prevention of Postpartum Traumatic Stress in Mothers with Preterm Infants: Manual Development and Evaluation ISSUES IN MENTAL HEALTH NURSING Shaw, R. J., Sweester, C. J., John, N. S., Lilo, E., Corcoran, J. B., Jo, B., Howell, S. H., Benitz, W. E., Feinstein, N., Melnyk, B., Horwitz, S. M. 2013; 34 (8): 578-586

  Abstract

  Premature birth has been associated with multiple adverse maternal psychological outcomes that include depression, anxiety, and trauma as well as adverse effects on maternal coping ability and parenting style. Infants who are premature are more likely to have poorer cognitive and developmental functioning and, thus, may be harder to parent, both as infants and as they get older. In response to these findings, a number of educational and behavioral interventions have been developed that target maternal psychological functioning, parenting, and aspects of the parent-infant relationship. The current study aimed to both develop and evaluate a treatment that integrates, for the first time, effective interventions for reducing symptoms of posttraumatic stress disorder (PTSD) and enhancing maternal-infant interactions. Conclusions from the study indicate that the intervention is feasible, able to be implemented with a high level of fidelity, and is rated as highly satisfactory by participants. Though encouraging, these findings are preliminary, and future studies should strive to reproduce these findings with a larger sample size and a comparison group.

  View details for DOI 10.3109/01612840.2013.789943

  View details for Web of Science ID 000209366600003

• Parental coping in the neonatal intensive care unit. Journal of clinical psychology in medical settings Shaw, R. J., Bernard, R. S., Storfer-Isser, A., Rhine, W., Horwitz, S. M. 2013; 20 (2): 135-142

  Abstract

  Fifty-six mothers of premature infants who participated in a study to reduce symptoms of posttraumatic stress disorder (PTSD) completed the Brief COPE, a self-report inventory of coping mechanisms, the Stanford Acute Stress Reaction Questionnaire to assess acute stress disorder (ASD) and the Davidson Trauma Scale to assess PTSD. 18 % of mothers had baseline ASD while 30 % of mothers met the criteria for PTSD at the 1-month follow-up. Dysfunctional coping as measured by the Brief COPE was positively associated with elevated risk of PTSD in these mothers (RR = 1.09, 95 % CI 1.02-1.15; p = .008). Maternal education was positively associated with PTSD; each year increase in education was associated with a 17 % increase in the relative risk of PTSD at 1 month follow-up (RR = 1.17, 95 % CI 1.02-1.35; p = .03). Results suggest that dysfunctional coping is an important issue to consider in the development of PTSD in parents of premature infants.

  View details for DOI 10.1007/s10880-012-9328-x

  View details for PubMedID 22990746

  View details for PubMedCentralID PMC3578086

• Personality and Psychopathology in African Unaccompanied Refugee Minors: Repression, Resilience and Vulnerability CHILD PSYCHIATRY & HUMAN DEVELOPMENT Huemer, J., Voelkl-Kernstock, S., Karnik, N., Denny, K. G., Granditsch, E., Mitterer, M., Humphreys, K., Plattner, B., Friedrich, M., Shaw, R. J., Steiner, H. 2013; 44 (1): 39-50

  Abstract

  Examining personality and psychopathological symptoms among unaccompanied refugee minors (URMs), we measured intra-individual dimensions (repression and correlates thereof) usually associated with resilience. Forty-one URMs completed the Weinberger Adjustment Inventory (WAI), assessing personality, and the Youth Self-Report (YSR), describing current symptoms. URMs endorsed high levels of Repressive Defensiveness, Denial of Distress, and Restraint; unexpectedly, URMs reported high Distress and reduced Happiness (WAI, p's < 0.05). Although YSR symptoms were below clinical cut points, there were notable correlations between Distress and Attention Problems, Self-destructive, and Aggressive Behavior (all on the YSR), correcting for multiple comparisons (p's < 0.004). URMs exposed to non-normative stressors reported non-symptomatic outcomes, and high levels of personality dimensions correlating with resilience. However, URMs also endorsed high Distress and low Happiness, calling their resilience into question. Positive correlations between WAI Distress and YSR symptom subscales suggest that URMs harbor vulnerabilities of clinical and forensic significance.

  View details for DOI 10.1007/s10578-012-0308-z

  View details for Web of Science ID 000314065000003

  View details for PubMedID 22661148

• Effectiveness of therapeutic and behavioral interventions for parents of low-birth-weight premature infants: A review INFANT MENTAL HEALTH JOURNAL Brecht, C. J., Shaw, R. J., St John, N. H., Horwitz, S. M. 2012; 33 (6): 651-665

  Abstract

  Premature birth has been associated with a number of adverse maternal psychological outcomes that include depression, anxiety, and trauma as well as adverse effects on maternal coping ability and parenting style. Infants and children who were premature are more likely to have poorer cognitive and developmental functioning and, thus, may be harder to parent. In response to these findings, there have been a number of educational and behavioral interventions developed that target maternal psychological functioning, parenting and aspects of the parent-infant relationship. Since the last comprehensive review of this topic in 2002, there have been a significant number of developments in the quality of the studies conducted and the theoretical models that address the experience of parents of premature infants. In the current review, eighteen new interventions were identified and grouped into four categories based on treatment length and the target of the intervention. Findings suggest a trend towards early, brief interventions that are theoretically based, specifically target parent trauma, and utilize cognitive behavioral techniques. Although it is difficult to generalize study findings, conclusions from the review suggest that targeted interventions may have positive effects on both maternal and infant outcomes.

