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May 2020 - Volume 208 - Issue 5

  • John A. Talbott, MD
  • 0022-3018
  • 1539-736X
  • 12 issues / year
  • Psychiatry 97/146; Clinical Neurology 145/199
  • 1.859

Predicting Patients' Readmission: Do Clinicians Outperform a Statistical Model? An Exploratory Study on Clinical Risk Judgment in Mental Health

Sofia Zanovello, MD, Valeria Donisi, PhD, Federico Tedeschi, PhD, Mirella Ruggeri, MD, PhD, Francesca Moretti, MD, PhD, Michela Rimondini, PhD, and Francesco Amaddeo, MD, PhD


We focus on a total of 142 patients discharged from acute psychiatric wards in the Verona Mental Health Department (Italy). Psychiatrists assessed patients' risk of readmission at 30 and 90 days post discharge, predicted their post discharge compliance, and assessed their Global Assessment of Functioning (GAF) score at admission and discharge. Clinicians' judgment outperformed the statistical model, with the difference reaching statistical significance for 30-day readmission. Clinicians' readmission risk judgment, both for 30 and 90 days, was found to be statistically associated with predicted compliance with community treatment and GAF score at discharge. 


Can Cognitive Remediation in Groups Prevent Relapses? Results of a 1-Year Follow-up Randomized Controlled Trial

Daniel R. Mueller, PhD, Zahra Khalesi, BSc, and Volker Roder, PhD

The purpose of this study was to investigate whether group integrated neurocognitive therapy (INT), a cognitive remediation approach, reduces relapse rates in schizophrenia outpatients. INT was compared with treatment as usual (TAU) in a randomized controlled trial. Fifty-eight stabilized outpatients participated in the study with 32 allocated to the INT group and 26 to the TAU group. A test battery was used at baseline, posttreatment at 15 weeks, and a 1-year follow-up. Relapse rates were significantly lower in the INT condition compared with TAU during therapy as well as at follow-up. The relapse rate after therapy was associated with significant reductions in negative and general symptoms, improvements in functional outcome, and overall cognition. The primary outcome of this study suggests that INT can prevent relapses in schizophrenia outpatients.

“We're Afraid to Say Suicide”: Stigma as a Barrier to Implementing a Community-Based Suicide Prevention Program for Rural Veterans

Lindsey L. Monteith, PhD, Noelle B. Smith, PhD, Ryan Holliday, PhD, Brooke A. Dorsey Holliman, PhD, Carl T. LoFaro, MSW, and Nathaniel V. Mohatt, PhD


We examined stigma as a potential barrier to community readiness in the implementation of a community-based suicide prevention program for rural veterans. In this qualitative study, community readiness interviews were conducted with 13 participants in a rural community. Themes included lack of awareness regarding veteran suicide, rare discussions of veteran suicide, and suicide-related stigma within the community. Results suggest that prioritizing destigmatization may be particularly important to implementing community-based suicide prevention programming in rural communities. 


Association Between Alexithymia and Immature Coping Styles Is Mediated by Self-Inconsistency and Is Correlated to Obsessive-Compulsive Symptoms

Chao Wu, MD, PhD, Chuan Shi, MD, Wentian Dong, MD, Bing Li, MD, and Rengang Wu, MD

This study aimed to investigate whether a multivariate association between alexithymia and coping styles is affected by self-inconsistency and whether the association contributed to obsessive-compulsive symptoms in 34 patients with obsessive-compulsive disorder (OCD) and 53 healthy participants. Alexithymia, coping styles, self-inconsistency, and obsessive-compulsive symptoms were evaluated using the Toronto Alexithymia Scale-20, the Coping Style Questionnaire, the Self-Consistency and Congruence Scale, and the Vancouver Obsessive-Compulsive Inventory, respectively. We found that self-inconsistency partially mediated the association between alexithymia and immature coping styles in the OCD patients but fully mediated the association in the healthy participants. The alexithymia-coping coupling was related to contamination, obsession, indecisiveness, and ritualization, but not the checking symptom dimension. 


