Evidence and Impact of Expectancies Associated with Psychotropic Medication Reductions in Persons with Mental Retardation

This study was an attempt to understand the presence and impact of staff expectancies related to psychotropic medication reductions conducted with persons diagnosed with mental retardation. Within a state operated developmental center in the Midwest, results indicated that direct support staff overwhelmingly expected individuals to get worse following such a reduction. These expectancies significantly impacted data recording practice leading to discrepant elevations reported by staff expecting deterioration. Finally, while written communication about planned psychotropic medication reductions did not appear to elevate data recording as was hypothesized, reductions were associated with increases in both behaviors and psychiatric symptoms. This study has implications for the treatment integrity of pharmacological interventions used with persons diagnosed with mental retardation

Antipsychotic treatment and sexual functioning:From mechanisms to clinical practice

Seksuele bijwerkingen komen bij verschillende medicijnen voor. Seksualiteit is voor veel mensen belangrijk en plezierig. Problemen in de seksualiteit komen regelmatig voor, en hangen samen met een verminderde kwaliteit van leven, ook binnen de algemene bevolking. Veel mensen, zowel artsen als patiënten, praten niet gemakkelijk over seksualiteit. Toch is het de moeite waard om te praten over seksuele bijwerkingen, want vaak is er wel iets aan te doen. Ook medicijnen die worden gebruikt in de behandeling van psychosen (antipsychotica) leiden regelmatig tot seksuele bijwerkingen, terwijl patiënten deze middelen vaak langdurig gebruiken. In het proefschrift “Antipsychotic treatment and sexual functioning: from mechanisms to clinical practice” van Marrit de Boer wordt beschreven welke factoren betrokken zijn bij seksueel functioneren en op welke manier antipsychotica het seksueel functioneren kunnen beïnvloeden. Het blijkt dat de kans op seksuele bijwerkingen verschilt per antipsychoticum. Deze verschillen zijn te herleiden tot de farmacologische kenmerken van de verschillende antipsychotica, onder andere de invloed op het dopaminesysteem in de hersenen. In het proefschrift wordt ook een vragenlijst beschreven waarmee seksuele bijwerkingen systematisch kunnen worden uitgevraagd. Daarnaast geeft het onderzoek informatie over hoe mensen die antipsychotica gebruiken en seksuele bijwerkingen ervaren via speciale behandelingsstrategieën geholpen kunnen worden. Er worden praktische adviezen gegeven die artsen kunnen gebruiken in de klinische praktijk. Als artsen niet beginnen over seksuele bijwerkingen, blijft het in driekwart van de gevallen onbesproken. Het is dus belangrijk dat artsen het onderwerp bespreekbaar maken, om samen met de patiënt de juiste afwegingen te kunnen maken

Antipsychotic treatment and sexual functioning:From mechanisms to clinical practice

Seksuele bijwerkingen komen bij verschillende medicijnen voor. Seksualiteit is voor veel mensen belangrijk en plezierig. Problemen in de seksualiteit komen regelmatig voor, en hangen samen met een verminderde kwaliteit van leven, ook binnen de algemene bevolking. Veel mensen, zowel artsen als patiënten, praten niet gemakkelijk over seksualiteit. Toch is het de moeite waard om te praten over seksuele bijwerkingen, want vaak is er wel iets aan te doen. Ook medicijnen die worden gebruikt in de behandeling van psychosen (antipsychotica) leiden regelmatig tot seksuele bijwerkingen, terwijl patiënten deze middelen vaak langdurig gebruiken. In het proefschrift “Antipsychotic treatment and sexual functioning: from mechanisms to clinical practice” van Marrit de Boer wordt beschreven welke factoren betrokken zijn bij seksueel functioneren en op welke manier antipsychotica het seksueel functioneren kunnen beïnvloeden. Het blijkt dat de kans op seksuele bijwerkingen verschilt per antipsychoticum. Deze verschillen zijn te herleiden tot de farmacologische kenmerken van de verschillende antipsychotica, onder andere de invloed op het dopaminesysteem in de hersenen. In het proefschrift wordt ook een vragenlijst beschreven waarmee seksuele bijwerkingen systematisch kunnen worden uitgevraagd. Daarnaast geeft het onderzoek informatie over hoe mensen die antipsychotica gebruiken en seksuele bijwerkingen ervaren via speciale behandelingsstrategieën geholpen kunnen worden. Er worden praktische adviezen gegeven die artsen kunnen gebruiken in de klinische praktijk. Als artsen niet beginnen over seksuele bijwerkingen, blijft het in driekwart van de gevallen onbesproken. Het is dus belangrijk dat artsen het onderwerp bespreekbaar maken, om samen met de patiënt de juiste afwegingen te kunnen maken

