Outpatient healthcare utilization among incident cases of systemic sclerosis: results from a population-based US cohort (1988-2016).

OBJECTIVE: Systemic sclerosis (SSc) is a complex, heterogeneous connective tissue disease with multiorgan dysfunction. This study aimed to compare healthcare utilization among incident cases of SSc versus age- and gender-matched comparators. METHOD: A population-based cohort of physician-diagnosed patients with SSc in Olmsted County, MN, USA, from 1 January 1988 to 31 December 2016 was assembled. A 2:1 cohort of age- and gender-matched non-SSc subjects was randomly selected for comparison. Patients were followed until death, migration from Olmsted County, or 31 December 2017. Outpatient utilization data were obtained beginning 12 months before the SSc incidence/index date and compared using negative binomial and multinomial models. Services were summarized as visit-days to avoid overestimation of services provided. RESULTS: The study included 69 incident SSc cases and 138 non-SSc comparators (mean ± sd age 57 ± 16 years at diagnosis/index, 90% female). Patients with SSc had higher utilization of outpatient physician, laboratory, and combined radiology visit-days annually for the year before and for each of the first 5 years after diagnosis than comparators. Among patients with SSc, healthcare utilization was highest during the year of SSc diagnosis. Rate ratios comparing utilization in patients with and without SSc ranged from 1.8 to 3.0 for all comparisons. CONCLUSION: Higher utilization of outpatient physician, laboratory, and radiology visit-days was observed among patients with SSc compared to non-SSc subjects throughout 5 years of disease duration, indicating high and continued care needs in this patient population. The highest utilization of services among SSc patients occurred during the year of SSc diagnosis.

The Clinical Utility of the NAB Judgment Subtest Among Individuals Diagnosed With Schizophrenia Spectrum Disorder Within a Forensic Inpatient Setting.

Executive functioning (EF) has been identified as a significant predictor in determining competence to stand trial. Individuals deemed incompetent to stand trial are provided a limited time frame before conservatorship is considered, thus, treatment providers practicing within inpatient facilities have a responsibility to efficiently identify factors that may lead to prolonged hospitalizations, in order to avoid delays in a defendant's legal proceedings. Although previous studies have demonstrated the utility of the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) Total Index Score in predicting length of stay (LOS), the Neuropsychological Assessment Battery (NAB) Judgment subtest provides a measure of executive function, which is a domain not captured by the RBANS. The current study examined the relationship between both the RBANS and NAB Judgment performance as predictors of LOS among 63 individuals diagnosed with schizophrenia spectrum disorders undergoing competency restoration treatment. Additionally, sensitivity analyses were used to determine cutoff scores for individuals requiring additional competency services. Results indicated that the NAB Judgment subtest was more predictive of LOS than the RBANS Total Index Score. Additionally, a raw score of ≤9 on NAB Judgment was indicative of increased LOS. These results highlight the utility of the NAB Judgment subtest within a forensic inpatient setting.

The association between clinicians' initial judgments of feigning and outcomes on symptom validity measures among pretrial forensic psychiatric inpatients.

Research suggests the use of validated symptom validity tests to detect feigning is imperative to increase accuracy over unaided clinical judgment, especially in forensic settings. This study examined performance on the Miller Forensic Assessment of Symptoms (M-FAST) and Structured Interview of Reported Symptoms (SIRS) during 297 assessments of forensic inpatients. The risk of being identified as feigning on the M-FAST or SIRS was similar for those who were referred for evaluation of feigning compared to those who were not, but individuals with malingering designations prior to the evaluation scored significantly higher than those without on the M-FAST and several SIRS subscales. Findings support the importance of utilizing objective methods of data collection.

Specificity and item endorsement rates of personality assessment inventory over-reporting scales across ethnic, gender, and diagnostic groups in a forensic inpatient sample.

The accurate evaluation of response style, particularly with respect to overreporting, is imperative in forensic settings wherein an external incentive to feign exists. Given the high cost of false positive errors in this context, as well as the associated cost of false negative errors, evaluators need to ensure that overreporting methods are effective with the unique patient populations with whom they work. Complicating this issue is that forensic samples often differ in predictable ways from the normative samples upon which typical psychological assessment instruments were normed. The purpose of the present investigation was to evaluate the specificity of the overreporting indices on the Personality Assessment Inventory, one of the most commonly used personality inventories, in a forensic sample with no ostensible incentive to feign. Although item endorsement and configural elevations on the Negative Impression Management (NIM) scale and the Malingering Index (MAL) were associated with genuine psychopathology, results indicated that the overall specificity estimates across groups were generally adequate. Further, and consistent with prior research, Rogers Discriminant Function (RDF) performed poorly in this sample.

