Preferences and Barriers to Care Following Psychiatric Hospitalization at Two Veterans Affairs Medical Centers: A Mixed Methods Study.

Patient preferences and barriers to care may impact receipt of adequate mental health treatment following psychiatric hospitalization and could inform quality improvement initiatives. This study assessed preferences for a broad range of post-hospital services and barriers to counseling by surveying 291 patients and interviewing 25 patients who had recently been discharged from an inpatient psychiatric stay at one of the two Veterans Affairs Medical Centers. Individual counseling was the most frequently reported service that survey respondents preferred, but did not receive; whereas, open-ended survey responses and interviews also identified telephone follow-up "check-in" calls as a frequently preferred service. Difficulty with transportation was the most commonly cited barrier to counseling among survey respondents and in interviews; however, patients strongly preferred in-person counseling to telephone or internet-video alternatives. Increasing support from family and support from an individual Veteran peer were also perceived to be helpful in the majority of survey respondents.

A randomized study of cognitive remediation for forensic and mental health patients with schizophrenia.

Cognitive remediation has proven efficacy for improving neurocognition in people with schizophrenia. The current study evaluated the benefits of cognitive remediation on neurocognition, functioning, psychotic symptoms, and aggression in a sample of forensic and mental health patients. Care recipients with schizophrenia or schizoaffective disorder (N = 78) receiving services in the forensic and mental health units of a state hospital were randomized to participate in cognitive remediation versus computer games control activities. Participants' neurocognition, functional capacity, experiential recovery, psychotic symptoms, and aggression incidents were assessed at baseline and posttreatment. Cognitive remediation was associated with improvements in several neurocognitive domains and circumscribed domains of functional capacity. People assigned to cognitive remediation experiences greater reductions in negative symptoms, agitation/excitement, and verbal and physical aggression. In addition to improving neurocognition in long-term hospitalized forensic and mental health patients, cognitive remediation may enhance efforts at reducing negative symptoms, emotion dysregulation, and aggression incidents. Forensic settings may represent a new frontier for the clinical dissemination of cognitive remediation.

Self-efficacy and quality of life among people with bipolar disorder.

People with bipolar disorders report a lower quality of life than the general population does, and few mutable factors associated with health-related quality of life (HRQoL) among people with bipolar disorders have been identified. Using a cross-sectional design, these analyses examined whether self-efficacy was associated with mental and physical HRQoL in a sample of 141 patients with bipolar disorder who completed baseline assessments for two randomized controlled trials. Multiple linear regression analyses indicated that higher levels of self-efficacy were associated with higher mental and physical HRQoL, after controlling for demographic factors and clinical factors (including mood symptoms, comorbid medical conditions, and substance use). Future research should examine whether targeted treatments that aim to improve self-efficacy (such as self-management interventions) lead to improvements in HRQoL among people with bipolar disorder and other serious mental illnesses.

Service utilization among veterans with schizophrenia and a comorbid anxiety disorder.

OBJECTIVE: The objective was to assess the prevalence and impact of anxiety disorders on service utilization among Veterans Health Administration (VHA) patients with schizophrenia. METHODS: This cross-sectional study examined diagnostic, utilization, and medication records included in the VHA National Psychosis Registry. Relationships between schizophrenia and anxiety disorders were evaluated along demographic and service utilization dimensions. RESULTS: During fiscal year 2011, 23.8% (N=20,722) of 87,006 VHA patients with schizophrenia were diagnosed as having a comorbid anxiety disorder; 15.2% of the sample had a posttraumatic stress disorder (PTSD) diagnosis and 8.6% a non-PTSD anxiety disorder. Comorbid anxiety disorders were associated with increased psychiatric comorbidity (depression, personality disorder, and substance use disorder), higher rates of psychiatric and medical hospitalization, and increased utilization of outpatient mental health services. CONCLUSIONS: Anxiety disorders are common among individuals with schizophrenia within the VHA and appeared in this study to convey additional disability in terms of psychiatric comorbidity and the need for increased psychiatric care. Future research should investigate ways to improve detection and enhance treatment provided to this population.

