Psychiatry Commons^™

Consumer Experience Of Mental Health Services During The Covid-19 Pandemic: Evidence From An Australian Mental Health System, Sarah Kelshaw, Jason Boyd, Irene Gallagher, Grant Sara

Patient Experience Journal

COVID-19 has increased the need for mental health care but disrupted its delivery. We examined impacts of the first year of the COVID-19 pandemic on consumer experience of NSW hospital and community mental health services, compared to their pre-COVID baseline. We also examined whether increased telehealth use was associated with changes in the quantity or experience of community mental health care. Data were 73,488 Your Experience of Service (YES) surveys from state mental health services in New South Wales (NSW), Australia, grouped into three periods: pre-COVID (January 2018 to March 2020), early-COVID (April to June 2020) and stable-COVID (July to …

Evaluating The Use Of Long-Acting Injectables As A Method To Improve Treatment Adherence In Patients With Schizophrenia: A Scoping Review, Britney Michelle Holton Msn, Fnp-Bc, Patricia Rena Jones-Purdy Msn, Cnrn, Margaret Harvey Phd, Aprn, Acnp-Bc, Chfn

Doctor of Nursing Practice Projects

Purpose/Background Medication adherence is a major issue for patients suffering from schizophrenia and medication non-adherence can lead to psychiatric morbidity. Although long-acting injectable (LAI) antipsychotics have been shown to improve treatment adherence, most clinicians continue to rely on oral therapies to manage schizophrenia. This scoping review will assess evidence-based literature to determine the relationship between the use of LAIs and medication adherence in patients with schizophrenia.

Methods A literature review was conducted between August 2020 and January 2021 to find studies that have evaluated medication adherence with the use of long-acting injectables in patients with schizophrenia. Relevant literature initially selected …

Process Improvement To Return Stabilized Behavioral Health Patients To Primary Care, Tessa Woodroof

Epsilon Sigma at-Large Research Conference

Purpose: The purpose of this project is to increase the number of open patient appointments by implementing a validated process in which stabilized behavioral health patients are repatriated to primary care. Currently, there is an increased demand for behavioral health services and decreased supply of behavioral health clinicians at the Nashville Veterans Affairs Medical Center (VAMC).

Aims: This project aims to teach behavioral health providers how to identify appropriate patients and complete successful discharges while helping primary care providers integrate the repatriation process into their workflow. Without the proposed intervention, veterans initiating behavioral health services in the catchment area will …

Suicide Prevention In Bangladesh: The Role Of Family, S M Yasir Arafat, Tamkeen Saleem, Todd M. Edwards, Syeda Ayat-E-Zainab Ali, Murad M. Khan

Department of Psychiatry

Background: Suicide is a public health problem that gets little attention in Bangladesh especially in prevention aspects. Recent studies revealed that a significant portion of risk factors is closely related to family events. However, potential prevention strategies considering the family structure and involving family dynamics of Bangladesh have not been discussed.
Objectives: We aim to highlight areas of family vulnerability and resilience when the threat of suicide is present, as well as the potential roles of family in suicide prevention in Bangladesh.
Methods: We conducted a thorough narrative and focused literature search and synthesized evidence based on available articles discussing …

Erratum To: Teachers’ Views On Preparation For Employment Of Young Autistic People, Biranavan Thavapalan, Emanuele Maria Merlo

Journal of Mind and Medical Sciences

Background. Contemporary literature indicates that there is significant support and assistance provided by schools for young autistic people, with a positive impact on the accessibility of jobs. Nevertheless, the employment rate of autistic people is unacceptably low in the UK. The current study investigated teachers’ views on the preparation for employment of young autistic people in the UK. Methods. Interviews were conducted with individuals from the educational field and thematic analysis was used to explore the teachers’ views regarding the factors that could have an impact on the preparation for employment of young autistic people. Results. Four main themes emerged …

Anxiety Sensitivity, Uncertainty And Recursive Thinking: A Continuum On Cyberchondria Conditions During The Covid Outbreak, Carmela Mento, Maria Catena Silvestri, Pilar Amezaga, Maria Anna Muscatello, Valentina Romeo, Antonio Bruno, Clemente Cedro

Journal of Mind and Medical Sciences

Background. Cyberchondria is a term used to refer to excessive surfing the web looking for health care information, excessive checking behavior being related to health-related anxiety. This period of quarantine for the Covid-19 pandemic is increasing the pathological use of the internet, and the excessive surfing the web looking for health care information. Another dimension related to the Covid-19 outbreak refers to uncertainty intolerance, for this reason being necessary for the healthcare professionals to provide clear and linear information. Aim. The aim of this review is to identify the psychological correlations connected to cyberchondria in the quarantine period. Methods. Following …