Partiality in Prosecution? Discretionary Prosecutorial Decision Making and Intimate Partner Violence.

In the United States, prosecutors are typically allotted a large amount of discretion when litigating a criminal case. Although some level of discretion is necessary for various reasons (e.g., lack of resources), concerns have arisen in both scholarly and popular discourse that prosecutorial discretion remains generally unchecked. Furthermore, research suggests prosecutors may be influenced by extralegal factors when making decisions about how to proceed with criminal charges. In this study, prosecutors responded to a case of alleged intimate partner violence, in which the sex and sexual orientation of the defendant and victim were manipulated. Neither sex nor sexual orientation impacted prosecutor choice to proceed with charges, the severity of the charge selected, or the harshness of the plea bargain offered. However, prosecutors were more willing to proceed without the victim's cooperation when the victim was female and perceived heterosexual males as more aggressive than heterosexual females. These data suggest prosecutorial decision making in cases of intimate partner violence may not be unduly influenced by defendant/victim sex and sexual orientation.

Risk-Sophistication-Treatment Inventory-Self Report (RSTI-SR): A confirmatory factor analysis and exploration of factor relations.

The RSTI-SR was recently designed to facilitate juvenile evaluations by tapping 3 pertinent juvenile psycho-legal variables including risk, developmental maturity, and treatment amenability. The present study examined the factor structure and construct validity of the RSTI-SR with 190 adolescent offenders (Mage = 15.6) who completed the RSTI-SR and a short battery of theoretically relevant psychological measures. The findings from the current study demonstrated that the proposed 3-factor model for the RSTI produced good fit to the data. Factorial invariance testing further found the model to be tenable for both male and female young offenders. Moreover, preliminary construct validity was established for the RSTI-SR factors through significant associations with relevant external variables including psychopathy, general personality (e.g., extraversion, agreeableness), coping, openness, and well-being. Initial results show the RSTI-SR to be a promising new measure for assessing the functioning of young offenders. (PsycINFO Database Record

Collaborative meta-analysis finds no evidence of a strong interaction between stress and 5-HTTLPR genotype contributing to the development of depression.

The hypothesis that the S allele of the 5-HTTLPR serotonin transporter promoter region is associated with increased risk of depression, but only in individuals exposed to stressful situations, has generated much interest, research and controversy since first proposed in 2003. Multiple meta-analyses combining results from heterogeneous analyses have not settled the issue. To determine the magnitude of the interaction and the conditions under which it might be observed, we performed new analyses on 31 data sets containing 38 802 European ancestry subjects genotyped for 5-HTTLPR and assessed for depression and childhood maltreatment or other stressful life events, and meta-analysed the results. Analyses targeted two stressors (narrow, broad) and two depression outcomes (current, lifetime). All groups that published on this topic prior to the initiation of our study and met the assessment and sample size criteria were invited to participate. Additional groups, identified by consortium members or self-identified in response to our protocol (published prior to the start of analysis) with qualifying unpublished data, were also invited to participate. A uniform data analysis script implementing the protocol was executed by each of the consortium members. Our findings do not support the interaction hypothesis. We found no subgroups or variable definitions for which an interaction between stress and 5-HTTLPR genotype was statistically significant. In contrast, our findings for the main effects of life stressors (strong risk factor) and 5-HTTLPR genotype (no impact on risk) are strikingly consistent across our contributing studies, the original study reporting the interaction and subsequent meta-analyses. Our conclusion is that if an interaction exists in which the S allele of 5-HTTLPR increases risk of depression only in stressed individuals, then it is not broadly generalisable, but must be of modest effect size and only observable in limited situations.

Adding Insult to Injury: Sex, Sexual Orientation, and Juror Decision-Making in a Case of Intimate Partner Violence.

Societal definitions of intimate partner violence (IPV) are highly gendered and heteronormative, resulting in dissonance regarding cases of same-sex IPV. This study explored perceptions of IPV when the context of the case is inconsistent with societal norms regarding sex and sexuality. Mock jurors read a vignette describing a case of alleged IPV in which the sex and sexual orientation of the defendant were manipulated. Participants (N = 415) rendered a verdict and provided ratings of the defendant, victim, and case. Results suggest participants were more confident in a guilty verdict when the defendant was male, compared to female. Further, male defendants were perceived as more morally responsible, but only when the victim was female. Perceptions regarding the crime suggest violence perpetrated by a man against a woman is viewed more adversely than any other condition. Data are discussed in terms of implications for legal decision-makers and public policy.