Does a latent class underlie schizotypal personality disorder? Implications for schizophrenia.

Despite growing enthusiasm for dimensional models of personality pathology, the taxonic versus dimensional status of schizotypal personality disorder (PD) remains a point of contention in modern psychiatry. The current study aimed to determine empirically the latent structure of schizotypal PD. We examined the latent structure of schizotypal PD in the Psychiatric Morbidity Survey in Great Britain and the second wave of the U.S.-based National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) survey. We analyzed composite indicators created from participant responses using the mean above minus mean below a cut (MAMBAC), Maximum Covariance (MAXCOV), and latent mode factor analysis (L-Mode) taxometric procedures. We also analyzed item-level responses using two latent variable mixture models--latent class analysis and latent class factor analysis. Taxometric and latent variable mixture analyses supported a dimensional, rather than taxonic, structure in both epidemiological samples. The dimensional model better predicted psychosis, intellectual functioning, disability, and treatment seeking than the categorical model based on DSM-IV diagnosis. People meeting criteria for schizotypal PD appear to exist on a spectrum of severity with the rest of the population. The possible dimensionality of schizotypal PD adds to growing support for a dimensional structure of PDs including other Cluster A disorders.

Pain conditions among veterans with schizophrenia or bipolar disorder.

OBJECTIVE: The purpose of this study was to assess the rates of chronic, noncancer pain conditions in patients with schizophrenia or bipolar disorder within the Veterans Health Administration (VHA) System. METHOD: This cross-sectional study used administrative data extracted from VHA treatment records of all individuals receiving VHA services in fiscal year 2008 (N=5,195,551). The associations between severe psychiatric disorders (schizophrenia and bipolar disorder) and chronic pain (arthritis, back pain, chronic pain, migraine, headache, psychogenic and neuropathic) were evaluated using a series of logistic regression analyses. RESULTS: Veterans with schizophrenia [odds ratio (OR)=1.21] and bipolar disorder (OR=2.17) were significantly more likely to have chronic pain overall relative to veterans without these psychiatric conditions. These associations were slightly lower than for the association between depression and pain in this sample (OR=2.61). The highest associations between specific psychiatric diagnosis and pain condition were found with chronic pain, headache and psychogenic pain. CONCLUSIONS: Noncancer pain conditions occur in elevated rates among patients with schizophrenia and bipolar disorder. Future research could further examine possible barriers to adequate pain treatment among people with serious mental illness, as well as the extent to which chronic pain might impact mental health recovery.

A psychometric study of recovery among Certified Peer Specialists.

The recovery model is wielding a welcome influence in the mental healthcare system. Despite its potential impact, systematic studies of the recovery construct as viewed by consumers and former consumers of mental health services have only recently begun to permeate the literature. We have embarked on an ongoing collaboration with the Georgia Mental Health Consumer Network to study the recovery experiences of Certified Peer Specialists (CPSs). As a first step, we evaluated the psychometric characteristics of a new measure of the recovery construct in CPSs. CPSs (N=84) enrolled in the GMHCN completed the Maryland Assessment of Recovery in Serious Mental Illness (MARS) along with measures of resilience, coping styles, community living, social support, internalized stigma, psychopathology, and personality. Recovery as measured by the MARS was associated with resilience, coping behaviors, quality of social support, community living, internalized stigma, and severity of psychopathology. Recovery did not demonstrate a statistically significant association with personality. Recovery appeared to mediate the effect of psychopathology and episodic stressors on community functioning. Our psychometric study supports the psychometric soundness of the MARS and the construct validity of recovery.

Peers and peer-led interventions for people with schizophrenia.

This article provides a snapshot of the nature, guiding philosophy, and empiric status of interventions for people with schizophrenia that go beyond traditional psychopharmacological and psychosocial treatments to include peer-led interventions. The authors discuss the nature and principles of peer-led interventions for people with schizophrenia and the types of peer-led interventions along with evidence of their effectiveness in fostering the recovery of people with schizophrenia and other severe mental illnesses. Focus is on 3 types of peer-led interventions: (1) mutual support/self-help, (2) consumer-operated services, and (3) peer support services.

