Psychiatry and Psychology Commons^™

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 …

Preferences For Support Resources Among Loved Ones Of Adults Prescribed Opioid Medications, Mansi Patel, Desta M. Pulley, Daniel Manvich

Rowan-Virtua Research Day

The opioid epidemic continues to be a leading cause of overdose and related deaths in America. While most interventions are focused on the individuals with opioid and substance use disorder (OUD/SUD); the impact caregivers and family can have on the treatment of patients with OUD is non-existent. The purpose of this study is to collect pilot data on peers, friends, and family members of patients with SUD/OUD to understand the barriers in psychosocial support and maintaining treatment retention; barriers to accessing medication assisted therapy (MAT) and naloxone; and caregiver fatigue and barriers for caregivers. The collected data will be used …

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 …

Analyzing The Effects Of The Covid-19 Pandemic On Mood Disorders In Patients, Alexa Golub, Joanna Petrides, Meagan Vermeulen

Rowan-Virtua Research Day

The COVID-19 pandemic brought about restrictions on social interactions, altered work settings/job losses, decreased access to groceries and essentials, and more

With strict prevention measures and isolating quarantine experiences, it was anticipated that the lockdown would have psychological effects

Some contributing psychological stressors included duration of quarantine, fear of infection, boredom, lack of supplies, inadequate information, and finances

This study aimed to quantify and evaluate any change in mood disorder diagnoses since the onset of the COVID-19 pandemic

The Brain Scan As Ideograph, Paige Welsh

English (MA) Theses

Medical imaging devices have enabled doctors to render images of the brain without cutting into the body. These images are colloquially called “brain scans.” Through journalism and mass dissemination online, brain scans have become an example of Michael Calvin McGee’s “ideograph,” a language term that subtly takes on outsized political and symbolic meaning to enforce state power. In conversation with theories of new materialism, I situate the brain scan as an ideograph within Jenny Edbauer’s model of rhetorical ecologies. The rhetorical force of the brain scan comes out of a collision between René Descarte’s mind/body dualism, the medical model of …

Parental Stress In Tuberous Sclerosis Complex, Jenny Do

Dissertations and Theses (Open Access)

Tuberous Sclerosis Complex (TSC) is a multi-systemic genetic disorder with great clinical variability. As the needs of one child with TSC may vastly differ from another, parenting demands may similarly differ. Characterizing parental stress, or emotional maladaptation arising from parenting duties, can enable healthcare providers to assist parents of children most efficiently with TSC-related symptoms and improve both parent and child health outcomes. This study surveyed 269 parents of children (aged 0-12 years) with TSC and received the following information: children’s TSC clinical features, parent demographics, and a Parent Stress Index (PSI) score. Parents reported higher stress levels for children …

The Effects Of The Transition From Pre-Nursing To Nursing On Mental Health, Andrew J. Davis, Paige R. Mullins, Kimberly A. Sell

Undergraduate Honors Theses

Mental health is an ever-growing crisis among adolescents and young adults, with suicide as second leading cause of death and the number of those negatively affected continually on the rise. Transitions are one of the major stressors prevalent among these age groups, placing individuals at risk for mental health deficits. This quantitative voluntary response comparative study assesses the transitional mental health of pre-nursing students and students in the nursing program at East Tennessee State University. Emailed to all with a declared major of pre-nursing or nursing, this study measured mental health using evidenced based assessment tools. The PHQ-9 for depression …

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 …

The Feasibility And Utility Of Harnessing Digital Health To Understand Clinical Trajectories In Medication Treatment For Opioid Use Disorder: D-Tect Study Design And Methodological Considerations, Lisa A. Marsch, Ching-Hua Chen, Sara R. Adams, Asma Asyyed, Monique B. Does, Saeed Hassanpour, Emily Hichborn, Melanie Jackson-Morris, Nicholas C. Jacobson, Heather K. Jones, David Kotz, Chantal A. Lambert-Harris, Zhiguo Li, Bethany Mcleman, Varun Mishra, Catherine Stanger, Geetha Subramaniam, Weiyi Wu, Cynthia I. Campbell

