Evaluation of the Online Component of a Blended Learning Electroconvulsive Therapy Curriculum for Psychiatry Residents to Treat Depression in Older Adults.

OBJECTIVE: The objective of this study was to evaluate the online component of a blended curriculum for psychiatry residents on the use of electroconvulsive therapy (ECT) to treat depression in older adults. METHODS: Second- and third-year general psychiatry residents completed a blended learning curriculum during their core geriatric psychiatry rotation. The curriculum consisted of didactic seminars, hands-on clinical management, and two online clinical cases focused on the management of late-life depression with ECT. Knowledge acquisition following module completion was measured using a nine-question multiple-choice test. The authors adapted the Medical E-Learning Evaluation Survey (MEES) to measure resident satisfaction, clinical relevance, and instructional design. RESULTS: A total of 37 residents completed both online modules. Of these, 35 residents completed the knowledge test and 23 completed the adapted MEES. Almost all participants (96%) agreed or strongly agreed that the modules were relevant to their clinical work, evidence-based, able to be completed in a reasonable amount of time, and a valuable learning experience. The average score on the knowledge test, after removing one outlier, was 83%. CONCLUSION: Psychiatry residents are very satisfied with the content and delivery of the online component of a blended curriculum for understanding the use of ECT for late-life depression. Future work should examine satisfaction with the remainder of the curricula as well as the impact on longer-term knowledge acquisition and patient care.

A Life Course Study on Traumatic Brain Injury and Physical and Emotional Trauma in Foster Children.

Foster children are exposed to high levels of abuse, violence, and other adverse events throughout their childhood and adolescent years. Forms of brain injury, notably traumatic brain injury (TBI), are understudied in the foster child population. This study aimed to explore different forms of brain injury and their cognitive, behavioral, and psychological/emotional effects on current and former foster children using a life course perspective. A thematic analysis with a life course perspective was used to examine semi-structured, open-ended interviews conducted with current and previous foster children between the ages of 16 and 29 years. The study included 47 participants: 25 males (53%) and 22 females (47%) with an average age of 21 years and an average of 11.2 years of education. Of 47 current and previous foster children between the ages of 16 and 29, two-thirds had sustained one or more TBIs. Through a thematic analysis, four overarching and inter-related themes emerged from the data: frequent TBI, normalization (of abuse, violence, injury, and neglect), emotional trauma, and dangerous coping methods such as alcohol use in 94% and recreational drug use in 81%. Normalization of adverse events, emotional trauma, and the use of dangerous coping methods occurred in 66%, 81%, and 49% of participants, respectively, and are the cumulative toxic long-term effects of early negative life experiences and repeated forms of brain injury. Early and continued exposure to TBI, abuse, violence, and/or neglect with continued maladaptive behaviors suggests that the participants may have experienced changes in brain structure and function over their lives that provided the milieu for continued vulnerability to personal and future injury to future generations. These behavioral and perceptual changes point to a toxic combination of injuries that result in continued vulnerability to repeated injury through contextual exposure to risks and maladaptive normalization, emotional trauma, and risky coping styles.

Psychosis and Comorbid Opioid Use Disorder: Characteristics and Outcomes in Opioid Substitution Therapy.

BACKGROUND AND OBJECTIVES: Substance use disorders are highly prevalent among individuals with psychotic disorders and are associated with negative outcomes. This study aims to explore differences in characteristics and treatment outcomes for individuals with psychotic disorders when compared with individuals with other nonpsychotic psychiatric disorders enrolled in treatment for opioid use disorder (OUD). METHODS: Data were collected from a prospective cohort study of 415 individuals enrolled in outpatient methadone maintenance treatment (MMT). Psychiatric comorbidity was assessed using the Mini-International Neuropsychiatric Interview. Participants were followed for 12 months. Participant characteristics associated with having a psychotic disorder versus another nonpsychotic psychiatric disorder were explored by logistic regression analysis. RESULTS: Altogether, 37 individuals (9%) with a psychotic disorder were identified. Having a psychotic disorder was associated with less opioid-positive urine drug screens (odds ratio [OR] = 0.97, 95% confidence interval [CI] = 0.95, 0.99, P = .046). Twelve-month retention in treatment was not associated with psychotic disorder group status (OR = 0.73, 95% CI = 0.3, 1.77, P = .485). Participants with psychotic disorders were more likely to be prescribed antidepressants (OR = 2.12, 95% CI = 1.06, 4.22, P = .033), antipsychotics (OR = 3.57, 95% CI = 1.74, 7.32, P = .001), mood stabilizers (OR = 6.61, 95% CI = 1.51, 28.97, P = .012), and benzodiazepines (OR = 2.22, 95% CI = 1.11, 4.43, P = .024). DISCUSSION AND CONCLUSIONS: This study contributes to the sparse literature on outcomes of individuals with psychotic disorders and OUD-receiving MMT. Rates of retention in treatment and opioid use are encouraging and contrast to the widely held belief that these individuals do more poorly in treatment. Higher rates of coprescription of sedating and QTc-prolonging medications in this group may pose unique safety concerns.