Clinical and Legal Considerations When Optimizing Trauma Narratives in Immigration Law Evaluations.

Asylum seekers in the United States face complex legal processes that require the construction of coherent and credible narratives to establish eligibility for legal status or immigration relief. In this article, we review clinical and legal considerations involved in optimizing trauma narratives in forensic psychiatric evaluations for immigration courts. We highlight significant challenges faced by asylum seekers, including the emotional impact of trauma and cultural factors affecting their ability to disclose their experiences, including the roles of symptoms and cultural and situational elements in disclosure and narrative development. We emphasize the importance of creating a therapeutic and empathetic environment to facilitate disclosure and partnering with interpreters across multiple culturally sensitive evaluations. We address the roles of common traumatic stressors in narrative development, including cultural challenges related to histories of torture, abduction, sexual violence, and human trafficking prevalent among asylum seekers, providing insights and guidance on each. Further, we address specific potential challenges to the forensic psychiatric evaluator during the narrative development process, such as transference, countertransference, malingering, and vicarious traumatization. We aim to provide guidance on the development of trauma narratives of asylees developed for both therapeutic and medico-legal effectiveness.

Trends in Individual Career Development Awards from National Institutes of Health to Physicians in Departments of Psychiatry (2013-2022).

OBJECTIVE: The authors examined trends of individual career development awards from the National Institutes of Health (NIH) to psychiatry faculty, especially physicians, in comparison to other departments. METHODS: Data were obtained on 33,392 career development awards from 2013 to 2022. We examined the number of awards each year averaged for 46 non-psychiatry departments, and for departments of psychiatry, the number of awards to all faculty, physicians, and physicians without a PhD. Linear regressions determined whether number of career development awards increased with time and if estimated slopes differed between faculty in non-psychiatry departments and other groups. RESULTS: In departments of psychiatry, 534 faculty received an NIH individual career development award during the 10-year period (534/33,392 or 1.6%), with 118 (22%) to physicians. The number of awards increased significantly over time for other departments and departments of psychiatry (estimated slopes of 3.05 and 2.38, respectively) and did not differ from one another. However, the number of awards to physicians and physicians without a PhD in departments of psychiatry (estimated slopes of 0.51 and - 0.07, respectively) have not increased. This lack of growth in awards for physicians and physicians without a PhD in departments of psychiatry differed significantly in comparison with the increase shown in awards to other departments over time (both p < 0.001). CONCLUSIONS: The number of NIH career development awards has increased NIH-wide, and for non-physician faculty but not for physicians in departments of psychiatry. These trends raise concerns for the future of psychiatrists in academic research.

Maternal Childhood Maltreatment, Internal Working Models, and Perinatal Substance Use: Is There a Role for Hyperkatifeia? A Systematic Review.

The parent-infant relationship is critical for socioemotional development and is adversely impacted by perinatal substance use. This systematic review posits that the mechanisms underlying these risks to mother-infant relationships center on 3 primary processes: (1) mothers' childhood maltreatment experiences; (2) attachment styles and consequent internal working models of interpersonal relationships; and (3) perinatal substance use. Further, the review considers the role of hyperkatifeia, or hypersensitivity to negative affect which occurs when people with substance use disorders are not using substances, and which drives the negative reinforcement in addiction. The authors performed a systematic review of articles (published 2000-2022) related to these constructs and their impact on mother-infant relationships and offspring outcomes, including original clinical research articles addressing relationships between these constructs, and excluding case studies, reviews, non-human animal studies, intervention studies, studies with fewer than 30% female-sex participants, clinical guidelines, studies limited to obstetric outcomes, mechanistic/biological studies, and studies with methodological issues precluding interpretation. Overall 1844 articles were screened, 377 were selected for full text review, and data were extracted from 157 articles. Results revealed strong relationships between mothers' childhood maltreatment experiences, less optimal internal working models, and increased risk for perinatal substance use, and importantly, all of these predictors interacted with hyperkatifeia and exerted a marked impact on mother-infant relationships with less data available on offspring outcomes. These data strongly support the need for future studies addressing the additive impact of maternal childhood maltreatment experiences, suboptimal internal working models, and perinatal substance use, with hyperkatifeia as a potential moderator, and their interacting effects on mother-infant socioemotional outcomes.

