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2.
Focus (Am Psychiatr Publ) ; 20(3): 277-284, 2022 Jul.
Article in English | MEDLINE | ID: mdl-37205025

ABSTRACT

The COVID-19 pandemic increased many known risk factors for mental health problems. In the context of overwhelmed health systems and resource and staffing shortages, the mental health needs of frontline health care workers (HCWs) gained attention as a major public health concern and a threat to high-quality care delivery. In response, mental health promotion initiatives were quickly developed to meet the demands of the public health crisis. Two years later, the context for psychotherapy has changed, especially as it pertains to the health care workforce. Particularly salient experiences-grief, burnout, moral injury, compassion fatigue, and racial trauma-have become routinely discussed as part of everyday clinical practice. Service programs have become more responsive to the needs, schedules, and identities of HCWs. In addition, mental health and other HCWs have contributed to advocacy and volunteer initiatives promoting health equity, culturally responsive care, and access to care across a range of settings. In this article, the authors review the benefits of these activities to individuals, organizations, and communities and summarize example programs. Many of these initiatives began in response to the acute public health crisis; however, engaging in these ways and spaces holds promise for increasing connection and prioritizing equity and structural change over the long term.

3.
Focus (Am Psychiatr Publ) ; 19(1): 61-65, 2021 Jan.
Article in English | MEDLINE | ID: mdl-34483770

ABSTRACT

This article highlights one department's efforts to bolster diversity, equity, and inclusion as an exemplar for other academic departments. It offers an approach for building an infrastructure and leadership group and details accomplishments associated with strategic plan priorities related to visibility, values, stakeholder education, recruitment, retention, promotion, and community engagement. It also delineates challenges encountered in transforming a departmental culture to one that is more diverse, equitable, and inclusive and strategies for overcoming these challenges. Finally, it discusses next steps and recommendations for other academic departments.

4.
Int J Yoga Therap ; 31(1)2021 Jan 01.
Article in English | MEDLINE | ID: mdl-34469534

ABSTRACT

Low-income, racial-minority, high-risk populations have limited access to evidence-based treatments for posttraumatic stress disorder (PTSD), and their acceptance of complementary interventions is unknown. Trauma Center Trauma-Sensitive Yoga (TC-TSY), which has demonstrated efficacy in community samples, has not yet been widely used with ethnic minority low-income individuals. This article presents a culturally tailored version of a TC-TSY intervention delivered as a drop-in service in a public hospital-based clinic to patients with histories of interpersonal violence and suicide attempts. TC-TSY was iteratively tailored to meet the unique clinical needs of individuals within this setting. Group facilitator observations are summarized; they describe a successful initial implementation and culturally informed adaptation of the group intervention. The facilitators' observations illustrated that group members accepted the integration of this structured, gentle yoga practice into outpatient behavioral health programming and identified site-specific modifications to inform formal study. The process by which TC-TSY was adapted and implemented for Black individuals with a history of interpersonal trauma at risk for suicidal behavior can serve as a guide for tailoring other complementary, integrative interventions to meet the needs of unique clinical settings. This process is offered as a foundation for future systematic testing of this complementary, integrated, culturally adapted trauma therapy in high-risk clinical populations.


Subject(s)
Meditation , Stress Disorders, Post-Traumatic , Yoga , Ethnic and Racial Minorities , Ethnicity , Humans , Minority Groups , Stress Disorders, Post-Traumatic/therapy
5.
Alcohol Treat Q ; 39(2): 225-237, 2021.
Article in English | MEDLINE | ID: mdl-33767527

ABSTRACT

Gender specific substance use disorder treatment has demonstrated promise in adult women, but is relatively unexplored in young adults. To address the specific needs of young adult females, the manual-based Women's Recovery Group (WRG) was adapted for women ages 18-25. Treatment engagement and retention, group cohesiveness, satisfaction, and substance use outcomes were measured during group treatment and at 1-month follow up. This pilot supports the feasibility and initial acceptability of the adapted form of the WRG for young adults. Data from this study may inform future gender specific treatment approaches for substance use disorders in younger populations.

