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Hogoboom A, Rouch M, Lauerman D, Pauselli L, Compton MT. Initial evidence of vowel space reduction in a subset of individuals with schizophrenia. Schizophr Res 2023; 255:158-164. [PMID: 36989674 DOI: 10.1016/j.schres.2023.03.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 03/06/2023] [Accepted: 03/12/2023] [Indexed: 03/31/2023]
Abstract
OBJECTIVE Acoustic phonetic measures have been found to correlate with negative symptoms of schizophrenia, thus offering a path toward quantitative measurement of such symptoms. These acoustic properties include F1 and F2 measurements (affected by tongue height and tongue forward/back position, respectively), which determine a general "vowel space." Among patients and controls, we consider two phonetic measures of vowel space: average Euclidean distance from a participant's mean F1 and mean F2, and density of vowels around one standard deviation of mean F1 and of F2. METHODS Structured and spontaneous speech of 148 participants (70 patients and 78 controls) was recorded and measured acoustically. We examined correlations between the phonetic measures of vowel space and ratings of aprosody obtained using two clinical research measures, the Scale for the Assessment of Negative Symptoms (SANS) and the Clinical Assessment Interview for Negative Symptoms (CAINS). RESULTS Vowel space measurements were significantly associated with patient/control status, attributed to a cluster of 13 patients whose phonetic values correspond to reduced vowel space as assessed by both phoenetic measures. No correlation was found between phonetic measures and relevant items and averages of ratings on the SANS and CAINS. Reduced vowel space appears to affect only a subset of patients with schizophrenia, potentially those on higher antipsychotic dosages. CONCLUSIONS Acoustic phonetic measures may be more sensitive measures of constricted vowel space than clinical research rating scales of aprosody or monotone speech. Replications are needed before further interpretation of this novel finding, including potential medication effects.
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Affiliation(s)
- Anya Hogoboom
- William & Mary, Department of English, Linguistics Program, Williamsburg, VA, USA
| | - Megan Rouch
- William & Mary, Department of English, Linguistics Program, Williamsburg, VA, USA
| | - Diana Lauerman
- William & Mary, Department of English, Linguistics Program, Williamsburg, VA, USA
| | - Luca Pauselli
- Icahn School of Medicine at Mount Sinai, Morningside/West Hospitals, Department of Psychiatry, New York, NY, USA
| | - Michael T Compton
- Columbia University Vagelos College of Physicians and Surgeons, Department of Psychiatry, New York, NY, USA; New York State Psychiatric Institute, New York, NY, USA.
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2
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Compton MT, Kelley ME, Anderson S, Ellis S, Graves J, Broussard B, Pauselli L, Zern A, Pope LG, Johnson M, Haynes NL. Opening Doors to Recovery: A Randomized Controlled Trial of a Recovery-Oriented Community Navigation Service for Individuals With Serious Mental Illnesses and Repeated Hospitalizations. J Clin Psychiatry 2023; 84. [PMID: 36652687 DOI: 10.4088/jcp.22m14498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Objective: Opening Doors to Recovery (ODR) is a community navigation and recovery support model created in southeast Georgia by diverse, collaborative stakeholders. Following promising results from a quasi-experimental study, this randomized controlled trial hypothesized that, among patients with serious mental illnesses being discharged from inpatient psychiatric settings, compared to those randomized to traditional case management (CM) services, those randomized to ODR would have (1) lower likelihood of hospitalization, fewer hospitalizations, and fewer inpatient days; (2) lower likelihood of arrest, fewer arrests, and longer time to arrest; and, secondarily, (3) greater housing satisfaction and housing stability; and (4) higher scores on several scales measuring recovery-related constructs. Methods: 240 individuals with Structured Clinical Interview for DSM-5 Disorders-based psychotic or mood disorders, functional impairment, and repeated hospitalizations were randomized (December 2014 to June 2018) to ODR or CM. Hospitalization and arrest data were collected from State agencies after 12 months, and housing- and recovery-related measures were collected in person, longitudinally at 4, 8, and 12 months. Intention-to-treat analyses were conducted. Effects of dropout were accounted for, and sensitivity analyses were run. Results: ODR was associated with fewer days hospitalized (RR = 0.86, P = .001), a lower incidence of arrests (OR = 0.35, P < .0005), and longer time to arrest (HR = 0.42, P = .001). In addition, measures of housing satisfaction (Cohen d = 0.45) and recovery (Cohen d = 0.33) were significantly more improved in ODR patients compared to CM patients. Conclusions: The ODR model appears to have advantages over more traditional CM services and could fill a gap in the service array. Studying the mediators of success, cost benefit, dissemination, fidelity, and financing of the model is warranted. Trial Registration: ClinicalTrials.gov identifier: NCT04612777.
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Affiliation(s)
- Michael T Compton
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, New York.,New York State Psychiatric Institute, New York, New York.,Corresponding author: Michael T. Compton, MD, MPH, Columbia University Vagelos College of Physicians and Surgeons, Department of Psychiatry, 722 W. 168th St, Room R249, New York, NY 10032
| | - Mary E Kelley
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health at Emory University, Atlanta, Georgia
| | | | | | | | - Beth Broussard
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Luca Pauselli
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, Morningside/West Hospitals, New York, New York
| | - Adria Zern
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, New York
| | - Leah G Pope
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, New York.,New York State Psychiatric Institute, New York, New York
| | - Mark Johnson
- Gateway Behavioral Health Services, Savannah, Georgia
| | - Nora Lott Haynes
- National Alliance on Mental Illness (NAMI) Georgia, Atlanta, Georgia
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3
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Compton MT, Graves J, Zern A, Pauselli L, Anderson S, Ashekun O, Ellis S, Langlois S, Pope L, Watson AC, Wood J. Characterizing Arrests and Charges Among Individuals With Serious Mental Illnesses in Public-Sector Treatment Settings. Psychiatr Serv 2022; 73:1102-1108. [PMID: 35378991 DOI: 10.1176/appi.ps.202000581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Individuals with serious mental illnesses are overrepresented in all facets of the legal system. State-level criminal histories of patients with serious mental illnesses were analyzed to determine the proportion who had been arrested and number of lifetime arrests and charges, associations of six variables with number of arrests, and the most common charges from individuals’ first two arrests and most recent two arrests. METHODS A total of 240 patients were recruited at three inpatient psychiatric facilities and gave consent to access their criminal history. Information was extracted from Record of Arrest and Prosecution (RAP) sheets for lifetime arrests in Georgia. RESULTS A total of 171 (71%) had been arrested. Their mean±SD lifetime arrests were 8.6±10.1, and mean lifetime charges were 12.6±14.6. In a Poisson regression, number of arrests was associated with lower educational attainment, Black or African American race, the presence of a substance use disorder, the presence of a mood disorder, and female sex. Common early charges included marijuana possession, driving under the influence of alcohol, and burglary and shoplifting. Common recent charges included probation violations, failure to appear in court, officer obstruction–related charges, and disorderly conduct. CONCLUSIONS Findings point to a need for policy and program development in the legal system (e.g., pertaining to charges such as willful obstruction of an officer), the mental health community (e.g., to ensure that professionals know about clients’ legal involvement and can partner in strategies to reduce arrests), and social services sectors (to address charges, such as shoplifting, often related to material disadvantage).
