Advocacy for Parents With Mental Illness and Their Families

As psychiatrists, we often do not ask our patients about parenting, which can be a central motivator and major stressor. We should not miss this opportunity to understand the importance of parenting to our patients and intervene in order to help

Therapeutic Assignments: Structured Framework for Interaction Between Medical Students and Patients on Psychiatry Clerkships

Medical students enjoy high level of patient contact on psychiatric clerkships. They have felt that forming a relationship with a patient can have therapeutic effects by imparting hope, decreasing their isolation and providing individualized attention. However students have encountered difficulties forming alliance with their patients, either due to acuity of illness such as psychosis or due to character pathology, addiction etc. They need to feel comfortable dealing with more difficult situations such as extremes of emotion or breaks with reality. Interviewing skills must be continually developed. We hope that Therapeutic Assignments (TA) will: provide a medium for students to improve their interviewing skills; enhance their comfort around communicating with patients about sensitive topics; form a therapeutic alliance with their patients, which will support the growth of empathy and be an important aspect in the patient’s treatment

Childhood Maltreatment, Emotional Dysregulation, and Psychiatric Comorbidities (poster)

There is a complex and bi-directional relationship between childhood trauma and emotional dysregulation. Childhood trauma is associated with: reduced ability to understand and regulate emotions; mediated by relational/attachment difficulties with caregivers and peers; heightened levels of internalizing and externalizing psychopathology; impaired social functioning beginning in childhood and continuing into adulthood

Mood Disorders and Trauma – What are the Associations?

Objectives: To characterize the relationship between childhood trauma/abuse, and mood dysregulation, and between childhood trauma/abuse and pediatric bipolar disorder (BD). To describe the clinical correlates and demographics of children with trauma/abuse and comorbid mood disorders in a community mental health setting. To explore associations between the diagnosis of BD in youth with histories of trauma and a family history of BD, the presence of specific symptom clusters, the presence of pretrauma mood symptoms. Methods We are assessing youths ages 8-18 who present with mood symptoms and past trauma divided into two groups: (1) Trauma Mood Disorder NOS (T+MD); (2) Trauma+Unmodified DSM-IV-TR BD (T+BD). Differences in clinical variables between groups are analyzed using t-tests for continuous and chi-square tests for categorical variables (α= 0.05). Youth are evaluated using the following psychiatric rating scales: (1) Structured Clinical Interview for DSM Disorders, Childhood Disorders Form (KID-SCID) mood module to establish the diagnosis of BD; (2) Brief Psychiatric Rating Scale for Children (BPRS-C); (3)Young Mania Rating Scale (YMRS); (4)Children’s Depression Rating Scale-Revised (CDRS-R); (5) Childhood Trauma Questionnaire (CTQ); (6) PTSD CheckList –Civilian Version (PCL-C); (7)Attention Deficit Hyperactivity Disorder IV (ADHD-IV) Rating Scale; (8) Substance Abuse (SA) screen: CRAFFT Other information obtained includes: Demographic characteristics and socioeconomic status; Number of medications and types; Percent of with a lifelong history of psychiatric hospitalization/out of home placement; Family history of psychiatric illness and substance use disorders Results - Clinical presentations: Mood Symptoms: BD\u3eMD in BPRS total score (p=0.06), BPRS Mania subscale (p=0.05),YMRS total score (p=0.06) BD\u3eMD in total number of mood episodes identified with KID-SCID: •MDE (p=0.04) Mania (without high outlying value) (p = 0.07) Substance use: No difference as assessed using CRAFT PTSD and trauma recollection: No differences in PTSD symptoms as assessed by PCL-C BD\u3eMD abuse identified with CTQ. Sexual abuse (without high outlying value) (p = 0.05). Physical neglect (p=0.07) Medications: BD\u3eMD 1.33 fewer medications (t=11.9, p=0.17) Conclusions Further data collection is ongoing to achieve our targeted sample size in order to identify clinical correlates in mood dsyregulated, traumatized youth. This will promote future research aimed at identifying biomarkers and preventive interventions

