Mental and Social Health Commons^™

Understanding Coordinated Specialty Care Best Practice Through Fidelity Practices: A Qualitative Exploration, Halley Read

Doctor of Philosophy in Translational Health Sciences Dissertations

Background: Coordinated Specialty Care (CSC) is a multidisciplinary care model for providing care to youth and young adults having their first episode of psychosis. While outcomes of CSC effectiveness are overwhelmingly positive, and widespread implementation has occurred in all US states and territories, what is CSC best practice regarding components and fidelity to the model is not clear. CSC implementation is well documented from a fidelity to the model standpoint, but the highly variable fidelity practices and versions of the model are not well understood. Nor are the experiences of those who deliver or receive care. Adding to the complexity …

Lifestyle Tools For Men’S Health And Disease Prevention: Well-Being Through Nutrition, Physical Activity, Stress Management, And Connection, Leigh A. Frame

Clinical Research and Leadership Faculty Publications

Mental health is an often-overlooked aspect of overall health and wellness (well-being). Mental illness is increasingly common with 1 in 5 American adults experiencing it annually, and 1 in 20 suffering from a serious mental illness each year [1]. Treatment rates for mental illness are lower in men (37.4%) compared to women (51.2%) [1]. Globally, treatment rates are similar with an estimated cost to the global economy of $1 trillion annually, yet less than 2% of government health expenditure is for mental health worldwide [2]. Despite this, only nine studies have been published specifically targeting men’s mental health through lifestyle …

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 …

Exploring The Role Of Immune Pathways In The Risk And Development Of Depression In Adolescence: Research Protocol Of The Idea-Flame Study., Valeria Mondelli, Annamaria Cattaneo, Naghmeh Nikkheslat, Laila Souza, Annabel Walsh, Zuzanna Zajkowska, Valentina Zonca, Moira Marizzoni, Helen L Fisher, Brandon A. Kohrt, Christian Kieling, Paola Di Meglio

Psychiatry and Behavioral Sciences Faculty Publications

No abstract provided.

Contextualization Of Psychological Treatments For Government Health Systems In Low-Resource Settings: Group Interpersonal Psychotherapy For Caregivers Of Children With Nodding Syndrome In Uganda., Byamah B Mutamba, Brandon A Kohrt, James Okello, Janet Nakigudde, Bernard Opar, Seggane Musisi, William Bazeyo, Joop De Jong

Psychiatry and Behavioral Sciences Faculty Publications

BACKGROUND: Evidence for the effectiveness of psychological treatments in low- and middle-income countries is increasing. However, there is a lack of systematic approaches to guide implementation in government health systems. The objective of this study was to address this gap by employing the Replicating Effective Programs (REP) framework to guide contextualization of a psychological treatment in the Uganda public health system for caregivers of children affected by nodding syndrome, a neuropsychiatric disorder endemic to Sub-Saharan Africa associated with high morbidity and disability.

METHODS: To contextualize a psychological treatment, we followed the four components of the REP framework: pre-conditions, pre-implementation, implementation, …

The Role Of Communities In Mental Health Care In Low- And Middle-Income Countries: A Meta-Review Of Components And Competencies., Brandon A Kohrt, Laura Asher, Anvita Bhardwaj, Mina Fazel, Mark J D Jordans, Byamah B Mutamba, Abhijit Nadkarni, Gloria A Pedersen, Daisy R Singla, Vikram Patel

Psychiatry and Behavioral Sciences Faculty Publications

Abstract

Community-based mental health services are emphasized in the World Health Organization’s Mental Health Action Plan, the World Bank’s Disease Control Priorities, and the Action Plan of the World Psychiatric Association. There is increasing evidence for effectiveness of mental health interventions delivered by non-specialists in community platforms in low- and middle-income countries (LMIC). However, the role of community components has yet to be summarized. Our objective was to map community interventions in LMIC, identify competencies for community-based providers, and highlight research gaps. Using a review-of-reviews strategy, we identified 23 reviews for the narrative synthesis. Motivations to employ community …

Prevalence And Correlates Of Depression And Alcohol Use Disorder Among Adults Attending Primary Health Care Services In Nepal: A Cross Sectional Study., Nagendra P Luitel, Emily C Baron, Brandon A Kohrt, Ivan H Komproe, Mark J D Jordans

Psychiatry and Behavioral Sciences Faculty Publications

BACKGROUND: Although depression and alcohol use disorder (AUD) are expected to be common among patients presenting to primary health care setting, there is limited research on prevalence of depression and AUD among people attending primary health care services in low-income countries. The aim of this study was to assess the prevalence of depression and AUD among adults attending primary care facilities in Nepal and explore factors associated with depression and AUD.