Examining the Relationships Between the Triarchic Psychopathy Constructs and Behavioral Deviance in a Community Sample.

Few studies have examined the extent to which psychopathic traits relate to the commission of mild to moderate acts of deviance, such as vandalism and minor traffic violations. Given that psychopathy is now studied in community populations, the relationship between psychopathic traits and less severe deviant behaviors, which are more normative among noninstitutionalized samples, warrants investigation. The current study examined the relationships between the triarchic model of psychopathy (Patrick, Fowles & Krueger, 2009) and seven forms of deviant behavior (drug use, alcohol use, theft, vandalism, school misconduct, assault, and general deviance) in a nationally representative sample. Triarchic disinhibition positively predicted each form of normative deviance. Boldness positively predicted drug and alcohol use as well as general deviance, while meanness negatively predicted school misconduct. Boldness and disinhibition also positively predicted overall lifetime engagement in deviant behavior. Implications are discussed, including support of the role of boldness within the psychopathy construct.

A comparison of self-report measures of psychopathy among nonforensic samples using item response theory analyses.

This study investigated how well components of the psychopathy trait are measured among college students with the Levenson Self-Report Psychopathy Scale (LSRP), the Personality Assessment Inventory-Antisocial Features Scale (PAI ANT), the Psychopathic Personality Inventory-Short Form (PPI-SF), and the Self-Report Psychopathy Scale-II (SRP-II). Using Samejima (1969)'s graded response model (GRM), the subscales were found to vary in their ability to measure the corresponding latent traits. The LSRP primary psychopathy factor is more precise in measuring the latent trait than the secondary psychopathy factor. The PAI ANT items show coherent psychometric properties, whereas the PPI-SF factors differ in their precision to measure the corresponding traits. The SRP-II factors are effective in discriminating among individuals with varying levels of the latent traits. Results suggest that multiple self-report measures should be used to tap the multidimensional psychopathy construct. However, there are concerns with respect to using negatively worded items to assess certain aspects of psychopathy. (PsycINFO Database Record

I'll See You in Court Again: Psychopathology and Hyperlitigious Litigants.

Persistent litigation is a problem in many legal jurisdictions and is costly at individual and systemic levels. This phenomenon is referred to as "querulous" behavior in psychiatric literature, whereas legal discourse refers to it as "vexatious litigation." We refer to this phenomenon as "hyperlitigious behavior" and those who engage in these actions as "hyperlitigious litigants." Hyperlitigious litigants and hyperlitigious behavior were once the focus of a considerable amount of psychiatric literature, but research devoted to these topics has declined over the past half century. A review of the published literature on hyperlitigious behavior in European and English-speaking countries highlights geographic differences in the conceptualization and management of this behavior. We provide an alternative framework to consider the motivation to engage in hyperlitigious behavior and suggest three strategies for mental health professionals who interact with these individuals. Finally, we call for a revival of discussions and research within the English-speaking psychiatric community to facilitate more informed decisions regarding the management and treatment of hyperlitigious behavior.

The emerging story of emerging technologies in neuropsychiatry.

The growth of new technologies in health care is exponential, and the impact of such rapid technological innovation on health care delivery is substantial. This review describes two emerging technologies-mobile applications and wearable technologies-and uses a virtual case report to illustrate the impact of currently available technologies on the health care experience of a patient with neuropsychiatric illness.

El crecimiento de las nuevas tecnologías en la atención de salud es exponencial y el impacto de esta rápida innovación tecnológica en las prestaciones de atención médica es sustancial. Esta revision describe dos tecnologías emergentes - las aplicaciones móviles y las tecnologías portátiles - y emplea un reporte de caso virtual para ilustrar el impacto de las tecnologías actualmente disponibles en la experiencia de la atención de salud de un paciente con patología neuropsiquiátrica.

La croissance des nouvelles technologies dans le domaine de la santé est exponentielle et l'impact d'une innovation technologique aussi rapide sur les prestations de santé est considérable. Cet article décrit deux technologies récentes, les applications mobiles et les technologies «portables¼, et présente une étude de cas virtuelle illustrant l'impact des technologies actuellement disponibles sur l'expérience thérapeutique d'un patient atteint d'une maladie neuropsychiatrique.

Patient-Centered Electroconvulsive Therapy Care: A Call to Action.

We present our experience applying the IOM's "10 Simple Rules" to our ECT Service at a major teaching hospital in order to achieve patient-centered care. We encourage all ECT providers to partner with their patients in engaging family members and significant others in each aspect of ECT care, especially the ECT treatment itself.