Telepsychiatry: The Evaluation and Treatment of Seniors in Rural Retirement Communities

Few studies examine the benefits from geriatric telepsychiatry in rural retirement communities. Objectives: 1. To demonstrate that using telepsychiatry a) standard approaches to psychiatric evaluation would yield diagnoses in Diagnostic and Statistical Manual of Mental Disorders (DSM-V); b. psychotherapies and pharmacotherapy could be effectively administered.  2. To examine the relationships among cognition, mood, agitation and functions at baseline and the response to treatment over time. Design: Prospective longitudinal study. Measures: Geriatric Depression scale (GDS), Mini Mental State Exam (MMSE), Barthel Index (BI), Pittsburgh Agitation Scale (PAS).  Setting: Video Teleconferencing.  Interventions: Psychotherapy, psychopharmacology. Participants: 428 Seniors over 55, met criteria for at least one DSM-V diagnosis. Results: Treatments were administered for a full range of psychiatric diagnoses and age-related medical conditions.  The most frequently prescribed pharmacological agents were: antidepressants (78%) antipsychotics (64%), memory enhancers (38%).   Participants (66%) received psychotherapy: individual (31%), couple (7%), family (13%). Variation in the MMSE scores were observed: 55% remained stable, 11% declined, 18% improved. GDS Scores improved from baseline to 26 weeks (p=0.02, d=0.99: 95% CI 0.39-1.56). PAS scores declined from baseline to 52 weeks  (McNemar’s S= 11.27, p=0.0008, d=1.17: 95% CI 0.63-1.68).   Function (BI) at week 26 was not statistically significantly different from baseline (t(26)=1.66, p=0.11, d=0.65: 95%CI -0.16-1.42). Participants maintained independence (64.5%) at 52 weeks  (McNemar’s S = 6.23, p=0.013, d=0.79: 95%CI 0.19-1.36) Conclusion: This study demonstrates the feasibility and benefit of providing a full complement of services via telepsychiatry to seniors and provides a rationale for more comprehensive reimbursement plans .

Preventing adolescents’ externalizing and internalizing symptoms : effects of the Penn Resiliency Program

This study reports secondary outcome analyses from a past study of the Penn Resiliency Program (PRP), a cognitive-behavioral depression prevention program for middle-school aged children. Middle school students (N = 697) were randomly assigned to PRP, PEP (an alternate intervention), or control conditions. Gillham et al., (2007) reported analyses examining PRP’s effects on average and clinical levels of depression symptoms. We examine PRP’s effects on parent-, teacher-, and self-reports of adolescents’ externalizing and broader internalizing (depression/anxiety, somatic complaints, and social withdrawal) symptoms over three years of follow-up. Relative to no intervention control, PRP reduced parent-reports of adolescents’ internalizing symptoms beginning at the first assessment after the intervention and persisting for most of the follow-up assessments. PRP also reduced parent-reported conduct problems relative to no-intervention. There was no evidence that the PRP program produced an effect on teacher- or self-report of adolescents’ symptoms. Overall, PRP did not reduce symptoms relative to the alternate intervention, although there is a suggestion of a delayed effect for conduct problems. These findings are discussed with attention to developmental trajectories and the importance of interventions that address common risk factors for diverse forms of negative outcomes.peer-reviewe

Development and Evaluation of a Pragmatic Measure of Adherence to Dialectical Behavior Therapy: The DBT Adherence Checklist for Individual Therapy

This paper presents two studies conducted to develop and evaluate a new pragmatic measure of therapist adherence to Dialectical Behavior Therapy (DBT): the DBT Adherence Checklist for Individual Therapy (DBT AC-I). Study 1 used item response analysis to select items from the gold standard DBT Adherence Coding Scale (DBT ACS) using archival data from 1271 DBT sessions. Items were then iteratively refined based on feedback from 33 target end-users to ensure relevance, usability, and understandability. Study 2 examined the psychometric properties of the DBT AC-I as a therapist self-report and observer-rated measure in 100 sessions from 50 therapist-client dyads, while also evaluating predictors of therapist accuracy in self-rated adherence. When used as a therapist self-report measure, concordance between therapist and observer ratings was at least moderate (AC1≥0.41) for all DBT AC-I items but overall concordance (ICC=0.09) as well as convergent (r=0.05) and criterion validity (AUC=0.54) with the DBT ACS were poor. Higher therapist accuracy was predicted by greater DBT knowledge and adherence as well as more severe client suicidal ideation. When used by trained observers, the DBT AC-I had excellent interrater reliability (ICC=0.93), convergent validity (r=0.90), and criterion validity (AUC=0.94). While therapists’ self-rated adherence on the DBT AC-I should not be assumed to reflect their actual adherence, some therapists may self-rate accurately. The DBT AC-I offers an effective and relatively efficient method of evaluating adherence to DBT when used by trained observers

There Must Be A Way

Photograph of Charlie Spivak; Red and white striped backgroundhttps://scholarsjunction.msstate.edu/cht-sheet-music/11156/thumbnail.jp

