Adapting an evidence-based mindfulness-based intervention for sheltered youth experiencing homelessness.

OBJECTIVES: Youth experiencing homelessness (YEH) face challenges that impact their physical, mental, and social wellbeing, emotion regulation, and coping. Mindfulness reduces stress and improves resilience, emotion regulation, and executive functioning. Mindfulness-based interventions (MBI) teach the practice of mindfulness to foster present-moment attention without judgement and enhance self-observation and self-regulation, resulting in greater awareness of thoughts and emotions and improved interpersonal relationships. One such intervention, .b, has been shown to lower stress among youth. While a pilot study of .b among sheltered youth found the intervention to be feasible, the need for modifications was identified to improve its relevance, accessibility, and incorporate a trauma-informed approach. METHODS: We used the ADAPT-ITT (Assessment, Decisions, Administration, Production, Topical experts, Integration, Training staff, and Testing) framework to adapt the .b mindfulness intervention to YEH living in an emergency shelter. Nine focus group discussions (n = 56), key informant interviews (n = 8), and beta testing with five youth working group sessions (n = 10) identified needed modifications. RESULTS: Adaptations to the curriculum and delivery modality were made to approximate the average length of stay in the shelter; integrate trauma-informed care approaches; increase diversity of images by race, ethnicity, age, sexual orientation, and gender identity; and increase the relevance of the audio-visual components. CONCLUSIONS: Youth and the health and social services providers who care for youth generally liked the core concepts and presentation of the curriculum. Using the ADAPT-ITT framework, minor, yet important, changes were made to increase the relevance, acceptability, and feasibility of the intervention. Next steps are to conduct a randomized attention control pilot study to assess feasibility and acceptability.

Relationship between mental health diagnoses and sexually transmitted infections.

Multiple studies have demonstrated a relationship between risk factors for sexually transmitted infections (STIs) and mental health needs. This "syndemic" phenomenon suggests that while many patients with mental health conditions are at higher risk for STI acquisition, the relationship also works in the opposite direction: Patients diagnosed with STIs are more likely to have mental health issues. The purposes of this review article are to examine the overlap between mental health and STIs, to provide mental health providers the tools to identify individuals with behavioral health concerns who may be at increased risk for STI acquisition, to discuss how STI diagnosis can affect mental health, and to review interventions to mitigate these risks, such as cognitive-behavioral therapy and motivational interviewing-based behavioral interventions. Integrating primary health care and mental health care for sexual health needs may also help improve delivery of both of these services.

Scratching Past Lymphadenopathy: A Case of Bartonella henselae Encephalitis.

A previously healthy 6-year-old boy presented with new onset seizure activity and altered mental status. His prehospital course included prolonged fever, vague abdominal complaints, and unusual behavior. Neurological testing was unrevealing, and his symptoms slowly improved without intervention. His primary pediatrician had ordered serum antibody titers to Bartonella henselae for testing of prolonged fever in the setting of exposure to a kitten; these were found to be positive for both immunoglobulin G and immunoglobulin M. Further examination for organ involvement revealed splenic and liver micro-abscesses. After completion of his antibiotic course, the patient returned to his cognitive and neurologic baseline with resolution of his abdominal abscesses. This case emphasizes the importance of obtaining a thorough exposure history when evaluating for infectious causes of encephalitis. [Pediatr Ann. 2020;49(8):e359-e362.].

Phenytoin as an effective treatment for polymorphic ventricular tachycardia due to QT prolongation in a patient with multiple drug intolerances.

We present a case of a 69-year-old woman presenting with polymorphic ventricular tachycardia caused by QT prolongation. Owing to known intolerances to a majority of antiarrhythmic medications, one remaining option was to initiate phenytoin. Phenytoin's narrow therapeutic window, multiple drug interactions and side effect profile make it an infrequently used antiarrhythmic. It is, however, a potent antiarrhythmic agent, which may be useful in treatment of ventricular tachycardia, especially in patients with multiple drug intolerances.