METHODS: We conducted a population-based cross-sectional health facility survey with 1474 adults attending 10 primary healthcare facilities in Chitwan district, Nepal. The prevalence of depression and AUD was assessed …

Perceived Access And Barriers To Care Among Illicit Drug Users And Hazardous Drinkers: Findings From The Seek, Test, Treat, And Retain Data Harmonization Initiative (Sttr)., Mika Matsuzaki, Quan M Vu, Marya Gwadz, Joseph A C Delaney, Irene Kuo, Maria Esther Perez Trejo, William E Cunningham, Chinazo O Cunningham, Katerina Christopoulos

Epidemiology Faculty Publications

BACKGROUND: Illicit drug use (DU) and hazardous drinking (HD) among marginalized populations may be associated with greater barriers to care.

METHODS: We used baseline data on the participants of the Seek, Test, Treat, and Retain data harmonization initiative. DU includes use of any illicit drugs within the past 6 months. HD was defined as scores ≥8 for men and ≥ 7 for women on Alcohol Use Disorders Identification Test within the past 12 months. Social support scores were assigned by summing scores from individual questions related to social support. Two outcomes for multivariable regression models and mediation analysis were perceived …

Canadian Network For Mood And Anxiety Treatments (Canmat) And International Society For Bipolar Disorders (Isbd) 2018 Guidelines For The Management Of Patients With Bipolar Disorder., Lakshmi N Yatham, Sidney H Kennedy, Sagar V Parikh, Ayal Schaffer, David J Bond, Robert M Post, +Several Additional Authors

Psychiatry and Behavioral Sciences Faculty Publications

The Canadian Network for Mood and Anxiety Treatments (CANMAT) previously published treatment guidelines for bipolar disorder in 2005, along with international commentaries and subsequent updates in 2007, 2009, and 2013. The last two updates were published in collaboration with the International Society for Bipolar Disorders (ISBD). These 2018 CANMAT and ISBD Bipolar Treatment Guidelines represent the significant advances in the field since the last full edition was published in 2005, including updates to diagnosis and management as well as new research into pharmacological and psychological treatments. These advances have been translated into clear and easy to use recommendations for first, …

Maternal Mental Health Priorities, Help-Seeking Behaviors, And Resources In Post-Conflict Settings: A Qualitative Study In Eastern Uganda., Wietse A Tol, Breeona Ebrecht, Rebecca Aiyo, Sarah M Murray, Amanda J Nguyen, Brandon A Kohrt, Sheila Ndyanabangi, Stephen Alderman, Seggane Musisi, Juliet Nakku

Psychiatry and Behavioral Sciences Faculty Publications

BACKGROUND: Limited knowledge exists to inform the selection and introduction of locally relevant, feasible, and effective mental health interventions in diverse socio-cultural contexts and health systems. We examined stakeholders' perspectives on mental health-related priorities, help-seeking behaviors, and existing resources to guide the development of a maternal mental health component for integration into non-specialized care in Soroti, eastern Uganda.

METHODS: We employed rapid ethnographic methods (free listing and ranking; semi-structured interviews; key informant interviews and pile sorting) with community health workers (n = 24), primary health workers (n = 26), perinatal women (n = 24), traditional and religious healers (n = …

Reducing Stigma Among Healthcare Providers To Improve Mental Health Services (Reshape): Protocol For A Pilot Cluster Randomized Controlled Trial Of A Stigma Reduction Intervention For Training Primary Healthcare Workers In Nepal., Brandon A Kohrt, Mark J D Jordans, Elizabeth L Turner, Kathleen J Sikkema, Nagendra P Luitel, Sauharda Rai, Daisy R Singla, Jagannath Lamichhane, Crick Lund, Vikram Patel

