Demographics and clinical characteristics of patients of prescribing psychologists, psychiatrists, and primary care physicians.

To describe the characteristics of patients receiving psychotropic medication from prescribing psychologists, psychiatrists, and primary care physicians. This descriptive study was conducted using private insurance claims of patients from New Mexico and Louisiana receiving psychotropic medications (anticonvulsants, antidepressants, antipsychotics, hypotensive agents, anxiolytics/sedatives/hypnotics, and stimulants) from 2004 to 2021 (N = 307,478). Patient characteristics were captured during the 6 months prior to their first psychotropic medication using administrative information, diagnosis and procedure codes, and medication data. Logistic regression models estimated the associations of patient characteristics with prescriber type. Additional logistic regression models estimated the association of prescriber type with medication classes prescribed. Patients were most likely to see specialists (psychologists or psychiatrists) if they had bipolar disorder (average marginal effect and 95% CI 0.214 [0.196, 0.231]), schizophrenia/psychotic disorders (0.118 [0.097, 0.138]), or had 1-4 visits of psychotherapy (0.267 [0.258, 0.026]). Specialist patients were most likely to see a prescribing psychologist if they had 1-4 visits of psychotherapy (0.196 [0.183, 0.210]) or had insomnia (0.309 [0.203, 0.415]). Prescribing psychologists were more likely to prescribe antidepressants (0.028 [0.011, 0.045]) and less likely to prescribe antipsychotics (-0.016 [-0.020, -0.012]) than psychiatrists. Primary care physicians were less likely to prescribe all psychotropic medications except antidepressants (0.011 [0.002, 0.019]) and anxiolytics (0.074 [0.067, 0.080]). Prescribing psychologists treat patients who are more similar to those of psychiatrists than patients of primary care physicians; they are less likely to prescribe antipsychotics and more likely to prescribe antidepressants. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Pediatric Mental Health Care and Scope-of-Practice Expansions.

To examine the association between psychologist and nurse practitioner scope-of-practice (SoP) regulations and pediatric mental health service access. A nationally representative sample of children with mental health needs was identified using 5 years of National Survey of Children's Health (2016-2020). Utilization was measured in two ways: (1) unmet mental health care needs and (2) receipt of mental health medication. Expanded SoP for psychologists and nurse practitioners was measured based on the child's state of residence and the year of the survey. The associations between both SoP expansion and both outcomes were assessed using logistic regression models adjusted for multiple covariates. The probability of having unmet mental health needs was 5.4 percentage points lower (95% CI - 0.102, - 0.006) for children living in a state with psychologist SoP expansion; however, there was no significant difference in unmet mental health needs between states with and without NP SoP expansion. The probability of receiving a mental health medication was 2.0 percentage points higher (95% CI 0.007, 0.034) for children living in a state with psychologist SoP expansion. Conversely, the probability of receiving a mental health medication was 1.5 percentage points lower (95% CI - 0.023, - 0.007) for children living in a state with NP SoP expansion. Expanded SoP for psychologists is associated with improved access to pediatric mental health care in terms of both unmet need and receiving medication. Expanded SoP for NPs, however, was not associated with unmet need and lower receipt of medication.

An Examination of Positive and Negative Outcomes During the COVID-19 Pandemic Among Persons With Multiple Sclerosis.