6.
Am Psychol ; 75(7): 875-886, 2020 10.
Article in English | MEDLINE | ID: mdl-32538638

ABSTRACT

This article proposes a framework for managing the behavioral health impacts of the COVID-19 global pandemic. This framework aligns and should be integrated with an existing public health pandemic intervals model. It includes six phases of a behavioral health pandemic response strategy: preplanning, response readiness, response mobilization, intervention, continuation, and amelioration. The ways behavioral health specialists can capitalize on their competence in the leadership, prevention, education, service, research, and advocacy domains within each behavioral health pandemic response phase are articulated. Behavioral health expertise can help ensure a more comprehensive, effective pandemic response that facilitates the flattening of the curve of disease spread, along with the corresponding emotional distress curve. A case illustration, the Caring Communities (CC) initiative, is offered as an exemplar of action steps in the leadership, prevention, education, service, research, and advocacy domains that behavioral health professionals can take within each of the behavioral health pandemic response phases. Key CC action steps include providing support groups, offering virtual wellness breaks, participating in educational outreach, creating and disseminating wellness guides, launching and leading a virtual behavioral health clinic for health care staff, participating in behavioral health research and program evaluation, and engaging in advocacy initiatives aimed at improving behavioral health care and addressing and reducing health disparities. Finally, recommendations for optimizing behavioral health contributions to future pandemic responses are proffered. (PsycInfo Database Record (c) 2020 APA, all rights reserved).


Subject(s)
Coronavirus Infections , Health Planning/organization & administration , Mental Disorders/therapy , Mental Health Services/organization & administration , Pandemics , Pneumonia, Viral , Psychological Distress , Public Health , COVID-19 , Coronavirus Infections/prevention & control , Humans , Pandemics/prevention & control , Pneumonia, Viral/prevention & control
7.
Psychol Serv ; 17(Suppl 1): 5-11, 2020.
Article in English | MEDLINE | ID: mdl-34858111

ABSTRACT

In recent years, behavioral health professionals have expressed increased interest in engaging in social justice advocacy in public health care systems. In this article, we use an ecological framework to explore opportunities for social justice advocacy in such systems and challenges associated with such efforts. We propose that ecological models are well-suited to conceptualize and address the various contexts that affect behavioral health needs, and we emphasize the importance of considering the multitude of increasingly superordinate systems within which behavioral health professionals work when pursuing advocacy initiatives. We outline the central tenets of ecological models, apply them to social justice advocacy, and provide examples of advocacy within and across ecological systems. Finally, we reflect on future directions for behavioral health professionals interested in using an ecological framework to guide their own advocacy efforts, with and on behalf of patients and communities, in public health care systems and affiliated institutions.

8.
Psychol Serv ; 17(S1): 62-68, 2020.
Article in English | MEDLINE | ID: mdl-30920275

ABSTRACT

Engaging in advocacy is an ethical responsibility for behavioral health professionals, as reflected in professional competencies across disciplines and in personal accounts of wanting to affect change at various levels of patients'/clients' and communities' ecologies. However, the literature is replete with examples of barriers to routine advocacy engagement, including lack of an organized structure into which efforts can be embedded. There exists the desire among behavioral health professionals to engage in more advocacy work, yet a shared sense of not knowing how to incorporate this work into existing professional roles. One way to address these barriers is to establish more collaborative advocacy work environments within the public sector settings that employ behavioral health professionals. This article offers the first descriptive account of developing, implementing, and maintaining such a collaborative interprofessional advocacy workgroup. To that end, this case study is one example of such a group, the Atlanta Behavioral Health Advocates, based within the Emory University School of Medicine in the Department of Psychiatry and Behavioral Sciences and situated also within Grady Health System, a public health care system. This paper details our experiences forming and engaging in this group, which we believe can serve as a model for others developing similar advocacy workgroups in public sector settings. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