Psychiatry and Behavioral Sciences Faculty Publications

Background

Non-specialist healthcare providers, including primary and community healthcare workers, in low- and middle-income countries can effectively treat mental illness. However, scaling-up mental health services within existing health systems has been limited by barriers such as stigma against people with mental illness. Therefore, interventions are needed to address attitudes and behaviors among non-specialists. Aimed at addressing this gap, REducing Stigma among HealthcAre Providers to ImprovE mental health services (RESHAPE) is an intervention in which social contact with mental health service users is added to training for non-specialist healthcare workers integrating mental health services …

Interpersonal Violence And Suicidality Among Former Child Soldiers And War-Exposed Civilian Children In Nepal., Anvita Bhardwaj, Christine Bourey, Sauharda Rai, Ramesh Prasad Adhikari, Carol M Worthman, Brandon A Kohrt

Psychiatry and Behavioral Sciences Faculty Publications

Background: Suicide risk reduction is crucial for 15-29-year-old youth, who account for 46% of suicide deaths in low- and middle-income countries. Suicide predictors in high-resource settings, specifically depression, do not adequately predict suicidality in these settings. We explored if interpersonal violence (IPV) was associated with suicidality, independent of depression, in Nepal.

Methods: A longitudinal cohort of child soldiers and matched civilian children, enrolled in 2007 after the People's War in Nepal, were re-interviewed in 2012. The Depression Self-Rating Scale and Composite International Diagnostic Interview assessed depression and suicidality, respectively. Non-verbal response cards were used to capture experiences of sexual and …

Feasibility Study Of A Family- And School-Based Intervention For Child Behavior Problems In Nepal., Ramesh P Adhikari, Nawaraj Upadhaya, Emily N Satinsky, Matthew D Burkey, Brandon A Kohrt, Mark J D Jordans

Psychiatry and Behavioral Sciences Faculty Publications

Background: This study evaluates the feasibility, acceptability, and outcomes of a combined school- and family-based intervention, delivered by psychosocial counselors, for children with behavior problems in rural Nepal.

Methods: Forty-one children participated at baseline. Two students moved to another district, meaning 39 children, ages 6-15, participated at both baseline and follow-up. Pre-post evaluation was used to assess behavioral changes over a 4-month follow-up period (n = 39). The primary outcome measure was the Disruptive Behavior International Scale-Nepal version (DBIS-N). The secondary outcome scales included the Child Functional Impairment Scale and the Eyberg Child Behavior Inventory (ECBI). Twelve key informant interviews …

Protocol For A Feasibility Study Of Group-Based Focused Psychosocial Support To Improve The Psychosocial Well-Being And Functioning Of Adults Affected By Humanitarian Crises In Nepal: Group Problem Management Plus (Pm+), M Sangrawla, E Van Hof, N Luitel, E Turner, K Marahatta, Brandon A. Kohrt

Psychiatry and Behavioral Sciences Faculty Publications

Background

The prevalence of common mental disorders increases in humanitarian emergencies while access to services to address them decreases. Problem Management Plus (PM+) is a brief five-session trans-diagnostic psychological WHO intervention employing empirically supported strategies that can be delivered by non-specialist lay-providers under specialist supervision to adults impaired by distress. Two recent randomized controlled trials in Pakistan and Kenya demonstrated the efficacy of individuallydelivered PM+. To make PM+ more scalable and acceptable in different contexts, it is important to develop a group version as well, with 6–8 participants in session. A study is needed to demonstrate the feasibility and …

Neural Correlates Of Taste Reactivity In Autism Spectrum Disorder., Jason A Avery, John E Ingeholm, Sophie Wohltjen, Meghan Collins, Cameron D Riddell, Stephen J Gotts, Lauren Kenworthy, Gregory L Wallace, W Kyle Simmons, Alex Martin

