Psychiatry Commons^™

Virtual Behavioral Health Treatment Satisfaction And Outcomes Across Time, Mindy R. Waite, Sara Diab, James Adefisoye

Journal of Patient-Centered Research and Reviews

Purpose: The COVID-19 pandemic continues to have major and long-lasting impacts on health care delivery and mental health. As health care shifted to telehealth, legislation was adjusted to expand telehealth allowances, creating a unique opportunity to elucidate outcomes. The aim of this study was to assess long-term patient and clinician satisfaction and outcomes with virtual behavioral health.

Methods: Data were obtained over 16 months from surveys to patients and clinicians receiving/providing virtual treatment. Outcomes data also were collected from medical records of adults receiving in-person and virtual behavioral health treatment. Data were summarized using descriptive statistics. Groups were compared using …

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 …

Association Between Suicide Rate And Human Development Index, Income, And The Political System In 46 Muslim-Majority Countries: An Ecological Study, S. M. Yasir Arafat, Marthoenis Marthoenis, Murad Khan, Mohsen Rezaeian

Brain and Mind Institute

Very little has been researched assessing the relationship between the suicide rate and the ecological perspectives of the country, especially in the Muslim majority countries. We aimed to determine the association between suicide rate and the ecological parameters of 46 Muslim majority countries. We extracted the Muslim majority countries and their suicide rate, income distribution, distribution of the WHO region and continents, and Human Development Index (HDI). We assessed the correlation of the proportion of Muslim populations, the total population of the countries, number of suicides, continent, income group, political system, and HDI score with the suicide rate. The median …

Inflammation Subtypes In Psychosis And Their Relationships With Genetic Risk For Psychiatric And Cardiometabolic Disorders, Lusi Zhang, Paulo Lizano, Bin Guo, Yanxun Xu, Leah H. Rubin, S. Kristian Hill, Ney Alliey-Rodriguez, Adam M. Lee, Baolin Wu, Sarah K. Keedy

School of Medicine Publications

Cardiometabolic disorders have known inflammatory implications, and peripheral measures of inflammation and cardiometabolic disorders are common in persons with psychotic disorders. Inflammatory signatures are also related to neurobiological and behavioral changes in psychosis. Relationships between systemic inflammation and cardiometabolic genetic risk in persons with psychosis have not been examined. Thirteen peripheral inflammatory markers and genome-wide genotyping were assessed in 122 participants (n = 86 psychosis, n = 36 healthy controls) of European ancestry. Cluster analyses of inflammatory markers classified higher and lower inflammation subgroups. Single-trait genetic risk scores (GRS) were constructed for each participant using previously reported GWAS summary statistics …

Pilot Mental Health Offender Program Improves Participant Outcomes And Lowers Costs In A Large Urban County, Colleen Bell, Mohsin Raza, David Kilcrease, Barbara L. Gracious

HCA Healthcare Journal of Medicine

Introduction

Mass incarceration, particularly of the mentally ill, continues to pervade our criminal justice system. Jails in many areas have become the largest mental health facilities, especially in large urban communities, despite increasing societal recognition that those with mental illness are not best served behind bars. Misdemeanors are an often-overlooked contributor to mass incarceration, and may be preventable for those with chronic severe mental illness.

Methods

This Northeast Florida pilot program, the Mental Health Offenders Program (MHOP), is based on the successful Miami Eleventh Circuit Court Criminal Mental Health Project. MHOP provided pretrial release from custody, through diversion with a …

Real-Time Fmri Neurofeedback And Ptsd: Efficacy In Symptom Relief And Neural Circuit Restoration, Sophia F. Ryker

University Honors Theses

Background: Posttraumatic stress disorder (PTSD) is recognized by the DSM-V as resulting from exposure to a traumatic event and the subsequent, prolonged experience of intrusive symptoms, avoidance behavior, altered cognitive functioning and hyperarousal. Current treatments often do not provide relief from symptoms and there is a need for neuro-scientifically informed interventions.

Methods: Through the review of all available studies using real-time fMRI neurofeedback (rt-fMRI-NF) as a treatment for PTSD, the efficacy of this therapeutic intervention was analyzed in order to make specific recommendations for the neurofeedback protocols of future studies.