The Vespa Project: Virtual Reality Interventions For Neurocognitive And Developmental Disorders, Emanuele Maria Merlo, Liam Alexander Mackenzie Myles, Salvatore Marco Pappalardo

Journal of Mind and Medical Sciences

VESPA is a financed project supported by the Sicilian Regional Research and Development funds, and it is structured by the development, research and validation of Virtual Reality (VR) based application for the diagnosis and treatment of neurocognitive conditions. In particular, this article presents its characteristics, referred to as the first (2013-2015) and second (2021-ongoing) generations of VESPA, with particular reference to literature regarding the VR technology application and development, the VR treatment of neurocognitive conditions and prior versions of this intervention. Through a comprehensive review of the research conducted over the last 5 years, evidence has emerged supporting VESPA’s aim …

Intelligent Malingering In The Setting Of Porphyria Variegata: A Rare Occurrence On Both Fronts, Gersham J. Rainone, Oleg E. Reznik, Mahrukh Majeed, Alina Popa

Transformative Medicine

Malingering can be a difficult diagnosis to discern, especially in patients with well-crafted stories presenting with signs and symptoms that align directly with the literature. This can further become a challenge when a patient is malingering in the setting of a rare disease, where many complaints can be subjective in nature and not entirely testable by physical exam alone. Malingering is responsible for billions of dollars of healthcare waste every single year, and this report can serve as a guide of history elements, signs and symptoms to look out for with patients malingering in the setting of the porphyrias. It …

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 …

Characterization Of Basal Ganglia Volume Changes In The Context Of Hiv And Polysubstance Use, Andrew J Monick, Michelle R Joyce, Natasha Chugh, Jason A Creighton, Owen P Morgan, Eric C Strain, Cherie L Marvel

Department of Medicine Faculty Papers

HIV and psychoactive substances can impact the integrity of the basal ganglia (BG), a neural substrate of cognition, motor control, and reward-seeking behaviors. This study assessed BG gray matter (GM) volume as a function of polysubstance (stimulant and opioid) use and HIV status. We hypothesized that comorbid polysubstance use and HIV seropositivity would alter BG GM volume differently than would polysubstance use or HIV status alone. We collected structural MRI scans, substance use history, and HIV diagnoses. Participants who had HIV (HIV +), a history of polysubstance dependence (POLY +), both, or neither completed assessments for cognition, motor function, and …

Long-Term Safety And Efficacy Of Deutetrabenazine In Younger And Older Patients With Tardive Dyskinesia, Martha Sajatovic

Faculty Scholarship

Objectives: To assess long-term safety and efficacy of deutetrabenazine in younger (<55 years) and older (≥55 years) adult participants with tardive dyskinesia (TD). Design: Three-year, single-arm, open-label extension (OLE) study enrolling participants who completed the 12-week, pivotal ARM-TD or AIM-TD studies. Setting: Seventy-six centers in the United States and Europe. Participants: A total of 337 participants with TD (119 younger and 218 older). Intervention: Deutetrabenazine was initiated at 12 mg/day and titrated once weekly by 6 mg/day using a response-driven dosing regimen until adequate dyskinesia control was reached or a clinically significant adverse event occurred. Measurements: This post hoc analysis assessed change and percent change from baseline in total motor Abnormal Involuntary Movement Scale (AIMS) score, response rates for ≥50% AIMS improvement, Clinical Global Impression of Change (CGIC), Patient Global Impression of Change (PGIC), and safety in younger and older participants with TD. Results: After 3 years of open-label treatment, mean deutetrabenazine dose was ∼39.5 mg/day in both groups. Mean±SE changes from baseline in total motor AIMS score were –6.7 ± 0.62 and –6.5 ± 0.47 in younger and older participants, respectively (percent changes: –61.4% ± 4.10% and –54.6% ± 3.01%); 76% of younger and 62% of older participants achieved ≥50% AIMS response. Most younger and older participants achieved treatment success per CGIC (67% and 76%) and PGIC (64% and 63%). Deutetrabenazine was generally well tolerated in both groups. Conclusions: Deutetrabenazine treatment was associated with sustained improvements in total motor AIMS score, treatment success, and improved quality of life, and was well tolerated in younger and older adults with TD in this 3-year OLE study.