IMPORTANCE: This study provides information to clinicians about how persons with MS coped in both positive and negative ways during a potentially traumatic experience (the coronavirus disease 2019 [COVID-19] pandemic), which will help clinicians to provide better services to this population in the face of stressful events. OBJECTIVE: To describe both positive and negative outcomes among persons with multiple sclerosis (MS) and to examine whether resilience and social support were related to positive and negative outcomes during the peak of the pandemic. DESIGN: An online survey administered during the COVID-19 pandemic. PARTICIPANTS: Participants were 74 individuals with MS and 104 healthy controls (HCs) recruited through social media and community support groups. OUTCOMES AND MEASURES: The survey included questionnaires that assessed both positive and negative responses to the pandemic, including benefit finding, loneliness, and distress. Resilience and social support were also assessed. RESULTS: Differences were noted between persons with MS and HCs on negative but not positive outcomes. Better social support and resilience were related to positive outcomes. CONCLUSIONS AND RELEVANCE: Both persons with MS and HCs were similar in benefit finding and stress management. However, negative outcomes were worse in the MS group. Our findings shed light on the importance of individuals with MS adopting a positive outlook to help during times of adversity. What This Article Adds: Among persons with disabilities such as multiple sclerosis, finding benefits during stressful times can be a potential coping mechanism. Furthermore, resilience and social support should be taken into account to moderate the effects of adverse events.

Psychotropic Medication Prescribing Across Medical Providers, 2016-2019.

OBJECTIVE: The authors sought to provide updated estimates of the proportion of psychotropic medications prescribed by different medical providers. METHODS: This pooled cross-sectional study used data from the Medical Expenditure Panel Survey (2016-2019). Nationally representative estimates of the percentages of all psychotropic medications prescribed by each provider type were calculated, and analyses stratified by medication type, insurance type, and age were conducted. RESULTS: Data from 58,547 psychotropic prescriptions reported by 7,693 unique individuals were analyzed. More than 60% of psychotropic medications were prescribed by providers other than psychiatrists (33.5%) or psychologists (2.2%), such as general practitioners, nurse practitioners, and physician assistants. This distribution varied significantly by medication, insurance, and patient age. CONCLUSIONS: Most psychotropic medication prescribing occurs in primary care; however, notable differences by medication, insurance, and age were observed, suggesting areas for future research.

Development and adaptation of a strength-based job interview training tool for transition age youth on the autism spectrum using community engaged methods.

Introduction: Kessler Foundation Strength Identification and Expression (KF-STRIDE) is a strength-based job interview training tool developed for young adults on the autism spectrum. The intervention is based on a positive psychology framework to increase knowledge of character strengths, and how to relate them to a future employer. The current study sought to evaluate the acceptability, usability and feasibility of KF-STRIDE, as well as to guide adaptations to improve the tool's ability to meet the needs of those on the spectrum. Methods: Mixed methods (post-intervention surveys, and semi-structured interviews with key stakeholders) were used to inform the evaluation and consequent adaptations of KF-STRIDE. Results: The major findings of the study were that KF-STRIDE was found to be largely acceptable and usable. Importantly, however, our qualitative analysis revealed modifications that could help to better suit the needs of young adults on the spectrum, which included the incorporation of additional skills (i.e. etiquette, practicing hygiene) and more opportunities to practice job interviewing. Thus, we altered the implementation of the intervention to be web-based to improve accessibility. We incorporated the presence of an animated character to deliver the content, to eliminate the need for a highly trained interventionist. Discussion: KF-STRIDE was modified to increase access by incorporating feedback from the autism community. Future directions include assessing the efficacy of KF-STRIDE in young adults on the spectrum to identify whether employment outcomes are improved after using the tool.

Twelve-month analysis of emergency argon laser retinopexy in an Irish tertiary hospital.

