Making an MPCT: Building and Sustaining a Multicultural Psychology Consultation Team (MPCT) Within an Academic Medical Center.

ABSTRACT: The synergistic epidemics of COVID-19, racial injustice, and health inequities sparked an unprecedented commitment from US hospital systems and treatment settings to address health disparities by increasing access to care for historically oppressed and underserved communities. However, the inability of hospital systems to actually provide multiculturally responsive care and, more broadly, to consistently practice cultural humility will only exacerbate patient distrust and the deleterious health and social outcomes we seek to mitigate. This perspective article describes the development of a multidisciplinary team of mental health providers committed to delivering culturally responsive mental health treatment while promoting inclusive workplace environments. We outline the Multicultural Psychology Consultation Team's (MPCT) origin, design, process, and structure and discuss successes and challenges in maintaining the model in its first two years. We recommend that systemic infusion of cultural humility, multiculturally responsive clinical care, and support for providers delivering care be prioritized in concert with efforts to increase access to care for diverse patients. We offer MPCT as a model for supporting these aims.

The half-painted picture: Reviewing the mental health impacts of cancer screening.

Cancer screening is recommended for select cancers worldwide. Cancer screening has become increasingly effective and accessible and often increases overall survival. However, the mental health effects of cancer screening, such as its impact on depression, anxiety, and post-traumatic stress disorder, are largely unknown. Conflicting available literature indicates the negative, neutral, and positive mental health effects of cancer screening across cancer types. There are a limited number of randomized controlled trials measuring the mental health effects of cancer screening. Overall, the more negative and life-threatening the screening results, the greater the mental health effects. Screening for cancer without a known precursor, for example, due to family history, can have positive impacts such as decreased worry and increased quality of life. However, receiving a cancer diagnosis often has negative mental effects that increase with the life-threatening potential of malignancy. In this study, we review the existing literature and provide recommendations for future research to determine if and when cancer screening is the best practice.

Transgender and Gender Diverse Patients in Intensive Mood Disorder Treatment: A Comparative Examination of Clinical Presentation and Treatment Outcomes.

Individuals who are transgender and gender diverse (TGD) are more likely to suffer from and to seek mental health services for mood disorders. Some literature suggests that TGD individuals, because of pervasive and systemic minority stress, may have more complex clinical presentations (i.e., psychiatric conditions and severity of symptoms) and may benefit from empirically based treatments to a lesser degree than their cisgender peers. However, research has yet to examine individuals who are TGD receiving treatment in specialized, intensive mood disorder treatment despite the propensity for them to be diagnosed with and treated for mood disorders. Using a sample of 1,326 adult patients in intensive mood disorder treatment (3.8% TGD), the clinical presentation and treatment outcomes were compared between patients who are TGD and cisgender. Contrary to previous research, TGD patients were largely similar if not healthier than their cisgender counterparts, including similar depression severity, quality of life, emotion dysregulation, and behavioral activation, and less severe rumination at admission. Despite similar to better reported mental health symptoms, TGD patients were diagnosed with more psychiatric conditions overall, including greater prevalence of social anxiety and neurodevelopmental diagnoses. Those who are TGD did not experience attenuated treatment response as predicted. Findings suggest that patients in intensive mood disorder treatment who are TGD may be more resilient than previously assumed, or supports may have increased to buffer effects of stigma on mental health, and emphasize the need to exercise discretion and sensitivity in diagnostic practices to prevent over-diagnosis and pathologizing of TGD individuals.

Co-occurring OCD and Panic Disorder: A Review of Their Etiology and Treatment.

Estimated rates of co-occurrence between obsessive and compulsive disorder (OCD) and panic disorder (PD) are notable, but vary considerably, with rates from epidemiological and clinical studies ranging from 1.8% to 22% (Rector et al., 2017). We reviewed the current empirical literature on the etiology, treatment, diagnostic assessment, and differential diagnosis of co-occurring OCD/PD. Best practices for cognitive-behavioral treatment, including identifying and addressing treatment barriers are also addressed. Although it is acknowledged in current literature that co-occurring OCD and PD levels may be clinically significant, there remains a need to thoroughly examine the possible consequences and future research directions of this overlap. Future research must continue to elucidate the biological and environmental causes of OCD/PD co-occurrence.