Dartmouth Scholarship

Introduction: Across the U.S., the prevalence of opioid use disorder (OUD) and the rates of opioid overdoses have risen precipitously in recent years. Several effective medications for OUD (MOUD) exist and have been shown to be life-saving. A large volume of research has identified a confluence of factors that predict attrition and continued substance use during substance use disorder treatment. However, much of this literature has examined a small set of potential moderators or mediators of outcomes in MOUD treatment and may lead to over-simplified accounts of treatment non-adherence. Digital health methodologies offer great promise for capturing intensive, longitudinal ecologically-valid …

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 …

An Exploration Of Psychological Trauma And Positive Adaptation In Adults With Congenital Heart Disease During The Covid-19 Pandemic, Liza Morton Dr, Calum Calderwood, Nicola Cogan, Claire Murphy, Evan Nix, Jacek Kolacz Dr

Patient Experience Journal

The growing population of adults with congenital heart disease (CHD) often have lifelong experience of dealing with potentially traumatic health crises and medical uncertainty whilst facing increased vulnerability to post-traumatic stress disorder (PTSD). The COVID-19 pandemic presents additional challenges for this population including increased risk of health complications, shielding and strict social distancing, changes to medical care provision and social stigma. Despite such challenges, adults with CHD have the potential to also experience positive changes, yet little is known as to what helps cultivate positive adaptation and post-traumatic growth (PTG) within this context. The current study comprised a cross-sectional, anonymous, …

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 …

Running Head: Ses, Food Literacy And Security, And Eating Disorders, Kendra Rigney

Masters Theses & Specialist Projects

Eating disorders have one of the highest mortality rates among all mental health conditions in terms of suicide rate and overall mortality rate, with college students reporting higher rates than the general population (Arcelus et al., 2011; Badrasawi & Zidan, 2019; Eisenberg et al., 2013; Perryman et al., 2018). The current literature has shown a relationship between binge-eating and bulimia symptoms and socioeconomic status, food literacy, and food security (Becker et al., 2017; Darling et al., 2017; Ferreira et al., 2021; Knesebeck et al., 2012; Rogers et al., 1997). The goal of the current study was to examine how perceived …

The Impact Of Outcomes On Depression Literacy In School-Age Children Who Received Depression Education, Loretta Q. Smith Aprn, Pnp-Bc, Bobby Bellflower Dnsc, Nnp-Bc, Faanp

Doctor of Nursing Practice Projects

Purpose/Background Recognizing mental illness is crucial in adolescence. It is the second leading cause of suicide and death in children 10-19 years of age. Early identification and recognition of signs and symptoms could prevent progressive mental health illness in early childhood and adulthood. We are seeking to answer the PICO question: In adolescents between 10 and 19 years of age who are enrolled in school (P), how does receiving education on depression awareness (I) compared to not receiving education on depression awareness (C) affect depression scores (O)?

Methods This review was conducted on articles about adolescent children. These articles were …

Boarding Barriers For Psychiatric Patients In Emergency Departments, Emmeline B. Martin Bsn, Rn, Alison Rossano Bsn, Rn, Diana Dedmon Dnp, Aprn, Fnp-Bc

Doctor of Nursing Practice Projects

Objective To identify past or current literature about emergency department holds and psychiatric patients consisting of the evaluation of patient outcomes, satisfaction and equity of care. It is already known that shorter boarding times from the emergency department to a psychiatric unit have positive patient outcomes such as a decrease in readmissions, increase in patient satisfaction and efficiency in appropriate treatment.

