Correlates of Suicide Attempts in Filipino Youths: An Analysis Based on the 2015 Global School-Based Student Health Survey.

There is a lower incidence of suicide in the Philippines compared to other developed/developing countries, but the trend has been increasing. This study aims to identify the correlates of suicide attempts in Filipino youth using the World Health Organization's 2015 Global School-Based Health Survey. All schools in the Philippines with grades 7-10 were included. A stratified sampling design was used, and participants were randomly sampled. Of the 8,761 students who participated in the survey, 16.2% have attempted suicide at least once in the past 12 months. The factors that increased the risk of suicide attempts include female gender, being physically attacked, getting bullied, feeling lonely, poor sleep, having few close friends, smoking, alcohol use, less physical activity, use of amphetamine/methamphetamine, and less parental supervision. The use of methamphetamine/amphetamine is the single best risk factor of suicide attempts among Filipino youth with OR= 4.6; 95% CI [3.8, 5.6].

Innovating Parkinson's Care: A Randomized Controlled Trial of Telemedicine Depression Treatment.

BACKGROUND: For several decades, a myriad of factors have contributed to the inadequate diagnosis and management of depression in Parkinson's disease (PD), leaving up to 60% of significantly symptomatic patients untreated. Poor access to evidence-based neuropsychiatric care is one major barrier to achieving optimal Parkinson's outcomes. OBJECTIVE: The goal of this study was to compare the efficacy of individual Parkinson's-informed, video-to-home cognitive-behavioral therapy (experimental group), to clinic-based treatment as usual (control group), for depression in PD. METHOD: Ninety United States military veterans with clinical diagnoses of both depression and PD were computer-randomized (1:1) to either the experimental or control group; randomization was stratified by baseline antidepressant use and blind to all other baseline data. The acute treatment period spanned 10 weeks and was followed by a 6-month extension phase. The Hamilton Depression Rating Scale was the a priori primary outcome. Depression treatment response was defined as a score ≤2 on the Clinical Global Impression Improvement Scale. All statistical analyses were intent to treat. RESULTS: Video-to-home cognitive-behavioral therapy outperformed clinic-based treatment as usual across three separate depression measures (P < 0.001). Effects were observed at the end of acute treatment and maintained through 6-month follow-up. Number needed to treat (based on treatment response classification) was 2.5 with an absolute risk reduction of 40%. CONCLUSION: Video-to-home cognitive-behavioral therapy may be an effective intervention to bypass access barriers to specialized, evidence-based depression care in PD and to address the unmet neuropsychiatric treatment needs of the Parkinson's community. © 2021 International Parkinson and Movement Disorder Society.

Coping with Suicidal Urges: An Important Factor for Suicide Risk Assessment and Intervention.

Suicide-related coping refers to strategies for adaptively managing suicidal urges and can be important an important factor for assessing risk and targeting intervention. The current study evaluated whether suicide-related coping predicted a suicidal event within 90-days, independently of other known risk factors. Veterans (N = 64) were evaluated shortly after a suicidal crisis and completed several assessments, including a measure of suicide-related coping. Multivariate analyses showed that suicide-related coping remained protective of a suicidal event (OR = 0.93; p = .047) after adjusting for suicidal ideation, previous suicide attempts, mood disorder, distress tolerance, and gender. Suicide-related coping may augment commonly assessed clinical factors in prediction of a suicidal event and is a suitable target for suicide prevention efforts.

Development and Evaluation of a Visual Remediation Intervention for People with Schizophrenia.

It is now well documented that schizophrenia is associated with impairments in visual processing at all levels of vision, and that these disturbances are related to deficits in multiple higher-level cognitive and social cognitive functions. Visual remediation methods have been slow to appear in the literature as a potential treatment strategy to target these impairments, however, in contrast to interventions that aim to improve auditory and higher cognitive functions in schizophrenia. In this report, we describe a National Institute of Mental Health (NIMH)-funded R61/R33 grant that uses a phased approach to optimize and evaluate a novel visual remediation intervention for people with schizophrenia. The goals of this project are: (1) in the R61 phase, to establish the optimal components and dose (number of sessions) of a visual remediation intervention from among two specific visual training strategies (and their combination) for improving low and mid-level visual functions in schizophrenia; and (2) in the R33 phase, to determine the extent to which the optimal intervention improves not only visual processing but also higher-level cognitive and role functions. Here we present the scientific background for and innovation of the study, along with our methods, hypotheses, and preliminary data. The results of this study will help determine the utility of this novel intervention approach for targeting visual perceptual, cognitive, and functional impairments in schizophrenia.

