Effects of sexual assault vs. other traumatic experiences on emotional and cannabis use outcomes in regular cannabis users with trauma histories: moderation by gender?

Introduction: While sexual assault may have particularly adverse emotional effects compared with other forms of trauma, it remains unclear which emotional outcome dimensions are impacted, whether cannabis outcomes are similarly impacted, and whether gender differences exist in sexual assault's links with these outcomes. Methods: N = 100 cannabis users with trauma histories (M age = 33.1) completed standardized measures of demographics, trauma exposure, posttraumatic stress (PTS) and depressive symptoms, hopelessness, and cannabis outcomes (frequency, medicinal prescription, motives, and craving). Results: Sexual assault was experienced more often by women (83.9%) than men (31.8%). A series of 2 × 2 analyses of variance [gender: women (n = 56) vs. men (n = 44) × trauma type: sexual assault (n = 61) vs. other (n = 39)] and logistic regression revealed that sexual assault survivors scored higher than other trauma survivors on re-experiencing and hyperarousal PTS symptoms (DSM-5 Clusters B and E), cognitive depressive symptoms, hopelessness, cannabis use frequency, medicinal cannabis prescription, cannabis use to cope with psychological symptoms, and compulsivity craving; and lower on social and enhancement cannabis use motives. In terms of gender main effects, women scored higher than men on cannabis use to cope with negative emotions. In terms of interactions for PTS Cluster D symptoms (negative alterations in mood/cognitions), among men only, sexual assault survivors scored higher than other trauma survivors; and for cannabis enhancement motives and purposefulness cannabis craving, among sexual assault survivors only, women scored higher than men. Discussion: Across many different trauma, women survivors' use of cannabis to cope with negative affect should be a specific therapeutic focus. Moreover, we identified specific emotional and cannabis use outcomes that should be of specific clinical concern among sexual assault survivors regardless of gender. Finally, in terms of gender differences of clinical interest among sexual assault survivors, while PTS Cluster D symptoms should be specific treatment targets in men, cannabis enhancement motives and purposefulness craving should be treatment targets in women.

Adaptive Functional Electrical Stimulation Delivers Stimulation Amplitudes Based on Real-Time Gait Biomechanics.

Functional electrical stimulation (FES) is often used in poststroke gait rehabilitation to decrease foot drop and increase forward propulsion. However, not all stroke survivors experience clinically meaningful improvements in gait function following training with FES. The purpose of this work was to develop and validate a novel adaptive FES (AFES) system to improve dorsiflexor (DF) and plantarflexor (PF) stimulation timing and iteratively adjust the stimulation amplitude at each stride based on measured gait biomechanics. Stimulation timing was determined by a series of bilateral footswitches. Stimulation amplitude was calculated based on measured dorsiflexion angle and peak propulsive force, where increased foot drop and decreased paretic propulsion resulted in increased stimulation amplitudes. Ten individuals with chronic poststroke hemiparesis walked on an adaptive treadmill with adaptive FES for three 2-min trials. Stimulation was delivered at the correct time to the dorsiflexor muscles during 95% of strides while stimulation was delivered to the plantarflexor muscles at the correct time during 84% of strides. Stimulation amplitudes were correctly calculated and delivered for all except two strides out of nearly 3000. The adaptive FES system responds to real-time gait biomechanics as intended, and further individualization to subject-specific impairments and rehabilitation goals may lead to improved rehabilitation outcomes.

Neither a problem nor my problem: Risk factors for underage drinking disengagement among college students.