BACKGROUND: Retinal tears occur as a result of traction at sites of retinal and vitreous adhesion-this allows retrohyaloid fluid into the subretinal space. Prompt management is required to prevent progression to rhegmatogenous retinal detachment (RRD). AIMS: To identify the post-procedural outcomes following treatment of retinal tears with laser retinopexy in an emergency setting. METHODS: Retrospective review of all patients who underwent emergency slit-lamp laser retinopexy between January and December 2021 in Cork University Hospital, an Irish tertiary referral centre. RESULTS: A total of 87 patients were identified-mean age of 60 ± 12 years and 54% female. Follow-up ranged from 1 week to 11 months. Pre-disposing risk factors were identified-myopia (37%), recent trauma (2%), and RRD family history (5%). All patients had slit-lamp mounted laser-retinopexy performed in the eye-casualty. 63 patients (72%) had a superior break, 66 patients (76%) had a horse-shoe retinal tear, and 21 patients (24%) had a retinal hole. Associated findings included lattice degeneration (26%), sub-retinal fluid (55%), and vitreous haemorrhage (33%). Fourteen patients (16%) required multiple slit-lamp laser retinopexies while 18 patients (21%) required intervention by a vitreo-retinal surgeon including indirect-laser retinopexy (3%), cryotherapy (11%), and pars-plana vitrectomy (6%). At the most recent follow-up, all the patients had anatomically attached retinas. CONCLUSION: A notable proportion of patients (21%) undergoing emergency laser retinopexy required further intervention. Patients with anteriorly located retinal tears would benefit from an early discussion with a vitreo-retinal surgeon. Departmental training in laser retinopexy and retinal tear management is recommended as part of ongoing quality improvement.

Examining Psychologist Prescriptive Authority as a Cost-Effective Strategy for Reducing Suicide Rates.

Six states (NM, LA, IL, IA, ID, CO) grant prescriptive authority to qualified psychologists, and research has shown that these policies are associated with a reduction in suicides. In this study, we assess the cost-effectiveness of these policies in reducing suicide rates. This study used a Markov Model with a time horizon of 20 years to estimate the incremental net monetary benefit (INMB) of the policy from the societal perspective with a simulated cohort of 100,000 people. Transition probabilities and utilities were collected from the literature, and costs were assessed using a mixed macro-micro costing approach. Using this approach, we found that the 20-year INMB for the policy was estimated to be $12.81 million ($USD) per quality-adjusted life year (QALY). The probability of cost-effectiveness was greater than 50% at a willingness-to-pay threshold as low as $10,000 per QALY. The probability of cost-effectiveness was only modestly associated with the implementation costs of the policy, but was sensitive to the estimated effect of the policy intervention. The models estimated in this study support prescriptive authority for psychologists as a cost-effective strategy for reducing state-level suicide rates. A considerable amount of research is needed to understand the impact of this policy with finer granularity.

Character Strengths as Moderators of the Relationship Between Adverse Childhood Experiences and Negative Health Outcomes.

Adverse childhood experiences (ACEs) refer to negative events of childhood. Research has demonstrated relationships between ACEs and adult mental and physical difficulties. Fewer studies have examined potential moderators of these relationships. This study assessed the role of character strengths in the relationship between ACEs and negative physical and mental health outcomes in adulthood. An online sample of 1,491 adults completed questionnaires measuring character strengths, exposure to ACEs, and aspects of physical/mental health. Results replicated previous findings that ACEs and character strengths are each meaningfully related to health outcomes. Gratitude and self-regulation were generally indicative of better health outcomes, kindness and appreciation of beauty of poorer outcomes. Character strengths remained meaningful correlates of adult behavioral and emotional health even when controlling for ACEs. Character strengths did not moderate the relationship between ACEs and health, suggesting that character strengths do not mitigate the effects of ACEs, but do make an independent contribution to physical and mental health. Supplementary Information: The online version contains supplementary material available at 10.1007/s41042-023-00097-3.

World beliefs, character strengths, and hope for the future.

Research in recent years has revealed the rate of premature and avoidable deaths from suicide and drug/|alcohol misuse is rising in the United States. These are sometimes referred to as deaths of despair based on evidence that they are concentrated in relatively poor communities with less access to social resources and low labor force participation. The pattern was first noted in middle-aged White men but seems to be gradually spreading to other ethnic groups. As a first step in establishing a psychological response to this public health issue, the present article summarizes two studies that compared psychological variables to demographics as predictors of hopefulness. A number of intriguing findings emerged. Despite concerns about American despair and conflict, U.S. residents proved the most hopeful among residents of eight countries. Low-income Americans are particularly hopeful except for low-income Whites. Positive character traits and primal beliefs about the world generally proved to be better predictors of hope than ethnicity, financial status, or their interaction. A number of relationships were found between psychological variables and community demographics. The findings as a group suggest hopefulness is driven more by psychological variables than by life circumstances. It is suggested that psychologists could play an important role in the study of this topic by implementing programs intended to enhance hopefulness in impoverished populations, and by encouraging an intentional communal focus on the importance of enhancing well-being.

