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An innovative child CBT training model for community mental health practitioners in Ontario.

Acad Psychiatry. 2009 Sep-Oct;33(5):394-9

Authors: Manassis K, Ickowicz A, Picard E, Antle B, McNeill T, Chahauver A, Mendlowitz S, Monga S, Adler-Nevo G

OBJECTIVE: Cognitive behavior therapy (CBT) for children has been shown efficacious, but community access to it is often limited by the lack of trained therapists. This study evaluated a child, CBT-focused, 20-session weekly group supervision seminar with a didactic component which was provided to community mental health practitioners by experienced CBT therapists from an academic center. METHODS: Twenty-two practitioners from four community mental health agencies completed the training in four groups (one for each agency); one group was trained by videoconference. The authors assessed outcomes immediately after the training and at 6-month follow-up using a mixed-method design including quantitative and qualitative methods to ensure a comprehensive evaluation. RESULTS: Participants’ knowledge on a multiple-choice test of child CBT increased with training, as did their self-reported confidence using CBT and desire to do further child CBT. Therapist age and use of an intake diagnostic screen related to positive outcomes, and participants advocated for more structured training. CONCLUSION: Child CBT can be successfully taught to community practitioners using this training model, but refinement based on participant feedback and further studies that include direct observation of CBT skills are needed.

PMID: 19828854 [PubMed - indexed for MEDLINE]

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Relationship between Resident-In-Training Examination in psychiatry and subsequent certification examination performances.

Acad Psychiatry. 2009 Sep-Oct;33(5):404-6

Authors: Juul D, Schneidman BS, Sexson SB, Fernandez F, Beresin EV, Ebert MH, Winstead DK, Faulkner LR

OBJECTIVE: This study analyzed the relationship between performance on The American College of Psychiatrists’ Psychiatry Resident-In-Training Examination (PRITE) and the ABPN Part 1 examination. METHODS: Pearson correlation coefficients were used to examine the relationship between performance on the 2002 PRITE and the 2003 Part 1 examination for 297 examinees. RESULTS: The correlation between the PRITE global psychiatry and the Part 1 psychiatry scores was 0.59, and the correlation between the PRITE global neurology and the Part 1 neurology scores was 0.39. CONCLUSION: Although the PRITE and the Part 1 examination have different purposes and are developed independently, the significant correlations between scores on the two tests support the use of PRITE results to guide preparation for the Part 1 examination. Guidelines for PRITE scores associated with poor performance on the Part 1 examination are provided.

PMID: 19828858 [PubMed - indexed for MEDLINE]

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Computer simulation and virtual reality in the diagnosis and treatment of psychiatric disorders.

Acad Psychiatry. 2009 Sep-Oct;33(5):413-7

Authors: Gorrindo T, Groves JE

PMID: 19828861 [PubMed - indexed for MEDLINE]

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Safe enough to sleep: sleep disruptions associated with trauma, posttraumatic stress, and anxiety in children and adolescents.

Child Adolesc Psychiatr Clin N Am. 2009 Oct;18(4):877-91

Authors: Charuvastra A, Cloitre M

Sleep disturbance is an essential symptom of posttraumatic stress disorder, and recent evidence suggests that disrupted sleep may play an important role in the development of posttraumatic stress disorder following traumatic stress. The authors review several aspects of sleep as it relates to posttraumatic stress disorder. First, there is an association between traumatic stress and different components of disrupted sleep in children and adolescents. Second, sleep disruption appears to be a core feature of other pediatric anxiety disorders, and the authors consider if this preexisting sleep vulnerability may explain in part why preexisting anxiety disorders are a risk factor for developing posttraumatic stress disorder following a traumatic event. Third, the authors consider attachment theory and the social context of trauma and sleep disruption. This article concludes with a consideration of the therapeutic implications of these findings.

PMID: 19836694 [PubMed - indexed for MEDLINE]

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Sleep patterns in autism spectrum disorders.

Child Adolesc Psychiatr Clin N Am. 2009 Oct;18(4):917-28

Authors: Johnson KP, Giannotti F, Cortesi F

Like children with other developmental disabilities, children with autism spectrum disorders suffer from sleep problems at a greater rate than typically developing children. It is increasingly recognized that addressing these sleep problems may improve daytime functioning and decrease family stress. The sleep problems experienced by children with autism spectrum disorders are presented in this article.

PMID: 19836696 [PubMed - indexed for MEDLINE]

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Insomnias of childhood and adolescence.

Child Adolesc Psychiatr Clin N Am. 2009 Oct;18(4):979-1000

Authors: Reid GJ, Huntley ED, Lewin DS

Childhood insomnias (CI) are a diverse group of sleep-related problems that present across the first 2 decades of life, ranging widely in severity. Little is understood about the origins of CI which are likely heterogeneous. Nevertheless, effective treatments for younger children have been shown to be efficacious. Defined within a development framework, this article reviews common correlates and causes of CI during the first two decades. A practical approach to the evaluation and treatment of insomnias among children and youth is presented.

PMID: 19836700 [PubMed - indexed for MEDLINE]

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Pharmacologic treatment of pediatric insomnia.

Child Adolesc Psychiatr Clin N Am. 2009 Oct;18(4):1001-16

Authors: Owens JA, Moturi S

Pediatric insomnia is common in children and adolescents, particularly in children who have comorbid medical, psychiatric, and neurodevelopmental disorders, and may be associated with cognitive, emotional, and psychosocial impairments that often result in significant caregiver burden. Although several behavioral interventions for pediatric insomnia are effective, there is a relative paucity of empiric evidence supporting the use of pharmacologic treatment. Sedative/hypnotic drugs are frequently used in clinical practice to treat pediatric insomnia, and guidelines for the use of these medications in general as well as for specific medications have been developed. This review presents expert consensus guidelines for the use of these medications in clinical practice, with a focus on the different classes of pharmacologic agents that are most commonly prescribed.