OBJECTIVE: Underage drinking disengagement (UDD; cognitive restructuring/minimizing agency) measures attitudes about the acceptability and responsibility of drinking. We examined demographic correlates of UDD, as well as the moderating effects of legal drinking status on the association between UDD and drinking. PARTICIPANTS: College student drinkers (n = 893; Mage = 19.48, range = 18-25; White = 74.1%; female = 68.1%) from a multi-site study. METHODS: An online confidential survey included the UDD Scale for College Students and the AUDIT-C. RESULTS: White and multiracial, underage students, or those living with others endorsed greater cognitive restructuring disengagement than Hispanic students, legal-age students, or those living alone or with parents, respectively. Greek membership and greater "party school" perceptions were related to more cognitive restructuring and minimizing agency. The associations between UDD and alcohol use were not moderated by legal drinking age status. CONCLUSION: Identifying and educating students at risk for UDD on the ramifications associated with underage drinking could combat drinking.

Social and cognitive determinants of medications for opioid use disorder outcomes: A systematic review using a social determinants of health framework.

Disparities exist in the engagement and success of individuals seeking medications for opioid use disorder (MOUD) treatment. Existing work suggests that individual-level factors such as cognitive functioning influence MOUD treatment, less is known about the role of environmental factors beyond the individual such as social determinants of health (SDOH). The aim of this systematic review was to summarize the literature of neuropsychological assessment in the context of MOUD treatment using an SDOH framework. We included peer-reviewed articles based in the United States and published in the English language that evaluated neuropsychological assessment on MOUD treatment outcomes. Three electronic databases were searched from January 2022 to September 2023 without restricting the date of publication for article inclusion. We identified 34 empirical articles that met inclusion criteria, the majority being nonrandomized clinical trials. Few studies examined differences in neuropsychological performance over time or in response to an adjunct intervention. Findings comparing cognitive functioning across MOUD and comparisons groups were mixed, as were findings from the studies that examined changes in cognitive functioning over time. Factors represented from the SDOH framework included educational attainment, premorbid intellectual functioning, and employment status. Neuropsychological domains and type of assessments varied, as did inclusion/exclusion and demographic characteristics. Existing literature is mixed on whether neuropsychological deficits in individuals with OUD are amenable to treatment, particularly among populations disproportionally disadvantaged by SDOH. More research is needed on the SDOH and other contextual factors that influence cognitive factors and MOUD treatment engagement and success.

Study Protocol for the Healing Opioid Misuse and Pain Through Engagement Trial: Integrated Treatment for Individuals With Co-occurring Chronic Pain and Opioid Use Disorder.

Chronic pain and opioid use disorder (OUD) are public health crises and their co-occurrence has led to further complications and public health impacts. Provision of treatments for comorbid chronic pain and OUD is paramount to address these public health crises. Medications for OUD (MOUD) are gold standard treatments for OUD that have also demonstrated benefit in pain management. However, clinics that provide MOUD for chronic pain or OUD often lack behavioral treatments to address the challenges experienced by individuals with both conditions. Developing and implementing a behavioral treatment that complements MOUD may better equip clinics to provide comprehensive care to the growing proportion of clients who present with comorbid chronic pain and OUD. In the Healing Opioid misuse and Pain through Engagement (HOPE) Trial, we are using an effectiveness-implementation hybrid design to examine the benefits of an integrated behavioral treatment and to determine the feasibility of implementing the integrated treatment into clinics that provide MOUD. The treatment integrated 2 evidence-based treatments-Acceptance and Commitment Therapy and Mindfulness-Based Relapse Prevention-to target the emotional, behavioral, and physiological sequelae of OUD and chronic pain. Implementation feasibility will include assessing changes in implementation readiness and identifying facilitators and barriers to implementing the integrated treatment among all personnel employed in clinics that provide MOUD. This commentary offers an overview of the study and design and details adaptations we made to our study protocol, based largely on clinic personnel time constraints and variable clinic procedures during the COVID-19 pandemic.

How Important is Position in Adaptive Treadmill Control?