Results: Evidence demonstrated successful reduction in symptom severity and normalizing …

Factors Affecting Emergency Department Mental Health Visits, Logan Daul

Honors Thesis

Research has shown that current quantities of emergency department visits for mental health and substance use are increasing at a startling rate. These increases are acknowledged in quantitative studies and some important information can be gathered from qualitative studies however determining specific causes for these emergent visits are difficult. The purpose of this study is to derive findings from statistical analyses focusing on quantities of emergency department visits for mental health and substance use disorders. Comparisons will be drawn at the state level between the per capita quantity of emergency department visits and poverty rate, climate, psychiatric healthcare infrastructure, urban …

Psychological Trauma Alters T-Lymphocyte Inflammation And Redox Through Sympathetic Mechanisms, Safwan K. Elkhatib

Theses & Dissertations

Posttraumatic stress disorder (PTSD) is a devastating psychiatric disorder characterized by distinctive symptom clusters, including intrusive memories (i.e., flashbacks), avoidance of related stimuli, affective changes, and hyperarousal. Strikingly, patients with PTSD face a significantly increased risk for a number of inflammation-driven pathologies, ranging from cardiovascular to autoimmune disease. Yet, the exact etiology of this increased risk remains unknown. The immune system is known to be strongly influenced by the sympathetic nervous system, and sympathetic overactivity is a hallmark of PTSD. Lymphoid organs, such as the spleen, are richly innervated by sympathetic nerve fibers which terminate near adaptive immune …

Integrating Mental Health Into Primary Care, Lori Hopwood, April Schmidt

Doctor of Nursing Practice Projects

BACKGROUND: The purpose of this project was to examine the effects of a newly integrated collaborative mental health care model. The primary goal of the integrated behavioral health program was designed to increase the ability of primary care providers to provide mental health services with the support and expertise of a consulting psychiatrist and behavioral health specialist. Additional goals were to improve access to care and improve mental health outcomes.

AIMS: The aim of this project was to evaluate a new way of integrating mental health services in a rural health, primary care practice in central Illinois.

METHODS: Measures …

Family-Centered Training And Therapy As Substance Abuse Intervention In Adolescents, Ryan St. John, Cam'ron Klotz, Muskaan Bibi, Archana Salek

Rowan-Virtua Research Day

We hypothesized that providing mental health resources for adolescents and educating their parents and families would decrease the prevalence of substance abuse in the Camden, NJ community given that overdose death had risen 138% from 2014-2018. Educating parents and families on the importance of adolescents dealing with mental disorders may help evaluate the mental stability of their child and prevent them from turning to illicit substance to cope. Increasing the communication and the availability of resources for adolescents to turn to before resorting to illicit substances can have beneficial effects.

Treating Trichotillomania With Olanzapine, Christopher Lee

Rowan-Virtua Research Day

Trichotillomania (TTM) is characterized by repetitive pulling of one’s hair leading to hair loss and problems in social, occupational, or other important areas of functioning. Often individuals with TTM try to decrease or stop hair pulling, however are often unsuccessful without treatment. Community prevalence studies suggest that TTM is a common disorder with point prevalence estimate of 0.5% to 2.0% and with significant psychological comorbidity. Of note, people with TTM are often embarrassed about their condition, so epidemiology data may be underestimated compared to the true prevalence of this condition. The female to male ratio for this condition is 4:1. …

An Interesting Case Of Factitious Disorder Superimposed On Self: Factitious Disorder Vs Somatic Symptom Disorder, Michaela Margolis, Logan Noone, Jessica Baaklini

Rowan-Virtua Research Day

Factitious disorder superimposed on self (FDIS) was first described in 1951by Richard Asher, who associated the disorder with Baron Munchhausen, who narrated unrealistic and exaggerated stories about his life.

Suspicion for FDIS should be raised when patients with atypical presentations of medical disorders seek excessive use of healthcare services despite ongoing lack of clinical evidence. Patients with FDIS often demand hospitalization for their symptoms, leading to unnecessary tests and treatments. These patients show signs of pathological lying, deceitfulness, are obstinate with medical staff, and display erratic behavior. When medical investigation does not support their symptoms, patients often develop new “symptoms” …

The Need For Depression And Anxiety Screenings At A Student-Run Clinic, Shayna Peterzell, Sahil Parikh, Alicia Podwojniak, Vibha Chauhan, Riya Tandra, Emily Forester, Saumil Parikh, Jessica-Sophie Horoschak, Patrick Pearce, Roma Padalkar, Sobiah Khan, Tara Pellegrino