  View details for DOI 10.1002/imhj.21349

  View details for Web of Science ID 000311375600010

  View details for PubMedCentralID PMC3925006

• Effectiveness of therapeutic behavioral interventions for parents of low birth weight premature infants: A review. Infant mental health journal Brecht, C., Shaw, R. J., Horwitz, S. M., John, N. H. 2012; 33 (6): 651-665

  Abstract

  Premature birth has been associated with a number of adverse maternal psychological outcomes that include depression, anxiety, and trauma as well as adverse effects on maternal coping ability and parenting style. Infants and children who were premature are more likely to have poorer cognitive and developmental functioning and, thus, may be harder to parent. In response to these findings, there have been a number of educational and behavioral interventions developed that target maternal psychological functioning, parenting and aspects of the parent-infant relationship. Since the last comprehensive review of this topic in 2002, there have been a significant number of developments in the quality of the studies conducted and the theoretical models that address the experience of parents of premature infants. In the current review, eighteen new interventions were identified and grouped into four categories based on treatment length and the target of the intervention. Findings suggest a trend towards early, brief interventions that are theoretically based, specifically target parent trauma, and utilize cognitive behavioral techniques. Although it is difficult to generalize study findings, conclusions from the review suggest that targeted interventions may have positive effects on both maternal and infant outcomes.

  View details for DOI 10.1002/imhj.21349

  View details for PubMedID 24532861

  View details for PubMedCentralID PMC3925006

• Brief Cognitive-Behavioral Intervention for Maternal Depression and Trauma in the Neonatal Intensive Care Unit: A Pilot Study JOURNAL OF TRAUMATIC STRESS Bernard, R. S., Williams, S. E., Storfer-Isser, A., Rhine, W., Horwitz, S. M., Koopman, C., Shaw, R. J. 2011; 24 (2): 230-234

  Abstract

  Parents of hospitalized premature infants are at risk for developing psychological symptoms. This randomized controlled pilot study examined the effectiveness of a brief cognitive-behavioral intervention in reducing traumatic and depressive symptoms in mothers 1 month after their infant's discharge from the hospital. Fifty-six mothers were randomly assigned to the intervention or control group. Results showed that mothers experienced high levels of symptoms initially and at follow-up. At follow-up, there was a trend for mothers in the intervention group to report lower levels of depression (p = .06; Cohen's f = .318), but levels of traumatic symptoms were similar for both groups. Brief psychological interventions may reduce depressive symptoms in this population. Estimates of the effect sizes can be used to inform future intervention studies.

  View details for DOI 10.1002/jts.20626

  View details for Web of Science ID 000289528300014

  View details for PubMedID 21438016

• Inter-rater reliability of the Pediatric Transplant Rating Instrument (P-TRI): Challenges to reliably identifying adherence risk factors during pediatric pre-transplant evaluations PEDIATRIC TRANSPLANTATION Fisher, M., Storfer-Isser, A., Shaw, R. J., Bernard, R. S., Drury, S., Ularntinon, S., Horwitz, S. M. 2011; 15 (2): 142-147

  Abstract

  The purpose of this study was to assess the inter-rater reliability of the P-TRI, a 17-item instrument developed to identify risk factors associated with poor treatment adherence in pediatric solid organ transplant candidates. Because factors influencing treatment adherence may vary with age, the 89 subject samples were divided into pre-adolescent (0-11 yr) and adolescent (12-19 yr) groups. Each subject received two independent P-TRI ratings based on pretransplant psychosocial assessments separately conducted by a PSYC and a SWTC. Inter-rater reliability was assessed using the delta statistic. Overall, agreement was higher in the pre-adolescent group, with delta>0.70 for five items and delta<0.30 for two items. For the adolescent group, one item had a delta>0.70 and seven items had a delta<0.30. Overall, PSYC P-TRI ratings indicated fewer areas of concern on items assessing family dynamics compared with SWTC P-TRI ratings, whereas the reverse was true for items related to psychiatric history. Results highlight the challenges of conducting a reliable pretransplant assessment of adherence-related risk factors and suggest the need for revisions to the P-TRI prior to its use in clinical practice.

  View details for DOI 10.1111/j.1399-3046.2010.01428.x

  View details for Web of Science ID 000288316300008

  View details for PubMedID 21226810

• Overt and Covert Aggression in College Women with Bulimia Nervosa ZEITSCHRIFT FUR KINDER-UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE Huemer, J., Sagar, A., Alquero, K., Denny, K., Shaw, R. J., Steiner, H. 2011; 39 (6): 409-415

  Abstract

  This study examines the prevalence of overt and covert aggression in women with bulimia nervosa (BN) as well as the relationship between the severity of BN and the frequency of aggressive acts.20 female college students with BN and 20 control subjects completed self-report measures of aggressive behavior and eating disorder pathology. They also completed the Juvenile Health and Wellness Survey-76 to assess general risk taking and indices of sexual behavior and mental health.BN subjects reported higher levels of both overt and covert aggression (p < .001). Overt aggression tended to be more premeditated, while the self-report of covert aggression behavior was more impulsive. Levels of aggressive behavior were significantly correlated with severity of BN (p < .01). Subjects with BN reported higher levels of risk-taking and sexual behaviors.Aggression is an important clinical issue in BN. Subtypes of aggression suggest different pathways for overt and covert aggressive acts with impulsive covert aggression being more closely related to the binge-purge cycle. Awareness of subtypes of aggression in BN may have important clinical and treatment implications.

