Psychiatry Commons^™

The Psychological Burden Of Nmosd - A Mixed Method Study Of Patients And Caregivers, Darcy C. Esiason, Nicole Ciesinski, Chelsi N. Nurse, Wendy Erler, Tom Hattrich, Ankita Deshpande, C. Virginia O'Hayer

Department of Psychiatry and Human Behavior Faculty Papers

Neuromyelitis optica spectrum disorder (NMOSD) is an inflammatory disorder of the central nervous system with common symptoms of rapid onset of eye pain, loss of vision, neck/back pain, paralysis, bowel and bladder dysfunction and heat sensitivity. The rare, unpredictable, and debilitating nature of NMOSD constitutes a unique psychological burden for patients and their caregivers, the specific nature and extent of which is not yet known. This mixed methods study, informed by both quantitative and qualitative data collected via self-report measures, focus groups, and in-depth interviews, aims to investigate and understand the psychological burden of patients with NMOSD and their caregiver/loved …

Olanzapine Pharmacokinetics: A Clinical Review Of Current Insights And Remaining Questions, Priyanka Kolli, Grace Kelley, Marianela Rosales, Justin Faden, Ryan Serdenes

Department of Psychiatry and Human Behavior Faculty Papers

Olanzapine is one of the most widely used antipsychotics since its initial approval by the US Food and Drug Administration in 1996 and has undergone extensive pharmacokinetic study. Despite being utilized in clinical psychiatry for decades, there remain questions regarding the variety of available formulations, the utility of therapeutic drug monitoring, altered kinetic properties in special populations/medical illnesses, the use of high-dose olanzapine, and drug interactions, among many others. We performed a narrative literature review of olanzapine pharmacokinetics in June 2023 using the US National Library of Medicine's PubMed.gov resource (https://www.ncbi.nlm.nih.gov/pubmed) and Google Scholar. Herein, we review clinically relevant aspects …

Engineering Virtuous Health Habits Using Emotion And Neurocognition: Flexibility For Lifestyle Optimization And Weight Management (Even Flow), Patrick J. Smith, Heather E. Whitson, Rhonda M. Merwin, C. Virginia O'Hayer, Timothy J. Strauman

Department of Psychiatry and Human Behavior Faculty Papers

Interventions to preserve functional independence in older adults are critically needed to optimize 'successful aging' among the large and increasing population of older adults in the United States. For most aging adults, the management of chronic diseases is the most common and impactful risk factor for loss of functional independence. Chronic disease management inherently involves the learning and adaptation of new behaviors, such as adopting or modifying physical activity habits and managing weight. Despite the importance of chronic disease management in older adults, vanishingly few individuals optimally manage their health behavior in the service of chronic disease stabilization to preserve …

Fetal Demise And Wernicke–Korsakoff Syndrome In A Patient With Hyperemesis Gravidarum: A Case Report, Alisa Olmsted, Andrea Desimone, Jahaira Lopez-Pastrana, Madeleine Becker

Department of Psychiatry and Human Behavior Faculty Papers

Background: Wernicke–Korsakoff syndrome is a neuropsychiatric disorder caused by thiamine deficiency composed of two related disorders accounting for an acute presentation and chronic progression. Hyperemesis gravidarum presents a significant risk factor for Wernicke–Korsakoff syndrome as symptoms may rapidly progress in the setting of pregnancy. We present the first-reported case of hyperemesis-gravidarum-associated Wernicke encephalopathy in a patient in the first half of pregnancy in which a missed diagnosis led to septic shock, fetal demise, and eventual profound Korsakoff syndrome.