Method A scoping review to analyze data by grouping articles into themes which included authors, date of publication, aims/purpose, methodology, sample, interventional details, and the key findings in each article. Excluded articles included those discussing COVID-19 and case management. …

Impact Of Ante- And Postnatal Depression Screening In Women With Hiv: A Scoping Review, Kimberly M. Grider Bsn, Rn, Pmh-Bc, Bao Chau Le Bsn, Rn, Blessing Okon Bsn, Rn, Diana Dedmon Dnp, Aprn, Fnp-Bc

Doctor of Nursing Practice Projects

Purpose/Background Maternal depression has been identified as a strong predictor of poor prenatal care. Among pregnant women living with Human Immunodeficiency Virus (HIV), mental health-related factors such as depression could potentially undermine effective antiretroviral therapy (ART) adherence, increase mortality, and cause poor HIV viral suppression consequently impacting vertical transmission of HIV. This scoping review aims to identify existing knowledge regarding the impact of ante- and postnatal depression screening in women with HIV and to adduce the necessity for effective screening.

Methods A literature search was performed for studies with primary outcomes of depression screening within the context of ante- or …

Adolescent Mothers And Kangaroo Mother Care: A Scoping Review, Genna K. Rivers, Robin B. Dail Phd, Rn, Faan, Robin Dawson Phd, Rn, Cpnp-Pc

Senior Theses

Kangaroo mother care (KMC), the practice in which mothers hold their infants skin-to-skin against their bare chest, can increase bonding and attachment between mothers and their infants. However, there is not much research on the benefits of KMC within the adolescent or teen mother population (13-19 years old). The purpose of this scoping review was to identify how common KMC is within the teen mother population, determine how KMC varies based on social determinants of health and race/ethnicity within the adolescent mother population, and how KMC impacts adolescent mothers’ maternal attachment and bonding with their infants. PubMed and CINAHL databases …

Supportive Neighborhoods, Family Resilience And Flourishing In Childhood And Adolescence, Sheila Barnhart, Molly R. Bode, Michael C. Gearhart, Kathryn Maguire-Jack

Social Work Faculty Publications

Flourishing is linked with health and well-being in childhood and adulthood. This study applied a promotive factors model to examine how neighborhood assets might benefit child and adolescent flourishing by promoting family resilience. Using data from the combined 2018 and 2019 National Survey of Children’s Health, structural equation models tested direct and indirect relationships between neighborhood physical environment, neighborhood social cohesion, family resilience, and flourishing among 18,396 children and 24,817 adolescents. After controlling for multiple covariates that may influence flourishing, the models supported that higher levels of neighborhood social cohesion were directly associated with higher levels of flourishing adolescents, and …

Nbome Toxicity And Fatalities: A Review Of The Literature, Matthew Lipow, Syed Zane Kaleem, Eduardo Espiridion

Transformative Medicine

In the decade since the introduction of the novel synthetic hallucinogen NBOMe into the consumer market, this drug has become an increasingly prevalent, yet poorly understood cause of altered mental status (AMS) resulting in hospitalization.

In this literature review, we conducted a PubMed query for mentions of NBOMe ingestion since Suzuki et al.’s publication of their 2015 review. Among English language publications published between October 2014 and June 8, 2021, were sixteen case reports and six case series detailing a total of 42 cases of NBOMe toxicity.

Notably, 26 (62%) patients experienced tachycardia, 22 (52%) had hypertension, 34 (81%) experienced …

Alzheimer's And Patient Caregiver Burnout: A Review Of The Literature, Madeline Hekeler

James Madison Undergraduate Research Journal (JMURJ)

The term “silent epidemic” is fitting for Alzheimer’s disease (AD), as its negative impact is widely felt but rarely discussed. Burnout among AD caregivers has become an epidemic of its own as caregivers experience an increase in health risks, stress, and financial burden. This literature review focuses on caregiver burnout and how imperative it is that caregivers are better supported in their role. Researchers have developed instruments to assess and intervene in caregiver burnout that have shown effectiveness among caregivers and their families.Nevertheless, further longitudinal research is warranted regarding more effective interventions, including stress management and social support mechanisms.

