Psychiatry Commons^™

Improving Suicide Risk Management In Military Primary Care, John A. Hoyos

Doctor of Nursing Practice Final Manuscripts

Background: In the military, completed suicides and attempt rates have risen across the services since 2001 by 82% per 100,000 in spite of various intervention programs. The literature suggests that absent and inadequate suicide assessments may be part of the problem. Primary care providers are often not prepared for risk assessment and management of suicidal patients.

Aim/Purpose of Project: The project sought to improve the consistency of providers in conducting adequate risk assessments and providing crisis hotline information to patients who were cleared to return home after an encounter, as required by NPSG 15.01.01.

Project Plan Process: This evidenced-based project …

Effect Of A 72 Hour Stroke Care Bundle On Early Outcomes After Acute Stroke: A Non Randomised Controlled Study, Martha Sajatovic, Anthony J. Furlan

Faculty Scholarship

Background Integrated care pathways (ICP) in stroke management are increasingly being implemented to improve outcomes of acute stroke patients. We evaluated the effect of implementing a 72 hour stroke care bundle on early outcomes among patients admitted within seven days post stroke to the national referral hospital in Uganda. Methods In a one year non-randomised controlled study, 127 stroke patients who had ‘usual care’ (control group) were compared to 127 stroke patients who received selected elements from an ICP (intervention group). Patients were consecutively enrolled (controls first, intervention group second) into each group over 5 month periods and followed to …

Facilitating Effective Communication Between First Responders And Older Adults During Fall Incidents: An Educational Intervention, Krystin M. Beeman, Erica L. Berger, Isabel A. Cabezas, Nicole M. Mathews

Dissertations, Masters Theses, Capstones, and Culminating Projects

PURPOSE. The purpose of this project was to provide first responders with communication strategies for older adults that may help when responding to fall- related calls. General information was also provided to First Responders on working with older adults with a focus on the aging process, fall risk factors, and communications strategies.

METHODS. A series of educational sessions to first responders at a local fire district were developed and presented by occupational therapy students. Materials were developed by presenters from evidence-based resources and tailored to the target population. Each presentation focused on statistics about older adults, the aging process, fall …

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.

Single-Session Dialectical Behavior Therapy Skills Training Versus Relaxation Training For Non-Treatment-Engaged Suicidal Adults: A Randomized Controlled Trial, Erin Ward-Ciesielski, Erin Ward-Ciesielski, Connor Jones, Madeline Wielgus, Chelsey Wilks, Marsha Linehan

Psychology Faculty Works

Background: Individuals who are not engaged in treatment are commonly overlooked in the design of intervention trials targeting suicidal populations as a result of recruitment methodology that requires individuals to be referred from their current provider. In fact, research suggests that the majority of individuals who die by suicide have not been in contact with mental health services in the year before their death. Methods/design: A randomized controlled trial of two brief, one-session interventions for adults who are not engaged in mental health treatment. Inclusion criteria include 1) 18 years or older, 2) experiencing suicidal ideation in the past week, …

Multiple Anti-Epileptic Drug Use In Children With Epilepsy In Mulago Hospital, Uganda: A Cross Ectional Study, Martha Sajatovic

Faculty Scholarship

Background: Seizures in up to one third of children with epilepsy may not be controlled by the first anti-epileptic drug (AED). In this study, we describe multiple AED usage in children attending a referral clinic in Uganda, the factors associated with multiple AED use and seizure control in affected patients. Methods: One hundred thirty nine patients attending Mulago hospital paediatric neurology clinic with epilepsy and who had been on AEDs for ≥6months were consecutively enrolled from July to December 2013 to reach the calculated sample size. With consent, the history and physical examination were repeated and the neurophysiologic and imaging …

Molecular Analyses Of Circadian Gene Variants Reveal Sex-Dependent Links Between Depression And Clocks, S-Q Shi, M. J. White, H. M. Borsetti, Julie S. Pendergast, A. Hida, C. M. Ciarleglio, P. A. De Verteuil, A. G. Cadar, C. Cala, D. G. Mcmahon, R. C. Shelton, S. M. Williams, C. H. Johnson

Biology Faculty Publications

An extensive literature links circadian irregularities and/or sleep abnormalities to mood disorders. Despite the strong genetic component underlying many mood disorders, however, previous genetic associations between circadian clock gene variants and major depressive disorder (MDD) have been weak. We applied a combined molecular/functional and genetic association approach to circadian gene polymorphisms in sex-stratified populations of control subjects and case subjects suffering from MDD. This approach identified significant sex-dependent associations of common variants of the circadian clock genes hClock, hPer3 and hNpas2 with major depression and demonstrated functional effects of these polymorphisms on the expression or activity of the hCLOCK …

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.