Case Presentation: We present the case of a 33-year-old primigravid African American woman at 15 weeks gestational age who initially presented at …

The Implementation Of A Required Book Club For Medical Students And Faculty, David B. Ney, Nethra Ankam, Anita Wilson, John Spandorfer

Department of Psychiatry and Human Behavior Faculty Papers

More medical schools are incorporating wellness activities and the medical humanities into their curriculum. Finding implementable programming that is feasible and enjoyable is challenging. Both student participants and faculty who might facilitate programs are busy with clinical and educational responsibilities. Book club discussions in general are an activity that bring people together and expose groups to literature. In medical education, informal books clubs have been shown to increase camaraderie and expose participants to topics in medicine that they may not have encountered without the structure of the group assignment. At one large private urban medical school, all fourth year medical …

Comorbidity Of Novel Crhr2 Gene Variants In Type 2 Diabetes And Depression, Mutaz Amin, Jurg Ott, Derek Gordon, Rongling Wu, Teodor T Postolache, Michael Vergare, Claudia Gragnoli

Department of Psychiatry and Human Behavior Faculty Papers

The corticotropin-releasing hormone receptor 2 (CRHR2) gene encodes CRHR2, contributing to the hypothalamic-pituitary-adrenal stress response and to hyperglycemia and insulin resistance. CRHR2-/- mice are hypersensitive to stress, and the CRHR2 locus has been linked to type 2 diabetes and depression. While CRHR2 variants confer risk for mood disorders, MDD, and type 2 diabetes, they have not been investigated in familial T2D and MDD. In 212 Italian families with type 2 diabetes and depression, we tested 17 CRHR2 single nucleotide polymorphisms (SNPs), using two-point parametric-linkage and linkage-disequilibrium (i.e., association) analysis (models: dominant-complete-penetrance-D1, dominant-incomplete-penetrance-D2, recessive-complete-penetrance-R1, recessive-incomplete-penetrance-R2). We detected novel linkage/linkage-disequilibrium/association …

Parents' Reports Of Children's Physical And Sedentary Behavior Engagement Among Parents In Weight Management, Catherine Van Fossen, Haley Kiser, Callie Lambert Brown, Joseph Skelton, Keeley Jean Pratt

Department of Psychiatry and Human Behavior Faculty Papers

Background: The purpose of this study was to explore the associations between demographics, family exercise participation, family discouragement of exercise, and the children's physical and sedentary behaviors to identify specific areas of physical activity intervention for children with parents engaged in medical weight management (MWM).

Methods: Parents (n = 294) of children aged 2-18 years old were recruited from two university MWM programs to complete a one-time survey. Bivariate analyses tested associations.

Results: Parents reported that sedentary activity was higher for children who identified as racial minorities (t(141) = -2.05, p < 0.05). Mobile phone and tablet use was higher for adolescents compared to school age and young children (H(2) = 10.96, p < 01) Exercise game use was higher for racial minority children compared to white children (U = 9440.5, z = 2.47, p ≤ 0.03). Male children (t(284) = 1.83, p < 0.07), children perceived to have a healthy weight status (t(120) = 4.68, p < 0.00), and younger children (t(289) = 1.79, p < 0.08) all engaged in more strenuous physical activity. Family exercise participation (t(162) = -2.93, p < 0.01) and family discouragement of exercise (U = 7813.50, z = -2.06, p ≤ 0.04) were significantly higher for children in racial minority families.

Conclusions: Future work should determine methods to engage children …

Optimization Of Neurite Tracing And Further Characterization Of Human Monocyte-Derived-Neuronal-Like Cells, Alfredo Bellon, Tuna Hasoglu, Mallory Peterson, Katherine Gao, Michael Chen, Elisabeta Blandin, Alonso Cortez-Resendiz, Gary Clawson, Liyi Elliot Hong

Department of Psychiatry and Human Behavior Faculty Papers

Deficits in neuronal structure are consistently associated with neurodevelopmental illnesses such as autism and schizophrenia. Nonetheless, the inability to access neurons from clinical patients has limited the study of early neurostructural changes directly in patients’ cells. This obstacle has been circumvented by differentiating stem cells into neurons, although the most used methodologies are time consuming. Therefore, we recently developed a relatively rapid (~20 days) protocol for transdifferentiating human circulating monocytes into neuronal-like cells. These monocyte-derived-neuronal-like cells (MDNCs) express several genes and proteins considered neuronal markers, such as MAP-2 and PSD-95. In addition, these cells conduct electrical activity. We have also …