Rowan-Virtua Research Day

General anxiety and major depressive disorder are common and treatable mental health disorders. The US Preventive Services Task Force provides strong evidence that early screening helps identify depression in primary care settings, promotes intervention and facilitates treatment. Many medical offices use validated screening tools, GAD-7 and PHQ-9, to measure symptom severities and further help guide treatment modalities for patients with anxiety and depression, respectively. The Rowan Community Health Clinic (RCHC) in Lindenwold, NJ is a student-run free clinic that serves patients regardless of patient gender, race, income, or insurance status. This study aims to determine if there is a need …

A Case Of Diabulimia In A 23-Year-Old Woman With Extensive Comorbidities, Stephen Poos, Kaitlin Mcgowan, Ashaki Martin

Rowan-Virtua Research Day

Diabulimia is defined as intentionally withholding insulin injections for the purpose of weight loss in the setting of type 1 diabetes mellitus (T1D).

It is characterized as an eating disorder (ED), although it does not yet have DSM diagnosis status.

Recognition of the condition among medical professionals is limited but growing.

A Preliminary Report: The Hippocampus And Surrounding Temporal Cortex Of Patients With Schizophrenia Have Impaired Blood-Brain Barrier, Eric L. Goldwaser, Randel L. Swanson, Edgardo J. Arroyo, Venkat Venkataraman, Mary C. Kosciuk, Robert G. Nagele, L. Elliot Hong, Nimish K. Acharya

Rowan-Virtua Research Day

Schizophrenia (SZ) is one of the most severe forms of mental illness, yet mechanisms remain unclear. A widely established brain finding in SZ is hippocampal atrophy, and a coherent explanation similarly is lacking. Epidemiological evidence suggests increased cerebrovascular and cardiovascular complications in SZ independent of lifestyle and medication, pointing to disease-specific pathology. Endothelial cell contributions to blood-brain barrier (BBB) compromise may influence neurovascular unit and peripheral vascular function, and we hypothesize that downstream functional and structural abnormalities may be explained by impaired BBB.

Seizure To Drug Induced Schizophrenia: A Rare Case Of Keppra-Induced Psychosis, Shadi Shams, Riddhima Issar, Nardin El-Shammaa, Munaza Khan

Rowan-Virtua Research Day

Levetiracetam is a broad-spectrum antiseizure medication and is approved as adjunctive therapy to treat focal-onset seizures in children and adults with epilepsy. Levetiracetam has a wide margin of safety and patient-friendly pharmacokinetics that distinguish it from other currently available antiepileptic drugs.

Most common side effects are fatigue, somnolence, dizziness, and upper respiratory infection. Neuropsychiatric symptoms are reported. Psychotic symptoms, paranoid ideation, hallucinations, and behavioral problems may occur in adult and pediatric patients. Among all adverse effects, the rate of psychosis is very low and ranges from less than 1% to 1.4%. A retrospective study showed that this rate is higher …

Effect Of Covid On Postpartum Depression (Ppd), Reshma Thomas, Karen Krieg, Joanna Petrides

Rowan-Virtua Research Day

Purpose:

1. To determine if the rates of postpartum depression have changed during COVID
2. To identify differences in characteristics of women with postpartum depression during COVID

Obsessions In Ocd Mimicking Capgras: A Case Report, Ricky Chu, Alexander Swartz, Helen Yi

Rowan-Virtua Research Day

Obsessive Compulsive Disorder (OCD) is a mentally debilitating condition that can present in a multitude of ways and its manifestations can vary within the diagnosed patient population. OCD can be diagnosed with the presence of either obsessions or compulsions and does not require both. Sometimes, OCD can affect a patient in a way that mimics delusional misidentification syndromes. In these cases, a patient's ego-dystonia can be a key distinguishing feature in diagnosis. In one specific delusional misidentification syndrome, Capgras, a patient possesses fixed beliefs that a known person (or sometimes object) is an imposter. And even though the textbook OCD …

Riluzole For Pediatric Patients With Treatment-Refractory Obsessive-Compulsive Disorder, Maheen Mohammad, Stuti Parikh

Rowan-Virtua Research Day

Obsessive-compulsive disorder (OCD) occurs in about 1-3% of the pediatric population, but many do not respond to standard therapies. Riluzole, a glutamate antagonist, has shown to be an effective treatment for refractory OCD in adults, however few trials have been conducted to show the effectiveness of Riluzole in children to treat refractory OCD. The study investigates the potential use of riluzole in children to treat refractory OCD.

