Medicine and Health Sciences Commons^™

Self-Harm In Female Youth With Undiagnosed Adhd: Implementing American Academy Of Pediatrics Screening Guidelines, Roselie M. Woodard

Dissertations

Attention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder characterized by inattention, hyperactivity, and impulsivity. If undiagnosed or untreated, ADHD can lead to severe psychosocial issues such as academic failure, substance abuse, unplanned pregnancy, and incarceration. The financial burden in the U.S. from diagnostic errors creates an immense, rising fiscal impact. Early diagnosis and management are crucial to prevent these complications.

Females with ADHD, particularly those with the inattentive subtype, often face diagnostic challenges due to symptom masking and over-compensation. This results in poorer cognitive functioning and self-esteem compared to males with ADHD. ADHD is linked to autonomic nervous …

Depression Screening And Education For Immigrants To Increase Access To Care, Viktoriya Ivantsova

Dissertations

Abstract

Problem: Immigrants are at risk for developing mental health disorders due to multiple factors including social, cultural, or economic factors. This can result in a lower quality of life and an increased chance of further disabilities. Although immigrants are at increased risk for the development of mental health disorders, studies show that utilization of available services and resources are low. Additionally, organizations that provide services to immigrants may not be implementing screening and psychoeducation.

Methods: This quality improvement (QI) project followed a descriptive, observational design along with an educational intervention. Using convenience sampling for recruitment, Russian and/or Ukrainian adults …

A Review Of The Role Of Anxiety In Diagnosis Of Children And Adolescents With Autism Spectrum Disorder: A Paradigm Shift In Conceptualization And Diagnosis, Evan Wahlquist

Dissertations

Early evidence of co-occurring anxiety symptoms in children and adolescents with autism spectrum disorder (ASD) dates back to the first descriptions of ASD by Leo Kanner (1943) and Hans Asperger (Frith & Mira, 1992). While current research has identified anxiety disorders as one of the most prevalent co-occurring disorders in children and adolescents with ASD, little is known about the nature of the relationship between these disorders. In an effort to explain these high prevalence rates, recent research has started to investigate the relationship between these two disorders. To join these efforts, this clinical research project explored the role of …

Hippocampal Volume And The Detection Of Mild Cognitive Impairment In An Older Adult Population: Assessing Performance On Cognitive Screeners Administered In-Person And Electronically, Kristen Fabrizi

Dissertations

The present study investigated how performance on in-person and electronic neuropsychological assessment measures predicted subcortical hippocampal volume and cognitive decline consistent with mild cognitive impairment. It was hypothesized that the Montreal Cognitive Assessment would display better predictive strength than the Cogstate Brief Battery when evaluating subcortical hippocampal volume measured via structural magnetic resonance imaging. It was further hypothesized that the Montreal Cognitive Assessment would be more sensitive to predicting group membership to the diagnostic classification of mild cognitive impairment compared to the Cogstate Brief Battery. The sample included 445 older adult participants selected from the Alzheimer’s Disease Neuroimaging Initiative 3. …

Missed And Prior Diagnoses In Children Later Diagnosed With Autism, Maire Diemer

Dissertations

Awareness of autism is rising, yet social determinants of health continue to impact rates, ages of diagnosis, and diagnostic load. Different psychiatric labels carry stigmas; unequal rates of diagnoses may indicate biases in the healthcare system. This study investigates six prior diagnoses (ADHD, disorders of conduct, adjustment, anxiety, mood, and intellectual disability) assigned to children who are later diagnosed with autism. The study investigates how race, sex, and geographic factors were associated with age of diagnosis and diagnostic load. This study utilized a sample of 13,850 children aged 2-10 who were diagnosed with autism on Missouri Medicaid between 2015 and …

Single-Case Pilot Study For Longitudinal Analysis Of Referential Failures And Sentiment In Schizophrenic Speech From Client-Centered Psychotherapy Recordings, Travis A. Musich

Dissertations

Though computational linguistic analyses have revealed the presence of distinctly characteristic language features in schizophrenic disordered speech, the relative stability of these language features in longitudinal samples is still unknown. This longitudinal pilot study analyzed schizophrenic disordered speech data from the archival therapy audio recordings of one patient spanning 23 years. End-to-end Neural Coreference Resolution software was used to analyze transcribed speech data from three therapy sessions to identify ambiguous pronouns, referred to as referential failures, which were reviewed and confirmed by multiple raters. Speech samples were analyzed using Google Cloud Natural Language API software for sentiment variables (i.e., score, …

Lifestyle Choices Related To Food Consumption And Their Relationship To Depression, Steven L. Jennings Jr.