Association of the Sweet-Liking Phenotype and Craving for Alcohol With the Response to Naltrexone Treatment in Alcohol Dependence: A Randomized Clinical Trial

Identification of moderators of the response to naltrexone hydrochloride treatment for alcohol dependence could improve clinical care for patients with alcohol use disorders. To investigate the preliminary finding that the sweet-liking (SL) phenotype interacts with a high level of craving for alcohol and is associated with an improved response to naltrexone in alcohol dependence. This 12-week double-blind, randomized, placebo-controlled clinical trial was conducted from February 1, 2010, to April 30, 2012, in an academic outpatient medical center. Eighty actively drinking patients were randomized by the SL (n = 22) or the sweet-disliking (SDL) (n = 58) phenotype and by pretreatment high (n = 40) or low (n = 40) craving for alcohol, with high craving defined as greater than the median. Patients and staff were blinded to categorization. Patients were excluded for unstable medical or psychiatric illness, including dependence on drugs other than nicotine. Four patients (2 in the placebo arm and 2 in the naltrexone arm) stopped medication therapy because of adverse effects. Data were analyzed from January 15, 2013, to May 15, 2016, based on intention to treat. Oral naltrexone hydrochloride, 50 mg/d, or daily placebo with weekly to biweekly brief counseling. The a priori hypothesis tested SL/SDL phenotype, pretreatment craving, and their interaction as moderators of frequency of abstinent and heavy drinking days during treatment, assessed with the timeline follow-back method. Eighty patients were randomized (57 men [71%]; 23 women [29%]; mean [SD] age, 47.0 [8.6] years). A nonsignificant effect of naltrexone on heavy drinking was noted (4.8 fewer heavy drinking days; Cohen d = 0.45; 95% CI, -0.01 to 0.90; F1,67 = 3.52; P = .07). The SL phenotype moderated the effect of naltrexone on heavy drinking (6.1 fewer heavy drinking days; Cohen d = 0.58; 95% CI, 0.12-1.03; F1,67 = 5.65; P = .02) and abstinence (10.0 more abstinent days; Cohen d = 0.57; 95% CI, 0.11-1.02; F1,67 = 5.36; P = .02), and high craving moderated heavy drinking (7.1 fewer heavy drinking days; Cohen d = 0.66; 95% CI, 0.20-1.11; F1,67 = 7.37; P = .008). The combination of the SL phenotype and high craving was associated with a strong response to naltrexone, with 17.1 fewer heavy drinking days (Cohen d = 1.07; 95% CI, 0.58-1.54; F1,67 = 19.33; P < .001) and 28.8 more abstinent days (Cohen d = 0.72; 95% CI, 0.25-1.17; F1,67 = 8.73; P = .004) compared with placebo. The SL phenotype and a high craving for alcohol independently and particularly in combination are associated with a positive response to naltrexone. The SL/SDL phenotype and a high craving for alcohol merit further investigation as factors to identify patients with alcohol dependence who are responsive to naltrexone. clinicaltrials.gov Identifier: NCT01296646

Access to transport and life opportunities

This report presents the findings from a study conducted by NatCen and the University of the West of England (UWE Bristol), commissioned by the Department for Transport (DfT) to investigate how access to transport affects the life opportunities and wellbeing of people living in England. This has provided new evidence that access to public and private transport has wide-ranging positive impacts on people’s lives. The study involves analyses of two national longitudinal data sets: Understanding Society and the English Longitudinal Study of Ageing (ELSA). Overall, the study reveals that having personal car access opens up life opportunities including, employment, access to services and social participation. The majority (69%) of the population have personal access to cars and a larger proportion (87%) of the population often use cars (at least once a week). The study also highlights the risk of economic and social exclusion for those with no personal car access and no access to good public transport. Nearly a third of the population do not have personal access to a car and this is more common amongst young adults, those in BME groups, those with impairments, unemployed people and those with low incomes. Given the benefits of personal car access, it is important that barriers to car access are not disproportionate for those who are more reliant on cars, particularly people living in small towns and rural areas, people with mobility impairments and people on low incomes

Psychosocial and productivity impact of caring for a child with peanut allergy

Background Limited previous research has assessed the psychosocial burden and productivity impact of caring for a child with peanut allergy and factors associated with burden. The objective of this research was to explore caregiver burden in terms of psychosocial and productivity impact of caring for a child with peanut allergy, the influence of caregiver and child gender on caregiver burden, and factors predicting caregiver burden in peanut allergy. Methods A cross-sectional survey of caregivers of children with peanut allergy was conducted in the United Kingdom, and included sociodemographic and clinical questions, EQ-5D, Hospital Anxiety and Depression Scale, Food Allergy Quality of Life-Parental Burden, Food Allergy Independent Measure, and productivity questions. Results One hundred caregivers (55% female) of children with peanut allergy (aged 4–15 years) completed the survey. Male and female caregivers reported mean levels of anxiety significantly higher than United Kingdom population norms. Caregivers of children with severe peanut allergy reported significant impacts on their careers and health-related quality of life. Neither caregiver nor child gender impacted burden, indicating that male and female caregivers are equally anxious and suffer the same level of negative career, productivity, and health-related quality-of-life impact due to their child’s peanut allergy. Caregivers’ perceived risk of outcomes related to their child’s peanut allergy (e.g., death or severe reaction) as measured by the Food Allergy Independent Measure independently predicted burden. Conclusions Caregivers of children with peanut allergy in the United Kingdom experience health-related quality-of-life, psychosocial, and productivity burden; this study demonstrates the high levels of anxiety reported by both male and female caregivers