To more closely mimic overground walking, researchers are developing adaptive treadmills (ATMs) that update belt speed in real-time based on user gait mechanics. Many existing ATM control schemes are solely based on position on the belt and do not respond to changes in gait mechanics, like propulsive forces, that result in increased overground walking speed. To target natural causal mechanisms to alter speed, we developed an ATM controller that adjusts speed via changes in position, step length, and propulsion. Gains on each input dictate the impact of the corresponding parameter on belt speed. The study objective was to determine the effect of modifying the position gain on self-selected walking speed, measures of propulsion, and step length. Twenty-two participants walked at their self-selected speed with four ATM controllers, each with a unique position gain. Walking speed, anterior and posterior ground reaction force peaks and impulses, net impulse, and step length were compared between conditions. Smaller position gains promoted more equivalent anterior and posterior impulses, resulting in a net impulse closer to zero (p = 0.0043), a characteristic of healthy gait. Walking speed, anterior and posterior ground reaction force peaks and impulses, and step length did not change between conditions (all p > 0.05). These results suggest that reducing the importance of position in the ATM controller may promote more balanced anterior and posterior impulses, possibly improving the efficacy of the ATM for gait rehabilitation by emphasizing changes in gait mechanics instead of position to naturally adjust speed.

Risk Stratification of QTc Prolongation in Critically Ill Patients Receiving Antipsychotics for the Management of Delirium Symptoms.

BACKGROUND: Patients experiencing significant agitation or perceptual disturbances related to delirium in an intensive care setting may benefit from short-term treatment with an antipsychotic medication. Some antipsychotic medications may prolong the QTc interval, which increases the risk of potentially fatal ventricular arrhythmias. In this targeted review, we describe the evidence regarding the relationships between antipsychotic medications and QTc prolongation and practical methods for monitoring the QTc interval and mitigating arrhythmia risk. METHODS: Searches of PubMed and Cochrane Library were performed to identify studies, published before February 2023, investigating the relationships between antipsychotic medications and QTc prolongation or arrhythmias. RESULTS: Most antipsychotic medications commonly used for the management of delirium symptoms (eg, intravenous haloperidol, olanzapine, quetiapine) cause a moderate degree of QTc prolongation. Among other antipsychotics, those most likely to cause QTc prolongation are iloperidone and ziprasidone, while aripiprazole and lurasidone appear to have minimal risk for QTc prolongation. Genetic vulnerabilities, female sex, older age, pre-existing cardiovascular disease, electrolyte abnormalities, and non-psychiatric medications also increase the risk of QTc prolongation. For individuals at risk of QTc prolongation, it is essential to measure the QTc interval accurately and consistently and consider medication adjustments if needed. CONCLUSIONS: Antipsychotic medications are one of many risk factors for QTc prolongation. When managing agitation related to delirium, it is imperative to assess an individual patient's risk for QTc prolongation and to choose a medication and monitoring strategy commensurate to the risks. In intensive care settings, we recommend regular ECG monitoring, using a linear regression formula to correct for heart rate. If substantial QTc prolongation (eg, QTc > 500 msec) is present, a change in pharmacologic treatment can be considered, though a particular medication may still be warranted if the risks of discontinuation (eg, extreme agitation, removal of invasive monitoring devices) outweigh the risks of arrhythmias. AIMS: This review aims to summarize the current literature on relationships between antipsychotic medications and QTc prolongation and to make practical clinical recommendations towards the approach of antipsychotic medication use for the management of delirium-related agitation and perceptual disturbances in intensive care settings.

Is Mindfulness Associated With Safer Cannabis Use? A Latent Profile Analysis of Dispositional Mindfulness Among College Students Who Use Cannabis.