Telephone-based cognitive behavioral therapy for depression in Parkinson disease: A randomized controlled trial.

OBJECTIVE: To determine whether, for patients with depression and Parkinson disease (PD), telephone-based cognitive-behavioral treatment (T-CBT) alleviates depressive symptoms significantly more than treatment as usual (TAU), we conducted a randomized controlled trial to evaluate the efficacy of a 10-session T-CBT intervention for depression in PD, compared to TAU. METHODS: Seventy-two people with PD (PWP) were randomized to T-CBT + TAU or TAU only. T-CBT tailored to PWPs' unique needs was provided weekly for 3 months, then monthly during 6-month follow-up. CBT targeted negative thoughts (e.g., "I have no control"; "I am helpless") and behaviors (e.g., social withdrawal, excessive worry). It also trained care partners to help PWP practice healthy habits. Blind raters assessed outcomes at baseline, midtreatment, treatment end, and 1 and 6 months post-treatment. Analyses were intent to treat. RESULTS: T-CBT outperformed TAU on all depression, anxiety, and quality of life measures. The primary outcome (Hamilton Depression Rating Scale score) improved significantly in T-CBT compared to TAU by treatment end. Mean improvement from baseline was 6.53 points for T-CBT and -0.27 points for TAU (p < 0.0001); gains persisted over 6-month follow-up (p < 0.0001). Improvements were moderated by a reduction in negative thoughts in the T-CBT group only, reflecting treatment target engagement. CONCLUSIONS: T-CBT may be an effective depression intervention that addresses a significant unmet PD treatment need and bypasses access barriers to multidisciplinary, evidence-based care. CLINICALTRIALSGOV IDENTIFIER: NCT02505737. CLASSIFICATION OF EVIDENCE: This study provides Class I evidence that for patients with depression and PD, T-CBT significantly alleviated depressive symptoms compared to usual care.

Towards the objective assessment of suicidal states: Some neurocognitive deficits may be temporally related to suicide attempt.

Neurocognitive detection of suicidal states has the potential to significantly advance objective risk assessment. This goal requires establishing that neurocognitive deficits fluctuate around the time of a suicide attempt. The current study therefore evaluated whether neurocognitive performance is temporally related to suicide attempt, in a sample at highrisk for suicide (n = 141). Evaluations consisted of a clinician-administered interview, self-report questionnaires, and neurocognitive tasks assessing response inhibition, attentional control, and memory recognition. Analyses examined whether neurocognitive scores significantly differed according to the following temporal suicide attempt categories: (a) past-week attempt; (b) past-year attempt (not in past week); and (c) no past-year attempt. Univariate results showed that response inhibition and memory recognition were significantly related to suicide attempt recency. Post-hoc pairwise tests showed that participants with a past-week suicide attempt showed greater impairments than those without a past-year attempt. Multivariate tests showed the same pattern of results, adjusting for age, suicide attempts prior to past year, mood disturbance, and suicidal ideation. These results show that neurocognitive assessment of response inhibition and memory recognition shows sensitivity to the recency of a suicide attempt. While future prospective studies are needed, results suggest that phasic neurocognitive deficits may serve as objective markers of short-term suicide risk.

The Quantification of Hop Landing Balance Using Trunk-Mounted Accelerometry.

CONTEXT: Balance is important for injury prediction, prevention, and rehabilitation. Clinical measurement of higher level balance function such as hop landing is necessary. Currently, no method exists to quantify balance performance following hopping in the clinic. OBJECTIVE: To quantify the sacral acceleration profile and test-retest reliability during hop landing. PARTICIPANTS: A total of 17 university undergraduates (age 27.6 [5.7] y, height 1.73 [0.11] m, weight 74.1 [13.9] kg). MAIN OUTCOME MEASURE: A trunk-mounted accelerometer captured the acceleration profile following landing from hopping forward, medially, and laterally. The path length of the acceleration traces were computed to quantify balance following landing. RESULTS: Moderate to excellent reliability (intraclass correlation coefficient .67-.93) for hop landing was established with low to moderate SEM (4%-16%) and minimal detectable change values (13%-44%) for each of the hop directions. Significant differences were determined in balance following hop landing from the different directions. CONCLUSION: The results suggest that hop landing balance can be quantified by trunk-mounted accelerometry.

Cognitive behavioral therapy improves diverse profiles of depressive symptoms in Parkinson's disease.

