Find the Words: Helping Students Develop Better Clinical Skills

On March 12, 2019, Katherine Shear, Marion E. Kenworthy Professor of Psychiatry in Social Work, Kristin Garay, and Matthea Marquart will present at the Columbia University Center for Teaching and Learning's 2019 Celebration of Teaching and Learning Symposium, as part of the Interactive Showcase of Teaching Innovations. Their poster, "Find the Words: Helping Students Develop Better Clinical Skills," will share the teaching innovation developed during Professor Shear's Fall 2018 online Introduction to Grief Therapy course, which she redesigned with a 2018 Teaching & Learning Grant for Hybrid Learning Course Redesign and Delivery from the Office of the Provost

Living with Hepatitis C: A Vermont Needs Assessment

Background: Hepatitis C (HCV) Viral infection of the liver spread primarily via blood-to-blood contact (e.g., intravenous drug use (IVDU)) United States: 3.2 million chronic HCV infections (2010) Vermont: 1.63 cases per 1000 people (2012-2013) Barriers to Care Exclusion of current IV drug users from HCV treatment programs despite their high rates of infection Lack of support, causing decreased treatment adherence Poor access to treatment: cost, transportation, competing priorities of housing, addiction management, and food HIV and HCV Research has shown that the multidisciplinary and integrated HIV model is appropriate for HCV Vermont CARES Non-profit organization that provides comprehensive services to clients with HIV in Vermonthttps://scholarworks.uvm.edu/comphp_gallery/1219/thumbnail.jp

Computerized adaptive measurement of depression: A simulation study

BACKGROUND: Efficient, accurate instruments for measuring depression are increasingly important in clinical practice. We developed a computerized adaptive version of the Beck Depression Inventory (BDI). We examined its efficiency and its usefulness in identifying Major Depressive Episodes (MDE) and in measuring depression severity. METHODS: Subjects were 744 participants in research studies in which each subject completed both the BDI and the SCID. In addition, 285 patients completed the Hamilton Depression Rating Scale. RESULTS: The adaptive BDI had an AUC as an indicator of a SCID diagnosis of MDE of 88%, equivalent to the full BDI. The adaptive BDI asked fewer questions than the full BDI (5.6 versus 21 items). The adaptive latent depression score correlated r = .92 with the BDI total score and the latent depression score correlated more highly with the Hamilton (r = .74) than the BDI total score did (r = .70). CONCLUSIONS: Adaptive testing for depression may provide greatly increased efficiency without loss of accuracy in identifying MDE or in measuring depression severity

Brief Measure for Screening Complicated Grief: Reliability and Discriminant Validity

BACKGROUND: Complicated grief, which is often under-recognized and under-treated, can lead to substantial impairment in functioning. The Brief Grief Questionnaire (BGQ) is a 5-item self-report or interview instrument for screening complicated grief. Although investigations with help-seeking samples suggest that the BGQ is valid and reliable, it has not been validated in a broader population. METHODOLOGY/PRINCIPAL FINDINGS: A questionnaire was mailed to a randomly selected sample (n = 5000) residing in one of 4 areas of Japan. The BCQ was examined for responders who were bereaved more than 6 months and less than 10 years (n = 915). Non-specific psychological distress was assessed with the K6 screening scale. Multiple group confirmatory factor analysis supported a uni-dimensional factor structure and the invariance of parameters across gender and age. Cronbach's alpha was sufficiently high (alpha = .75) to confirm internal consistency. Average Variance Extracted (0.39) was higher than the shared covariance (0.14) between BGQ and K6, suggesting discriminant validity. CONCLUSIONS: The results of this study support the reliability and validity of the BGQ in the Japanese population. Future studies should examine predictive validity by using structured interviews or more detailed scales for complicated grief

Auxiliary Marker-Assisted Classification in the Absence of Class Identifiers

Constructing classification rules for accurate diagnosis of a disorder is an important goal in medical practice. In many clinical applications, there is no clinically significant anatomical or physiological deviation exists to identify the gold standard disease status to inform development of classification algorithms. Despite absence of perfect disease class identifiers, there are usually one or more disease-informative auxiliary markers along with feature variables comprising known symptoms. Existing statistical learning approaches do not effectively draw information from auxiliary prognostic markers. We propose a large margin classification method, with particular emphasis on the support vector machine (SVM), assisted by available informative markers in order to classify disease without knowing a subject’s true disease status. We view this task as statistical learning in the presence of missing data, and introduce a pseudo-EM algorithm to the classification. A major distinction with a regular EM algorithm is that we do not model the distribution of missing data given the observed feature variables either parametrically or semiparametrically. We also propose a sparse variable selection method embedded in the pseudo-EM algorithm. Theoretical examination shows that the proposed classification rule is Fisher consistent, and that under a linear rule, the proposed selection has an oracle variable selection property and the estimated coefficients are asymptotically normal. We apply the methods to build decision rules for including subjects in clinical trials of a new psychiatric disorder and present four applications to data available at the UCI Machine Learning Repository

Cognitive-Behavior Therapy (CBT) for Panic Disorder: Relationship of Anxiety and Depression Comorbidity with Treatment Outcome

Research evaluating the relationship of comorbidity to treatment outcome for panic disorder has produced mixed results. The current study examined the relationship of comorbid depression and anxiety to treatment outcome in a large-scale, multi-site clinical trial for cognitive-behavior therapy (CBT) for panic disorder. Comorbidity was associated with more severe panic disorder symptoms, although comorbid diagnoses were not associated with treatment response. Comorbid generalized anxiety disorder (GAD) and major depressive disorder (MDD) were not associated with differential improvement on a measure of panic disorder severity, although only rates of comorbid GAD were significantly lower at posttreatment. Treatment responders showed greater reductions on measures of anxiety and depressive symptoms. These data suggest that comorbid anxiety and depression are not an impediment to treatment response, and successful treatment of panic disorder is associated with reductions of comorbid anxiety and depressive symptoms. Implications for treatment specificity and conceptual understandings of comorbidity are discussed

Validity and reliability of the Structured Clinical Interview for the Trauma and Loss Spectrum (SCI-TALS)

Background. DSM-IV identifies three stress response disorders (acute stress Disorder (ASD), post-traumatic stress Disorder (PTSD) and adjustment disorders (AD)) that derive from specific life events. An additional condition of complicated grief (CG), well described in the literature, is triggered by bereavement. This paper reports on the reliability and validity of the Structured Clinical Interview for Trauma and Loss Spectrum (SCI-TALS) developed to assess the spectrum of stress response. The instrument is based on a spectrum model that emphasizes soft signs, low-grade symptoms, subthreshold syndromes, as well as temperamental and personality traits comprising clinical and subsyndromal manifestations. Methods. Study participants, enrolled at 6 Italian Departments of Psychiatry located at six sites, included consecutive patients with PTSD, 44 with CG and a comparative group of 48 unselected controls. Results. We showed good reliability and validity of the SCI-TALS. Domain scores were significantly higher in participants with PTSD or CG compared to controls. There were high correlations between specific SCI-TALS domains and corresponding scores on established measures of similar constructs. Participants endorsing grief and loss events reported similar scores on all instruments, except those with CG who scored significantly higher on the domain of grief reactions. Conclusion. These findings provide strong support for the internal consistency, the discriminant validity and the reliability of the SCI-TALS. These results also support the existence of a specific grief-related condition and the proposal that different forms of stress response have similar manifestations