Objectives: Previous research cites mindfulness as a protective factor against risky substance use, but the specific association between dispositional mindfulness (DM) and cannabis use has been inconsistent. Despite known heterogeneity of DM facets across college students, much of the prior research in this area has relied on variable-centered approaches. Only a handful of prior studies within the cannabis literature have utilized person-centered approaches, and only one has specifically examined unique profiles of dispositional mindfulness in relation to patterns of use among college students. Method: The present study used latent profile analysis (LPA) to identify subtypes of DM and their relationships with cannabis use behaviors (i.e., hazardous use and consequences of use) in a sample of 683 U.S. college students who endorsed past-month cannabis use and participated in an online survey of substance use behaviors, hypothesizing that a three-profile model would be replicated. We also examined whether age and prior experience with mindfulness predicted DM profile membership (hypothesizing that these variables would differentially predict membership) and explored mean differences in alcohol use across profiles. Results: LPA results revealed three discrete profiles of DM: non-judgmentally aware, judgmentally observing, and moderate traits. Participants in the non-judgmentally aware profile were less likely to have prior mindfulness experience than the other profiles, but age did not predict profile membership. Judgmentally observing had more hazardous cannabis use and consequences than the other profiles, and no mean differences emerged on alcohol use. Conclusions: These results build upon the only known study that investigated how DM relates to cannabis use. Further research is needed to elucidate this relationship, which can inform the application of mindfulness interventions for hazardous cannabis use in college students. Pre-registration: This study was not pre-registered.

Effectiveness and feasibility of a motivational interviewing intake (MII) intervention for increasing client engagement in outpatient addiction treatment: an effectiveness-implementation hybrid design protocol.

BACKGROUND: Client discontinuation from outpatient addiction treatment programs is common, and the initial intake is the service delivery point with the highest attrition rate. Replacing the comprehensive intake assessment with a person-centered Motivational Interviewing (MI) intervention is a potential solution to address provider and client concerns about the disengaging, time-intensive nature of the typical initial intake. It remains unclear whether the use of an alternative to the standard intake at the initial visit can fit within typical organizational reporting requirements, whether it decreases attrition, and whether implementation of person-centered intake procedures within outpatient addiction treatment programs is feasible, acceptable, and can be sustained. PURPOSE: To describe the methods and design of an effectiveness-implementation hybrid type 1 trial of a Motivational Interviewing at Intake (MII) intervention using the Consolidated Framework for Implementation Research (CFIR). METHODS: The study will determine the effectiveness of two intake conditions: (1) standard comprehensive intake assessment (intake-as-usual [IAU]), and (2) MII consisting of a person-centered discussion between provider and client about the client's desire and intent to enter treatment. Although both interventions are focused on understanding client presenting complaints and needs for treatment, the delivery differs as the IAU uses a semi-structured assessment guide, while MII applies the theory of MI to have a conversation about treatment engagement. Adults seeking outpatient addiction treatment services will be randomly assigned to the MII condition (n = 75) or the IAU condition (n = 75). Primary outcomes will be client engagement (i.e., treatment entry, attendance, and completion) obtained from the electronic medical record. Secondary outcomes (client motivation and therapeutic alliance) will be putative mechanisms of client engagement assessed immediately before and after the intake. The trial also will explore determinants of effective, sustainable implementation using assessments of organizational readiness and capacity to change, as well as interviews on MII implementation feasibility. CONCLUSION: This trial of an MII intervention will investigate the feasibility of a motivational intervention as an initial contact with substance use treatment-seeking clients as well as indicators of intervention effectiveness within the systems where it is employed. Trial registration Clinicaltrials.gov identifier: NCT05489068.

The effects of protective behavioral strategies on heavy drinking following a pure motivational interviewing intervention.

Background: Protective behavioral strategies (PBS) are cognitive-behavioral strategies that students use to prevent risky drinking. Prior work supports PBS as a mechanism of change following a brief motivational intervention (BMI) among college students. This study investigated the necessity of discussing PBS by examining changes in PBS use and drinking following an alcohol intervention that used the parent method of Motivational Interviewing (MI), or Pure MI. Methods: Data came from a pilot study that looked at the effects of Pure MI that targeted risky social drinking behavior. The study comprised 42 college students who endorsed hazardous drinking in the last 2 weeks and social anxiety symptoms. Participants completed measures of safe and heavy drinking behaviors at baseline and one-month follow-up. Results: The results showed that PBS use increased from baseline to one-month follow-up. Further, the reduction in heavy drinking in social situations was partially explained by an increase in PBS use from pre- to post-intervention. Conclusions: Despite not introducing PBS into discussions during the MI intervention, we found that students who used more PBS reported reduced heavy drinking in social situations. Implications from the study suggest that interventions focused on student motivation rather than knowledge can promote safe and reduce hazardous drinking behaviors.

