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Ruiz-Yu B, Ni HW, He E. The Role of Interactional Processes in Mental Health Disparities: A Narrative Review of Existing Research and Recommendations for Providers. J Clin Psychol Med Settings 2025; 32:239-252. [PMID: 39187647 DOI: 10.1007/s10880-024-10025-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2024] [Indexed: 08/28/2024]
Abstract
Mental health disparities between racial/ethnic minority groups and non-Latinx Whites in the United States persist despite significant efforts aimed at decreasing these disparities. Efforts to address mental health disparities have largely focused on individual (e.g., stigma, help-seeking, health behaviors) and structural (e.g., public policy, interventions, addressing poverty) level factors. In contrast, this paper considers how processes at the interactional level (i.e., interactions between patients and providers) are also an important contributor to racial/ethnic disparities in mental health. Specifically, social psychological research has demonstrated how biases, including stereotypes, prejudice, and discrimination, can affect patient-provider interactions and contribute to mental health disparities. This narrative review of empirical studies that examine interactional processes between patients and mental health providers identified eleven studies to be included. Concepts represented in the studies are summarized and additional frameworks that can help explain how disparities are maintained are proposed. Last of all, practical suggestions for mitigating provider bias during patient-provider interactions are provided based on the findings from the narrative review.
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Affiliation(s)
- Bernalyn Ruiz-Yu
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA.
- Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, 90095, USA.
| | - H Wenwen Ni
- Department of Psychology, Sonoma State University, Rohnert Park, CA, USA
| | - Emily He
- Department of Psychology, Clark University, Worcester, MA, USA
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Brenner AM, Coverdale J, Castillo EG, Balon R, Morreale MK, Beresin EV, Seritan AL, Thomas LA, Aggarwal R, Guerrero APS. What We Are Allowed to Say: Academic Freedom and Teaching Racial Disparities in Psychiatry Education. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2025:10.1007/s40596-025-02155-1. [PMID: 40389801 DOI: 10.1007/s40596-025-02155-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2025]
Affiliation(s)
- Adam M Brenner
- University of Texas Southwestern Medical Center, Dallas, TX, USA.
| | | | - Enrico G Castillo
- Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | | | | | - Eugene V Beresin
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Lia A Thomas
- VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Rashi Aggarwal
- Northwell Health at Staten Island University Hospital, Staten Island, NY, USA
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Oluwoye O, Oshodi O, Stokes B. Understanding Community-Level Determinants and Navigating Care for Psychosis: The Experiences of Black Service Users and Their Family Members. J Racial Ethn Health Disparities 2025:10.1007/s40615-025-02472-z. [PMID: 40355792 DOI: 10.1007/s40615-025-02472-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2025] [Revised: 04/28/2025] [Accepted: 04/30/2025] [Indexed: 05/15/2025]
Abstract
INTRODUCTION Prior research on the experiences of individuals in the early stages of psychosis have primarily focused on identifying facilitators and barriers at individual and interpersonal level determinants on the pathway to care, with very few studies focused on Black individuals and their family members. The purpose of this study is to explore and understand perceived community-level determinants that support or hinder the experiences of Black service users in the early stages of psychosis and their family members/support persons as they navigate care. METHODS In-depth semi-structured interviews were conducted with six Black young adults in the early stages of psychosis and 11 Black family members of individuals enrolled in early intervention services for psychosis. RESULTS Qualitative data was thematically analyzed, and five core themes emerged from the analysis: (1) access to social networks, resources, and opportunities; (2) combating racism and discrimination; (3) stigma in the Black community; (4) diverse representation and cultural relevancy; and (5) public education and awareness on psychosis. CONCLUSIONS Findings explored how community and societal factors hinder access to resources, shape experiences navigating care, and identify facilitators to support services and improve the experiences of Black individuals in the early stages of psychosis and family members.
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Affiliation(s)
- Oladunni Oluwoye
- Elson S. Floyd College of Medicine, Washington State University, 412 E. Spokane Falls Blvd, Spokane, WA, 99210-1495, USA.
| | - Oluwatofunmi Oshodi
- Prevention Science Program, Washington State University, Pullman, WA, USA
- Columbia University Irving Medical Center, New York, NY, USA
| | - Bryony Stokes
- Elson S. Floyd College of Medicine, Washington State University, 412 E. Spokane Falls Blvd, Spokane, WA, 99210-1495, USA
- New York State Psychiatric Institute, New York, NY, USA
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Loane EM, Vera San Juan N, Young AH, Gale-Grant O, Heslin M. Service user perspectives and experiences of their diagnosis of psychotic major depression: A qualitative study. PLoS One 2025; 20:e0322868. [PMID: 40315217 PMCID: PMC12047751 DOI: 10.1371/journal.pone.0322868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Accepted: 03/20/2025] [Indexed: 05/04/2025] Open
Abstract
BACKGROUND Evidence suggests psychotic major depression can be overlooked in clinical settings and thus lead to delays in diagnosis. There have been multiple theories about why this happens, however no research has investigated this from a service users' perspective. AIMS The aim of this study was to explore service users' perspectives and experiences of their diagnosis of psychotic major depression. Where there appeared to be a substantial delay between initial symptoms and diagnosis, reasons for this was explored in depth. METHODS This study used a qualitative approach based on semi-structured interviews with service users diagnosed with psychotic major depression. Interviews were audio recorded and transcribed verbatim. Data was analysed using thematic analysis. RESULTS Ten interviews were conducted. Four overarching themes were identified: difficulty retelling the story, barriers to symptom identification, experiences following disclosure, responses to diagnosis. The theme of barriers to symptom identification highlighted that psychotic symptoms can be overlooked in the diagnostic process. Service users reported that health professionals do not always check for psychotic symptoms in clinical assessments. Service users have difficulty verbalising their symptoms, or find it difficult to disclose due to stigma, fear or shame. Short/rushed appointments, lack of consistency with health professionals, being moved between services and medicalising language made disclosure of psychotic symptoms less likely. CONCLUSIONS Psychotic major depression should be actively considered as a differential diagnosis by healthcare professionals when assessing an individual for unipolar depression. Healthcare professionals should be mindful of the specific barriers to disclosure of psychotic symptoms, and building rapport should be prioritised to facilitate disclosure.
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Affiliation(s)
- Emilia May Loane
- Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
| | - Norha Vera San Juan
- Institute for Global Health, University College London, London, United Kingdom
- Rapid Research Evaluation and Appraisal Lab (RREAL), University College London, London, United Kingdom
| | - Allan H. Young
- Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
| | - Oliver Gale-Grant
- Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
| | - Margaret Heslin
- Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
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Gao YN, Olfson M. Variation in Hospital Admission Rates for Schizophrenia Spectrum Disorder Emergency Department Visits in 11 States. Psychiatr Serv 2025; 76:443-450. [PMID: 40065670 DOI: 10.1176/appi.ps.20240441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/02/2025]
Abstract
OBJECTIVE The authors examined patterns in hospital admission rates for patients with a schizophrenia spectrum disorder (SSD)-related visit to an emergency department (ED). METHODS The authors identified 116,928 ED visits for SSD across 1,071 hospitals in an 11-state sample drawn from the 2020 State Emergency Department Databases and State Inpatient Databases. The distribution of hospital-level admission rates was described by using a finite mixture model. Hospital- and county-level characteristics were compared across hospitals with low, medium, or high SSD admission shares. RESULTS Admission shares for patients with an SSD ED visit were highly variable and multimodal across hospitals. Although the overall mean admission share for patient ED visits with a primary SSD diagnosis was 56.6% (95% CI=53.0%-60.2%), the mean admission share was 5.6% (95% CI=4.8%-6.4%) in the lowest quintile and was 95.4% (95% CI=94.6%-96.3%) in the highest quintile. The presence of psychiatric beds in a hospital was associated with increased odds of admission (OR=2.56, 95% CI=1.83-3.59). A hospital's size, mental health visit volume, urbanicity, availability of psychiatric consultation, emergency mental health services, and outpatient mental health services, as well as county-level inpatient beds, were not significantly associated with admission rates. CONCLUSIONS Hospital admission rates for patients with an SSD ED visit varied widely, and the presence of inpatient psychiatric beds was positively associated with admission. These findings raise equity concerns by suggesting that variation in inpatient psychiatric bed availability contributes to ED disposition of patients with an SSD-related visit.
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Affiliation(s)
- Y Nina Gao
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, and New York State Psychiatric Institute, New York City (both authors); Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City (Olfson)
| | - Mark Olfson
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, and New York State Psychiatric Institute, New York City (both authors); Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City (Olfson)
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Bruckner TA, Singh P, Hvidtfeldt C, Andersen L. Involuntary Psychiatric Commitments Among Non-Western Immigrants During the Muhammad Cartoon Controversy in Denmark. J Immigr Minor Health 2025; 27:234-241. [PMID: 39514056 DOI: 10.1007/s10903-024-01651-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2024] [Indexed: 11/16/2024]
Abstract
Persons deemed a danger to themselves, others, or gravely disabled may receive involuntary psychiatric commitment if family, other residents, law enforcement, or clinicians initiate this process. On September 30, 2005, a Danish newspaper published cartoons depicting the Prophet Muhammad. This publication led to the worst foreign policy crisis in Denmark since World War II. Whereas protests within Denmark against the cartoon remained peaceful, this cartoon controversy-including the attacks on four Danish embassies outside of Denmark-may have reduced societal tolerance for threatening or deviant behavior among non-Western immigrants. We applied Box-Jenkins interrupted time-series methods to test whether this cartoon controversy coincided with greater than expected counts of new involuntary psychiatric commitments among non-Western immigrants. The analytic period spans 48 quarters from January 1995 to December 2006. Findings support the hypothesis in that new involuntary psychiatric commitments rose 43% during the controversy (p <.01). Changes in help-seeking overall for mental health services do not appear to account for this rise in new involuntary commitments. Population-wide controversies may lower societal tolerance for behavior deemed deviant-and in this case, specifically among non-Western immigrants.
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Affiliation(s)
- Tim A Bruckner
- Center for Population, Inequality, and Policy, University of California, Irvine, USA.
- Joe C. Wen School of Population and Public Health, University of California, Irvine, USA.
| | - Parvati Singh
- Department of Epidemiology, College of Public Health, Ohio State University, Columbus, USA
| | | | - Lars Andersen
- Rockwool Foundation Research Unit, Copenhagen, Denmark
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Clauss JA, Foo CYS, Leonard CJ, Dokholyan KN, Cather C, Holt DJ. Screening for Psychotic Experiences and Psychotic Disorders in General Mental Health Treatment Settings: A Systematic Review and Meta-Analysis. Harv Rev Psychiatry 2025:00023727-990000000-00020. [PMID: 40095846 DOI: 10.1097/hrp.0000000000000419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/19/2025]
Abstract
BACKGROUND The absence of systematic psychosis screening within general mental health services contributes to substantial treatment delays and poor long-term outcomes for individuals with psychotic symptoms. We conducted a meta-analysis to estimate rates of subclinical psychotic symptoms for psychotic experiences (PE), clinical high-risk for psychosis syndrome (CHR-P), and psychotic disorders that were identified via studies screening treatment-seeking individuals. These rates can inform implementation recommendations for routine psychosis screening in general mental health settings. METHODS PubMed and Web of Science databases were searched to identify empirical studies with information on PE, CHR-P, or psychotic disorder prevalence identified by screening inpatients and outpatients (age < 65 years) receiving general mental health care. PE was identified using threshold scores on validated self-reported questionnaires, and CHR-P and psychotic disorder were identified using gold-standard structured interview assessments. A meta-analysis of each outcome was conducted using the restricted maximum likelihood estimator method to assess effect sizes in a random effects model. RESULTS The analyses included 41 independent samples (k = 32 outpatient, k = 2 inpatient, k = 7 combined settings) with a total of 25,751 patients (58% female, mean age: 24.1 years). PE prevalence was 44.3% (95% CI: 35.8-52.8%; 28 samples, n = 21,957); CHR-P prevalence was 26.4% (95% CI: 20.0-32.7%; 28 samples, n = 14,395); and psychotic disorder prevalence was 6.6% (95% CI: 3.3-9.8%; 32 samples, n = 20,371). Rates did not differ by sex, age, or setting type. CONCLUSIONS The high prevalence of psychotic symptoms in general mental health treatment settings underscores the need for early-detection psychosis screening. These base rates can be used to plan training and allocation of resources required to conduct psychosis assessments and build capacity for delivering interventions for CHR-P and early psychosis in non-specialty mental health treatment settings.