The Impact On Adolescent Mental Health In South Jersey Due To The Cancelation And Return Of Sports, Tara Pellegrino, Tara Young

Rowan-Virtua Research Day

Due to the Covid-19 pandemic, many organized sports programs have been canceled or limited in participation. While research prior to the pandemic has strongly suggested that participation in organized sports has benefits for mental and physical health, especially in adolescence, there have been minimal studies on how the removal of organized sports affects mental health outcomes. Additionally, studies have found that the stress of the pandemic and its associated life changes has greatly decreased mental health outcomes in our target population. These findings may indicate the importance of return to organized sports in a time where mental health outcomes are …

A Case Of Acute Disseminated Encephalomyelitis In An Adult Male With Bipolar Disorder, Jinisha Patwa, Tracey Harris

Rowan-Virtua Research Day

Acute disseminated encephalomyelitis (ADEM) is a rare demyelinating disease characterized by inflammation of the brain and spinal cord. The rapidly progressive inflammation in the central nervous system is known to occur in response to a prior infection or immunization.

The clinical signs of ADEM may manifest up to 60 days post illness or vaccination. Some develop encephalopathy and neurologic symptoms which include confusion, psychosis, and tetraparesis. Paresthesia of the limbs and muscular atrophy indicate a worse prognosis and higher risk of relapse as opposed to those with only CNS involvement. A predominantly psychiatric presentation is also possible.

Risk factors include …

Assessing The Impact Of The Covid-19 Pandemic On Adolescent Mental Health, Vanessa Pizutelli, Yanil Morales, Christina Copeland, Archana Salek

Rowan-Virtua Research Day

Adolescence is a crucial period in which adverse childhood experiences, social relationships, and habits can influence mental wellbeing. According to the CDC, the onset of mental illness is 14.5 years old, which is why it is imperative that individuals with mental health conditions receive early intervention. Since the start of the Covid-19 pandemic, research has shown a dramatic decline in adolescent mental health. Specifically in New Jersey, it has been reported that individuals ages 18-23 have the highest levels of stress and depressive symptoms since the start of the pandemic. In light of these findings, it is vital that more …

Bullous Pemphigoid With Excoriation Disorder In A 59 Year Old Woman, Kaitlin Mcgowan, Stephen Poos, Nguyen Vo

Rowan-Virtua Research Day

Bullous pemphigoid is the most common autoimmune blistering disease. Classic symptoms include blisters overlying urticarial plaques on the torso and extremities. The condition can result in intense pruritus that begins during the prodromal period.

Excoriation disorder is related to obsessive compulsive disorder (OCD) and is characterized by recurrent skin picking that results in lesions, repeated attempts to stop or decrease the picking, and resultant mental distress or impairment in functioning.

We present a case of a 59-year-old Caucasian female who presented with diffuse rash on most of her body. This particular case is notable for its concurrent severe dermatological and …

Long-Term Lithium Use In The Younger Population: Do The Benefits Outweigh The Risks? - A Case Report, Seema Shekar, Alexander Garcia, Rachel Shmuts

Rowan-Virtua Research Day

For decades lithium has been the mainstay treatment for bipolar disorder. While its side effect profile is extensive and varied its most notable adverse effect, and one most feared by treating clinicians, is nephrotoxicity/ end-stage renal disease (ESRD). While the link between long-term lithium use and ESRD has been accepted by the medical community at large for many years, more recent scientific studies call the association into question. In fact, newer studies on the association between Li use and ESRD have shown a negative/inconclusive correlation. Despite this controversy the consensus still remains that ESRD secondary to long-term Li use is …

An Exploration Of Covid-19 Impact On Healthcare Workers’ Mental Health In China, Jenny Yang

Nursing | Senior Theses

Background

In December 2019, the first confirmed human case of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) or COVID-19 occurred in Wuhan, China. By March 2020, the World Health Organization (WHO) had classified the COVID-19 outbreak as a pandemic due to the rapid spread of the virus to other countries. Many people have been affected by the COVID-19 pandemic in various aspects, especially front-line healthcare workers. Hospital working conditions are constantly changing to cope with the problems that arise from the pandemic. These problems can result in an unsafe patient-to-nurse ratio, understaffed healthcare workers in hospitals, equipment shortage, and increased …