Examining Psychometrics of the Frost Multidimensional Perfectionism Scale in Children Ages 8-12 Years Using Child and Parent Report.

Perfectionism, especially the evaluative concerns domain, correlates positively with mental health distress. The Frost Multidimensional Perfectionism Scale (F-MPS) is one of the most widely used measures of perfectionism, but has not been validated in children or as a measure of parent-report of child perfectionism. The present study aimed to validate the reliability and concurrent, convergent, and factor analytic validity of the F-MPS as a measure for young children. The F-MPS was administered to a sample of 114 children ages 8-12, and their parent. Results suggest that the F-MPS is valid for parent, but not child, report of child perfectionism. The lack of support for the child report may be due to developmental limitations of children understanding and reporting of their own perfectionism traits. In contrast, parent-report using the brief version of the F-MPS appears to be an economical and valid measure of perfectionism in young children. Improved measures of perfectionism in youth would aid in early intervention to buffer the negative mental health effects of the maladaptive aspects of perfectionism.

Measurement and impacts of intersectionality on obsessive-compulsive disorder symptoms across intensive treatment.

Historically, intensive obsessive-compulsive and related disorder (OCRD) treatment settings have been underrepresentative in terms of patient race and ethnicity. The present study piloted a novel technique to measure multiple marginalized identities and assess their impact on obsessive-compulsive disorder (OCD) symptoms and treatment response across intensive residential treatment (IRT). Participants included 715 residents receiving IRT for OCRD. Measures included the Yale-Brown Obsessive-Compulsive Scale, Dimensional Obsessive-Compulsive Scale (DOCS), Obsessive Beliefs Questionnaire-44, and measures of depression and quality of life. In addition, we piloted a marginalized identity score, an additive measure of intersectionality. Most patients endorsed holding primarily privileged identities. Higher marginalized identity score was significantly correlated with higher depression symptom severity and lower quality of life throughout treatment. Both at baseline and discharge, higher marginalized identity score was significantly and positively correlated with greater OCD symptom severity. Higher marginalized identity score was significantly associated with greater severity of DOCS1, DOCS2, DOCS4, and obsessive beliefs across multiple domains. Consistent with previous literature, patients in our IRT setting were not demographically representative of the general population. Individuals with more marginalized identities endorsed higher symptoms of OCD, obsessive beliefs, OCD dimensions, and depression, as well as lower quality of life at admission and discharge. Results support increased consideration of the role marginalization plays in symptom severity, symptom presentation, and treatment response across treatment settings. Further investigation is warranted to better address the multiplicative effects of holding intersecting marginalized identities and how treatment may be adapted to ameliorate these inequities. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Coping with discrimination: The insidious effects of gender minority stigma on depression and anxiety in transgender individuals.

OBJECTIVES: We examined types of discrimination encountered by transgender and gender diverse (TGD) individuals and the associations with symptoms of depression and anxiety, as well as the mediating and moderating effects of coping responses. METHOD: This online study included 695 TGD individuals ages 16 years and over (M = 25.52; standard deviation = 9.68). RESULTS: Most participants (76.1%) reported discrimination over the past year. Greater exposure to discrimination was associated with more symptoms of depression and anxiety. These associations were mediated by coping via detachment and via internalization, although a direct effect remained. CONCLUSIONS: Many TGD people will encounter discrimination and this is associated with greater psychological distress. Engagement in the internalization of blame or detachment partially explains the association between discrimination and mental health issues. These findings elucidate possible avenues for interventions to bolster adaptive coping responses for TGD people and highlight that actions to decrease discrimination are urgently needed.

Comparing treatment response between LGBQ and heterosexual individuals attending a CBT- and DBT-skills-based partial hospital.