  View details for DOI 10.1024/1422-4917/a000139

  View details for Web of Science ID 000296582300005

  View details for PubMedID 22031013

• Psychosocial assessment prior to pediatric transplantation: A review and summary of key considerations PEDIATRIC TRANSPLANTATION Annunziato, R. A., Fisher, M. K., Jerson, B., Bochkanova, A., Shaw, R. J. 2010; 14 (5): 565-574

  Abstract

  Prior to listing for transplantation, patients participate in a comprehensive, multidisciplinary evaluation. One component of this process, incorporated by the vast majority of transplant centers, is a psychosocial assessment conducted by a mental health professional. The primary objectives of a pre-transplant psychosocial assessment are to identify risk factors for difficulty adjusting post-transplant as well as behaviors that may compromise transplantation outcomes. This paper aims to provide a summary of key considerations for pediatric transplant teams describing what this assessment might include, when it should be performed, training requirements for the evaluators, how results of the evaluation might best be utilized and suggestions for optimal patient preparation. Our findings suggest that the evaluation, which can be conducted by a variety of professionals, should include assessment of patient knowledge and motivation for transplant, mental health and substance abuse history, presence or absence of family and social support, availability of financial resources, past history of treatment adherence, and the quality of the family's relationship with the transplant team. Repeat assessments and utilizing the initial evaluation for outcome assessment should be considered. Finally, the evaluation offers a unique opportunity for better preparing patients and families for transplantation.

  View details for DOI 10.1111/j.1399-3046.2010.01353.x

  View details for Web of Science ID 000279765900003

  View details for PubMedID 20609171

• Concurrent Treatment of Steroid-Related Mood and Psychotic Symptoms With Risperidone PEDIATRICS Ularntinon, S., Tzuang, D., Dahl, G., Shaw, R. J. 2010; 125 (5): E1241-E1245

  Abstract

  Corticosteroid treatment is an important therapeutic modality for many pediatric medical conditions including acute lymphoblastic leukemia. However, steroid-induced behavioral and mood abnormalities are common and potentially disabling adverse effects that have been widely reported in the pediatric literature. From this case series, we report the efficacy of risperidone in 3 children with acute lymphoblastic leukemia who developed steroid-related mood and psychotic symptoms during treatment with prednisone and dexamethasone. Risperidone is an effective short-term pharmacologic agent for controlling steroid-related psychiatric adverse effects when cessation or dose reduction of steroid therapy is not an option.

  View details for DOI 10.1542/peds.2009-1815

  View details for Web of Science ID 000277232800060

  View details for PubMedID 20385646

• Pediatric psychogenic nonepileptic seizures: A study of assessment tools EPILEPSY & BEHAVIOR Salpekar, J. A., Plioplys, S., Siddarth, P., Bursch, B., Shaw, R. J., Asato, M. R., LaFrance, W. C., Weisbrot, D. M., Dunn, D. W., Austin, J. K., Olson, D. M., Caplan, R. 2010; 17 (1): 50-55

  Abstract

  The goal of this study was to identify assessment tools and associated behavioral domains that differentiate children with psychogenic nonepileptic seizures (PNES) from those with epilepsy. A sample of 24 children with PNES (mean age 14.0 years, 14 female), 24 children with epilepsy (mean age 13.6 years, 13 female), and their parents were recruited from five epilepsy centers in the United States. Participants completed a battery of behavioral questionnaires including somatization, anxiety, and functional disability symptoms. Children with PNES had significantly higher scores on the Childhood Somatization and Functional Disability Inventories, and their parents reported more somatic problems on the Child Behavior Checklist (CBCL). Depression, anxiety, and alexithymia instruments did not differentiate the groups. Measures of somatization and functional disability may be promising tools for differentiating the behavioral profile of PNES from that of epilepsy. Increased somatic awareness and perceived disability emphasize the similarity of PNES to other pediatric somatoform disorders.

  View details for DOI 10.1016/j.yebeh.2009.10.002

  View details for Web of Science ID 000273837700007

  View details for PubMedID 19948427

• Traumatic Stress Reactions in Parents in Pediatric Intensive Care: A Review CURRENT PSYCHIATRY REVIEWS Ularntinon, S., Bernard, R., Wren, F., St John, N., Horwitz, S. M., Shaw, R. J. 2010; 6 (4): 261–68

  View details for DOI 10.2174/157340010793499422

  View details for Web of Science ID 000213237400005

• Comparison of Short-Term Psychological Outcomes of Respiratory Failure Treated by Either Invasive or Non-Invasive Ventilation PSYCHOSOMATICS Shaw, R. J., Harvey, J. E., Bernard, R., Gunary, R., Tiley, M., Steiner, H. 2009; 50 (6): 586-591

  Abstract

  There is now widespread recognition of the development of symptoms of posttraumatic stress disorder (PTSD) in individuals subjected to treatment in the hospital intensive care unit (ICU).The authors sought to investigate traumatic aspects of the ICU hospitalization experience.A group of 20 adult pulmonary patients requiring ventilation in the ICU were compared with 20 patients treated without ventilation. Subjects completed a semistructured interview about their hospital experience and were given self-report measures to assess PTSD and coping style.Subjects requiring invasive ventilation were significantly more likely to endorse symptoms of PTSD. There was a strong correlation between symptoms of PTSD and recall of memories of traumatic medical events. Symptoms of PTSD were positively associated with habitual experiences of distress and negatively associated with the use of denial of distress.Specific traumatic aspects of a patient's treatment, in this case the experience of intubation and mechanical ventilation, may be an additive risk factor for the development of PTSD.