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Affiliation(s)
- Jacqueline A Clauss
- From Harvard Medical School (Drs. Clauss, Foo, Cather, and Holt); Psychosis and Clinical Research Program, Department of Psychiatry, Massachusetts General Hospital (Drs. Clauss, Foo, Cather, and Holt, and Ms. Leonard and Ms. Dokholyan); Center of Excellence for Psychosocial and Systemic Research, Department of Psychiatry, Massachusetts General Hospital (Drs. Foo, Cather, and Holt, and Ms. Leonard), Boston, MA; Maryland Psychiatric Research Center, University of Maryland School of Medicine (Dr. Clauss)
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Roberts-Eversley N, Williams T, Hernández R, Lynch KA, Wu Y, Rebollo G, Haider F, Udom U, Gany F, Lubetkin E. New York City Faith-Based Leaders' Views on COVID-19's Impact on the Mental Health Needs of Black/African American Communities. J Community Health 2025:10.1007/s10900-025-01443-z. [PMID: 40025249 DOI: 10.1007/s10900-025-01443-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2025] [Indexed: 03/04/2025]
Abstract
This investigation sought to understand the mental health needs of Black/African Americans during the COVID-19 pandemic and explore the church leaders' perspectives and experiences in supporting the mental health of their communities during this time. This exploratory qualitative study uses semi-structured interviews with 21 church leaders from predominantly Black neighborhoods in Brooklyn and Harlem, New York City (NYC), which were most adversely impacted by COVID-19. Neighborhoods were selected based on COVID-19 infection and mortality data from the NYC Department of Health. Transcripts were coded and thematically analyzed using Dedoose software. Four overarching themes and one subtheme emerged: (1) The COVID-19 pandemic amplified underlying community quality of life challenges, creating a "downward cascade" of mental health, (1a) COVID-19 is a source of collective grief and trauma; (2) Faith-based leaders play a key role in providing mental health support to their community; (3) Faith-based leaders seek strategies to reduce mental health stigma, normalize conversations around mental health; and (4) Faith-based leaders often operate in isolation from citywide mental health services, disconnected from existing programs and resources. Leaders anticipate a higher demand for mental health services. On the road to emotional wellness post-pandemic, public awareness of symptoms of mental health issues must be emphasized and available resources utilized to reduce stigma and encourage help-seeking behavior. Addressing these implications requires comprehensive multi-sector community driven efforts that include collaboration with faith-based communities to support community resilience and improve mental healthcare access.
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Affiliation(s)
- Nicole Roberts-Eversley
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 633 Third Ave., 4thFloor, New York, NY, 10017, USA.
| | | | - Raúl Hernández
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 633 Third Ave., 4thFloor, New York, NY, 10017, USA
| | - Kathleen A Lynch
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 633 Third Ave., 4thFloor, New York, NY, 10017, USA
| | - Yumeng Wu
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 633 Third Ave., 4thFloor, New York, NY, 10017, USA
| | - Gabriela Rebollo
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 633 Third Ave., 4thFloor, New York, NY, 10017, USA
| | | | - Udeme Udom
- City College of New York, New York, NY, USA
| | - Francesca Gany
- Immigrant Health and Cancer Disparities Service, Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Erica Lubetkin
- Department of Community Health and Social Medicine, CUNY School of Medicine, New York, NY, USA
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Lewczyk J. Homelessness and First-Episode Psychosis: An Integrative Review. J Am Psychiatr Nurses Assoc 2025:10783903251314873. [PMID: 39994900 DOI: 10.1177/10783903251314873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/26/2025]
Abstract
BACKGROUND About 115,000 young people in the United States experience a first episode of psychosis (FEP) annually. FEP is associated with functional decline and long-term executive functioning impairment. Schizophrenia is a risk factor for homelessness with up to 20% of individuals diagnosed experiencing homelessness. Homelessness conveys many burdens including higher rates of victimization, incarceration, and substance use. The intersection of homelessness and FEP represents a uniquely vulnerable population undergoing the compounding effects of two highly stigmatizing burdensome experiences that negatively impact health outcomes, treatment engagement, and life expectancy. AIMS This study reviews the literature to explore what is currently known about the impacts of homelessness on individuals with FEP, knowledge gaps, directions for research, and recommendations for action. METHODS An integrative review was conducted in April 2023 with APAPsychInfo, APAPsychArticle, Medline, and CINAHL. RESULTS This is the first known review to examine available literature on homelessness and FEP. Current literature examines aspects of FEP and homelessness, but not the likely compounding and interacting relationships between multiple variables. Although the associations among variables such as FEP, homelessness, substance use, legal involvement, family involvement, and treatment engagement have not been studied, the literature available may be suggestive of a compounding negative effect on FEP outcomes. CONCLUSION FEP programs should define homelessness, report rates of homelessness, and conduct research examining the compounding effects of homelessness and FEP as well as other factors like race and ethnicity. Research and policy should support housing interventions for homeless individuals to improve treatment engagement and health outcomes.
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Affiliation(s)
- Jessica Lewczyk
- Jessica Lewczyk, MSN, PMHNP, Boston Medical Center, Boston, MA, USA
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Sen P, Knolle F. Altered neural signalling during reward anticipation in children and early adolescents with high psychotic-like experiences. Neuroimage Clin 2025; 45:103756. [PMID: 39983553 PMCID: PMC11889563 DOI: 10.1016/j.nicl.2025.103756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2024] [Revised: 01/23/2025] [Accepted: 02/14/2025] [Indexed: 02/23/2025]
Abstract
BACKGROUND Schizophrenia is associated with abnormalities in neurodevelopmental processes. Furthermore, dysfunctional neural circuits involved in reward processing may be linked to the development of symptoms in schizophrenia and are predictive of long-term functional outcome. It is however unknown whether neural signatures of reward anticipation are detectable in children with high psychotic-like experiences. METHODS Using data from the ABCD study 4.1, we defined a healthy control (N = 50) and a high psychotic-like experience (N = 50) group with a Prodromal Psychosis Syndrome (PPS) score > 3 and distress score > 6 at baseline (9-10 years) and 2nd year follow-up (11-12 years). While undergoing functional MR-imaging, all children completed the Monetary Incentive Delay task. Using the preprocessed ABCD-data, we explored whether behaviour and brain activations for reward and loss anticipation in areas underlying reward processing differed between groups and time-points. Furthermore, we investigated whether those brain activations that showed differences between the groups were predictive of later PPS scores. Additionally, we also employed computational modelling to assess response vigour. RESULTS While response times did not differ, the computational model revealed that response vigour for salient cues was significantly lower in the high PLEs compared to controls at baseline. We also found that children with high PLEs demonstrated lower activation during reward anticipation in the anterior insula at the baseline time-point; the nucleus accumbens, the putamen, the dorsolateral (dlPFC) and the ventral medial prefrontal cortex at the 2nd year follow-up, and in the caudate at both timepoints, compared to controls. Regression analysis revealed that deactivations in the left anterior insula and left dlPFC, was predictive of later PPS scores. CONCLUSION This study reveals that neural alterations during reward anticipation are detectable in children with high PLEs. These dysfunctions in neural activation patterns may serve as potential predictive biomarkers for psychosis.
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Affiliation(s)
- Pritha Sen
- School of Medicine and Health, Department of Diagnostic and Interventional Neuroradiology, Technical University of Munich, Munich, Germany; School of Medicine and Health, TUM-NIC Neuroimaging Center, Technical University of Munich, Munich, Germany; Graduate School of Systemic Neurosciences, Ludwig Maximilian University, Munich, Germany.
| | - Franziska Knolle
- School of Medicine and Health, Department of Diagnostic and Interventional Neuroradiology, Technical University of Munich, Munich, Germany; School of Medicine and Health, TUM-NIC Neuroimaging Center, Technical University of Munich, Munich, Germany.
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Gerhart J, Oswald LB, McLouth L, Gibb L, Perry L, England AE, Sannes T, Schoenbine D, Ramos K, Greenberg J, O’Mahony S, Levine S, Baron A, Hoerger M. Understanding and Addressing Mental Health Disparities and Stigma in Serious Illness and Palliative Care. ILLNESS, CRISES, AND LOSS 2025; 33:109-129. [PMID: 39668846 PMCID: PMC11633853 DOI: 10.1177/10541373231201952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2024]
Abstract
Patients receiving palliative care experience stigma associated with their illness, personal identity, and healthcare utilization. These stigmas can occur at any stage of the disease process. Varying stigmas combine to cause palliative care patients to feel misunderstood, contribute to treatment barriers, and further negative stereotypes held by clinicians. Stigma surrounding palliative care patients stems from complex intersections of varied access to resources, familial and physical environment, socioeconomic status, mental health and disorders, and identity characteristics. This article examines the relationship between mental health stigma and palliative care through three pathways: stigma and barriers existing within healthcare, the tendency of this stigma to undermine social support, and the deferral of treatment-seeking in response to stigma. Recommendations to address and diminish stigmatization are presented, including advocacy, increased research and assessment, and contextual and intersectional awareness. Clinicians are also encouraged to turn to their colleagues for peer support and team-based care.
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Affiliation(s)
- James Gerhart
- Department of Psychology, Central Michigan University, Mt. Pleasant, MI, USA
- Rush University Medical Center, Department of Psychiatry and Behavioral Sciences, Chicago, IL, USA
| | | | - Laurie McLouth
- University of Kentucky College of Medicine, Department of Behavioral Science, Lexington, KY, USA
| | - Lindsey Gibb
- Department of Psychology, Central Michigan University, Mt. Pleasant, MI, USA
| | - Laura Perry
- Tulane University School of Medicine, Department of Medicine, Center for Health Outcomes, Implementation, and Community-Engaged Science (CHOICES), New Orleans, LA, USA
| | | | - Timothy Sannes
- UMass Memorial Medical Center, Department of Psychiatry, Boston, MA, USA
| | | | - Katherine Ramos
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA
- Department of Medicine Geriatrics, Duke University, Durham, NC, USA
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Health Care System, Durham, NC, USA
| | - Jared Greenberg
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Sean O’Mahony
- Department of Internal Medicine – Palliative Care, Rush University Medical Center, Chicago, IL, USA
| | - Stacie Levine
- Department of Medicine – Section of Geriatrics and Palliative Care, University of Chicago, Chicago, IL, USA
| | - Aliza Baron
- Department of Medicine – Section of Geriatrics and Palliative Care, University of Chicago, Chicago, IL, USA
| | - Michael Hoerger
- Department of Psychology, Tulane Cancer Center, Tulane University, New Orleans, LA, USA
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Rudecindo B, Kuo P, Smith WA, Tao KW, Imel ZE. Microaggressions and Cultural Ruptures in Psychiatry: Extending Multicultural Counseling Orientation to Psychiatric Services. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2025; 23:9-18. [PMID: 39776458 PMCID: PMC11701827 DOI: 10.1176/appi.focus.20240034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/11/2025]
Abstract
Racial microaggressions and cultural ruptures have a significant impact on mental health care for Black, Indigenous, and people of color (BIPOC) communities. This article reviews the application of the multicultural counseling orientation framework in psychiatry to address these challenges and improve therapeutic outcomes. The authors outline strategies to integrate cultural humility into psychiatric practice, with an emphasis on self-reflection, feedback, and the recognition of microaggressions. By fostering cultural humility, providers can create therapeutic spaces where patients feel safe and validated. The article also discusses cultural opportunities for exploring patients' identities and advocates for open dialogue that addresses these aspects early in treatment. Structural recommendations include enhancing training programs to incorporate equity-focused coursework, promoting recruitment and retention of BIPOC clinicians, and developing institutional policies to address systemic inequities. Adopting these approaches can reduce the adverse effects of microaggressions, build trust, and improve mental health outcomes for BIPOC patients. The authors suggest that future efforts should emphasize systemic changes in training, recruitment, and community engagement to create a more inclusive mental health care system.
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Affiliation(s)
- Brendalisse Rudecindo
- Department of Educational Psychology (Rudecindo, Tao, Imel) and Huntsman Mental Health Institute, Department of Education, Culture, & Society, and Ethnic Studies Program (Smith), University of Utah, Salt Lake City; Perelman School of Medicine, University of Pennsylvania, Philadelphia (Kuo)
| | - Patty Kuo
- Department of Educational Psychology (Rudecindo, Tao, Imel) and Huntsman Mental Health Institute, Department of Education, Culture, & Society, and Ethnic Studies Program (Smith), University of Utah, Salt Lake City; Perelman School of Medicine, University of Pennsylvania, Philadelphia (Kuo)
| | - William A Smith
- Department of Educational Psychology (Rudecindo, Tao, Imel) and Huntsman Mental Health Institute, Department of Education, Culture, & Society, and Ethnic Studies Program (Smith), University of Utah, Salt Lake City; Perelman School of Medicine, University of Pennsylvania, Philadelphia (Kuo)
| | - Karen W Tao
- Department of Educational Psychology (Rudecindo, Tao, Imel) and Huntsman Mental Health Institute, Department of Education, Culture, & Society, and Ethnic Studies Program (Smith), University of Utah, Salt Lake City; Perelman School of Medicine, University of Pennsylvania, Philadelphia (Kuo)
| | - Zachary E Imel
- Department of Educational Psychology (Rudecindo, Tao, Imel) and Huntsman Mental Health Institute, Department of Education, Culture, & Society, and Ethnic Studies Program (Smith), University of Utah, Salt Lake City; Perelman School of Medicine, University of Pennsylvania, Philadelphia (Kuo)
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Kouakou MR, Cabrera-Mendoza B, Pathak GA, Cannon TD, Polimanti R. Genetically Informed Study Highlights Income-Independent Effect of Schizophrenia Liability on Mental and Physical Health. Schizophr Bull 2024; 51:85-94. [PMID: 38848523 PMCID: PMC11661948 DOI: 10.1093/schbul/sbae093] [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] [Indexed: 06/09/2024]
Abstract
BACKGROUND AND HYPOTHESIS Individuals with schizophrenia (SCZ) suffer from comorbidities that substantially reduce their life expectancy. Socioeconomic inequalities could contribute to many of the negative health outcomes associated with SCZ. STUDY DESIGN We investigated genome-wide datasets related to SCZ (52 017 cases and 75 889 controls) from the Psychiatric Genomics Consortium, household income (HI; N = 361 687) from UK Biobank, and 2202 medical endpoints assessed in up to 342 499 FinnGen participants. A phenome-wide genetic correlation analysis of SCZ and HI was performed, also assessing whether SCZ genetic correlations were influenced by the HI effect on SCZ. Additionally, SCZ and HI direct effects on medical endpoints were estimated using multivariable Mendelian randomization (MR). STUDY RESULTS SCZ and HI showed overlapping genetic correlations with 70 traits (P < 2.89 × 10-5), including mental health, substance use, gastrointestinal illnesses, reproductive outcomes, liver diseases, respiratory problems, and musculoskeletal phenotypes. SCZ genetic correlations with these traits were not affected by the HI effect on SCZ. Considering Bonferroni multiple testing correction (P < 7.14 × 10-4), MR analysis indicated that SCZ and HI may affect medical abortion (SCZ OR = 1.07; HI OR = 0.78), panic disorder (SCZ OR = 1.20; HI OR = 0.60), personality disorders (SCZ OR = 1.31; HI OR = 0.67), substance use (SCZ OR = 1.2; HI OR = 0.68), and adjustment disorders (SCZ OR = 1.18; HI OR = 0.78). Multivariable MR analysis confirmed that SCZ effects on these outcomes were independent of HI. CONCLUSIONS The effect of SCZ genetic liability on mental and physical health may not be strongly affected by socioeconomic differences. This suggests that SCZ-specific strategies are needed to reduce negative health outcomes affecting patients and high-risk individuals.