OBJECTIVE: Despite a greater need for mental health treatment in individuals identifying as lesbian, gay, bisexual, queer, and other sexual minority identities (LGBQ+), no prior study has examined mental health treatment outcomes for LGBQ+ populations receiving standard care. We compared individuals identifying as LGBQ+ or heterosexual on treatment outcomes following a partial hospital program based on cognitive behavioral therapy (CBT) and dialectical behavior therapy (DBT). METHOD: A total of 441 participants (19% LGBQ+; mean age = 34.42 years; 56% female, 42% male, 2% nonbinary) attending a partial hospital program completed measures at admission and discharge as part of standard care. We compared LGBQ+ and heterosexual individuals on symptom outcomes (24-item Behavior and Symptom Identification Scale, 7-item Generalized Anxiety Disorder Scale, 9-item Patient Health Questionnaire), program dropout due to inpatient hospitalization, clinical global improvement, and perceived quality of care, controlling for baseline characteristics using propensity score adjustment. RESULTS: Controlling for baseline demographic and clinical variables and a 10% false discovery rate, LGBQ+ and heterosexual individuals did not differ on treatment outcomes. However, when examining sexual identity subgroups, bisexual individuals reported more self-injurious and suicidal thoughts and worse perceptions of care at posttreatment compared to all other sexual identities. CONCLUSIONS: Findings support the comparable effectiveness of CBT- and DBT-skills-based hospital treatment for LGBQ+ and heterosexual individuals overall but suggest specific treatment disparities for bisexual individuals. Future research is needed to establish the effectiveness of traditional evidence-based treatment in other settings and to determine whether LGBQ+ affirmative treatments for specific LGBQ+ subgroups are superior to traditional treatments. (PsycINFO Database Record

Workplace Policies and Mental Health among Working-Class, New Parents.

Little research has explored linkages between workplace policies and mental health in working-class, employed parents, creating a gap in our knowledge of work-family issues across social class levels. The current U.S. study addresses this gap by employing hierarchical linear modeling techniques to examine how workplace policies and parental leave benefits predicted parents' depressive symptoms and anxiety in a sample of 125, low-income, dual-earner couples interviewed across the transition to parenthood. Descriptive analyses revealed that, on average, parents had few workplace policies, such as schedule flexibility or child care supports, available to them. Results revealed, however, that, when available, schedule flexibility was related to fewer depressive symptoms and less anxiety for new mothers. Greater child care supports predicted fewer depressive symptoms for fathers. In terms of crossover effects, longer maternal leave predicted declines in fathers' anxiety across the first year. Results are discussed with attention to how certain workplace policies may serve to alleviate new parents' lack of time and resources (minimize scarcity of resources) and, in turn, predict better mental health during the sensitive period of new parenthood.

Patterns of Anxious Arousal During a Speech Task Between Nonanxious Controls and Individuals With Social Anxiety Disorder Pre- and Posttreatment.

Although research indicates that anxious arousal in response to feared stimuli is related to treatment outcome (Heimberg et al., 1990), less is known about the patterns of anxious arousal. We identified patterns of anxious arousal in individuals with social anxiety disorder (SAD) at pre- (n= 61) and posttreatment (n= 40; 12-session CBGT, Heimberg & Becker, 2002), and in non-anxious controls (NACs; n= 31) using an assessment speech task administered at pretreatment (SAD) or the pretreatment equivalent (NACs), as well as at posttreatment (SAD only). We identified nine patterns of anxious arousal across groups that we further clustered into three groups: fear habituation, fear plateau, and fear increase. Chi-square and adjusted standardized residual analyses revealed that individuals in the pretreatment SAD group displayed the fear habituation patterns significantly more than chance and the fear plateau patterns significantly less than chance. In contrast, NACs displayed the fear plateau patterns significantly more than chance and the fear habituation patterns significantly less than chance. At posttreatment, treatment non-responders displayed fear habituation patterns significantly more than chance, whereas treatment responders displayed the fear habituation patterns significantly less than chance. Findings indicate that fear habituation during an anxiety-provoking assessment task is not necessary for treatment response.

Compound eye formation in the termite Incisitermes minor (Isoptera: Kalotermitidae).