Psychiatry and Behavioral Sciences Faculty Publications

Selective or 'picky' eating habits are common among those with autism spectrum disorder (ASD). These behaviors are often related to aberrant sensory experience in individuals with ASD, including heightened reactivity to food taste and texture. However, very little is known about the neural mechanisms that underlie taste reactivity in ASD. In the present study, food-related neural responses were evaluated in 21 young adult and adolescent males diagnosed with ASD without intellectual disability, and 21 typically-developing (TD) controls. Taste reactivity was assessed using the Adolescent/Adult Sensory Profile, a clinical self-report measure. Functional magnetic resonance imaging was used to evaluate hemodynamic responses …

Spotlight On Once-Monthly Long-Acting Injectable Aripiprazole And Its Potential As Maintenance Treatment For Bipolar I Disorder In Adult Patients., Vanessa Torres-Llenza, Pooja Lakshmin, Daniel Z Lieberman

Psychiatry and Behavioral Sciences Faculty Publications

The lack of long-term medication adherence is a challenge in the treatment of bipolar disorder, particularly during the maintenance phase when symptoms are less prominent. The rate of nonadherence is ~20%-60% depending on how strict a definition is used. Nonadherence worsens the course of bipolar disorder and can add hundreds of thousands of dollars to the lifetime cost of treating the illness. Long-acting injectable (LAI) medication is an attractive alternative to daily dosing of oral medication, especially among patients who are ambivalent about treatment. The purpose of this paper is to review the evidence for the safety and efficacy of …

A Web Application To Increase Interest In Treatment Among Problem Drinkers, Daniel Z. Lieberman, Sheela Kadekar, Suena W. Huang, Melissa Lausin

Psychiatry and Behavioral Sciences Posters and Presentations

Problem: Access to treatment for substance abuse disorders is limited, and practical strategies are needed to expand opportunities for individuals to receive effective interventions.

Approach: Can an automated, online program reach a hidden population of alcohol abusers who are not served by currently available treatment programs, and increase their interest in treatment?

Comparison Of Alcohol Abusers Who Seek Traditional Treatment Versus Those Who Use An Online Program, Suena Huang, Daniel Z. Lieberman

Psychiatry and Behavioral Sciences Posters and Presentations

Problem: Access to treatment for substance abuse disorders is limited, and practical strategies are needed to expand opportunities for individuals to receive effective interventions.

Approach: Can an automated, online program reach a hidden population of alcohol abusers who are not served by currently available treatment programs?

The majority of individuals with alcohol use disorders do not receive treatment. Practical strategies are needed to expand opportunities for individuals to receive effective interventions. An online program was designed to increase users’ motivation for change, and users of this program were compared to a traditional help-seeking population. Data was collected from 1,297 individuals …

Predicting User Preferences For Educational Content Based On The Results Of An Automated Evaluation For Alcohol Use Problems, Daniel Z. Lieberman, Vilmaris Quinones Cardona, Kenneth Williams

Psychiatry and Behavioral Sciences Posters and Presentations

Computer programs may be more effective than traditional selfhelp manuals because they are interactive, and can automatically modify their content to meet the specific needs of a user. Successfully predicting the type of information that will be most relevant to an individual may lead to greater engagement with the program and better outcomes. The current study tests the association of information obtained during an automated evaluation for alcohol use problems with subsequent preference for educational modules.

Bartenders And Hairdressers As Natural Helpers After The Terrorist Attacks Of September 11, Daniel Z. Lieberman, James Macintyre, Larry S. Wissow, Rebecca A. Powers, David B. Pruitt

Psychiatry and Behavioral Sciences Posters and Presentations

Question: Why were professional mental health services apparently underutilized after 9/11, and did people receive emotional support from alternative sources?

Approach: Bartenders and hairdressers in New York City were surveyed by telephone to evaluate their role as natural community helpers.

Objective: Pathological emotional responses to trauma can paradoxically lead to reluctance to engage in treatment. Some people may feel more comfortable discussing emotional reactions with members of the community, such as bartenders or personal service providers, who are referred to as “natural helpers,” and can serve as de facto care givers. The purpose of this study was to learn more …

Characteristics Of Participants In An On-Line Alcohol Abuse Evaluation Program, Daniel Z. Lieberman

Psychiatry and Behavioral Sciences Posters and Presentations

Access to treatment for substance abuse disorders is limited, and practical strategies are needed to expand opportunities for individuals to receive evidence-based interventions. Automated or semi-automated treatments have shown promise in other disorders. Identifying the characteristics of patients who will be able to benefit from this unconventional approach will increase the likelihood of success. The current study examined 1,297 individuals using an on-line alcohol evaluation program. Subjects had high scores on the AUDIT, and a substantial amount of ambivalence about the possible harm that their drinking caused, but very low levels of identifying themselves as actual problem drinkers.