OBJECTIVE: Depression is among the most common and debilitating nonmotor complaints in Parkinson's disease (PD), yet there is a paucity of controlled research to guide treatment. Little research has focused on the extent to which specific depressive symptom profiles may dictate unique clinical recommendations to ultimately improve treatment outcomes. The current study examined the impact of cognitive behavioral therapy (CBT) on different types of depressive symptoms in PD. It was hypothesized that the cognitive (eg, guilt, rumination, and negative attitudes towards self) and behavioral (eg, avoidance and procrastination) symptoms targeted most intensively by the treatment protocol would show the most robust response. The extent to which stabilized antidepressant use moderated specific symptom change was examined on an exploratory basis. METHOD: Eighty depressed people with PD participated in a randomized controlled trial of CBT plus clinical management, versus clinical management only. Hamilton Depression Rating Scale (HAMD) and Beck Depression Inventory (BDI) subscale scores, reflecting depressive symptom heterogeneity in PD, were the focus of this investigation. RESULTS: CBT response was associated with significant improvements in mood, sleep, anxiety, and somatic symptoms (HAMD), and negative attitudes toward self, performance impairment, and somatic symptoms (BDI). As hypothesized, the largest effect sizes were observed for cognitive and behavioral (vs somatic) symptoms of depression. Stabilized antidepressant use moderated the effect of CBT on somatic complaints (HAMD and BDI). CONCLUSIONS: CBT may improve a diverse array of depressive symptoms in PD. Cognitive and behavioral (vs somatic) symptoms showed the greatest change. Combining CBT with antidepressants may help optimize the management of somatic complaints in depression in PD (dPD).

A Naturalistic Study of Racial Disparities in Diagnoses at an Outpatient Behavioral Health Clinic.

OBJECTIVE: The authors examined electronic medical record (EMR) outpatient data to determine whether African Americans with schizophrenia or schizoaffective disorder were more likely than non-Latino whites to screen positive for major depression. METHODS: EMR data for 1,657 patients at Rutgers University Behavioral Health Care certified community outpatient clinics were deidentified and accrued for 9 months starting July 1, 2017. A Fisher's exact test was used to compare differences in the proportion of patients with positive screens for major depression (cutoff score of ≥15 on the nine-item Patient Health Questionnaire) among African-American and non-Latino white patients diagnosed as having schizophrenia or schizoaffective disorder. RESULTS: Among patients diagnosed as having schizophrenia, African Americans were more likely than non-Latino whites (p<.003) to screen positive for major depression. The between-group difference in positive screens was not significant among patients diagnosed as having schizoaffective disorder. CONCLUSIONS: The results are consistent with findings from a large body of literature suggesting that racial differences in the diagnosis of schizophrenia in the United States result in part from clinicians underemphasizing the relevance of mood symptoms among African Americans compared with other racial-ethnic groups. If the results are replicated, a case could be made that routine screening for major depression in community mental health settings could reduce racial disparities in schizophrenia diagnoses.

Personalized Telemedicine for Depression in Parkinson's Disease: A Pilot Trial.

High rates of depression are observed in Parkinson's disease, and limited access to care complicates management. The purpose of this pilot project was to evaluate the feasibility and impact of a personalized cognitive-behavioral telemedicine program for depression in Parkinson's disease (dPD). Thirty-four individuals with dPD and their carepartners participated in this pilot study. A 10-module self-help workbook, tailored to the unique needs of the dPD population, was created to be used as either a stand-alone intervention, with minimal therapist support, or a supplement to formal telephone-administered cognitive-behavioral therapy sessions. Improvements in depression, anxiety, quality of life, sleep, negative thoughts, and caregiver burden were observed over the course of the 4-month study, independent of treatment modality (guided self-help vs formal telephone-based psychotherapy). Future research will utilize randomized controlled designs and continue to focus on delivery models that can improve access to this and other evidence-based mental health interventions for dPD.

Multifocal necrotising leucoencephalopathy following Salmonella infection in an immunocompetent patient.

Multifocal necrotising leucoencephalopathy is a rare disorder affecting the central nervous system. It is characterised pathologically by microscopic areas of necrosis with pontine predilection but also involvement of extrapontine regions, including the cerebellum, medulla and cerebral hemispheres. It usually occurs on the background of immunosuppression. Here we describe an immunocompetent patient with a recent history of Salmonella infection who presented with subacute neurological deterioration. At postmortem, she had evidence of multifocal necrotising leucoencephalopathy.

Hierarchical Classes Analysis (HICLAS): A novel data reduction method to examine associations between biallelic SNPs and perceptual organization phenotypes in schizophrenia.