Mood Disorders and Trauma – What are the Associations? Future Directions

Background: Mood dysregulation in traumatized children often is misdiagnosed as Bipolar Disorder (BD) and conversely the diagnosis of BD is often overlooked. This presents a diagnostic quagmire that is critical to understand in more depth and to date has received little attention in the literature. We aim to characterize the relationship between childhood trauma and mood dysregulation and between childhood trauma and pediatric BD by describing clinical correlates of children with trauma and comorbid mood disorders in a community mental health setting. Methods: 40 youth between the ages of 8-18 years, who present to child psychiatry at Community Healthlink clinics with symptoms of mood dysregulation and history of trauma will be assessed. Children will be divided into two groups: (1) Mood Disorder NOS (MD NOS) (n=20); and (2) Unmodified DSM-IV-TR BD (n=20) At the end of 6 months, youth with MD NOS will be re-evaluated to determine if progressed to the diagnosis of BD Future Directions Better understanding the association between trauma and development of mood disorders will increase our knowledge of the diverse effects of such events on youths’ emotional and behavioral development Identifying clinical correlates that help predict later development of BD in mood dsyregulated, traumatized youth, will promote future research aimed at identifying biological markers and preventive treatment interventions Presented at the UMass Department of Psychiatry Research Day, October 2010

Survey of Threats and Assaults by Patients on Psychiatry Residents

Objective:To determine the current life time professional prevalence of threats and assaults by patients on psychiatry residents, their consequences, perceived adequacy of supports and institutional responses. Methods:An anonymous survey of 519 psychiatry residents in 13 psychiatry programs across the United States was conducted between March and June 2008. Results:The response rate for this survey was 38% (n = 204). Sixty one percent of the responders were female, and 30% were members of a visibly identifiable ethnic minority.The majority (72.4%) of those involved in an incident reported experiencing mild to severe psychological distress. Almost a third (31.6%) made requests to the hospital or department to improve safety. Most residents (93.8%) felt policies on psychological support after an assault would be helpful. Conclusion:This study calls attention to the high numbers of residents that are affected by violence during their training, and underscores the need for clear policy and training, in order to prevent and adequately respond to assaults, threats, and their consequences among psychiatry residents. Presented at the UMass Department of Psychiatry Research Day, October 2009

Mood Disorders and Trauma: What are the Associations?

Objectives: Mood dysregulation in traumatized children may be misdiagnosed as bipolar disorder (BD) and conversely, the diagnosis of BD overlooked. Our aim is to characterize the relationship between trauma and mood dysregulation and pediatric BD. Methods: We are assessing youths ages 8-18 who present with mood symptoms and past trauma divided into two groups: 1. Trauma+Unmodified DSM-IV-TR BD (T+BD) and 2. Trauma+Mood Disorder NOS (T+MD). Differences in clinical variables between groups are analyzed using t-tests for continuous and chi-square tests for categorical variables (α= 0.05). Results: Age at onset of trauma for youth with T+BD (n=10) compared with T+MD (n=10) was similar (2.6±1.8 versus 3.3±1.9 years; p=0.4) as were types of trauma and number of incidents, and age at onset of mood symptoms (T+BD 7±2.5 versus T+MD 7.8±1.8 p=0.4). The T+BD group had higher scores on the sexual abuse subscale of the Childhood Trauma Questionnaire (p=0.04) and BPRS mania subscale (p=0.02), and higher total number of major depressive episodes (p=0.04) and manic episodes (p=0.03) per the KSCID. Youth with T+BD reported a trend toward higher rates of ideation to self-harm compared to youth with T+MD (p=0.08). Both groups had similar PTSD and ADHD symptoms, and similar number of psychotrophic medications (BD 3.6±2.9 MD 2.7±2.1 p=0.4). Finally, family history findings suggest a trend towards higher rates of any Axis I disorder in the T+BD families (p=0.07), and significantly higher rates of anxiety disorders (p=0.05), BD (p=0.04), and schizophrenia (p=0.02). Conclusions: Results suggest differences in clinical presentation and higher rates of BD and schizophrenia in the T+BD families. Taken together, these preliminary results suggest potential biological and genetic vulnerabilities which may predispose children to develop specific mood disorders under certain circumstances; the ability to identify these children early on could change their prognostic trajectory