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Affiliation(s)
- Manuela R Kouakou
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Brenda Cabrera-Mendoza
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- Cooperative Studies Program Clinical Epidemiology Research Center (CSP-CERC), VA Connecticut Healthcare System, West Haven, CT, USA
| | - Gita A Pathak
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- Cooperative Studies Program Clinical Epidemiology Research Center (CSP-CERC), VA Connecticut Healthcare System, West Haven, CT, USA
| | - Tyrone D Cannon
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- Department of Psychology, Yale University, New Haven, CT, USA
- Wu Tsai Institute, Yale University, New Haven, CT, USA
| | - Renato Polimanti
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- Cooperative Studies Program Clinical Epidemiology Research Center (CSP-CERC), VA Connecticut Healthcare System, West Haven, CT, USA
- Wu Tsai Institute, Yale University, New Haven, CT, USA
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14
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Sabin ML. What United States of America do you live in? Lancet 2024; 404:2256-2257. [PMID: 39647484 DOI: 10.1016/s0140-6736(24)02620-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2024]
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15
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Gonzales L, Saperstein AM, Qian M, Gorecki A, Medalia A. Psychiatric and functional correlates of stigma associated with cognitive impairment in schizophrenia. Psychiatry Res 2024; 342:116233. [PMID: 39461092 PMCID: PMC11617260 DOI: 10.1016/j.psychres.2024.116233] [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: 08/16/2024] [Revised: 10/08/2024] [Accepted: 10/13/2024] [Indexed: 10/29/2024]
Abstract
Schizophrenia is the most strongly stigmatized psychiatric diagnosis, with negative stereotypes including assumptions of incompetence and inability to recover. Individuals with cognitive impairment associated with schizophrenia (CIAS) have reported stigma experiences, suggesting that CIAS carries stigma in addition to the stigma associated with schizophrenia as a diagnostic label. While research has established that mental illness stigma more generally is linked with poor psychiatric and functional outcomes, no research has explored correlates of CIAS stigma. This study evaluated cognitive, psychiatric, and functional correlates of CIAS stigma among 54 individuals with schizophrenia spectrum disorders participating in a cognitive remediation trial. Participants with greater estimated cognitive decline reported higher levels of CIAS stigma experiences. Participants who reported higher levels of CIAS stigma also scored higher on a measure of depressive symptom severity. No significant associations were found between CIAS stigma and positive and negative psychosis symptoms or general psychopathology ratings. CIAS stigma was not associated with performance-based functional capacity or ratings of community functioning. Findings suggest that CIAS stigma is linked with the degree of cognitive decline and depressive symptom severity among individuals with schizophrenia spectrum disorders. Additional research is needed to elucidate directionality and the relationship between CIAS stigma and functioning outcomes.
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Affiliation(s)
- Lauren Gonzales
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons and New York-Presbyterian, New York, NY, United States; New York State Office of Mental Health, New York, NY, United States.
| | - Alice M Saperstein
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons and New York-Presbyterian, New York, NY, United States; New York State Office of Mental Health, New York, NY, United States
| | - Min Qian
- Department of Biostatistics, Columbia University Mailman School of Public Health, New York, NY, United States
| | - Adam Gorecki
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons and New York-Presbyterian, New York, NY, United States
| | - Alice Medalia
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons and New York-Presbyterian, New York, NY, United States; New York State Office of Mental Health, New York, NY, United States
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16
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Camejo DA, Bido-Medina RO, Koh KA, Keuroghlian AS. Reconsidering the City of New York Directive on Mental Health Involuntary Removals. Harv Rev Psychiatry 2024; 32:218-227. [PMID: 39514869 DOI: 10.1097/hrp.0000000000000412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2024]
Abstract
BACKGROUND Homelessness is a visible manifestation of large-scale societal challenges, such as lack of affordable housing, poverty, and health inequities. Governments may miss opportunities to address these structural problems by removing people experiencing homelessness from public spaces. On 29 November 2022, after a press conference by Mayor Eric Adams, the city of New York issued a directive entitled Mental Health Involuntary Removals. The program authorized mental health providers and NYPD officers to take any person into custody who appears mentally ill and displays inability to meet basic living needs, even when no dangerous act has been observed. METHODS We reviewed the existing literature from 1973 to 2023 for studies, enacted legislation, state and federal policies, and interventions related to homelessness, mental health, and admission of people experiencing homelessness into psychiatric hospitals in the United States. We used academic databases, including PubMed, PsycInfo, and JSTOR for peer-reviewed articles, government reports, and policy analyses. Our search strategy included keyword combinations such as "homelessness and mental health," "policy interventions for homeless populations," and "health care services costs." We applied inclusion criteria focusing on reports and articles that directly address the intersectionality of homelessness, mental health policy, and psychiatric care. RESULTS Homelessness and mental illness frequently intersect, creating complex challenges that require nuanced solutions. Forced hospitalization of people experiencing homelessness in New York City, while intended to address critical social and health care issues, carries a risk for significant long-term harm. This approach places strain on the mental health care system and may ultimately exacerbate the problems it purports to resolve.
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Affiliation(s)
- Daniel A Camejo
- From Massachusetts General Hospital, Boston, MA (Drs. Camejo, Bido-Medina, Koh, and Keuroghlian)
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17
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Sanders AA, Roberts JD, McDowell MC, Muller A. The Consequences of Misdiagnosing Race-Based Trauma Response in Black Men: A Critical Examination. SOCIAL WORK IN PUBLIC HEALTH 2024; 39:721-733. [PMID: 39033343 DOI: 10.1080/19371918.2024.2380821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/23/2024]
Abstract
Mental illness is a significant public health concern prevalent in America. Over one in five U.S. adults are affected, yet less than half receive treatment. Among African Americans, only one in three seek treatment with statically lower rates among Black males. Therefore, an accurate diagnosis is crucial for appropriate treatment, while misdiagnosis leads to stigma, discrimination, and untreated illness. This paper examines the implications of misdiagnosing trauma responses in Black men, highlighting systemic biases that impede suitable care and perpetuate negative narratives. The authors propose a conceptual framework incorporating historical trauma, discrimination, and traumatic stress reactions, emphasizing the need for cultural competence and humility. This framework involves public narratives that influence perceptions and judgments, reviewing research evidence, advocating for competent trauma assessments, community empowerment, and future research directions. This paper underscores the importance of understanding and addressing the unique challenges Black men face in mental health diagnosis and treatment.
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Affiliation(s)
- Ashley A Sanders
- College of Health and Human Services, Saginaw Valley State University, University Center, Michigan, USA
| | - J Dontaè Roberts
- School of Health Sciences, Winston Salem State University, Winston-Salem, North Carolina, USA
| | - Melvin C McDowell
- College of Health and Human Services, Saginaw Valley State University, University Center, Michigan, USA
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18
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Racadio ER, Rai A, Kizilirmak P, Agarwal S, Sosa E, Desborough C, Adnan T, Zhou L, Balasubramanian A, Sharma A, Motsepe-Ditshego P. Diversity and Representation Among United States Participants in Amgen Clinical Trials. J Racial Ethn Health Disparities 2024; 11:3112-3127. [PMID: 37755687 PMCID: PMC11480170 DOI: 10.1007/s40615-023-01768-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 08/17/2023] [Accepted: 08/18/2023] [Indexed: 09/28/2023]
Abstract
OBJECTIVE Describe the demographic profile of US participants in Amgen clinical trials over a 10-year period and variations across therapeutic areas, indications, and geographies. METHODS Cross-sectional retrospective study including participants enrolled (2005-2020) in phase 1-3 trials completed between January 1, 2012 and June 30, 2021. RESULTS Among 31,619 participants enrolled across 258 trials, one-fifth represented racial minority populations (Asian, 3%; Black or African American, 17%; American Indian or Alaska Native, Native Hawaiian or Other Pacific Islander, multiracial, each < 1%); fewer than one-fifth (16%) represented an ethnic minority population (Hispanic or Latino). Compared with census data, representation of racial and ethnic groups varied across US states. Across most therapeutic areas (bone, cardiovascular, hematology/oncology, inflammation, metabolic disorders, neuroscience) except nephrology, participants were predominantly White (72-81%). A similar proportion of males and females were enrolled between 2005 and 2016; male representation was disproportionately higher than female between 2016 and 2020. Across most medical indications, the majority of participants were 18-65 years of age. CONCLUSIONS AND RELEVANCE While the clinical research community is striving to achieve diversity and proportional representation across clinical trials, certain populations remain underrepresented. Our data provide a baseline assessment of the diversity and representation of US participants in Amgen-sponsored clinical trials and add to a growing body of evidence on the importance of diversity in clinical research. These data provide a foundation for strategies aimed at supporting more equitable and representative research, and a baseline from which to assess the impact of future strategies to advance health equity.
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Affiliation(s)
| | | | | | | | | | | | | | - Lei Zhou
- Amgen Inc, Thousand Oaks, CA, USA
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19
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Hutto A, Zikry TM, Bohac B, Rose T, Staebler J, Slay J, Cheever CR, Kosorok MR, Nash RP. Using a natural language processing toolkit to classify electronic health records by psychiatric diagnosis. Health Informatics J 2024; 30:14604582241296411. [PMID: 39466373 DOI: 10.1177/14604582241296411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/30/2024]
Abstract
Objective: We analyzed a natural language processing (NLP) toolkit's ability to classify unstructured EHR data by psychiatric diagnosis. Expertise can be a barrier to using NLP. We employed an NLP toolkit (CLARK) created to support studies led by investigators with a range of informatics knowledge. Methods: The EHR of 652 patients were manually reviewed to establish Depression and Substance Use Disorder (SUD) labeled datasets, which were split into training and evaluation datasets. We used CLARK to train depression and SUD classification models using training datasets; model performance was analyzed against evaluation datasets. Results: The depression model accurately classified 69% of records (sensitivity = 0.68, specificity = 0.70, F1 = 0.68). The SUD model accurately classified 84% of records (sensitivity = 0.56, specificity = 0.92, F1 = 0.57). Conclusion: The depression model performed a more balanced job, while the SUD model's high specificity was paired with a low sensitivity. NLP applications may be especially helpful when combined with a confidence threshold for manual review.
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Affiliation(s)
- Alissa Hutto
- Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Tarek M Zikry
- Department of Biostatistics, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Buck Bohac
- North Carolina Translational and Clinical Sciences Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Terra Rose
- Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill, NC, USA
- Department of Health Sciences, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Jasmine Staebler
- Department of Health Sciences, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Janet Slay
- Department of Health Sciences, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - C Ray Cheever
- University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Michael R Kosorok
- Department of Biostatistics, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA
- Department of Statistics and Operations Research, University of North Carolina, Chapel Hill, NC, USA
| | - Rebekah P Nash
- Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill, NC, USA
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20
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Weiss A, Chaudhry S, Marhefka A, Khunkhun V. Early Intervention in the Treatment of Psychosis. Child Adolesc Psychiatr Clin N Am 2024; 33:645-658. [PMID: 39277317 DOI: 10.1016/j.chc.2024.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/17/2024]
Abstract
This article aims to: (1) describe the evolution of first episode of psychosis (FEP) approaches; (2) define a model of multidisciplinary care; (3) identify challenges and limitations; (4) discuss the unique challenges for those first experiencing psychosis; (5) identify strategies to expand early psychosis interventions. The authors take the medical standpoint and use the differential diagnosis and initial medical work-up as a context for assessment. The remainder of the article will be focused on treatment of FEP in those with schizophrenia-spectrum disorders.