Improving Detection Of Mental Health Problems In Community Settings In Nepal: Development And Pilot Testing Of The Community Informant Detection Tool, Prasansa Subba, Nagendra P. Luitel, Brandon A. Kohrt, Mark Jordans

Psychiatry and Behavioral Sciences Faculty Publications

Background

Despite increasing efforts to expand availability of mental health services throughout the world, there continues to be limited utilization of these services by persons with mental illness and their families. Community-based detection that facilitates identification and referral of people with mental health problems has been advocated as an effective strategy to increase help-seeking and service utilization. The Community Informant Detection Tool (CIDT) was developed for the community informants to identify people with depression, psychosis, alcohol use problems, epilepsy, and child behavioral problems in community settings. The CIDT has been validated in Nepal and found to be effective in promoting …

A 6-Month Open-Label Extension Study Of Vortioxetine In Pediatric Patients With Depressive Or Anxiety Disorders., Robert L Findling, Adelaide S Robb, Melissa P Delbello, Michael Huss, Nora K Mcnamara, Elias H Sarkis, Russell E Scheffer, Lis H Poulsen, Grace Chen, Ole M Lemming, Philippe Auby

Psychiatry and Behavioral Sciences Faculty Publications

OBJECTIVES: In this 6-month open-label extension (OLE) of NCT01491035 (a 14-day, open-label, pharmacokinetic/safety lead-in study), the long-term safety and tolerability of vortioxetine (5-20 mg/day) were investigated in children and adolescents with a DSM-IV-TR™ diagnosis of depressive or anxiety disorder in the United States or Germany. The study also was designed to provide data to inform dose selection and titration in future pediatric studies with vortioxetine.

METHODS: Safety evaluations included spontaneously reported adverse events (AEs), the Columbia Suicide Severity Rating Scale (C-SSRS), and the Pediatric Adverse Events Rating Scale (PAERS; clinician administered). Clinical effectiveness was determined by Clinical Global Impressions. Comorbid …

The Relationship Between Self-Reported Borderline Personality Features And Prospective Illness Course In Bipolar Disorder., Georg Riemann, Nadine Weisscher, Robert M Post, Lori Altshuler, Susan Mcelroy, Marc A Frye, Paul E Keck, Gabriele S Leverich, Trisha Suppes, Heinz Grunze, Willem A Nolen, Ralph W Kupka

Psychiatry and Behavioral Sciences Faculty Publications

Background

Although bipolar disorder (BD) and borderline personality disorder (BPD) share clinical characteristics and frequently co-occur, their interrelationship is controversial. Especially, the differentiation of rapid cycling BD and BPD can be troublesome. This study investigates the relationship between borderline personality features (BPF) and prospective illness course in patients with BD, and explores the effects of current mood state on self-reported BPF profiles.

Methods

The study included 375 patients who participated in the former Stanley Foundation Bipolar Network. All patients met DSM-IV criteria for bipolar-I disorder (n = 294), bipolar-II disorder (n = 72) or bipolar disorder NOS ( …

Towards A Global Policy Against Alcohol Marketing To Youth: Challenges And Recommendations For Research., Alisa Padon, Rajiv N Rimal

Prevention and Community Health Faculty Publications

No abstract provided.

Cortical Activation During Action Observation, Action Execution, And Interpersonal Synchrony In Adults: A Functional Near-Infrared Spectroscopy (Fnirs) Study, Anjana Bhat, Michael Hoffman, Susanna Trost, Mckenzie Culotta, Jeffrey Eilbott, Daisuke Tsuzuki, Kevin A. Pelphrey

Psychiatry and Behavioral Sciences Faculty Publications

Introduction: Humans engage in Interpersonal Synchrony (IPS) as they synchronize their own actions with that of a social partner over time. When humans engage in imitation/IPS behaviors, multiple regions in the frontal, temporal, and parietal cortices are activated including the putative Mirror Neuron Systems (Iacoboni, 2005; Buxbaum et al., 2014). In the present study, we compared fNIRS-based cortical activation patterns across three conditions of action observation (“Watch” partner), action execution (“Do” on your own), and IPS (move “Together”).