Evaluating the impact of prescriptive authority for psychologists on the rate of deaths attributed to mental illness.

BACKGROUND: Five states have enacted policies granting prescriptive authority to psychologists in an effort to increase access to psychoactive medications; however, little is known regarding the public health impact of these policies. Policies in two of these states, New Mexico and Louisiana, have had sufficient time to license more than a handful of prescribing psychologists. This study estimates the impact of psychologist prescriptive authority policies in New Mexico and Louisiana on deaths attributable to mental illness and suicides. METHODS: State-level annual death rates from all 50 states were obtained for deaths with an underlying cause of death attributable to mental illness and to suicide (1999-2013) from the Centers for Disease Control and Prevention's WONDER database. State characteristics were collected for the pre-policy time period (1999-2004). We estimated the impact of the policy on the rates of deaths attributable to mental illness and to suicide using a comparative interrupted time series design, and policy effect estimates were generated for New Mexico and Louisiana separately. We used the synthetic control method to create synthetic New Mexico and synthetic Louisiana for use as the comparators. RESULTS: Immediately following the start of psychologist prescribing, the rate of deaths attributable to mental illness declined by 4.55 deaths per 100,000 (95% CI: [-8.30, -0.79]) in New Mexico relative to the control, but there was no change in Louisiana. There was no immediate change in the suicide rate in either state; however, the annual change in the overall suicide rate was 0.12 suicides per 100,000 (95% CI: [-0.18, -0.06]) per year lower than expected in Louisiana following implementation. CONCLUSIONS: These findings suggest that policies granting prescriptive authority to psychologists have the potential to reduce the mental health mortality gap, though considerable questions remain.

A Summary of Construct Validity Evidence for Two Measures of Character Strengths.

The VIA Inventory of Strengths has become the most widely used instrument in the world for measuring the construct referred to character strengths. However, several limitations were noted in its original development. In response, the VIA Assessment Suite for Adults was developed as a battery of instruments intended to address those gaps. The suite includes two inventories providing dimensional measures of the character strengths: the VIA Inventory of Strengths-Revised and the Global Assessment of Character Strengths. Short forms were also developed for each. So far, five reasonably sized samples of adults (total N = 7,924) have provided evidence for the empirical validity of some subset of these instruments, making them the most thoroughly vetted measures of character strengths available today. This article aggregates previously available and new findings on their construct validity. Evidence concerning substantive validity, structural validity, and external validity is reviewed, and in some cases aggregated across samples. The findings generally support the construct validity of the instruments evaluated according to all three standards, with exceptions noted. Recommendations are offered for their use in research and applied settings.

An nusual ocular manifestation of multiple myeloma.

A man in his 70s with a history of multiple myeloma presented with a 4-day history of right ptosis and a rapidly enlarging upper eyelid mass. On examination, a large, firm, smooth, pink lesion was found to descend from the conjunctiva of the superior fornix. The patient underwent excision biopsy. Histopathological analysis demonstrated monoclonal plasma cells expressing light-chain kappa, consistent with extramedullary plasmacytoma. Clinical ophthalmic manifestations of multiple myeloma are rare but also diverse. Ocular surface manifestations of multiple myeloma are extremely uncommon. Variable examination findings mean those involving the conjunctiva and may be particularly challenging to diagnose. Secondary ocular extramedullary plasmacytoma, despite its rarity, should be considered in patients with multiple myeloma.

Prediction of serious misconduct in law enforcement officers.