  View details for Web of Science ID 000272488900006

  View details for PubMedID 19996229

• The Italian version of the Response Evaluation Measure-71 COMPREHENSIVE PSYCHIATRY Prunas, A., Madeddu, F., Pozzoli, S., Gatti, C., Shaw, R. J., Steiner, H. 2009; 50 (4): 369-377

  Abstract

  The aim of the present study was to analyze the psychometric properties of the Italian version of the Response Evaluation Measure (REM-71), a 71-item self-report measure previously developed for the assessment of defenses in adults and adolescents. The authors also examined the differences in the use of defenses based on sex and age (early adolescence, late adolescence, and early adulthood), and the association between defenses, psychosocial health, and psychologic distress in a large community sample.The Italian version of REM-71 was obtained through back-translation and administered to 1648 (1020 female subjects, mean age = 19.5 years, SD = +/-5.77) community subjects, aged between 13 and 68 years, voluntarily recruited among high school and university students in Milan, Italy, and the surrounding area. All subjects completed a self-report measure to assess demographic variables and satisfaction with life. A subsample (n = 1197) completed the Italian version of the Symptom Checklist-90-Revised to assess symptoms of psychologic distress.Results were highly consistent with those obtained in the original English version of the REM-71 and included satisfactory internal consistency of the measure. Factor analyses yielded 2 principal factors that showed overall stability across age and sex subgroups. Factor 1 and factor 2 defenses were significantly correlated, in line with theoretical expectations, with positive and negative aspects of various domains of life.Results provide further support for the structure and validity of the REM-71 as a useful instrument for the assessment of defenses in adolescents and adults and suggest no major cross-cultural differences in the organization of these defenses.

  View details for DOI 10.1016/j.comppsych.2008.09.010

  View details for Web of Science ID 000266820100011

  View details for PubMedID 19486736

• The Relationship Between Acute Stress Disorder and Posttraumatic Stress Disorder in the Neonatal Intensive Care Unit PSYCHOSOMATICS Shaw, R. J., Bernard, R. S., DeBlois, T., Ikuta, L. M., Ginzburg, K., Koopman, C. 2009; 50 (2): 131-137

  Abstract

  Having an infant hospitalized in the neonatal intensive care unit (NICU) is a highly stressful event for parents. Researchers have proposed posttraumatic stress disorder (PTSD) as a model to explain the psychological reaction of parents to their NICU experience.The authors sought to examine the prevalence of PTSD in parents 4 months after the birth of their premature or sick infants and the relationship of PTSD and symptoms of acute stress disorder (ASD) immediately after their infant's birth.Eighteen parents completed a self-report measure of ASD at baseline in addition to self-report measures of PTSD and depression at a 4-month follow-up assessment.In the sample, 33% of fathers and 9% of mothers met criteria for PTSD. ASD symptoms were significantly correlated with both PTSD and depression. Fathers showed a more delayed onset in their PTSD symptoms, but, by 4 months, were at even greater risk than mothers.The relatively high levels of psychological distress experienced by parents coupled with the potential negative outcomes on the parent and infant suggest that it is important to try to prepare parents for the expected psychological reactions that may occur in the event of a NICU hospitalization and also to support parents during the transition to home care.

  View details for Web of Science ID 000265270400005

  View details for PubMedID 19377021

• Defence mechanisms in schizophrenia PERSONALITY AND MENTAL HEALTH Shaw, R. J., Geurse, M. K., Steiner, H. 2008; 2 (4): 240-248

  View details for DOI 10.1002/pmh.47

  View details for Web of Science ID 000207692700004

• Posttraumatic stress disorder following traumatic injury: Narratives as unconscious indicators of psychopathology BULLETIN OF THE MENNINGER CLINIC Hashemi, B., Shaw, R. J., Hong, D. S., Hall, R., Nelson, K., Steiner, H. 2008; 72 (3): 179-190

  Abstract

  Current conventional assessment methodologies used to diagnose posttraumatic stress disorder (PTSD) rely heavily on symptom counts obtained from clinical interviews or self-report questionnaires. Such measures may underestimate the impact of traumatic events, particularly in individuals who deny or repress emotional distress. This case report illustrates the use of two methods of narrative analysis to assess unconscious representations of PTSD. Linguistic analysis and a computerized analysis of referential activity were able to capture unconscious aspects of the traumatic experience.

  View details for PubMedID 18990054

• Hypnosis-provoked nonepileptic events in children EPILEPSY & BEHAVIOR Olson, D. M., Howard, N., Shaw, R. J. 2008; 12 (3): 456-459

  Abstract

  The purpose of this study was to describe the use of hypnotic suggestion as a means of precipitating nonepileptic events in children while they are undergoing video electroencephalographic monitoring (VEEG) for differential diagnosis of seizurelike behavior.Nine children aged 8-16 years were referred for VEEG to differentiate between epileptic seizures and nonepileptic events. All subjects underwent psychiatric consultation. Hypnosis was attempted in all subjects to try to provoke typical seizurelike events.In eight of nine patients, their typical seizurelike events were provoked by hypnosis. In all eight children, video and EEG analysis of the provoked events demonstrated them to be nonepileptic. No epileptiform abnormalities were present on interictal EEGs. No epileptic seizures occurred.Hypnosis is a useful and ethical means of provoking psychogenic nonepileptic events in children. Hypnotic suggestion should be considered as a provocative method when possibly psychogenic nonepileptic events have not occurred spontaneously during diagnostic evaluation.

  View details for DOI 10.1016/j.yebeh.2007.12.003

  View details for Web of Science ID 000254553900014

  View details for PubMedID 18249039

• Pediatric Transplant Rating Instrument - A scale for the pretransplant psychiatric evaluation of pediatric organ transplant recipients PEDIATRIC TRANSPLANTATION Fung, E., Shaw, R. J. 2008; 12 (1): 57-66

  Abstract

  Although the majority of pediatric solid organ transplant centers in the United States employ psychosocial criteria to assess the suitability of potential transplant candidates, there are no standardized pretransplant psychosocial assessment measures. Assessment scales that have been developed were designed for adult transplant recipients and are not suitable for use in the pediatric population. The P-TRI was developed to address this gap in the pediatric pretransplant psychosocial evaluation. It is intended to identify areas of psychosocial vulnerability that may be associated with poor treatment adherence and to facilitate the development of informed and focused psychosocial interventions for pediatric patients before and after transplant surgery. Items on the rating instrument were generated based on a review of the major correlates of treatment adherence in the pediatric population. Data are currently being collected for further reliability and validity analyses.