Development And Management Of Depression During And After Pregnancy, Alexa Bouts, Maria Patnella, Jourdan Ujlaki, Emily Wells, Hannah Lamb, Michelle Musser

Pharmacy and Wellness Review

Depression during pregnancy is common, whether it is a new onset of the disease or emerging symptoms of the already existent disease. Due to patient and prescriber concerns with antidepressant use during pregnancy, approximately three-quarters of those diagnosed with depression remain untreated. Furthermore, up to half of pregnant women with depression remain undiagnosed due to lack of recognition. As a result, both mother and fetus are at risk for negative health outcomes including substance abuse, functional impairment, increased risk of postnatal depression and poor pregnancy outcomes. Benefits must be balanced against the risks when considering pharmacologic treatment options to manage …

Intergenerational Risk And Resilience Pathways From Discrimination And Acculturative Stress To Infant Mental Health, Sabrina R. Liu, Curt A. Sandman, Elyssia Poggi Davis, Laura M. Glynn

Psychology Faculty Articles and Research

Preconception and prenatal stress impact fetal and infant development, and women of color are disproportionately exposed to sociocultural stressors like discrimination and acculturative stress. However, few studies examine links between mothers’ exposure to these stressors and offspring mental health, or possible mitigating factors. Using linear regression, we tested associations between prenatally assessed maternal acculturative stress and discrimination on infant negative emotionality among 113 Latinx/Hispanic, Asian American, Black, and Multiethnic mothers and their children. Additionally, we tested interactions between stressors and potential pre- and postnatal resilience-promoting factors: community cohesion, social support, communalism, and parenting self-efficacy. Discrimination and acculturative stress were related …

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.

Adverse Childhood Experiences And Resilience In Medical School Students: A Scope Of Medical Literature, Andrea Soto Abarca, Yvette Cortino, Juan C. Lopez-Alvarenga, Maya Guevara

MEDI 9331 Scholarly Activities Clinical Years

Background: Adverse childhood experiences (ACEs) represent certain types of childhood trauma that are associated with long-term negative effects on health and wellbeing. The elevated number of ACEs can lead to depression, suicidality, alcoholism, and substance use. Factors that can protect a person from increased health risks include resilience, which is broadly defined as the ability to overcome challenges or bounce back from adversity. Few studies have analyzed the exposure of ACEs in medical students, however, there has been extensive literature on how low levels of resilience are linked to higher rates of depression, fatigue, and burnout among medical students. …

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 …

Effect Of Computer-Assisted Cognitive Behavior Therapy Vs Usual Care On Depression Among Adults In Primary Care: A Randomized Clinical Trial, Jesse H. Wright, Jesse J. Owen, Tracy D. Eells, Becky F. Antle, Laura B. Bishop, Renee Girdler, Lesley M. Harris, R. Brent Wright, Michael J. Wells, Rangaraj Gopalraj, Michael E. Pendleton, Shehzad Ali

Counseling Psychology: Faculty Scholarship

Importance Depression is a common disorder that may go untreated or receive suboptimal care in primary care settings. Computer-assisted cognitive behavior therapy (CCBT) has been proposed as a method for improving access to effective psychotherapy, reducing cost, and increasing the convenience and efficiency of treatment for depression.

Objectives To evaluate whether clinician-supported CCBT is more effective than treatment as usual (TAU) in primary care patients with depression and to examine the feasibility and implementation of CCBT in a primary care population with substantial numbers of patients with low income, limited internet access, and low levels of educational attainment.

Design, Setting, …

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 …

Optimism And Lipid Profiles In Midlife: A 15-Year Study Of Black And White Adults, Farah Qureshi, Jackie Soo, Ying Chen, Brita Roy, Donald Lloyd-Jones, Laura D. Kubzansky, Julia K. Boehm

Psychology Faculty Articles and Research

Introduction

Optimism is associated with better cardiovascular health, yet little is known about the underlying mechanisms and whether protective relationships are consistently observed across diverse groups. This study examines optimism's association with lipid profiles over time and separately among Black and White men and women.

Methods

Data were from 3,206 middle-aged adults in the Coronary Artery Risk Development in Young Adults study. Optimism was measured in 2000–2001 using the Revised Life Orientation Test. Triglyceride, total cholesterol, high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol measurements were obtained at 5-year intervals through 2015–2016. Linear mixed models evaluated relationships between optimism and …

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 …