An Opportunity For Primary Prevention Research In Psychotic Disorders, Elliot S. Gershon, S. Hong Lee, Xuan Zhou, John A. Sweeney, Carol Tamminga, Godfrey A. Pearlson, Brett A. Clementz, Matcheri S. Keshavan, Ney Alliey-Rodriguez, Matthew Hudgens-Haney

School of Medicine Publications

An opportunity has opened for research into primary prevention of psychotic disorders, based on progress in endophenotypes, genetics, and genomics. Primary prevention requires reliable prediction of susceptibility before any symptoms are present. We studied a battery of measures where published data supports abnormalities of these measurements prior to appearance of initial psychosis symptoms. These neurobiological and behavioral measurements included cognition, eye movement tracking, Event Related Potentials, and polygenic risk scores. They generated an acceptably precise separation of healthy controls from outpatients with a psychotic disorder.

Methods

The Bipolar and Schizophrenia Network on Intermediate Phenotypes (B-SNIP) measured this battery …

Hospital Readmission In Alcohol Use Disorder Patients: The Role Of Anti-Craving Medications And Discharge Disposition, Jordan Calabrese, Jonathon Brown, Mashtura Hasan, Samuel Neuhut, Young Jo

HCA Healthcare Journal of Medicine

Background

Alcohol use disorder (AUD) results in frequent hospital readmissions. Although the literature has shown the efficacy of anti-craving medications (ACM), they are infrequently prescribed upon discharge. The outcomes of discharge to substance use treatment facilities (STF) have also not been fully explored. This study seeks to determine the impact of ACM as well as discharge to STF on readmissions for people with AUD.

Methods

This retrospective case-control study analyzed encounters made within HCA Healthcare hospitals across the United States from 2016 to 2018 for adults with AUD. The case definition was the presence of ACM defined as acamprosate or …

A Mixed-Methods, Cross-Sectional Study Of Perceived Stigma Among Ugandans With Epilepsy, Carol Blixen, Martha Sajatovic

Faculty Scholarship

Background: Epilepsy is associated with stigma and negatively impacts the lives of people living with epilepsy (PLWE) and their immediate families. More understanding of the stigma and discrimination experienced by PLWE in sub-Saharan Africa is needed. Methods: In a cross-sectional, mixed methods study, forty- eight PLWE who met the study inclusion criteria were enrolled. In depth interviews and focus group discussions were conducted and were audiotaped and transcribed verbatim. Analysis was conducted using a thematic, constant comparative approach with an emphasis on dominant themes. Perceived stigma was measured using the Kilifi epilepsy stigma score. Associations between socio-demographic factors and Kilifi …

Determining The Optimal Exercise Intensity Level For Adjunctive Treatment Of Major Depressive Disorder, C James Block

Clinical Research in Practice: The Journal of Team Hippocrates

A clinical decision report using:

Helgadóttir B, Hallgren M, Ekblom Ö, Forsell Y. Training fast or slow? Exercise for depression: A randomized controlled trial. Prev Med. 2016;91:123-131. https://doi.org/10.1016/j.ypmed.2016.08.011

for a patient seeking an exercise regimen to help with depressive symptoms.

Long-Acting Antipsychotic Injectables Vs. Oral Antipsychotics: Comparing Compliance, Relapse, And Re-Hospitalization Rates, Latoria Boyland Bsn, Rn, Kara Darretta Bsn, Rn, Ansley Geno Bsn, Rn, Keevia Porter Dnp, Np-C, Rn

Doctor of Nursing Practice Projects

Purpose/Background Psychosis is a psychiatric disorder characterized by hallucinations and delusions. These symptoms not only negatively impact a patient’s quality of life but can also make treatment compliance difficult. This lack of treatment compliance ultimately leads to higher relapse and re-hospitalization rates among this population. Thus, it is imperative that effective treatments are developed, utilized, and made readily available for patients. Antipsychotics are medications that block dopamine D2 receptors. These medications are used for psychosis to help to improve patient outcomes. Currently, two routes of antipsychotic administration are available, oral antipsychotics or long-acting antipsychotic injections (LAIs). Oral antipsychotic administration requires …