COVID-19 communication resources in a major health system: development and dissemination.

OBJECTIVES: Early in the pandemic, institutional leadership recognised the importance of providing staff with practical, clinically based communication resources. This paper describes the process of cultivating and disseminating rapid communication resources across a multisite institution to assist others who may need to rapidly respond to communication challenges in the future. METHODS: In April 2020, the Mayo Healthcare Incident Command System charged the Center for Palliative Medicine with developing and disseminating clinical communication resources within several weeks. The Education Chair for the Center for Palliative Medicine created a COVID-19 communication task force composed of clinician-educators with expertise in serious illness communication from all three academic Mayo Clinic sites. The task force elected to focus on providing accessible, just-in-time online content curated from existing resources and adapted to situational needs. RESULTS: The task force developed one-page resources with example language on 16 topic areas. Topics included exploring patient values, discussing time-limited trials and making recommendations. The COVID-19 communication website was launched on 28 May, 6 weeks after the institutional request. CONCLUSIONS: Key takeaway lessons were the need for: (1) alignment with institutional need and priority, (2) rapid team formation with communication education experts across a variety of institutional geographic settings, (3) quick consensus on topic and content delivery to be practically helpful to clinicians, (4) collaboration with outside groups to use and adapt already available resources when possible and (5) early and iterative involvement with information specialists to help facilitate institutional dissemination.

Resurgence of Eating Disorders with Olanzapine.

BACKGROUND: Olanzapine is commonly utilized in palliative care for the treatment of nausea, and a known side effect of olanzapine is increased appetite. Olanzapine is also known to cause re-emergence of eating disorders (EDs) in patients utilizing olanzapine for its antipsychotic effects. It is unclear to what extent this may also occur in patients with serious/life-limiting illness. METHODS AND RESULTS: We present a case of a 70-year-old female with recurrent ovarian cancer and a history of bulimia nervosa (BN) that developed resurgence of her BN after initiation of olanzapine for cancer-associated nausea. Her BN resolved with reducing the dose of olanzapine. CONCLUSION: It is important to recognize that recurrence of EDs can occur when using olanzapine in the palliative care setting.

Bereavement Service Preferences of Surviving Family Members: Variation among Next of Kin with Depression and Complicated Grief.

BACKGROUND: Research indicates that bereavement services reduce distress and support adjustment in the bereaved, particularly those experiencing significant levels of depression or grief. However, the service use of bereaved individuals and whether utilization differs among those experiencing depression and complicated grief currently remain unclear. Research is needed to clarify the preferences of the bereaved, including specific bereaved subgroups. OBJECTIVES: The purpose of this study was to explore the bereavement service preferences of bereaved family members whose loved one died in the hospital and identify group differences in service use among individuals with and without depression and complicated grief, considering time since the death of the patient. DESIGN: In this cross-sectional study, self-report data were collected from family members primarily between 3 and 18 months following the death of the patient in the hospital. SETTING: Academic medical center. MEASUREMENTS: We explored helpfulness ratings and actual and projected service utilization of a comprehensive list of hospital and community bereavement services, and compared findings between those with and without depression and complicated grief, considering timing since patient death. RESULTS: Services receiving the highest helpfulness ratings by the entire sample included time alone with the deceased, a quiet room to be alone after the death, sympathy cards from hospital staff, memorial services, chaplain support before/during time of death, an educational grief booklet, grief book recommendations, a check-in phone call from hospital staff, individual counseling, and a relationship-specific support group. Individuals with depression and complicated grief reported a greater willingness to utilize specific services, including a memorial website, support groups, a holiday workshop, and individual/family psychotherapy. CONCLUSION: Findings indicate a difference in the projected service use of the bereaved experiencing depression and/or complicated grief. Follow-up screenings 6-12 months post-bereavement are recommended to identify those in need of formal psychosocial support.

ICU versus Non-ICU Hospital Death: Family Member Complicated Grief, Posttraumatic Stress, and Depressive Symptoms.

BACKGROUND: Family members of patients who die in an ICU are at increased risk of psychological sequelae compared to those who experience a death in hospice. OBJECTIVE: This study explored differences in rates and levels of complicated grief (CG), posttraumatic stress disorder (PTSD), and depression between family members of patients who died in an ICU versus a non-ICU hospital setting. Differences in family members' most distressing experiences at the patient's end of life were also explored. METHODS: The study was an observational cohort. Subjects were next of kin of 121 patients who died at a large, Midwestern academic hospital; 77 died in the ICU. Family members completed measures of CG, PTSD, depression, and end-of-life experiences. RESULTS: Participants were primarily Caucasian (93%, N = 111), female (81%, N = 98), spouses (60%, N = 73) of the decedent, and were an average of nine months post-bereavement. Forty percent of family members met the Inventory of Complicated Grief CG cut-off, 31% met the Impact of Events Scale-Revised PTSD cut-off, and 51% met the Center for Epidemiologic Studies Depression Scale depression cut-off. There were no significant differences in rates or levels of CG, PTSD, or depressive symptoms reported by family members between hospital settings. Several distressing experiences were ranked highly by both groups, but each setting presented unique distressing experiences for family members. CONCLUSIONS: Psychological distress of family members did not differ by hospital setting, but the most distressing experiences encountered at end of life in each setting highlight potentially unique interventions to reduce distress post-bereavement for family members.

