The MCMI-IV: A New Normal Quartet for Parental Fitness Litigants.

The Millon series (i.e., MCMI-II/MCMI-III) has a longstanding history of use in clinical and forensic settings. For forensic psychologists, the Millon series can serve as a unique tool in evaluations related to parental fitness due to its incorporation of DSM diagnostic categories and the use of base rate (BR) scores. There is limited research on parental fitness populations broadly, though previous research has found a common positive impression management style referred to as the normal quartet with forensic populations on the MCMI-III. It is unknown if there is a continued presence of the normal quartet in the MCMI-IV, published in 2015. With the current study, we examined parental fitness litigant response patterns on the MCMI-IV and assessed the presence of a normal quartet. The sample consisted of 330 parental fitness litigants in the northeast region of the United States. Results of the current study suggest a new normal quartet: elevations on the Desirability (Y), Histrionic (4A), Turbulent (4B), and Compulsive (7) scales. The clinical implications for the use of the MCMI-IV by forensic psychologists with parental fitness litigants are discussed including limitations and areas for future research.

Psychological Flexibility, Pain Characteristics and Risk of Opioid Misuse in Noncancerous Chronic Pain Patients.

Chronic pain has an estimated annual prevalence rate between 10 and 35%. In the US, first-line treatment for chronic pain is often opioids. OBJECTIVE: To our knowledge, this is the first study exploring psychological flexibility and its association with pain severity, pain interference and risk of opioid misuse in chronic pain patients. METHODS: Data were collected at two outpatient pain clinics in the northeastern United States. Adults (N = 99) completed a cross-sectional survey with validated measures. Pain severity and pain interference were hypothesized to uniquely predict the risk of opioid misuse. Pain severity was hypothesized to predict pain interference. Finally, psychological flexibility was hypothesized as an indirect effect in these relationships. RESULTS: Main findings suggest that pain severity predicts risk of opioid misuse, mediated by psychological flexibly. Pain interference also predicts risk of opioid misuse, mediated by psychological flexibility. Finally, results suggest pain severity predicts pain interference, mediated by psychological flexibility. DISCUSSION: Implications of findings are discussed in terms of future psychological and medical assessments and interventions for chronic pain patients seeking prescription opioids.

Validation of the Philadelphia Mindfulness Scale on experienced meditators and nonmeditators.

OBJECTIVE: The Philadelphia Mindfulness Scale's (PHLMS) psychometric properties, theoretical assumptions, convergent validity, and relationships to symptom, happiness and social desirability measures were investigated in novel samples. METHODS: Internet-recruited general public samples of experienced meditators (n = 67, 21 male, 46 female, average age 50) and nonmeditators (n = 61, 28 male, 32 female, and 1 transgender; average age 41.9) were used. RESULTS: Meditators scored higher than nonmeditators on both PHLMS Acceptance, t(126) = 2.77, p < .01, d = 0.49, and Awareness t(126) = 4.18, p < .01, d = 0.74. Higher PHLMS Acceptance subscale scores were associated with decreased scores on all symptom measures in nonmeditators, but only in select measures among meditators. Generally, PHLMS Awareness subscale scores were not related to symptoms. Awareness interacted with meditator status on outcome measures. CONCLUSIONS: PHLMS may be used in the general public and experienced meditator populations. Mindfulness facets become intercorrelated in experienced meditators.

Pilot randomized controlled trial of a symptom cluster intervention in advanced cancer.

OBJECTIVE: This study evaluated a three-session acceptance-based cognitive behavioral -acceptance and commitment therapy (CBT-ACT) intervention targeting a common symptom cluster in advanced cancer-worry-insomnia-depression-fatigue. METHODS: Twenty-eight patients with advanced cancer were randomly assigned to the CBT-ACT intervention or waitlist. At preintervention, participants completed a psychodiagnostic interview, standardized questionnaires, and a sleep diary. Intervention and waitlist groups were reassessed after 6 weeks, at which point the waitlist group completed the intervention. RESULTS: Participants receiving the intervention demonstrated improved sleep efficiency (P = 0.0062, d = 1.08), sleep latency (P = 0.028, d = -0.86), insomnia severity (P = 0.0047, d = -1.18), and worry (P = 0.026, d = -0.89) compared with waitlist controls. They also demonstrated a 7-point reduction on depression (P = 0.03, d = -0.88), reduced hyperarousal (P = 0.005, d = -1.51), and a decrease in distress (P = 0.032, d = -0.83). Effects were maintained for the whole sample in sensitivity analyses. Effects on uncertainty intolerance approached significance (P = 0.058). No effect was found on fatigue. CONCLUSIONS: The CBT-ACT group performed significantly better than the waitlist control group. CBT-ACT yielded strong effects for worry, sleep, depression, emotional distress, total distress, and hyperarousal. Future studies will enhance the fatigue and uncertainty tolerance components of the intervention.