Sleep Quality and Health-Related Quality of Life in Older People With Subjective Cognitive Decline, Mild Cognitive Impairment, and Alzheimer Disease

Minmin Leng, MD, Huiru Yin, PhD, Ping Zhang, PhD, Yong Jia, PhD, Mingyue Hu, MD, Guichen Li, MD, Chunyan Wang, PhD, and Li Chen, PhD*


We aimed to investigate sleep quality and health-related quality of life (HRQOL) in older adults with subjective cognitive decline (SCD), mild cognitive impairment (MCI), and Alzheimer disease (AD). A total of 221 participants were divided into the following five groups: normal controls (NCs), SCD without memory concerns (SCD-0), SCD with memory concerns (SCD-1), MCI, and AD according to their cognitive status. Compared with NC, individuals with SCD-0, SCD-1, MCI, and AD had more sleep problems and reduced HRQOL. Participants with poor sleep quality had an increased risk of cognitive impairment compared with participants with good sleep quality. Within all five subgroups, individuals with poor sleep quality reported more difficulties in HRQOL than individuals with good sleep quality. 


The Relation Between Posttraumatic Stress Symptom Severity and Startle Potentiation to Predictable and Unpredictable Threat

Lynne Lieberman, MA, Carter J. Funkhouser, MA, Stephanie M. Gorka, PhD, Huiting Liu, MA, Kelly A. Correa, MA, Erin C. Berenz, PhD, K. Luan Phan, MD, and Stewart A. Shankman, PhD


Aberrant threat reactivity has been implicated in the pathophysiology of posttraumatic stress disorder (PTSD); however, the literature on this association is mixed. One factor that may contribute to this inconsistent association is differences in severity of posttraumatic stress symptoms (PTSSs) across studies, but no studies have tested this hypothesis. The relation between PTSD and threat reactivity may also differ between unpredictable threats (U-threats) and predictable threats (P-threats), given burgeoning evidence to support a particular role for aberrant responding to U-threat in PTSD. The present study examined how PTSS severity relates to startle potentiation to U-threat and P-threat in a trauma-exposed community sample (N = 258). There was a negative linear, but not quadratic, relation between PTSS severity and startle potentiation to U-threat, but not P-threat. Blunted defensive responding to U-threat may therefore contribute to higher levels of PTSSs and may represent a novel treatment target for higher levels of PTSSs.


Temperament, Character, and Defense Mechanism Changes With Treatment in Depression: A 9-Month Naturalistic Follow-up

Abdulkadir Sencer Tabakci, MD, Ejder Akgun Yildirim, MD, PhD, Murat Erkiran, MD, Umut Mert Aksoy, MD, Halide Erten Sahan, MD, Ozgecan Tuna, MD, Nesrin Buket Tomruk, MD, and Nihat Alpay, MD


The aim of this study was to evaluate the changes in temperament, character, and defense mechanisms with the treatment and remission in patients with major depressive disorder. The study was designed as a longitudinal observational follow-up study of patients with repeated measures at 0, 12, and 36 weeks. In baseline comparisons, the major depression group showed higher harm avoidance and novelty seeking scores and lower self-directness and mature defense styles scores compared with healthy controls. In the follow-up, temperament dimensions and neurotic defenses remained unchanged, mature defense styles and self-directness revealed significant increase, and immature defense styles revealed significant decrease. Although there was no significant difference in the defense styles, harm avoidance and novelty seeking scores remained higher in MDD patients compared with healthy controls in 36 weeks. 


French Red Cross Volunteer Rescue Workers: Psychological Characteristics and Healthcare Support After the January 2015 Terrorist Attacks in Paris

Julie Meudal, MD, Stéphanie Vandentorren, MD, PhD, Laurent Simeoni, MIB, and Céline Denis, MD


We examined the psychological characteristics of volunteer rescuers after the January 2015 terrorist attacks in France. We analyzed the results of the IMPACTS study regarding the somatic, psychological, and social characteristics of the French Red Cross volunteer rescuers who intervened during these terrorist attacks. Forty-one volunteers were included. Nine were presenting anxiety disorders, 11 were displaying recurrent depressive episodes, and five were displaying abusive alcohol consumption. Twenty-seven were provided with a debriefing after their intervention. Half of the most exposed volunteers had no contact with mental health professionals 9 months after their intervention. A healthcare protocol, covering short-, medium-, and long-term care, should be systematically proposed to volunteer rescue workers to minimize the risk of chronic psychic posttraumatic disorders.