  View details for DOI 10.1111/j.1399-3046.2007.00785.x

  View details for Web of Science ID 000252122200011

  View details for PubMedID 18186890

• EOSINOPHILIC MENINGOENCEPHALITIS: PSYCHIATRIC PRESENTATION AND TREATMENT INTERNATIONAL JOURNAL OF PSYCHIATRY IN MEDICINE Hong, D. S., Bernstein, M., Smith, C., Gans, H., Shaw, R. J. 2008; 38 (3): 287-295

  Abstract

  Eosinophilic meningoencephalitis (EM) is usually a self-limited neurological illness commonly accompanied by a variety of neurological symptoms. The presence of acute psychotic symptoms in EM, however, has not previously been reported, and there is no literature to guide its treatment and management. In this case report, the onset of psychotic symptoms in a hypoactive delirium and their significant improvement following the administration of atypical antipsychotics are described in a boy with EM. This case report demonstrates the efficacy and safety of antipsychotic agents during the acute phase of meningoencephalitis.

  View details for DOI 10.2190/PM.38.3.e

  View details for Web of Science ID 000261315400005

  View details for PubMedID 19069573

• PARENTS OF CHILDREN WITH NON-EPILEPTIC EVENTS (NEE): PSYCHOLOGICAL AND MEDICAL PROFILES 62nd Annual Meeting of the American-Epilepsy-Society/2nd Biennial North American Regional Epilepsy Congress Plioplys, S., Siddarth, P., Asato, M., Austin, J. K., Bursch, B., Dunn, D. W., Shaw, R. J., Salpekar, J. A., ZUKERMAN, J., Caplan, R. WILEY-BLACKWELL. 2008: 151–151

  View details for Web of Science ID 000260306600346

• Defense mechanisms in schizophrenia Personality and Mental Health Shaw RJ, Geurse M, Steiner H 2008; 2: 240-248
• Factitious disorder by proxy: Pediatric condition falsification HARVARD REVIEW OF PSYCHIATRY Shaw, R. J., Dayal, S., Hartman, J. K., DeMaso, D. R. 2008; 16 (4): 215-224

  Abstract

  We present a comprehensive overview of the condition factitious disorder by proxy, also known as Munchausen syndrome by proxy. The review begins by highlighting essential definitions and the etiology and epidemiology of the disorder. It then analyzes relevant clinical issues such as assessment and diagnostic methods. The final section is a detailed discussion of the complex issues facing the clinician, including the process of confronting the perpetrator, relevant legal issues, and the treatment of the caretaker, child, and family through a multidisciplinary, team approach.

  View details for DOI 10.1080/10673220802277870

  View details for Web of Science ID 000258001000001

  View details for PubMedID 18661364

• Psychiatric medications for the treatment of pruritus Conference on the Futute of Psychiatric Diagnosis - Refining the Research Agenda Shaw, R. J., Dayal, S., Good, J., Bruckner, A. L., Joshi, S. V. LIPPINCOTT WILLIAMS & WILKINS. 2007: 970–78

  Abstract

  To review the use of psychiatric medications in the treatment of pruritus.A literature review was conducted using the key words pruritus, psychiatric, and treatment.Three categories of pruritus are described: dermatologic, systemic, and psychogenic. Peripheral and central nervous system mechanisms of pruritus are reviewed. Conventional dermatologic treatments for pruritus are contrasted with some of the common psychopharmacologic treatment modalities that include anxiolytic, antidepressant, and antipsychotic agents. A treatment algorithm is offered to help guide the treatment of patients with pruritus.Psychiatric medications have been used successfully in the treatment of pruritus that is associated with both psychocutaneous and systemic disorders, which are resistant to conventional treatment.

  View details for DOI 10.1097/PSY.0b013e3181572799

  View details for PubMedID 17991825

• Multidisciplinary management of pediatric nonepileptic seizures JOURNAL OF THE AMERICAN ACADEMY OF CHILD AND ADOLESCENT PSYCHIATRY Plioplys, S., Asato, M. R., Bursch, B., Salpekar, J. A., Shaw, R., Caplan, R. 2007; 46 (11): 1491-1495

  View details for DOI 10.1097/chi.0b013e31814dab98

  View details for Web of Science ID 000250358100011

  View details for PubMedID 18049299

• Subtypes of pediatric delirium: A treatment algorithm PSYCHOSOMATICS Karnik, N. S., Joshi, S. V., Paterno, C., Shaw, R. 2007; 48 (3): 253-257

  Abstract

  Delirium in adult populations of hospitalized patients has been well characterized into hyperactive, hypoactive, and mixed subtypes. The degree to which these subtypes apply to pediatric populations has yet to be fully demonstrated. In this case report, the authors present two cases of delirium that serve as examples of the hyperactive and hypoactive/mixed types and then discuss treatment. They find marked differences in the response of different delirium subtypes to haloperidol and risperidone and theorize as to the neurochemical pathways by which these pharmacological agents might work. This framework provides an algorithm for the treatment of pediatric delirium.

  View details for Web of Science ID 000246210400010

  View details for PubMedID 17478595

• Abdominal migraine and treatment with intravenous valproic acid PSYCHOSOMATICS Tan, V., Sahami, A. R., Peebles, R., Shaw, R. J. 2006; 47 (4): 353-355

  View details for Web of Science ID 000238767900013

  View details for PubMedID 16844896

• Acute stress disorder among parents of infants in the neonatal intensive care nursery PSYCHOSOMATICS Shaw, R. J., Deblois, T., Ikuta, L., Ginzburg, K., Fleisher, B., Koopman, C. 2006; 47 (3): 206-212

  Abstract

  The authors examined the prevalence of acute stress disorder (ASD) in parents of infants hospitalized in the neonatal intensive care unit (NICU). Forty parents were assessed after the birth of their infants. Parents completed self-report measures of ASD, parental stress, family environment, and coping style: 28% of parents developed symptoms of ASD. ASD was associated with female gender, alteration in parental role, family cohesiveness, and emotional restraint. Family environment and parental coping style are significantly associated with the development of trauma symptoms. Results from this study suggest potential interventions to help minimize psychological distress in parents.