An Innovative Non-Pharmacologic Treatment For Delusional Misidentification In Persons With Major Neurocognitive Disorder, Anne E Adams, Jennifer Rittereiser, Alisha Garcia, Melany Sattler, James M Ellison

Department of Psychiatry and Human Behavior Faculty Papers

Misidentification delusions are false, fixed beliefs that assign an incorrect identity to a previously familiar or unfamiliar person or place. Such delusions are common in several neuropsychiatric disorders and place a particular burden on individuals with Major Neurocognitive Disorder and their caregivers. No standard pharmacologic or non-pharmacologic treatment approaches have been shown to be consistently effective in addressing this problem. We describe two caregiver-care recipient dyads in which an innovative non-pharmacologic, digital intervention reduced delusional misidentification, improved care recipient behavior, and decreased caregiver burden.

The Effect Of Humanitude Care Methodology On Improving Empathy: A Six-Year Longitudinal Study Of Medical Students In Japan., Yusuke Fukuyasu, Hitomi U Kataoka, Miwako Honda, Toshihide Iwase, Hiroko Ogawa, Masaru Sato, Mayu Watanabe, Chikako Fujii, Jun Wada, Jennifer Desantis, Mohammadreza Hojat Professor, Joseph S. Gonnella

Department of Psychiatry and Human Behavior Faculty Papers

BACKGROUND: Empathy, which involves understanding another person's experiences and concerns, is an important component for developing physicians' overall competence. This longitudinal study was designed to test the hypothesis that medical students' empathy can be enhanced and sustained by Humanitude Care Methodology, which focuses on perception, emotion and speech.

METHODS: This six-year longitudinal observational study examined 115 students who entered Okayama University Medical School in 2013. The study participants were exposed to two empathy-enhancing programs: (1) a communication skills training program (involving medical interviews) and (2) a Humanitude training program aimed at enhancing their empathy. They completed the Jefferson Scale of …

The Effectiveness Of The More Than Sad School Based Gatekeeper Training Program, Guy Diamond, Lawrence Ogunkua, Matthew B. Wintersteen, Tita Atte, Perri Rosen, Robert Gallop

Department of Psychiatry and Human Behavior Faculty Papers

Schools have the unique opportunity to identify and refer youth at risk for suicide. School-based gatekeeper training programs aim to improve staff’s ability to talk to students about mental health concerns and refer them for an assessment. Unfortunately, progress in evaluating the available programs has been limited. In fact, the popular and widely used More Than Sad program has received no rigorous evaluation to date. This study sets out to evaluate the effectiveness of the More Than Sad program in a quasi-experimental, wait-list control design with a large number of school personnel, across geographically diverse communities. Fourteen school districts with …

Safety And Efficacy Of Catheter Directed Thrombolysis (Cdt) In Elderly With Pulmonary Embolism (Pe)., Eneida Harrison, Jin Sun Kim, Vladimir Lakhter, Ka U Lio, Rami Alashram, Huaqing Zhao, Rohit Gupta, Maulin Patel, James Harrison, Joseph Panaro, Kerry Mohrien, Riyaz Bashir, Gary Cohen, Gerard Criner, Parth Rali

Department of Psychiatry and Human Behavior Faculty Papers

INTRODUCTION: Acute pulmonary embolism (PE) remains a common cause for morbidity and mortality in patients over 65 years. Given the increased risk of bleeding in the elderly population with the use of systemic thrombolysis, catheter-directed therapy (CDT) is being increasingly used for the treatment of submassive PE. Nevertheless, the safety of CDT in the elderly population is not well studied. We, therefore, aimed to evaluate the safety of CDT in our elderly patients.