Development of the Occupational Performance Inventory of Sexuality and Intimacy (OPISI): Phase One

Background: The occupational therapy profession needs a framework to guide understanding of the occupational nature of sexuality and intimacy, assessment, intervention design, and measurement of outcomes. This study aimed to define the occupational nature of sexuality and intimacy and develop a theoretical and occupation-based screen, in-depth self-assessment, and performance measure. Method: The Occupational Performance Inventory of Sexuality and Intimacy (OPISI) was developed following DeVellis’s (2017) guidelines for scale development that involved mapping the construct, generating an item pool, determining the format for measurement, and reviewing the initial item pool. Results: The Occupational Therapy Sexual Assessment Framework (OTSAF) was developed to define the occupational nature of sexuality and intimacy, depict how the theoretical constructs intertwine with the domain of occupational therapy, and guide scale development. The OPISI includes a self-screen, in-depth self-assessment, and an individualized measure to establish baseline performance and detect self-perceived change in ability, satisfaction, understanding, and confidence in skills and ability to improve occupational performance associated with sexuality and intimacy over time. Conclusion: The OTSAF defines the occupational nature of sexuality and intimacy and informs the occupational therapy scope of practice. The OPISI includes theoretical and occupation-based tools to adequately screen, assess, and measure performance related to the complex occupational nature of sexuality and intimacy. Formal validation is needed prior to releasing the OPISI for clinical use

Quality of life and healthcare utilization and costs among adults with autism

OBJECTIVES The objectives of this study are to: 1) assess construct validity of the World Health Organization’s Quality of Life-BREF (WHOQOL-BREF) instrument, 2) evaluate quality of life (QOL) among adults with autism and 3) assess the prevalence, healthcare utilization and costs, and medication use among adults with autism enrolled in the Medicaid program. METHODS The study methodology included both primary and secondary data collection techniques. For objectives one and two, a cross-sectional, descriptive quantitative design was utilized. An internet-based survey using Qualtrics was administered to adults with autism enrolled with the Interactive Autism Network (IAN). The WHOQOL-BREF instrument was validated using confirmatory factor analysis (CFA). Structural equation modeling (SEM) was used to identify the factors influencing QOL among adults with autism. For objective three, a retrospective descriptive analysis of 2006-2008 Medicaid claims data for 39 states was conducted. Logistic regression was performed to assess trends in prevalence of autism and generalized linear mixed models (GLMM) were used to determine the predictors of healthcare utilization and costs among adults with autism. RESULTS The survey sample included 265 adults with autism. Based on the CFA analysis for objective one, the second-order hierarchical model of WHOQOL-BREF instrument was considered the best fitting model among adults with autism. Results from the SEM analysis conducted under objective two revealed the modified Wilson and Cleary’s QOL model tested in the study to have an adequate fit. Study results depicted autism severity (negative), maladaptive coping (negative), social support (positive) and functional independence (positive) as significant predictors of QOL. Study analyses under objective three highlighted a ~38% increase in the prevalence of autism from 2006 to 2008. Significant variation between demographic variables and healthcare expenditure and costs was observed after controlling for disease severity and other comorbid conditions. CONCLUSIONS Study results indicated that the WHOQOL-BREF is a psychometrically sound instrument to assess quality of life among adults with autism. Health care professionals involved in the management of autism among these adults should consider factors such as social support and coping when designing treatment strategies. With increasing prevalence, medical services as well as costs associated with management of adults with autism enrolled in the Medicaid program are likely to increase in the coming years