  View details for Web of Science ID 000237226100003

  View details for PubMedID 16684937

• Practice patterns in pediatric consultation-liaison psychiatry - A national survey PSYCHOSOMATICS Shaw, R. J., Wamboldt, M., Bursch, B., Stuber, M. 2006; 47 (1): 43-49

  Abstract

  The purpose of this survey was to describe the current status of pediatric consultation-liaison (C-L) services in the United States. A total of 144 pediatric C-L programs were surveyed, with a response rate of 33%. Financial and staffing constraints were cited as common problems; 61% of programs reported an increase in consultation requests over the past 5 years, however, 30% of services reported a decrease in funding. Collection rates for professional billings average 30%; 57% of services reported an increase in clinical service demands at the expense of teaching and liaison activities. Discussion includes recommendations based on the results of the survey.

  View details for Web of Science ID 000234270000005

  View details for PubMedID 16384806

• Medical posttraumatic stress disorder. Psychiatric Times Shaw RJ, Bernard R 2006; 23: 25-38
• A typology of non-adherence in pediatric renal transplant recipients PEDIATRIC TRANSPLANTATION Shaw, R. J., Palmer, L., Blasey, C., Sarwal, M. 2003; 7 (6): 489-493

  Abstract

  We reviewed 112 pediatric renal transplant recipients to document the rate of medication non-adherence (NA) and to examine the relationships between NA, comorbid psychiatric illness, and the outcome variables of acute and chronic rejection and graft loss. A total of 32.5% of subjects had clinically significant NA with treatment based on review of serum immunosuppressant levels. NA was found to be significantly related to acute and chronic rejection, and graft loss (p < 0.001). NA was also related to the presence of comorbid psychiatric illness (p < 0.001). Logistic regression indicated that NA was a significant predictor for acute and chronic rejection, while psychiatric illness predicted graft loss. Adolescents had significantly higher rates of NA as well as shorter intervals between transplant date and onset of NA when compared with child patients (p < 0.001). Physician ratings of the primary reasons for NA suggested that lack of parental supervision and parent-child conflict were the major factors related to NA.

  View details for Web of Science ID 000186500400014

  View details for PubMedID 14870900

• Treatment of feeding disorders in children with Down Syndrome Clinical Child Psychology and Psychiatry Shaw RJ, Garcia M, Thorn M, Farley CA 2003; 8: 105-117
• A comparison of clinical ratings with vocal acoustic measures of flat affect and alogia JOURNAL OF PSYCHIATRIC RESEARCH Alpert, M., Shaw, R. J., Pouget, E. R., Lim, K. O. 2002; 36 (5): 347-353

  Abstract

  In this report we compare clinical ratings of flat affect and alogia with objective measures of the patient's speech prosody and productivity. Thirty schizophrenic patients were evaluated with the Scale for the Assessment of Negative Symptoms (SANS) and the St. Hans Rating Scale for extra pyramidal side effects. Their speech was recorded and analyzed acoustically for measures of prosody and productivity. Correlations between pairs of SANS items and acoustic measures (e.g. Vocal Inflection and Fundamental Frequency Variance) were weak. The SANS item and global ratings were strongly related. Ratings of bradykinesia overlapped with the SANS ratings but not with the acoustic measures. The SANS ratings appear to be derived from global impressions, with diffuse confounding of flat affect with alogia, and with bradykinesia. Acoustic analysis has the potential to provide objective measures that may help develop operational definitions of these constructs and enhance clinical assessment.

  View details for Web of Science ID 000178254700010

  View details for PubMedID 12127603

• Pseudologia fantastica associated with pervasive developmental disorder PSYCHIATRY-INTERPERSONAL AND BIOLOGICAL PROCESSES Teaford, T., Shaw, R. J., Reiss, A., Lotspeich, L. 2002; 65 (2): 165-171

  Abstract

  This case study describes the association of Pseudologia Fantastica (PF) and Pervasive Developmental Disorder Not Otherwise Specified (PDD-NOS) in a 14-year-old girl. PF is seen in a number of diagnostic entities, but has not previously been reported in PDD spectrum disorders. Treatment implications are discussed along with a formulation of the psychological and cognitive functions of PF in a person with a PDD diagnosis.

  View details for Web of Science ID 000176500400007

  View details for PubMedID 12108140

• Acute stress disorder following ventilation PSYCHOSOMATICS Shaw, R. J., Robinson, T. E., Steiner, H. 2002; 43 (1): 74-76

  View details for Web of Science ID 000174337000014

  View details for PubMedID 11927764

• Linguistic analysis to assess medically related posttraumatic stress symptoms PSYCHOSOMATICS Shaw, R. J., Harvey, J. E., Nelson, K. L., Gunary, R., Kruk, H., Steiner, H. 2001; 42 (1): 35-40

  Abstract

  The authors examined the presence of posttraumatic stress symptoms (PTSS) in 20 patients requiring ventilation after acute respiratory distress. The subjects completed a semistructured interview about their ventilation experience that was subject to content and linguistic analysis. Subjects also completed two self-report measures to assess PTSS and socioemotional adjustment. Subjects who endorsed PTSS were more likely to use a narrative style suggesting emotional involvement in their recall of the stressful event. The authors indicate that the presence of PTSS is a common consequence of traumatic medical experiences and that denial of distress may be an adaptive short-term coping strategy.