9.
J Affect Disord ; 245: 827-833, 2019 02 15.
Article in English | MEDLINE | ID: mdl-30699866

ABSTRACT

BACKGROUND: This study investigated distinct trajectories of treatment response in a naturalistic intensive/residential treatment (IRT) program for adults with severe obsessive-compulsive disorder (OCD). We hypothesized that: (1) distinct trajectories would emerge and (2) demographic variables, psychiatric comorbidity, OCD symptom subtype, level of insight, previous exposure and response prevention (ERP) treatment, and quality of life, would differentially predict assignment to these trajectories. METHODS: Participants included 305 individuals with primary OCD admitted for IRT. RESULTS: Two trajectories emerged over the course of the first eight weeks of treatment, with the vast majority of participants demonstrating treatment response. The first trajectory (96%, n = 292) showed a negative, linear treatment response (a.k.a. "linear responders") and more severe OCD symptoms at admission. The second trajectory (4%, n = 13) had less severe OCD symptoms at admission and did not exhibit a significant overall change in symptoms over the course of treatment. More specifically, this second trajectory or "u-shaped responders" show a non-significant linear response through week four of treatment, followed by slightly increased symptoms in week five. Assignment to these classes was not differentially predicted by hypothesized predictor variables. LIMITATIONS: Our final model had inconsistent fit indices and small class prevalance of the u-shaped responder group; therefore, model selection was based on both fit indices and substantive meaning. CONCLUSIONS: This study emprically derived two distinct trajectories of OCD symptom severity over the course of IRT. These findings have the potential to refine IRT for patients with severe OCD, and to potentially guide future investigation into the optimal delivery of ERP treatment for OCD generally.


Subject(s)
Mental Disorders/epidemiology , Obsessive-Compulsive Disorder/therapy , Residential Treatment/methods , Adult , Comorbidity , Female , Humans , Male , Massachusetts/epidemiology , Models, Psychological , Obsessive-Compulsive Disorder/epidemiology , Quality of Life , Time Factors , Treatment Outcome , Young Adult
10.
J Clin Psychol ; 74(10): 1791-1807, 2018 10.
Article in English | MEDLINE | ID: mdl-29696644

ABSTRACT

OBJECTIVES: A shorter version of the Obsessive Beliefs Questionnaire (OBQ-44) is needed to promote the use of this measure in research and increase our understanding of cognitive phenomena maintaining obsessive-compulsive disorder (OCD). Additionally, an abbreviated version of the OBQ-44 would encourage frequent monitoring of dysfunctional beliefs in intensive care settings. This study aimed to validate a nine-item version of the questionnaire (OBQ-9). METHOD: Participants seeking intensive/residential treatment for OCD (N = 311) completed relevant measures on a weekly basis and at admission and discharge. RESULTS: A confirmatory factor analysis revealed that the OBQ-9's factor structure replicated the three-factor solution of the OBQ-44. The OBQ-9 demonstrated good psychometric properties and convergent validity and was sensitive to treatment effects. Finally, the OBQ-9 subscales predicted specific OCD dimensions over and above depressive symptoms. CONCLUSION: The OBQ-9 appears to be a psychometrically sound tool for routine outcome monitoring of dysfunctional beliefs in hospital-based settings.


Subject(s)
Obsessive-Compulsive Disorder/diagnosis , Psychiatric Status Rating Scales/standards , Psychometrics/standards , Thinking/physiology , Adolescent , Adult , Factor Analysis, Statistical , Female , Humans , Male , Obsessive-Compulsive Disorder/physiopathology , Reproducibility of Results , Residential Treatment , Young Adult
11.
Depress Anxiety ; 34(11): 1057-1064, 2017 11.
Article in English | MEDLINE | ID: mdl-28715850

ABSTRACT

OBJECTIVE: Exposure and response prevention (ERP) is an effective treatment for individuals with obsessive-compulsive disorder (OCD), yet a substantial number of individuals with OCD do not fully respond to this intervention. Based on emerging experimental and clinical research on acceptance, this study sought to explore whether willingness to experience unpleasant thoughts, emotions, and bodily sensations during ERP was associated with improved treatment response. METHODS: Two hundred eighty-eight adults with OCD receiving residential ERP provided self-rated willingness and other exposure-related variables during each daily coached ERP session. Obsessive-compulsive and depressive symptom severity was assessed every week. Multilevel modeling was used to study the impact of willingness on treatment outcome during the first 6 weeks of residential care. RESULTS: Data indicated that individuals with higher willingness during ERP reported faster symptom reduction during residential treatment, even when controlling for length of stay, psychopharmacological intervention, depression, adherence, and rituals performed during ERP. These results appear to have both statistical and clinical significance. CONCLUSIONS: Willingness to fully experience unpleasant and unwanted thoughts, emotions, and bodily sensations during exposures appears to be a marker of successful exposure therapy in adults with OCD. Future research should examine how willingness may enhance extinction learning during ERP.