Do anxiety sensitivity cognitive concerns and/or depression symptoms independently explain sleep disturbances in a high anxiety sensitive treatment-seeking sample?

Cognitive models of insomnia posit a role for anxiety sensitivity (AS) in sleep difficulties. While sleep disturbances have been linked to AS, particularly AS cognitive concerns, prior studies have rarely accounted for the correlated construct of depression. We used pre-treatment intervention trial data from 128 high AS, treatment-seeking adults with a DSM-5 diagnosis of an anxiety, depressive, or posttraumatic stress disorder to determine whether AS cognitive concerns and/or depression are independently associated with sleep impairment domains (e.g., sleep quality, latency, daytime dysfunction). Participants provided data on AS, depressive symptoms, and sleep impairments. AS cognitive concerns (but not other AS dimensions) were correlated with four of five sleep impairment domains; depression was correlated with all five. Multiple regressions revealed four of five sleep impairment domains were predicted by depression with no independent contribution of AS cognitive concerns. In contrast, AS cognitive concerns and depression were independently associated with daytime dysfunction. Results suggest previous findings linking AS cognitive concerns to sleep impairments may have been largely secondary to the overlap of cognitive concerns with depression. Findings demonstrate the importance of incorporating depression into the cognitive model of insomnia. Both AS cognitive concerns and depression may be useful targets for reducing daytime dysfunction.

Higher baseline emotion dysregulation predicts treatment dropout in outpatients with borderline personality disorder.

Treatment dropout is high among outpatients with borderline personality disorder (BPD) and is associated with myriad negative therapeutic and psychosocial outcomes. Identifying predictors of treatment dropout can inform treatment provision for this population. The present study investigated whether symptom profiles of static and dynamic factors could predict treatment dropout. Treatment-seeking outpatients with BPD (N = 102) completed pre-treatment measures of BPD symptom severity, emotion dysregulation, impulsivity, motivation, self-harm, and attachment style to determine their collective impact on dropout prior to 6 months of treatment. Discriminant function analysis was used to classify group membership (treatment dropout vs. nondropout) but did not produce a statistically significant function. Groups were distinguished by baseline levels of emotion dysregulation with higher dysregulation predicting premature treatment dropout. Clinicians working with outpatients with BPD might benefit from optimizing emotion regulation and distress tolerance strategies earlier in treatment to reduce premature dropout. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Trajectories of change in subclinical anxiety and alcohol use during alcohol treatment: A parallel process growth model.

BACKGROUND: Anxiety is implicated in the course and prognosis of alcohol use disorder (AUD); however, it is unclear how current AUD treatments affect the joint trajectories of anxiety and alcohol use. We used data from the Combined Pharmacotherapies and Behavioral Interventions for Alcohol Dependence (COMBINE) study to examine the longitudinal relationship between subclinical anxiety symptoms and alcohol use during and following AUD treatment in adults with AUD and no comorbid anxiety disorders. METHODS: Univariate and parallel process growth models using five waves of COMBINE study data were analyzed from 865 adults randomized to medication (n = 429) or medication plus psychotherapy (n = 436). Weekly drinking quantity and average weekly anxiety symptoms were measured at baseline, mid-treatment, end-of-treatment, and three follow-up periods. RESULTS: Significant positive associations of anxiety symptoms and drinking were found at mid-treatment and over time. Temporal associations revealed that higher mid-treatment anxiety predicted decreases in drinking over time. Baseline anxiety and drinking predicted mid-treatment anxiety and drinking. Only baseline anxiety predicted increases in drinking over time. Group differences revealed mid-treatment drinking predicted decreases in anxiety over time in the medication group. CONCLUSIONS: Findings demonstrate the influence of subclinical anxiety on alcohol use during and up to one year after AUD treatment. Baseline anxiety symptoms may influence drinking behavior over the course of treatment. Findings suggest that greater attention to negative affect in AUD treatment is warranted even for those individuals who do have a comorbid anxiety disorder.

