A neuropsychological feedback model for memory clinic trainees.

Memory clinics that specialize in evaluating and treating cognitive decline in older adults are increasingly common and serve as an important training setting for neuropsychology practicum students, interns, and postdoctoral residents. Following a neuropsychological evaluation, trainees are tasked with sharing results, diagnoses, and treatment recommendations, a practice referred to as feedback. Despite the importance and complexity of providing feedback in this setting, no specific model of feedback delivery exists to guide trainees when learning this crucial skill within a memory clinic. The following article presents a feedback model for memory clinic trainees and details its development based on best practices available in the literature. The feedback model aims to promote trainees' confidence in their clinical skills and increase patient and visit partner understanding of evaluation results. It is also our hope that this model will advance the field of education within neuropsychology.

Personality predictors of 6-month readmission in adult psychiatric inpatients.

Readmission of psychiatric inpatients is highly prevalent and places a significant financial burden on the healthcare system. Rehospitalisation is often used as a metric of quality of care in psychiatric settings, but little is known about how specific personality traits impact readmission in adult psychiatric inpatients. A convenience sample of 94 adults (mean age = 36.8 years; female = 54.3%; European American = 76.6%) at an inpatient psychiatric hospital completed the Personality Inventory for DSM-5-Brief Form (PID-5-BF; American Psychiatric Association, 2013); demographic and medical information and readmission data were extracted via chart review. Poisson regression was used to predict number of readmissions at 6 months after discharge from PID-5-BF domain scores of Negative Affectivity, Detachment, Antagonism, Disinhibition and Psychoticism. Twenty-three patients (24.5%) were readmitted at least once by 6-month follow-up. Higher PID-5-BF Negative Affectivity domain scores predicted greater number of readmissions at 6 months (incidence rate ratio (IRR) = 1.14, robust standard error (RSE) = 0.05, p < .01, 95% confidence interval [1.04, 1.25]). The other PID-5-BF domain scores were not significantly related to number of readmissions. Thus, greater negative affect, indicative of higher trait neuroticism, heightened experience of negative emotions and poor self-concept, was a significant personality predictor of readmission in the study. These results suggest that assessing this trait domain might help to identify psychiatric inpatients at greater risk for readmission and determine those most in need of enhanced services to reduce rehospitalisation.

Assessing an Epidemic: Utility of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition Level 2 Substance Use Screener in Adult Psychiatric Inpatients.

BACKGROUND: Inpatient psychiatric hospitals provide an important point of care for assessing and stabilizing substance use and for facilitating linkage to appropriate treatment. Toxicology screening provides a key measure of substance use yet may miss many cases of substance use because of variable windows of detection and the limited scope of substances assessed. This study assesses the utility of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) Level 2 Substance Use screener as a supplemental tool for identifying substance use by self-report within an inpatient psychiatric hospital setting. METHODS: From a larger sample of 97 adult psychiatric inpatients, 60 who underwent drug toxicology testing and completed the DSM-5 screener were assessed. We examined the sensitivity and specificity of the self-report screener in comparison with drug toxicology test results collected by chart review. RESULTS: Sensitivity of the DSM-5 screener varied across substances assessed: The self-report measure identified 100% of individuals who tested positive for opioid use, 83% who tested positive for cannabis use, 50% who tested positive for cocaine use, and 37% who tested positive for benzodiazepine use. The self-report measure also identified 27 instances among 60 participants in which substance use identified by self-report was not detected by toxicology testing. CONCLUSION: The brief and easily administered DSM-5 Level 2 Substance Use screener shows promise for improving identification of substance use in an inpatient psychiatric hospital setting. This measure may also provide psychiatric inpatient nursing staff with a means of working collaboratively with patients to assess substance use and coordinate appropriate treatment plans.

PROMIS®-assessed sleep problems and physical health symptoms in adult psychiatric inpatients.