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Affiliation(s)
- Ashley Weiss
- Early Psychosis Intervention Clinic New Orleans (EPIC-NOLA); Department of Psychiatry, Section of Child and Adolescent Psychiatry, Tulane University School of Medicine, 1440 Canal Street, Suite 1000, New Orleans, LA 70112, USA.
| | - Serena Chaudhry
- Early Psychosis Intervention Clinic New Orleans (EPIC-NOLA); Department of Psychiatry, Tulane University School of Medicine, 1440 Canal Street, Suite 1000, New Orleans, LA 70112, USA
| | - Alicia Marhefka
- Department of Psychiatry, University of Maryland School of Medicine, 655 Wset Baltimore Street, Baltimore, MD 21201, USA
| | - Vininder Khunkhun
- Department of Psychiatry, Section of Child and Adolescent Psychiatry, Tulane University School of Medicine, 1440 Canal Street, Suite 1000, New Orleans, LA 70112, USA
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21
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Spann DJ, Cicero DC, Straub KT, Pellegrini AM, Kerns JG. Examining measures of schizotypy for gender and racial bias using item response theory and differential item functioning. Schizophr Res 2024; 272:120-127. [PMID: 39214022 DOI: 10.1016/j.schres.2024.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 07/24/2024] [Accepted: 08/22/2024] [Indexed: 09/04/2024]
Abstract
Schizotypy involves schizophrenia-like traits and symptoms, with the Wisconsin Schizotypy Scales (WSS) being frequently used in previous research. There is some evidence that schizophrenia-spectrum symptom levels, including when using the WSS, might vary both by gender and by race and ethnicity. However, previous research has rarely examined to what extent the WSS show gender and racial bias. Further, this has not been previously examined for the Cognitive Slippage Scale, a measure of disorganized schizotypy. In this study, we examined biases for a subset of items from the WSS in a large sample of undergraduate students (n = 21,829). Using item response theory to test for levels of differential item functioning (DIF), we found some evidence of problematic DIF for all scales, including for negative, positive, and disorganized schizotypy scales. There was evidence of problematic DIF especially by gender and for Black and Multiracial participants. Overall, the current results suggest that gender and/or racial bias on these scales should be an important consideration in using these scales and our results could have implications for assessment of schizophrenia-spectrum symptoms.
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22
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Alter IL, Tucker LH, Dragon JM, Grewal MR, Saperstein A, Stroup TS, Medalia AA, Golub JS. National Cohort Data Suggests an Association Between Serious Mental Illness and Audiometric Hearing Loss. Otolaryngol Head Neck Surg 2024; 171:716-723. [PMID: 38606639 DOI: 10.1002/ohn.763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 02/29/2024] [Accepted: 03/20/2024] [Indexed: 04/13/2024]
Abstract
OBJECTIVE To explore whether there is an association between serious mental illness (SMI) and hearing loss (HL) among US Hispanic adults. STUDY DESIGN AND SETTING Cross-sectional epidemiological study (Hispanic Community Health Study), including multicentered US volunteers. METHODS Multivariable linear regressions were conducted to study the association between SMI and HL. Adjustments were made for potential confounders including age, sex, education, vascular disease (hypertension or diabetes mellitus), and cognition. SMI was defined by (1) antipsychotic medication classification and (2) the use of at least 1 antipsychotic medication specifically used to treat SMI in clinical psychiatric practice. HL was measured by pure tone audiometry. RESULTS A total of 7581 subjects had complete data. The mean age was 55.2 years (SD = 7.5 years) and the mean pure tone average in the better ear was 16.8 dB (SD = 10.7 dB). A total of 194 (2.6%) subjects were taking a HCHS-defined antipsychotic and 98 (1.3%) were taking at least 1 antipsychotic specifically used to treat SMI. On multivariable regression, use of HCHS's classified antipsychotics was associated with 3.75 dB worse hearing (95% confidence interval [CI] = 2.36-5.13, P < .001) and use of antipsychotics specific for SMI was associated with 4.49 dB worse hearing (95% CI = 2.56-6.43, P < .001) compared to those not using antipsychotics. CONCLUSION SMI, as defined by either the use of HCHS-defined antipsychotics or the use of antipsychotic medication specific for SMI, is associated with worse hearing, controlling for potential confounders. Whether SMI contributes to HL, antipsychotic medication (through ototoxicity) contributes to HL, or whether HL contributes to SMI is unknown and warrants further investigation.
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Affiliation(s)
- Isaac L Alter
- Department of Otolaryngology-Head and Neck Surgery, Columbia University Vagelos College of Physicians and Surgeons, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, New York, USA
| | - Lauren H Tucker
- Department of Otolaryngology-Head and Neck Surgery, Columbia University Vagelos College of Physicians and Surgeons, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, New York, USA
| | - Jacqueline M Dragon
- Department of Otolaryngology-Head and Neck Surgery, Columbia University Vagelos College of Physicians and Surgeons, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, New York, USA
| | - Maeher R Grewal
- Department of Otolaryngology-Head and Neck Surgery, University of Utah-School of Medicine, Salt Lake City, Utah, USA
| | - Alice Saperstein
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | - T Scott Stroup
- New York State Psychiatric Institute, New York, New York, USA
| | - Alice A Medalia
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, Columbia University, New York, New York, USA
- New York State Psychiatric Institute, New York, New York, USA
| | - Justin S Golub
- Department of Otolaryngology-Head and Neck Surgery, Columbia University Vagelos College of Physicians and Surgeons, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, New York, USA
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23
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Stephens RL, Leavitt I, Cornea E, Jarskog LF, Gilmore JH. Early cognitive development and psychopathology in children at familial high risk for schizophrenia. Schizophr Res 2024; 271:262-270. [PMID: 39068878 PMCID: PMC11384306 DOI: 10.1016/j.schres.2024.07.034] [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: 01/12/2024] [Revised: 07/10/2024] [Accepted: 07/13/2024] [Indexed: 07/30/2024]
Abstract
Schizophrenia is a neurodevelopmental disorder associated with deficits in cognitive development and childhood psychopathology. Previous studies have focused on older children and the few studies of early childhood have yielded inconsistent findings. We studied cognitive development and psychopathology in children at familial high risk (FHR) of schizophrenia and matched controls from 1 to 6 years and hypothesized that FHR children would show consistent deficits across cognitive and behavioral measures in early childhood. STUDY DESIGN Cognitive development in children at high familial risk for schizophrenia or schizoaffective disorder (n = 33) and matched healthy controls (n = 66) was assessed at 1 and 2 years with the Mullen Scales of Early Learning, and at 4 and 6 years with the Stanford Binet Intelligence Scales, BRIEF-P/BRIEF and CANTAB. Psychopathology was assessed at 4 and 6 years with the BASC-2. General linear models were used to examine differences on outcome scores, and chi-square analyses were used to explore differences in the proportion of "at risk" or "below average" score profiles. STUDY RESULTS FHR children scored significantly lower than controls on Mullen Composite at age 2, and demonstrated broad deficits in IQ, executive function and working memory and 4 and 6 years. FHR children were also rated as significantly worse on most items of the BASC-2 at ages 4 and 6. CONCLUSIONS Children at FHR for schizophrenia demonstrate abnormal cognitive development and psychopathology at younger ages than previously detected, suggesting that early detection and intervention needs to be targeted to very early childhood.
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Affiliation(s)
- Rebecca L Stephens
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC, USA
| | - Isabel Leavitt
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC, USA
| | - Emil Cornea
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC, USA
| | - L Fredrik Jarskog
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC, USA
| | - John H Gilmore
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC, USA.
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24
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Williams K, French A, Jackson N, McMickens CL, White D, Vinson SY. Mental Health Crisis Responses and (In)Justice: Intrasystem and Intersystem Implications. Psychiatr Clin North Am 2024; 47:445-456. [PMID: 39122339 DOI: 10.1016/j.psc.2024.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/12/2024]
Abstract
Mental health crises among people who are marginalized merit special consideration. These groups are both overserved and underserved by mental health crisis systems: over-represented in acute treatment settings by number while facing inequities in outcomes. The predisposing, precipitating, and perpetuating factors that contribute to crises, however, neither begin nor end with the mental health system. Rather, these factors are multisystemic. As an illustration of this concept, this article highlights select marginalized groups, those that have faced inequities in mental health diagnosis and treatment due to race, medical complexity, age, and criminal justice system involvement.
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Affiliation(s)
- Kamille Williams
- Department of Psychiatry and Behavioral Sciences, Morehouse School of Medicine, 720 Westview Drive Southwest, Atlanta, GA 30310, USA.
| | - Alexis French
- Department of Psychiatry and Behavioral Sciences, Duke University, 2608 Erwin Road, Durham, NC 27705, USA
| | - Nicole Jackson
- Lorio Forensics, 675 Seminole Avenue Northeast, Atlanta, GA 30307, USA
| | - Courtney L McMickens
- Department of Psychiatry and Behavioral Sciences, Duke University, 2608 Erwin Road, Durham, NC 27705, USA; Lorio Forensics, 675 Seminole Avenue Northeast, Atlanta, GA 30307, USA
| | - DeJuan White
- Department of Psychiatry and Behavioral Sciences, Emory University, 12 Executive Park Drive Northeast, Atlanta, GA 30329, USA
| | - Sarah Y Vinson
- Department of Psychiatry and Behavioral Sciences, Morehouse School of Medicine, 720 Westview Drive Southwest, Atlanta, GA 30310, USA; Lorio Forensics, 675 Seminole Avenue Northeast, Atlanta, GA 30307, USA; Department of Psychiatry and Behavioral Sciences, Emory University, 12 Executive Park Drive Northeast, Atlanta, GA 30329, USA
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25
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Rodriguez L, Brown KM, Lindsay C, Remmert JE, Oslin DW. Three Lessons Learned About Power and Improving Recruitment of Underrepresented Populations in Clinical Trials. Psychiatr Serv 2024; 75:820-823. [PMID: 38369885 DOI: 10.1176/appi.ps.20230189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/20/2024]
Abstract
This Open Forum is relevant for investigators who conduct research with historically understudied and marginalized populations. The authors introduce a U.S. Department of Veterans Affairs clinical trial that experienced challenges with recruitment of African American or Black veterans and was terminated for not achieving its recruitment goals. The role of power dynamics in clinical research is discussed, specifically how unequal distributions of power may create recruitment challenges. The authors summarize three lessons learned and offer recommendations for sharing power equitably between investigators and potential participants. By recounting these experiences, the authors seek to promote culturally sensitive, veteran-centered approaches to recruitment in future clinical trials.
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Affiliation(s)
- Lauren Rodriguez
- Mental Illness Research, Education, and Clinical Center (MIRECC) (Rodriguez, Oslin), Center for Health Equity Research and Promotion (Brown, Lindsay), and Veterans Community Advisory Board (VCAB) (Brown, Lindsay), Corporal Michael J. Crescenz Medical Center, U.S. Department of Veterans Affairs (VA), Philadelphia; Center for Integrated Healthcare, Syracuse VA Medical Center, Syracuse, New York (Remmert); Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Oslin)
| | - Kimberly M Brown
- Mental Illness Research, Education, and Clinical Center (MIRECC) (Rodriguez, Oslin), Center for Health Equity Research and Promotion (Brown, Lindsay), and Veterans Community Advisory Board (VCAB) (Brown, Lindsay), Corporal Michael J. Crescenz Medical Center, U.S. Department of Veterans Affairs (VA), Philadelphia; Center for Integrated Healthcare, Syracuse VA Medical Center, Syracuse, New York (Remmert); Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Oslin)
| | - Charles Lindsay
- Mental Illness Research, Education, and Clinical Center (MIRECC) (Rodriguez, Oslin), Center for Health Equity Research and Promotion (Brown, Lindsay), and Veterans Community Advisory Board (VCAB) (Brown, Lindsay), Corporal Michael J. Crescenz Medical Center, U.S. Department of Veterans Affairs (VA), Philadelphia; Center for Integrated Healthcare, Syracuse VA Medical Center, Syracuse, New York (Remmert); Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Oslin)
| | - Jocelyn E Remmert
- Mental Illness Research, Education, and Clinical Center (MIRECC) (Rodriguez, Oslin), Center for Health Equity Research and Promotion (Brown, Lindsay), and Veterans Community Advisory Board (VCAB) (Brown, Lindsay), Corporal Michael J. Crescenz Medical Center, U.S. Department of Veterans Affairs (VA), Philadelphia; Center for Integrated Healthcare, Syracuse VA Medical Center, Syracuse, New York (Remmert); Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Oslin)
| | - David W Oslin
- Mental Illness Research, Education, and Clinical Center (MIRECC) (Rodriguez, Oslin), Center for Health Equity Research and Promotion (Brown, Lindsay), and Veterans Community Advisory Board (VCAB) (Brown, Lindsay), Corporal Michael J. Crescenz Medical Center, U.S. Department of Veterans Affairs (VA), Philadelphia; Center for Integrated Healthcare, Syracuse VA Medical Center, Syracuse, New York (Remmert); Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Oslin)
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Mickelberg AJ, Walker B, Ecker UKH, Fay N. Helpful or harmful? The effect of a diagnostic label and its later retraction on person impressions. Acta Psychol (Amst) 2024; 248:104420. [PMID: 39088996 DOI: 10.1016/j.actpsy.2024.104420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2024] [Accepted: 07/17/2024] [Indexed: 08/03/2024] Open
Abstract
Diagnostic labels for mental health conditions can inadvertently reinforce harmful stereotypes and exacerbate stigma. If a diagnosis is incorrect and a label is wrongly applied, this may negatively impact person impressions even if the inaccurate label is later corrected. This registered report examined this issue. Participants (N = 560) read a vignette about a hospital patient who was either diagnosed with schizophrenia, diagnosed with major depressive disorder, or not diagnosed with a mental health condition. The diagnostic labels were later retracted strongly, retracted weakly, or not retracted. Participants completed several stigma measures (desire for social distance, perceived dangerousness, and unpredictability), plus several inferential-reasoning measures that tested their reliance on the diagnostic label. As predicted, each mental health diagnosis elicited stigma, and influenced inferential reasoning. This effect was stronger for the schizophrenia diagnosis compared to the major depressive disorder diagnosis. Importantly, the diagnostic label continued to influence person judgments after a clear retraction (strong or weak), highlighting the limitations of corrections in reducing reliance on person-related misinformation and mental health stigma.