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Affiliation(s)
- Michael T Compton
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Compton, Zern, Pope); Gateway Behavioral Health Services, Savannah, Georgia (Graves, Anderson, Ellis); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, and St. Luke's/West Hospital Center, New York City (Pauselli); DeKalb Community Service Board, Atlanta (Ashekun, Langlois); Helen Bader School of Social Welfare, University of Wisconsin-Milwaukee, Milwaukee (Watson); Department of Criminal Justice, College of Liberal Arts, Temple University, Philadelphia (Wood)
| | - JaShala Graves
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Compton, Zern, Pope); Gateway Behavioral Health Services, Savannah, Georgia (Graves, Anderson, Ellis); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, and St. Luke's/West Hospital Center, New York City (Pauselli); DeKalb Community Service Board, Atlanta (Ashekun, Langlois); Helen Bader School of Social Welfare, University of Wisconsin-Milwaukee, Milwaukee (Watson); Department of Criminal Justice, College of Liberal Arts, Temple University, Philadelphia (Wood)
| | - Adria Zern
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Compton, Zern, Pope); Gateway Behavioral Health Services, Savannah, Georgia (Graves, Anderson, Ellis); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, and St. Luke's/West Hospital Center, New York City (Pauselli); DeKalb Community Service Board, Atlanta (Ashekun, Langlois); Helen Bader School of Social Welfare, University of Wisconsin-Milwaukee, Milwaukee (Watson); Department of Criminal Justice, College of Liberal Arts, Temple University, Philadelphia (Wood)
| | - Luca Pauselli
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Compton, Zern, Pope); Gateway Behavioral Health Services, Savannah, Georgia (Graves, Anderson, Ellis); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, and St. Luke's/West Hospital Center, New York City (Pauselli); DeKalb Community Service Board, Atlanta (Ashekun, Langlois); Helen Bader School of Social Welfare, University of Wisconsin-Milwaukee, Milwaukee (Watson); Department of Criminal Justice, College of Liberal Arts, Temple University, Philadelphia (Wood)
| | - Simone Anderson
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Compton, Zern, Pope); Gateway Behavioral Health Services, Savannah, Georgia (Graves, Anderson, Ellis); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, and St. Luke's/West Hospital Center, New York City (Pauselli); DeKalb Community Service Board, Atlanta (Ashekun, Langlois); Helen Bader School of Social Welfare, University of Wisconsin-Milwaukee, Milwaukee (Watson); Department of Criminal Justice, College of Liberal Arts, Temple University, Philadelphia (Wood)
| | - Oluwatoyin Ashekun
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Compton, Zern, Pope); Gateway Behavioral Health Services, Savannah, Georgia (Graves, Anderson, Ellis); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, and St. Luke's/West Hospital Center, New York City (Pauselli); DeKalb Community Service Board, Atlanta (Ashekun, Langlois); Helen Bader School of Social Welfare, University of Wisconsin-Milwaukee, Milwaukee (Watson); Department of Criminal Justice, College of Liberal Arts, Temple University, Philadelphia (Wood)
| | - Samantha Ellis
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Compton, Zern, Pope); Gateway Behavioral Health Services, Savannah, Georgia (Graves, Anderson, Ellis); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, and St. Luke's/West Hospital Center, New York City (Pauselli); DeKalb Community Service Board, Atlanta (Ashekun, Langlois); Helen Bader School of Social Welfare, University of Wisconsin-Milwaukee, Milwaukee (Watson); Department of Criminal Justice, College of Liberal Arts, Temple University, Philadelphia (Wood)
| | - Stephanie Langlois
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Compton, Zern, Pope); Gateway Behavioral Health Services, Savannah, Georgia (Graves, Anderson, Ellis); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, and St. Luke's/West Hospital Center, New York City (Pauselli); DeKalb Community Service Board, Atlanta (Ashekun, Langlois); Helen Bader School of Social Welfare, University of Wisconsin-Milwaukee, Milwaukee (Watson); Department of Criminal Justice, College of Liberal Arts, Temple University, Philadelphia (Wood)
| | - Leah Pope
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Compton, Zern, Pope); Gateway Behavioral Health Services, Savannah, Georgia (Graves, Anderson, Ellis); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, and St. Luke's/West Hospital Center, New York City (Pauselli); DeKalb Community Service Board, Atlanta (Ashekun, Langlois); Helen Bader School of Social Welfare, University of Wisconsin-Milwaukee, Milwaukee (Watson); Department of Criminal Justice, College of Liberal Arts, Temple University, Philadelphia (Wood)
| | - Amy C Watson
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Compton, Zern, Pope); Gateway Behavioral Health Services, Savannah, Georgia (Graves, Anderson, Ellis); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, and St. Luke's/West Hospital Center, New York City (Pauselli); DeKalb Community Service Board, Atlanta (Ashekun, Langlois); Helen Bader School of Social Welfare, University of Wisconsin-Milwaukee, Milwaukee (Watson); Department of Criminal Justice, College of Liberal Arts, Temple University, Philadelphia (Wood)
| | - Jennifer Wood
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Compton, Zern, Pope); Gateway Behavioral Health Services, Savannah, Georgia (Graves, Anderson, Ellis); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, and St. Luke's/West Hospital Center, New York City (Pauselli); DeKalb Community Service Board, Atlanta (Ashekun, Langlois); Helen Bader School of Social Welfare, University of Wisconsin-Milwaukee, Milwaukee (Watson); Department of Criminal Justice, College of Liberal Arts, Temple University, Philadelphia (Wood)
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4
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Rosenfield PJ, Jiang D, Pauselli L. Childhood adversity and psychotic disorders: Epidemiological evidence, theoretical models and clinical considerations. Schizophr Res 2022; 247:55-66. [PMID: 34210561 DOI: 10.1016/j.schres.2021.06.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 05/31/2021] [Accepted: 06/04/2021] [Indexed: 02/08/2023]
Abstract
While genetic factors play a critical role in the risk for schizophrenia and other psychotic disorders, increasing evidence points to the role of childhood adversity as one of several environmental factors that can significantly impact the development, manifestations and outcome of these disorders. This paper reviews the epidemiological evidence linking childhood adversity and psychotic disorders and explores various theoretical models that seek to explain the connection. We discuss neurobiological parallels between the impact of childhood trauma and psychosis on the brain and then explore the impact of childhood adversity on different domains of clinical presentation. Finally, implications for prevention and treatment are considered, both on individual and structural levels.
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Affiliation(s)
- Paul J Rosenfield
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, United States of America.
| | - David Jiang
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, United States of America.
| | - Luca Pauselli
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, United States of America.
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5
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Abstract
There is a sparse literature on women who hear voices globally, even though there are documented gendered dimensions of distress in the context of globalization and climate change and research indicates that trauma and psychosocial stress may be related to an increased prevalence of voice-hearing or auditory verbal hallucinations (AVHs). There is also a gap in the cultural phenomenology of voice-hearing in general, as well as idioms of distress for non-western peoples. This article presents results of a mixed methods study that: 1) estimated community prevalence of voice-hearing among Maasai women in northern Tanzania; 2) examined any demographic correlates and two specific hypothesized correlates (i.e., psychological stress and potentially traumatic events); and 3) engaged women in semi-structured interviews about their everyday lives and the phenomenological experience of voice-hearing. The prevalence of voice-hearing (39.4%) in this nonclinical sample (n = 71) was quite high compared to other studies in sub-Saharan Africa. Most women also reported high psychosocial stress and traumatic life events. They also talked about gendered conditions of social adversity in a context of rapid social, economic, and climate change. Women who reported hearing voices had a statistically significantly higher level of psychological distress, met criteria for severe psychological distress, and reported more potentially traumatic life events. In a logistic regression model, psychosocial stress predicted voice-hearing. The presence of distressing voices may offer a straightforward way to quickly identify people in the community experiencing the most extreme levels of psychosocial stress and traumatic events-a potentially simple but effective screening tool for health workers on the ground.
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Affiliation(s)
- Neely Myers
- Southern Methodist University, Department of Anthropology, Dallas, Texas
- University of Texas-Southwestern Medical School, Department of Psychiatry, Dallas, Texas
| | | | - Luca Pauselli
- Icahn School of Medicine at Mount Sinai, Mount Sinai Morningside/West, Department of Psychiatry, New York, New York
| | - Marne Chacon
- Southern Methodist University, Department of Anthropology, Dallas, Texas
| | - Michael Compton
- Columbia University Vagelos College of Physicians and Surgeons
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6
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Lilli A, Parollo M, Mazzocchetti L, De Sensi F, Rossi A, Notarstefano P, Santoro A, Aquaro GD, Cresti A, Lapira F, Faggioni L, Tessa C, Pauselli L, Bongiorni MG, Berruezo A, Zucchelli G. Ventricular tachycardia ablation guided or aided by scar characterization with cardiac magnetic resonance: rationale and design of VOYAGE study. BMC Cardiovasc Disord 2022; 22:169. [PMID: 35421939 PMCID: PMC9012027 DOI: 10.1186/s12872-022-02581-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 03/23/2022] [Indexed: 11/26/2022] Open
Abstract
Background Radiofrequency ablation has been shown to be a safe and effective treatment for scar-related ventricular arrhythmias (VA). Recent preliminary studies have shown that real time integration of late gadolinium enhancement cardiac magnetic resonance (LGE-CMR) images with electroanatomical map (EAM) data may lead to increased procedure efficacy, efficiency, and safety. Methods VOYAGE is a prospective, randomized, multicenter controlled open label study designed to compare in terms of efficacy, efficiency, and safety a CMR aided/guided workflow to standard EAM-guided ventricular tachycardia (VT) ablation. Patients with an ICD or with ICD implantation expected within 1 month, with scar related VT, suitable for CMR and multidetector computed tomography (MDCT) will be randomized to a CMR-guided or CMR-aided approach, whereas subjects unsuitable for imaging or with image quality deemed not sufficient for postprocessing will be allocated to standard of care ablation. Primary endpoint is defined as VT recurrences (sustained or requiring appropriate ICD intervention) during 12 months follow-up, excluding the first month of blanking period. Secondary endpoints will include procedural efficiency, safety, impact on quality of life and comparison between CMR-guided and CMR-aided approaches. Patients will be evaluated at 1, 6 and 12 months. Discussion The clinical impact of real time CMR-guided/aided ablation approaches has not been thoroughly assessed yet. This study aims at defining whether such workflow results in more effective, efficient, and safer procedures. If proven to be of benefit, results from this study could be applied in large scale interventional practice. Trial registrationClinicalTrials.gov, NCT04694079, registered on January 1, 2021.
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7
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Ku BS, Pauselli L, Covington MA, Compton MT. Computational linguistic analysis applied to a semantic fluency task: A replication among first-episode psychosis patients with and without derailment and tangentiality. Psychiatry Res 2021; 304:114105. [PMID: 34298424 PMCID: PMC8719331 DOI: 10.1016/j.psychres.2021.114105] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 07/02/2021] [Accepted: 07/05/2021] [Indexed: 12/01/2022]
Abstract
Automated tools do not yet exist to measure formal thought disorder, including derailment and tangentiality, both of which can be subjectively rated using the Scale for the Assessment of Positive Symptoms after a clinical research interview. CoVec, a new automated tool, measures the semantic similarity among words averaged in a five- and ten-word window (Coherence-5 and Coherence-10, respectively). One prior report demonstrated that this tool was able to differentiate between patients with those types of thought disorder and patients without them (and controls). Here, we attempted a replication of the initial findings using data from a different sample of patients hospitalized for initial evaluation of first-episode psychosis. Participants were administered a semantic fluency task and the animal lists were analyzed with CoVec. In this study, we partially replicated the prior findings, showing that first-episode patients with derailment had significantly lower Coherence-5 and Coherence-10 compared with patients without derailment. Further research is warranted on this and other highly reliable and objective methods of detecting formal thought disorder through simple assessments such as semantic fluency tasks.