  View details for Web of Science ID 000166369100006

  View details for PubMedID 11161119

• Case study: Treatment adherence in a 13-year-old deaf adolescent male Clinical Child Psychology and Psychiatry Shaw RJ, Palmer L, Hyte H, Yorgin P, Sarwal M 2001; 6 (4): 551-562
• The mere exposure effect in patients with schizophrenia SCHIZOPHRENIA BULLETIN Marie, A., Gabrieli, J. D., Vaidya, C., Brown, B., Pratto, F., Zajonc, R. B., Shaw, R. J. 2001; 27 (2): 297-303

  Abstract

  The mere exposure effect refers to the development of an emotional preference for previously unfamiliar material because of frequent exposure to that material. This study compared schizophrenia subjects (n = 20) to normal controls (n = 21) to determine whether implicit memory, as demonstrated by the mere exposure effect, was intact. Patients with schizophrenia demonstrated a normal preference for both verbal and visual materials seen earlier relative to novel materials, despite impaired performance on a recognition task for explicit memory using similar materials. Previous studies of schizophrenia subjects have shown a dissociation between implicit and explicit memory on verbal tasks. We found a similar dissociation demonstrated by normal functioning on an implicit memory task and impaired functioning on an explicit memory task. Potential implications of these findings are discussed with regard to treatment and rehabilitation.

  View details for Web of Science ID 000168512400013

  View details for PubMedID 11354596

• Treatment adherence in adolescents: Development and psychopathology Clinical Child Psychology and Psychiatry Shaw RJ 2001; 6: 137-150
• Prosody and lexical accuracy in flat affect schizophrenia PSYCHIATRY RESEARCH Alpert, M., Rosenberg, S. D., Pouget, E. R., Shaw, R. J. 2000; 97 (2-3): 107-118

  Abstract

  To test the hypothesis that flat affect in schizophrenia involves a motor-expressive deficiency, but not an emotional deficiency, we compared the acoustic properties of speech that are used to express emotion with the emotional content of the words. DSM-III-R schizophrenic patients were divided into flat (N=20) and non-flat affect (N=26) groups on the basis of rating-scale scores. Twenty normal subjects also were included. Subjects were recorded on audio tape as they described a happy and a sad experience for about 10 min. The recordings were analyzed acoustically for fluency and for two types of prosody: inflection and emphasis. Words from transcriptions of the recordings were sorted by content analysis software into psychologically meaningful categories; we compared 'pleasure' and 'distress' word categories. Patients with flat affect spoke with less inflection, and were less fluent. However, they were similar to the other groups in the rate at which they used 'pleasure' words to describe happy experiences and 'distress' words to describe sad experiences. The behavioral deficiency in flat affect appears to be restricted to reduced activity in communicative motor channels. Other aspects of emotion processing seem intact.

  View details for Web of Science ID 000166779600003

  View details for PubMedID 11166083

• Case study: selective mutism in an immigrant child Child Psychology and Psychiatry Zelenko M, Shaw RJ 2000; 5 (4): 555-562
• Case study: Suprasellar germinoma presenting with psychotic and obsessive-compulsive symptoms JOURNAL OF THE AMERICAN ACADEMY OF CHILD AND ADOLESCENT PSYCHIATRY Mordecai, D., Shaw, R. J., Fisher, P. G., Mittelstadt, P. A., Guterman, T., Donaldson, S. S. 2000; 39 (1): 116-119

  Abstract

  This case describes a 13-year-old boy who had a suprasellar germinoma involving the bilateral basal ganglia. His presenting symptoms included left-sided weakness, diabetes insipidus, a decline in academic functioning as well as psychotic and obsessive-compulsive symptoms. His neuroradiological findings and clinical symptoms lend support to the potential role of the basal ganglia in psychotic and obsessive-compulsive symptomatology.

  View details for Web of Science ID 000084518400024

  View details for PubMedID 10638075

• The relationship between affect expression and affect recognition in schizophrenia SCHIZOPHRENIA RESEARCH Shaw, R. J., Dong, M., Lim, K. O., Faustman, W. O., Pouget, E. R., Alpert, M. 1999; 37 (3): 245-250

  Abstract

  To examine the relationship between affect expression and affect recognition, we assessed 30 clinically stable, medicated schizophrenic inpatients. Affect expression was assessed using both a standard clinical rating scale (SANS) and a computerized acoustic voice analysis (VOXCOM). Affect recognition was assessed using the Florida Affect Battery (FAB). The schizophrenics' performance on the FAB was impaired, indicating broad deficits in affect recognition (p<0.05). There were no significant correlations between measures of affect expression and affect recognition, suggesting that the expressive impairment in schizophrenia is not related to their ability to discern emotions in others. SANS Inappropriate Affect, however, was negatively correlated with facial affect recognition (p = 0.001), suggesting that raters' impression of inappropriate affect may indicate a failure in the process of affect attunement.

  View details for Web of Science ID 000080871500005

  View details for PubMedID 10403196

• The pediatric psychiatric pretransplant evaluation Child Psychology and Psychiatry Shaw RJ, Taussig HN 1999; 4: 353-365
• The Academy of Psychosomatic Medicine practice guidelines for psychiatric consultation in the general medical setting PSYCHOSOMATICS Bronheim, H. E., Fulop, G., Kunkel, E. J., Muskin, P. R., Schindler, B. A., Yates, W. R., Shaw, R., Steiner, H., Stern, T. A., Stoudemire, A. 1998; 39 (4): S8-S30

  Abstract

  This practice guideline seeks to provide guidance to psychiatrists who regularly evaluate and manage patients with medical illnesses. The guideline is intended to delineate the knowledge base, professional expertise, and integrated clinical approach necessary to effectively manage this complex and diverse patient population. This guideline was drafted by a work group consisting of psychiatrists with clinical and research expertise in the field, who undertook a comprehensive review of the literature. The guideline was reviewed by the executive council of the Academy of Psychosomatic Medicine and revised prior to final approval. Some of the topics discussed include qualifications of C-L consultants, patient assessment, psychiatric interventions (e.g., psychotherapy, pharmacotherapy), medicolegal issues, and child and adolescent consultations.