The power of SNP association studies to detect valid relationships with clinical phenotypes in schizophrenia is largely limited by the number of SNPs selected and non-specificity of phenotypes. To address this, we first assessed performance on two visual perceptual organization tasks designed to avoid many generalized deficit confounds, Kanizsa shape perception and contour integration, in a schizophrenia patient sample. Then, to reduce the total number of candidate SNPs analyzed in association with perceptual organization phenotypes, we employed a two-stage strategy: first a priori SNPs from three candidate genes were selected (GAD1, NRG1 and DTNBP1); then a Hierarchical Classes Analysis (HICLAS) was performed to reduce the total number of SNPs, based on statistically related SNP clusters. HICLAS reduced the total number of candidate SNPs for subsequent phenotype association analyses from 6 to 3. MANCOVAs indicated that rs10503929 and rs1978340 were associated with the Kanizsa shape perception filling in metric but not the global shape detection metric. rs10503929 was also associated with altered contour integration performance. SNPs not selected by the HICLAS model were unrelated to perceptual phenotype indices. While the contribution of candidate SNPs to perceptual impairments requires further clarification, this study reports the first application of HICLAS as a hypothesis-independent mathematical method for SNP data reduction. HICLAS may be useful for future larger scale genotype-phenotype association studies.

Decreased Mortality Rates of Inmates With Mental Illness After a Tobacco-Free Prison Policy.

OBJECTIVE: Negative health consequences of smoking have prompted many correctional facilities to become tobacco free, including the New Jersey Department of Corrections, and this study examined the results of implementing tobacco-free policies. METHODS: Mortality rates in the total population of inmates and in a subgroup with identified special mental health needs or mental illnesses (referred to in this article as persons with special needs) were measured from January 2005 through June 2014, a period during which tobacco use was significantly reduced and then eliminated. RESULTS: The total mortality rate of all causes of death combined was three times higher for persons with special needs in 2005 compared with those without special needs. The total annual mortality rate decreased by 13%, from 232 to 203 per 100,000 population between 2005 and 2013. The mortality rate for persons identified as having special needs decreased by 48%, from an average of 676 per 100,000 population over the eight-year period before the ban to 353 per 100,000 in the 18 months after the ban. Reduced mortality among persons with special needs between 2005 and 2014 in half-year increments was correlated with the reduction and elimination of tobacco products (median bootstrapped Pearson r=.60, 95% confidence interval [CI] =.21 to .86). In strong contrast, however, the bootstrapped correlation between the mortality rate of persons not identified as having special needs and tobacco sales over the same period was not significant (median Pearson r=-.13, CI=-.50 to .28). No other major medical intervention occurred during these years. CONCLUSIONS: This striking correlation of quick and substantial reduction of mortality among individuals with a mental illness in association with the reduction and subsequent ban of smoking suggests that smoking may play a major role in the reduced life span of persons with mental illness.

Service Use and Self-Reported Symptoms Among Persons With Positive PTSD Screens and Serious Mental Illness.

OBJECTIVE: Although many studies have reported higher rates of trauma exposure and posttraumatic stress disorder (PTSD) among persons with severe mental illness, the screening, diagnosis, and treatment of PTSD in public mental health centers remain at a suboptimal level and PTSD is often overlooked and untreated. This study used routine PTSD screening and service use data in electronic medical records to determine the association of PTSD, psychiatric symptoms, and service use in a sample of individuals with serious mental illness in a community-based treatment setting. METHODS: The sample included 1,834 active clients between January 2007 and November 2010 who were screened for PTSD and who completed the 24-item Behavior and Symptom Identification Scale (BASIS-24). Service data included services provided a year before and a year after the screening date. RESULTS: PTSD was associated with more severe psychiatric symptoms and increased no-show rates but not with increased service use or use of high-intensity services. PTSD likelihood interacted with race in accounting for elevated scores among African Americans on the psychosis domain of the BASIS-24. CONCLUSIONS: PTSD screening is feasible and recommended in service environments and may contribute significantly to better understanding of racial-ethnic and other differences in service use and diagnostic practices.

Is disorganization a feature of schizophrenia or a modifying influence: evidence of covariation of perceptual and cognitive organization in a non-patient sample.

A subgroup of people with schizophrenia is characterized by reduced organization in perception, thought, language, and motor functioning, and these impairments covary significantly. While this may reflect multiple expressions of an illness-related core processing impairment, it may also represent the extreme end of an organization-disorganization dimension that is found throughout the general population. In this view, disorganization is a modifying influence on illness expression. To obtain preliminary information on this hypothesis, we examined covariation of perceptual and cognitive organization in a non-patient sample. Subjects completed a battery of perceptual tasks with demonstrated sensitivity to schizophrenia and disorganization, and a battery of questionnaires examining cognitive organization. Our results indicated that level of perceptual organization ability, across multiple tasks, was associated with self-reported levels of cognitive organization on multiple measures. This is thus preliminary evidence for a common process affecting perceptual and cognitive organization in the general population, suggesting that disorganization may reflect a modifying influence mechanism, instead of an illness-related process, in schizophrenia.