METHODS: We conducted a retrospective observational study of consecutive patients aged >65 years with a diagnosis of PE from our Pulmonary Embolism Response Team database. We compared …

12 Tips To Guarantee A Fragmented (Absolutely Terrible) Curriculum In A Time Of Crisis, Constance Tucker, Abigail Kay

Department of Psychiatry and Human Behavior Faculty Papers

Medical education scholarship is filled with articles focused on rigorous curriculum design and innovation. In the midst of a public health crisis, the authors aim to provide a reflective guide to curriculum development focused on curriculum gone wrong. The authors propose twelve recommendations that will bring all educators closer to curricular failure.

Linguistic Analysis Of Empathy In Medical School Admission Essays., Mary Yaden, David Yaden, Anneke Buffone, Johannes Eichstaedt, Patrick Crutchley, Laura Smith, Jonathan Cass, Clara Callahan, Susan Rosenthal, Lyle Ungar, Andrew Schwartz, Mohammadreza Hojat

Department of Psychiatry and Human Behavior Faculty Papers

Objectives: This study aimed to determine whether words used in medical school admissions essays can predict physician empathy.

Methods: A computational form of linguistic analysis was used for the content analysis of medical school admissions essays. Words in medical school admissions essays were computationally grouped into 20 'topics' which were then correlated with scores on the Jefferson Scale of Empathy. The study sample included 1,805 matriculants (between 2008-2015) at a single medical college in the North East of the United States who wrote an admissions essay and completed the Jefferson Scale of Empathy at matriculation.

Results: After correcting for multiple …

Results Of The Adhere Upper Airway Stimulation Registry And Predictors Of Therapy Efficacy., Erica Thaler, Richard Schwab, Joachim Maurer, Ryan Soose, Christopher Larsen, Suzanne Stevens, Damien Stevens, Maurits Boon, Colin Huntley, Karl Doghramji, Tina Waters, Alan Kominsky, Armin Steffen, Eric Kezirian, Benedikt Hofauer, Ulrich Sommer, Kirk Withrow, Kingman Strohl, Clemens Heiser

Department of Psychiatry and Human Behavior Faculty Papers

OBJECTIVE/HYPOTHESIS: The ADHERE Registry is a multicenter prospective observational study following outcomes of upper airway stimulation (UAS) therapy in patients who have failed continuous positive airway pressure therapy for obstructive sleep apnea (OSA). The aim of this registry and purpose of this article were to examine the outcomes of patients receiving UAS for treatment of OSA.

STUDY DESIGN: Cohort Study.

METHODS: Demographic and sleep study data collection occurred at baseline, implantation visit, post-titration (6 months), and final visit (12 months). Patient and physician reported outcomes were also collected. Post hoc univariate and multivariate analysis was used to identify predictors of …

Quetiapine And Wolff-Parkinson-White Syndrome, Michael Chen, Hassaan Gomaa, Alonso Cortez-Resendiz, Christopher Martin, Andrew Francis, Alfredo Bellon

Department of Psychiatry and Human Behavior Faculty Papers

Quetiapine is occasionally associated with cardiovascular adverse effects such as QTc prolongation. QTc prolongation is a side effect that requires monitoring in order to avoid more serious cardiac complications. One particular understudied area is the potential for antipsychotics to elicit electroconduction abnormalities in patients with Wolff-Parkinson-White (WPW) Syndrome. In the present report, we describe a case of quetiapine overdose in a patient with WPW.

