Integrating mental health professionals in residencies to reduce health disparities

Health disparities in primary care remain a continual challenge for both practitioners and patients alike. Integrating mental health services into routine patient care has been one approach to address such issues, including access to care, stigma of health-care providers, and facilitating underserved patients’ needs. This article addresses examples of training programs that have included mental health learners and licensed providers into family medicine residency training clinics. Descriptions of these models at two Midwestern Family Medicine residency clinics in the United States are highlighted. Examples of cross-training both medical residents and mental health students are described, detailing specific areas where this integration improves mental health and medical outcomes in patients. Challenges to effective integration are discussed, including larger system buy-in, medical providers’ knowledge of mental health treatment, and the skills for clinical providers to possess in order to present mental health options to patients. Patients who traditionally experience multiple barriers to mental health treatment now have increased access to comprehensive care. As a result of more primary care clinics ascribing to an integrated care model of practice, providers may benefit from not only increased coordination of patient services but also utilizing behavioral health professionals to address health barriers in patients’ lives

Investigating Trajectories of Social Recovery in Individuals with First Episode Psychosis:A Latent Class Growth Analysis

Background Social disability is a hallmark of severe mental illness yet individual differences and factors predicting outcome are largely unknown. Aim To explore trajectories and predictors of social recovery following a first episode of psychosis (FEP). Method A sample of 764 individuals with FEP were assessed on entry into early intervention in psychosis (EIP) services and followed up over 12 months. Social recovery profiles were examined using latent class growth analysis. Results Three types of social recovery profile were identified: Low Stable (66%), Moderate-Increasing (27%), and High-Decreasing (7%). Poor social recovery was predicted by male gender, ethnic minority status, younger age at onset of psychosis, increased negative symptoms, and poor premorbid adjustment. Conclusions Social disability is prevalent in FEP, although distinct recovery profiles are evident. Where social disability is present on entry into EIP services it can remain stable, highlighting a need for targeted intervention. Declaration of interest Non

Director-Matcher Task Project

The Director-Matcher Task Project aims to create a new flexible web toolkit for the collection of data for psychology, linguistic, and cognitive science based research. The toolkit was initially developed to record instances of code switching, a linguistic concept concerned with a speaker alternating between multiple languages during one conversation. The project is based on Toy Task experiments, a modification of the director-matcher task, developed at the University of Bangor’s bilingual research center. Traditionally, two subjects separated by a wall were tasked with matching object placement on a set of chessboards through vocal communication. The Director-Matcher Task Project uses web technologies such as HTML5, JavaScript, and PHP to digitize the concept. The toolkit separates the board and participants physically by providing an online interface for conducting code switching studies, allowing research to be carried out by subjects all over the world without direct physical contact. It also attempts to limit the cognitive bias of participants as much as possible, by removing as many references to a specific language as possible from the toy-task itself, to help foster more pure and natural code switching data. The toolkit further fosters the ability to analyze session voice data and board states to create corpora for the code switching experiments.http://opus.ipfw.edu/stu_symp2014/1020/thumbnail.jp

Efficient Dispatch of Multi-object Polymorphic Call Sites in Contextual Role-Oriented Programming Languages

Adaptive software becomes more and more important as computing is increasingly context-dependent. Runtime adaptability can be achieved by dynamically selecting and applying context-specific code. Role-oriented programming has been proposed as a paradigm to enable runtime adaptive software by design. Roles change the objects’ behavior at runtime, thus adapting the software to a given context. The cost of adaptivity is however a high runtime overhead stemming from executing compositions of behavior-modifying code. It has been shown that the overhead can be reduced by optimizing dispatch plans at runtime when contexts do not change, but no method exists to reduce the overhead in cases with high context variability. This paper presents a novel approach to implement polymorphic role dispatch, taking advantage of run-time information to effectively guard abstractions and enable reuse even in the presence of variable contexts. The concept of polymorphic inline caches is extended to role invocations. We evaluate the implementation with a benchmark for role-oriented programming languages achieving a geometric mean speedup of 4.0× (3.8× up to 4.5×) with static contexts, and close to no overhead in the case of varying contexts over the current implementation of contextual roles in Object Team

The American Public’s Perception of Illegal Steroid Use: A National Survey, 2013

Through the surge of news about doping scandals in the media, it is expected that the public is aware of the magnitude of the problem among professional athletes; however, it is uncertain whether the public is aware that the problem often starts when athletes are younger. To this end, the National Baseball Hall of Fame and Museum, the Taylor Hooton Foundation, and the Professional Baseball Athletic Trainers Society partnered with the Center for Social Development and Education and the Center for Survey Research at the University of Massachusetts Boston to conduct the most comprehensive national opinion survey to date to assess the public’s knowledge, perceptions, and beliefs about the use of performance enhancing drugs among adolescents. It is hoped that the findings obtained through this survey will provide a foundation for a national dialogue about this problem

Cannabis use is associated with increased psychotic symptoms and poorer psycho-social functioning in first-episode psychosis: A report from the UK National EDEN study