A Telehealth Behavioral Coaching Intervention For Neurocognitive Disorder Family Carers., Ann Steffen, Judith Gant

Psychology Faculty Works

No abstract provided.

More Illness In Offspring Of Bipolar Patients From The U.S. Compared To Europe., Robert M. Post, Lori L. Altshuler, Ralph Kupka, Susan L. Mcelroy, Mark A. Frye, Michael Rowe, Heinz Grunze, + 4 More

Psychiatry and Behavioral Sciences Faculty Publications

Background

Evidence suggests that patients with bipolar disorder from the United States have an earlier age of onset and a more difficult course of illness than those from Germany and the Netherlands. These characteristics were related to a greater family burden of psychiatric illness and the experience of more psychosocial adversity in childhood. We hypothesized that this greater illness burden would extend to the offspring of the US patients.

Methods

968 outpatients (average age 41) with bipolar illness gave informed consent for participation in a treatment outcome network and filled out a detailed questionnaire about their illness and family history …

A Nursing Approach To Self-Management Education For Individuals With Mental Illness And Diabetes, Edna Fuentes-Casiano, Martha Sajatovic

Faculty Scholarship

Patients with serious mental illness (SMI) and diabetes often seek care in primary care settings and have worse health outcomes than patients who have either illness alone. Individual, provider, and system-level barriers present challenges to addressing both psychiatric and medical comorbidities. This article describes the feasibility, acceptability, and implementation of Targeted Training and Illness Management (TTIM), a self-management intervention delivered by trained nurse educators and peer educators to groups of individuals with SMI and diabetes to improve self-management of both diseases. TTIM is intended to be delivered in a primary care setting. Findings are intended to support the future development …

Factors Affecting Depression Among Married Women Living In Urban Squatter Settlements Of Karachi, Pakistan, Shireen Shehzad, Salima Farooq, Yasmin Parpio, Rozina Karmaliani Professor, Nargis Asad, Iqbal Azam Syed, Omrana Pasha

School of Nursing & Midwifery

Background: Depression is one of the growing public health concerns among women worldwide. This is one of the most under-recognized and under-treated mental illnesses worldwide. Women of developing countries are inexplicably affecting with depression. Purpose: The purpose of study is to assess the prevalence and associative factors of depression among women of aged 20 to 40 years living in urban squatter settlements of Karachi, Pakistan. The identification of all the potential determinants will potentially help in formulating preventive strategies in order to decline the prevalence of depression among women and improve the well being of women.
Methods: An analytical cross-sectional …

Measuring Cognitive Load: Mixed Results From A Handover Simulation For Medical Students., J. Q. Young, D. M. Irby, M.L. Barilla-Labarca, O. Ten Cate, P. S. O'Sullivan

Journal Articles

The application of cognitive load theory to workplace-based activities such as patient handovers is hindered by the absence of a measure of the different load types. This exploratory study tests a method for measuring cognitive load during handovers.The authors developed the Cognitive Load Inventory for Handoffs (CLI4H) with items for intrinsic, extraneous, and germane load. Medical students completed the measure after participating in a simulated handover. Exploratory factor and correlation analyses were performed to collect evidence for validity.Results yielded a two-factor solution for intrinsic and germane load that explained 50 % of the variance. The extraneous load items performed poorly …

Baseline Striatal Functional Connectivity As A Predictor Of Response To Antipsychotic Drug Treatment, D. Sarpal, M. Argyelan, D. G. Robinson, P. R. Szeszko, K. H. Karlsgodt, M. John, N. Weissman, J. A. Gallego, J. M. Kane, T. Lencz, A. K. Malhotra