Dissertations

Dieting, or the act of restricting oneself to small amounts or particular kinds of foods on the basis of health, spirituality, lifestyle, and moral decisions, is a practice that dates to 1066 A.D. However, with social media being as influential as it is, one might believe dieting is a new obsession or at least an obsession to which popular culture is returning. Despite this, it is only in recent years that researchers have begun to focus on the health benefits of such behaviors. The present study was designed to take this focus a step further by exploring the potential risks …

Visualizing Depressive Symptom Improvement: Implementing The 17-Item Hamilton Depression Rating Scale, Briana Raterman

Dissertations

Visualizing Depressive Symptom Improvement: Implementing the 17-Item Hamilton Depression Rating Scale

Abstract

Problem

Depression, a mental health diagnosis, has affected about 18.5% of adults (Villarroel & Terlizzi, 2020). Ketamine, a medication initially used as an anesthetic, has improved depressive symptoms in individuals struggling with treatment-resistant depression.

Method

This quality improvement (QI) project used the 17-item Hamilton Depression Rating Scale questionnaire to assess depressive symptom changes in patients receiving intramuscular ketamine for treatment-resistant depression. The questionnaire was administered to patients pre-and post-intramuscular ketamine administration. The data was collected on injections one, three, and six on each participant’s set schedule of injections …

Life Matters, Marina Fischer

Dissertations

Problem: One of the challenges facing many primary care providers is managing hypertension. Hypertension contributes to cardiovascular disease events. Consequently, the high occurrence of hypertension related visits signifies a clinical practice gap in hypertension management resulting in substandard blood pressure outcomes. The purpose of this clinical scholarship project was to assess the difference of pre and post Quality of Life Scale (QOLS) scores in a hypertensive population.

Methods: This quality improvement project used a longitudinal, observational design with prospective data collection. The sample included newly diagnosed hypertensive adults ages 21 to 64 years old. The sample was administered the World …

Mental Health Treatment In Juvenile Correctional Facilities: Utilizing Assessment To Inform Treatment, Sarah Riccio

Dissertations

Youth in juvenile correctional facilities face a wide range of mental health difficulties. Over the years, the juvenile justice system has prioritized the need for providing appropriate and effective treatment services to youth throughout their detainment. Despite these ongoing efforts, treatment practices in juvenile correctional facilities continue to fall short. This study will first focus on assessment practices within these facilities and the impact current practices have on diagnosis and subsequent treatment. Emphasis will be placed on the importance of comprehensive evaluations for informing diagnosis and determining the individual treatment needs of detained youth. An integrated approach to assessment will …

Exploration Of Patient Variables And Characteristics Best Suited For Medical Marijuana Treatment For Anxiety And Depressive Disorders, Corey Gazoo

Dissertations

Individuals with posttraumatic stress, anxiety and depressive disorders are currently being prescribed medical marijuana as a treatment in many states across the United States. However, marijuana is still considered a schedule one narcotic by the Drug Enforcement Administration and federal government, which provides several barriers and challenges to conduct research such as approval from the U.S. Food and Drug Administration and following guidelines from the National Institute on Drug Abuse issued by the DEA. Additionally, individuals prescribed medical marijuana for mental health disorders are not always thoroughly instructed on the type of medical marijuana, the dosage, and how frequently to …

Implementing A Depression Screening In A Pediatric Acute Care Setting For Adolescents With Type 1 Diabetes, Kelcie Marler

Dissertations

Problem: Depression among adolescents with Diabetes Mellitus type 1 (DM 1) is three times more prevalent than adolescents without chronic disease. Diagnosis of depression has been found to negatively affect the quality-of-care management, quality of life, and results in an increase in hospital admissions with hypoglycemia or hyperglycemia events.

Methods: A depression screening, the patient health questionnaire 9 (PHQ-9), a validated screening tool for use among adolescents was implemented in this quality improvement (QI) project. It was the first cycle of a plan-do-study-act (PDSA) cycle for in a pediatric ICU. Adolescents between the ages of 12 – 18, were …

Risk And Protective Factors For Psychological Distress Following A Morally Injurious Event In Combat Veterans, Aaron Keating

Dissertations

Morally injurious events have been shown to increase the likelihood of experiencing anxiety, depressive, and posttraumatic stress symptoms of combat veterans. Research has found that guilt and shame are associated with higher levels of symptomology following morally injurious events. Similarly, individuals who are high in trait proneness to guilt and shame may be at higher risk for developing symptoms following a morally injurious event; however, no research to date has examined this possibility. In addition, acts that go against what one considers morally right bring about cognitive dissonance which then leads to anxiety. In order to reduce anxiety caused by …