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Affiliation(s)
- Amy J Mickelberg
- School of Psychological Science, University of Western Australia, Australia.
| | - Bradley Walker
- School of Psychological Science, University of Western Australia, Australia
| | - Ullrich K H Ecker
- School of Psychological Science, University of Western Australia, Australia; Public Policy Institute, University of Western Australia, Australia
| | - Nicolas Fay
- School of Psychological Science, University of Western Australia, Australia.
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Sankoh M, Clifford J, Peterson RE, Prom-Wormley E. Racial and ethnic differences in comorbid psychosis: a population-based study. Front Psychiatry 2024; 15:1280253. [PMID: 39140109 PMCID: PMC11320602 DOI: 10.3389/fpsyt.2024.1280253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 06/27/2024] [Indexed: 08/15/2024] Open
Abstract
Introduction Differences in the prevalence of psychiatric conditions such as psychosis as well as patterns of comorbidity for psychosis have been reported between racial and ethnic groups. It is unclear whether those differences are consistent for comorbid psychosis. Methods Self-reported diagnostic data from American adults ages 18-99 participating in the Collaborative Psychiatric Epidemiology Surveys (CPES) (N ~ 11,844) were used to test the association between four racial and ethnic group categories (White, Asian, Hispanic, Black) and comorbid psychosis. Comorbid psychosis was measured as a 4-level categorical variable (No mental illness nor psychosis, Mental Illness, Psychosis only, comorbid psychosis (i.e., Psychosis + Mental Illness). Chi-square tests were used to determine significant differences in the prevalence of comorbid psychosis by race and ethnicity. A multinomial logistic regression was used to test the association between racial and ethnic classifications and comorbid psychosis after adjusting for common demographic characteristics (i.e., education, sex, income, and age). Results Relative to White participants, Hispanic and Asian participants were less likely to be affected with comorbid psychosis. (Adjusted Odds Ratio, AORAsian = 0.32, CI = 0.22 - 0.47, p <0.0001, AORHispanic = 0.66, CI = 0.48 - 0.92, p = 0.012). Relative to White participants there was not significant association for comorbid psychosis in Black participants (AORBlack = 0.91, CI = 0.70 - 1.20, p = 0.52) In contrast Hispanic and Black participants were more likely to report psychosis alone (AORHispanic = 1.94, CI = 1.27-2.98, p = 0.002, AORBlack = 1.86, 1.24-2.82, p = 0.003) compared to White participants. Conclusion There were different patterns of associations by race and ethnicity for psychosis and comorbid psychosis. The lower prevalence of comorbid psychosis in non-White groups may be due to underdiagnosis or underreporting of other mental disorders.
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Affiliation(s)
- Mariam Sankoh
- Department of Integrative Life Sciences, Virginia Commonwealth University, Richmond, VA, United States
| | - James Clifford
- Department of Public Health, Brody School of Medicine, East Carolina University, Greenville, NC, United States
| | - Roseann E. Peterson
- Department of Psychiatry and Behavioral Sciences, Institute for Genomics in Health, Downstate Health Sciences University, State University of Brooklyn, New York, NY, United States
| | - Elizabeth Prom-Wormley
- Department of Epidemiology, Virginia Commonwealth University, Richmond, VA, United States
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Lawrence HR, Schneider RA, Rubin SB, Matarić MJ, McDuff DJ, Jones Bell M. The Opportunities and Risks of Large Language Models in Mental Health. JMIR Ment Health 2024; 11:e59479. [PMID: 39105570 PMCID: PMC11301767 DOI: 10.2196/59479] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2024] [Revised: 05/31/2024] [Accepted: 06/01/2024] [Indexed: 08/07/2024] Open
Abstract
Unlabelled Global rates of mental health concerns are rising, and there is increasing realization that existing models of mental health care will not adequately expand to meet the demand. With the emergence of large language models (LLMs) has come great optimism regarding their promise to create novel, large-scale solutions to support mental health. Despite their nascence, LLMs have already been applied to mental health-related tasks. In this paper, we summarize the extant literature on efforts to use LLMs to provide mental health education, assessment, and intervention and highlight key opportunities for positive impact in each area. We then highlight risks associated with LLMs' application to mental health and encourage the adoption of strategies to mitigate these risks. The urgent need for mental health support must be balanced with responsible development, testing, and deployment of mental health LLMs. It is especially critical to ensure that mental health LLMs are fine-tuned for mental health, enhance mental health equity, and adhere to ethical standards and that people, including those with lived experience with mental health concerns, are involved in all stages from development through deployment. Prioritizing these efforts will minimize potential harms to mental health and maximize the likelihood that LLMs will positively impact mental health globally.
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Affiliation(s)
| | | | | | - Maja J Matarić
- Google LLC, Mountain View, CA, 90291, United States, 13103106000
| | - Daniel J McDuff
- Google LLC, Mountain View, CA, 90291, United States, 13103106000
| | - Megan Jones Bell
- Google LLC, Mountain View, CA, 90291, United States, 13103106000
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Johnson AL. Psychotic white men and bipolar black women? Racialized and gendered implications of mental health terminology. Soc Sci Med 2024; 352:117015. [PMID: 38788530 DOI: 10.1016/j.socscimed.2024.117015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 04/10/2024] [Accepted: 05/20/2024] [Indexed: 05/26/2024]
Abstract
This study investigates the intersection of race, gender, and criminality in the language surrounding mental health and illness. Applying computational methods of word embeddings to full text data from major American newspapers between 2000 and 2023, I show that the landscape of mental health is broadly racialized as black, challenging the notion of mental illness as a predominantly white phenomenon. Cultural ideas about mental illness are gendered such that women are medicalized and men are criminalized, yet certain terms blur the boundary between illness and criminality. I highlight how stereotypes embedded in mental health language perpetuate stigma around men's mental health and justify social control with notable implications for black men. I conclude with recommendations for the mental health movement by advocating for more inclusive discussions around men's mental health and revised person-centric language.
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Affiliation(s)
- Amy L Johnson
- Lehigh University. Sociology and Anthropology Department. 31 Williams Dr, Bethlehem, PA, USA 18015.
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Wise EA, Yan H, Oh E, Leoutsakos J. Racial/ethnic differences in neuropsychiatric disturbances associated with incident dementia. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2024; 16:e12615. [PMID: 38974877 PMCID: PMC11224973 DOI: 10.1002/dad2.12615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 05/28/2024] [Accepted: 06/06/2024] [Indexed: 07/09/2024]
Abstract
INTRODUCTION Neuropsychiatric symptoms (NPS) are nearly universal in dementia; some cross-sectional studies of NPS in dementia have found racial/ethnic differences, though it is unknown if NPS prevalence differs among racial/ethnic groups before and after dementia diagnosis. METHODS Participants were followed annually at Alzheimer's Disease Centers and were assessed on the Neuropsychiatric Inventory-Questionnaire (NPI-Q) with at least one follow-up visit at which they were diagnosed with dementia. Descriptive statistics were generated by race/ethnicity. NPS were modeled over time as a function of race/ethnicity and with diagnosis date as the baseline. RESULTS NPS were present in 95% in at least one time point. After adjusting for covariates, there were no statistically significant differences in NPI-Q total scores among racial/ethnic groups at the time of and after dementia diagnosis. DISCUSSION Findings from our prospective cohort study suggest that when individuals are matched at the time of conversion to dementia, there are no racial/ethnic differences in NPS. Highlights Neuropsychiatric symptoms of dementia are frequent and increase caregiver burden.Prior studies reported more neuropsychiatric symptoms (NPS) in Black compared to White individuals with dementia.National Alzheimer's Coordinating Center Black, White, and Hispanic participants did not differ in NPS at the time of dementia diagnosis.
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Affiliation(s)
- Elizabeth A. Wise
- Department of Psychiatry and Behavioral SciencesJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Haijuan Yan
- Department of Psychiatry and Behavioral SciencesJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Esther Oh
- Department of MedicineDepartment of Psychiatry and Behavioral SciencesDepartment of PathologyJohns Hopkins University School of MedicineJohns Hopkins University School of NursingBaltimoreMarylandUSA
| | - Jeannie‐Marie Leoutsakos
- Department of Psychiatry and Behavioral SciencesJohns Hopkins University School of MedicineBaltimoreMarylandUSA
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Oh H, Karcher NR, Li Verdugo J, Botello R, DeVylder JE, Anglin D. Ethno-racial disparities in psychosis-like experiences among students in higher education: Findings from the Healthy Minds Study 2020-2021. Psychiatry Res 2024; 337:115959. [PMID: 38749075 PMCID: PMC11246701 DOI: 10.1016/j.psychres.2024.115959] [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: 10/28/2023] [Revised: 05/06/2024] [Accepted: 05/09/2024] [Indexed: 07/16/2024]
Abstract
BACKGROUND Ethno-racial variations of psychosis-like experiences exist in the general population; however, it is unknown whether this variation exists among emerging adults in higher education, and whether there are differences across ethnic groups within racial categories. METHODS Using the Health Minds Study data from 2020 to 2021, we used multivariable logistic regression models to examine race/ethnicity and psychosis-like experiences, adjusting for socio-demographic characteristics (age, gender, international student status). We then adjusted for food insecurity, parental education, and social belonging. RESULTS Black, Hispanic/Latinx, multiracial, and American Indian/Alaska Native students had greater odds of 12-month psychosis-like experiences when compared with White students. These associations attenuated and were no longer statistically significant for Black and Hispanic/Latinx students after adjusting for food insecurity and parental education. Multiracial and American Indian/Alaska Native students still had greater odds of psychosis-like experiences after further adjusting for sense of belonging. When looking at ethnic subgroups, Filipinx and multi-ethnic Asian students had significantly greater odds than East Asian students, and multi-ethnic Black students had greater odds than African Americans. CONCLUSION Odds of psychosis-like experiences vary across and within ethno-racial categories among emerging adults in higher education. Future research may explore psychosis as a disparity impacting Native American/Alaska Native and multiracial/multi-ethnic populations.
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Affiliation(s)
- Hans Oh
- University of Southern California, United States.
| | - Nicole R Karcher
- Washington University in St. Louis School of Medicine, United States
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Jiang Z, Seyedi S, Griner E, Abbasi A, Rad AB, Kwon H, Cotes RO, Clifford GD. Evaluating and mitigating unfairness in multimodal remote mental health assessments. PLOS DIGITAL HEALTH 2024; 3:e0000413. [PMID: 39046989 PMCID: PMC11268595 DOI: 10.1371/journal.pdig.0000413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 06/13/2024] [Indexed: 07/27/2024]
Abstract
Research on automated mental health assessment tools has been growing in recent years, often aiming to address the subjectivity and bias that existed in the current clinical practice of the psychiatric evaluation process. Despite the substantial health and economic ramifications, the potential unfairness of those automated tools was understudied and required more attention. In this work, we systematically evaluated the fairness level in a multimodal remote mental health dataset and an assessment system, where we compared the fairness level in race, gender, education level, and age. Demographic parity ratio (DPR) and equalized odds ratio (EOR) of classifiers using different modalities were compared, along with the F1 scores in different demographic groups. Post-training classifier threshold optimization was employed to mitigate the unfairness. No statistically significant unfairness was found in the composition of the dataset. Varying degrees of unfairness were identified among modalities, with no single modality consistently demonstrating better fairness across all demographic variables. Post-training mitigation effectively improved both DPR and EOR metrics at the expense of a decrease in F1 scores. Addressing and mitigating unfairness in these automated tools are essential steps in fostering trust among clinicians, gaining deeper insights into their use cases, and facilitating their appropriate utilization.
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Affiliation(s)
- Zifan Jiang
- Department of Biomedical Informatics, Emory University School of Medicine, Atlanta, Georgia, United States of America
- Department of Biomedical Engineering, Emory University and Georgia Institute of Technology, Atlanta, Georgia, United States of America
| | - Salman Seyedi
- Department of Biomedical Informatics, Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - Emily Griner
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - Ahmed Abbasi
- Department of IT, Analytics, and Operations, University of Notre Dame, Notre Dame, Indiana, United States of America
| | - Ali Bahrami Rad
- Department of Biomedical Informatics, Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - Hyeokhyen Kwon
- Department of Biomedical Informatics, Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - Robert O. Cotes
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - Gari D. Clifford
- Department of Biomedical Informatics, Emory University School of Medicine, Atlanta, Georgia, United States of America
- Department of Biomedical Engineering, Emory University and Georgia Institute of Technology, Atlanta, Georgia, United States of America
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Sparrow R, Fornells-Ambrojo M. Two people making sense of a story: narrative exposure therapy as a trauma intervention in early intervention in psychosis. Eur J Psychotraumatol 2024; 15:2355829. [PMID: 38856038 PMCID: PMC11168218 DOI: 10.1080/20008066.2024.2355829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 04/19/2024] [Indexed: 06/11/2024] Open
Abstract
Background: Narrative exposure therapy (NET) is a recommended intervention for people with multiple trauma histories; however, research is lacking into its use with people experiencing psychosis, many of whom report multiple trauma histories.Objective: This study aimed to explore experiences of NET in early intervention in psychosis (EIP) services.Method: Eight clinicians and four experts with lived experience (experts by experience) of psychosis and multiple trauma were interviewed on a single occasion using two versions (clinician and expert by experience) of a semi-structured interview schedule. Data was analysed using thematic analysis.Results: Five overarching themes were generated, relating to fear and avoidance of memories, importance of trust, organizing memories and making new meaning, reconnecting with emotions, and considerations when delivering NET in EIP.Conclusions: Directly addressing the impact of multiple trauma in people experiencing first episode psychosis is frightening and emotive, but helps to address painful memories and organize them into a personal narrative. Increases in distress and anomalous experiences were carefully considered by clinicians, but typically outweighed by the benefits of NET. Challenges were comparable to those described in non-psychosis research. Implications for clinical practice and future research are outlined.
