Locked in and Growing Old: The Psychiatric, Forensic, and Cognitive Correlates of 30 Years of Psychiatric Hospitalization.

OBJECTIVE: As the number of older adults in the United States continues to grow, the population of older adults with severe mental illness in institutional settings (OASIS) is expected to place a significant demand on healthcare resources. This study presents an update to research regarding the clinical characteristics of OASIS inpatients with histories of extensive hospitalization through the use of a newly developed psychiatric measure: the Clinician-Rated Dimension of Psychosis Symptom Severity. METHODS: We investigated an OASIS sample (N = 55) with an average of nearly 30 continuous years of hospitalization at a forensic state psychiatric hospital. RESULTS: The average OASIS patient exhibited the most prominent psychiatric symptoms via delusions and negative symptoms, received psychotropic medications at substantially higher doses than recommended therapeutic levels, rarely committed acts of institutional violence (IV), and performed more than two standard deviations below the normative mean on cognitive testing. More severe hallucination symptoms were associated with higher psychotropic medication dosage, and more severe depressive symptoms were associated with more IV incidents. OASIS inpatients performed moderately worse than general psychiatric inpatients in the areas of overall cognition, immediate memory, and delayed memory; older age was associated with poorer language and attention. No psychiatric or cognitive factors predicted IV incidents. CONCLUSION: These results highlight the continued importance of understanding the psychiatric, forensic, and cognitive factors associated with aging in an institutional setting and how these factors among OASIS inpatients may vary from general psychiatric inpatients.

Beliefs About the Direct Comparison of E-Cigarettes and Cigarettes.

BACKGROUND: Recent data suggests that positive beliefs about electronic cigarettes (e-cigs) use can lead to later e-cig use. Considering that many advertisements claim that e-cigs are superior to cigarettes, individuals' likelihood to view e-cigs more favorably than cigarettes can also influence subsequent e-cig use; however, no studies have directly assessed such a comparison. OBJECTIVES: The present study created and validated the Comparing E-Cigarettes and Cigarettes questionnaire (CEAC), which asks individuals to directly compare e-cigs and cigarettes on a number of dimensions, in two independent samples. METHODS: In sample 1 (451 undergraduates; mean age = 20.35, SD = 5.44, 72.4% female, 73.4% Caucasian) we explored the factor structure of the CEAC and in sample 2 (699 community adults collected via Amazon's Mechanical Turk; mean age = 34.04, SD = 10.9, 47.7% female, 83.3% Caucasian) we replicated the factor structure. RESULTS: Exploratory factor analysis suggested a three-factor structure: General Benefits (α = 0.80), General Effects (α = 0.86), and Health Benefits (α = 0.88), which was replicated via confirmatory factor analysis, χ2 = 4.36; RMSEA = 0.07, 90% CI = 0.06-0.08; TLI = 0.99; CFI = 0.99, and was relatively invariant across product use and gender. Individuals reported viewing e-cigs as safer and more beneficial than cigarettes and these beliefs were higher in e-cig users. CONCLUSIONS: Future work should establish how these comparative beliefs are influenced by e-cig use and/or influence subsequent transition to and increases in e-cig use. Although e-cigs are likely less harmful than cigarettes, and thus these comparative beliefs represent that state of nature, e-cigs are not completely without risk.

Unique and interactive effects of impulsivity facets on reckless driving and driving under the influence in a high-risk young adult sample.