Exploration Of Physician Attitudes About Self-Care And Personal Mental Health: Possible Barriers To Physician Well Being, Candich Farrar

Dissertations

The present study was designed to examine physicians’ mental health, attitudes, and behaviors toward self-care and the utilization of mental health services. As the medical field can be very demanding and exhausting, it is believed that many physicians suffer from mental illnesses such as anxiety and depression. However, it was theorized that many physicians do not engage in adequate self-care regimes or seek support and suppress their symptoms, which may further exacerbate their illnesses. A thorough literature review was performed to explore the following: possible barriers to physicians seeking mental health services to address high rates of mental illnesses, physicians …

Improving Access To Mental Health Care With Nurse Practitioners, Jessica Whelan

Dissertations

Problem: Over 40% of those with mental illness are untreated since the supply of psychiatrists does not meet the demand. The psychiatric mental health nurse practitioner (PMHNP) may be an adjunct in providing those services. The purpose of this quality assurance study was to evaluate outcomes of care between a PMHNP and a psychiatrist (medical doctor [MD]).

Methods: An observational, descriptive design with a retrospective medical record review of adult patients over a six-month period in a suburban, Midwestern, privately owned psychiatric practice.

Results: A total of 787 individual patients encountered at least one visit (N=787) although 3,679 …

The Influence Of Stressful Life Events On The Development Of Type 2 Diabetes, Joshua Minks

Dissertations

This study examined the relationship between distress and the development of Type 2 diabetes mellitus (T2DM) in the presence of established risk factors. Distress secondary to mental health disparities, stressful life events, and work conditions has been shown to promote insulin resistance and the development of T2DM.

Subjects (N=79) diagnosed with T2DM within the previous six months were recruited from SSM Health Centers and VA Medical Centers in the greater St. Louis area. They completed the Recent Life Changes Questionnaire, ENRICHD Social Support Instrument, and a demographic survey and analyses were conducted to determine differences between the veteran …

The Predictors Of Juvenile Recidivism: Testimonies Of Adult Students 18 Years And Older Exiting From Alternative Education, La Toshia Palmer

Dissertations

Purpose: The purpose of this descriptive, qualitative study was to identify and describe the importance of the predictors of juvenile recidivism and the effectiveness of efforts to prevent/avoid juvenile recidivism as perceived by previously detained, arrested, convicted, and/or incarcerated adult students 18 years of age and older exiting from alternative education in Northern California. A second purpose was to explore the types of support provided by alternative schools and the perceived importance of the support to avoid recidivism according to adult students 18 years of age and older exiting from alternative education.

Methodology: This qualitative, descriptive research design identified …

Impulsive Choice In Unmedicated And Medicated Children Diagnosed With Adhd: Examining The Variables Of Reward Type And Adhd Subtype, Nicole Henriksen

Dissertations

Developmentally inappropriate and impairing impulsive behaviors are often seen in attention-deficit/hyperactivity disorder (ADHD). One method for objectively assessing impulsivity is the Choice-Delay Task (C-DT) which presents repeated opportunities to choose between a smaller, sooner (SS) or larger, later (LL) reward. A preference for the SS reward that results in less total reward is considered impulsive. Many studies have found that participants diagnosed with ADHD choose the SS reward more than typical controls. However, less is known about the effects of different types of rewards, or the comparative performance of certain subgroups, such as children diagnosed with ADHD Predominantly Inattentive Type …

The Intersection Of Depression, Partner Violence And Poverty During The Perinatal Period, Catherine L. Kothari

Dissertations

Problem: Despite the wealth of research documenting the individual links between maternal depression, partner violence, and poverty, important gaps remain regarding their combined interactions, and their variation related to perinatal timing (pregnancy and postpartum). The current dissertation examined the interplay of these phenomena across perinatality.

Methods: This dissertation utilized secondary analysis of telephone survey data from a representative sample of women recruited during their postpartum hospital stay and interviewed four times over the subsequent 18 months. Linear regression was used for predictive modeling of fixed effects, and generalized estimating equation regression was used for multivariate analysis of temporal trends.

Findings: …

Teaching Language To Children With Developmental Disabilities Using Combined Direct Reinforcement And Stimulus-Stimulus Pairing, Brighid Helene Fronapfel-Sonderegger

Dissertations

Several researchers have used stimulus-stimulus pairing (the pairing of speech sounds with established reinforcers) to increase the frequency of specific vocalizations in children with disabilities. However, only a few addressed the utility of stimulus-stimulus pairing to increase functional language, and none combined stimulus-stimulus pairing and direct reinforcement. The present study combined stimulus-stimulus pairing and direct reinforcement to successfully teach 2 to 10 functional mands in 21–49 7-minute sessions with four children with developmental disabilities with low verbal repertoires. Following mand training, two children were taught 10 tacts for pictures using the combined direct reinforcement and stimulus-stimulus pairing procedure in a …

Refugee Experiences Of Trauma And Ptsd Effects On Psychological, Physical, And Financial Well-Being, Karen J. Cusack

Dissertations

No abstract provided.