Subject(s)
Cognitive Behavioral Therapy/methods , Implosive Therapy/methods , Motivation , Obsessive-Compulsive Disorder/psychology , Obsessive-Compulsive Disorder/therapy , Adult , Female , Humans , Male , Middle Aged , Residential Treatment , Treatment Outcome , Young Adult
12.
Am J Drug Alcohol Abuse ; 42(2): 168-77, 2016 Mar.
Article in English | MEDLINE | ID: mdl-26837461

ABSTRACT

BACKGROUND: Characterizing methamphetamine use in relation to age, HIV serostatus and seroconversion is pertinent given the increasingly older age of the population with HIV and the intertwined epidemics of methamphetamine use and HIV. OBJECTIVES: Study aims were to investigate whether (i) methamphetamine use differs by age and HIV serostatus, and (ii) receiving an HIV diagnosis impacts methamphetamine use among younger and older persons with HIV. METHODS: This study examined methamphetamine use characteristics among 217 individuals with a lifetime methamphetamine dependence diagnosis who completed an in-person study assessment. RESULTS: Multivariable regressions revealed that HIV serostatus uniquely attenuates methamphetamine use, such that persons with HIV report a smaller cumulative quantity (ß = -0.16, p = 0.01) and a fewer number of days (ß = -0.18, p = 0.004) of methamphetamine use than persons without HIV. Among the HIV+ sample, all participants persisted in methamphetamine use after receiving an HIV diagnosis, with about 20% initiating use after seroconversion. Repeated measures analysis of variance indicated that density of methamphetamine use (i.e. grams per day used) was greater among the younger, relative to the older, HIV+ group (p = 0.02), and increased for both age groups following seroconversion (p < 0.001). CONCLUSION: These analyses indicate that although HIV serostatus may attenuate methamphetamine use behaviors, many people with HIV initiate, or persist in, methamphetamine use after receiving an HIV diagnosis. These findings raise the question of whether tailoring of prevention and intervention strategies might reduce the impact of methamphetamine and HIV across the age continuum.


Subject(s)
AIDS Serodiagnosis , Aging/psychology , Amphetamine-Related Disorders/psychology , Amphetamine-Related Disorders/virology , HIV Infections/psychology , Methamphetamine/adverse effects , Seroconversion , Adult , Amphetamine-Related Disorders/complications , Female , HIV Infections/complications , Humans , Male , Middle Aged , Risk-Taking , Young Adult
13.
J Affect Disord ; 175: 475-80, 2015 Apr 01.
Article in English | MEDLINE | ID: mdl-25679203

ABSTRACT

Apathy and depression are inter-related yet separable and prevalent neuropsychiatric disturbances in persons infected with HIV. In the present study of 225 HIV+ persons, we investigated the role of an incident depressive episode in changes in apathy. Participants completed the apathy subscale of the Frontal Systems Behavior Scale during a detailed neuropsychiatric and neuromedical evaluation at visit 1 and again at approximately a 14 month follow-up. The Composite International Diagnostic Interview was used to obtain diagnoses of a new major depressive disorder. At their follow-up visit, participants were classified into four groups depending on their visit 1 elevation in apathy and new major depressive episode (MDE) status. Apathetic participants at baseline with a new MDE (n=23) were at risk for continued, clinically elevated apathy at follow-up, although severity of symptoms did not increase. Of the 144 participants without clinically elevated apathy at visit 1, those who developed a new MDE (n=16) had greater apathy symptomatology at follow-up than those without MDE. These findings suggest that HIV+ individuals, who do not as yet present with elevated apathy, may be at greater risk of elevated psychiatric distress should they experience a new/recurrent depressive episode. Thus, in the context of previous findings, it appears that although apathy and depression are separable constructs, they interact such that a new depressive episode is a risk factor for incident apathy.


Subject(s)
Apathy , Depressive Disorder, Major/psychology , HIV Infections/psychology , Depressive Disorder, Major/complications , Female , HIV Infections/complications , Humans , Longitudinal Studies , Male , Middle Aged , Neuropsychological Tests , Risk Factors
14.
AIDS Behav ; 19(1): 166-77, 2015 Jan.
Article in English | MEDLINE | ID: mdl-25008384