Racial and ethnic disparities in women's mental health: a narrative synthesis of systematic reviews and meta-analyses of the US-based samples.

Over 2 decades of research indicate the significance of racial or ethnic disparities in mental illness in the United States. However, minoritized racial or ethnic groups tend to report overall lower prevalence rates of psychiatric disorders than White adults, although this varies depending on gender and race or ethnicity. We conducted a rigorous and systematic narrative synthesis on the differences in the prevalence rates and symptoms that differ across racial or ethnic women in depression, anxiety, eating disorders, and premenstrual syndrome or premenstrual dysphoric disorder. Seven systematic reviews and meta-analyses that examined racial/ethnic differences in depression and eating disorders were included. No review that examined racial/ethnic differences in anxiety or premenstrual syndrome or premenstrual dysphoric disorder met inclusion criteria. Methodological quality of the reviews, which was determined by the Assessment of Multiple Systematic Reviews criteria, revealed that the results of 5 reviews were rated as critically low confidence, one review was rated as low confidence, and one review was rated as high confidence. Findings were inconsistent across systematic reviews and meta-analyses because of the methodological differences in the original studies. Overall, racially or ethnically minoritized women generally report lower prevalence rates in depressive and eating disorders than the White women; however, they exhibit different or greater symptom presentation that could influence prevalence estimates depending on the diagnostic criteria followed. Methodological considerations are provided to strengthen the literature on racial or ethnic mental health disparities in women.

Shared trauma, resilience, and growth: A roadmap toward transcultural conceptualization.

Objective: Countless communities worldwide are exposed directly and subsequently to the effects of massive-scale collective stressors, from natural disasters to human-caused. In contexts of collective adversity, health care providers who are also members of these communities share and interdependently affect the range of responses their patients have. We aim to conceptualize this spectrum, termed shared trauma, shared resilience, and shared growth. Method: In this metasynthesis, we review the literature on these underacknowledged dynamics globally. We include prior conceptualizations of direct and indirect trauma, collective trauma, cultural context, and the COVID-19 pandemic toward clearer conceptualization of shared mental health in global collective stressor contexts. Results: Most trauma and resilience research focuses on prevailing concepts and measures with questionable cross-cultural applicability. These works usually center on acute, highly distressing threats to physical safety at the individual level. The scarce literature on shared trauma describes it as a rare phenomenon, entailing conflicting messages of narrative accounts within contexts of few cultures with medium to high degrees of individualism. There has been little consideration of other non-Western and indigenous communities with more collectivist values and collective trauma histories. There is limited understanding of these concepts as they pertain to the vast majority of cultures. As a result, shared trauma, resilience, and growth have been poorly conceptualized, differentiated, or empirically researched. Conclusions: We propose uniquely inclusive models of shared trauma, resilience, and growth. These models reflect the cumulative effects and interplay of direct to indirect, acute to chronic, individual to collective, and historic to transgenerational factors influenced by cultural context. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Adult Cochlear Implantation Under Local Anesthesia and Conscious Sedation with Dexmedetomidine: Efficacy and a Method to Interact with the Conscious and Cooperative Patient.