Risky driving behaviors are disproportionately high among young adults and impulsivity is a robust risk factor. Recent conceptualizations have proposed multidimensional facets of impulsivity comprised of negative urgency, premeditation, perseverance, sensation seeking, and positive urgency (UPPS-P model). Prior studies have found these facets are associated with risky driving behaviors in college student samples, but no prior studies have examined these facets in clinical samples. This study examined the unique and interactive effects of UPPS-P impulsivity facets on past-year risky driving behaviors in a sample of high-risk young adults (ages 18-30 years) with a history of substance use and antisocial behavior and their siblings (n=1,100). Multilevel Poisson regressions indicated that sensation seeking and negative urgency were uniquely and positively associated with both frequency of past-year reckless driving and driving under the influence. Moreover, lack of premeditation was uniquely and positively associated with reckless driving, whereas lack of perseverance was uniquely and positively associated with driving under the influence. Furthermore, lack of premeditation moderated and strengthened the positive association between sensation seeking and driving under the influence. These study findings suggest that assessing multiple facets of trait impulsivity could facilitate targeted prevention efforts among young adults with a history of externalizing psychopathology.

Negative Urgency Mediates the Relationship between Amygdala and Orbitofrontal Cortex Activation to Negative Emotional Stimuli and General Risk-Taking.

The tendency toward impulsive behavior under emotional duress (negative and positive urgency) predicts a wide range of maladaptive risk-taking and behavioral disorders. However, it remains unclear how urgency relates to limbic system activity as induced from emotional provocation. This study used functional magnetic resonance imaging to examine the relationship between brain responses to visual emotional stimuli and urgency traits. Twenty-seven social drinkers (mean age = 25.2, 14 males) viewed negative (Neg), neutral (Neu), and positive (Pos) images during 6 fMRI scans. Brain activation was extracted from a priori limbic regions previously identified in studies of emotional provocation. The right posterior orbitofrontal cortex (OFC) and left amygdala were activated in the [Neg>Neu] contrast, whereas the left posterior OFC was activated in the [Pos>Neu] contrast. Negative urgency was related to the right lateral OFC (r = 0.43, P = 0.03) and the left amygdala (r = 0.39, P = 0.04) [Neg>Neu] activation. Negative urgency also mediated the relationship between [Neg>Neu] activation and general risk-taking (regression weights = 3.42 for right OFC and 2.75 for the left amygdala). Emotional cue-induced activation in right lateral OFC and left amygdala might relate to emotion-based risk-taking through negative urgency.

Transitioning From Cigarettes to Electronic Cigarettes Increases Alcohol Consumption.

OBJECTIVE: Electronic cigarettes (e-cigs) are a nicotine delivery device that have recently been linked to alcohol use. Many individuals that smoke cigarettes transition to e-cigs as an alternative to cigarette use, despite potential negative health effects of e-cigs. No research to date has examined how former smokers that have transitioned to e-cigs differ from former smokers that do not use e-cigs, particularly in relation to alcohol use. Further, no research has examined how former smokers that use e-cigs regularly or socially may differ in alcohol consumption. METHOD: Using an online community dwelling sample (Former smokers N = 198, mean age = 34.70, SD = 11.45, 56.1% female, 78.3% Caucasian, 37.9% e-cig users), the present study assessed smoking status and alcohol use, with the latter assessed using a timeline followback calendar and the alcohol use disorder identification test (AUDIT). RESULTS: In all former smokers, total drinks (b = 4.01, p = 0.02) and average drinks per drinking day (b = 0.61, p =.01) were both related to e-cig use status, with e-cig users reporting higher alcohol consumption. Among e-cig using former smokers, social users, but not regular users, showed positive relationships with AUDIT scores, b = 1.90, p =.02, total drinks, b = 9.12, p <.001, average drinks, b = 0.98, p =.006, and hazardous drinking status, OR = 3.21, p =.01. CONCLUSIONS: Findings suggest that: (1) former smokers who use e-cigs may have a potential for higher alcohol use; and (2) those who use e-cigs socially may be at heightened risk for hazardous patterns of alcohol consumption. This should be taken into consideration by healthcare providers.

The use of performance validity tests among inpatient forensic monolingual Spanish-speakers.

