Psychiatry and Psychology Commons^™

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 …

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 …