Indigenous perspectives on depression in rural regions of India and the United States.

Depression is a major health concern in India, yet indigenous Indian perspectives on depression have often been disregarded in favor of Western conceptualizations. The present study used quantitative and qualitative measures modeled on the Explanatory Model Interview Catalogue (EMIC) to elicit beliefs about the symptoms, causes, treatments, and stigma associated with depression. Data were collected from 92 students at a university in the Himalayan region of Northern India and from 97 students at a university in the Rocky Mountain region of the United States. U.S. participants in this study were included primarily to approximate a "Western baseline" (in which professional conceptions of depression are predominantly rooted) from which to elucidate Indian perspectives. Compared to U.S. participants, Indian participants were more likely to view restive symptoms (e.g., irritation, anxiety, difficulty thinking) as common features of depression, to view depression as the result of personally controllable causes (e.g., failure), to endorse social support and spiritual reflection or relaxation (e.g., yoga, meditation) as useful means for dealing with depression, and to associate stigma with depression. Efforts aimed at reducing depression among Indians should focus more on implementing effective and culturally acceptable interventions, such as yoga, meditation, and increasing social support.

Negative life experiences and the development of cluster C personality disorders: a cognitive perspective.

Early negative experiences have long been thought to play an important role in the development of personality disorders. Most of the literature regarding these early life experiences has focused on borderline personality disorder, with only occasional focus on other personality disorders. Utilizing cognitive theory of personality disorders (Beck et al., 2004), the authors conceptualize cluster C personality disorders (avoidant, dependent, and obsessive-compulsive). They then critically review the relevant literature on early negative life experiences and later development of these disorders to determine whether the theory is supported by the empirical data. The theory regarding avoidant and dependent personality disorders has limited support, whereas data relating to obsessive-compulsive personality disorder are much weaker. Implications and future research suggestions are discussed.

Nonverbal Social Skills of Adults with Mild Intellectual Disability Diagnosed with Depression.

Depression is one of the most common psychiatric disorders in adults with intellectual disability (ID), yet little is known about depressive behaviors in an ID population. This study examined the nonverbal social skills of 18 adults with mild ID diagnosed with depression and a matched sample of adults with mild ID without depression. Nonverbal social skills were coded from videotapes of actual social interactions. Results indicate that adults with mild ID diagnosed with depression evidence a profile of maladaptive nonverbal social skills including limited body movement, a restricted range of facial expressions, infrequent smiling, speaking in a flat and quiet voice, and taking a long time to respond to the questions or comments of a social partner. Findings from this study have implications for enhancing the early detection and diagnosis of depression and guiding theories of and treatments for depression in an ID population.

Does gender moderate associations among impulsivity and health-risk behaviors?

The present study explores the relations among gender, impulsivity and three health-risk behaviors relevant to young adults (tobacco use, alcohol problems and gambling problems) in a sample of 197 college-age individuals. We sought to determine whether impulsivity is associated with health-risk behaviors in the same ways for men and women. For tobacco use and gambling problems, men were at higher risk than women, and impulsivity was not significantly associated with higher risk. Higher levels of motor impulsivity in men accounted for a significant amount of the gender difference in risk for alcohol problems. That is, impulsivity as measured by the Barratt Impulsiveness Scale (version 11), mediated the association between gender and risk for alcohol problems. For impulsivity as measured by Stop Signal Reaction Time (i.e. response inhibition), gender moderated the association between impulsivity and alcohol problems. Specifically, lower levels of impulsivity were associated with greater risk for alcohol problems in both men and women, but the effect was stronger in men. We speculate that this seemingly paradoxical result might be the result of coping drinking to deal with negative affect associated with behavioral overcontrol. These findings suggest that prevention efforts might well focus on identifying individuals at high risk for alcohol problems, especially males, by assessing response inhibition.