Massachusetts Child Psychiatry Access Project (MCPAP) University of Massachusetts (UMass) Parent Satisfaction Study

Objective: To evaluate parents’ experience with Massachusetts Child Psychiatry Access Project (MCPAP), a Consultation Liaison model, aimed at improving access to child psychiatry for primary care (consultations to primary care providers are done either by phone contact and/or by a direct evaluation of the child by a MCPAP clinician). Methods: IRB approved Parent Satisfaction Questionnaire (PSQ) sent to families referred to the MCPAP between 2/2008-8/2008, identified using the University of Massachusetts Medical Center (UMMHC) database. Results: 360 initial and 348 follow up PSQ were mailed, and 158 PSQ returned, defining a response rate of 46.2%. 78.9% of parents agreed or strongly agreed that the services provided were offered in a timely manner. 74.9% of parents agreed or strongly agreed with the statement that their child’s issues were understood. 50% agreed or strongly agreed that their child’s situation improved following their contact with the services. 74.2% agreed or strongly agreed that the quality of the service they received was satisfying. 69% agreed or strongly agreed that the service met their family’s need. 58.6% of parents agreed or strongly agreed that the service helped them deal with their issues more effectively. 67.3% agreed or strongly agreed that they were better satisfied with the service compared to previous contact with mental health providers for their child. Conclusions: PSQ suggest high satisfaction rates with MCPAP. Notable are the high rates of parents reporting they felt prepared, heard and understood. Parents were also highly satisfied with the face to face contact they had with MCPAP clinician, when that contact had occurred. Parents reported being less satisfied with regards to follow up appointments in the community and reaching their goals for their child. The results show high parental satisfaction with MCPAP evaluation process, but also highlight the need for appropriate mental health follow up in the community in order to help children and families reach their goals. Presented at the American Academy of Child & Adolescent Psychiatry (AACAP) Annual Meeting, October 29, 2009

Comparison of Use of the Massachusetts Child Psychiatry Access Program and Patient Characteristics Before vs During the COVID-19 Pandemic

This cross-sectional study compares the number of encounters at the Massachusetts Child Psychiatry Access Program, patient characteristics, and mental health diagnoses before vs during the COVID-19 pandemic

Psychiatric Symptomatology, Mood Regulation, and Resting State Functional Connectivity of the Amygdala: Preliminary Findings in Youth With Mood Disorders and Childhood Trauma

Background: As mood dysregulation and hyperarousal are overlapping and prominent features of posttraumatic stress disorder (PTSD), and mood disorders (MD) including bipolar disorder (BD), we aimed to clarify the role of trauma and MD on the resting state functional connectivity (RSFC) of amygdala in MD youth with or without trauma exposure, and healthy controls (HC). Methods: Of 23 subjects, 21 completed the magnetic resonance imaging (MRI) protocol, 5 were excluded for subject motion, leaving final sample size of 16: nine subjects with MD (5/9 with trauma), and 7 HC. Youth were assessed with Schedule for Affective Disorders and Schizophrenia for School Aged Children-Present and Lifetime Version (K-SADS-PL), and other behavioral measures including Young Mania Rating Scale (YMRS). Imaging data were acquired using functional MRI in 3-T scanner. Imaging included T1-weighted structural MRI and 6-min resting state acquisition. Results: In between group analysis, the average correlation coefficients between left anterior cingulate cortex (Acc) and left insula cortex with left amygdala regions were significantly larger in HC compared to the patient population. Connectivity between left amygdala and left cingulate cortex shows a significant negative correlation with YMRS severity. Conclusions: In this preliminary study, MD with trauma youth had more manic symptoms and difficulties regulating anger. While MD youth showed reduced RSFC of left amygdala with left acc and left insula, no significant difference between the subgroups of children with MD was observed. However, when looking at both clinical groups together, we observed a significant correlation of RSFC of left amygdala to left acc, and YMRS scores