Can Computers Assist Treatment? Virtual Reality as a Possible Cue Exposure Technique With Adolescent Substance Abusers

<p>Substance use disorders are one of the most common psychiatric diagnoses among adolescents; marijuana is the illicit drug used most frequently by youth. Treatment dropout and relapse following treatment are common; innovative strategies are needed to improve treatment outcomes for youth substance abusers. The aim of this study was to develop and evaluate the feasibility of a virtual reality (VR) cue reactivity paradigm for adolescent cannabis abusers and to compare it to a video cue reactivity paradigm. Forty-two treatment-seeking youth with a cannabis use disorder completed the study, which incorporated three parts. During Part 1, drug and neutral video clips were shown to 11 youth and five substance-abuse experts who provided craving/usefulness ratings for each video clip. During Part 2, five youth met in a focus group and then individually to provide input on the development of the VR paradigm. During Part 3, 26 youth completed a laboratory procedure involving neutral and drug-related video clips and VR presentations. Heart rate, skin conductance, and skin temperature were measured as well as craving. Higher levels of craving and skin conductance were observed during drug-related presentations. The presentations did not significantly differ in their ability to elicit craving and arousal. Results suggest that youth can experience subjective and physiological reactivity to VR drug cues warranting further study with a larger, more diverse sample. Implications are discussed.</p>Dissertatio

Immunoglobulin G immune response to SARS-CoV-2 vaccination in people living with multiple sclerosis within Multiple Sclerosis Partners Advancing Technology and Health Solutions

The impact of multiple sclerosis (MS) disease-modifying therapies (DMTs) on SARS-CoV-2 vaccination response is uncertain. Post-SARS-CoV-2 vaccination blood samples across multiple DMTs were tested for SARS-CoV-2 immunoglobulin G (IgG) response. Three hundred twenty-two people with MS were included; 91.9% received an mRNA vaccine. Post-vaccination reactive IgG rates (IgG index > 1) were 40% for anti-CD20 (32/80 patients); 41% for sphingosine 1-phosphate receptor modulators (S1PRM, 16/39); and 100% for all other classes, including the no DMT group. Anti-CD20 therapies and S1PRMs reduce IgG response to SARS-CoV-2 vaccination; IgG response is preserved with other DMTs

Ethnic Differences Among Adolescents Beginning Treatment for Depression

Abstract: This study examines ethnic/racial differences at the start of treatment among participants in the Treatment for Adolescents with Depression Study (TADS). African American and Latino youth were compared to Caucasian youth on symptom presentation and cognitive variables associated with depression. Contrary to hypothesis, there were no significant differences in symptom presentation as measured by the interviewbased items of the Children&apos;s Depression Rating Scale -Revised (CDRS-R). However, African American and Latino youth were both rated as demonstrating more severe symptoms on the observational items of the CDRS-R compared to Caucasian youth. In terms of cognitive variables associated with depression, African Americans reported fewer negative cognitive biases compared to Caucasians, but cognitive biases were significantly correlated with depression severity across ethnic groups

Clinician Training, Then What? Randomized Clinical Trial of Child STEPs Psychotherapy Using Lower-Cost Implementation Supports with versus without Expert Consultation

Objective: Implementation of evidence-based treatments in funded trials is often supported by expert case consultation for clinicians; this may be financially and logistically difficult in clinical practice. Might less costly implementation support produce acceptable treatment fidelity and clinical outcomes? Method: To find out, we trained 42 community clinicians from four community clinics in Modular Approach to Therapy for Children (MATCH), then randomly assigned them to receive multiple lower-cost implementation supports (LC) or expert MATCH consultation plus lower-cost supports (CLC). Clinically referred youths (N = 200; ages 7–15 years, M = 10.73; 53.5% male; 32.5% White, 27.5% Black, 24.0% Latinx, 1.0% Asian, 13.5% multiracial, 1.5% other) were randomly assigned to LC (n = 101) or CLC (n = 99) clinicians, and groups were compared on MATCH adherence and competence, as well as on multiple clinical outcomes using standardized measures (e.g., Child Behavior Checklist, Youth Self-Report) and idiographic problem ratings (Top Problems Assessment). Results: Coding of therapy sessions revealed substantial therapist adherence to MATCH in both conditions, with significantly stronger adherence in CLC; however, LC and CLC did not differ significantly in MATCH competence. Trajectories of change on all outcome measures were steep, positive, and highly similar for LC and CLC youths, with no significant differences; a supplemental analysis of posttreatment outcomes also showed similar LC and CLC posttreatment scores, with most LC–CLC differences nonsignificant. Conclusions: The findings suggest that effective implementation of a complex intervention in clinical practice may be supported by procedures that are less costly and logistically challenging than expert consultation

Evaluating a Modular Approach to Therapy for Children With Anxiety, Depression, Trauma, or Conduct Problems (MATCH) in School-Based Mental Health Care: Study Protocol for a Randomized Controlled Trial