ABSTRACT

This study sought to determine the effects of HIV-associated neurocognitive disorders (HAND) on health literacy, which encompasses the ability to access, understand, appraise, and apply health-related information. Participants included 56 HIV seropositive individuals, 24 of whom met Frascati criteria for HAND, and 24 seronegative subjects who were comparable on age, education, ethnicity, and oral word reading. Each participant was administered a brief battery of well-validated measures of health literacy, including the Expanded Numeracy Scale (ENS), Newest Vital Sign (NVS), Rapid Estimate of Adult Literacy in Medicine (REALM), and Brief Health Literacy Screen (BHLS). Results revealed significant omnibus differences on the ENS and NVS, which were driven by poorer performance in the HAND group. There were no significant differences on the REALM or the BHLS by HAND status. Among individuals with HAND, lower scores on the NVS were associated with greater severity of neurocognitive dysfunction (e.g., working memory and verbal fluency) and self-reported dependence in activities of daily living. These preliminary findings suggest that HAND hinders both fundamental (i.e., basic knowledge, such as numeracy) and critical (i.e., comprehension and application of healthcare information) health literacy capacities, and therefore may be an important factor in the prevalence of health illiteracy. Health literacy-focused intervention may play an important role in the treatment and health trajectories among persons living with HIV infection.


Subject(s)
Cognition Disorders/etiology , HIV Infections/complications , Health Literacy/statistics & numerical data , Activities of Daily Living , California/epidemiology , Cognition Disorders/diagnosis , Cognition Disorders/drug therapy , Cross-Sectional Studies , Female , HIV Infections/drug therapy , HIV Infections/epidemiology , Health Knowledge, Attitudes, Practice , Health Status Disparities , Humans , Male , Middle Aged , Pilot Projects , Surveys and Questionnaires
15.
J Neurovirol ; 20(6): 561-70, 2014 Dec.
Article in English | MEDLINE | ID: mdl-25326107

ABSTRACT

Treatment of hepatitis C virus (HCV) with pegylated interferon and ribavirin (IFN/RBV) can be associated with neuropsychiatric side effects, which may necessitate dose reductions or treatment discontinuation. This study aimed to characterize the time course and predictors of cognitive and affective/mood symptoms after IFN/RBV treatment initiation. Forty individuals enrolled in a longitudinal project underwent comprehensive cognitive, medical, and psychiatric assessment at baseline and 10 weeks, 6 months, 12 months, and 18 months after treatment initiation. Analyses were conducted to determine the prevalence of neurocognitive impairment over time; explicate the relationship between neurocognitive impairment, neuropsychiatric symptoms, and liver disease at each time point; and identify predictors of neurocognitive decline as well as cognitive effects of viral clearance. By 10 weeks after initiating IFN/RBV, the prevalence of neurocognitive impairment rose from 22.5 to 47.4% (p < 0.05). Infection with genotype 1 and premorbid depression were associated with more severe declines (p < 0.05). After 18 months, 42.5% remained neurocognitively impaired, independent of viral clearance, severity of liver disease, and current depressive symptoms. Undetectable viral load was not associated with improvement 18 months after initiating treatment (p > 0.10). Results of the current study indicate that IFN/RBV treatment-emergent neurocognitive declines are significant, prevalent, and may persist long after treatment cessation. Clinicians should monitor cognition throughout the course of treatment for HCV, noting that early declines may indicate individuals at elevated risk for persistent neurocognitive impairment. Longer-term studies are needed to determine whether lasting declines may remit over longer intervals or with newer direct acting agents.


Subject(s)
Antiviral Agents/adverse effects , Cognition/drug effects , Depression/drug therapy , Hepatitis C, Chronic/drug therapy , Interferon-alpha/adverse effects , Polyethylene Glycols/adverse effects , Ribavirin/adverse effects , Adult , Affect/drug effects , Antiviral Agents/administration & dosage , Depression/complications , Depression/physiopathology , Depression/virology , Drug Therapy, Combination , Female , Genotype , Hepacivirus/drug effects , Hepacivirus/genetics , Hepacivirus/growth & development , Hepatitis C, Chronic/complications , Hepatitis C, Chronic/physiopathology , Hepatitis C, Chronic/virology , Humans , Interferon-alpha/administration & dosage , Longitudinal Studies , Male , Middle Aged , Polyethylene Glycols/administration & dosage , Psychological Tests , Recombinant Proteins/administration & dosage , Recombinant Proteins/adverse effects , Ribavirin/administration & dosage , Viral Load/drug effects
16.
J Clin Exp Neuropsychol ; 36(9): 992-1001, 2014.
Article in English | MEDLINE | ID: mdl-25283135