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Affiliation(s)
- Rachel Sparrow
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Miriam Fornells-Ambrojo
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
- Early Intervention in Psychosis Services, North East London NHS Foundation Trust, London, UK
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van der Ven E, Olino TM, Diehl K, Nuñez SM, Thayer G, Bridgwater MA, Ereshefsky S, Musket C, Lincoln SH, Rogers RT, Klaunig MJ, Soohoo E, DeVylder JE, Grattan RE, Schiffman J, Ellman LM, Niendam TA, Anglin DM. Ethnoracial Risk Variation Across the Psychosis Continuum in the US: A Systematic Review and Meta-Analysis. JAMA Psychiatry 2024; 81:447-455. [PMID: 38381422 PMCID: PMC10882506 DOI: 10.1001/jamapsychiatry.2023.5497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 11/26/2023] [Indexed: 02/22/2024]
Abstract
Importance Studies suggest a higher risk of schizophrenia diagnoses in Black vs White Americans, yet a systematic investigation of disparities that include other ethnoracial groups and multiple outcomes on the psychosis continuum is lacking. Objective To identify ethnoracial risk variation in the US across 3 psychosis continuum outcomes (ie, schizophrenia and other psychotic disorders, clinical high risk for psychosis [CHR-P], and psychotic symptoms [PSs] and psychotic experiences [PEs]). Data Sources PubMed, PsycINFO and Embase were searched up to December 2022. Study Selection Observational studies on ethnoracial differences in risk of 3 psychosis outcomes. Data Extraction and Synthesis Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were followed. Using a random-effects model, estimates for ethnoracial differences in schizophrenia and PSs/PEs were pooled and moderation by sampling and setting was determined, along with the assessment of heterogeneity and risk of bias. Main Outcomes and Measures Risk of schizophrenia and other psychotic disorder, CHR-P, and conversion to psychosis among CHR-P and PSs/PEs. Results Of 64 studies in the systematic review, 47 were included in the meta-analysis comprising 54 929 people with schizophrenia and 223 097 with data on PSs/PEs. Compared with White individuals, Black individuals had increased risk of schizophrenia (pooled odds ratio [OR], 2.07; 95% CI, 1.64-2.61) and PSs/PEs (pooled standardized mean difference [SMD], 0.10; 95% CI, 0.03-0.16), Latinx individuals had higher risk of PSs/PEs (pooled SMD, 0.15; 95% CI, 0.08-0.22), and individuals classified as other ethnoracial group were at significantly higher risk of schizophrenia than White individuals (pooled OR, 1.81; 95% CI, 1.31-2.50). The results regarding CHR-P studies were mixed and inconsistent. Sensitivity analyses showed elevated odds of schizophrenia in Asian individuals in inpatient settings (pooled OR, 1.84; 95% CI, 1.19-2.84) and increased risk of PEs among Asian compared with White individuals, specifically in college samples (pooled SMD, 0.16; 95% CI, 0.02-0.29). Heterogeneity across studies was high, and there was substantial risk of bias in most studies. Conclusions and Relevance Findings of this systematic review and meta-analysis revealed widespread ethnoracial risk variation across multiple psychosis outcomes. In addition to diagnostic, measurement, and hospital bias, systemic influences such as structural racism should be considered as drivers of ethnoracial disparities in outcomes across the psychosis continuum in the US.
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Affiliation(s)
- Els van der Ven
- Department of Clinical, Neuro- and Developmental Psychology, Vrije Universiteit, Amsterdam, the Netherlands
| | - Thomas M. Olino
- Department of Psychology, Temple University, Philadelphia, Pennsylvania
| | - Katharina Diehl
- Department of Clinical, Neuro- and Developmental Psychology, Vrije Universiteit, Amsterdam, the Netherlands
| | - Stephanie M. Nuñez
- Department of Psychology, The City College of New York, City University of New York, New York
| | - Griffin Thayer
- Department of Psychology, The City College of New York, City University of New York, New York
| | | | - Sabrina Ereshefsky
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento
| | - Christie Musket
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
- VA Connecticut Healthcare System, West Haven, Connecticut
| | - Sarah Hope Lincoln
- Department of Psychological Sciences, Case Western Reserve University, Cleveland, Ohio
| | - R. Tyler Rogers
- New York State Psychiatric Institute, Columbia University Irving Medical Center, New York, New York
| | - Mallory J. Klaunig
- Department of Psychological Science, University of California, Irvine, Irvine
| | - Emily Soohoo
- Department of Biological Sciences, San Jose State University, San Jose, California
| | | | - Rebecca E. Grattan
- School of Psychology, Victoria University of Wellington–Te Herenga Waka, Wellington, New Zealand
| | - Jason Schiffman
- Department of Psychological Science, University of California, Irvine, Irvine
| | - Lauren M. Ellman
- Department of Psychology, Temple University, Philadelphia, Pennsylvania
| | - Tara A. Niendam
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento
| | - Deidre M. Anglin
- Department of Psychology, Temple University, Philadelphia, Pennsylvania
- The Graduate Center, City University of New York, New York
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Hall H. Dissociation and misdiagnosis of schizophrenia in populations experiencing chronic discrimination and social defeat. J Trauma Dissociation 2024; 25:334-348. [PMID: 36065490 DOI: 10.1080/15299732.2022.2120154] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 08/12/2022] [Indexed: 10/14/2022]
Abstract
As recently as the late 20th century, Schizophrenia, a category of mental illness with widely varying phenotypic symptoms, was believed by psychobiologists to be a genetically based disorder in which the environment played a limited etiological role. Yet a growing body of evidence indicates a strong correlation between schizophrenia and environmental factors. This theoretical paper explores the relationship between highly elevated rates of schizophrenia in some low-income minority communities worldwide and trauma-related dissociative symptoms that often mimic schizophrenia. Elevated rates of schizophrenia in racially and ethnically isolated, inner-city Black populations are well documented. This paper contains evidence proposing that this amplification in the rate of schizophrenia is mediated by childhood trauma, disorganized attachment, and social defeat. Further, evidence demonstrating how these three variables combine in early childhood to incubate dissociative disorders will also be conveyed. The misdiagnosis of dissociative disorders as schizophrenia is theorized to partially mediate the increased rate of schizophrenia in communities that experience high levels of racial/ethnic discrimination. It is argued that this misdiagnosis is often attributable to cultural misunderstanding and/or a lack of knowledge about dissociative disorders.
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Bauer AG, Williams J, Hambrick E, Rempfer M, Bennett K, Christensen K, Berkley-Patton JY. Mental health attitudes, norms, beliefs, and experiences with care among young Black men: A theory of planned behavior assessment. PSYCHOLOGICAL TRAUMA : THEORY, RESEARCH, PRACTICE AND POLICY 2024; 16:653-660. [PMID: 37053405 PMCID: PMC10570394 DOI: 10.1037/tra0001462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/15/2023]
Abstract
OBJECTIVE Young Black/African American men (YBM) are at greater risk for trauma and related mental health concerns compared to young non-Hispanic White men but are less likely to receive mental health care when needed. The current study used a Theory of Planned Behavior (TPB)-guided framework to qualitatively explore beliefs, norms, and intentions related to seeking mental health screening and linkage to care (LTC) among YBM exposed to trauma. METHOD Participants (N = 55, Mage = 23 years) were YBM aged 18-30 recruited from urban community settings in Kansas City, MO, between October 2018 and April 2019 for participation in focus groups. RESULTS Participants discussed lived experiences with trauma and mental health care, plus salient behavioral beliefs-both positive and negative. Key normative referents were significant others and family members, and participants endorsed greater motivation to seek care with their support. Control beliefs ranged from individual and interpersonal facilitators and barriers to more systemic factors (e.g., availability of providers, cost, lack of access, disparities in incarceration). CONCLUSIONS Tailored interventions are needed to promote engagement in mental health services among YBM, with strategies that recognize cultural contexts and ongoing needs for general well-being. Recommendations for providers and systems are discussed. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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Affiliation(s)
- Alexandria G. Bauer
- Center of Alcohol & Substance Use Studies, Rutgers University, 607 Allison Road, Piscataway, NJ 08854, United States
| | - Joah Williams
- Department of Psychology, University of Missouri-Kansas City, 5030 Cherry Street, Kansas City, MO 64110, United States
| | - Erin Hambrick
- Department of Psychology, University of Missouri-Kansas City, 5030 Cherry Street, Kansas City, MO 64110, United States
| | - Melisa Rempfer
- Department of Psychology, University of Missouri-Kansas City, 5030 Cherry Street, Kansas City, MO 64110, United States
| | - Kymberly Bennett
- Department of Psychology, University of Missouri-Kansas City, 5030 Cherry Street, Kansas City, MO 64110, United States
| | - Kelsey Christensen
- Department of Biomedical and Health Informatics, University of Missouri-Kansas City, 2411 Holmes Street, Kansas City, MO 64108, United States
| | - Jannette Y. Berkley-Patton
- Department of Biomedical and Health Informatics, University of Missouri-Kansas City, 2411 Holmes Street, Kansas City, MO 64108, United States
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Amsalem D, Jankowski SE, Pagdon S, Smith S, Yang LH, Valeri L, Markowitz JC, Lewis-Fernández R, Dixon LB. "It's Tough to Be a Black Man with Schizophrenia": Randomized Controlled Trial of a Brief Video Intervention to Reduce Public Stigma. Schizophr Bull 2024; 50:695-704. [PMID: 38372704 PMCID: PMC11059800 DOI: 10.1093/schbul/sbae019] [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] [Indexed: 02/20/2024]
Abstract
BACKGROUND AND HYPOTHESIS Racial discrimination and public stigma toward Black individuals living with schizophrenia create disparities in treatment-seeking and engagement. Brief, social-contact-based video interventions efficaciously reduce stigma. It remains unclear whether including racial identity experiences in video narrative yields greater stigma reduction. We hypothesized that we would replicate findings showing sustained stigma reduction in video-intervention groups vs control and that Black participants would show greater stigma reduction and emotional engagement than non-Black participants only for a racial-insights video presenting a Black protagonist. STUDY DESIGN Recruiting using a crowdsourcing platform, we randomized 1351 participants ages 18-30 to (a) brief video-based intervention, (b) racial-insights-focused brief video, or (c) non-intervention control, with baseline, post-intervention, and 30-day follow-up assessments. In 2-minute videos, a young Black protagonist described symptoms, personal struggles, and recovery from schizophrenia, with or without mentioning race-related experiences. STUDY RESULTS A 3 × 3 ANOVA showed a significant group-by-time interaction for total scores of each of five stigma-related domains: social distance, stereotyping, separateness, social restriction, and perceived recovery (all P < .001). Linear mixed modeling showed a greater reduction in stigma from baseline to post-intervention among Black than non-Black participants in the racial insights video group for the social distance and social restriction domains. CONCLUSIONS This randomized controlled trial replicated and expanded previous findings, showing the anti-stigma effects of a brief video tailored to race-related experiences. This underscores the importance of personalized, culturally relevant narratives, especially for marginalized groups who, more attuned to prejudice and discrimination, may particularly value identification and solidarity. Future studies should explore mediators/moderators to improve intervention efficacy.
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Affiliation(s)
- Doron Amsalem
- New York State Psychiatric Institute and Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Samantha E Jankowski
- New York State Psychiatric Institute and Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Shannon Pagdon
- New York State Psychiatric Institute and Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Stephen Smith
- New York State Psychiatric Institute and Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Lawrence H Yang
- Department of Social and Behavioral Sciences, College of Global Public Health, New York University, New York, NY, USA
- Department of Epidemiology, Mailman School of Public Health, New York, NY, USA
| | - Linda Valeri
- Department of Biostatistics, Columbia University Mailman School of Public Health, New York, NY, USA
| | - John C Markowitz
- New York State Psychiatric Institute and Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Roberto Lewis-Fernández
- New York State Psychiatric Institute and Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Lisa B Dixon
- New York State Psychiatric Institute and Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
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Medina C, Akinkunmi A, Bland N, Velthorst E, Reichenberg A, Khachadourian V, Modabbernia A, Janecka M. Differences in schizophrenia treatments by race and ethnicity-analysis of electronic health records. SCHIZOPHRENIA (HEIDELBERG, GERMANY) 2024; 10:48. [PMID: 38671009 PMCID: PMC11053048 DOI: 10.1038/s41537-024-00470-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 04/11/2024] [Indexed: 04/28/2024]
Abstract
Racial disparities in prescriptions of anti-psychotics have been highlighted before. However, (i) the evidence on other medications, including anti-depressant or mood stabilizing medications is lacking, and (ii) the role of potentially confounding factors and (iii) specificity of such disparities to schizophrenia (SCZ), are still unknown. We used electronic health records (EHRs) from 224,212 adults to estimate the odds ratios of receiving a prescription for different nervous system medications among patients with SCZ of different race/ethnicity, and analogous linear models to investigate differences in prescribed medication doses. To verify specificity of the observed patterns to SCZ, we conducted analogous analyses in depression and bipolar disorder (BD) patients. We found that Black/African American (AA) and Hispanic patients with SCZ were more likely to be prescribed haloperidol (Black/AA: OR = 1.52 (1.33-1.74); Hispanic: OR = 1.32 (1.12-1.55)) or risperidone (Black/AA: OR = 1.27 (1.11-1.45); Hispanic: OR = 1.40 (1.19-1.64)), but less likely to be prescribed clozapine (Black/AA: OR = 0.40 (0.33-0.49); Hispanic: OR = 0.45 (0.35-0.58)), compared to white patients. There were no race/ethnicity-related differences in the prescribed medication doses. These patterns were not specific to SCZ: Asian, Hispanic and Black/AA patients with BD or depression were more likely to be prescribed anti-psychotics, but less likely to be prescribed antidepressants or mood-stabilizers. In conclusion, we found racial/ethnic disparities in the medications prescribed to patients with SCZ and other psychiatric conditions. We discuss the potential implications for the quality of care for patients of diverse races/ethnicities.