Well-Being and Self-Disorders in Schizotypal Disorder and Asperger Syndrome/Autism Spectrum Disorder

Maria Nilsson, MD, PhD, Peter Handest, PhD, Jessica Carlsson, PhD, Lena Nylander, PhD, Lennart Pedersen, MSc, Erik Lykke Mortensen, MSc,  and Sidse Arnfred, MD, DMSc


We explored subjective well-being in two groups of young adult participants diagnosed with either schizotypal disorder (Sd) (n = 29) or Asperger syndrome/autism spectrum disorder (As/ASD) (n = 22). Well-being was impaired in both groups and was lower in the Sd group than in the As/ASD group. The negative effect of self-disorders on well-being was still significant when adjusted for diagnosis, age and gender, and level of function. The present findings point toward clinically important disorder-specific differences in the nature of impaired well-being between the Sd group and the As/ ASD group, as there seems to be a self-disorder–driven additional contribution to impaired subjective well-being within the schizophrenia spectrum. These findings further nuance the understanding of fundamental and clinically important qualitative differences between the schizophrenia spectrum and the autism spectrum.


Varieties of Religious (Non)Affiliation A Primer for Mental Health Practitioners on the “Spiritual but Not Religious” and the “Nones”

David Saunders, MD, PhD, Michael Norko, MD, MA, Brian Fallon, MD, MPH, James Phillips, MD, Jenifer Nields, MD, Salman Majeed, MD, Joseph Merlino, MD, MPA, and Fayez El-Gabalawi, MD


This article first identifies and describes the evolving varieties of religio-spiritual orientation and affiliation, as identified in survey studies. Particular attention is given to the examination of those who identify as spiritual but not religious (SBNR) and None (i.e., no religious affiliation), which is important to mental health practice because many patients now identify as SBNR or None. Next, empirical data are considered, including what the literature reveals regarding mental health outcomes and SBNRs and Nones. We conclude with a summary of the main points and five recommendations that mental health practitioners and researchers need to consider.

Trauma and Suicide: A Pilot Study Assessing Risk in Adults Diagnosed With Schizophrenia Spectrum Disorders

Adrienne Reid Allen, PsyD and Kathryn M. Hagen, PsyD

Forty-seven participants diagnosed with schizophrenia spectrum disorders participated in the study. An archival design was used to identify the severity of suicide risk in participants with trauma and psychosis. Data included a chart review of documented trauma and responses to the Childhood Experience of Care and Abuse Questionnaire, Columbia–Suicide Severity Rating Scale, Beck Depression Inventory-II, and the Positive and Negative Syndrome Scale. Results of a linear regression indicated that chart-documented trauma and heightened depression scores were predictive of increased suicidality. Results suggest that, for patients with schizophrenia, depression severity and chart documented trauma may be strong predictors of suicidality. 


Not Just Homeless, Creutzfeldt-Jakob Disease: A Case Report

Jacopo Pieroni, MD, Alessio Pecori, MD, Daniele Imperiale, MD, and Simona Maule, MD

Over a 3-month period, a homeless person was admitted several times to emergency departments after displaying severe behavioral changes and paranoia. No psychiatric tests were performed but all other tests were repeatedly normal; anti-anxiety treatments or painkillers were the common outcome. It may seem that any diagnosis rested on the patient's immediately apparent social circumstances. Indeed, the patient was admitted to our internal medicine department after a diagnosis of acute delirium within a context of social disadvantage. This social predicament, namely, the patient's evident homelessness, proved to be a false but significant and overarching influence on several misdiagnoses until that moment. Subsequently, actual psychological observations, assessments and tests indicated and confirmed the presence of Creutzfeldt-Jakob disease. Creutzfeldt-Jakob disease is an uncommon and fatal disease; however, early diagnosis can enable the implementation of an important palliative care program. The starkly impoverished social circumstances of a patient should never distract a medical practitioner from a comprehensive diagnosis. Homelessness, for example, may invite certain physical and mental considerations, but it must not overdetermine our response and must not obscure or detract from a wider diagnosis. Homelessness is not a medical condition.


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