OBJECTIVE: The goal of this study was to assess the relationship between sleep problems and somatic symptoms in a sample of adult psychiatric inpatients and evaluate the utility of the Patient-Reported Outcomes Measurement Information System® (PROMIS®) Sleep Disturbance Measure as a predictor of physical health symptom severity within this population. METHOD: Ninety-five adults were assessed following admission to an inpatient psychiatric hospital. Demographic and medical information were extracted via chart review. Participants completed the PROMIS® Sleep Disturbance Measure-Short Form, the PROMIS® Depression Measure-Short Form, the DSM-5 Cross-Cutting Symptom Measure (CCSM), and the Patient Health Questionnaire-Physical Symptoms (PHQ-15). A hierarchical linear regression was conducted predicting severity of physical symptoms from PROMIS® Sleep scores, while controlling for gender, depression scores, number of medications, number of psychiatric diagnoses, and whether the participant was undergoing detoxification. RESULTS: Data showed that 50% of participants reported medium/high levels of physical health symptoms, and 41% reported moderate/severe levels of sleep disturbance. A positive screen on the CCSM Somatic Symptoms domain was a significant predictor of more self-reported physical health symptoms (ß = 0.278, p = .005, 95% CI [1.24, 6.61]). When PROMIS® Sleep scores were included, the model accounted for significantly more variability in physical health symptom scores (ΔR2 = 0.085, F = 9.150, p < .001), and the CCSM Somatic Screener remained a significant predictor (ß = 0.230, p = .013, 95% CI [0.70, 5.79]). PROMIS® Sleep scores significantly predicted physical health symptom scores (ß = 0.364, p = .001, 95% CI [0.11, 0.42]). CONCLUSIONS: A significant proportion of psychiatric inpatients report elevated levels of physical health symptoms, and greater sleep disturbance is a significant predictor of somatic symptoms severity. The PROMIS® Sleep Disturbance Measure may be a better predictor of physical health symptoms among psychiatric inpatients than the CCSM alone. The PROMIS® Sleep Disturbance Measure may also serve as a useful screening and outcome assessment tool in future clinical and research work among this understudied population. Identifying and intervening with psychiatric inpatients at risk for poor sleep and more severe physical health symptoms has the potential to positively impact patients' hospitalization and postdischarge outcomes. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

A Randomized Clinical Trial of a Brief Internet-based Group Intervention to Reduce Sexual Transmission Risk Behavior Among HIV-Positive Gay and Bisexual Men.

Background: HIV disproportionately affects sexual minority men, and developing strategies to reduce transmission risk is a public health priority. Purpose: The goal was to empirically test a newly developed, Information, Motivation, Behavioral skills (IMB) theoretically derived, online HIV sexual risk reduction intervention (called HINTS) among a sample of sexual minority men living with HIV. Methods: Participants were 167 men randomized to either the four-session online HINTS intervention or to a time-matched, online control condition. Participants were assessed at baseline and at 6-month follow-up for demographic, medical and psychosocial factors, and sexual risk behavior. Analyses examined group differences in incidence rates of condomless anal sex (CAS) at follow-up with all male sex partners and by partner serostatus, either seroconcordant or serodiscordant for HIV infection. Results: Men assigned to the HINTS intervention reported decreased CAS with serodiscordant partners, a behavior that confers high risk of HIV transmission, compared to the control group. Men assigned to the HINTS intervention also reported increased CAS with seroconcordant partners, a behavior indicative of serosorting. Although the IMB model did not appear to mediate these intervention effects, some IMB components were associated with behavioral outcomes at 6-month follow-up. Conclusions: A new group-based sexual risk reduction intervention conducted exclusively online was successful in reducing HIV transmission risk behavior in a sample of gay and bisexual men living with HIV. Future work should consider utilizing this intervention with other groups living with HIV, perhaps in combination with biomedical HIV prevention strategies.

Online Partner Seeking and Sexual Risk Among HIV+ Gay and Bisexual Men: A Dialectical Perspective.

For almost two decades, researchers have explored the relationship between online partner seeking (OPS) and HIV/STI transmission risk behavior among men who have sex with men (MSM), including gay- and bisexual-identified men. A dichotomy has emerged with some findings that OPS is associated with greater sexual risk behavior, and a sparser but emerging literature that men may use OPS for sexual risk reduction. This study examined the association between proportion of partners met online and sexual risk behavior in a sample of 170 HIV-positive gay- and bisexual-identified men. Participants completed assessments including psychosocial factors and a comprehensive assessment of sexual behavior, including total number of male partners, and condomless insertive and receptive anal sex with HIV-negative/unknown serostatus partners or HIV-positive male partners. Our findings support taking a dialectical stance and indicate that OPS may impact risk differently given different individual and contextual circumstances.