Modifying Group Interpersonal Psychotherapy For Peripartum Adolescents In Sub-Saharan African Context: Reviewing Differential Contextual And Implementation Considerations, Manasi Kumar, Helen Verdeli, Shekhar Saxena, Inge Petersen, Keng Yen Huang, Caleb Othieno, Nancy Grote, Roslyn Law, Jurgen Unutzer, Mary Mckay

Brain and Mind Institute

Background: This study describes adaptation and modification of World Health Organization (WHO) recommended group interpersonal psychotherapy (IPT-G) for depressed peripartum adolescents. The adaptation process includes accommodating contextual factors and strategies to address intervention implementation barriers, such as engagement problems with adolescents, caregivers, and providers, and stigma and dearth of mental health specialists. The modifications include and adolescent relevant iterations to the therapy format and content.

Methods: A multi-stakeholder led two-stage intervention adaptation and modification process integrating mixed qualitative methods were used with pregnant and parenting adolescents, their partners, and health care workers. In-depth interviews focusing on personal, relationship, social, and …

Hallermann-Streiff Syndrome And Psychosis: A Case Report, Tarvis Peacock, Ubaid Khokhar, Jaclyn Murphy, Zach Murphy

HCA Healthcare Journal of Medicine

Hallermann-Streiff syndrome is a rare genetic congenital disorder, with fewer than 200 cases reported to date, that is characterized by brachycephaly with frontal bossing, micrognathia, a “bird-like” beaked nose, microphthalmia with congenital cataracts, dental abnormalities, hypotrichosis, skin atrophy, and short stature. There is limited data on psychosis in individuals with Hallermann-Streiff syndrome; the information available depicts mania rather than psychosis. This case report reviews the presentation and treatment of psychosis in a 32-year-old male with Hallermann-Streiff syndrome who was involuntarily admitted to an inpatient psychiatric unit for persecutory delusions and hallucinations. The patient’s psychosis responded well to risperidone with a …

Treatment Preferences For Pharmacological Versus Psychological Interventions Among Primary Care Providers In Nepal: Mixed Methods Analysis Of A Pilot Cluster Randomized Controlled Trial., Anvita Bhardwaj, Dristy Gurung, Sauharda Rai, Bonnie N Kaiser, Cori L Cafaro, Kathleen J Sikkema, Crick Lund, Nagendra P Luitel, Brandon A. Kohrt

Psychiatry and Behavioral Sciences Faculty Publications

There is increasing evidence supporting the effectiveness of psychological interventions in low- and middle-income countries. However, primary care providers (PCPs) may prefer treating patients with medication. A secondary exploratory analysis of a pilot cluster randomized controlled trial was conducted to evaluate psychological vs. pharmacological treatment preferences among PCPs. Thirty-four health facilities, including 205 PCPs, participated in the study, with PCPs in 17 facilities assigned to a standard version of the mental health Gap Action Programme (mhGAP) training delivered by mental health specialists. PCPs in the other 17 facilities received mhGAP instruction delivered by specialists and people with lived experience of …

Friend Of The Devil: Negative Social Influences Driving Substance Use Disorders, Matthew B. Pomrenze, Franciely Paliarin, Rajani Maiya

School of Medicine Faculty Publications

Substance use disorders in humans have significant social influences, both positive and negative. While prosocial behaviors promote group cooperation and are naturally rewarding, distressing social encounters, such as aggression exhibited by a conspecific, are aversive and can enhance the sensitivity to rewarding substances, promote the acquisition of drug-taking, and reinstate drug-seeking. On the other hand, withdrawal and prolonged abstinence from drugs of abuse can promote social avoidance and suppress social motivation, accentuating drug cravings and facilitating relapse. Understanding how complex social states and experiences modulate drug-seeking behaviors as well as the underlying circuit dynamics, such as those interacting with mesolimbic …

A Novel Treatment Of Postpartum Depression And Review Of Literature., Jennifer Yoon, Jason Gu Md, Katherine B. Martin Md

Department of Psychiatry

Early-onset postpartum depression has been shown to have a unique neurobiological basis compared to major depressive disorder, implying a need for targeted treatments such as the recent Food and Drug Administration (FDA)-approved brexanolone. In this case report, a woman with a past medical history of major depressive disorder was diagnosed with postpartum depression due to worsening mood with suicidal and homicidal ideations. She was treated with vilazodone and aripiprazole with good effect after consideration of her past medication trials. Her regimen is unique in clinical practice and not reported in current literature for the treatment of postpartum depression. It may …