Methods: Fifteen typically developing adults completed a reach and cleanup task with the right arm while cortical activation was …

Barriers And Facilitators To The Integration Of Mental Health Services Into Primary Health Care: A Systematic Review Protocol., Edith K Wakida, Dickens Akena, Elialilia S Okello, Alison Kinengyere, Ronald Kamoga, Arnold Mindra, Celestino Obua, Zohray M Talib

Health Policy and Management Faculty Publications

Background

Mental health is an integral part of health and well-being and yet health systems have not adequately responded to the burden of mental disorders. Integrating mental health services into primary health care (PHC) is the most viable way of closing the treatment gap and ensuring that people get the mental health care they need. PHC was formally adapted by the World Health Organization (WHO), and they have since invested enormous amounts of resources across the globe to ensure that integration of mental health services into PHC works.

Methods

This review will use the SPIDER (Sample, Phenomenon of Interest, Design, …

Reduced Nicotine Content Cigarettes In Smokers Of Low Socioeconomic Status: Study Protocol For A Randomized Control Trial., Nicolle M Krebs, Sophia I Allen, Susan Veldheer, Diane J Martinez, Kimberly Horn, Craig Livelsberger, Jennifer Modesto, Robin Kuprewicz, Ashley Wilhelm, Shari Hrabovsky, Abid Kazi, Alyse Fazzi, Jason Liao, Junjia Zhu, Emily Wasserman, Samantha M Reilly, Lisa Reinhart, Neil Trushin, Robinn E Moyer, Rebecca Bascom, Jonathan Foulds, John P Richie, Joshua E Muscat

Prevention and Community Health Faculty Publications

BACKGROUND:

The Family Smoking Prevention and Tobacco Control Act gave the Food and Drug Administration jurisdiction over the regulation of all tobacco products, including their nicotine content. Under this act, a major strategy to reduce harm from cigarette tobacco is lowering the nicotine content without causing unintended adverse consequences. Initial research on reduced nicotine content (RNC) cigarettes has shown that smokers of these cigarettes gradually decrease their smoking frequency and biomarkers of exposure. The effectiveness of this strategy needs to be demonstrated in different populations whose response to RNC cigarettes might be substantially mediated by personal or environmental factors, such …

Cohort Profile: Seek, Test, Treat And Retain United States Criminal Justice Cohort., Redonna Chandler, Michael S Gordon, Bridget Kruszka, Lauren N Strand, Frederick L Altice, Irene Kuo, +Several Additional Authors

Epidemiology Faculty Publications

BACKGROUND: The STTR treatment cascade provides a framework for research aimed at improving the delivery of services, care and outcomes of PLWH. The development of effective approaches to increase HIV diagnoses and engage PLWH in subsequent steps of the treatment cascade could lead to earlier and sustained ART treatment resulting in viral suppression. There is an unmet need for research applying the treatment cascade to improve outcomes for those with criminal justice involvement.

METHODS: The Seek, Test, Treat, and Retain (STTR) criminal justice (CJ) cohort combines data from 11 studies across the HIV treatment cascade that focused on persons involved …

Universal Connection Through Art: Role Of Mirror Neurons In Art Production And Reception., Bartlomiej Piechowski-Jozwiak, François Boller, Julien Bogousslavsky

Neurology Faculty Publications

Art is defined as expression or application of human creative skill and imagination producing works to be appreciated primarily for their aesthetic value or emotional power. This definition encompasses two very important elements—the creation and reception of art—and by doing so it establishes a link, a dialogue between the artist and spectator. From the evolutionary biological perspective, activities need to have an immediate or remote effect on the population through improving survival, gene selection, and environmental adjustment, and this includes art. It may serve as a universal means of communication bypassing time, cultural, ethnic, and social differences. The neurological mechanisms …