Performance validity tests (PVTs) are an integral part of neuropsychological assessments. Yet no studies have examined how Spanish-speaking forensic inpatients perform on PVTs, making it difficult to interpret these tests in this population. The present study examined archival data collected from monolingual Spanish-speaking forensic inpatients (n = 55; Mage = 49.6 years, SD = 12.0; 84.9% male; 93.5% diagnosed with a Psychotic Spectrum Disorder) to determine how this population performs on several PVTs. Most participants' scores on the Dot Counting Test (DCT; 82.2%; n = 45), Repeatable Battery for Assessment of Neuropsychological Status-Effort Index (RBANS EI; 84.4%; n = 33), and Test of Memory Malingering (TOMM; 79.1%; n = 43) were indicative of valid performance. Few participants, however, had Rey-15 Item Test (FIT) scores in the valid range (24.5% to 48.0%; Recall n = 50 and Combined n = 49, respectively); although FIT Recall specificity was improved when cutoff scores were lowered. Total years of education, but not other educational factors, were significantly associated with performance on PVTs (r = .33-.40, p = .01-.03). Study results suggest the DCT, TOMM, and RBANS EI may be more appropriate PVTs for Spanish-speaking forensic inpatients compared to the FIT.

Decision making of forensic psychiatric inpatients deemed incompetent to stand trial.

This study examined decision making and its correlates among forensic psychiatric inpatients deemed incompetent to stand trial (IST). This study utilized archival data (n = 41; Mean Age = 44.27, SD = 15.89, 79.1% Male; 34.1% Caucasian). Decision making was measured using the Iowa Gambling Task (IGT), which is purported to simulate real-life decision making. Correlates included cognitive functioning, psychiatric symptom severity, and impulsivity. Participants selected more frequently from disadvantageous decks, which yield larger immediate monetary gains with a larger long-term monetary losses (Mean NET = -9.51, SD = 26.70), but avoided decks yielding frequent monetary losses (Mean GLF = 10.10, SD = 26.70). Consistently, participants selected most frequently from a deck yielding the most immediate monetary gains and the least frequent monetary losses compared to other decks (ps < 0.05). Based upon their selections, participants lost a significant amount of money (M = -$1,493.22, SD = $1,182.26). IGT outcomes were differentially associated with cognitive functioning (rs = -0.26 to 0.47), psychiatric symptom severity (rs = -0.41 to 0.37), and impulsivity (rs = -0.47 to 0.28; all ps = 0.003-0.98). Findings can guide future research, as well as guide competency restoration and decision-making interventions, for this population.

Preliminary support for the role of alcohol cues in food cravings and attentional biases.

This study examined whether alcohol odors, in isolation or when combined with pictures, would influence food attentional biases and cravings. Participants' cravings and attentional biases to food and alcohol pictures were assessed after exposure to alcohol or water odors ( n = 77; mean age = 30.84 years, 51.9% female, 83.1% Caucasian). Food attentional biases were increased by alcohol odors, but food cravings were increased only by a combination of alcohol odors and food pictures. These effects were related with self-reported problematic food consumption. These findings support a research program for further examining the effect of alcohol cues on problematic food consumption.

Impaired verbal learning in forensic inpatients with Schizophrenia Spectrum Disorder.

The present study aimed to: (a) examine verbal learning performances among forensic inpatients diagnosed with Schizophrenia Spectrum Disorder (SSD); and (b) compare verbal learning performances among forensic SSD inpatients, SSD outpatients, and a small control sample. Participants included forensic SSD inpatients (n = 71), SSD outpatients (n = 305; see Stone et al.), and a control sample from the California Verbal Learning Test-II (CVLT-II) manual (n = 78; see Delis, Kramer, Kaplan, & Ober). Five verbal learning outcomes were measured using the CVLT-II. The average forensic SSD inpatients performed 1 to 1.5 standard deviations below the mean across the five verbal learning outcomes, many of whom (26.8% to 36.6%) performed in the impaired range across the five outcomes. Forensic SSD inpatients performed significantly lower than the SSD outpatients on three verbal learning outcomes and significantly lower than healthy controls on all five verbal learning outcomes. Results indicated forensically committed SSD inpatients have diminished verbal learning performances. Study findings could help define normative verbal learning performances in different types of SSD patients, may guide the development of compensatory strategies for verbal learning deficits, and could subsequently lead to more successful clinical outcomes in this population.