When Words Fail: Providing Effective Psychological Treatment for Depression in Persons with Aphasia.

More than 2 million people in the United States are living with some form of aphasia, a communication disorder that has been associated with high incidence of clinical depression. Despite their large numbers, persons with aphasia have received little clinical attention from psychologists and other mental health providers. The life participation interventions and supported communication methods developed and routinely employed by speech-language pathologists could assist mental health professionals in addressing the needs of this underserved population. This paper examines the psychological challenges facing individuals living with aphasia and the factors contributing to depressive symptoms among those with significant communication loss. In addition, it explores the potential compatibility between life participation interventions developed by speech-language pathologists and evidence-based cognitive-behavioral interventions for depression, such as behavioral activation. Specific adaptations to behavioral activation for individuals experiencing aphasia-related depressive symptoms are explored, along with strategies for integrating supported communication in the provision of mental health treatment.

An Exploration of the Mediators Between Childhood Maltreatment and Intimate Partner Violence.

Intimate partner violence (IPV) is associated with numerous long-term consequences and warrants significant clinical attention. Recent theoretical models and empirical research have suggested that several factors play a role in the development of IPV perpetration, including childhood maltreatment, early maladaptive schemas, anger, and difficulties in emotion regulation. This study investigated the relationship between childhood maltreatment and IPV, specifically examining the mediation of this relationship by several variables thought to be related to this pernicious problem, including early maladaptive schemas, the experience of anger, and emotion regulation difficulties. In a young adult collegiate sample of 110 women in relationships, results of a bootstrapped multiple mediation analysis supported the hypothesis that childhood maltreatment predicted physical aggression within intimate partner relationships and found that the total indirect effect of childhood maltreatment on physical aggression through the 3 proposed mediators was significant. However, consistent with recent empirical findings, only difficulties in emotion regulation significantly mediated the relationship between childhood maltreatment and physical aggression within the sample.

Prevalence of clinically elevated depressive symptoms in college athletes and differences by gender and sport.

BACKGROUND: There are approximately 400,000 National Collegiate Athletic Association (NCAA) student athletes and 5-7 million high school student athletes competing each year. According to the US Department of Health and Human Services, the depression prevalence rate for young adults, which ranges from 10% to 85% across studies, is higher than that of other age groups. Given the relatively high prevalence of depression in individuals of collegiate age in the general population, the prevalence of depression among athletes in this age group warrants further study. This multiyear study examined the prevalence of depressive symptoms in college athletes, as well as demographic factors related to increased or decreased rates of depressive symptoms by gender and sport. OBJECTIVE: To describe the prevalence of depression symptoms among NCAA division I student athletes at a single institution over 3 consecutive years. METHOD: Participants (n=465) completed a battery of measures during their yearly spring sports medicine physical across 3 consecutive years. The battery included the Center for Epidemiological Studies Depression Scale (CES-D) and a demographic questionnaire, administered during the course of routine sports medicine physical examinations. Differences in depressive symptoms prevalence and relative risk ratios were calculated by gender and sport. RESULTS: The prevalence rate for a clinically relevant level of depressive symptoms, as measured on the CES-D (CES-D ≥16), was 23.7%. A moderate to severe level of depressive symptoms was reported by 6.3%. There was a significant gender difference in prevalence of depressive symptoms, χ(2) (1)=7.459, p=0.006, with female athletes exhibiting 1.844 times the risk of male athletes for endorsing clinically relevant symptoms. CONCLUSIONS: The CES-D identified clinically relevant levels of depressive symptoms in nearly one-quarter of college student athletes in this large cross-sectional sample. Female college athletes reported significantly more depressive symptoms than males. Findings suggest that depression prevalence among college athletes is comparable to that found in the general college population. In light of these findings, sports medicine personnel may wish to implement depression screening and assessment of depressive symptoms across sports to identify at-risk athletes. Risk factors related to depression in college athletes warrant additional study.