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Affiliation(s)
- Benson S. Ku
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Luca Pauselli
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, Morningside/West Hospital Center, New York, NY, USA
| | | | - Michael T. Compton
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA,New York State Psychiatric Institute, New York, NY, USA,Corresponding author: Michael T. Compton, M.D., M.P.H., New York State Psychiatric Institute, 722 W. 168 Street, Room R249, New York, NY 10032. Tel: 646-774-8476.
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8
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Affiliation(s)
- Paul J Rosenfield
- Department of Psychiatry, Icahn School of Medicine at
Mount Sinai, New York, NY
| | - Luca Pauselli
- Department of Psychiatry, Icahn School of Medicine at
Mount Sinai, New York, NY
| | - David Jiang
- Department of Psychiatry, Icahn School of Medicine at
Mount Sinai, New York, NY
| | - Dolores Malaspina
- Department of Psychiatry, Icahn School of Medicine at
Mount Sinai, New York, NY
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9
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Rolin SA, Bareis N, Bradford JM, Rotter M, Rosenfeld B, Pauselli L, Compton MT, Stroup TS, Appelbaum PS, Dixon LB. Violence risk assessment for young adults receiving treatment for early psychosis. Int J Law Psychiatry 2021; 76:101701. [PMID: 33887604 PMCID: PMC8140412 DOI: 10.1016/j.ijlp.2021.101701] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 03/22/2021] [Accepted: 04/11/2021] [Indexed: 06/12/2023]
Abstract
AIM Although the absolute risk of violence is small for individuals with mental illnesses, a specific subgroup of individuals who appear to be at increased risk for violence includes young people experiencing emerging or early psychosis. Prior research has identified risk factors for violence in this population, though no prior studies using a formal risk assessment tool have been identified. This study used the Historical Clinical Risk Management-20, version 3 (HCR-20) to identify risk of future violence among a sample of young adults with early psychosis and relevant predictors of risk unique to this population. METHODS The HCR-20 was administered to a sample of young adults with early psychosis (N = 53) enrolled at one OnTrackNY site, part of a statewide program providing early intervention services to young adults presenting with a first episode of non-affective psychosis. A Confirmatory Factor Analysis (CFA) was conducted to explore the relative importance of the HCR-20 items for this population. RESULTS The average age of participants was 21.9 years (SD 3.6 years) and most were male (69.8%, n = 37). Most patients were assessed to be at low risk for future violence based on the Case Prioritization summary risk rating (67.9%, n = 36). The CFA identified 4 items that were not of relative predictive value in identifying the risk of violence in this sample: history of substance use (item H5), history of major mental disorder (item H6), living situation (item R2), and personal support (item R3). CONCLUSION This study presents a formal approach to assessing violence risk in a population at elevated risk of violence, demonstrates the feasibility of using a standardized risk assessment tool in early intervention services, and identifies factors of particular importance associated with predicting violence in this population. Future research should implement violence risk assessment with a structured tool such as the HCR-20 and assess its accuracy in predicting future violent behavior in this setting.
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Affiliation(s)
- Stephanie A Rolin
- Department of Psychiatry, Columbia University Irving Medical Center and New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, USA.
| | - Natalie Bareis
- Department of Psychiatry, Columbia University Irving Medical Center and New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, USA
| | - Jean-Marie Bradford
- Department of Psychiatry, Columbia University Irving Medical Center and New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, USA
| | - Merrill Rotter
- Department of Psychiatry, Albert Einstein College of Medicine, New York, NY, USA
| | - Barry Rosenfeld
- Department of Psychology, Fordham University, NY, New York, USA
| | - Luca Pauselli
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, Mount Sinai Morningside/West, New York, NY, USA
| | - Michael T Compton
- Department of Psychiatry, Columbia University Irving Medical Center and New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, USA
| | - T Scott Stroup
- Department of Psychiatry, Columbia University Irving Medical Center and New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, USA
| | - Paul S Appelbaum
- Department of Psychiatry, Columbia University Irving Medical Center and New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, USA
| | - Lisa B Dixon
- Department of Psychiatry, Columbia University Irving Medical Center and New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, USA
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10
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van der Ven E, Scodes J, Basaraba C, Pauselli L, Mascayano F, Nossel I, Bello I, Humensky J, Susser E, Wall M, Dixon L. Trajectories of occupational and social functioning in people with recent-onset non-affective psychosis enrolled in specialized early intervention services across New York state. Schizophr Res 2020; 222:218-226. [PMID: 32513547 PMCID: PMC8273912 DOI: 10.1016/j.schres.2020.05.051] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 04/03/2020] [Accepted: 05/19/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Despite the benefits of early intervention services for the initial stages of psychosis ongoing impairments in functioning are common. AIMS To identify 1-year trajectories of occupational and social functioning in individuals enrolled in OnTrackNY, a statewide program offering early intervention services for recent-onset psychosis in community settings. METHOD We included 937 persons with recent-onset psychosis enrolled at 19 programs across New York State. Demographic, social and clinical data was collected at program entry and at 3, 6, 9 and 12 months. We used growth mixture models to identify occupational and social functioning trajectories and examined the association between trajectory class, baseline factors and symptoms during 1-year follow-up. RESULTS Four distinct trajectory classes of occupational and social functioning were identified. The converging (58.0%) class had disparate levels of functioning at baseline (low occupational, higher social) which eventually converged. The other classes had high-stable (14.8%), moderate-stable (17.8%) and low-improving (9.4%) trajectories. Female gender, educational attainment and private insurance status were significantly associated with the trajectory characterized by higher functioning, while living alone, homelessness, a longer period from psychosis onset to program enrollment, a schizophrenia diagnosis and cannabis use at enrollment were associated with the poorest trajectory. The differences in severity of symptoms by trajectory class diminished over time. CONCLUSIONS Trajectories of occupational and social functioning showed substantial variation, but overall, remained stable or improved during 1-year follow-up. The relationship between symptoms and occupational and social functioning attenuated after the acute treatment phase.
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Affiliation(s)
- Els van der Ven
- Mailman School of Public Health, Columbia University, New York, NY, USA; School for Mental Health and Neuroscience (MHeNS), Maastricht University, Maastricht, the Netherlands.
| | - Jennifer Scodes
- Mental Health Data Science, Columbia University, New York, NY, USA,New York State Psychiatric Institute, New York, NY, USA
| | - Cale Basaraba
- Mental Health Data Science, Columbia University, New York, NY, USA,New York State Psychiatric Institute, New York, NY, USA
| | - Luca Pauselli
- New York State Psychiatric Institute, New York, NY, USA,Division of Behavioral Health Services and Policy Research, Columbia University, New York, NY, USA
| | - Franco Mascayano
- Mailman School of Public Health, Columbia University, New York, NY, USA,New York State Psychiatric Institute, New York, NY, USA
| | - Ilana Nossel
- New York State Psychiatric Institute, New York, NY, USA,Division of Behavioral Health Services and Policy Research, Columbia University, New York, NY, USA
| | - Iruma Bello
- New York State Psychiatric Institute, New York, NY, USA,Division of Behavioral Health Services and Policy Research, Columbia University, New York, NY, USA
| | | | - Ezra Susser
- Mailman School of Public Health, Columbia University, New York, NY, USA,New York State Psychiatric Institute, New York, NY, USA
| | - Melanie Wall
- Mailman School of Public Health, Columbia University, New York, NY, USA,New York State Psychiatric Institute, New York, NY, USA
| | - Lisa Dixon
- New York State Psychiatric Institute, New York, NY, USA,Division of Behavioral Health Services and Policy Research & Center for Practice Innovations, Columbia University, New York, NY, USA
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Ku BS, Pauselli L, Manseau M, Compton MT. Neighborhood-level predictors of age at onset and duration of untreated psychosis in first-episode psychotic disorders. Schizophr Res 2020; 218:247-254. [PMID: 31948900 PMCID: PMC7299734 DOI: 10.1016/j.schres.2019.12.036] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 11/20/2019] [Accepted: 12/27/2019] [Indexed: 01/18/2023]
Abstract
OBJECTIVE Recent years have witnessed growing interest in the role of the social environment in the development and outcomes of schizophrenia. We investigated whether neighborhood characteristics are associated with two important prognostic factors in early-course psychosis, age at onset of psychosis (AOP) and duration of untreated psychosis (DUP). METHODS Data were collected from patients admitted to the hospital for first-episode schizophrenia-spectrum disorder. We collected data on perceived neighborhood disorder during childhood/adolescence and extracted data on 13 neighborhood characteristics from the American Community Survey based upon individual addresses. Four neighborhood-level factors were derived from factor analysis. Multiple logistic regression analyses assessed the association between specific neighborhood characteristics and the two prognostic factors (earlier AOP and longer DUP) in early-course psychosis. RESULTS 143 participants had valid addresses geo-coded. Neighborhood-level residential instability was associated with an earlier AOP (OR = 1.760; p = 0.022) even after controlling for known risk factors (OR = 2.026; p = 0.020) and also after controlling for individual-level residential instability (OR = 1.917; p = 0.037). The general socioeconomic status neighborhood factor (OR = 1.119; p = 0.019) and perceived neighborhood disorder (OR = 1.075; p = 0.005) were associated with a longer DUP. But only perceived neighborhood disorder (OR = 1.146; p = 0.011) remained significant, and general socioeconomic status was close to significant (OR = 1.215; p = 0.062), after controlling for individual-level predictors and socioeconomic status. CONCLUSIONS This study found evidence that neighborhood-level characteristics (in this case, residential instability) may be associated with earlier AOP, and perceptions of neighborhood disorder are associated with a longer treatment delay. Socioenvironmental factors should be more consistently considered going forward in research on early psychotic disorders.