Does autocthonous primary production influence oviposition by Aedes japonicus japonicus (Diptera: Culicidae) in container habitats?

Aedes (Finlaya) japonicus japonicus (Theobald) (Diptera: Culicidae) is recently invasive in North America and has expanded its range rapidly since 1998. Throughout its native and expanded range, Ae. j. japonicus larvae are commonly observed in many types of natural and artificial water-filled containers that vary in organic matter content and exposure to sunlight. Larvae are most often found in containers with decaying leaf material or algae, and we postulated that the added autocthonous primary production from algae could be both an important food source for larvae and an influential oviposition attractant to adult Ae. j. japonicus. We tested this hypothesis by placing plastic containers with varied levels of shading to manipulate algal density in the field, and then monitored oviposition by natural populations of Ae. j. japonicus. Over 99% of larvae hatching from eggs laid on the walls of our containers were Ae. j. japonicus, indicating that this species is a dominant colonizer of artificial containers in the study areas. Although full shading treatments effectively reduced algal biomass (significant reduction in chlorophyll a levels), at only one of three sites did this appear to affect Ae. j. japonicus oviposition. We conclude that algae in larval habitats are not a major factor in oviposition choices of adult Ae. j. japonicus females except when in situ primary production is high enough to substantially alter overall organic matter content cues.

Effects of comorbid psychopathy on criminal offending and emotion processing in male offenders with antisocial personality disorder.

Antisocial personality disorder (ASPD) and psychopathy are two syndromes with substantial construct validity. To clarify relations between these syndromes, the authors evaluated 3 possibilities: (a) that ASPD with psychopathy and ASPD without psychopathy reflect a common underlying pathophysiology; (b) that ASPD with psychopathy and ASPD without psychopathy identify 2 distinct syndromes, similar in some respects; and (c) that most correlates of ASPD reflect its comorbidity with psychopathy. Participants were 472 incarcerated European American men who met Diagnostic and Statistical Manual (4th ed., American Psychiatric Association, 1994) criteria for ASPD and Psychopathy Checklist criteria for psychopathy, who met the criteria for ASPD but not for psychopathy, or who did not meet diagnostic criteria for either ASPD or psychopathy (controls). Both individuals with ASPD only and those with ASPD and psychopathy were characterized by more criminal activity than were controls. In addition, ASPD with psychopathy was associated with more severe criminal behavior and weaker emotion facilitation than ASPD alone. Group differences in the association between emotion dysfunction and criminal behavior suggest tentatively that ASPD with and ASPD without prominent psychopathic features may be distinct syndromes.

Specifying the impulsivity of female inmates with borderline personality disorder.

Impulsivity is regarded as a core feature of borderline personality disorder (BPD; M. C. Zanarini, J. G. Gunderson, & F. R. Frankenburg, 1989) despite lack of evidence from laboratory research (D. M. Dougherty, J. M Bjork, H. C. G. Huckabee, F. G. Moeller, & A. C. Swann, 1999). This study examined impulsivity in incarcerated women with BPD using a passive avoidance task (J. P. Newman & W. A. Schmitt, 1998) and the Impulsiveness-Monotony Avoidance-Detachment inventory (IMD; D. Schalling, 1978). As predicted, incarcerated women diagnosed with BPD committed more passive avoidance errors and reported more impulsivity on the IMD than controls. These findings identify disinhibition as a potentially important component of the impulsivity that characterizes BPD. Specifying the impulsive behavior identified with BPD may contribute to the effective assessment and management of the disorder.

Utilization of emotion cues in male and female offenders with antisocial personality disorder: results from a lexical decision task.

Antisocial personality disorder (ASPD) diagnoses have demonstrated good reliability and validity in male offenders. However, there is a paucity of research assessing utilization of emotion cues in ASPD individuals and the extent to which correlates of ASPD in males generalize to females. This investigation examined emotion utilization in incarcerated men and women with and without ASPD using a lexical decision task with emotional and neutral words. The performance of male offenders with ASPD was similar to that of male controls, whereas women with ASPD demonstrated greater emotional facilitation than female controls. Moreover, the number of violent crimes committed by female inmates with ASPD was related to emotion facilitation, suggesting a link between their sensitivity to emotion cues and antisocial behavior.

Deficient response modulation and emotion processing in low-anxious Caucasian psychopathic offenders: results from a lexical decision task.

The clinical and research literatures on psychopathy have identified an emotion paradox: Psychopaths display normal appraisal but impaired use of emotion cues. Using R. D. Hare's (1991) Psychopathy Checklist-Revised and the G. S. Welsh Anxiety Scale (1956), the authors identified low-anxious psychopaths and controls and examined predictions concerning their performance on a lexical-decision task. Results supported all the predictions: (a) low-anxious psychopaths appraised emotion cues as well as controls; (b) their lexical decisions were relatively unaffected by emotion cues; (c) their lexical decisions were relatively unaffected by affectively neutral word-frequency cues; and (d) their performance deficits were specific to conditions involving right-handed responses. The authors propose that deficient response modulation may underlie both the emotional and cognitive deficits associated with low-anxious psychopaths.