BACKGROUND: This study describes the efficacy of cochlear implantation under local anesthesia with conscious sedation with dexmedetomi- dine in adult patients and proposes a method to communicate with the conscious and cooperative patient intraoperatively. This less invasive anesthetic procedure is suitable for patients with comorbidities preventing general anesthesia. METHODS: Unilateral cochlear implantation with Oticon Medical systems was performed in 10 adult patients with comorbidities preventing general anesthesia. Classical cochlear implantation was performed under local anesthesia and conscious sedation with dexmedetomidine. Cue cards were used to support intraoperative dialogue. Outcome measures were intraoperative adverse events, patient perceptions, as well as post- operative completions measured with a questionnaire. RESULTS: The procedure was successful for all 10 patients. Dexmedetomidine lead to rapid and successful conscious sedation and no case of high blood pressure or aggravation of comorbidities was noted. Stapedial reflex measurements led to reliable thresholds. The usage of the cue cards was successful: patients were able to read the cue cards and thereby the medical team could inform the patients of surgical progress and ask the patients questions. CONCLUSION: Cochlear implantation and intraoperative dialogue with the conscious and cooperative patient is possible. The main advantage of the anesthetic procedure is the reduction in intra- and postoperative complications. Further, expected benefits include a less invasive procedure, the conscious state of the patient which enables the recording of auditory perception, and the absence of nonauditory percepts such as facial nerve stimulation during implant stimulation, a shorter surgical duration, and lower-associated costs.

Telehealth Literacy as a Social Determinant of Health: A Novel Screening Tool to Support Vulnerable Patient Equity.

Background: Telehealth has evolved as a solution to COVID-19 isolation precautions and remote care with well-established health, socioeconomic, and practical benefits. However, there are many gaps in the current literature regarding telehealth use among older, low health literate, and resource-limited populations. There are ethical considerations that warrant understanding this digital divide. Objective: The objective of this review is to propose the Telehealth Literacy Screening Tool (TLST) for use in older adults and support the future inclusion of telehealth literacy as an important social determinant of health (SDOH). Methods: Initially a four-week outreach was performed that targeted older adults and low-health literate patients at the MedVantage Clinic (MVC) within Ochsner Health (OH) to identify common barriers to patient engagement with the OH Epic MyChart telehealth platform. Themes from those barriers directed a meta-synthetic review of the methods and ethical considerations of current, validated technological and telehealth literacy screening tools. Those findings were reported based on the standards of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement. Results: Based on the barriers identified during our MVC patient outreach, PRISMA-reported review of telehealth literacy screening research, and evaluation of the MyChart platform and the technological resources required for its use; we developed a multidimensional questionnaire for telehealth literacy screening of older adults. Conclusion: The TLST is designed to identify patients in need of additional interventions for successful connection to telehealth services. This is an important step towards addressing the ethical obligation to decrease disparities in telehealth literacy for vulnerable populations and identifying telehealth literacy as a SDOH.

Early Repolarization Pattern Is Associated with Increased Risk of Early Ventricular Arrhythmias during Acute ST Segment Elevation Myocardial Infarction.

BACKGROUND: Early repolarization (ER) and acute ST segment elevation myocardial infarction (STEMI) are sharing the pathophysiology of J wave syndromes. It is speculated that early ventricular arrhythmias (VAs) during STEMI may be predisposed by ER. Our aim was to study the association between ER pattern and risk of VAs during acute STEMI. METHODS: The study included 102 male patients with acute STEMI who were divided into two groups: cases and controls. Cases included 52 patients with sustained VAs during the first 48 hours from the onset of STEMI, while controls included 50 patients with no VAs. On 12-lead surface electrocardiogram, ER was defined as ≥ 1 mm elevation of J point in at least two inferior or lateral leads with or without ST segment elevation. RESULTS: Mean age was 48.44 ± 10.08 years and mean left ventricular ejection fraction (LVEF) was 42.25 ± 11.1%. ER pattern was more frequent in cases than controls (29 vs 14 patients, P = 0.008). Notched J wave (P = 0.0007) and horizontal ST segment (P = 0.033) were more frequent in cases than controls. On adjusted regression model, LVEF (OR: 0.95, 95% CI: 0.91-0.99, P = 0.015) and ER (OR: 3.39, 95% CI: 1.41-8.12, P = 0.006) could predict VAs, while QTc interval (P = 0.24) and QTd (P = 0.86) did not have predictive effect. Inferior/inferolateral and global ER pattern (P = 0.044 and 0.031 respectively), notched J wave (P = 0.001), increasing J wave amplitude (P = 0.042), and ST segment elevation (P = 0.001) were associated with a higher risk of VAs. CONCLUSIONS: ER is associated with increased risk of VAs in the setting of acute STEMI.