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Affiliation(s)
- Benson S. Ku
- Emory University School of Medicine, Department of Psychiatry and Behavioral Sciences, Atlanta, GA, USA,Corresponding author: Benson Ku, M.D., , 100 Woodruff Circle Suite 327, Atlanta, GA 30322, (404) 727-8381, Fax: 289-802-1992
| | - Luca Pauselli
- Columbia University Vagelos College of Physicians and Surgeons, Department of Psychiatry, New York State Psychiatric Institute, New York, NY, USA,Icahn School of Medicine at Mount Sinai, St. Luke’s/West Hospital Center, Department of Psychiatry, New York, NY, USA
| | - Marc Manseau
- New York University School of Medicine, Department of Psychiatry, New York, NY, USA
| | - Michael T. Compton
- Columbia University Vagelos College of Physicians and Surgeons, Department of Psychiatry, New York State Psychiatric Institute, New York, NY, USA
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12
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Langlois S, Pauselli L, Anderson S, Ashekun O, Ellis S, Graves J, Zern A, Gaffney E, Shim RS, Compton MT. Effects of perceived social status and discrimination on hope and empowerment among individuals with serious mental illnesses. Psychiatry Res 2020; 286:112855. [PMID: 32092596 PMCID: PMC7775621 DOI: 10.1016/j.psychres.2020.112855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 02/06/2020] [Accepted: 02/06/2020] [Indexed: 10/25/2022]
Abstract
Hope and empowerment are key elements of recovery in the context of serious mental illnesses (SMI). We examined predictors of hope among individuals with SMI and tested a hypothesized path model in which perceived social status and perceived discrimination adversely impact hope, directly and through their impacts on depressive symptoms. Data from 232 individuals with SMI receiving care in public-sector settings were used in both a multiple linear regression (predicting Herth Hope Scale scores), and in path analyses examining both direct and indirect effects of perceived social status (Social Status Ladder) and perceived discrimination (Everyday Discrimination Scale). Depressive symptoms, perceived social status, and perceived discrimination were predictive of hope. Path analyses revealed that perceived social status has a direct effect on hope and empowerment but also impacts hope through its effects on depression. Similarly, perceived everyday discrimination affects hope and empowerment, though this effect is mediated through its effects on depression. Two alternative models and a trimmed hypothesized model did not fit the data or improve fit. These social determinants of mental health should provoke program and policy change to improve mental health and enhance recovery among persons with SMI.
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Affiliation(s)
| | - Luca Pauselli
- Icahn School of Medicine at Mount Sinai, St. Luke's/West Hospital Center, Department of Psychiatry, 1 Gustave L. Levy Place, New York, NY, USA
| | - Simone Anderson
- Gateway Behavioral Health Services, 800 E 70th St, Savannah, GA, USA
| | | | - Samantha Ellis
- Gateway Behavioral Health Services, 800 E 70th St, Savannah, GA, USA
| | - JaShala Graves
- Gateway Behavioral Health Services, 800 E 70th St, Savannah, GA, USA
| | - Adria Zern
- Columbia University Vagelos College of Physicians and Surgeons, Department of Psychiatry, 722 W. 168(th) Street, New York, NY, USA
| | - Ebony Gaffney
- Gateway Behavioral Health Services, 800 E 70th St, Savannah, GA, USA
| | - Ruth S Shim
- University of California, Davis, Department of Psychiatry and Behavioral Sciences, 2230 Stockton Blvd, Sacramento, CA, USA
| | - Michael T Compton
- Columbia University Vagelos College of Physicians and Surgeons, Department of Psychiatry, 722 W. 168(th) Street, New York, NY, USA.
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13
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Compton MT, Bakeman R, Capulong L, Pauselli L, Alolayan Y, Crisafio A, King K, Reed T, Broussard B, Shim R. Associations Between Two Domains of Social Adversity and Recovery Among Persons with Serious Mental Illnesses Being Treated in Community Mental Health Centers. Community Ment Health J 2020; 56:22-31. [PMID: 31552538 DOI: 10.1007/s10597-019-00462-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 09/07/2019] [Indexed: 11/24/2022]
Abstract
As mental health services are increasingly embracing the recovery model, we conducted a study to better understand how social adversity impacts recovery. We also examined how associations between social adversity and recovery are influenced (moderated or mediated) by symptom severity. Data on seven social adversity measures, eight recovery measures, and symptom severity were collected from 300 English-speaking participants, ages 18-65 years, with a diagnosis of a psychotic or mood disorder, from five community mental health agencies in diverse neighborhoods in Washington, D.C. We employed standard correlation, exploratory factor analyses, analysis of variance, and hierarchic regression procedures. Diagnostic category and gender impacted Home Environment Adversities (e.g., food insecurity, perceived neighborhood disorder), the diagnostic category-by-gender interaction influenced Social and Economic Adversities (e.g., years of education and income), and gender affected Recovery. Controlling for diagnostic category and gender, Social and Economic Adversities accounted for 1.7% of variance in Recovery, while Home Environment Adversities accounted for 8.6% (their joint influence was 3.4%). Although symptom severity did not moderate these associations, it partially mediated the effect of Social and Economic Adversities on Recovery, and substantially mediated the effect of Home Environment Adversities on Recovery. The extent to which patients with serious mental illnesses experience recovery may be meaningfully influenced not only by symptoms, but by their social and environmental circumstances.
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Affiliation(s)
- Michael T Compton
- Division of Behavioral Health Services and Policy Research, Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY, USA.
| | - Roger Bakeman
- Department of Psychology, Georgia State University, Atlanta, GA, USA
| | | | - Luca Pauselli
- Division of Behavioral Health Services and Policy Research, Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Yazeed Alolayan
- Department of Neurology, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Anthony Crisafio
- Department of Psychiatry and Behavioral Sciences, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Kelly King
- Department of Psychiatry and Behavioral Sciences, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Thomas Reed
- Department of Psychiatry and Behavioral Sciences, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Beth Broussard
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Ruth Shim
- Department of Psychiatry and Behavioral Sciences, UC Davis School of Medicine, Sacramento, CA, USA
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14
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Bernardini F, Attademo L, Trezzi R, Gobbicchi C, Balducci P, Del Bello V, Menculini G, Pauselli L, Piselli M, Sciarma T, Moretti P, Tamantini A, Quartesan R, Compton M, Tortorella A. Air pollutants and daily number of admissions to psychiatric emergency services: evidence for detrimental mental health effects of ozone. Epidemiol Psychiatr Sci 2019; 29:e66. [PMID: 31690359 PMCID: PMC8061137 DOI: 10.1017/s2045796019000623] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 10/07/2019] [Accepted: 10/09/2019] [Indexed: 11/23/2022] Open
Abstract
AIMS Aim of the current study is to investigate the associations between daily levels of air pollutants (particulate matter, ozone, carbon monoxide, nitrogen dioxide) and daily admissions for mental disorders to the emergency department of two general hospitals in Umbria region (Italy). METHODS We collected data about daily admissions to psychiatric emergency services of two general hospitals, air pollutants' levels and meteorological data for the time period 1 January 2015 until 31 December 2016. We assessed the impact of an increase in air pollutants on the number of daily admissions using a time-series econometric framework. RESULTS A total of 1860 emergency department admissions for mental disorders were identified. We observed a statistically significant impact of ozone levels on daily admissions. The estimated coefficient of O3 is statistically significant at the 1% level. All other pollutants were not significantly associated with the number of daily admissions. CONCLUSIONS Short-term exposure to ozone may be associated with increased psychiatric emergency services admissions. Findings add to previous literature on existing evidence for air pollution to have an impact on mental health. Ozone may be considered a potential environmental risk factor for impaired mental health.
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Affiliation(s)
- F. Bernardini
- Department of Mental Health, AAS5 ‘Friuli Occidentale’, Pordenone, Italy
| | - L. Attademo
- Department of Mental Health, ASP Basilicata, Potenza, Italy
| | - R. Trezzi
- Research and Statistics Division, Board of Governors of the Federal Reserve System, Washington, DC, USA
| | - C. Gobbicchi
- Department of Mental Health, AUSL Umbria 2, Terni, Italy
| | - P.M. Balducci
- Division of Psychiatry, Department of Medicine, University of Perugia, Perugia, Italy
| | - V. Del Bello
- Division of Psychiatry, Department of Medicine, University of Perugia, Perugia, Italy
| | - G. Menculini
- Division of Psychiatry, Department of Medicine, University of Perugia, Perugia, Italy
| | - L. Pauselli
- Columbia University, College of Physicians & Surgeons, New York, USA
| | - M. Piselli
- Department of Mental Health, AUSL Umbria 2, Terni, Italy
- Functional Area of Psychiatry, University of Perugia, Perugia, Italy
| | - T. Sciarma
- Division of Psychiatry, Department of Medicine, University of Perugia, Perugia, Italy
| | - P. Moretti
- Division of Psychiatry, Department of Medicine, University of Perugia, Perugia, Italy
| | - A. Tamantini
- Department of Mental Health, AUSL Umbria 2, Terni, Italy
- Functional Area of Psychiatry, University of Perugia, Perugia, Italy
| | - R. Quartesan
- Division of Psychiatry, Department of Medicine, University of Perugia, Perugia, Italy
| | - M.T. Compton
- Columbia University, College of Physicians & Surgeons, New York, USA
| | - A. Tortorella
- Division of Psychiatry, Department of Medicine, University of Perugia, Perugia, Italy
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15
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Haselden M, Brister T, Robinson S, Covell N, Pauselli L, Dixon L. Effectiveness of the NAMI Homefront Program for Military and Veteran Families: In-Person and Online Benefits. Psychiatr Serv 2019; 70:935-939. [PMID: 31272337 DOI: 10.1176/appi.ps.201800573] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study aimed to evaluate the effectiveness of Homefront, a six-session, peer-taught family education program by the National Alliance on Mental Illness (NAMI), delivered in person or online, for families or support persons of military service members or of veterans with mental illness. METHODS Program participants completed online surveys at baseline, at the end of the program (postprogram), and at 3-month follow-up, which measured subjective empowerment, burden, coping, psychological distress, family functioning, experience of caregiving, and knowledge of mental illness. A mixed-effects model examined change over time. RESULTS A total of 119 individuals (in person, N=63 [53%]; online, N=56 [47%]) enrolled. Participants showed statistically significant improvement on all dimensions between baseline, postprogram, and follow-up, except for subjective burden, which improved between baseline and follow-up. Results for in-person and online formats did not differ. CONCLUSIONS The six-session NAMI Homefront program was associated with benefits for military and veteran family members and support persons.