Pain and Bright Light Therapy in Nursing Home Patients with Dementia

Smerte, søvnproblemer og atferd og psykologiske symptomer ved demens (APSD) er vanlig blant sykehjemspasienter med demens. Symptomene er ofte komorbide og kan utløse hverandre. Sykehjemspasienter med demens har høy risiko for ugunstige bivirkninger ved medisinbruk, og alternative ikke-farmakologiske behandlinger bør utvikles og forskes på. Lys synkroniserer døgnrytmen vår, og påvirker søvn og en rekke psykologiske og fysiologiske funksjoner også hos sykehjemspasienter med demens. Lysterapi er et ikke-farmakologisk alternativ for behandling av søvn og noen APSD, og kan indirekte ha effekt på smerte. Hensikten med denne hovedoppgaven var å undersøke smerte i et utvalg av sykehjemspasienter med demens. Effekten av lysterapi på smerte ble undersøkt, og assosiasjoner mellom smerte, søvn og APSD. Gjennom en «linear mixed model» analyse ble effekten av lysterapi over 24 uker på smerte undersøkt. Korrelasjonelle analyser ble gjennomført ved baseline (startpunktet) mellom smerte (Mobilization – Observation – Behaviour – Intensity – Dementia 2, MOBID-2), søvnproblemer (Sleep Disorders Inventory, SDI), depresjon (Cornell Scale of Depression in Dementia, CSDD), agitasjon (Cohen-Mansfield Agitation Inventory, CMAI), APSD (Neuropsychiatric Inventory – Nursing Home Version, NPI-NH), medisinbruk og demografiske variabler kjønn (sex) og alder. Det var ikke signitifkant effekt av lysterapi på smerte. Depresjon hadde en prediktiv effekt for smerte i «linear mixed model» analysen og var positivt korrelert på startpunktet. Smerte var korrelert med total medisinbruk, psykotropisk medisinbruk og følgende APSD variabler: total NPI-NH, vrangforestillinger, manglende hemning og eufori. Resultatene bekrefter smerte-depresjons dyaden funnet i andre studier. Det var overraskende at det var ingen assosiasjon mellom smerte og søvn, og agitasjon, men assosiasjoner mellom vrangforestillinger, manglende hemning og eufori noe som ikke er et konsistent funn i feltet. Mer forskning trengs for å undersøke smerte-depresjonsdyaden hos sykehjemspasienter med demens, særlig med ikke-farmakologiske behandlinger rettet mot nettopp smerte og depresjon.Hovedoppgave psykologprogrammetPROPSY317PRPSY

A Randomized Controlled Trial of Sertraline in Young Children With Autism Spectrum Disorder.

Objective: Selective serotonin reuptake inhibitors like sertraline have been shown in observational studies and anecdotal reports to improve language development in young children with fragile X syndrome (FXS). A previous controlled trial of sertraline in young children with FXS found significant improvement in expressive language development as measured by the Mullen Scales of Early Learning (MSEL) among those with comorbid autism spectrum disorder (ASD) in post hoc analysis, prompting the authors to probe whether sertraline is also indicated in nonsyndromic ASD. Methods: The authors evaluated the efficacy of 6 months of treatment with low-dose sertraline in a randomized, double-blind, placebo-controlled trial in 58 children with ASD aged 24 to 72 months. Results: 179 subjects were screened for eligibility, and 58 were randomized to sertraline (32) or placebo (26). Eight subjects from the sertraline arm and five from the placebo arm discontinued. Intent-to-treat analysis showed no significant difference from placebo on the primary outcomes (MSEL expressive language raw score and age equivalent combined score) or secondary outcomes. Sertraline was well tolerated, with no difference in side effects between sertraline and placebo groups. No serious adverse events possibly related to study treatment occurred. Conclusion: This randomized controlled trial of sertraline treatment showed no benefit with respect to primary or secondary outcome measures. For the 6-month period, treatment in young children with ASD appears safe, although the long-term side effects of low-dose sertraline in early childhood are unknown. Clinical Trial Registration: www.ClinicalTrials.gov, identifier NCT02385799