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Affiliation(s)
- Candice Medina
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Seaver Autism Center for Research and Treatment, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Child and Adolescent Psychiatry, NYU Grossman School of Medicine, New York, NY, USA
| | | | - Nevaeh Bland
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Eva Velthorst
- GGZ Noord Holland Noord, Stationsplein, Heerhugowaard, Netherlands
| | - Avi Reichenberg
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Seaver Autism Center for Research and Treatment, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Environmental Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Vahe Khachadourian
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Magdalena Janecka
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
- Seaver Autism Center for Research and Treatment, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
- Department of Child and Adolescent Psychiatry, NYU Grossman School of Medicine, New York, NY, USA.
- Department of Genetic & Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA.
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Johnson K, Weldon AJ, Burmeister MA. Differential effects of cannabis constituents on schizophrenia-related psychosis: a rationale for incorporating cannabidiol into a schizophrenia therapeutic regimen. Front Psychiatry 2024; 15:1386263. [PMID: 38716117 PMCID: PMC11074403 DOI: 10.3389/fpsyt.2024.1386263] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 04/11/2024] [Indexed: 01/06/2025] Open
Abstract
Schizophrenia is a serious mental health disorder that confers one of the highest mortality rates of all psychiatric illnesses. Although the disorder's psychotic symptoms are treatable with conventional antipsychotics, they remain incurable. Moreover, medication adherence is poor, and individuals with schizophrenia choose to self-medicate with illicit substances, including cannabis. It is well-established that the delta-9-tetrahydrocannabinol (delta-9-THC) component of cannabis elicits psychotomimetic effects at high doses; worsens schizophrenia-related psychosis; commonly develops into cannabis use disorder in individuals with schizophrenia; and increases the risk of earlier-onset schizophrenia symptoms in those harboring genetic susceptibility. However, individuals with schizophrenia commonly use cannabis and cannabis derivatives such as cannabidiol (CBD). These products seem to alleviate psychotic symptoms and relieve adverse side effects of antipsychotic medications. Therefore, one notion that has gained traction is the potential utility of cannabis-derived cannabidiol (CBD) as adjunct treatment to reduce schizophrenia-associated psychosis and other symptoms. Currently, preclinical and clinical data remain inconclusive. The present review distinguishes the mechanisms underlying schizophrenia-associated vs. cannabis-induced psychosis; reviews the evidence for delta-9-THC-mediated exacerbation vs. CBD-mediated amelioration of schizophrenia-associated psychosis; and describes potential approaches for incorporating CBD into schizophrenia therapeutic regimen in a safe and efficacious manner.
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Affiliation(s)
- Kennadi Johnson
- William Carey University School of Pharmacy, Departments of Pharmaceutical Sciences and Pharmacy Practice, Biloxi, MS, United States
| | - Abby J. Weldon
- William Carey University School of Pharmacy, Department of Pharmaceutical Sciences, Biloxi, MS, United States
| | - Melissa A. Burmeister
- William Carey University School of Pharmacy, Department of Pharmaceutical Sciences, Biloxi, MS, United States
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40
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Clauss JA, Foo CYS, Leonard CJ, Dokholyan KN, Cather C, Holt DJ. Screening for psychotic experiences and psychotic disorders in general psychiatric settings: a systematic review and meta-analysis. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.04.14.24305796. [PMID: 38699350 PMCID: PMC11065042 DOI: 10.1101/2024.04.14.24305796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2024]
Abstract
Background The absence of systematic screening for psychosis within general psychiatric services contribute to substantial treatment delays and poor long-term outcomes. We conducted a meta-analysis to estimate rates of psychotic experiences, clinical high-risk for psychosis syndrome (CHR-P), and psychotic disorders identified by screening treatment-seeking individuals to inform implementation recommendations for routine psychosis screening in general psychiatric settings. Methods PubMed and Web of Science databases were searched to identify empirical studies that contained information on the point prevalence of psychotic experiences, CHR-P, or psychotic disorders identified by screening inpatient and outpatient samples aged 12-64 receiving general psychiatric care. Psychotic experiences were identified by meeting threshold scores on validated self-reported questionnaires, and psychotic disorders and CHR-P by gold-standard structured interview assessments. A meta-analysis of each outcome was conducted using the Restricted Maximum Likelihood Estimator method of estimating effect sizes in a random effects model. Results 41 independent samples (k=36 outpatient) involving n=25,751 patients (58% female, mean age: 24.1 years) were included. Among a general psychiatric population, prevalence of psychotic experiences was 44.3% (95% CI: 35.8-52.8%; 28 samples, n=21,957); CHR-P was 26.4% (95% CI: 20.0-32.7%; 28 samples, n=14,395); and psychotic disorders was 6.6% (95% CI: 3.3-9.8%; 32 samples, n=20,371). Conclusions High rates of psychotic spectrum illness in general psychiatric settings underscore need for secondary prevention with psychosis screening. These base rates can be used to plan training and resources required to conduct assessments for early detection, as well as build capacity in interventions for CHR-P and early psychosis in non-specialty mental health settings.
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Affiliation(s)
- Jacqueline A. Clauss
- Psychosis Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Cheryl Y. S. Foo
- Psychosis Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
- Center of Excellence for Psychosocial and Systemic Research, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | - Katherine N. Dokholyan
- Psychosis Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Corinne Cather
- Psychosis Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
- Center of Excellence for Psychosocial and Systemic Research, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Daphne J. Holt
- Psychosis Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
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Kassam AS, Karalis P, Aydinian T, Panjwani A, Martinez G, Whiteman A, Daas M, Cunningham EA. Racial disparities with PRN medication usage in inpatient psychiatric treatment. SCHIZOPHRENIA (HEIDELBERG, GERMANY) 2024; 10:46. [PMID: 38615056 PMCID: PMC11016118 DOI: 10.1038/s41537-024-00461-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 03/15/2024] [Indexed: 04/15/2024]
Abstract
Racial disparities in psychiatric diagnoses and treatment have significant public health implications, contributing to inequities in healthcare outcomes. We specifically examined racial disparities regarding pro re nata (PRN), or as needed, medications. Data from 14,616 encounters across 2019-2020 within Community Health Network's inpatient psychiatric setting in Indianapolis, Indiana were included in this study. Due to the demographic sample size, analyses were narrowed to Black and White patients. Primary outcomes included comparisons across race for all PRN administrations and PRN administrations of antipsychotics vs. non-antipsychotics. Logistic regression was used to examine associations between race and PRN administrations by medication category, including all antipsychotics vs. non-antipsychotics overall, hydroxyzine, and lorazepam, independently. Significant differences in the percentage of administrations between Black and White patients were observed. Black patients received more PRN medications overall (71.0%) compared to White patients (67.7%) (p < 0.01). Further, while 17.7% of Black patients were administered PRN antipsychotics, this was true for only 8.2% of White patients (p < 0.001). When comparing antipsychotic PRNs with non-antipsychotic, hydroxyzine, and lorazepam PRNs, independently, Black patients were 58% (OR 1.58, p < 0.001), 109% (OR 2.09, p < 0.001), and 32% (OR 1.32, p < 0.001), more likely to receive antipsychotic PRNs, respectively, than White patients, controlling for sex, age, length of stay, and psychotic disorder diagnosis. Our study identifies yet another area of medical care with significant racial disparities. In this analysis of PRN medications during psychiatric admission, we identified significant differences in medication utilization by race. This information provides a basis for further investigation of disparities in patient-centered data.
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Affiliation(s)
- Areef S Kassam
- Community Health Network, Behavioral Health Department, Indianapolis, IN, USA.
| | - Peter Karalis
- Community Health Network, Behavioral Health Department, Indianapolis, IN, USA
| | - Taline Aydinian
- Harvard Medical School, Department of Psychiatry, Boston, MA, USA
| | - Anita Panjwani
- Purdue University, Department of Nutrition Science, West Lafayette, IN, USA
- Center on Aging and the Life Course, Purdue University, West Lafayette, IN, USA
| | - Gabriel Martinez
- Community Health Network, Behavioral Health Department, Indianapolis, IN, USA
| | - Aaron Whiteman
- Community Health Network, Behavioral Health Department, Indianapolis, IN, USA
| | - Magdoline Daas
- Community Health Network, Behavioral Health Department, Indianapolis, IN, USA
| | - E Ann Cunningham
- Community Health Network, Behavioral Health Department, Indianapolis, IN, USA
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Wand T. We have to cancel psychiatric nursing and forge a new way forward. Int J Ment Health Nurs 2024; 33:215-219. [PMID: 38308416 DOI: 10.1111/inm.13301] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 01/19/2024] [Indexed: 02/04/2024]
Affiliation(s)
- Timothy Wand
- Nursing and Midwifery Research Unit, Wollongong Hospital, Illawarra Shoalhaven Local Health District and University of Wollongong, Wollongong, New South Wales, Australia
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43
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Wolny J, Moussa-Tooks AB, Bailey AJ, MacDonald Iii AW, Mervis JE, Hetrick WP. Measurement invariance of the Revised-Green Paranoid Thought Scale across Black and White Americans. Schizophr Res 2024; 266:227-233. [PMID: 38428120 PMCID: PMC10961092 DOI: 10.1016/j.schres.2024.02.024] [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: 04/27/2023] [Revised: 11/11/2023] [Accepted: 02/17/2024] [Indexed: 03/03/2024]
Abstract
Given the culturally diverse landscape of mental healthcare and research, ensuring that our psychological constructs are measured equivalently across diverse populations is critical. One construct for which there is significant potential for inequitable assessment is paranoia, a prominent feature in psychotic disorders that can also be driven by culture and racial marginalization. This study examined measurement invariance-an analytic technique to rigorously investigate whether a given construct is being measured similarly across groups-of the Revised-Green Paranoid Thought Scale (R-GPTS; Freeman et al., 2021) across Black and White Americans in the general population. Racial group differences in self-reported paranoia were also examined. The analytic sample consisted of 480 non-Hispanic White and 459 non-Hispanic Black Americans. Analyses demonstrated full invariance (i.e., configural, metric, and scalar invariance) of the R-GPTS across groups, indicating that the R-GPTS appropriately captures self-reported paranoia between Black and White Americans. Accordingly, it is reasonable to compare group endorsement: Black participants endorsed significantly higher scores on both the ideas of reference and ideas of persecution subscales of the R-GPTS (Mean ± SD = 10.91 ± 7.12 versus 8.21 ± 7.17 and Mean ± SD = 10.18 ± 10.03 versus 6.35 ± 8.35, for these subscales respectively). Generalized linear modeling revealed that race remained a large and statistically significant predictor of R-GPTS total score (β = -0.38756, p < 0.001) after controlling for relevant demographic factors (e.g., sex, age). This study addresses a critical gap within the existing literature as it establishes that elevations in paranoia exhibited by Black Americans in the R-GPTS reflect actual differences between groups rather than measurement artifacts.
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Affiliation(s)
- J Wolny
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN, United States of America.
| | - Alexandra B Moussa-Tooks
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN, United States of America; Program in Neuroscience, Indiana University Bloomington, IN, United States of America; Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, IN, United States of America
| | - Allen J Bailey
- Division of Alcohol, Drugs, and Addiction, McClean Hospital, Belmont, MA; Department of Psychiatry, Harvard Medical School, Boston, MA, United States of America
| | - Angus W MacDonald Iii
- Department of Psychology, University of Minnesota, Minneapolis, MN, United States of America; Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical Center, Minneapolis, MN, United States of America
| | - Joshua E Mervis
- Department of Psychology, Temple University, Philadelphia, PA, United States of America
| | - William P Hetrick
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN, United States of America; Program in Neuroscience, Indiana University Bloomington, IN, United States of America; Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, United States of America
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Gooding DC, Mohrbacher DA, Umucu E, Van Hulle CA, Lewis JP, Carter FP, Gleason CE. Ethnoracialized group differences in attitudes and knowledge about schizophrenia and willingness to engage in biomarker research: The UBIGR Study. Psychiatry Res 2024; 334:115776. [PMID: 38377801 PMCID: PMC11835010 DOI: 10.1016/j.psychres.2024.115776] [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: 11/21/2023] [Revised: 02/03/2024] [Accepted: 02/06/2024] [Indexed: 02/22/2024]
Abstract
Although there is renewed optimism in biomarker research in schizophrenia, there is also need for greater inclusion of historically underrepresented groups in the research. In the present study, we surveyed 599 African American, 352 American Indian/Alaska Native, and 725 NonHispanic White participants about their attitudes toward research, knowledge and attitudes about schizophrenia, and willingness to engage in biomarker testing. Attitudes toward research were examined using the standardized 7-item Research Attitudes Questionnaire (RAQ) measure. Using structural equation modeling (SEM), we tested our predictive model of the likelihood of willingness to engage in biomarker testing for schizophrenia risk. Members of historically underrepresented groups were less willing to engage in biomarker testing. Overall, attitudes toward research, particularly trust, influenced biomarker testing willingness. These findings suggest that factors influencing willingness to engage in schizophrenia biomarker testing may be modifiable by outreach engagement and education.