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Affiliation(s)
- Morgan Haselden
- New York State Psychiatric Institute, New York (Haselden, Covell, Pauselli); National Alliance on Mental Illness, Arlington, Virginia (Brister, Robinson); Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University (Covell, Pauselli, Dixon). Editor Emeritus Howard H. Goldman, M.D., Ph.D., served as decision editor on the manuscript
| | - Teri Brister
- New York State Psychiatric Institute, New York (Haselden, Covell, Pauselli); National Alliance on Mental Illness, Arlington, Virginia (Brister, Robinson); Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University (Covell, Pauselli, Dixon). Editor Emeritus Howard H. Goldman, M.D., Ph.D., served as decision editor on the manuscript
| | - Suzanne Robinson
- New York State Psychiatric Institute, New York (Haselden, Covell, Pauselli); National Alliance on Mental Illness, Arlington, Virginia (Brister, Robinson); Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University (Covell, Pauselli, Dixon). Editor Emeritus Howard H. Goldman, M.D., Ph.D., served as decision editor on the manuscript
| | - Nancy Covell
- New York State Psychiatric Institute, New York (Haselden, Covell, Pauselli); National Alliance on Mental Illness, Arlington, Virginia (Brister, Robinson); Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University (Covell, Pauselli, Dixon). Editor Emeritus Howard H. Goldman, M.D., Ph.D., served as decision editor on the manuscript
| | - Luca Pauselli
- New York State Psychiatric Institute, New York (Haselden, Covell, Pauselli); National Alliance on Mental Illness, Arlington, Virginia (Brister, Robinson); Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University (Covell, Pauselli, Dixon). Editor Emeritus Howard H. Goldman, M.D., Ph.D., served as decision editor on the manuscript
| | - Lisa Dixon
- New York State Psychiatric Institute, New York (Haselden, Covell, Pauselli); National Alliance on Mental Illness, Arlington, Virginia (Brister, Robinson); Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University (Covell, Pauselli, Dixon). Editor Emeritus Howard H. Goldman, M.D., Ph.D., served as decision editor on the manuscript
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16
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Birnbaum ML, Cleary SD, Ramsay Wan C, Pauselli L, Compton MT. Factor structure of the Cannabis Experiences Questionnaire in a first-episode psychosis sample. Early Interv Psychiatry 2019; 13:495-501. [PMID: 29052952 PMCID: PMC5910296 DOI: 10.1111/eip.12509] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 06/28/2017] [Accepted: 08/20/2017] [Indexed: 11/27/2022]
Abstract
AIM The Cannabis Experiences Questionnaire (CEQ) was developed to measure the subjective experiences of cannabis use both during and after intoxication. Despite the need to better understand the nature of the complex and significant relationship between cannabis use and early psychosis, this questionnaire has rarely been used in individuals with first-episode psychosis. METHODS We conducted a set of factor analyses using CEQ data from 194 first-episode psychosis patients who used cannabis in order to uncover the underlying factor structure of the questionnaire and thus the overarching types of psychological experiences during/after using cannabis in young people with psychotic disorders. RESULTS Our exploratory factor analysis identified 4 subscales, including: Distortions of Reality and Self-Perception (Factor 1), Euphoria Effects (Factor 2), Slowing and Amotivational Effects (Factor 3), and Anxiety and Paranoia Effects (Factor 4). CONCLUSIONS Elucidating the underlying factor structure of the CEQ in first-episode psychosis samples could help researchers move towards a deeper understanding of the types of experiences associated with cannabis intoxication among young adults with first-episode psychosis and could inform the development of programs designed to reduce use, improve the course of illness, and possibly delay or prevent the onset of psychotic symptoms in those at risk.
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Affiliation(s)
- Michael L Birnbaum
- The Zucker Hillside Hospital, Psychiatry Research, Northwell Health, Glen Oaks, New York.,Lenox Hill Hospital, Department of Psychiatry, Northwell Health, New York, New York.,Hofstra Northwell School of Medicine, Hempstead, New York.,The Feinstein Institute for Medical Research, Manhasset, New York
| | - Sean D Cleary
- Milken Institute School of Public Health, Department of Epidemiology and Biostatistics, The George Washington University, Washington, District of Columbia
| | | | - Luca Pauselli
- Department of Psychiatry, Columbia University College of Physicians & Surgeons, New York, New York
| | - Michael T Compton
- Department of Psychiatry, Columbia University College of Physicians & Surgeons, New York, New York
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17
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Balducci PM, Bernardini F, Pauselli L, Tortorella A, Compton MT. Correlates of Involuntary Admission: Findings from an Italian Inpatient Psychiatric Unit. Psychiatr Danub 2018; 29:490-496. [PMID: 29197207 DOI: 10.24869/psyd.2017.490] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Involuntary admission is challenging in terms of providing the most effective but least restrictive care in accordance with the country's regulations. A better understanding of correlates of voluntary versus involuntary admission legal status is crucial to improve clinical decision-making and effectiveness of the overall mental health care system. SUBJECTS AND METHODS We collected chart-review data pertaining to 848 patients, discharged between June 2011 and June 2014, from an Italian inpatient psychiatric unit. Diverse sociodemographic and clinical variables were collected. Bivariate analyses and binary logistic regression were performed to examine correlates of involuntary admission. RESULTS Bivariate analyses showed that involuntary status was related to: the reason for hospitalization, not being on psychiatric medications at admission, and being admitted from another inpatient ward (in particular, from the emergency department). The final regression model identified four main variables independently associated with legal status: being admitted for psychotic features, suicidal behavior, or impulsive behavior, and not being on medication at admission (Nagelkerke pseudo R2=0.15, p<0.001). A strong association with length of stay was also documented. CONCLUSIONS Understanding the causes and consequences of involuntary admission will enhance the field's understanding of how to provide the most effective, but least restrictive, psychiatric care.
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Affiliation(s)
- Pierfrancesco Maria Balducci
- Department of Medicine, Section of Psychiatry, University of Perugia, Piazzale Lucio Severi, Edificio Ellisse, 8 piano, Sant'Andrea delle Fratte, 06132 Perugia PG, Italy,
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18
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Compton MT, Lunden A, Cleary SD, Pauselli L, Alolayan Y, Halpern B, Broussard B, Crisafio A, Capulong L, Balducci PM, Bernardini F, Covington MA. The aprosody of schizophrenia: Computationally derived acoustic phonetic underpinnings of monotone speech. Schizophr Res 2018; 197:392-399. [PMID: 29449060 PMCID: PMC6087691 DOI: 10.1016/j.schres.2018.01.007] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 01/11/2018] [Accepted: 01/14/2018] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Acoustic phonetic methods are useful in examining some symptoms of schizophrenia; we used such methods to understand the underpinnings of aprosody. We hypothesized that, compared to controls and patients without clinically rated aprosody, patients with aprosody would exhibit reduced variability in: pitch (F0), jaw/mouth opening and tongue height (formant F1), tongue front/back position and/or lip rounding (formant F2), and intensity/loudness. METHODS Audiorecorded speech was obtained from 98 patients (including 25 with clinically rated aprosody and 29 without) and 102 unaffected controls using five tasks: one describing a drawing, two based on spontaneous speech elicited through a question (Tasks 2 and 3), and two based on reading prose excerpts (Tasks 4 and 5). We compared groups on variation in pitch (F0), formant F1 and F2, and intensity/loudness. RESULTS Regarding pitch variation, patients with aprosody differed significantly from controls in Task 5 in both unadjusted tests and those adjusted for sociodemographics. For the standard deviation (SD) of F1, no significant differences were found in adjusted tests. Regarding SD of F2, patients with aprosody had lower values than controls in Task 3, 4, and 5. For variation in intensity/loudness, patients with aprosody had lower values than patients without aprosody and controls across the five tasks. CONCLUSIONS Findings could represent a step toward developing new methods for measuring and tracking the severity of this specific negative symptom using acoustic phonetic parameters; such work is relevant to other psychiatric and neurological disorders.