  View details for Web of Science ID 000075014800023

  View details for PubMedID 9691717

• Defense style and family environment CHILD PSYCHIATRY & HUMAN DEVELOPMENT Thienemann, M., Shaw, R. J., Steiner, H. 1998; 28 (3): 189-198

  Abstract

  Prospective observations of the defense styles of normal individuals suggest that the quality of the childhood family environment may influence the maturity of defense styles used in adulthood. In this study, 106 female adolescent psychiatric patients completed the Defense Style Questionnaire, and the Family Environment Scale (FES). Positive family characteristics such as cohesion and expressiveness, as measured by the FES, were correlated with the report of Mature Defenses. Negative family characteristics such as conflict were correlated with the report of Immature Defenses. Similar although weaker correlations were found after controlling for the effects of depression and defensiveness on the self-report measures.

  View details for Web of Science ID 000072516800005

  View details for PubMedID 9540242

• The academy of psychosomatic medicine practice guidelines for psychiatric consultation in the general medical center Psychosomatics Bronheim H, Fulop G, Kunkel E, Muskin P, Schindler B, Yates W, Shaw RJ, Steiner H, Stern TA, Stoudemire A 1998; 39: S8-S30
• Bulimia as a disturbance of narcissism: Self-esteem and the capacity to self-soothe ADDICTIVE BEHAVIORS Steinberg, B. E., Shaw, R. J. 1997; 22 (5): 699-710

  Abstract

  A review of the literature on eating disorders reveals that, although psychodynamic formulations linking narcissistic dynamics--particularly difficulties with self-soothing--and eating disorders are common in the theoretical and clinical literature, little empirical work has attempted to substantiate this claim. In this study, 117 women completed the Eating Disorder Inventory and the Bulimia Test Revised and four scales that measure different components of narcissism (the Multidimensional Self-Esteem Inventory, measuring self-esteem, the Self-Care Questionnaire, and two subscales of the Ego Functioning Assessment Questionnaire, measuring self-soothing). The four scales used to assess narcissism were all highly correlated with each other, indicating that they measure a similar construct. In addition, the eating-disorder measures were correlated with the measures of narcissism, suggesting that a relationship exists between bulimia and narcissism, as assessed using self-report instruments.

  View details for Web of Science ID 000071341900012

  View details for PubMedID 9347071

• Temperament in juvenile eating disorders PSYCHOSOMATICS Shaw, R. J., Steiner, H. 1997; 38 (2): 126-131

  Abstract

  Previous studies have suggested an association between temperament and eating disorder pathology. The purpose of this study was to differentiate on the basis of temperament among patients with anorexia, bulimia, and major depression. In this study, 101 adolescent girls completed the Revised Dimensions of Temperament Survey (Self), a self-report measure that identifies nine dimensions of temperament. Significant differences were found between the diagnostic groups while controlling for disturbances in mood and defensiveness. Specific subscales differentiated the subjects with anorexia from those with bulimia. These data support the concept of using temperament to differentiate patients with related psychiatric syndromes.

  View details for Web of Science ID A1997WL68300006

  View details for PubMedID 9063043

• Recognition of facial expression and emotional prosody in schizophrenia Shaw, R. J., Ringo, D. L., Dong, M., Lim, K. O. ELSEVIER SCIENCE INC. 1996: 268–68

  View details for Web of Science ID A1996UE89300260

• Temperament as a correlate of adolescent defense mechanisms CHILD PSYCHIATRY & HUMAN DEVELOPMENT Shaw, R. J., Ryst, E., Steiner, H. 1996; 27 (2): 105-114

  Abstract

  The Revised Dimensions of Temperament Survey, which assesses nine dimensions of temperament, and the Defense Style Questionnaire, used to assess defense mechanisms, were completed by 107 female adolescents. Temperament was found to be strongly correlated with defense style, particularly with immature defenses (p = 0.0001). The findings support the hypothesis that the biological dimension of temperament is correlated with specific defense mechanisms.

  View details for Web of Science ID A1996VP57900004

  View details for PubMedID 8936796

• A Case of Abulia From Left Middle Cerebral Artery Stroke in an Adolescent Treated Successfully With Short Duration Olanzapine. Clinical neuropharmacology Connor, A. T., Crawford, A. n., Levy, R. J., Schneider, L. M., Hollander, S. A., Shaw, R. J. ; 43 (3): 86–89

  Abstract

  Abulia is defined as a pathological state of amotivation, apathy, and global absence of willpower. It presents with a challenging array of overlapping symptoms, making effective identification and treatment difficult.We describe the first known report of an adolescent with a ventricular assist device who developed abulia following a left middle cerebral artery (MCA) stroke who responded successfully to treatment with olanzapine.The neurobiological etiology of abulia is still unclear but is postulated to be related to deficits in the dopaminergic reward circuitry in the frontal-subcortical-mesolimbic regions. There have been reports of poststroke patients with abulia being treated by modulating this dopamine circuitry and in some cases with short-term low-dose olanzapine.Further research is needed to develop a better understanding of the pathophysiology of abulia leading to more effective treatment algorithms including more specific diagnostic tools and effective pharmacological interventions.

  View details for DOI 10.1097/WNF.0000000000000389

  View details for PubMedID 32384311