The postembryonic development and caste differentiation patterns of lower termites have been described multiple times in a variety of different species. However, most of these studies focused on gross ontogeny, without carefully describing the maturation of any particular organ or organ system. The few studies that have attempted to correlate caste development and organ differentiation have produced somewhat inconsistent results, especially in the area of eye formation. Therefore, in order to help further elucidate the relationship between eye formation and postembryonic differentiation in lower termites, we studied eye development in the termite, Incisitermes minor (Hagen). Eye formation in I. minor began in the earliest larvae, with only an eye primordium. However, in all later larval stages, characteristic eye structures were observed and were shown to progressively differentiate through larval and nymphal stages. Curiously, pigmentation began with three to eight groups of cells in early larvae and the number of these pigmented groups increased along the developmental time course. Ultimately, a uniformly pigmented eye area was formed by the early nymphal stage. The overall eye area also gradually increased along with normal caste development, but the characteristic lenses seen in a prototypical insect compound eye did not completely form until after the final nymphal stage. Electrophysiological measurements provided clear evidence that eyes were indeed functional at all stages of development where pigment was present. Based upon this data, the eye development pattern in I. minor appeared to follow a divergent pathway from holometabolous insects and an intermediate pathway between typical hemimetabolous eye development and the heterochronic shift observed in other termite species.

Mental Health Literacy for Anxiety Disorders: How perceptions of symptom severity might relate to recognition of psychological distress.

PURPOSE: Improving mental health literacy is an important consideration when promoting expedient and effective treatment seeking for psychological disorders. Low recognition serves as a barrier to treatment (Coles and Coleman, 2010), and this article examines recognition by lay individuals of severity for three psychological disorders: social anxiety, generalized anxiety, and major depression using a dimensional approach. DESIGN: Vignettes of mild/subclinical, moderate, and severe cases of each disorder were rated for severity by a team of expert assessors and 270 participants (mean age = 26.8; 76.7% women). FINDINGS: Difference ratings were calculated comparing participants' responses to scores from the assessors. A within-groups factorial ANOVA with LSD follow-up was performed to examine the effects of Diagnosis and Severity on difference ratings. Both main effects [Diagnosis, F(2, 536)=35.26, Mse=1.24; Severity, F(2, 536)=9.44, Mse=1.93] and the interaction were significant [F(4, 1072)=13.70, Mse=1.13] all p's < 0.001. Social anxiety cases were underrated in the mild/subclinical and moderate cases, generalized anxiety cases were underrated at all three severities, and major depression cases were overrated at all three severities. SOCIAL IMPLICATIONS: Judgments of severity may underlie the low recognition rates for social anxiety disorder and generalized anxiety disorder. Future efforts should focus on improved recognition and education regarding anxiety disorders in the population, particularly before they become severe. VALUE: This project demonstrates the importance of considering judgments of symptom severity on a continuum, and in a range of cases, rather than just the ability to correctly label symptoms, when determining whether or not people recognize psychological disorders.

Differences Among Lesbian, Gay, Bisexual, Heterosexual Individuals, and those Who Reported an Other Identity on an Open-Ended Response on Levels of Social Anxiety.

Previous research suggests that individuals with a marginalized sexual orientation report higher levels of emotional distress (Cochran, 2001; Mayer, 2003), including higher prevalence of social anxiety (Gilman et al., 2001; Potoczniak, Aldea, & DeBlaere, 2007; Safren & Pantalone, 2006) than heterosexuals. The present study builds on previous research by examining results across sexual minority identities, including an additional write-in response option. One hundred eighty individuals participated in an online study in which they indicated their sexual orientation and completed measures of social anxiety. Results indicated that in a sample recruited in a liberal urban population, lesbian/gay, and heterosexual individuals rated similar levels of social anxiety across four Liebowitz Social Anxiety Scale subscales (fear, avoidance, social, and performance; Liebowitz, 1987). Alternatively, individuals who identified as bisexual, or indicated a write-in sexual orientation rated significantly higher levels of social anxiety than the heterosexual, and lesbian/gay groups. Findings highlight the importance of offering a write-in sexual identity option, as well as looking at differences among group experiences across sexual minorities. Future studies should investigate potential group differences in social anxiety across sexual orientations in larger samples so that comparisons can be made among subgroups of the write-in response group, as well as investigate potential contributors to these group differences.

Regional cortical thinning predicts worsening apathy and hallucinations across the Alzheimer disease spectrum.