The Use of RBANS among Inpatient Forensic Monolingual Spanish Speakers.

OBJECTIVE: The Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) has been shown to be an effective screener for detecting neurocognitive impairments in English speaking forensic psychiatric inpatients, but no studies have examined whether the RBANS would have the same utility among monolingual Spanish speaking inpatients. This study sought to examine RBANS performance, as well as risk factors (i.e., educational, neurological, and medical) influencing RBANS performance, in that particular population. METHOD: The present study examined archival data collected from monolingual Spanish speaking inpatients (n = 34; mean age = 48.71, SD = 11.99; 85.3% men; 93.5% with Schizophrenia Spectrum Disorder). All participants must have RBANS data, and must not have a diagnosis of malingering or major neurocognitive disorder. Medical records of eligible participants were examined. RESULTS: Our findings indicated that most participants (75.8%) performed in the impaired range for the RBANS Total Index; however, the frequency of impaired performances varied on more specific RBANS indices (42.4%-72.7% of the participants). Although neurological and medical risk factors were not associated with RBANS Total Index performance (all p's = .26-.82), years of education appeared to be inversely associated with RBANS Total Index score (all p's = .04-.07). CONCLUSIONS: These findings can serve as the first step in helping to define "normative" cognition among Spanish speaking forensic psychiatric inpatients. Such findings can reduce the likelihood of over-pathologizing performance and increase the likelihood that treatment goals will be better tailored to the patient's cognitive ability.

Prohibition of e-cigarettes in the US: Are prohibitions where alcohol is consumed related to lower alcohol consumption?

Recently, research has suggested negative consequences related to electronic cigarette (e-cig) use, including the increased risk for alcohol use and abuse. Previous work found that cigarette smoking ban legislation lowered overall smoking and alcohol use rates; however, researchers have not yet examined the potential effects of prohibiting e-cig use. The present study surveyed 617 individuals from a community-based online sample in the US (mean age = 33.33, SD = 10.50, 54.7 per cent female) who reported their smoking/e-cig use status, alcohol consumption, and the presence of e-cig prohibitions where they consume alcohol. E-cig prohibition was associated with a lower likelihood of being an e-cig user (OR = 0.12, p < 0.001) or dual user (use both cigarettes and e-cigs) (OR = 0.07, p < 0.001). Alcohol Use Disorder Identification Test scores (b = -1.92, p < 0.001), total drinks consumed over 14 days (b = -4.58, p = 0.002), and average drinks per drinking day (b = -0.71, p < 0.001) were all lower when e-cigs were prohibited. Findings are an initial step in this line of research and suggest important future work examining implications of e-cig prohibition recommendations and policy.

Combined expectancies of alcohol and e-cigarette use relate to higher alcohol use.