This study compared 143 law enforcement officers with a history of serious misconduct and 429 matched comparators who had completed the Candidate and Officer Personnel Survey-Revised (COPS-R), an inventory developed specifically for psychological evaluation of public safety candidates. Most had also completed the Personality Assessment Inventory (PAI), which allowed for scoring of scales and indices from the PAI Police and Public Safety Report (PAI-PPSR), as well as the recently developed PAI-Plus. Correlations and t tests indicated significant small group differences on seven COPS-R scales and one PAI-Plus index. Analyses were repeated for officers with substance use-related problems compared with nonproblem officers. These identified four COPS-R and two PAI-PPSR scales that were significant predictors. Relative risk ratio analyses indicated the clinical utility of these scales at certain cutoff scores in predicting serious misconduct in law enforcement officers and candidates. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Preliminary Evidence for an Association between Journal Submission Requirements and Reproducibility of Published Findings: A Pilot Study.

Systemic efforts have been employed to improve the reproducibility of published findings in psychology. To date, little research has been conducted evaluating how well these efforts work. In an effort to bridge this gap, the current study looked at journal submission requirements intended to encourage authors to engage in best practices for facilitating reproducible science and offers preliminary evidence for their potential efficacy. We calculated reproducibility indices (p-curves) for three randomly selected empirical studies published in each of 23 psychology journals in 2019 and correlated quantitative results from those analyzes with the number of submission requirements for each journal that intended to ensure compliance with best reporting practices. Results indicated a greater number of submission requirements at a given outlet was associated with indices indicating greater likelihood of reproducibility of findings. We frame findings as impetus for future, more extensive, research to identify causal links between submission requirements and reproducibility.

Representative Sampling of the Via Assessment Suite for Adults.

Character strengths have become a popular topic in personality research. A set of questionnaires has recently been developed as measures of character strengths: the VIA Inventory of Strengths-Revised, two 96-item short forms of that instrument, and two new measures called the Global Assessment of Character Strengths and Signature Strengths Survey. Collectively, these are referred to as the VIA Assessment Suite for Adults. Prior research has supported the reliability and validity of these measures. The current study extended those findings through a demographically stratified sample of 1,765 U.S. resident adults. Results indicated the scores were interchangeable across all three versions of the VIA-IS, irrespective of whether the items are all positively keyed or a mix of positive and negative items. In addition, the VIA-IS-R factor structure is also consistent with a previously identified three-factor model for the strengths. By freeing residual covariances, a model was developed for which adequate fit was replicable. This provided the foundation for demonstrating measurement invariance. The present study also explored differences in strengths across demographic categories and evaluated various approaches to identifying key (signature) strengths for the respondents. Recommendations on the use of the different instruments are provided.

Resilience in the face of interpersonal loss: The role of character strengths.

The present study assessed whether seven specific character strengths may function to promote resilience or growth following interpersonal loss. A sample of 3710 adults, including 557 who experienced a recent interpersonal loss (defined as death of a first-degree relative or divorce in the previous six months), completed questionnaires at least once across three time points to evaluate the extent to which character strengths predicted the presence of or changes in depression and functional impairment over a six-month period. Exploratory analyses also assessed changes in character strengths over time after loss. Results indicated that depression generally decreased over time and was unrelated to loss. Further, higher scores on the examined strengths predicted resilience, in that they predicted consistently lower levels of depression and impairment over time, regardless of loss. Thus, the seven examined strengths appeared to protect against depression and impairment over time. The loss group demonstrated higher levels of hope and gratitude across time points. Consistent with the concept of post-traumatic growth, results suggest that these strengths may be particularly salient when confronted with loss. Contrary to predictions of post-traumatic growth theory, however, there was little change in strengths over time.

Cross-Validation of the VIA Inventory of Strengths-Revised and its Short Forms.