Trust And Glycemic Control In Black Patients With Diabetic Retinopathy: A Pilot Study, Barry W. Rovner, Robin J. Casten

Department of Psychiatry and Human Behavior Faculty Papers

Diabetic retinopathy (DR) is more prevalent in blacks than whites because, compared to whites, blacks on average have worse glycemic control. Both of these racial disparities reflect differences in sociocultural determinants of health, including physician mistrust. This randomized, controlled 6-month pilot trial compared the efficacy of a culturally tailored behavioral health/ophthalmologic intervention called Collaborative Care for Depression and Diabetic Retinopathy (CC-DDR) to enhanced usual care (EUC) for improving glycemic control in black patients with DR (n = 33). The mean age of participants was 68 years (SD 6.1 years), 76% were women, and the mean A1C was 8.7% (SD 1.5%). …

Medical Marijuana-Induced Tacrolimus Toxicity., Daniel Moadel, Keira Chism

Department of Psychiatry and Human Behavior Faculty Papers

As both recreational and therapeutic marijuana use increases in the US, more attention is being paid to its direct medical and psychoactive effects. One crucial dimension is the potential for marijuana or marijuana-derived therapies to interact with other prescribed medications. Tacrolimus is an immunosuppressant medication prescribed to prevent rejection in patients receiving solid organ and bone marrow transplants. Clinically, it is characterized by a narrow therapeutic index and multiple drug-drug interactions. Constituents in marijuana are known to inhibit cytochrome P-450 3A, which is normally responsible for metabolizing tacrolimus, leading to the potential for a dangerous interaction. Though this phenomenon has …

Depressive Symptoms In People With Vision Impairment: A Cross-Sectional Study To Identify Who Is Most At Risk, Claire Nollett, Barbara Ryan, Nathan Bray, Catey Bunce, Robin J. Casten, Rhiannon Tudor Edwards, David Gillespie, Daniel J. Smith, Miles Stanford, Tom H. Margrain

Department of Psychiatry and Human Behavior Faculty Papers

Objective To identify the risk factors for significant depressive symptoms in people with visual impairment in England and Wales to provide information on who is most at risk and to whom support services could be targeted in future. Design A cross-sectional study using baseline data from a pragmatic randomised controlled trial. Setting and participants 990 participants aged 18 or over attending 1 of 14 low-vision rehabilitation primary care optometry-based clinics in South Wales or two hospital clinics in London. Outcome measure A score of ≥6 on the Geriatric Depression Scale-15 was classed as clinically significant depressive symptoms. Results In a …

Functional Outcomes Of The Low Vision Depression Prevention Trial In Age-Related Macular Degeneration., Ashley D. Deemer, Robert W. Massof, Barry W. Rovner, Robin J. Casten, Catherine V. Piersol

Department of Psychiatry and Human Behavior Faculty Papers

Purpose: To compare the efficacy of behavioral activation (BA) plus low vision rehabilitation with an occupational therapist (OT-LVR) with supportive therapy (ST) on visual function in patients with age-related macular degeneration (AMD).

Methods: Single-masked, attention-controlled, randomized clinical trial with AMD patients with subsyndromal depressive symptoms (n = 188). All subjects had two outpatient low vision rehabilitation optometry visits, then were randomized to in-home BA + OT-LVR or ST. Behavioral activation is a structured behavioral treatment aiming to increase adaptive behaviors and achieve valued goals. Supportive therapy is a nondirective, psychological treatment that provides emotional support and controls for attention. Functional …

Illness Cognitions And Coping Self-Efficacy In Depression Among Persons With Low Vision., Bonnie A Sturrock, Jing Xie, Edith E Holloway, Mark Hegel, Robin J. Casten, David Mellor, Eva Fenwick, Gwyneth Rees

Department of Psychiatry and Human Behavior Faculty Papers

PURPOSE: To investigate the mediating role of coping self-efficacy (CSE) between two types of illness cognitions (i.e., acceptance and helplessness) and depressive symptoms in persons with low vision.

METHODS: This was a single-group, cross-sectional study. Patients with visual acuity < 6/12 in the better eye and at least minimal depressive symptoms (≥5 on the Patient Health Questionnaire-9 [PHQ-9]) were recruited from vision rehabilitation services and participated in telephone-administered structured interviews at one time point. Measures were the PHQ-9, CSE Scale, and Illness Cognition Questionnaire. Structural equation modeling (SEM) devised the causal flow of illness cognitions and their observed indirect effects on depressive symptoms via the CSE mediators: problem focused, emotion focused, and social support.

