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Mistler CB, Shrestha R, Gunstad J, Collins L, Madden L, Huedo-Medina T, Sibilio B, Copenhaver NM, Copenhaver M. Application of the multiphase optimisation strategy (MOST) to optimise HIV prevention targeting people on medication for opioid use disorder (MOUD) who have cognitive dysfunction: protocol for a MOST study. BMJ Open 2023; 13:e071688. [PMID: 37399447 PMCID: PMC10314648 DOI: 10.1136/bmjopen-2023-071688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 06/21/2023] [Indexed: 07/05/2023] Open
Abstract
INTRODUCTION People who inject drugs (PWID) have remained a contributor to the consistent HIV incidence rates in the US for decades. Pre-exposure prophylaxis (PrEP) is a promising biomedical intervention for HIV prevention among individuals at risk for HIV infection, including PWID. However, PWID report the lowest rates of PrEP uptake and adherence among at-risk groups. Tailored HIV prevention interventions must include strategies that compensate for cognitive dysfunction among PWID. METHODS AND ANALYSIS Using the multiphase optimisation strategy, we will be conducting a 16-condition factorial experiment to investigate the effects of four different accommodation strategy components to compensate for cognitive dysfunction among 256 PWID on medication for opioid use disorder. This innovative approach will inform optimisation of a highly effective intervention to enhance PWID's ability to process and utilise HIV prevention content to improve PrEP adherence and HIV risk reduction in a drug treatment setting. ETHICS AND DISSEMINATION The institutional review board at the University of Connecticut approved this protocol (H22-0122) with an institutional reliance agreement with APT Foundation Inc. All participants are required to sign an informed consent form prior to engaging in any study protocols. The results of this study will be disseminated on national and international platforms through presentations at major conferences and journals. TRIAL REGISTRATION NUMBER NCT05669534.
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Affiliation(s)
- Colleen B Mistler
- Department of Allied Health Sciences, University of Connecticut, Storrs, Connecticut, USA
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
| | - Roman Shrestha
- Department of Allied Health Sciences, University of Connecticut, Storrs, Connecticut, USA
- University of Connecticut Institute for Collaboration on Health Intervention and Policy, Storrs, Connecticut, USA
| | - John Gunstad
- Department of Psychology, Kent State University, Kent, Ohio, USA
| | - Linda Collins
- Department of Social and Behavioral Science, New York University College of Global Public Health, New York, New York, USA
| | - Lynn Madden
- Department of Internal Medicine-AIDS, Yale University School of Medicine, New Haven, Connecticut, USA
- Apt Foundation Inc, New Haven, Connecticut, USA
| | - Tania Huedo-Medina
- Department of Allied Health Sciences, University of Connecticut, Storrs, Connecticut, USA
- Department of Clinical, Health Psychology and Research Methods, University of the Basque Country, Bilbao, Spain
| | - Brian Sibilio
- University of Connecticut Institute for Collaboration on Health Intervention and Policy, Storrs, Connecticut, USA
| | - Nicholas M Copenhaver
- Department of Allied Health Sciences, University of Connecticut, Storrs, Connecticut, USA
| | - Michael Copenhaver
- Department of Allied Health Sciences, University of Connecticut, Storrs, Connecticut, USA
- University of Connecticut Institute for Collaboration on Health Intervention and Policy, Storrs, Connecticut, USA
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Mistler CB, Shrestha R, Gunstad J, Sanborn V, Copenhaver MM. Adapting behavioural interventions to compensate for cognitive dysfunction in persons with opioid use disorder. Gen Psychiatr 2021; 34:e100412. [PMID: 34504995 PMCID: PMC8370499 DOI: 10.1136/gpsych-2020-100412] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 07/21/2021] [Indexed: 01/20/2023] Open
Abstract
Treatment for opioid use disorder (OUD) is often in the context of biobehavioural interventions, consisting of medication for OUD (for example, methadone and buprenorphine), which is accompanied by psychoeducation and/or behavioural therapies. Patients with OUD often display weaknesses in cognitive function that may impact the efficacy of such behavioural interventions. A review of the literature was conducted to: (1) describe common cognitive dysfunction profiles among patients with OUD, (2) outline intervention approaches for patients with OUD, (3) consider the cognitive demands that interventions place on patients with OUD and (4) identify potential accommodation strategies that may be used to optimise treatment outcomes. Cognitive profiles of patients with OUD often include weaknesses in executive function, attention, memory and information processing. Behavioural interventions require the patients' ability to learn, understand and remember information (placing specific cognitive demands on patients). Accommodation strategies are, therefore, needed for patients with challenges in one or more of these areas. Research on accommodation strategies for patients with OUD is very limited. We applied research from populations with similar cognitive profiles to form a comprehensive collection of potential strategies to compensate for cognitive dysfunction among patients with OUD. The cognitive profiles and accommodation strategies included in this review are intended to inform future intervention research aimed at improving outcomes among patients with OUD.
