Sociodemographic and clinical correlates of the frequently hospitalized African American patients with severe and persistent mental illness.

BACKGROUND: Many researchers and clinicians are becoming increasingly concerned about the phenomenon of frequent psychiatric inpatient hospitalization in those with severe and persistent mental illness. This study aims to shed light on this occurrence in the African American psychiatric inpatient population by examining their sociodemographic and clinical correlates. METHODS: We retrospectively reviewed the medical charts of 39 African American patients who have had ≥3 inpatient psychiatric admissions in a year at Howard University Hospital, an urban, academically-affiliated hospital serving a predominantly African American population in Washington, DC. RESULTS: Most frequently readmitted African American inpatients were male (62%), unmarried (95%), homeless (62%), intoxicated at admission (90%), unemployed (97%), and age ≥35 (87%); expressed suicidal ideations (85%); had a DSM-5 diagnosis of a psychotic spectrum disorder (59%) and less than fair insight into their illness (56%); and stayed in the hospital for ≤4 days (82%). CONCLUSIONS: Many lessons can be learned from this study on African American psychiatric inpatient treatment recidivists, despite the work's limitations. Among these lessons are the need for strong case management, creative aftercare planning, and well-orchestrated, multifaceted services focused on these sociodemographic and clinical correlates- especially homelessness, unemployment, substance use, mood dysregulation, and psychosis-to successfully meet this patient populations' clinical needs.

Factors associated with non-adherence to Buprenorphine-naloxone among opioid dependent African-Americans: A retrospective chart review.

BACKGROUND AND OBJECTIVES: Opioid use disorders are common, chronic relapsing disorders. Buprenorphine (BUP) is an FDA approved medication in the treatment of opioid use disorders, but patient adherence to this medication remains a challenge. To identify risk factors for non-adherence, this chart review study examined the association between DSM-IV Axis I psychiatric disorders, substance use, demographics, and adherence to BUP-naloxone in African-American patients. METHODS: Charts were selected of patients who had ≥5 visits and completed psychometric screens (Patient Health Questionnaire, Mood Disorder Questionnaire, and a posttraumatic stress disorder questionnaire) at the time of the initial visit (N = 50). Urine drug screens (UDS) were also obtained. Treatment adherence was defined as BUP presence in UDS for ≥80% of the visits. RESULTS: A total of 48% of patients were adherent to treatment. Non-adherent patients had higher rates of use for not only opioids, but also cocaine, and alcohol. Cocaine use was associated with BUP-naloxone non-adherence even after controlling for opioid use. Attendance in cognitive behavioral group therapy sessions (CBT) was significantly associated with adherence. Patients endorsing PTSD symptoms showed higher adherence to treatment compared to those who did not endorse these symptoms. CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE: Our results indicate that alcohol and illicit substance use is associated with non-adherence to BUP-naloxone treatment, and suggests that CBT and efforts to promote abstinence from non-opioid substance use may improve adherence among African-Americans. These findings contribute to growing literature on understanding adherence to BUP-naloxone, which is critical to reduce morbidity and mortality.

Pollen-specific immunoglobulin E positivity is associated with worsening of depression scores in bipolar disorder patients during high pollen season.

OBJECTIVE: An association between allergic disease and depression has been consistently reported, but whether the key mediating ingredients are predominantly biological, psychological, or mere artifacts remains unknown. In the current study, we examined a hypothesized relationship between allergen-specific immunoglobulin E (IgE) status and changes in allergy symptoms with worsening in depression scores. METHODS: In patients with recurrent mood disorders, we individually coupled sensitization to specific seasonal aeroallergens (as assessed by allergen-specific IgE) with temporal windows of exposure to aeroallergens (low versus high tree or ragweed pollen counts, measured according to the National Allergy Bureau guidelines). We compared Structured Interview Guide for the Hamilton Depression Rating Scale-Seasonal Affective Disorder Version (SIGH-SAD) depression score changes in 41 patients with mood disorders [25 with major depression and 16 with bipolar I disorder, diagnosed by Structured Clinical Interview for DSM (SCID)] seropositive for tree or ragweed pollen-specific IgE antibody versus 53 patients with mood disorders (30 with major depression and 23 with bipolar I disorder) seronegative for aeroallergen-specific IgE. RESULTS: Worsening in total depressive scores from low to high pollen exposure was greater in allergen-specific IgE-positive patients as compared to allergen-specific IgE antibody-negative patients (p = 0.01). When stratified by polarity, the association was significant only in patients with bipolar I disorder (p = 0.004). This relationship was resilient to adjustment for changes in allergy symptom scores. CONCLUSION: To our knowledge, this is the first report of coupling a molecular marker of vulnerability (allergen-specific IgE) with a specific environmental trigger (airborne allergens) leading to exacerbation of depression in patients with bipolar I disorder.