Perceived racial/ethnic discrimination among young adult college students: Prevalence rates and associations with mental health.

Objective/Participants: In a large, diverse sample of college students (N = 2,230), this online study investigated racial/ethnic differences on type of discriminatory event experienced and perceived stress, and whether discrimination-related stress was associated with mental health symptoms. Methods: Prevalence of lifetime/past year discriminatory events was assessed and frequency of discrimination-related stress was compared across racial/ethnic groups. Correlations between discrimination-related stress and mental health symptoms were also examined. Results: All racial/ethnic groups reported experiencing all types of discriminatory events, though prevalence was lowest for White students. Racial/ethnic minority (i.e., Asian, Black, Latinx) students reported greater discrimination-related perceived stress compared to White, non-Hispanics. Across all racial/ethnic groups, discrimination-related stress was positively associated with negative mental health outcomes (e.g., anxiety/depressive symptoms). Conclusions: These results highlight the need to continue efforts to reduce discriminatory experiences of racial/ethnic minority students and to incorporate antiracism interventions in universities to mitigate the pervasive negative experiences of minority students.

Development and Pilot of a Process for Regularly Sharing Summary Patient Safety Data.

OBJECTIVE: Dissemination of patient safety data is key to understanding safety events and improving the quality of patient care. However, there is limited guidance on how psychiatry residency programs can create a supportive environment in which to disclose and discuss such information. The authors developed and piloted a resident-led Patient Safety Presentation process at an Accreditation Council for Graduate Medical Education-accredited psychiatry residency program, sharing patient safety data while enhancing residents' education and engagement in patient safety. METHODS: From September 2020 through February 2021, the authors convened a workgroup of psychiatry residents and faculty members to devise and conduct the presentation process. The process consisted of an introductory hour-long training of residents in patient safety concepts, followed a week later by the presentation by two psychiatry residents. The authors evaluated the pilot presentation process using pre- and post-presentation resident surveys. RESULTS: The introductory training and the Patient Safety Presentation were included into the didactic schedules of all 32 program residents. Twenty (62.5%) and 17 (53.1%) residents completed the pre- and post-presentation surveys, respectively. Improvements were seen in residents' knowledge regarding the medical center's patient safety practices and perspectives on patient safety practices. On the post-presentation survey, all 17 residents reported overall satisfaction with the presentation. CONCLUSIONS: The piloted Patient Safety Presentation process increased psychiatry residents' knowledge of and engagement in patient safety. The development and pilot of the presentation process serve as an illustrative case study for other residency programs that are aspiring to grow this aspect of their curriculum.

Fear of negative evaluation and suicidal ideation among college students: the moderating role of impulsivity-like traits.

Objective: Fear of negative evaluation (FNE) is a key trait of social anxiety and has been linked to isolation and low self-esteem. Impulsivity has been shown to amplify the risk of socially anxious individuals engaging in risky behaviors such as suicidal behaviors; yet little research has examined associations between FNE and suicidality or the relationship between FNE and impulsivity. Participants/Methods: This study tested whether FNE was associated with suicidal ideation in a sample of 1,816 college students from 10 universities. Analyses also examined whether impulsivity-like traits moderated the relationship between FNE and suicidal ideation. Results: Results showed that FNE was significantly associated with suicidal ideation and the positive association between FNE and suicidal ideation was strongest among individuals with higher negative urgency and lower perseverance. Conclusions: These findings highlight FNE as an important risk factor of suicidal ideation in college students and illuminates potential influence of impulsivity on this relationship.