Electronic cigarettes (e-cigs) were created to approximate the look, feel, and experience of using a cigarette. Since cigarette and alcohol use co-occur, we hypothesized that e-cig and alcohol use also co-occur, likely due to shared positive drug expectations. Using self-report data from two independent samples of community-dwelling alcohol using adults, the present study: (1) modified the Nicotine and Other Substance Interaction Expectancy Questionnaire (NOSIE) to assess expectancies of combined e-cig and alcohol use (i.e. the individuals perceived likelihood of using e-cigs and alcohol together; NOSIE-ER); and (2) examined the relationships among e-cig use, expectancies, and alcohol use across e-cig use status. In the first sample (N=692, mean age=32.6, SD=9.74, 50.7% female, 82.2% Caucasian), exploratory factor analysis suggested the presence of two factors: (1) alcohol use leads to e-cig use (Scale 1; α=0.85); and (2) e-cig use leads to alcohol use (Scale 2; α=0.91). In the second sample (N=714, mean age=34.1, SD=10.89, 47.8% female, 75.6% Caucasian), confirmatory factor analysis supported this factor structure (χ(2)=47.00, p<0.01, df=19; RMSEA=0.08, 90% CI=0.05-0.11; TLI=0.99; CFI=0.99). Compared to non e-cig users, e-cig users had significantly higher problematic alcohol use in both samples (b's=0.09 to 0.14, p's<.05). Expectancies of combined e-cig and alcohol use were significantly related to problematic alcohol use (b's=-0.92 to 0.26, p's<.05). In sum, e-cig use is related to alcohol use and expectancies of combined e-cig and alcohol use; consequently, reshaping of beliefs about needs or desires to co-use could be a prime point of intervention.

Elucidating the Association between Trait Mindfulness and Alcohol Use Behaviors among College Students.

Trait mindfulness has been considered a protective factor against alcohol use behaviors; however, the specific trait mindfulness facets, the specific alcohol use behaviors, and the mechanism underlying this relationship remain unclear. The present study examined the relationship between specific trait mindfulness facets and specific alcohol use behaviors, and how cued alcohol cravings might mediate this relationship. High-risk, young adult, undergraduate social drinkers (n = 240, 75% Caucasian, 70% female, mean age 19.4 years) completed a series of questionnaires and reported their level of alcohol cravings following alcohol pictorial cue exposure. Trait mindfulness was associated with less problematic alcohol use (r = -0.19, p < 0.01), but was not associated with alcohol use quantity (r = -0.07, p = 0.30) and duration (r = -0.08, p = 0.21). Only acting with awareness was associated with all types of alcohol use behaviors-including less problematic alcohol use (ß = -0.18, p = 0.02), lower alcohol use quantity (ß = -0.16, p = 0.04), and shorter alcohol use duration (ß = -0.19, p = 0.02). Cued alcohol cravings mediated the negative associations of overall trait mindfulness (b = -0.50, p < 0.05) and acting with awareness (b = -0.32, p < 0.05) with problematic alcohol use, and the negative associations of acting with awareness with alcohol use quantity (b = -1.24, p < 0.05) and alcohol use duration (b = -0.34, p < 0.05). These findings suggest that the protective effect of trait mindfulness likely operates through reducing cued alcohol cravings and might be most specific to acting with awareness among college students, thus suggesting a differential role of separate trait mindfulness facets in this high risk group.

Examination of a short English version of the UPPS-P Impulsive Behavior Scale.

The current study examines a recently developed short English version of the UPPS-P Impulsive Behavior Scale. Participants were 251 undergraduate students (59.3% male; mean age=21.16 (SD=4.18); 72% Caucasian). The short version generally replicated the internal consistency (0.74-0.88 across subscales) and inter-scale correlations of the full English UPPS-P. Moreover, the estimated loss of shared variance was small (0%-6.4% reductions across subscales) as compared to a 66% time-savings. Structural equation modeling replicated previously supported factor structures and relationships to external outcomes using the full UPPS-P. This short UPPS-P scale should be considered a valid and reliable alternative to the full UPPS-P in English-speaking non-clinical adult samples.

A meta-analysis of the relationship between trait mindfulness and substance use behaviors.