Introduction: Schools have become a primary setting for providing mental health care to youths in the U.S. School-based interventions have proliferated, but their effects on mental health and academic outcomes remain understudied. In this study we will implement and evaluate the effects of a flexible multidiagnostic treatment called Modular Approach to Therapy for Children with Anxiety, Depression, Trauma, or Conduct Problems (MATCH) on students' mental health and academic outcomes. Methods and Analysis: This is an assessor-blind randomized controlled effectiveness trial conducted across five school districts. School clinicians are randomized to either MATCH or usual care (UC) treatment conditions. The target sample includes 168 youths (ages 7-14) referred for mental health services and presenting with elevated symptoms of anxiety, depression, trauma, and/or conduct problems. Clinicians randomly assigned to MATCH or UC treat the youths who are assigned to them through normal school referral procedures. The project will evaluate the effectiveness of MATCH compared to UC on youths' mental health and school related outcomes and assess whether changes in school outcomes are mediated by changes in youth mental health. Ethics and Dissemination: This study was approved by the Harvard University Institutional Review Board (IRB14-3365). We plan to publish the findings in peer-reviewed journals and present them at academic conferences. Clinical Trial Registration: ClinicalTrials.gov ID: NCT02877875. Registered on August 24, 2016

Common Genetic Polymorphisms Influence Blood Biomarker Measurements in COPD

Implementing precision medicine for complex diseases such as chronic obstructive lung disease (COPD) will require extensive use of biomarkers and an in-depth understanding of how genetic, epigenetic, and environmental variations contribute to phenotypic diversity and disease progression. A meta-analysis from two large cohorts of current and former smokers with and without COPD [SPIROMICS (N = 750); COPDGene (N = 590)] was used to identify single nucleotide polymorphisms (SNPs) associated with measurement of 88 blood proteins (protein quantitative trait loci; pQTLs). PQTLs consistently replicated between the two cohorts. Features of pQTLs were compared to previously reported expression QTLs (eQTLs). Inference of causal relations of pQTL genotypes, biomarker measurements, and four clinical COPD phenotypes (airflow obstruction, emphysema, exacerbation history, and chronic bronchitis) were explored using conditional independence tests. We identified 527 highly significant (p 10% of measured variation in 13 protein biomarkers, with a single SNP (rs7041; p = 10−392) explaining 71%-75% of the measured variation in vitamin D binding protein (gene = GC). Some of these pQTLs [e.g., pQTLs for VDBP, sRAGE (gene = AGER), surfactant protein D (gene = SFTPD), and TNFRSF10C] have been previously associated with COPD phenotypes. Most pQTLs were local (cis), but distant (trans) pQTL SNPs in the ABO blood group locus were the top pQTL SNPs for five proteins. The inclusion of pQTL SNPs improved the clinical predictive value for the established association of sRAGE and emphysema, and the explanation of variance (R2) for emphysema improved from 0.3 to 0.4 when the pQTL SNP was included in the model along with clinical covariates. Causal modeling provided insight into specific pQTL-disease relationships for airflow obstruction and emphysema. In conclusion, given the frequency of highly significant local pQTLs, the large amount of variance potentially explained by pQTL, and the differences observed between pQTLs and eQTLs SNPs, we recommend that protein biomarker-disease association studies take into account the potential effect of common local SNPs and that pQTLs be integrated along with eQTLs to uncover disease mechanisms. Large-scale blood biomarker studies would also benefit from close attention to the ABO blood group

New Frontiers in Transdiagnostic Treatment: Youth Psychotherapy for Internalizing and Externalizing Problems and Disorders

Comorbidity is common among youths referred for mental health treatment. Yet, the majority of evidence-based treatments (EBTs) for young people are focal, addressing one or a homogeneous cluster of disorders or problems. In addition, most of these EBTs have been developed and tested in research settings under controlled conditions that are useful experimentally but may limit the generalizability of findings to referred youths in clinical practice treated by real-world practitioners. Recently, researchers have begun to develop transdiagnostic treatments that may support implementation in everyday practice. Here, we describe a transdiagnostic program called MATCH (Modular Approach to Therapy for Children With Anxiety, Depression, Trauma, or Conduct Problems; MATCH-ADTC), which employs a modular design to facilitate personalizing treatment to fit individual youths. We summarize evidence to date supporting the effectiveness of MATCH with youths treated by practitioners in community clinic and school settings. Directions for the future include replication of the effectiveness research, plus tests of adaptations designed for different populations and settings.Psycholog

Case Studies of Online Testing in Multicultural School Districts

In this chapter, the authors use excerpts from in-depth case studies to explore the implementation of computer-based testing in diverse contexts. The case studies describe the online testing experiences of six Texas school districts and several individual campuses within each district. The challenges that district personnel reported experiencing in planning and implementing online assessments are highlighted, and the issues that may differentially affect students in multicultural contexts based on variables such as setting (i.e., urban or rural), student age (i.e., elementary or secondary), district financial resources, and student language status (English learner or native English-speaking) are described in detail