Journal Articles

OBJECTIVE: Clinical response to antipsychotic drug treatment is highly variable, yet prognostic biomarkers are lacking. The authors recently demonstrated that successful antipsychotic drug treatment alters resting-state functional connectivity of the striatum. The goal of the present study was to test whether intrinsic striatal connectivity patterns provide prognostic information and can serve as a potential biomarker of treatment response to antipsychotic drugs. METHOD: The authors used resting-state functional MRI (fMRI) to develop a prognostic index in a discovery cohort of 41 first-episode schizophrenia patients, then tested this index in an independent cohort of 40 newly hospitalized chronic patients with acute psychosis. …

Burnout-Depression Overlap: A Study Of New Zealand Schoolteachers, Renzo Bianchi, Irvin Sam Schonfeld, Eric Mayor, Eric Laurent

Publications and Research

We examined the overlap of burnout with depression in a sample of 184 New Zealand schoolteachers. Burnout and depressive symptoms were strongly correlated with each other (r = .73; disattenuated correlation: .82) and moderately correlated with dysfunctional attitudes, ruminative responses, and pessimistic attributions. All the participants with high frequencies of burnout symptoms were identified as clinically depressed. Suicidal ideation was reported by 36% of those participants. Three groups of teachers emerged from a two-step cluster analysis: “low burnout-depression,” “medium burnout-depression,” and “high burnout-depression.” The correlation between the affective-cognitive and somatic symptoms of depression was similar in strength to the burnout-depression …

Healthcare Access In Women’S Prisons: An Intersectional Perspective, Megan R. Bray

UROP Posters

This project will be identifying the key factors that contribute to the significant lack of health care in prisons in the U.S., specifically in women’s correctional facilities. I will be lending my focus to disparities in mental health, HIV/AIDs care, reproductive health, trans health, and physical health issues among women who are either currently incarcerated or those who have completed their sentences and are at higher risk for re-entry after attempting re-integration. There is a lack of care, access, and proper treatment for women inmates in U.S. prisons and reform is needed. I foresee the best possible way to accomplish …

Remission Of Psychosis In Treatment-Resistant Schizophrenia Following A Seizure: A Case Report, Hena Jawaid, Sana Younus, Hanif Mesiya

Department of Psychiatry

The authors report a case of treatment-resistant schizophrenia in a 22-year-old woman, who, despite multiple trials of antipsychotics, did not respond to treatment. Clozapine treatment was initiated, but the patient's symptoms did not remit until after she had a clozapine-induced seizure. The authors discuss the importance in considering that electroconvulsive therapy may be effective in reducing positive and negative symptoms in patients suffering from treatment-resistant schizophrenia.

Burnout And Depression: Label-Related Stigma, Help-Seeking, And Syndrome Overlap, Renzo Bianchi, Jay Verkuilen, Romain Brisson, Irvin Sam Schonfeld, Eric Laurent

Publications and Research

We investigated whether burnout and depression differed in terms of public stigma and help-seeking attitudes and behaviors. Secondarily, we examined the overlap of burnout and depressive symptoms. A total of 1046 French schoolteachers responded to an Internet survey in November–December 2015. The survey included measures of public stigma, help-seeking attitudes and behaviors, burnout and depressive symptoms, self-rated health, neuroticism, extraversion, history of anxiety or depressive disorder, social desirability, and sociodemographic variables.The burnout label appeared to be less stigmatizing than the depression label. In either case, however, fewer than 1% of the participants exhibited stigma scores signaling agreement with the proposed …

The Effects Of A Trauma-Informed Care Training Program On Mental Health Professionals Knowledge, Skills, And Attitudes With The Smi, Angelina Pelletier

PCOM Psychology Dissertations

Trauma has been found to be highly prevalent among individuals diagnosed with SMIs. Mental health professionals have been reported to misdiagnose or avoid addressing trauma in this population. There is a need to provide information about trauma and to foster awareness among mental health professionals who are treating individuals diagnosed with SMIs. With a TIC approach, operating from a recovery-oriented philosophy, there have been interventions created to address trauma and SMIs with the aim of developing awareness about trauma and the impact it may have on someone’s life. With these factors in mind, mental health professionals should be competent in …

Initiation And Retention In Couples Outpatient Treatment For Parents With Drug And Alcohol Use Disorders, Abbly L. Braitman, Michelle L. Kelley