An Interventional Pilot Of Customized Adherence Enhancement Combined With Long-Acting Injectable Antipsychotic Medication (Cae-L) For Poorly Adherent Patients With Chronic Psychotic Disorder In Tanzania, Christopher J. Burant, Carol E. Blixen, Kristin A. Cassidy, Jennifer B. Levin, Martha Sajatovic

Faculty Scholarship

Background: Chronic psychotic disorders (CPD) impose a particularly significant burden in resource-limited settings. Combining long-acting antipsychotic medication (LAI) with a customized adherence enhancement intervention (CAE-L) has potential to advance care. Methods: Nineteen adults ≥ age 18 with CPD who self-reported missing ≥20% of antipsychotic medication within the last month were stabilized on oral haloperidol prior to transitioning to monthly haloperidol decanote for 25 weeks. Outcome evaluations were conducted at baseline and Week 25. Primary outcomes were oral medication adherence assessed via the Tablet Routines Questionnaire (TRQ) and LAI injection frequency. Secondary outcomes included CPD symptoms measured by the Brief Psychiatric …

Directly Observed Weekly Fluoxetine For Major Depressive Disorder Among Hemodialysis Patients: A Single-Arm Feasibility Trial, Kelley M. Kauffman, Jacqueline Dolata, Maria Figueroa, Douglas Gunzler, Anne Huml, Julie Pencak, Martha Sajatovic, Ashwini R. Sehgal

Faculty Scholarship

Rationale & Objective: Major depressive disorder (MDD) is common among hemodialysis patients, but treatment can add to their pill burden and may be limited by nonadherence. We sought to investigate the value of directly observed, once-weekly fluoxetine dosing in MDD. Study Design: Feasibility trial of adult hemodialysis patients with untreated MDD. The diagnosis of MDD was determined using the Mini International Neuropsychiatric Interview. Setting & Participants: 16 patients at 15 hemodialysis facilities in Northeast Ohio. Intervention: Patients were initially prescribed 20 mg of fluoxetine once daily for 2 weeks to assess their tolerance. The patients took this daily fluoxetine unobserved …

Contingency Management: Dealing Abstinence From Methamphetamines, Casey Collins, Amy G Burns, Lindsey Cunningham, Brenda Fairman

View All Washington/Montana GME

Presented at the 2022 Virtual Northwest Medical Research Symposium

Duty To Warn Notifications In Residency Training, Savannah Patterson, Kelly Wurzel

View All Washington/Montana GME

Presented at the 2022 Virtual Northwest Medical Research Symposium

Does Probiotic Supplementation Improve Depression/Anxiety Outcome Measures?, Kathryn M. Decleene

Theses and Graduate Projects

Background: Depression and anxiety continue to be a healthcare burden worldwide. Current depression and anxiety treatments include medications and psychotherapy; however, for many patients this is not enough. Literature has recently come out detailing the gut-brain axis and its potential impact on mental health.

Purpose: This literature review sought to answer the question if probiotics could play a role in the treatment of depression and anxiety. Specifically, does supplementation with a probiotic improve clinical outcome measures of depression, anxiety, or both? Methods: A comprehensive literature review was conducted using PubMed and Google Scholar using the search terms probiotics, …

Lowering Depression Symptoms In Adults: Exploring Nonpharmacologic/Non-Talk Therapy Based Approaches, Alyssa A. Raiolo

Theses and Graduate Projects

Background: Depression has a high prevalence, affecting more than 300 million people worldwide.1 Antidepressants and talk therapy are the current mainstays for treatment. Given the high prevalence of depression, there is value in the research regarding further treatment options.

Purpose: A literature review of studies exploring additional treatment modalities to lower depression symptoms in adults.

Methods: A comprehensive literature review was conducted using with the search terms <(adults) AND (depression, low mood, mental health) AND (pharmacologic, SSRI, SNRI) OR ( physical activity, fitness, exercise), OR (time outdoors, UV exposure, phototherapy) OR (non-talk therapy)>. Inclusion criteria were studies that were published from 2015 to the present. Exclusion criteria were studies not in English.

