ABSTRACT
While agreement between clients and their clinicians on therapy goals has frequently been investigated as a process-level variable (i.e., working alliance), dyadic convergence on presenting concerns is also important for initial case formulation. Transdiagnostic presenting problems, like sleep difficulty, pose a particular challenge for client-therapist convergence. The current study describes sleep difficulty in a treatment-seeking college population and investigates the impact of client and therapist baseline sleep problem reports on therapy outcomes.Data were collected through a large practice research network, with the sample comprising 47,023 clients from 99 university counseling centers across the United States.A larger proportion of clients (49.3%) had self-reported high baseline sleep difficulty than those with a clinician-identified sleep concern (16.0%). Clients with baseline sleep difficulty were more likely to end treatment with greater self-reported sleep difficulty and psychological symptom distress, although they may experience larger gross symptom change than clients without baseline sleep difficulty. Clinician-identified sleep concerns were significantly associated with client outcomes, particularly when clients did not report baseline sleep difficulty themselves.Findings from this study suggest that it may be efficacious and efficient with limited time for treatment to address sleep concerns in a college setting.Clinicians' attendance to their clients' transdiagnostic presenting concerns, like sleep difficulty, may increase clients' own awareness of problematic patterns of behavior. When time for therapy is short, as is often the case in college counseling, it may be efficient to prioritize these concerns with the potential to impact a broad range of symptoms.
Subject(s)
Professional-Patient Relations , Sleep Wake Disorders , Counseling , Humans , Self Report , Treatment OutcomeABSTRACT
This study is the first genetically-informed investigation of avoidant/restrictive food intake disorder (ARFID), an eating disorder that profoundly impacts quality of life for those affected. ARFID is highly comorbid with autism, and we provide the first estimate of its prevalence in a large and phenotypically diverse autism cohort (a subsample of the SPARK study, N = 5,157 probands). This estimate, 21% (at a balanced accuracy 80%), is at the upper end of previous estimates from studies based on clinical samples, suggesting under-diagnosis and potentially lack of awareness among caretakers and clinicians. Although some studies suggest a decrease of disordered eating symptoms by age 6, our estimates indicate that up to 17% (at a balanced accuracy 87%) of parents of autistic children are also at heightened risk for ARFID, suggesting a lifelong risk for disordered eating. We were also able to provide the first estimates of narrow-sense heritability (h2) for ARFID risk, at 0.45. Genome-wide association revealed a single hit near ZSWIM6, a gene previously implicated in neurodevelopmental conditions. While, the current sample was not well-powered for GWAS, effect size and heritability estimates allowed us to project the sample sizes necessary to more robustly discover ARFID-linked loci via common variants. Further genetic analysis using polygenic risk scores (PRS) affirmed genetic links to autism as well as neuroticism and metabolic syndrome.
ABSTRACT
OBJECTIVE: Postoperative headache is an undesirable consequence of retrosigmoid vestibular schwannoma (VS) removal. An ultrasonic bone aspirator (UBA) may reduce headache by minimizing subarachnoid bone dust dispersion. The feasibility of removing internal auditory canal (IAC) bone with a UBA is unknown. This study assessed volume and duration of IAC bone removal in clinical and laboratory settings. STUDY DESIGN: (1) Retrospective review of radiologic data and intraoperative videos. (2) Cadaveric temporal bone model. SETTING: (1) Tertiary care medical center. (2) Laboratory. SUBJECTS METHODS: We calculated the volume of IAC bone drilled during retrosigmoid VS removal using postoperative computed tomography scans. We then measured the time spent actively drilling IAC bone by analyzing operative videos. Finally, we measured bone ablation rates in a cadaveric temporal bone model using a drill and UBA. RESULTS: The mean ± SD volume of IAC bone removed during surgery was 0.32 ± 0.17 mL (n = 9). The time spent actively removing IAC bone with a drill was only 10.4 ± 3.5 minutes, less than a third of the total IAC opening time of 34.2 ± 13.1 minutes (n = 5). On cadaveric specimens, the UBA removed bone at 0.21 ± 0.03 or 0.35 ± 0.07 µL/s at 15% or 50% power, respectively (n = 4). This extrapolates to 15.0 ± 3.0 to 25.0 ± 3.9 minutes to remove the same 0.32 mL from surgery. CONCLUSIONS: The volume and duration of IAC bone removal during retrosigmoid VS surgery are small. Using a UBA at low power instead of a drill would extend the length of surgery by 5 to 15 minutes, with the theoretical potential for reducing headache.
