Axial level‐specific regulation of neuronal development: Lessons from PITX2

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/109833/1/jnr23471.pd

Virtual Behavioral Health Treatment Satisfaction and Outcomes Across Time

Purpose: The COVID-19 pandemic continues to have major and long-lasting impacts on health care delivery and mental health. As health care shifted to telehealth, legislation was adjusted to expand telehealth allowances, creating a unique opportunity to elucidate outcomes. The aim of this study was to assess long-term patient and clinician satisfaction and outcomes with virtual behavioral health. Methods: Data were obtained over 16 months from surveys to patients and clinicians receiving/providing virtual treatment. Outcomes data also were collected from medical records of adults receiving in-person and virtual behavioral health treatment. Data were summarized using descriptive statistics. Groups were compared using various chi-squared tests for categorical variables, Likert response trends over time, and conditional independence, with Wilcoxon rank-sum or Jonckheere trend test used to assess continuous variables. P-values of ≤ 0.05 were considered statistically significant. Results: Patients gave high ratings to virtual treatment and indicated a preference for virtual formats. Both patient and clinician preference for virtual visits increased significantly with time, and many clinicians perceived virtual services to be equally effective to in-person. Virtual programs had higher completion rates, attendance rates, and number of treatment visits, suggesting that virtual behavioral health had equivalent or better outcomes to in-person treatment and that attitudes toward telehealth changed over time. Conclusions: If trends found in this study continue, telehealth may emerge as a preferred option long term This is important considering the increase in mental health needs associated with the COVID-19 pandemic and the eventuality that in-person restrictions ease as the pandemic subsides

Health care utilization as a proxy to introduce a novel disease screen in pediatric populations

Background: The global economic burden of treating genetically distinct conditions is growing rapidly. An interest in prophylactic treatment and pharmacogenetic decision-making has emerged in concert with an increasing usage of genetic tools, such as prenatal genetic testing, biomarker assays, and personal genomic tests, to presymptomatically identify these conditions. However, little is known about the optimal timing of these approaches to best impact patient care and, where applicable, to consider the cost of care in providing prophylactic treatment. Purpose: To determine the optimal developmental timepoint in early childhood to screen for certain health conditions presymptomatically and measure the financial impact of the resulting clinical actions. Methods: A retrospective review of vaccination compliance, as a proxy for health care utilization, of the 3,969,953 eligible individuals from 2012 through 2018 using de-identified data from the Wisconsin Immunization Registry. Further analysis across racial groups was assessed, and the financial impact of changes in cost of care. Concurrently, a parental survey was conducted to determine preference for the timing and disease inclusions of genetic tests. Results: Overall vaccination rates revealed maximal compliance during the first 6 months of visits, with the highest compliance rate at month 4 (71.2%). However, this rate significantly differed when racial groups were assessed independently, with compliance in Caucasian children highest at 4 months (80.0%) and all other racial backgrounds highest at 2 months (66.3%–72.6%). Conclusion: Results demonstrated that health care utilization is greatest within the first 4 months after birth, suggesting an optimal time to administer tests designed to detect health conditions presymptomatically

Predicting substance use disorder treatment follow-ups and relapse across the continuum of care at a single behavioral health center

Introduction: Substance use disorder is often a chronic condition, and its treatment requires patient access to a continuum of care, including inpatient, residential, partial hospitalization, intensive outpatient, and outpatient programs. Ideally, patients complete treatment at the most suitable level for their immediate individual needs, then transition to the next appropriate level. In practice, however, attrition rates are high, as many patients discharge before successfully completing a treatment program or struggle to transition to follow-up care after program discharge. Previous studies analyzed up to two programs at a time in single-center datasets, meaning no studies have assessed patient attrition and follow-up behavior across all five levels of substance use treatment programs in parallel. Methods: To address this major gap, this retrospective study collected patient demographics, enrollment, discharge, and outcomes data across five substance use treatment levels at a large Midwestern psychiatric hospital from 2017 to 2019. Data analyses used descriptive statistics and regression analyses. Results: Analyses found several differences in treatment engagement based on patient-level variables. Inpatients were more likely to identify as Black or female compared to lower-acuity programs. Patients were less likely to step down in care if they were younger, Black, had Medicare coverage were discharging from inpatient treatment, or had specific behavioral health diagnoses. Patients were more likely to relapse if they were male or did not engage in follow-up SUD treatment. Conclusions: Future studies should assess mechanisms by which these variables influence treatment access, develop programmatic interventions that encourage appropriate transitions between programs, and determine best practices for increasing access to treatment

Substance use disorder treatment outcomes and transitions at a large midwestern healthcare system