Effects of Education and Media Framing on Genetic Knowledge and Attitudes

Genetic education is paramount to continued genetic advances, as well as for beneficial use of the outcomes of such advances. However, a large body of literature suggests that the public’s genetic literacy remains inadequate. Previous research has found a positive relationship between educational level and genetic literacy. The current research explores this in 2 samples of UK students: school (A-Level) and undergraduates. A between groups ANOVA revealed a significant difference in genetic literacy scores between the educational levels. The current study further explored genetic literacy of Psychology undergraduates, as psychologists are likely to play a key role in the genomic era, for example contributing to genomic research and providing genetic counselling. Results revealed low genetic literacy in Psychology undergraduate students, highlighting the need for genetic education improvements. To this end, experimental manipulations were conducted to investigate the effects of media framing and feedback on views of genetic determinism and knowledge calibration. A between groups ANOVA showed no significant difference between high and low determinism media framing. The knowledge calibration findings suggested that participants were underconfident in their genetic knowledge. No correlation was found between knowledge and perceived knowledge (confidence) in the group of participants who received feedback. In contrast, a positive correlation between knowledge and confidence was found in the no-feedback condition. Future research is needed to build on these findings

Attachment-based family therapy for adolescents with suicidal ideation: a randomized controlled trial.

OBJECTIVE: To evaluate whether Attachment-Based Family Therapy (ABFT) is more effective than Enhanced Usual Care (EUC) for reducing suicidal ideation and depressive symptoms in adolescents. METHOD: This was a randomized controlled trial of suicidal adolescents between the ages of 12 and 17, identified in primary care and emergency departments. Of 341 adolescents screened, 66 (70% African American) entered the study for 3 months of treatment. Assessment occurred at baseline, 6 weeks, 12 weeks, and 24 weeks. ABFT consisted of individual and family meetings, and EUC consisted of a facilitated referral to other providers. All participants received weekly monitoring and access to a 24-hour crisis phone. Trajectory of change and clinical recovery were measured for suicidal ideation and depressive symptoms. RESULTS: Using intent to treat, patients in ABFT demonstrated significantly greater rates of change on self-reported suicidal ideation at post-treatment evaluation, and benefits were maintained at follow-up, with a strong overall effect size (ES = 0.97). Between-group differences were similar on clinician ratings. Significantly more patients in ABFT met criteria for clinical recovery on suicidal ideation post-treatment (87%; 95% confidence interval [CI] = 74.6-99.6) than patients in EUC (51.7%; 95% CI = 32.4-54.32). Benefits were maintained at follow-up (ABFT, 70%; 95% CI = 52.6-87.4; EUC 34.6%; 95% CI = 15.6-54.2; odds ratio = 4.41). Patterns of depressive symptoms over time were similar, as were results for a subsample of adolescents with diagnosed depression. Retention in ABFT was higher than in EUC (mean = 9.7 versus 2.9). CONCLUSIONS: ABFT is more efficacious than EUC in reducing suicidal ideation and depressive symptoms in adolescents. Additional research is warranted to confirm treatment efficacy and to test the proposed mechanism of change (the Family Safety Net Study).Clinical Trial Registry Information: Preventing Youth Suicide in Primary Care: A Family Model, URL: http://www.clinicaltrials.gov, unique identifier: NCT00604097

An improved database of coastal flooding in the United Kingdom from 1915 to 2016

Coastal flooding caused by extreme sea levels can produce devastating and wide-ranging consequences. The ‘SurgeWatch’ v1.0 database systematically documents and assesses the consequences of historical coastal flood events around the UK. The original database was inevitably biased due to the inconsistent spatial and temporal coverage of sea-level observations utilised. Therefore, we present an improved version integrating a variety of ‘soft’ data such as journal papers, newspapers, weather reports, and social media. SurgeWatch2.0 identifies 329 coastal flooding events from 1915 to 2016, a more than fivefold increase compared to the 59 events in v1.0. Moreover, each flood event is now ranked using a multi-level categorisation based on inundation, transport disruption, costs, and fatalities: from 1 (Nuisance) to 6 (Disaster). For the 53 most severe events ranked Category 3 and above, an accompanying event description based upon the Source-Pathway-Receptor-Consequence framework was produced. Thus, SurgeWatch v2.0 provides the most comprehensive and coherent historical record of UK coastal flooding. It is designed to be a resource for research, planning, management and education