Improvement in depression scores after 1 hour of light therapy treatment in patients with seasonal affective disorder.

The purpose of this study was to investigate possible rapid effects of light therapy on depressed mood in patients with seasonal affective disorder. Participants received 1 hour of bright light therapy and 1 hour of placebo dim red light in a randomized order crossover design. Depressed mood was measured at baseline and after each hour of light treatment using two self-report depression scales (Profile of Mood States-Depression-Dejection [POMS-D] subscale and the Beck Depression Inventory II [BDI-II]). When light effects were grouped for the two sessions, there was significantly greater reduction in self-report depression scores by -1.3 (p = 0.02) on the BDI-II and -1.2 (p = 0.02) on the POMS-D. A significant but modest improvement was detected after a single active light session. This is the first study, to our knowledge, to document an immediate improvement with light treatment using a placebo-controlled design with a clinical sample of depressed individuals.

Rapid improvement of depressive symptoms and cognition in an elderly patient with a single session of piano playing: a clinical treatment report.

BACKGROUND AND AIMS: Music has been used as a non-pharmacological modality in the treatment of different conditions since ancient times. It has received attention in modern medicine in recent decades, particularly in geriatric population. The effects of music on mood and cognition are well documented. The aim of the current case report is to highlight the benefits of musical activities in the geriatric population. METHODS: We report a naturalistic treatment outcome in an elderly patient on a geriatric psychiatric unit related to a single session of piano playing. RESULTS: A rapid and sustained improvement in mood and cognition of an elderly patient was observed after a single session of playing piano. Notwithstanding the limitations of a single subject, uncontrolled case study, the effect was dramatic. CONCLUSION: Our findings support previous claims regarding music therapy including effects of a single session music-based therapeutic interventions, and we conclude that music therapy for geriatric patients with mood and cognitive deficits is worth further systematic investigation.

Coma falsely attributed to Lyme disease.

Neuroborreliosis has very low prevalence in Kentucky and coma due to Lyme disease is uncommon in North America. A patient diagnosed with Lyme disease in Kentucky, based on coma, typical inflammatory changes on brain imaging, and a positive ELISA resulted in an erroneous clinical impression. Diagnosis should have been confirmed by a positive result on Western Blot, polymerase chain reaction (PCR), or real-time polymerase chain reaction (RT-PCR) testing. Physicians must apply careful consideration before diagnosing a rare disease in areas where that condition is uncommon without first eliminating other differential options. Neuroborreliosis clinicalfindings are nonspecific and often require confirmatory testing, especially in nonclassical case presentations.

Illustrating and analyzing the processes of multi-institutional collaboration: Lessons learnt at Howard University Hospital.

Multi-institutional collaboration offers a promising approach to the dissemination of resources for capacity building and the improvement of the training of new investigators and residents, especially in areas of novel curricular content. Physicians should keep pace with the rapid growth of curricular content in an era of restricted resources. Such collaborations, in which educational entities work together and share resources and infrastructure, have been employed in health care to improve quality of care, capacity building, disparity reduction, and resident training. This paper examines a federally funded multi-institutional collaboration for the project STRIDE (Seek, Treat, Reach to Identify Pretrial Defendants Enhancement) between Yale University, George Mason University (GMU), and Howard University, a Historically Black University. The STRIDE study collaboration focused on mental health, opioid addiction, and infectious disease/HIV among Africans Americans involved in CJS (Criminal Justice System). We discuss some of the challenges and benefits of collaborative research projects conducted at Historically Black Colleges and University (HBCUs) and highlight the educational opportunities created by such collaborations for residents and other trainees, leading to the development of independent investigators through multi-institutional, structured collaborative research. We identify some unique challenges such as substance use, race, stigma, incarceration among participants, and the cultural and power difference between participating institutions, and thereby address these issues and how it impacted the course of the multi-institutional collaborative effort.