Amyloid-ß associated cortical thinning in clinically normal elderly.

OBJECTIVE: Both amyloid-ß (Aß) deposition and brain atrophy are associated with Alzheimer's disease (AD) and the disease process likely begins many years before symptoms appear. We sought to determine whether clinically normal (CN) older individuals with Aß deposition revealed by positron emission tomography (PET) imaging using Pittsburgh Compound B (PiB) also have evidence of both cortical thickness and hippocampal volume reductions in a pattern similar to that seen in AD. METHODS: A total of 119 older individuals (87 CN subjects and 32 patients with mild AD) underwent PiB PET and high-resolution structural magnetic resonance imaging (MRI). Regression models were used to relate PiB retention to cortical thickness and hippocampal volume. RESULTS: We found that PiB retention in CN subjects was (1) age-related and (2) associated with cortical thickness reductions, particularly in parietal and posterior cingulate regions extending into the precuneus, in a pattern similar to that observed in mild AD. Hippocampal volume reduction was variably related to Aß deposition. INTERPRETATION: We conclude that Aß deposition is associated with a pattern of cortical thickness reduction consistent with AD prior to the development of cognitive impairment.

Prospective Study of a Novel Risk Stratification Process for Opioid-Related Harm Reduction in Cancer Patients Seen in an Outpatient Palliative Care Clinic.

Background: Oncologists and palliative specialists prescribe opioids for millions of cancer patients despite limited research on effective screening and mitigation strategies to reduce risk of opioid-related harm in that population. Objective: To evaluate the efficacy of a novel opioid risk stratification process for predicting significant aberrant behaviors (SABs) related to prescribed opioid medications. Design and Setting/Subjects: This is a prospective, longitudinal study of 319 consecutive patients referred to an outpatient palliative care clinic between 2010 and 2012, a period during which prescription opioid-related deaths began to increase in the United States. Measures: Patients completed a psychodiagnostic/substance use risk assessment with a licensed clinical psychologist or social worker at the initial palliative clinic visit. Patients were assigned to Low-, Moderate-, or High-Risk groups based on predetermined stratification criteria and were managed via an opioid harm reduction approach. The primary dependent measure was the presence of at least one SAB after the initial visit. Results: Eighteen percent of patients (n = 56) demonstrated at least one major aberrant behavior. Odds of future aberrant behavior was 15 times greater in the High-Risk versus the Low-Risk category. Five risk factors significantly enhanced our risk model: age 18 to 45 years, job instability, history of bipolar diagnosis, history of substance abuse, and theft. Conclusion: Our risk stratification process provides a useful model for predicting those at greatest risk of future aberrant behaviors and most in need of comanagement. We recommend additional studies to test our proposed streamlined risk stratification tool.

Emergency department initiated treatments for tobacco (EDITT): a pilot study.

BACKGROUND: Emergency departments (EDs) have strong potential to initiate tobacco interventions with economically disadvantaged populations. PURPOSE: We piloted three ED-initiated tobacco interventions and derived parameter estimates for future trials. METHODS: The study enrolled adult patients being treated in an urban ED who were daily smokers. Exclusion criteria included severe illness or pain, isolation (for contagion), altered mental status, an insurmountable language barrier, temporary residence, and lack of telephone access. Subjects in the Bedside + Booster group received motivational counseling by a trained counselor at the bedside, up to three telephone sessions post-visit, and a self-help guide. Subjects in the Faxed Referral group had their personal contact information faxed to the hospital's tobacco dependence clinic, whereupon they received identical treatment as the Bedside + Booster group, but all sessions occurred over the telephone (i.e., no bedside counseling). The Standard Referral group received the self-help guide and a referral to the hospital's tobacco dependence clinic. We used a 2:2:1 randomization schedule to maximize our experience with the motivational interventions. Outcomes were assessed at 1 and 3 months. RESULTS: We enrolled 90 subjects. Of the 36 subjects assigned to the Bedside + Booster condition, 31 (87%) completed bedside counseling and at least one booster session, while 22 (61%) completed the maximum four sessions. Of the 37 subjects assigned to the Faxed Referral group, 28 (76%) completed at least one telephone session, while 19 (51%) completed the maximum four sessions. Quit attempts over the 3 months ranged from 18% (Standard Referral) to 57% (Faxed Referral). Seven-day abstinence was attained by 8% (Bedside + Booster), 14% (Faxed Referral), and 6% (Standard Referral) at 3 months. CONCLUSIONS: Motivational cessation counseling can be feasibly initiated during the ED encounter with minimal medical staff involvement. Adequately powered trials are needed to study ED-initiated interventions that include post-visit follow-up.