BACKGROUND: The relationship between trait mindfulness and substance use behaviors has been inconsistent across studies. The current meta-analysis aimed at quantifying the magnitude of this relationship, and at determining how this relationship varies in context of (1) mindfulness facets, (2) substance type, (3) sample characteristics, and (4) substance use severity. METHODS: Using electronic databases, the literature search yielded 303 articles, but only 39 articles met inclusion criteria to be included in this meta-analysis. The relationship was quantified as a Pearson's r correlation coefficient for all studies. RESULTS: Findings indicated a small, negative, and significant trait mindfulness-substance use behaviors relationship (r=-0.13). This relationship varied across substance type, clinical status of the sample, and substance use severity. Mindfulness facet was not a significant moderator; however, only particular facets (e.g., acting with awareness, non-judgment, and non-reactivity) were consistently associated with substance use behaviors. CONCLUSIONS: This meta-analysis quantified the trait mindfulness-substance use behaviors relationship, which can be used as future effect size estimates. Findings also indicated that the trait mindfulness-substance use behaviors relationship was more robust: (1) for alcohol and tobacco use compared to marijuana use behaviors; (2) for problematic compared to non-problematic substance use behaviors; and (3) with inpatient compared to outpatient and non-clinical samples. Further work should continue to examine if acting with awareness, non-judgment, and non-reactivity mindfulness facets are more robustly associated with substance use behaviors. Failure to consider these factors, or collapsing across these factors, could explain the smaller or inconsistently reported associations across previous studies.

Religiosity and substance use among Asian American college students: moderated effects of race and acculturation.

BACKGROUND: Religiosity is a well-established protective factor against substance use among Caucasians, but limited research has examined its role among Asian Americans. The purposes of this study were (1) to examine whether the associations between religiosity and substance use outcomes differed across Caucasians and Asian Americans, and (2) to test whether acculturation moderated the associations between religiosity and substance use outcomes among Asian Americans. METHOD: We utilized a large and diverse cross-sectional sample of 839 college students to test whether race moderated the associations between religiosity and substance use outcomes (Study 1). We then replicated and extended our findings in a separate college sample of 340 Asian Americans, and examined the moderating role of acculturation on the associations between religiosity and substance use outcomes (Study 2). RESULTS: Controlling for age, gender, and paternal education, religiosity was protective against alcohol use, alcohol problems, and marijuana use among Caucasians but was unrelated to these outcomes among Asian Americans in Study 1. In Study 2, religiosity was protective against alcohol problems only at high levels of acculturation. Moreover, religiosity was protective against marijuana use at both high and mean levels of acculturation, but not at low levels of acculturation. CONCLUSIONS: The protective effects of religiosity on alcohol use and problems varied across Caucasian and Asian American college students, and religiosity protected against alcohol problems and marijuana use only among more acculturated Asian Americans. These findings underscore the need to examine culturally-specific correlates of substance use outcomes among Asian Americans.

Dispositions to rash action moderate the associations between concurrent drinking, depressive symptoms, and alcohol problems during emerging adulthood.

"Impulsivity" has been consistently identified as a key personality predictor of alcohol-related problems and subsequent alcohol use disorder. Multiple prior studies have demonstrated impulsivity is an individual difference factor that strengthens the effects of some risk factors, such as alcohol consumption and depressive symptoms, on alcohol problems. However, recent research indicated common measures of impulsivity actually reflect multiple dispositions toward rash action, and that alcohol problems were most consistently related to one of those dispositions, negative urgency. Little research has examined how specific dispositions to rash action may act as putative moderators of other risk factors for alcohol problems. The goal of the current study was to test which dispositions to rash action moderated the effects of concurrent alcohol use or depressive symptoms on alcohol problems. Using a large cross-sectional sample of college students (n = 573), the current study utilized semicontinuous regression models, which allow prediction of both the likelihood and level of alcohol problems. Negative urgency was found to be the main predictor of alcohol problems, above and beyond other dispositions to rash action, which replicates prior research. However, each of the other dispositions exhibited risk-enhancing effects on the relations between either depressive symptoms or alcohol use and concurrent alcohol problems. Specifically, lower levels of premeditation enhanced the association between depressive symptoms and alcohol problems, while lower perseverance and higher sensation seeking were related to more alcohol problems at higher levels of alcohol use. Results suggest that multiple dispositions to rash action were related to problematic alcohol use both directly and via their interaction with other risk factors.