Conclusions: Aside from the currently recommended approaches to treating …

Can Exercise Be An Alternative Treatment Option For Depression, Walker Rogers

Theses and Graduate Projects

As most people know, exercise has always been beneficial for our overall health. No matter which exercise program it is, they all provide some sort of benefit. A growing problem has been depression as more and more people are being diagnosed. Since normally, most people would be prescribed SSRIs, I wanted to find out if there were alternative options. I sought to determine if exercise can be an alternative treatment option for depression. A comprehensive literature review was conducted using the websites PubMed, NCBI, Science Direct, & Academic Search Premier and using the search terms depression, anxiety, exercise, yoga, resistance …

Implementing A Delirium Precautions Order Set At Osceola Regional Medical Center, Marisa Taddeo, Gabriella Meyerson, Israel Taylor, Monica Arias Garcia, Sonia Dela Cruz, Katrina Kesterson

North Florida Division GME Research Day 2022

No abstract available.

Psychosocial And Mental Health Challenges Faced By Emerging Adults Living With Hiv And Support Systems Aiding Their Positive Coping: A Qualitative Study From The Kenyan Coast, Moses K. Nyongesa, Carophine Nasambu, Rachael Mapenzi, Hans M. Koot, Pim Cuijpers, Charles R. J. C. Newton, Amina Abubakar

Institute for Human Development, East Africa

Background: In sub-Saharan Africa, there is little data on the challenges faced by young people living with HIV tran- sitioning into adult life. Adapting the socio-ecological framework, this qualitative study investigated the challenges faced by emerging adults living with HIV from a rural Kenyan setting. Additionally, the study explored support systems that aid positive coping among these young adults.

Methods: In April 2018, in-depth interviews were conducted with a convenience sample of 22 young adults living with HIV (12 females), 18–24 years old, from rural Kilifi, coast of Kenya. Data were analyzed thematically using NVIVO 11 software.

Results …

Evaluating The Data Of Patient Scales (Phq-9, Bdi, Gad-7) From The Lehigh Valley Health Network Transcranial Magnetic Stimulation (Tms) Program, Courtney Chellew, Eugene Kim, Brett Williamson Msw, Mba

Department of Psychiatry

No abstract provided.

A Case Of Irritable Bowel Syndrome In The Setting Of Generalized Anxiety Disorder, Stephen Driscoll

Capstone Showcase

Irritable Bowel Syndrome (IBS) is a functional gastrointestinal disorder characterized by a relapsing-remitting course of abdominal discomfort and change in stool form and/or frequency in the absence of any structural or biochemical abnormalities. Currently there is debate on its pathogenesis but there is no definitive conclusion. Treatment consists of primarily playing symptomalogic catch-up with anti-spasmodics, anti-diarrheals, stool softeners, or laxatives depending on which symptoms the patient is currently experiencing. Patients with IBS typically struggle to control their symptoms long term, like the patient described in this case study. This case study explores a possible link between IBS and its’ most …

The Effectiveness Of Probiotics In Adults With Depressive Symptoms, Brianna Rees

Capstone Showcase

Introduction: Depression affects over 21 million adults in the United States and continues to rise, affecting more people due to the recent pandemic. Because the prevalence of this debilitating mental health disease is increasing, it is even more crucial to find additional therapeutic treatments to alleviate depressive symptoms in adults whose depression is not controlled on current anti-depressant medication or therapy. Depression has been shown to be linked to the gut-brain axis, meaning gut health is connected to our mental health. Therefore, probiotics may be effective in altering the gut microbiome, and ultimately affecting cognitive patterns in the brain.

Methods: …

Quality Of Life Before And After Cosmetic Surgery: Should Body Dysmorphic Disorder Be Considered An Absolute Or Relative Contraindication For Cosmetic Surgery?, Lindsay Conlisk

Capstone Showcase

Body Dysmorphic Disorder (BDD) has historically been regarded as a strong contraindication for cosmetic plastic surgery. New research now suggests that the contraindications to cosmetic surgery in patients with BDD may not be so absolute. This paper reviews diagnostic criteria, diagnostic challenges, and current standard of treatment of BDD. It then presents the idea of insight analysis in the BDD patient as a significant factor in determining if patients with BDD may or may not benefit from cosmetic surgery or procedures.

Conditions That Mimic Attention Deficit Hyperactivity Disorder In A Pediatric Population: A Diagnostic Guide For Primary Care Providers, Elena Schatell

Capstone Showcase

This article outlines common neurobiological, developmental, psychological, and other medical diagnoses and conditions that symptomatically mimic attention deficit hyperactivity disorder (ADHD) in the pediatric population. Many of these disorders are comorbid with ADHD, but they may also be misdiagnosed as ADHD. Due to the similarity in presentation, these conditions must be included when formulating a differential diagnosis. Accurately diagnosing a child with ADHD requires a thorough evaluation and work up to rule out diagnoses on the differential.