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Affiliation(s)
- Colleen B Mistler
- Allied Health Sciences, University of Connecticut, Storrs, Connecticut, USA
| | - Roman Shrestha
- Allied Health Sciences, University of Connecticut, Storrs, Connecticut, USA
| | - John Gunstad
- Department of Psychology, Kent State University, Kent, Ohio, USA
| | - Victoria Sanborn
- Department of Psychology, Kent State University, Kent, Ohio, USA
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Characteristics and Service Use of Older Adults with Schizoaffective Disorder Versus Older Adults with Schizophrenia and Bipolar Disorder. Am J Geriatr Psychiatry 2017; 25:941-950. [PMID: 28478998 PMCID: PMC6013831 DOI: 10.1016/j.jagp.2017.03.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 02/23/2017] [Accepted: 03/21/2017] [Indexed: 12/23/2022]
Abstract
OBJECTIVE The purpose of this study was to determine if schizoaffective disorder in older adults is differentiated from schizophrenia and bipolar disorder with respect to community functioning, cognitive functioning, psychiatric symptoms, and service use. DESIGN Secondary analysis of baseline data collected from the Helping Older People Experience Success psychosocial skills training and health management study. SETTING Three community mental health centers in New Hampshire and Massachusetts. PARTICIPANTS Adults over the age of 50 (N = 139, mean age: 59.7 years, SD: 7.4 years) with persistent functional impairment and a diagnosis of schizoaffective disorder (N = 52), schizophrenia (N = 51), or bipolar disorder (N = 36). MEASUREMENTS Health status (36-Item Short Form Health Survey [SF-36]), performance-based community living skills (UCSD Performance-Based Skills Assessment), neuropsychological functioning (Delis-Kaplan Executive Functioning subtests), psychiatric symptoms (Brief Psychiatric Rating Scale, Center for Epidemiologic Studies Depression Scale, Scale for the Assessment of Negative Symptoms), medical severity (Charlson comorbidity index), and acute service use. RESULTS Older adults with schizoaffective disorder had depressive symptoms of similar severity to bipolar disorder, and thought disorder symptoms of similar severity to schizophrenia. Schizoaffective disorder compared with schizophrenia was associated with better community functioning, but poorer subjective physical and mental health functioning as measured by the SF-36. Older adults with schizoaffective disorder had greater acute hospitalization compared with adults with schizophrenia, though their use of acute care services was comparable to individuals with bipolar disorder. CONCLUSIONS Findings from this study suggest that schizoaffective disorder in older adults occupies a distinct profile from either schizophrenia or bipolar disorder with respect to community functional status, symptom profile, and acute services utilization.
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Lewandowski KE, Sperry SH, Malloy MC, Forester BP. Age as a predictor of cognitive decline in bipolar disorder. Am J Geriatr Psychiatry 2014; 22:1462-8. [PMID: 24262287 PMCID: PMC3977013 DOI: 10.1016/j.jagp.2013.10.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Revised: 09/06/2013] [Accepted: 10/02/2013] [Indexed: 01/10/2023]
Abstract
OBJECTIVE Cognitive dysfunction is a core feature of bipolar disorder (BD) in both adult and geriatric patients. However, little is known about whether cognitive functioning declines at a faster rate in patients with BD, and there are conflicting reports regarding the relationship between age and cognitive functioning in this population. This cross-sectional study examined the relationship between age and cognitive functioning in patients with BD. METHODS Patients with BD I (N = 113) and healthy adults (N = 64) ages 18-87 completed measures of processing speed, attention, executive functioning, verbal fluency, and clinical symptomatology. Groupwise comparisons were used to examine differences between patients and the comparison group and adult and geriatric BD cohorts. A series of linear regressions was conducted to examine the relationship of age and cognitive functioning and clinical variables and cognition. RESULTS Patients performed significantly worse than the comparison group on all neuropsychological measures. Age was a significant predictor of Trails A scores with older age associated with worse performance. CONCLUSIONS Older age was associated with poorer performance on Trails A in patients with BD but not healthy adults. These results are suggestive of greater dysfunction in processing speed with older age in patients with BD compared with a healthy comparison group. Because cognitive functioning is associated with community outcomes, these findings suggest a need for treatments targeting cognitive symptoms across the life span. Future research exploring neurobiologic evidence for neurodegenerative processes in BD will pave the way for potential therapeutic interventions.