Psychology Faculty Publications

The focus of the current study was to identity mental health, relationship factors, substance use related problems, and individual factors as predictors of couples-based substance abuse treatment initiation and attendance. Heterosexual couples with children that met study criteria were invited to attend 12 sessions of outpatient behavioral couples therapy. Men were more likely to initiate treatment if they had a higher income, had greater relationship satisfaction, were initiating treatment for alcohol use disorder only, were younger when they first suspected a problem, and had higher depression but lower hostility or phobic anxiety. Men attended more treatment sessions if they reported …

Determinants Of Activity Levels In African Americans With Mild Cognitive Impairment., Barry W. Rovner, Md, Robin J. Casten, Phd, Benjamin E. Leiby, Phd

Department of Neurology Faculty Papers

Engaging in cognitive, social, and physical activities may prevent cognitive decline. In a sample of older African Americans with mild cognitive impairment (MCI; N=221), we investigated the cross-sectional relationships between activity levels and participants' demographic, clinical, and neuropsychological characteristics. The average age of participants was 75.4 years (SD, 7.0); 177 (80.1%) were women. Participation in cognitive/social activities was positively associated with education, depression, literacy, mobility, instrumental activities of daily living (IADL), verbal learning, and subcomponents of executive function. A linear regression identified IADLs, education, depression, and verbal learning as independent predictors. Participation in physical activities was positively associated with sex, …

Translating Knowledge For Action Against Stroke--Using 5-Minute Videos For Stroke Survivors And Caregivers To Improve Post-Stroke Outcomes: Study Protocol For A Randomized Controlled Trial (Movies4stroke)., Ayeesha Kamran Kamal, Adeel Khoja, Bushra Usmani, Nargis Asad, Asma Ahmed, Iqbal Azam, Sarah Saleem, Saleem Sayani

Department of Medicine

Background: Two thirds of the global mortality of stroke is borne by low and middle income countries (LMICs). Pakistan is the world’s sixth most populous country with a stroke-vulnerable population and is without a single dedicated chronic care center. In order to provide evidence for a viable solution responsive to this health care gap, and leveraging the existing >70 % mobile phone density, we thought it rational to test the effectiveness of a mobile phone-based video intervention of short 5-minute movies to educate and support stroke survivors and their primary caregivers.

Methods: Movies4Stroke will be a randomized control, outcome assessor …

Depression With Pain Co Morbidity Effect On Quality Of Life Among Hiv Positive Patients In Uganda: A Cross Sectional Study, Shirley Moore, Martha Sajatovic

Faculty Scholarship

Background: Depression with pain comorbidity (DPC) has not been clearly defined among HIV positive patients in sub-Saharan Africa. It still remains a challenge despite many studies in Africa documenting a high prevalence of pain and depression among people living with HIV/AIDS. Both are associated with a grave impact on the health related outcomes in this pandemic. This study aimed at determining the prevalence, factors associated and effect on quality of life of DPC among HIV positive patients. Methods: In a cross-sectional survey, 345 HIV positive patients were enrolled into the study. Using a pre-tested standardised questionnaire the presence of DPC …

Knowledge, Attitudes And Perceptions Of Stroke: A Cross-Sectional Survey In Rural And Urban Uganda, Svetlana Pundik, Anthony J. Furlan, Martha Sajatovic

Faculty Scholarship

Background: Information regarding the increasing burden of non-communicable diseases such as stroke is largely unknown among the vulnerable communities. This analysis, which is part of a larger U.S. National Institute of Heath-funded Medical Education Partnership Initiative neurological disorder survey, assessed community knowledge and attitudes on stroke and stroke risk factors. Methods: A population cross-sectional survey was conducted in urban and rural Mukono, district, central Uganda. Through the systematic sampling method, data were gathered from 377 adult participants who were interviewed about selected aspects of stroke knowledge, attitudes and perception using a pretested structured questionnaire. Results: A total of 377 participants …

Asenapine For Bipolar Disorder, Thomas Scheidemantel, Irina Korobkova, Martha Sajatovic