Analysis Of Factors Involved In Ratings Of Treatment Acceptability For Trichotillomania, Amy J. Elliott

Dissertations

Based on the literature, trichotillomania (or chronic hair pulling) appears to be responsive to behavioral interventions, with habit reversal as the most promising intervention. Habit reversal has been shown effective with children and adults of varying levels of severity, but some have questioned the generality and acceptability of the procedure. Little is known about the acceptability of interventions for habit disorders. These two research studies were designed to answer questions regarding the acceptability of behavioral and pharmacological interventions for trichotillomania and to expand the conceptual knowledge of treatment acceptability.

Study 1 compared the acceptability of four interventions targeting trichotillomania. The …

Eating-Disorder Patterns In The Minnesota Multiphasic Personaity Inventory, Karen Baer-Barkley

Dissertations

Problem. Early intervention is crucial for effective treatment of eating disorders. While there have recently been many assessment tools developed specifically for eating disorders, a screening tool is still needed. This study sought to identify, in an eating-disordered sample, the existence of a v-shaped pattern on scales 4-5-6 of the MMPI, a commonly used general measure of psychopathology.

Method. The sample consisted of 356 females who were being treated for eating disorders through the HOPE program between 1989 and 1996. Past research on the MMPI has produced equivocal results on identifying significant patterns on the clinical scales. Since prior research …

The Relationship Between Co-Dependence And Borderline Personality Disorder, Helen P. Bird

Dissertations

Problem. Co-dependence (CODC) is described as an "incurable disease" by some practitioners in the addictions treatment business. The CODC concept developed in isolation from mainstream psychology and psychiatry and remains an unverified diagnostic category. It has been compared with Borderline Personality Disorder (BPD) and this relationship was investigated.

Method. Representative samples of the voluminous literature on CODC and BPD were reviewed in an effort to identify commonalities. The characteristics used for comparison were the ones identified by Dr. E. G. Goldstein in Borderline Disorders: Clinical Models & Techniques (1990). Two self-report, anonymous instruments were used; one was completed by clinicians …

Detecting Malingered Psychotic Symptoms With The Rorschach Projective Technique, Kristin M. Batchelder

Dissertations

Problem. Criminal defendants may be strongly motivated to avoid prosecution by appearing mentally ill, and the malingering of psychotic symptoms is of special concern in legal proceedings. Much research has been conducted to determine accurate methods to detect malingering. These include clinical interviews, structured personality tests, intelligence tests, and projective techniques. This present study investigated the ability of specific variables on the Rorschach Projective Technique to detect malingered protocols.

Method. The 83 subjects in this study were restricted to male pre-trial defendants in the Federal Judicial system who were placed into three categories by diagnosis: (1) malingering psychotic symptoms, (2) …

Motivational Effects On A Psychometric Measure Of Prefrontal Brain Functioning In Patients With Chronic Schizophrenia And Related Disorders, Paul C. Smith

Dissertations

This study compared multiple sequential performances on a computerized version of the Wisconsin Card Sorting Test (Grant & Berg, 1948; Harris, 1986) by adult men receiving institutional inpatient treatment for chronic schizophrenia and related disorders. Participants were exposed to differential test conditions of minimal post-session non-contingent token reinforcement (baseline phases) and enhanced intra-session performance-contingent token reinforcement (experimental phase). Each major participant resided at the same continuing treatment unit at Kalamazoo Regional Psychiatric Hospital receiving similar social therapies but idiosyncratic psychotropic medication regimens, changes in which were tracked in relation to test performances. A simple single-subject reversal design was employed with …

The Effects Of Spouse-Based Cognitive-Behavior Therapy On The Treatment Of Agoraphobia, Joan Woods

Dissertations

The purpose of this clinical research was to determine whether spouse-supported treatment of agoraphobia would result in greater improvement on measures of exposure and avoidance than would individual treatment or no treatment. It was hypothesized that Couples Treatment subjects would demonstrate a significantly greater change from pretest to posttest than would Individual Treatment subjects or No-Treatment Control subjects. The study further predicted that significant improvements would be demonstrated for both treated groups on the same outcome measures, pretest to posttest and from pretest to follow-up.

Total N was 10 subjects, all were agoraphobic, married, and female, with 4 in Couples …