OBJECTIVES: To examine regions of cortical thinning and cerebrospinal fluid (CSF) Alzheimer disease (AD) biomarkers associated with apathy and hallucinations in a continuum of individuals including clinically normal elderly, mild cognitive impairment, and mild AD dementia. DESIGN: Cross-sectional and longitudinal studies. SETTING: Fifty-seven research sites across North America. PARTICIPANTS: Eight-hundred twelve community-dwelling volunteers; 413 participants in the CSF sub-study. MEASUREMENTS: Structural magnetic resonance imaging data and CSF concentrations of amyloid-ß 1-42, total tau, and phosphorylated tau derived from the Alzheimer Disease Neuroimaging Initiative database were analyzed. Apathy and hallucinations were measured at baseline and over 3 years using the Neuropsychiatric Inventory-Questionnaire. General linear models and mixed effects models were used to evaluate the relationships among baseline cortical thickness in seven regions, and baseline CSF biomarkers, apathy, and hallucinations at baseline and longitudinally. Covariates included diagnosis, sex, age, apolipoprotein E genotype, premorbid intelligence, memory performance, processing speed, antidepressant use, and AD duration. RESULTS: Reduced baseline inferior temporal cortical thickness was predictive of increasing apathy over time, and reduced supramarginal cortical thickness was predictive of increasing hallucinations over time. There was no association with cortical thickness at baseline. CSF biomarkers were not related to severity of apathy or hallucinations in cross-sectional or longitudinal analyses. CONCLUSIONS: These results suggest that greater baseline temporal and parietal atrophy is associated with worsening apathy and hallucinations in a large AD spectrum cohort, while adjusting for multiple disease-related variables. Localized cortical neurodegeneration may contribute to the pathophysiology of apathy and hallucinations and their adverse consequences in AD.

Subjective cognitive complaints and amyloid burden in cognitively normal older individuals.

Accumulating evidence suggests that subjective cognitive complaints (SCC) may indicate subtle cognitive decline characteristic of individuals with preclinical Alzheimer's disease (AD). In this study, we sought to build upon previous studies by associating SCC and amyloid-ß deposition using positron emission tomography with Pittsburgh Compound B (PiB-PET) in cognitively normal older individuals. One-hundred thirty one subjects (mean age 73.5±6) were administered three subjective cognitive questionnaires and a brief neuropsychological battery. A relationship between a subjective memory complaints composite score and cortical PiB binding was found to be significant, even after controlling for depressive symptoms. By contrast, there were no significant relationships between objective cognitive measures of memory and executive functions and cortical PiB binding. Our study suggests that SCC may be an early indicator of AD pathology detectable prior to significant objective impairment.

Neuropsychiatric symptoms and global functional impairment along the Alzheimer's continuum.

BACKGROUND/AIMS: Neuropsychiatric symptoms in Alzheimer's disease (AD) are highly prevalent. We sought to determine whether neuropsychiatric symptoms were related to global functional impairment at baseline and over a 3-year period in older normal control (NC), mild cognitive impairment (MCI) and mild AD dementia subjects. METHODS: Eight hundred and twelve subjects (229 NC, 395 MCI, 188 AD) from the Alzheimer's Disease Neuroimaging Initiative study underwent cognitive and behavioral assessments over 3 years. RESULTS: Greater hallucinations, anxiety and apathy were associated with greater global functional impairment at baseline, while the presence of hallucinations and apathy at baseline was associated with greater global functional impairment over time across all subjects. The following neuropsychiatric symptoms were not significantly associated with global functioning: delusions, agitation, depression, euphoria, disinhibition, irritability, aberrant motor behaviors, sleep and appetite. CONCLUSIONS: These results suggest that increased baseline hallucinations, apathy and anxiety are associated with current and future disease progression in AD.

Validation of the Face Name Associative Memory Exam in cognitively normal older individuals.

The recently developed Face Name Associative Memory Exam (FNAME), a challenging paired associative learning task, shows promise in detecting the subtle cognitive changes characteristic of preclinical Alzheimer's disease. In this study, we evaluated the validity and reliability of the FNAME in 210 cognitively normal older individuals (58-90 years of age). Construct validity of the measure was assessed by principal components analysis, which revealed two independent factors. Correlations between the FNAME subtests and another episodic memory test were significant. The results indicated strong test-retest reliability in a subsample (n = 41). Normative data stratified by age were also generated.