What pandemic? A multisite study of drinking motives and drinking games participation among college students during a pandemic (COVID-19) academic year.

A drinking game (DG) is a widely practiced social activity that tends to encourage rapid alcohol consumption. While social restrictions during the pandemic (COVID-19) academic year were implemented as a health measure across many colleges/universities, the extent to which college student drinkers continued to play DGs in-person is not well understood. Because theory and research suggest that drinking motives are proximal correlates of drinking behaviors, we examined which drinking motives increased the likelihood of playing DGs in-person, and playing DGs in-person in a group of 10 + people during the 2020-21 pandemic academic year. College students (past-year drinkers) from 12 universities completed an online survey (N = 900; Mage = 19.42, Range = 18-25; SDage = 1.45, White = 73.1%, 69.2% female). Of the students surveyed, 590 students played DGs, with 460 students only playing DGs in-person. Of the students who played DGs in-person, 274 students reported that the maximum number of people they played DGs with in-person exceeded the CDC's recommended guidelines (10 + people). Accounting for demographics, general alcohol use, and perceived COVID-19 threat, social drinking motives were positively associated with an increased likelihood of playing DGs in-person; the inverse was found for coping motives. Drinking motives were not associated with the likelihood of playing DGs with 10 + people but greater alcohol use and lower perceived threat of COVID-19 were. Given that the pandemic did not deter many student drinkers from playing DGs in-person, further investment in targeted intervention and public health initiatives aimed at substance-free alternatives promoting engagement and enhancement of social activities may be needed.

Investigating pathways from anxiety sensitivity to impairment in a treatment-seeking sample.

BACKGROUND: Previous research suggests that high anxiety sensitivity (AS) - a fear of arousal-related body sensations - may have implications not only for mental health symptoms but also for functional impairment. The aim of the present study was to examine whether elevated AS is associated with functional impairment by way of heightened anxiety symptoms and resultant depressive symptoms or unhealthy coping behaviours (i.e., alcohol use, exercise avoidance, sleep problems) in a chained mediation model. METHOD: Participants were 128 treatment-seeking individuals with high AS who qualified for an anxiety, depression, or posttraumatic stress disorder diagnosis. They completed self-report measures of AS, anxiety, depression, and unhealthy coping behaviours as part of a pre-treatment assessment battery for a larger study examining the efficacy of a cognitive behavioural intervention for AS. Data were analyzed using path analysis. RESULTS: Results revealed a direct association between AS and functional impairment that was partially mediated through a chained indirect pathway from AS to anxiety symptoms to depression symptoms to functional impairment. Unhealthy coping behaviours did not serve as mediators. LIMITATIONS: Results are limited by the cross-sectional nature of the data. CONCLUSIONS: The present findings have clinical implications insofar as supporting the relevance of reducing AS and focusing on depressive symptoms when seeking to improve clients' functioning.

C-L Case Conference: Torsades de Pointes in a Patient With Lifelong Medical Trauma, COVID-19, Remdesivir, Citalopram, Quetiapine, and Hemodialysis.

We present a case of Torsades de Pointes (TdP) in a patient with COVID-19 infection and multiple TdP risk factors including QT-interval prolongation, hemodialysis, bradycardia, and treatment with remdesivir, citalopram, and quetiapine. The case was complicated by post-resuscitation anxiety superimposed on a history of medical trauma since childhood. Top experts in the field of consultation-liaison psychiatry, trauma informed care, and cardiac electrophysiology provide perspectives on this case with a review of the literature. Key teaching topics include identification of TdP risk factors in patients with a complex illness; the necessity for prompt electrophysiology consultation in clinical scenarios with high risk for TdP; and the approach to patients with medical trauma using a trauma-informed lens. We highlight the contributions of COVID-19, the pharmacokinetics of QT-interval-prolonging psychotropic medications, the risks of hemodialysis, and the role of remdesivir-induced bradycardia in this first reported case of TdP in a patient treated with remdesivir.