Neuropsychological outcomes after psychosocial intervention for depression in Parkinson's disease.

The authors describe neuropsychological outcomes in people with Parkinson's disease (PD) after their participation in an NIH-sponsored, randomized, controlled trial of cognitive-behavioral treatment for depression. Improvements in mood were associated with modest gains in verbal memory and executive functioning over the 10-week treatment period and accounted for greater variance in neuropsychological outcomes at the end of treatment than other known correlates of cognitive functioning in PD, such as disease severity, age, and education. Baseline working memory and executive skills were also associated with depression improvement over time.

Barriers to mental health care utilization in Parkinson's disease.

BACKGROUND: Parkinson's disease (PD) is frequently complicated by co-occurring psychiatric problems such as depression and anxiety that negatively affect the course and management of the illness. Yet, in most cases, these psychiatric comorbidities are neither recognized nor treated to remission. The primary purpose of this study was to identify and describe barriers to mental health care utilization for people with PD. Secondary objectives included the assessment of attitudes and preferences regarding the need for mental health services in the PD community and the acceptability of telehealth interventions as a method for improving access and quality of care. METHODS: A total of 769 people with PD completed an anonymous cross-sectional questionnaire assessing barriers to mental health care utilization in this medical population. Respondents were drawn from a national sample. RESULTS: Commonly endorsed barriers to mental health care utilization in PD reflect the patients' incomplete understanding of mental health problems, access issues, and illness-specific concerns, as well as the inadequate screening and detection of psychiatric complications by medical providers and the need for more effective treatments in this medical population. Several demographic, medical, and psychiatric variables also influenced the likelihood of accessing mental health care. Interest in telehealth approaches to mental health treatment was high and, in several instances, correlated with perceived barriers to mental health care utilization. CONCLUSIONS: People with PD may encounter a multitude of barriers that impede their pursuit of mental health care. Clinical implications are discussed and further research is needed to replicate and extend these findings.

A randomized-controlled trial of an intervention to improve antidepressant adherence among Latinos with depression.

BACKGROUND: Studies have consistently shown that Latinos with depression have lower adherence to antidepressant medication. Given that low adherence is associated with poorer response to treatment, this is a likely source of unequal care. The current study examined the efficacy of a motivational interviewing intervention for improving antidepressant adherence among Latinos with a depressive disorder. METHODS: Participants were 50 Latinos with a DSM-IV diagnosis of major depression or dysthymia who were receiving treatment at a community mental health center. Participants were recruited from July 2007 to December 2009 and were randomized to receive usual care (UC) or Motivational Enhancement Therapy for Antidepressants (META). META participants received three sessions of motivational interviewing as an enhancement to their usual care. Participants were assessed as baseline (time 1), 5 weeks (time 2), and 5 months (time 3). Antidepressant adherence was measured with the Medication Event Monitoring System (MEMS®) and changes in depression were measured with the Beck Depression Inventory-II (BDI-II). RESULTS: After adjusting for covariates, META participants showed significantly higher antidepressant adherence than UC participants at time 2 (72% versus 42%, respectively, p < .01) and time 3 (60% versus 34%, p < .01). The groups did not differ on mean BDI-II score across time. However, after adjusting for covariates, META participants were significantly more likely to show symptom remission on the BDI-II, compared to UC participants (OR = 7.0, p < .05). CONCLUSIONS: This initial trial of META demonstrated feasibility and promising effects for improving antidepressant adherence. Some effects on depression were also observed.

Concordance between measured and self-perceived weight status of persons with serious mental illness.

OBJECTIVE: This study investigated concordance between self-perceived and measured weight status for persons with serious mental illness. METHODS: A total of 586 mental health clients assessed their weight as underweight, normal, overweight, or obese. The agreement between these self-assessments and the same categories based on measured body mass index was related to gender, ethnicity, education, age, and psychiatric diagnosis. RESULTS: Three hundred consumers (51%) underestimated their weight (they thought they weighed less than they did); only 35 (6%) overestimated it. In logistic regression analyses, gender, education, and psychiatric diagnosis showed significant effects on accuracy of self-perception, but ethnicity and age did not. CONCLUSIONS: People with serious mental illness are more likely than others to have weight problems, which contribute to higher rates of morbidity and mortality. However, they also tend to underestimate their weight. This gap between reality and self-perception must be addressed.