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Affiliation(s)
- Michael T Compton
- Columbia University College of Physicians & Surgeons, Department of Psychiatry, New York, NY, USA.
| | - Anya Lunden
- College of William and Mary, Department of English, Linguistics Program, Williamsburg, VA, USA
| | - Sean D Cleary
- The George Washington University Milken Institute School of Public Health, Department of Epidemiology and Biostatistics, Washington, DC, USA
| | - Luca Pauselli
- Columbia University College of Physicians & Surgeons, Department of Psychiatry, New York, NY, USA
| | - Yazeed Alolayan
- Case Western Reserve University, Department of Neurology, Cleveland, OH, USA
| | | | | | - Anthony Crisafio
- The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | | | | | - Francesco Bernardini
- Université Libre de Bruxelles, Erasme Hospital, Department of Psychiatry, Anderlecht, Belgium
| | - Michael A Covington
- The University of Georgia, Institute for Artificial Intelligence, Athens, GA, USA
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19
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Pauselli L, Galletti C, Verdolini N, Paolini E, Gallucci D, Balducci PM, Bernardini F, Kogan JH, Shim R, Moretti P, Compton MT. Predictors of Client Satisfaction with Outpatient Mental Health Clinic Services in Italy and New York. Community Ment Health J 2018; 54:562-570. [PMID: 29147978 DOI: 10.1007/s10597-017-0196-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 11/04/2017] [Indexed: 10/18/2022]
Abstract
The aim of this cross-sectional study was to assess factors associated with client satisfaction in two mental health outpatient settings in Italy and the US. Sociodemographic and clinical variables, hope, and personality characteristics were evaluated in 18-65-year-old patients who had been receiving services for at least 2 months in one of two outpatient clinics, in Italy and the US. Patients were administered: the Healthy Days Core Module, the Kessler Screening Scale for Psychological Distress, the Verona Service Satisfaction Survey, the Client Satisfaction Inventory, the Health Service OutPatient Experience questionnaire, the Herth Hope Index, and the NEO Five-Factor Inventory-3. Bivariate tests for differences between the two samples were conducted, a Satisfaction Composite z-score was computed, and a stepwise, backward elimination, multiple linear regression model-including the variables that were significantly associated with Satisfaction Composite Score in bivariate tests-was built. From July 1, 2015 to April 30, 2016, 184 patients (121 in Foligno, 63 in New York City) were enrolled in the study. Predictors of client satisfaction included: receiving services in New York City, being older, having lower educational attainment, having inner positive readiness and expectancy as well as interconnectedness with self and others, and high scores on the agreeableness personality domain. Interestingly, diagnosis and treatment characteristics did not influence satisfaction. Client satisfaction with outpatient mental health services is mainly influenced by sociodemographic characteristics and personality factors more than clinical variables or patterns of care. These findings could have implications regarding trends toward value-based payment models.
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Affiliation(s)
- Luca Pauselli
- Department of Medicine, Section of Psychiatry, University of Perugia, Perugia, Italy. .,Department of Psychiatry, Columbia University, College of Physicians and Surgeons, New York, NY, USA. .,New York State Psychiatric Institute (NYSPI), 1051 Riverside Drive, Box 100, New York, NY, 10032, USA.
| | - Chiara Galletti
- Department of Medicine, Section of Psychiatry, University of Perugia, Perugia, Italy
| | - Norma Verdolini
- Department of Medicine, Section of Psychiatry, University of Perugia, Perugia, Italy.,Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Enrico Paolini
- Department of Medicine, Section of Psychiatry, University of Perugia, Perugia, Italy
| | - Daniela Gallucci
- Department of Medicine, Section of Psychiatry, University of Perugia, Perugia, Italy
| | | | - Francesco Bernardini
- Department of Psychiatry, Erasme Hospital, Université Libre de Bruxelles, Anderlecht, Belgium
| | - Jerome H Kogan
- Department of Psychiatry, Lenox Hill Hospital, New York, NY, USA
| | - Ruth Shim
- Department of Psychiatry and Behavioral Sciences, UC Davis Health System, Sacramento, CA, USA
| | - Patrizia Moretti
- Department of Medicine, Section of Psychiatry, University of Perugia, Perugia, Italy
| | - Michael T Compton
- Department of Psychiatry, Columbia University, College of Physicians and Surgeons, New York, NY, USA
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Pauselli L, Halpern B, Cleary SD, Ku BS, Covington MA, Compton MT. Computational linguistic analysis applied to a semantic fluency task to measure derailment and tangentiality in schizophrenia. Psychiatry Res 2018; 263:74-79. [PMID: 29502041 PMCID: PMC6048590 DOI: 10.1016/j.psychres.2018.02.037] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 12/18/2017] [Accepted: 02/16/2018] [Indexed: 12/31/2022]
Abstract
Although rating scales to assess formal thought disorder exist, there are no objective, high-reliability instruments that can quantify and track it. This proof-of-concept study shows that CoVec, a new automated tool, is able to differentiate between controls and patients with schizophrenia with derailment and tangentiality. According to ratings from the derailment and tangentiality items of the Scale for the Assessment of Positive Symptoms, we divided the sample into three groups: controls, patients without formal thought disorder, and patients with derailment/tangentiality. Their lists of animals produced during a one-minute semantic fluency task were processed using CoVec, a newly developed software that measures the semantic similarity of words based on vector semantic analysis. CoVec outputs were Mean Similarity, Coherence, Coherence-5, and Coherence-10. Patients with schizophrenia produced fewer words than controls. Patients with derailment had a significantly lower mean number of words and lower Coherence-5 than controls and patients without derailment. Patients with tangentiality had significantly lower Coherence-5 and Coherence-10 than controls and patients without tangentiality. Despite the small samples of patients with clinically apparent thought disorder, CoVec was able to detect subtle differences between controls and patients with either or both of the two forms of disorganization.
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Affiliation(s)
- Luca Pauselli
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY, USA.
| | - Brooke Halpern
- Department of Psychiatry, Lenox Hill Hospital, New York, NY, USA
| | - Sean D Cleary
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | - Benson S Ku
- Hofstra Northwell School of Medicine, Hempstead, NY, USA
| | | | - Michael T Compton
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY, USA
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Compton MT, Anderson S, Broussard B, Ellis S, Halpern B, Pauselli L, O'Neal M, Druss BG, Johnson M. A potential new form of jail diversion and reconnection to mental health services: II. Demonstration of feasibility. Behav Sci Law 2017; 35:492-500. [PMID: 29098714 DOI: 10.1002/bsl.2319] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2017] [Revised: 07/31/2017] [Accepted: 08/06/2017] [Indexed: 06/07/2023]
Abstract
Given fragmentation between mental health and criminal justice systems, we tested the feasibility of implementing a potential new form of pre-booking jail diversion. Our "linkage system" consists of three steps: (i) individuals with serious mental illnesses and an arrest history give special consent to be enrolled in a statewide database; (ii) if an officer has an encounter with an enrolled patient and runs a routine background check, he or she receives an electronic message to call; and (iii) the "linkage specialist" provides brief telephonic assistance to the officer. Of 206 eligible individuals, 199 (96.6%) opted in, the database received 679 hits, and the linkage specialist received 31 calls (and in at least three cases an arrest was probably averted). The mean number of arrests was 0.59 ± 0.92 in the year before enrollment (38.7% arrested) and 0.48 ± 0.83 during the 12-month intervention (30.7% arrested). Implementation is feasible, and a signal that the system might reduce incarceration was detected, encouraging development of a larger study.
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Affiliation(s)
- Michael T Compton
- Columbia University College of Physicians and Surgeons, Department of Psychiatry, New York, NY, U.S.A
| | | | - Beth Broussard
- Lenox Hill Hospital, Department of Psychiatry, New York, NY, U.S.A
| | | | - Brooke Halpern
- Lenox Hill Hospital, Department of Psychiatry, New York, NY, U.S.A
| | - Luca Pauselli
- Columbia University College of Physicians and Surgeons, Department of Psychiatry, New York, NY, U.S.A
| | | | - Benjamin G Druss
- Rollins School of Public Health, Department of Health Policy and Management, Atlanta, GA, U.S.A
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Compton MT, Halpern B, Broussard B, Anderson S, Smith K, Ellis S, Griffin K, Pauselli L, Myers N. A potential new form of jail diversion and reconnection to mental health services: I. Stakeholders' views on acceptability. Behav Sci Law 2017; 35:480-491. [PMID: 29098720 DOI: 10.1002/bsl.2320] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2017] [Revised: 07/31/2017] [Accepted: 09/07/2017] [Indexed: 06/07/2023]
Abstract
The most effective point of intervention to prevent unnecessary arrest/incarceration of persons with serious mental illnesses is the initial encounter with police. We piloted a new police-mental health linkage system. When officers run an enrolled participant's name/identifiers, they receive an electronic message that the person has mental health considerations and that they should call for information. The linkage specialist receives the call and assists telephonically. In this qualitative study to examine acceptability of the linkage system, we conducted nine focus groups with diverse stakeholders (e.g., enrolled patients, officers). Focus groups revealed that patients enrolled with the hope that the linkage system would prevent negative interactions with police and minimize risk of arrest. Officers reported preferring not to arrest mental health patients and were genuinely invested in helping them, and felt that the linkage system might be an additional tool during encounters. Findings revealed acceptability of the intervention, and further research is warranted.