Cardiomyopathy due to ingestion of Adderall.

A patient is described who developed cardiomyopathy after receiving a therapeutic course of dextroamphetamine/amphetamine. The patient's cardiac function deteriorated to the point of heart failure, necessitating a heart transplantation. Cardiomyopathy associated with amphetamine use is a serious and potentially lethal condition. With early diagnosis, identification of the cause, and treatment, cardiomyopathy may be reversible. The dangers of therapeutic use of amphetamines are discussed, as well as problems and assumptions associated with U.S. Food and Drug Administration monitoring and removal from the market of harmful substances.

Mindfulness buffers the effects of cue-induced craving on alcohol demand in college drinkers.

Alcohol consumption among young adult college students represents a significant public health problem. The presence of alcohol-related cues in drinkers' environments can trigger powerful alcohol cravings, which may influence drinking outcomes. Less is known about how this cue-induced craving influences behavioral economic demand for alcohol. In addition, research has suggested that trait mindfulness may be an important buffer of the effects of internal states of craving on drinking decisions. Based on this literature, we hypothesized that cue-induced cravings would be associated with increased alcohol demand, an effect that would be attenuated among drinkers who have higher levels of mindfulness. Young adult college student drinkers (n = 69) completed a laboratory-based cue-induced craving assessment, a self-report assessment of trait mindfulness, and an alcohol purchase task. Findings revealed that cue-induced craving was related to higher alcohol demand. Consistent with the study hypothesis, acceptance, a component of mindfulness, buffered the effects of cue-induced craving on alcohol demand. Results raise the possibility that mindfulness-based interventions may be useful in helping disrupt the link between internal states of craving and drinking decisions in young adult college student drinkers.

A small randomized pilot study of a workplace mindfulness-based intervention for surgical intensive care unit personnel: effects on salivary α-amylase levels.

OBJECTIVE: To determine whether a workplace stress-reduction intervention decreases reactivity to stress among personnel exposed to a highly stressful occupational environment. METHODS: Personnel from a surgical intensive care unit were randomized to a stress-reduction intervention or a waitlist control group. The 8-week group mindfulness-based intervention included mindfulness, gentle yoga, and music. Psychological and biological markers of stress were measured 1 week before and 1 week after the intervention. RESULTS: Levels of salivary α-amylase, an index of sympathetic activation, were significantly decreased between the first and second assessments in the intervention group with no changes in the control group. There was a positive correlation between salivary α-amylase levels and burnout scores. CONCLUSIONS: These data suggest that this type of intervention could decrease not only reactivity to stress but also the risk of burnout.

Drug utilization, safety and clinical use of Actos and Avandia.

BACKGROUND AND OBJECTIVE: The impetus for this review was recent increased warnings of cardiovascular toxicity, fractures and bladder cancer associated with glitazone use. METHODS: A drug utilization review was performed regarding the use of Actos (pioglitazone) and Avandia (rosiglitazone) at Cooper Green Mercy Hospital (CGMH), an inner city safety net hospital in Birmingham, Alabama. Pharmacy records were reviewed hospital-wide to determine usage patterns of all anti-diabetic medications. Medline and the FDA websites were searched for articles on safety and efficacy of pioglitazone and rosiglitazone. Considerations were relative utilization profile, comparative efficacy, indications, relative cost, and safety profile of the two available medications in this drug class. RESULTS: On the basis of all of these factors, a hospital-wide switch of all rosiglitazone prescriptions to all pioglitazone was implemented, which was estimated to result in savings of $83,000 for the first year. No episodes of worsening of control of diabetes were anticipated, nor were episodes of decreased efficacy or adverse effects as a result of automatically switching patients from rosiglitazone to pioglitazone at the time of prescription filling. CONCLUSIONS: The conclusions can be summarized in a number of key points. • Clinicians should follow the American Diabetes Association guidelines [1] for treatment. • The basis for diabetic control is weight loss, diet and exercise. • Initial medication management for type II Diabetes Mellitus includes metformin and insulin. • There are no circumstances in which use of glitazone medications is preferable to other medication groups, and there are no clinical circumstances in which use of glitazone medications is absolutely necessary, as opposed to other classes of diabetic medication. • There are significant contraindications, warnings and precautions to use of glitazones, which must be taken into consideration before use in every individual patient. • Glitazones in particular should not be used in the following circumstances: congestive heart failure (CHF), concurrent bladder cancer or severe osteoporosis.