PMID: 19836701 [PubMed - indexed for MEDLINE]

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HIV risk reduction among detained adolescents: a randomized, controlled trial.

Pediatrics. 2009 Dec;124(6):e1180-8

Authors: Bryan AD, Schmiege SJ, Broaddus MR

OBJECTIVES: Criminally involved adolescents engage in high levels of alcohol-related risky sex. A theory-based sexual and alcohol risk-reduction intervention was designed, implemented, and evaluated in juvenile detention facilities. Participants and METHODS: In a randomized, controlled trial, 484 detained adolescents received 1 of 3 group-based interventions: combined sexual and alcohol risk reduction (group psychosocial intervention [GPI] + group motivational enhancement therapy [GMET]); sexual risk reduction only (GPI); or HIV/sexually transmitted disease prevention information only (group information-only intervention [GINFO]). Follow-up data were obtained 3, 6, 9, and 12 months after the intervention. Behavioral outcomes were condom-use behavior, frequency of intercourse while drinking, and alcohol-related problems. RESULTS: Condom-use behavior measured as frequency of condom use during sex (ranging from never to always) decreased over time, although the GPI and GPI + GMET interventions mitigated this tendency at the 3-, 6-, and 9-month follow-up assessments. Although both active interventions were significantly more successful than the GINFO condition and the pattern of effects favored the GPI + GMET, there were no statistically significant differences between the GPI and GPI + GMET interventions. CONCLUSIONS: Findings support the feasibility of integrating alcohol-specific sexual risk content into a theory-based sexual risk-reduction intervention and provide additional evidence that theory-based interventions are effective at reducing risky sex in this population. There was limited evidence of intervention effects on alcohol-use outcomes. Future research should focus on strengthening the GPI + GMET to most effectively target risky sexual behavior among at-risk adolescents.

PMID: 19901006 [PubMed - indexed for MEDLINE]

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Eating disorder symptoms improved by antireflux surgery: a case report with a six-year follow up.

Isr J Psychiatry Relat Sci. 2009;46(3):231-5

Authors: Eraslan D, Ozturk O, Bor S

BACKGROUND: Anorexia nervosa (AN) is a chronic disorder that can overlap with lower esophageal sphincter failure and delayed gastric emptying. Patients with anorexia nervosa or other eating disorders may have a high incidence of gastrointestinal complaints, which can also be observed in gastroesophageal reflux disease (GERD). The overlap in the symptoms of these disorders may cause problems in differential diagnosis and treatment decisions. CASE DESCRIPTION: We report on a case of a patient with anorexia nervosa who did not benefit from conventional treatment strategies such as psychotropic drugs and psychotherapy, but remitted after antireflux surgery. CONCLUSION: When dealing with patients with symptoms of anorexia nervosa, physicians should keep in mind that these patients may have serious esophagogastric complications that can affect their response to psychiatric treatment. Alternatively, some patients with primary esophageal disorders may present with symptoms of eating disorders.

PMID: 20039526 [PubMed - in process]

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The role of spirituality healing with perceptions of the medical encounter among Latinos.

J Gen Intern Med. 2009 Nov;24 Suppl 3:542-7

Authors: Reyes-Ortiz CA, Rodriguez M, Markides KS

BACKGROUND: Little is known about the relationship between spirituality healing and perceptions about the medical encounter among Latinos. OBJECTIVES: To examine the association between spirituality healing and attitudes of self-reported perceptions about the medical encounter. DESIGN: A cross-sectional telephone survey. PARTICIPANTS: 3,728 Latinos aged >or=18 years residing in the United States from Wave 1 of the Pew Hispanic Center/Robert Wood Johnson Foundation Latino Health Survey. MEASUREMENTS: Dependent variables were ever prayed for healing (yes/no), ever asked others to pray for healing (yes/no), considered important spiritual healing (very vs. somewhat or not important), and ever consulted a ‘curandero’ (folk healer in Latin America) (yes/no). The primary independent variables were feelings about the last time seeing a Doctor (confused by information given, or frustrated by lack of information) and perception of quality of medical care (excellent, good, fair or poor) within the past 12 months. RESULTS: Six percent of individuals reported that they had ever consulted a curandero, 60% prayed for healing, 49% asked others to pray for healing, and 69% considered spiritual healing as very important. In multivariable analyses, feeling confused was associated with increased odds of consulting a curandero (OR = 1.58; 95% CI, 1.02-2.45), praying for healing (OR = 1.30; 95% CI, 1.03-1.64), asking others to pray for healing (OR = 1.29; 95% CI, 1.03-1.62), and considering spiritual healing as very important (OR = 1.30; 95% CI, 1.01-1.66). Feeling frustrated by a lack of information was associated with asking others to pray for healing (OR = 1.29; 95% CI, 1.04-1.60). A better perception of quality of medical care was associated with lower odds of consulting a curandero (OR = 0.83; 95% CI, 0.70-0.98). CONCLUSION: Feelings about the medical encounter were associated with spirituality healing, praying for healing, and asking others to pray for healing. Feeling confused and perception of poor quality of medical care were associated with consulting a curandero.

PMID: 19842004 [PubMed - in process]

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