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Affiliation(s)
- Michael T Compton
- Columbia University College of Physicians and Surgeons, Department of Psychiatry, New York, NY, USA
| | - Brooke Halpern
- Lenox Hill Hospital, Department of Psychiatry, New York, NY, USA
| | - Beth Broussard
- Lenox Hill Hospital, Department of Psychiatry, New York, NY, USA
| | | | - Kelly Smith
- Gateway Behavioral Health Services, Savannah, GA, USA
| | | | - Kara Griffin
- Southern Methodist University, Department of Anthropology, Dallas, TX, USA
| | - Luca Pauselli
- Columbia University College of Physicians and Surgeons, Department of Psychiatry, New York, NY, USA
| | - Neely Myers
- Southern Methodist University, Department of Anthropology, Dallas, TX, USA
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Verdolini N, Murru A, Attademo L, Garinella R, Pacchiarotti I, Bonnin CDM, Samalin L, Pauselli L, Piselli M, Tamantini A, Quartesan R, Carvalho AF, Vieta E, Tortorella A. The aggressor at the mirror: Psychiatric correlates of deliberate self-harm in male prison inmates. Eur Psychiatry 2017. [PMID: 28641217 DOI: 10.1016/j.eurpsy.2017.04.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND Deliberate self-harm (DSH) causes important concern in prison inmates as it worsens morbidity and increases the risk for suicide. The aim of the present study is to investigate the prevalence and correlates of DSH in a large sample of male prisoners. METHODS A cross-sectional study evaluated male prisoners aged 18+ years. Current and lifetime psychiatric diagnoses were assessed with the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders - DSM-IV Axis I and Axis II Disorders and with the Addiction Severity Index-Expanded Version. DSH was assessed with The Deliberate Self-Harm Inventory. Multivariable logistic regression models were used to identify independent correlates of lifetime DSH. RESULTS Ninety-three of 526 inmates (17.7%) reported at least 1 lifetime DSH behavior, and 58/93 (62.4%) of those reported a DSH act while in prison. After multivariable adjustment (sensitivity 41.9%, specificity 96.1%, area under the curve=0.854, 95% confidence interval CI=0.811-0.897, P<0.001), DSH was significantly associated with lifetime psychotic disorders (adjusted Odds Ratio aOR=6.227, 95% CI=2.183-17.762, P=0.001), borderline personality disorder (aOR=6.004, 95% CI=3.305-10.907, P<0.001), affective disorders (aOR=2.856, 95% CI=1.350-6.039, P=0.006) and misuse of multiple substances (aOR=2.024, 95% CI=1.111-3.687, P=0.021). CONCLUSIONS Borderline personality disorder and misuse of multiple substances are established risk factors of DSH, but psychotic and affective disorders were also associated with DSH in male prison inmates. This points to possible DSH-related clinical sub-groups, that bear specific treatment needs.
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Affiliation(s)
- N Verdolini
- Bipolar Disorders Unit, Institute of Neuroscience, University of Barcelona, IDIBAPS CIBERSAM, Hospital Clínic, c/Villarroel, 170, 12-0, 08036 Barcelona, Spain; Division of Psychiatry, Clinical Psychology and Rehabilitation, Department of Medicine, University of Perugia, Santa Maria della Misericordia Hospital, Edificio Ellisse, 8 Piano, Sant'Andrea delle Fratte, 06132 Perugia, Italy
| | - A Murru
- Bipolar Disorders Unit, Institute of Neuroscience, University of Barcelona, IDIBAPS CIBERSAM, Hospital Clínic, c/Villarroel, 170, 12-0, 08036 Barcelona, Spain
| | - L Attademo
- Division of Psychiatry, Clinical Psychology and Rehabilitation, Department of Medicine, University of Perugia, Santa Maria della Misericordia Hospital, Edificio Ellisse, 8 Piano, Sant'Andrea delle Fratte, 06132 Perugia, Italy; Department of Mental Health, Division of Psychiatry 1, "Azienda Socio-Sanitaria Territoriale Papa Giovanni XXIII", Piazza OMS 1, 24127 Bergamo, Italy
| | - R Garinella
- Division of Psychiatry, Clinical Psychology and Rehabilitation, Department of Medicine, University of Perugia, Santa Maria della Misericordia Hospital, Edificio Ellisse, 8 Piano, Sant'Andrea delle Fratte, 06132 Perugia, Italy; Centro di Selezione e Reclutamento Nazionale dell'Esercito, Italian Ministry of Defence, Viale Mezzetti, 2, 06034 Foligno, Perugia, Italy
| | - I Pacchiarotti
- Bipolar Disorders Unit, Institute of Neuroscience, University of Barcelona, IDIBAPS CIBERSAM, Hospital Clínic, c/Villarroel, 170, 12-0, 08036 Barcelona, Spain
| | - C Del Mar Bonnin
- Bipolar Disorders Unit, Institute of Neuroscience, University of Barcelona, IDIBAPS CIBERSAM, Hospital Clínic, c/Villarroel, 170, 12-0, 08036 Barcelona, Spain
| | - L Samalin
- Bipolar Disorders Unit, Institute of Neuroscience, University of Barcelona, IDIBAPS CIBERSAM, Hospital Clínic, c/Villarroel, 170, 12-0, 08036 Barcelona, Spain; EA 7280, Department of Psychiatry, CHU Clermont-Ferrand, University of Auvergne, 58, rue Montalembert, 63000 Clermont-Ferrand, France; Pôle de psychiatrie, Fondation FondaMental, hôpital Albert-Chenevier, 40, rue de Mesly, 94000 Créteil, France
| | - L Pauselli
- Division of Psychiatry, Clinical Psychology and Rehabilitation, Department of Medicine, University of Perugia, Santa Maria della Misericordia Hospital, Edificio Ellisse, 8 Piano, Sant'Andrea delle Fratte, 06132 Perugia, Italy; New York Psychiatric Institute Columbia University Medical Center, 1051 Riverside Dr, Unit 100, 10032 New York City, NY, USA
| | - M Piselli
- Functional Area of Psychiatry, University of Perugia, AUSL Umbria 2, Servizio Psichiatrico Diagnosi e Cura Ospedale "S. Giovanni Battista", via Massimo Arcamone, 06034 Foligno, Perugia, Italy
| | - A Tamantini
- Functional Area of Psychiatry, University of Perugia, AUSL Umbria 2, Servizio Psichiatrico Diagnosi e Cura Ospedale "S. Giovanni Battista", via Massimo Arcamone, 06034 Foligno, Perugia, Italy
| | - R Quartesan
- Division of Psychiatry, Clinical Psychology and Rehabilitation, Department of Medicine, University of Perugia, Santa Maria della Misericordia Hospital, Edificio Ellisse, 8 Piano, Sant'Andrea delle Fratte, 06132 Perugia, Italy
| | - A F Carvalho
- Department of Clinical Medicine, Translational Psychiatry Research Group, Faculty of Medicine, Federal University of Ceará, Av. da Universidade, 2853, 60020-180 Benfica, Fortaleza - CE, Brazil
| | - E Vieta
- Bipolar Disorders Unit, Institute of Neuroscience, University of Barcelona, IDIBAPS CIBERSAM, Hospital Clínic, c/Villarroel, 170, 12-0, 08036 Barcelona, Spain.
| | - A Tortorella
- Division of Psychiatry, Clinical Psychology and Rehabilitation, Department of Medicine, University of Perugia, Santa Maria della Misericordia Hospital, Edificio Ellisse, 8 Piano, Sant'Andrea delle Fratte, 06132 Perugia, Italy
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Pauselli L, Verdolini N, Bernardini F, Compton MT, Quartesan R. Predictors of Length of Stay in an Inpatient Psychiatric Unit of a General Hospital in Perugia, Italy. Psychiatr Q 2017; 88:129-140. [PMID: 27167133 DOI: 10.1007/s11126-016-9440-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The aim of this study was to understand which of a number of factors are most associated with psychiatric inpatient length of stay (LoS). We hypothesized that a longer LoS would be predicted by: older age, male gender, unmarried marital status, foreign nationality, more than one hospitalization, being hospitalized involuntarily, psychotic symptoms and behavioral dyscontrol at admission, discharge diagnosis of psychotic and personality disorders, not having a substance use disorder, treatment with more than one class of medications, and being discharged to a community residential facility. All admissions to the Psychiatric Inpatient Unit of Santa Maria della Misericordia, Perugia Hospital, Umbria, Italy, from June 2011 to June 2014, were included in a medical record review. Bivariate analyses were performed and a multiple linear regression model was built using variables that were associated (p < .05) with LoS in bivariate tests. The study sample included 1236 patients. In the final, most parsimonious regression model, five variables independently explained 18 % of variance in LoS: being admitted involuntarily, being admitted for thought disorders, not having a substance-related disorder, having had more than one hospitalization, and being discharged to a community residential facility. LoS on this inpatient psychiatric unit in Umbria was associated with a number of sociodemographic and clinical characteristics. Knowledge of these and other predictors of LoS will be increasingly important to, when possible, reduce the length of restrictive, costly hospitalizations and embrace community-based services.
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Affiliation(s)
- Luca Pauselli
- Scuola di Specializzazione in Psichiatria, Università degli Studi di Perugia, Piazzale Lucio Severi, Edificio Ellisse, 8 Piano, Sant'Andrea delle Fratte, 06132, Perugia, PG, Italy. .,Ospedale Santa Maria della Misericordia, Perugia, Italy.