An Assessment of Five (PANSS, SAPS, SANS, NSA-16, CGI-SCH) commonly used Symptoms Rating Scales in Schizophrenia and Comparison to Newer Scales (CAINS, BNSS).

Scales measuring positive and negative symptoms in schizophrenia remain the primary mo Scales measuring positive and negative symptoms in schizophrenia remain the primary mode of assessing and diagnosing schizophrenia by clinicians and researchers. The scales are mainly used to monitor the severity of positive and negative symptoms and track treatment response in schizophrenics. Although these scales are widely used, quality as well as general utility of each scale varies. The quality is determined by the validity and reliability of the scales. The utility of the scale is determined by the time of administration and the settings for which the scales can be administered in research or clinical settings. There are relatively fewer articles on the utility of newer scales like CAINS (Clinical Assessment Interview for Negative Symptoms) and the BNSS (Brief Negative Symptom Scale) that compare them to the older scales PANSS (Positive and Negative Symptoms Scale), SAPS (Scale for the Assessment of Positive Symptoms) SANS (the Scale for the Assessment of Negative Symptoms), NSA-16 (Negative Symptom Assessment-16) and CGI-SCH (Clinical Global Impression Schizophrenia. The older scales were developed more than 30 years ago. Since then, our understanding of negative symptoms has evolved and currently there are newer rating scales evaluating the validity of negative symptoms. The older scales do not incorporate the latest research on negative symptoms. CAINS and BNSS are attractive for both their reliability and their concise accessible format, however, a scale that is simpler, accessible, user-friendly, that incorporates a multidimensional model of schizophrenia, addresses the psychosocial and cognitive component has yet to be developed.

Prediction of outcome of bright light treatment in patients with seasonal affective disorder: Discarding the early response, confirming a higher atypical balance, and uncovering a higher body mass index at baseline as predictors of endpoint outcome.

BACKGROUND: We tested the hypothesis that the early improvement in mood after the first hour of bright light treatment compared to control dim-red light would predict the outcome at six weeks of bright light treatment for depressed mood in patients with Seasonal Affective Disorder (SAD). We also analyzed the value of Body Mass Index (BMI) and atypical symptoms of depression at baseline in predicting treatment outcome. METHODS: Seventy-eight adult participants were enrolled. The first treatment was controlled crossover, with randomized order, and included one hour of active bright light treatment and one hour of control dim-red light, with one-hour washout. Depression was measured on the Structured Interview Guide for the Hamilton Rating Scale for Depression-SAD version (SIGH-SAD). The predictive association of depression scores changes after the first session. BMI and atypical score balance with treatment outcomes at endpoint were assessed using multivariable linear and logistic regressions. RESULTS: No significant prediction by changes in depression scores after the first session was found. However, higher atypical balance scores and BMI positively predicted treatment outcome. LIMITATIONS: Absence of a control intervention for the six-weeks of treatment (only the first session in the laboratory was controlled). Exclusion of patients with comorbid substance abuse, suicidality and bipolar I disorder, and patients on antidepressant medications, reducing the generalizability of the study. CONCLUSION: Prediction of outcome by early response to light treatment was not replicated, and the previously reported prediction of baseline atypical balance was confirmed. BMI, a parameter routinely calculated in primary care, was identified as a novel predictor, and calls for replication and then exploration of possible mediating mechanisms.

Suicidality and montelukast.

BACKGROUND: Suicide is a serious public health problem. Prevention of suicide depends to a great degree on identification and mitigation of its risk factors. Allergy has been associated with mood and anxiety disorders, risk factors for suicidality. Antiallergic medication could modulate or mediate these predictive associations. Recently, the FDA issued a warning raising concerns about the suicidality potential of montelukast and other leukotriene (LT) antagonists. OBJECTIVE: The purpose of this review is to integrate the emerging interpretations of the link between suicidality, suicide risk factors, allergy and treatment of allergy in particular, with LT antagonists. METHODS: We reviewed the available reports on the possible relationships between montelukast, allergy, suicide, suicidality and suicide risk factors. We also present the positions of the FDA, manufacturer, and national organizations of allergists and immunologists on the possible role of montelukast in suicidality. CONCLUSION: At present, there is insufficient data to prove that there is a link between montelukast and suicidality. Inquiring about mood changes and suicidal ideation should be integrated in general medical practice.