Background: Substance use disorder (SUD) is diagnosed in 10% of the U.S. population across a lifetime. Although around 10% of individuals with SUD go into long-term remission each year, the disease is considered chronic and is punctuated by many periods of abstinence, relapse, and eventual long-term remission. Nevertheless, only 35%–50% of individuals with SUD experience long-term remission within 17 years of diagnosis. To account for disease chronicity and varying levels of need over time, several treatment programs exist, each tailored to an individual’s current acuity and needs. These treatments include inpatient, residential, partial hospitalization program (PHP), intensive outpatient program, and outpatient treatment. Patients are assessed and referred for a specific level of treatment, and individual outcomes are superior if patients enter and complete the recommended program. However, many patients choose to reduce their lengths of stay, discharge against medical advice, or enter programs mismatched with their current acuity. Purpose: This retrospective study describes patient populations within the 5 unique SUD programs as well as variables related to program completion and length of stay. Methods: Medical records were used to collect data. Eligible subjects were adults enrolled in SUD treatment at a midwestern psychiatric hospital between January 1, 2017, and November 20, 2019. Data included demographics, diagnoses, tobacco use, number and length of stays, referrals, discharge against medical advice, and program type. Basic descriptive statistics were conducted. Results: Of the total population (N=4990), the majority of patients receiving treatment for SUD were male (59.9%), current smokers (61.8%), and had a mean age of 39.9 years. Further, many patients had concurrent mental health diagnoses; depression and/or anxiety disorders were prevalent in 53%–57% of patients. Within the context of substance use, patients were most likely to have been diagnosed with alcohol use disorder, opioid use disorder, cocaine use disorder, and cannabis use disorder. Similarly, patients were most likely to receive treatment for alcohol use, cannabis use, opioid use, and cocaine use. Co-occurring diagnoses were extremely common, and patients in PHP programming had the greatest number of diagnoses. Conclusion: Patients receiving treatment for substance use disorder are highly varied, and population differences exist among programs. These data suggest opportunities for tailoring programs to meet the current and long-term needs of patients

Low-dose clonidine in veterans with Posttraumatic stress disorder

Posttraumatic stress disorder (PTSD) symptoms of hyperarousal are mediated through sympathetic nervous system hyperactivity. PTSD symptoms, including distressing thoughts and memories, flashbacks, hyperarousal, and sleep disturbances, have been linked with elevated norepinephrine levels in the cerebrospinal fluid. Clonidine, an alpha2-adrenergic agonist, reduces the release of norepinephrine and has been suggested as a treatment for PTSD. However, literature for use of clonidine in PTSD is limited. The objective of this study was to evaluate clinical records of patients with PTSD treated with clonidine to assess reported efficacy and safety. A cohort of veterans with PTSD treated with clonidine at a midwestern VA hospital between July 2015 and January 2018 were studied retrospectively. Medical records of 79 patients with moderate to severe PTSD symptoms were reviewed by three independent clinicians using the Clinical Global Impressions (CGI) scale to quantify symptom severity (CGI-S) before starting clonidine and subjects\u27 change in symptoms (CGI-I) after starting clonidine. Data on adverse events were also collected. Subgroup analyses were conducted on the impact of comorbid diagnoses, concurrent medications, and substance use. Mean CGI-S score at baseline was 4.8 (5 = markedly ill). After treatment with low-dose clonidine, 72% of patients experienced improvement, and 49% scored much improved or very much improved. Adverse effects were reported by 18 out of 79 subjects. In this retrospective analysis of veterans prescribed clonidine for PTSD, CGI-I scores suggested improvement in PTSD symptoms, and minimal side effects were reported. In addition, some comorbid diagnoses and concurrent medications were correlated with variations in outcomes

Distinct populations of GABAergic neurons in mouse rhombomere 1 express but do not require the homeodomain transcription factor PITX2.

International audienceHindbrain rhombomere 1 (r1) is located caudal to the isthmus, a critical organizer region, and rostral to rhombomere 2 in the developing mouse brain. Dorsal r1 gives rise to the cerebellum, locus coeruleus, and several brainstem nuclei, whereas cells from ventral r1 contribute to the trochlear and trigeminal nuclei as well as serotonergic and GABAergic neurons of the dorsal raphe. Recent studies have identified several molecular events controlling dorsal r1 development. In contrast, very little is known about ventral r1 gene expression and the genetic mechanisms regulating its formation. Neurons with distinct neurotransmitter phenotypes have been identified in ventral r1 including GABAergic, serotonergic, and cholinergic neurons. Here we show that PITX2 marks a distinct population of GABAergic neurons in mouse embryonic ventral r1. This population appears to retain its GABAergic identity even in the absence of PITX2. We provide a comprehensive map of markers that places these PITX2-positive GABAergic neurons in a region of r1 that intersects and is potentially in communication with the dorsal raphe