| | - Norma Verdolini
- Scuola di Specializzazione in Psichiatria, Università degli Studi di Perugia, Piazzale Lucio Severi, Edificio Ellisse, 8 Piano, Sant'Andrea delle Fratte, 06132, Perugia, PG, Italy.,Ospedale Santa Maria della Misericordia, Perugia, Italy
| | - Francesco Bernardini
- Scuola di Specializzazione in Psichiatria, Università degli Studi di Perugia, Piazzale Lucio Severi, Edificio Ellisse, 8 Piano, Sant'Andrea delle Fratte, 06132, Perugia, PG, Italy.,Ospedale Santa Maria della Misericordia, Perugia, Italy
| | - Michael T Compton
- Department of Psychiatry, Lenox Hill Hospital, New York, NY, USA.,Department of Psychiatry, Hofstra Northwell School of Medicine, Hempstead, NY, USA
| | - Roberto Quartesan
- Ospedale Santa Maria della Misericordia, Perugia, Italy.,Sezione di Psichiatria, Dipartimento di Medicina, Università degli Studi di Perugia, Perugia, Italy
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Bernardini F, Lunden A, Covington M, Broussard B, Halpern B, Alolayan Y, Crisafio A, Pauselli L, Balducci PM, Capulong L, Attademo L, Lucarini E, Salierno G, Natalicchi L, Quartesan R, Compton MT. Associations of acoustically measured tongue/jaw movements and portion of time speaking with negative symptom severity in patients with schizophrenia in Italy and the United States. Psychiatry Res 2016; 239:253-8. [PMID: 27039009 DOI: 10.1016/j.psychres.2016.03.037] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Revised: 03/15/2016] [Accepted: 03/23/2016] [Indexed: 10/22/2022]
Abstract
This is the first cross-language study of the effect of schizophrenia on speech as measured by analyzing phonetic parameters with sound spectrography. We hypothesized that reduced variability in pitch and formants would be correlated with negative symptom severity in two samples of patients with schizophrenia, one from Italy, and one from the United States. Audio recordings of spontaneous speech were available from 40 patients. From each speech sample, a file of F0 (pitch) and formant values (F1 and F2, resonance bands indicating the moment-by-moment shape of the oral cavity), and the portion of the recording in which there was speaking ("fraction voiced," FV), was created. Correlations between variability in the phonetic indices and negative symptom severity were tested and further examined using regression analyses. Meaningful negative correlations between Scale for the Assessment of Negative Symptoms (SANS) total score and standard deviation (SD) of F2, as well as variability in pitch (SD F0) were observed in the Italian sample. We also found meaningful associations of SANS affective flattening and SANS alogia with SD F0, and of SANS avolition/apathy and SD F2 in the Italian sample. In both samples, FV was meaningfully correlated with SANS total score, avolition/apathy, and anhedonia/asociality.
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Affiliation(s)
- Francesco Bernardini
- School of Psychiatry, University of Perugia, Perugia, Italy; Lenox Hill Hospital, Department of Psychiatry, New York, NY, United States.
| | - Anya Lunden
- College of William and Mary, Williamsburg, VA, United States
| | | | - Beth Broussard
- Lenox Hill Hospital, Department of Psychiatry, New York, NY, United States
| | - Brooke Halpern
- Lenox Hill Hospital, Department of Psychiatry, New York, NY, United States
| | - Yazeed Alolayan
- The George Washington University, Washington, DC, United States
| | | | - Luca Pauselli
- School of Psychiatry, University of Perugia, Perugia, Italy; Lenox Hill Hospital, Department of Psychiatry, New York, NY, United States
| | - Pierfrancesco M Balducci
- School of Psychiatry, University of Perugia, Perugia, Italy; Lenox Hill Hospital, Department of Psychiatry, New York, NY, United States
| | - Leslie Capulong
- Lenox Hill Hospital, Department of Psychiatry, New York, NY, United States
| | - Luigi Attademo
- School of Psychiatry, University of Perugia, Perugia, Italy
| | | | | | - Luca Natalicchi
- Community Mental Health Service, Ponte San Giovanni, Perugia, Italy
| | - Roberto Quartesan
- School of Psychiatry, University of Perugia, Perugia, Italy; Division of Psychiatry, Department of Medicine, University of Perugia, Perugia, Italy
| | - Michael T Compton
- Lenox Hill Hospital, Department of Psychiatry, New York, NY, United States; Hofstra Northwell School of Medicine, Department of Psychiatry, Hempstead, NY, United States
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Del Bello V, Verdolini N, Pauselli L, Attademo L, Bernardini F, Quartesan R, Moretti P. Personality and psychotic symptoms as predictors of self-harm and attempted suicide. Psychiatr Danub 2015; 27 Suppl 1:S285-S291. [PMID: 26417781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND Nonfatal suicidal behaviours (NSB), including suicide ideation, suicide plan and suicide attempt, constitute a serious problem for public healthcare services. Suicide gesture (SG) which refers to self-injurious behaviour with no intent to die, differs from NSB in a variety of important ways. The aim of this study was to investigate demographic and clinical characteristics of NSB and SG to examine whether self-injurers with intent to die differ significantly from self injurers without such intent. METHODS All admissions for NSB and SG to the Psychiatric Inpatient Unit of University / General Hospital Santa Maria della Misericordia, Perugia, Umbria, Italy, from January 2015 to June 2015 were included in a medical record review. Basic descriptive statistics and distributional properties of all variables were first examined. Bivariate analyses were performed using Chi-square tests for group comparisons and t-test for independent samples used when appropriated. RESULTS The study sample included 38 patients. Of these 23 had committed NSB (13.1%), 15 had commetted SG (8.5%). Number of married NSB was significantly higher than the number of married SG (p=0.08). We found a significant difference between NSB and SG related to the item of impulse control that was poorer in SG than NSB (p=0.010). BPRS items of hostility (p=0.082), suspiciousness (p=0.042) and excitement (p=0.02) were found to be significantly higher in SG than NSB. Borderline personality disorder (p=0.032) and Passive-Aggressive personality disorder (p=0,082) diagnosed by the means of the SCID-II, were more represented in SG than NSB (p=0.044). Schizoid personality disorder was significantly related to NSB (p=0.042). No others significant differences were found. CONCLUSIONS NSB and SG are different for many psychopathological characteristics. These results confirm the importance of classifying individuals on the basis of the intent to die. Additional research is needed to understand and elucidate psychopatological and clinical characteristics of the different categories of self-injurers to find risk factors specific to suicide attempts.
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Affiliation(s)
- Valentina Del Bello
- School of Specialization in Psychiatry, Division of Psychiatry, Clinical Psychology and Rehabilitation, Department of Medicine, University of Perugia, Perugia, Italy,
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Pauselli L, Verdolini N, Santucci A, Moretti P, Quartesan R. Bipolar and Borderline Personality Disorders: a descriptive comparison of psychopathological aspects in patients discharged from an Italian Inpatient Unit using PANSS and BPRS. Psychiatr Danub 2015; 27 Suppl 1:S170-S176. [PMID: 26417755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND There is current scientific debate in consideration of the possibility to consider the Borderline Personality Disorder (BPD) as a mood disorder within the bipolar spectrum furthermore, authors reported about the challenging differential diagnosis of BPD and Bipolar Disorder (BD). SUBJECTS AND METHODS 32 patients hospitalized in the Inpatient Psychiatric Unit in Perugia, discharged with a diagnosis of BD or BPD, were included. Factor analyses of BPRS and PANSS items were performed. Association between socio-demographic, clinical and psychopathological variables was tested using bivariate analyses. RESULTS Factor analysis identified 6 Factors, explaining 67.6% of the variance, interpreted as follow: 1) Euphoric Mania, 2) Psychosis, 3) Inhibited Depression, 4) Disorganization, 5) Psychosomatic features, and 6) Mixed features. Bivariate analyses identified statistically significant differences between BPD and BD according to: PANSS positive symptoms domain, BPRS total score, Euphoric Mania and Disorganization. No statistically significant differences came up on socio-demographic and clinical aspects. CONCLUSION Even though the sample is small, interesting findings came out from our investigation. Our findings are in line with the current literature. Euphoric mood, is one of the aspects which best differentiated BD from BPD. Higher scores in Disorganization, BPRS and PANSS positive symptoms in BD may be related to the fact that our sample is a group of patients from an acute inpatient unit, so the impact of the symptoms severity for BD may be remarkable.
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Affiliation(s)
- Luca Pauselli
- School of Specialization in Psychiatry, University of Perugia, Piazza Lucio Severi, Edifico Ellisse 8th Floor, Sant'Andrea delle Fratte, 06132 - Perugia. Italy,
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Elisei S, Pauselli L, Balducci PM, Moretti P, Quartesan R. Mood disorders in general hospital inpatients: one year data from a psychiatric consultation-liaison service. Psychiatr Danub 2013; 25 Suppl 2:S268-S271. [PMID: 23995191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND Mood disorders (MD) show higher prevalence among psychiatric disorders. As a matter of fact 10% of inpatients in non psychiatric health care structures are affected by MD. A consultation-liaison service bridges the gap between psychiatric and other medical disciplines and increases the cooperation in the context of care, improving the diagnostic process for all inpatients in medical wards. SUBJECTS AND METHODS Our sample is composed of 1702 patients assessed from 1 January 2012 to 31 December 2012 referred from the wards for psychiatric specialist evaluation in Santa Maria della Misericordia, Perugia, Italy. Each patient was assessed by a consultant psychiatrist performing a psychiatric interview leading to a diagnosis according to DSM-IV-TR criteria. Clinical and sociodemographic data were collected and registrered in the clinical records. SPSS software (ver. 18) was used for data analysis. Chi-square test and T-student tests were performed as appropriate. A p-value<0.05 was considered statistically significant. RESULTS 17% of our sample shows a diagnosis within the mood disorder spectrum. As for the source of referrals we find that 51.4% came from the Emergency room, 39% from medical wards and 9.4% from surgical wards. On the basis of the consultation referral urgent status we found that 84% of requests needed to be seen within 24 h, most of them come from Emergency room. Statistically significant correlations can be found between the source of referrals, the reasons for the referrals, psychiatric care prior to the evaluation and the psychiatric disorder which was diagnosed during the assessment. CONCLUSIONS Consultation-liaison service for MD in an italian general hospital is generally based on emergency/urgency referrals from the Emergency room for patients already assessed to mental care facilities by private or national health service psychiatrists.
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Affiliation(s)
- Sandro Elisei
- Division of Psychiatry, Clinical Psychology and Rehabilitation, Department of Clinical and Experimental Medicine - University of Perugia, Santa Maria della Misericordia Hospital, Perugia, Italy,
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