The VIA Inventory of Strengths is an extremely popular index of the 24 character strengths that comprise the VIA Classification of Character Strengths and Virtues. The inventory has recently been extensively revised. The current study sought to evaluate the reliability and validity of the revised VIA Inventory, including newly developed short forms and scales measuring the virtue component of the VIA Classification. This study used two samples of adults, one comprised of 743 individuals recruited through Amazon Mechanical Turk (MTurk), and another of 631 individuals who accessed the VIA Institute of Character website to complete an earlier version of the VIA Inventory. Participants completed the new version of the inventory as well as a measure of related behaviors. The current study examines internal consistency, factor structure, test-retest reliability, criterion-related validity, convergent and discriminant validity, and item discrimination statistics. The results suggest the inventory generally meets psychometric standards for a measure of the targeted character strengths and virtues.

Using the VIA Classification to Advance a Psychological Science of Virtue.

The VIA Classification of Character Strengths and Virtue has received substantial attention since its inception as a model of 24 dimensions of positive human functioning, but less so as a potential contributor to a psychological science on the nature of virtue. The current paper presents an overview of how this classification could serve to advance the science of virtue. Specifically, we summarize previous research on the dimensional versus categorical characterization of virtue, and on the identification of cardinal virtues. We give particular attention to the three-dimensional model of cardinal virtues that includes moral, self-regulatory, and intellectual domains. We also discuss the possibility that these three clusters be treated as fundamental elements of a virtue model, meaning that they clearly and directly contribute to both individual and communal flourishing across various cultures. This discussion includes a summary of previous speculations about the evolution of adaptations underlying the human capacity for using behavioral repertoires associated with the three virtues, as well as discussing ways in which they simultaneously enhance community and individual, in the last case focusing particularly on evidence concerning mating potential. We then discuss the relationship between the evolutionary perspective on virtues and Aristotle's concept of the reciprocity of the virtues. Finally, we provide speculations about the nature of practical wisdom. While accepting the potential value of future revisions to the VIA model, that model even under its current conditions has the potential to generate a number of intriguing and testable hypotheses about the nature of virtue.

Robot-Aided Training of Propulsion During Walking: Effects of Torque Pulses Applied to the Hip and Knee Joints During Stance.

We sought to evaluate the effects of the application of torque pulses to the hip and knee joint via a robotic exoskeleton in the context of training propulsion during walking. Based on our previous study, we formulated a set of conditions of torque pulses applied to the hip and knee joint associated with changes in push-off posture, a component of propulsion. In this work, we quantified the effects of hip/knee torque pulses on metrics of propulsion, specifically hip extension (HE) and normalized propulsive impulse (NPI), in two experiments. In the first experiment, we exposed 16 participants to sixteen conditions of torque pulses during single strides to observe the immediate effects of pulse application. In the second experiment, we exposed 16 participants to a subset of those conditions for 200 strides to quantify short-term adaptation effects. During pulse application, NPI aligned with the expected modulation of push-off posture, while HE was modulated in the opposite direction. The timing of the applied pulses, early or late stance, was crucial, as the effects were often in the opposite direction when changing timing condition. Extension torque applied at late stance increased HE in both experiments - range of change in HE: (2.9 ± 0.4 deg, 7.7 ± 1.0 deg), . The same conditions resulted in a negative change in NPI only in the single pulse experiment - change in NPI for knee torque: -3.0 ± 0.4 ms, - and no significant change for hip torque. Also, knee extension and flexion torque during early and late stance, respectively, increased NPI during single pulse application - range of change in NPI: (3.8, 4.6) ± 0.8 ms, . During repeated pulse application, NPI increased for late stance flexion torque - range of change in NPI: (4.5 ± 0.7 ms, 4.8 ± 0.8 ms), , but not late stance extension torque. After exposure, we observed positive after-effects in HE in three conditions - range of change in HE: (2.0 ± 0.3 deg, 3.7 ± 0.7 deg) - and significant positive after-effects in NPI for early stance flexion torques - change in NPI: (2.7 ± 0.6 ms, ). These results indicate that positive propulsive after-effects can be achieved through repeated exposure to torque pulses.