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Affiliation(s)
- Kathryn E. Lewandowski
- Schizophrenia and Bipolar Disorder Program, McLean Hospital, 115 Mill St., Belmont, MA, 02478 USA,Harvard Medical School, Department of Psychiatry, Landmark Ctr., 401 Park Dr., Boston, MA, 02215, USA
| | - Sarah H. Sperry
- Schizophrenia and Bipolar Disorder Program, McLean Hospital, 115 Mill St., Belmont, MA, 02478 USA
| | - Mary C. Malloy
- Geriatric Mood Disorders Research Program, McLean Hospital, 115 Mill St., Belmont, MA 02478 USA
| | - Brent P. Forester
- Harvard Medical School, Department of Psychiatry, Landmark Ctr., 401 Park Dr., Boston, MA, 02215, USA,Geriatric Mood Disorders Research Program, McLean Hospital, 115 Mill St., Belmont, MA 02478 USA
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Bartels SJ, Pratt SI, Mueser KT, Forester BP, Wolfe R, Cather C, Xie H, McHugo GJ, Bird B, Aschbrenner KA, Naslund JA, Feldman J. Long-term outcomes of a randomized trial of integrated skills training and preventive healthcare for older adults with serious mental illness. Am J Geriatr Psychiatry 2014; 22:1251-61. [PMID: 23954039 PMCID: PMC3836872 DOI: 10.1016/j.jagp.2013.04.013] [Citation(s) in RCA: 106] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2012] [Revised: 03/28/2013] [Accepted: 04/24/2013] [Indexed: 11/18/2022]
Abstract
OBJECTIVE This report describes 1-, 2-, and 3-year outcomes of a combined psychosocial skills training and preventive healthcare intervention (Helping Older People Experience Success [HOPES]) for older persons with serious mental illness. METHODS A randomized controlled trial compared HOPES with treatment as usual (TAU) for 183 older adults (age ≥ 50 years [mean age: 60.2]) with serious mental illness (28% schizophrenia, 28% schizoaffective disorder, 20% bipolar disorder, 24% major depression) from two community mental health centers in Boston, Massachusetts, and one in Nashua, New Hampshire. HOPES comprised 12 months of weekly skills training classes, twice-monthly community practice trips, and monthly nurse preventive healthcare visits, followed by a 1-year maintenance phase of monthly sessions. Blinded evaluations of functioning, symptoms, and service use were conducted at baseline and at a 1-year (end of the intensive phase), 2-year (end of the maintenance phase), and 3-year (12 months after the intervention) follow-up. RESULTS HOPES compared with TAU was associated with improved community living skills and functioning, greater self-efficacy, lower overall psychiatric and negative symptoms, greater acquisition of preventive healthcare (more frequent eye exams, visual acuity, hearing tests, mammograms, and Pap smears), and nearly twice the rate of completed advance directives. No differences were found for medical severity, number of medical conditions, subjective health status, or acute service use at the 3-year follow-up. CONCLUSION Skills training and nurse facilitated preventive healthcare for older adults with serious mental illness was associated with sustained long-term improvement in functioning, symptoms, self-efficacy, preventive healthcare screening, and advance care planning.
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Affiliation(s)
- Stephen J Bartels
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, NH; Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, Hanover, NH; The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Hanover, NH.
| | - Sarah I Pratt
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, NH; The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Hanover, NH
| | - Kim T Mueser
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, NH; Dartmouth Psychiatric Research Center, Lebanon, NH; Center for Psychiatric Rehabilitation, Boston University, Boston, MA
| | - Brent P Forester
- Department of Psychiatry, Harvard University, Cambridge, MA; Geriatric Psychiatry Research Program, McLean Hospital, Belmont, MA
| | | | - Corinne Cather
- Schizophrenia Program, Massachusetts General Hospital, Boston, MA
| | - Haiyi Xie
- Dartmouth Psychiatric Research Center, Lebanon, NH
| | | | | | - Kelly A Aschbrenner
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, NH
| | - John A Naslund
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Hanover, NH
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