ABSTRACT

BACKGROUND: In order to detect HIV-associated neurocognitive decline, it is important to accurately estimate individuals' premorbid levels of cognitive functioning. Although previous studies have operated under the assumption that word reading tests are valid and stable indicators of premorbid abilities in HIV infection, studies of other populations have found that this is not always the case. Therefore, it is important to empirically examine the validity of word reading tests as estimates of premorbid functioning specifically within the HIV population. METHOD: The Wide Range Achievement Test-4 Reading subtest (WRAT-4 Reading) was administered along with comprehensive neurocognitive assessments to 150 HIV seropositive (HIV+) and 76 HIV seronegative (HIV-) age-, education-, and sex-matched participants; a subset of 48 HIV+ individuals completed a second study visit (M = 14.4 months), in which the alternate version of the WRAT-4 was administered. RESULTS: Although HIV+ individuals evidenced worse current neurocognitive functioning than HIV- participants, WRAT-4 Reading performance was comparable between groups. Longitudinally, HIV+ participants evidenced improved disease and neuropsychological functioning, yet WRAT-4 Reading demonstrated strong test-retest reliability and no practice effect, and did not differ between the initial and follow-up assessments. Test-retest differences in reading performance were minor and were not associated with changes in neurocognitive performance or changes in HIV disease. CONCLUSIONS: We found no evidence of WRAT-4 Reading performance decline in HIV infection, despite HIV+/HIV- group differences in neurocognitive functioning. Additionally, reading performances among HIV+ individuals demonstrated consistency across study visits. These results begin to support the validity of the WRAT-4 Reading subtest as an indicator of premorbid cognitive functioning in HIV+ individuals.


Subject(s)
Cognition Disorders/etiology , Dyslexia/diagnosis , Dyslexia/etiology , HIV Infections/complications , Achievement , Adult , Cognition Disorders/diagnosis , Cohort Studies , Cross-Sectional Studies , Female , HIV Infections/diagnosis , Humans , Male , Middle Aged , Neuropsychological Tests , Psychiatric Status Rating Scales , Psychometrics , Reproducibility of Results
17.
Addict Behav ; 38(12): 2874-8, 2013 Dec.
Article in English | MEDLINE | ID: mdl-24018233

ABSTRACT

AIMS: Attention-Deficit/Hyperactivity Disorder (ADHD) is widely regarded as a common comorbidity of methamphetamine (MA) dependence, but the frequency, persistence, and real-world impact of ADHD among MA users are not known. METHODS: Four hundred individuals with MA use disorders within 18months of evaluation and 355 non-MA using comparison subjects completed a comprehensive neuropsychiatric research battery, including self-report measures of everyday functioning. RESULTS: In logistic regression models adjusting for potential confounds, lifetime diagnoses of ADHD as determined by a structured clinical interview were significantly more prevalent among the MA participants (21%) versus comparison subjects (6%), particularly the hyperactive and combined subtypes. MA use was also associated with an increased persistence of combined subtype of ADHD into adulthood. Among the MA users, lifetime ADHD diagnoses were uniquely associated with greater concurrent risk of declines in instrumental activities of daily living, elevated cognitive symptoms in day-to-day life, and unemployment. CONCLUSIONS: Findings indicate that ADHD is prevalent among chronic MA users, who are at increased risk for persistence of childhood diagnoses of ADHD into their adult years. ADHD also appears to play an important role in MA-associated disability, indicating that targeted ADHD screening and treatment may help to improve real-world outcomes for individuals with MA use disorders.


Subject(s)
Amphetamine-Related Disorders/psychology , Attention Deficit Disorder with Hyperactivity/chemically induced , Central Nervous System Stimulants/adverse effects , Methamphetamine/adverse effects , Activities of Daily Living , Adult , Alcoholism/psychology , Attention Deficit Disorder with Hyperactivity/psychology , Cognition Disorders/chemically induced , Cognition Disorders/psychology , Depressive Disorder/chemically induced , Depressive Disorder/psychology , Female , Humans , Male , Retrospective Studies
18.
Clin Neuropsychol ; 27(2): 256-75, 2013.
Article in English | MEDLINE | ID: mdl-23181946

ABSTRACT

Individuals infected with HIV show moderate deficits in decision-making, but the ecological relevance of such deficits on everyday functioning has not previously been described. This study sought to examine the magnitude, cognitive correlates, and everyday functioning impact of risky decision-making impairment in HIV-associated neurocognitive disorders (HAND). Participants included 68 HIV+ individuals with HAND, 78 HIV+ individuals without HAND, and 51 HIV- comparison participants, who were administered the Iowa Gambling Task (IGT) alongside a comprehensive neuropsychological test battery and self-report measures assessing aspects of everyday functioning. HIV+ individuals with HAND performed more poorly on the IGT relative to the other two groups, most notably during the last three trial blocks. Within the HIV+ group, IGT performance during the last three trial blocks was most strongly associated with cognitive flexibility, but was not significantly related to declines in instrumental activities of daily living (IADLs), unemployment, or medication non-adherence. While overall IGT performance across the last three trial blocks may be helpful diagnostically in identifying decision-making impairment in HAND, examination of alternate, more specific metrics (e.g., individual deck selections across trial blocks) may be more useful in delineating the role of poor decision-making in HIV-related disability, and should be examined in future research.