Faculty Scholarship

Asenapine (Saphris®) is an atypical antipsychotic drug which has been approved by the US Food and Drug Administration for the treatment of schizophrenia in adults, as well as the treatment of acute manic or mixed episodes of bipolar I in both adult and pediatric populations. Asenapine is a tetracyclic drug with antidopaminergic and antiserotonergic activity with a unique sublingual route of administration. In this review, we examine and summarize the available literature on the safety, efficacy, and tolerability of asenapine in the treatment of bipolar disorder (BD). Data from randomized, double-blind trials comparing asenapine to placebo or olanzapine in the …

Describing The Prevalence And Awareness Of Sport-Related Concussion In University Intramural And Club Sport Participants, Makenzie L. Brown

Health, Human Performance and Recreation Undergraduate Honors Theses

Background: Concussion injuries are growing in number among athletes across the nation. The majority of concussion research to date focuses on collegiate and high school athletes. University athletes make up a small percentage of the student body population compared to the large number of students that participate in club and intramural sports. These students participate in the same sports, assume the same risks, and may experience the same adverse effects of concussion, often without appropriate medical oversight.

Purpose: The purpose of this study was to determine if concussion is a problem among intramural and club sport participants, if these participants …

Topical Administration Of Psychotropic Medications In Pluronic Lecithin Organogel To Treat Patients With Dementia: A Retrospective Observational Study, Cornelius W. Thomas, Md, Suzanne Holroyd, Md. Chair, Department Of Psychiatry

Marshall Journal of Medicine

OBJECTIVE: Treatment of mood and behavioral symptoms in geriatric patients with advanced dementia may be impeded by poor compliance with oral medications. Pluronic lecithin organogel (PLO) is a compounding substrate that can be used for the topical administration of psychotropic medications.

METHODS: Charts of patients treated with psychotropic medications compounded with PLO cream were reviewed for treatment outcomes. All patients were treated by a nursing home outreach service.

RESULTS: Records from twenty-four patients, mean age 86.8 + 5.9, were reviewed. Common psychiatric symptoms included agitation, aggressive behavior, and depression. Medications most commonly administered as a PLO cream included quetiapine and …

Knowledge And Attitudes Of Parkinson's Disease In Rural And Urban Mukono District, Uganda: A Cross-Sectional, Community-Based Study, Martha Sajatovic

Faculty Scholarship

Background. Parkinson's disease (PD) negatively affects the quality of life. There is limited information on PD published from Africa. Lack of adequate knowledge poses a barrier in the provision of appropriate treatment and care for individuals with PD. Methods. A cross-sectional survey was conducted in urban and rural Mukono district, central Uganda. Through the systematic sampling method, data were gathered from 377 adult participants, interviewed on selected aspects of PD knowledge and attitudes. Results. Of the 377 participants, 47% were from urban settings and 68% (260/377) were women with a median age (IQR) of 34 (26-48) years. Half of the …

Standards Of Evidence For Efficacy, Effectiveness, And Scale-Up Research In Prevention Science: Next Generation., Denise C. Gottfredson, Thomas D. Cook, Frances E.M. Gardner, Deborah Gorman-Smith, George W. Howe, Irwin N. Sandler, Kathryn M. Zafft

Psychiatry and Behavioral Sciences Faculty Publications

A decade ago, the Society of Prevention Research (SPR) endorsed a set of standards for evidence related to research on prevention interventions. These standards (Flay et al., Prevention Science 6:151-175, 2005) were intended in part to increase consistency in reviews of prevention research that often generated disparate lists of effective interventions due to the application of different standards for what was considered to be necessary to demonstrate effectiveness. In 2013, SPR's Board of Directors decided that the field has progressed sufficiently to warrant a review and, if necessary, publication of "the next generation" of standards of evidence. The Board convened …

Early Mortality And Functional Outcome After Acute Stroke In Uganda: Prospective Study With 30 Day Follow-Up, Martha Sajatovic

Faculty Scholarship

Identification of early outcomes post stroke and their predictors is important in stroke management strategies. We prospectively analysed 30-day outcomes (mortality and functional ability) after stroke and their predictors among patients admitted within 7 days post event to a national referral hospital in Uganda. This was a prospective study of acute stroke patients consecutively enrolled between February and July 2014. Social demographics, clinical, laboratory, imaging characteristics, outcomes (all through 30 days), time of death were assessed using standardised questionnaires. Multiple regression was used to analyse the independent influence of factors on outcomes. Of 127 patients, 88 (69.3 %) had ischemic …