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Affiliation(s)
- Diane Carol Gooding
- Department of Psychology, UW-Madison, Madison, WI, USA; Department of Psychiatry, SMPH, UW-Madison, Madison, WI, USA; Geriatrics and Gerontology, Dept. of Medicine, SMPH, UW-Madison, Madison, WI, USA.
| | - Denise A Mohrbacher
- Department of Population Health Sciences, SMPH, UW-Madison, Madison, WI, USA
| | - Emre Umucu
- Department of Public Health Sciences, University of Texas - El Paso, TX, USA
| | - Carol A Van Hulle
- Geriatrics and Gerontology, Dept. of Medicine, SMPH, UW-Madison, Madison, WI, USA; Wisconsin Alzheimer's Disease Research Center, UW-Madison, Madison, WI, USA
| | - Jordan P Lewis
- Memory Keepers Medical Discovery Team, Dept of Family Medicine & Biobehavioral Health, University of Minnesota Medical School, Duluth campus, MN, USA
| | - Fabu P Carter
- Wisconsin Alzheimer's Disease Research Center, UW-Madison, Madison, WI, USA
| | - Carey E Gleason
- Geriatrics and Gerontology, Dept. of Medicine, SMPH, UW-Madison, Madison, WI, USA; Wisconsin Alzheimer's Disease Research Center, UW-Madison, Madison, WI, USA; Geriatric Research, Education, and Clinical Center, William S. Middleton Memorial VA Hospital, UW-Madison, WI, USA
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Clark I, Wallman P, Gee S, Taylor D. Clinical outcomes with paliperidone palmitate 3-monthly injection as monotherapy: observational 3-year follow-up of patients with schizophrenia. Eur Psychiatry 2024; 67:e15. [PMID: 38450540 DOI: 10.1192/j.eurpsy.2024.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND Paliperidone palmitate 3-monthly (PP3M) has been tested in 1-year controlled studies. The aim of this study was to examine the relapse outcomes with PP3M monotherapy at 3 years in patients with schizophrenia. METHODS This was an observational, non-interventional study of patients started on PP3M according to their clinical need. All patients had a diagnosis of schizophrenia (ICD-10 F20) and were between 18 and 65 years of age. The study took place in a mental health facility in South East London, UK. RESULTS Among the 166 patients who started PP3M, 97 (58%) met inclusion criteria and were observed for 36 months. In total, five patients (5%) experienced a relapse (defined as step-up in clinical care) while on PP3M. There were no relapses between months 18 and 36. Of the original 97 patients, 56 (58%) remained on PP3M monotherapy at 3 years, and 71 (73%) remained on either PP3M or paliperidone palmitate one-monthly. Reasons for discontinuation of PP3M included patient refusal (n = 11, 33% of discontinuations) and adverse effects in (n = 8, 24%). CONCLUSION PP3M is a highly effective monotherapy treatment for reducing relapse in people with schizophrenia.
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Affiliation(s)
- Ivana Clark
- Pharmacy Department, Maudsley Hospital, South London and Maudsley NHS Foundation Trust, Denmark hill LondonSE5 8AZ, UK
- Institute of Pharmaceutical Science, King's College London, 150 Stamford Street, LondonSE1 9NH, UK
| | - Phoebe Wallman
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, 16 De Crespigny Park, LondonSE5 8AF
| | - Siobhan Gee
- Pharmacy Department, Maudsley Hospital, South London and Maudsley NHS Foundation Trust, Denmark hill LondonSE5 8AZ, UK
- Institute of Pharmaceutical Science, King's College London, 150 Stamford Street, LondonSE1 9NH, UK
| | - David Taylor
- Pharmacy Department, Maudsley Hospital, South London and Maudsley NHS Foundation Trust, Denmark hill LondonSE5 8AZ, UK
- Institute of Pharmaceutical Science, King's College London, 150 Stamford Street, LondonSE1 9NH, UK
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Lopez JD, Daniels W, Joshi SV. Oppositional Defiant Disorder: Clinical Considerations and When to Worry. Pediatr Rev 2024; 45:132-142. [PMID: 38425161 DOI: 10.1542/pir.2022-005922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Affiliation(s)
- Juan David Lopez
- San Francisco Department of Public Health, Children, Youth and Families, San Francisco, CA
| | - Whitney Daniels
- Division of Child and Adolescent Psychiatry and Child Development, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA
| | - Shashank V Joshi
- Division of Child and Adolescent Psychiatry and Child Development, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA
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Franklin JB, Leewiwatanakul B, Taylor AD, Baller EB, Zwiebel SJ. Consultation-Liaison Case Conference: Overcoming Bias in the Differential Diagnosis of Psychosis. J Acad Consult Liaison Psychiatry 2024; 65:195-203. [PMID: 37717789 PMCID: PMC10947773 DOI: 10.1016/j.jaclp.2023.09.001] [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: 06/30/2023] [Revised: 08/28/2023] [Accepted: 09/09/2023] [Indexed: 09/19/2023]
Abstract
We present the case of a 34-year-old Black patient with no significant psychiatric history who presented with catatonia and psychotic symptoms following a recent severe acute respiratory syndrome coronavirus-2 infection, whose diagnosis of coronavirus disease 2019 encephalitis was delayed by premature attribution of his symptoms to a primary psychiatric etiology. Top experts in the consultation-liaison field provide guidance for this commonly encountered clinical case based on their experience and a review of the available literature. Key teaching topics include the diagnosis and management of coronavirus disease 2019 encephalitis, cognitive bias, and racial bias. Specifically, this case illustrates the role of the consultation-liaison psychiatrist in identifying medical conditions that may overlap with psychiatric presentations and in advocating for marginalized patients.
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Affiliation(s)
- Joshua B Franklin
- Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.
| | - Bruce Leewiwatanakul
- Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Adrienne D Taylor
- Division of Medical Psychiatry, Department of Psychiatry, Brigham and Women's Hospital, Boston, MA
| | - Erica B Baller
- Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Samantha J Zwiebel
- Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
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Jiang Z, Seyedi S, Griner E, Abbasi A, Rad AB, Kwon H, Cotes RO, Clifford GD. Multimodal Mental Health Digital Biomarker Analysis From Remote Interviews Using Facial, Vocal, Linguistic, and Cardiovascular Patterns. IEEE J Biomed Health Inform 2024; 28:1680-1691. [PMID: 38198249 PMCID: PMC10986761 DOI: 10.1109/jbhi.2024.3352075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2024]
Abstract
OBJECTIVE Psychiatric evaluation suffers from subjectivity and bias, and is hard to scale due to intensive professional training requirements. In this work, we investigated whether behavioral and physiological signals, extracted from tele-video interviews, differ in individuals with psychiatric disorders. METHODS Temporal variations in facial expression, vocal expression, linguistic expression, and cardiovascular modulation were extracted from simultaneously recorded audio and video of remote interviews. Averages, standard deviations, and Markovian process-derived statistics of these features were computed from 73 subjects. Four binary classification tasks were defined: detecting 1) any clinically-diagnosed psychiatric disorder, 2) major depressive disorder, 3) self-rated depression, and 4) self-rated anxiety. Each modality was evaluated individually and in combination. RESULTS Statistically significant feature differences were found between psychiatric and control subjects. Correlations were found between features and self-rated depression and anxiety scores. Heart rate dynamics provided the best unimodal performance with areas under the receiver-operator curve (AUROCs) of 0.68-0.75 (depending on the classification task). Combining multiple modalities provided AUROCs of 0.72-0.82. CONCLUSION Multimodal features extracted from remote interviews revealed informative characteristics of clinically diagnosed and self-rated mental health status. SIGNIFICANCE The proposed multimodal approach has the potential to facilitate scalable, remote, and low-cost assessment for low-burden automated mental health services.
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Ravi M, Lathan EC, Wallace S, Hinojosa CA, Jones D, Villalobos J, Karra S, Powers A, Michopoulos V. Indirect effect of negative evaluations of therapy on the association between racial stress and posttraumatic stress disorder symptoms in pregnant Black persons. PSYCHOLOGICAL TRAUMA : THEORY, RESEARCH, PRACTICE AND POLICY 2024; 16:382-389. [PMID: 37824259 PMCID: PMC10842040 DOI: 10.1037/tra0001593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/14/2023]
Abstract
OBJECTIVE Black pregnant individuals are at disproportionate risk for posttraumatic stress disorder (PTSD) compared to other groups. A wealth of literature suggests racial stress contributes to this inequity, but cultural and structural mechanisms, such as perceived barriers to mental health treatment, underlying the relationship between racial stress and PTSD symptoms remain understudied. Negative evaluations of psychotherapy and stigma represent potential mechanisms, though no previous studies have examined these associations. To address this gap, we tested an indirect effect of racial stress on PTSD symptoms through perceived barriers to mental health treatment in pregnant Black individuals. METHOD Mediation analyses were used to assess an indirect relationship between racial stress and PTSD symptoms through perceived barriers to mental health treatment. RESULTS At the bivariate level, racial stress was significantly associated with PTSD symptoms (r = .20, p = .03) and negative evaluations of therapy (r = .22, p = .02), but not with stigma (r = .140, p = .147). Negative evaluations of therapy were also associated with PTSD symptoms (r = .43, p < .001). There was an indirect effect of racial stress on PTSD symptoms through a negative evaluation of therapy, β = .08, SE = 0.04, CI [0.01, 0.18]. More specifically, racial stress was associated with a more negative evaluation of therapy, which was in turn associated with more PTSD symptoms. CONCLUSIONS Results highlight the need for accessible and culturally competent mental health care for pregnant Black individuals. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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Affiliation(s)
- Meghna Ravi
- Emory University School of Medicine, Department of Psychiatry and Behavioral Sciences, Atlanta, GA, United States of America
| | - Emma C. Lathan
- Emory University School of Medicine, Department of Psychiatry and Behavioral Sciences, Atlanta, GA, United States of America
| | - Shimarith Wallace
- Emory University School of Medicine, Department of Psychiatry and Behavioral Sciences, Atlanta, GA, United States of America
| | - Cecilia A. Hinojosa
- Emory University School of Medicine, Department of Psychiatry and Behavioral Sciences, Atlanta, GA, United States of America
| | - Dominique Jones
- Emory University School of Medicine, Department of Psychiatry and Behavioral Sciences, Atlanta, GA, United States of America
| | - Jamie Villalobos
- Emory University School of Medicine, Department of Psychiatry and Behavioral Sciences, Atlanta, GA, United States of America
| | - Sriya Karra
- Emory University School of Medicine, Department of Psychiatry and Behavioral Sciences, Atlanta, GA, United States of America
| | - Abigail Powers
- Emory University School of Medicine, Department of Psychiatry and Behavioral Sciences, Atlanta, GA, United States of America
| | - Vasiliki Michopoulos
- Emory University School of Medicine, Department of Psychiatry and Behavioral Sciences, Atlanta, GA, United States of America
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Bradford DE, DeFalco A, Perkins ER, Carbajal I, Kwasa J, Goodman FR, Jackson F, Richardson LNS, Woodley N, Neuberger L, Sandoval JA, Huang HJ, Joyner KJ. Whose Signals Are Being Amplified? Toward a More Equitable Clinical Psychophysiology. Clin Psychol Sci 2024; 12:237-252. [PMID: 38645420 PMCID: PMC11028731 DOI: 10.1177/21677026221112117] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/23/2024]
Abstract
Research using psychophysiological methods holds great promise for refining clinical assessment, identifying risk factors, and informing treatment. Unfortunately, unique methodological features of existing approaches limit inclusive research participation and, consequently, generalizability. This brief overview and commentary provides a snapshot of the current state of representation in clinical psychophysiology, with a focus on the forms and consequences of ongoing exclusion of Black participants. We illustrate issues of inequity and exclusion that are unique to clinical psychophysiology, considering intersections among social constructions of Blackness and biased design of current technology used to measure electroencephalography, skin conductance, and other signals. We then highlight work by groups dedicated to quantifying and addressing these limitations. We discuss the need for reflection and input from a wider variety of stakeholders to develop and refine new technologies, given the risk of further widening disparities. Finally, we provide broad recommendations for clinical psychophysiology research.
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Affiliation(s)
| | | | | | - Iván Carbajal
- Oregon State University, School of Psychological Science
| | - Jasmine Kwasa
- Carnegie Mellon University, Center for the Neural Basis of Cognition
| | - Fallon R. Goodman
- George Washington University, Department of Psychological and Brain Sciences
| | | | | | | | | | | | - Helen J. Huang
- University of Central Florida, Department of Mechanical and Aerospace Engineering
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