Subject(s)
Cognition Disorders/psychology , Decision Making , HIV Infections/psychology , Risk-Taking , Activities of Daily Living , Adult , Anti-HIV Agents/therapeutic use , Cognition Disorders/etiology , Female , HIV Infections/complications , HIV Infections/drug therapy , Humans , Male , Medication Adherence , Middle Aged , Neuropsychological Tests , Surveys and Questionnaires
19.
J Neuropsychiatry Clin Neurosci ; 24(3): 331-9, 2012.
Article in English | MEDLINE | ID: mdl-23037647

ABSTRACT

Chronic methamphetamine (MA) use is commonly associated with neural injury and neurocognitive deficits. The authors examined the nature and correlates of self-reported neurobehavioral symptoms (e.g., apathy, disinhibition, and executive dysfunction) in 73 individuals with histories of MA dependence (MA+) and 85 comparison participants with comparable demographics and risk histories. MA+ individuals endorsed significantly more severe neurobehavioral symptoms on the Frontal Systems Behavioral Scale, especially those of disinhibition and executive dysfunction. Elevations in neurobehavioral symptoms were independent of common comorbidities, including hepatitis C infection, attention-deficit/hyperactivity disorder (ADHD), mood disorders, and other substance-use factors. Notably, the severity of neurobehavioral symptoms was uniquely associated with self-reported decrements in instrumental activities of daily living in the MA-dependent sample. Findings indicate that chronic MA users may experience elevated neurobehavioral symptoms of disinhibition and executive dysfunction, potentially increasing their risk of functional declines.


Subject(s)
Activities of Daily Living , Amphetamine-Related Disorders/complications , Amphetamine-Related Disorders/psychology , Cognition Disorders/etiology , Inhibition, Psychological , Activities of Daily Living/psychology , Adult , Chronic Disease , Executive Function/physiology , Female , Humans , Male , Middle Aged , Neuropsychological Tests , Psychiatric Status Rating Scales , Self Report
20.
AIDS Behav ; 16(8): 2286-96, 2012 Nov.
Article in English | MEDLINE | ID: mdl-22722882

ABSTRACT

While performance-based tests of everyday functioning offer promise in facilitating diagnosis and classification of HIV-associated neurocognitive disorders (HAND), there remains a dearth of well-validated instruments. In the present study, clinical correlates of performance on one such measure (i.e., Medication Management Test-Revised; MMT-R) were examined in 448 HIV+ adults who were prescribed antiretroviral therapy. Significant bivariate relationships were found between MMT-R scores and demographics (e.g., education), hepatitis C co-infection, estimated premorbid IQ, neuropsychological functioning, and practical work abilities. MMT-R scores were not related to HIV disease severity, psychiatric factors, or self-reported adherence among participants with a broad range of current health status. However, lower MMT-R scores were strongly and uniquely associated with poorer adherence among participants with CD4 T cell counts <200. In multivariate analyses, MMT-R scores were predicted by practical work abilities, estimated premorbid functioning, attention/working memory, learning, and education. Findings provide overall mixed support for the construct validity of the MMT-R and are discussed in the context of their clinical and research implications for evaluation of HAND.


Subject(s)
Anti-Retroviral Agents/therapeutic use , Cognition Disorders/complications , HIV Infections/drug therapy , HIV Infections/psychology , Medication Adherence , Activities of Daily Living , Adult , Aged , CD4-Positive T-Lymphocytes , Cognition Disorders/diagnosis , Cognition Disorders/psychology , Cross-Sectional Studies , Female , HIV Infections/complications , Humans , Male , Middle Aged , Neuropsychological Tests , Predictive Value of Tests , Regression Analysis , Retrospective Studies , Sex Distribution , Socioeconomic Factors , Surveys and Questionnaires , Task Performance and Analysis , Young Adult
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