Suffering compounded: the relationship between abuse history and distress in five palliative care domains.

BACKGROUND: Research with breast cancer patients suggests that abuse survivors experience more psychological distress and disorders, particularly depression and anxiety, than patients without abuse histories. However, we do not yet understand the impact of abuse on other palliative care domains for individuals with other cancer types. OBJECTIVES: This study explores the relationship between past abuse and distress in a group of cancer patients referred for palliative care. This study also explores differences in distress level and likelihood of meeting diagnostic criteria for major depression and generalized anxiety disorder between patients with and without abuse histories. SETTING/SUBJECTS: Data were from 164 new, palliative care outpatients who completed an initial clinician-administered assessment and the James Supportive Care Screening patient self-report. DESIGN: Multivariate analyses of variance were conducted to explore differences between patients who reported an abuse history and those who did not on the number of items endorsed and associated distress on five palliative care domains. Chi-square tests were conducted to identify differences in diagnosis of depression and anxiety between patients with and without abuse histories. RESULTS: Twenty-eight percent reported abuse histories. Patients with abuse histories endorsed more physical problems, psychological concerns, and spiritual concerns and greater distress related to psychological and spiritual concerns than patients without abuse histories. Patients with abuse histories more frequently received diagnoses of major depression disorder and generalized anxiety disorder. CONCLUSIONS: These differences underscore the impact of abuse on the adjustment of cancer patients referred for palliative care. Assessment of patient abuse history by palliative care teams and referral for psychological treatment may help reduce patient distress.

Neurological complications of vaccination with outer surface protein A (OspA).

A wide range of neurological complications have been reported via the medical literature and the VAERS system after vaccination with recombinant outer surface protein A (OspA) of Borrelia. To explore this issue, 24 patients reporting neurological adverse events (AE) after vaccination with Lymerix, out of a group of 94 patients reporting adverse events after Lymerix vaccination, were examined for causation. Five reports of cerebral ischemia, two transient Ischemic attacks, five demyelinating events, two optic neuritis, two reports of transverse myelitis, and one non-specific demyelinating condition are evaluated in this paper. Caution is raised on not actively looking for neurologic AE, and for not considering causation when the incidence rate is too low to raise a calculable difference to natural occurence.

Acute brachial diplegia due to Lyme disease.

OBJECTIVE: to describe acute brachial diplegia as the initial manifestation of Lyme disease. BACKGROUND: bilateral, predominantly motor, cervical radiculoplexus neuropathy, the "dangling arm syndrome," has not been reported as a complication of acute Lyme infection. METHODS: retrospective series of 5 patients from 2 tertiary neuromuscular centers. RESULTS: there were 4 men and 1 woman with an average age of 69 years. One recalled a tick bite, and preceding constitutional symptoms included headache (2) and fever, arthralgias, and fatigue in 1 patient each. Proximal arm weakness and acute pain developed within 3 weeks from onset; pain was bilateral in 3 patients and unilateral in 2 patients, and was described as severe throbbing. Arm weakness was bilateral at onset in 3 patients, and right sided in 2 patients followed by spread to the left arm within days. All the patients had weakness in the deltoid and biceps that was 3/5 or less (Medical Research Council scale), with variable weakness of the triceps and wrist extensors; 1 patient had a flail right arm and moderate (4/5) weakness of the proximal left arm muscles. Light touch was normal in the regions of weakness, and 1 patient had mildly reduced pin sensation over the forearm. Serum IgM Lyme titers were elevated in all the patients and were detected in the cerebrospinal fluid in 4 tested patients. The cerebrospinal fluid protein ranged between 135 and 176 mg/dL with lymphocytic pleocytosis (range, 42 to 270 cells). Electrodiagnostic studies showed normal median and ulnar motor potentials with asymmetrically reduced sensory amplitudes in the median (4), ulnar (3), and radial, and lateral antebrachial cutaneous potentials in 1 patient each. Two patients had acute denervation in the cervical or proximal arm muscles. There was full recovery after antibiotic therapy in 4 patients and considerable improvement in 1 patient after 2 months. CONCLUSION: acute brachial diplegia is a rare manifestation of acute Lyme infection and responds promptly to antibiotic therapy.