RESULTS: The study comprised 163 patients (mean age 62 years; 61% female), most with age-related macular degeneration (26%) and moderate vision impairment (44%, <6/18-6/60). Structural equation modeling indices indicated a perfect fit (χ2 < 0.001, P = 1.00), accounting for 55% of the variance in depressive symptoms. Lower levels of acceptance and higher levels of helplessness illness cognitions were associated with lower self-efficacy in problem-focused coping (β = 0.38, P < 0.001, β = -0.28, P < 0.01, respectively), which in turn was associated with greater depressive symptom severity (β = -0.54, P < 0.001).

CONCLUSIONS: Lack of acceptance and greater helplessness relating to low vision led to a lack of perceived capability to engage in problem-focused coping, which in turn promoted depressive symptoms. Third-wave cognitive-behavioral treatments that focus on acceptance may be …

Pay For Performance And Treatment Outcome, Emily Loscalzo, Psyd, A. Levit, Robert Sterling, Phd, Stephen Weinstein, Phd

Department of Psychiatry and Human Behavior Faculty Papers

Introduction:

Pay for Performance (P4P): Models which offer fiscal incentives to medical and behavioral health providers for meeting specific expectations related to patient care have gained popularity over the last decade as a means of improving quality of care (Bremer et al., 2008). Research by McLellan et al. (2008) has supported the feasibility of implementing such programs and the openness of substance abuse treatment facilities to participating in P4P.

Preserving Cognition In Older African Americans With Mild Cognitive Impairment., Barry W. Rovner, Robin J. Casten

Department of Psychiatry and Human Behavior Faculty Papers

No abstract provided.

Clinical Management Of Insomnia, Karl Doghramji, Paul P. Doghramji

Department of Psychiatry and Human Behavior Faculty Papers

Throughout the book, we are guided by our main goal of providing practitioners with clinically relevant, evidence-based, and state-of-the-art information in the evaluation and management of insomnia. We have made a concerted attempt to ensure that our reviews are consistent with professional guidelines to the extent that current knowledge permits.

Genetic Polymorphisms And Antidepressant Adverse Effects, Rajnish Mago, S. Gupta, Kelly Huhn, R. Shah

Department of Psychiatry and Human Behavior Faculty Papers

Abstract

Background

Aim: to assess whether pharmacogenetic polymorphisms are associated with increased adverse effects or non-response with certain antidepressants whose metabolism is highly dependent on specific CYP450 isoenzymes. This is interim analysis of an ongoing study

Methods

We used a Case Control design comparing patients with major depressive disorder or generalized anxiety disorder who had had increased adverse effects from specified antidepressants (Cases) to patients who were poor responders to an antidepressant but without significant adverse effects (Controls) Genecept Assay™ (battery of pharmacogenetic tests relevant to psychiatry) was obtained using saliva or cheek swab

Results

Importantly, 57.1% of Cases were …

Low Vision Depression Prevention Trial In Age-Related Macular Degeneration: A Randomized Clinical Trial., Barry W. Rovner, Robin J Casten, Mark T Hegel, Robert W Massof, Benjamin E Leiby, Allen C Ho, William S Tasman

Department of Psychiatry and Human Behavior Faculty Papers

PURPOSE: To compare the efficacy of behavior activation (BA) + low vision rehabilitation (LVR) with supportive therapy (ST) + LVR to prevent depressive disorders in patients with age-related macular degeneration (AMD).

DESIGN: Single-masked, attention-controlled, randomized, clinical trial with outcome assessment at 4 months.

PARTICIPANTS: Patients with AMD and subsyndromal depressive symptoms attending retina practices (n = 188).