This is a pre-copyedited, author-produced PDF of an article accepted for publication in Schizophrenia Bulletin following peer review. The version of record Seddon, J. L., et al. (2016). Cannabis Use Is Associated With Increased Psychotic Symptoms and Poorer Psychosocial Functioning in First-Episode Psychosis: A Report From the UK National EDEN Study. Schizophrenia Bulletin, 42(3), 619-625. https://doi.org/10.1093/schbul/sbv154 is available online at: https://academic.oup.com/schizophreniabulletin/article/42/3/619/2413898#39400533Background: The use of cannabis during the early stage of psychosis has been linked with increased psychotic symptoms. This study aimed to examine the use of cannabis in the 12 months following a first-episode psychosis (FEP) and the link with symptomatic course and outcome over one year post psychosis onset. Method: 1027 FEP patients were recruited upon inception to specialised early intervention services for psychosis in the UK. Participants completed assessments at baseline, six and twelve months. Results: The results indicate that the use of cannabis was significantly associated with increased severity of psychotic symptoms, mania, depression and poorer psycho-social functioning. Continued use of cannabis following the first episode of psychosis was prognostic of outcome at one year. These associations were significant after adjusting for age, gender, DUP, age of psychosis onset, ethnicity and other drug use. Conclusion: This is the largest cohort study of first-episode psychosis patients receiving care within early intervention services. Cannabis use, in particular continued use, is associated with poorer symptomatic and functional outcome during the first-episode of psychosis. The results highlight the need for effective and early intervention for cannabis use in FEP

The course of negative symptom in first episode psychosis and the relationship with social recovery.

AIMS: To investigate trajectories of negative symptoms during the first 12months of treatment for first episode psychosis (FEP), their predictors and relationship to social recovery. METHOD: 1006 participants were followed up for 12months following acceptance into Early Intervention in Psychosis services. Negative symptom trajectories were modelled using latent class growth analysis (LCGA) and predictors of trajectories examined using multinomial regression. Social recovery trajectories - also modelled using LCGA - of members of each negative symptom trajectory were ascertained and the relationship between negative symptom and social recovery trajectories examined. RESULTS: Four negative symptom trajectories were identified: Minimal Decreasing (63.9%), Mild Stable (13.5%), High Decreasing (17.1%) and High Stable (5.4%). Male gender and family history of non-affective psychosis predicted stably high negative symptoms. Poor premorbid adolescent adjustment, family history of non-affective psychosis and baseline depression predicted initially high but decreasing negative symptoms. Members of the Mild Stable, High Stable and High Decreasing classes were more likely to experience stably low functioning than the Minimal Decreasing class. CONCLUSIONS: Distinct negative symptom trajectories are evident in FEP. Only a small subgroup present with persistently high levels of negative symptoms. A substantial proportion of FEP patients with elevated negative symptoms at baseline will achieve remission of these symptoms within 12months. However, elevated negative symptoms at baseline, whether or not they remit, are associated with poor social recovery, suggesting targeted interventions for service users with elevated baseline negative symptoms may help improve functional outcomes.This is the author accepted manuscript. The final version is available from Elsevier via http://dx.doi.org/10.1016/j.schres.2016.04.01

Measuring adherence in social recovery therapy with people with first episode psychosis

Background:The SUPEREDEN3 study, a phase II randomized controlled trial, suggests that social recovery therapy (SRT) is useful in improving functional outcomes in people with first episode psychosis. SRT incorporates cognitive behavioural therapy (CBT) techniques with case management and employment support, and therefore has a different emphasis to traditional CBT for psychosis, requiring a new adherence tool.Aims:This paper describes the SRT adherence checklist and content of the therapy delivered in the SUPEREDEN3 trial, outlining the frequency of SRT techniques and proportion of participants who received a full therapy dose. It was hypothesized that behavioural techniques would be used frequently, consistent with the behavioural emphasis of SRT.Method:Research therapists completed an adherence checklist after each therapy session, endorsing elements of SRT present. Data from 1236 therapy sessions were reviewed to determine whether participants received full, partial or no therapy dose.Results:Of the 75 participants randomized to receive SRT, 57.3% received a full dose, 24% a partial dose, and 18.7% received no dose. Behavioural techniques were endorsed in 50.5% of sessions, with cognitive techniques endorsed in 34.9% of sessions.Conclusions:This report describes an adherence checklist which should be used when delivering SRT in both research and clinical practice. As hypothesized, behavioural techniques were a prominent feature of the SRT delivered in SUPEREDEN3, consistent with the behavioural emphasis of the approach. The use of this adherence tool would be considered essential for anyone delivering SRT looking to ensure adherence to the model

Structure and stability of symptoms in first episode psychosis: a longitudinal network approach.

Early psychosis is characterised by heterogeneity in illness trajectories, where outcomes remain poor for many. Understanding psychosis symptoms and their relation to illness outcomes, from a novel network perspective, may help to delineate psychopathology within early psychosis and identify pivotal targets for intervention. Using network modelling in first episode psychosis (FEP), this study aimed to identify: (a) key central and bridge symptoms most influential in symptom networks, and (b) examine the structure and stability of the networks at baseline and 12-month follow-up. Data on 1027 participants with FEP were taken from the National EDEN longitudinal study and used to create regularised partial correlation networks using the 'EBICglasso' algorithm for positive, negative, and depressive symptoms at baseline and at 12-months. Centrality and bridge estimations were computed using a permutation-based network comparison test. Depression featured as a central symptom in both the baseline and 12-month networks. Conceptual disorganisation, stereotyped thinking, along with hallucinations and suspiciousness featured as key bridge symptoms across the networks. The network comparison test revealed that the strength and bridge centralities did not differ significantly between the two networks (C = 0.096153; p = 0.22297). However, the network structure and connectedness differed significantly from baseline to follow-up (M = 0.16405, p = <0.0001; S = 0.74536, p = 0.02), with several associations between psychosis and depressive items differing significantly by 12 months. Depressive symptoms, in addition to symptoms of thought disturbance (e.g. conceptual disorganisation and stereotyped thinking), may be examples of important, under-recognized treatment targets in early psychosis, which may have the potential to lead to global symptom improvements and better recovery