INTERVENTIONS: Before randomization, all subjects had 2 outpatient LVR visits, and were then randomized to in-home BA+LVR or ST+LVR. Behavior activation is a structured behavioral treatment that aims to increase adaptive behaviors and achieve valued goals. Supportive therapy is a nondirective, psychological treatment …

Who's Your Expert? Use Of An Expert Opinion Survey To Inform Development Of American Psychiatric Association Practice Guidelines., Joel Yager, Robert Kunkle, Laura J. Fochtmann, Sara M. Reid, Robert Plovnick, James E. Nininger, Joel J. Silverman, Michael J. Vergare

Department of Psychiatry and Human Behavior Faculty Papers

OBJECTIVE: For many clinical questions in psychiatry, high-quality evidence is lacking. Credible practice guidelines for such questions depend on transparent, reproducible, and valid methods for assessing expert opinion. The objective of this study was to develop and demonstrate the feasibility of a method for assessing expert opinion to aid in the development of practice guidelines by the American Psychiatric Association (APA).

METHODS: A "snowball" process initially soliciting nominees from three sets of professional leaders was used to identify experts on a guideline topic (psychiatric evaluation). In a Web-based survey, the experts were asked to rate their level of agreement that …

Influence Of The X-Chromosome On Neuroanatomy: Evidence From Turner And Klinefelter Syndromes., David S Hong, Fumiko Hoeft, Matthew J Marzelli, Jean-Francois Lepage, David Roeltgen, Judith L. Ross, Allan L Reiss

Department of Psychiatry and Human Behavior Faculty Papers

Studies of sex effects on neurodevelopment have traditionally focused on animal models investigating hormonal influences on brain anatomy. However, more recent evidence suggests that sex chromosomes may also have direct upstream effects that act independently of hormones. Sex chromosome aneuploidies provide ideal models to examine this framework in humans, including Turner syndrome (TS), where females are missing one X-chromosome (45X), and Klinefelter syndrome (KS), where males have an additional X-chromosome (47XXY). As these disorders essentially represent copy number variants of the sex chromosomes, investigation of brain structure across these disorders allows us to determine whether sex chromosome gene dosage effects …

Sociocultural Influences On Diabetes Self-Management Behaviors In Older African Americans, Barry W. Rovner, Robin J. Casten, Lynn Fields Harris

Department of Psychiatry and Human Behavior Faculty Papers

Objective. The purpose of this observational study was to describe the associations between cultural beliefs that are prevalent in older African Americans and adherence to diabetes self-management (DSM) behaviors.

Methods. In a community population of 110 older African Americans with type 2 diabetes, the investigators administered surveys that assess present time orientation (PTO), future time orientation (FTO), and religiosity, as well as exercising habits, reading food labels, and checking blood glucose.

Results. Participants who reported regularly exercising had significantly lower PTO scores and higher FTO and religiosity scores than participants who did not regularly exercise. Similarly, participants who reported reading …

Improving Function In Age-Related Macular Degeneration: A Randomized Clinical Trial., Barry W. Rovner, Robin J Casten, Mark T Hegel, Robert W Massof, Benjamin E. Leiby, Allen C. Ho, William S. Tasman

Department of Psychiatry and Human Behavior Faculty Papers

PURPOSE: To compare the efficacy of problem-solving therapy (PST) with supportive therapy (ST) to improve targeted vision function (TVF) in age-related macular degeneration (AMD).

DESIGN: Single-masked, attention-controlled, randomized clinical trial with outcome assessments at 3 months (main trial endpoint) and 6 months (maintenance effects).

PARTICIPANTS: Patients with AMD (n = 241) attending retina practices.

INTERVENTIONS: Whereas PST uses a structured problem-solving approach to reduce vision-related task difficulty, ST is a standardized attention-control treatment.

MAIN OUTCOME MEASURES: We assessed TVF, the 25-item National Eye Institute Vision Function Questionnaire plus Supplement (NEI VFQ), the Activities Inventory (AI), and vision-related quality of life …