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This study examined the association between cognitive distortions and ADHD severity after accounting for depression, anxiety, and personality traits. Archival data were collected on 112 adult participants diagnosed with ADHD after an extensive assessment, which included inventories measuring mood, anxiety, and personality traits. Pearson correlations were used to assess the associations of ADHD and these comorbid variables. Regression analyses assessed the contribution of predictor comorbid variables to hypothesized associations with ADHD. Results indicated that the relationship between cognitive distortions and ADHD symptom severity was no longer statistically significant once mood, anxiety, and personality traits were taken into consideration. These findings illuminate the complex role of cognitive distortions, comorbidities, and personality traits in the presentation of adult ADHD. As such, this study has clinical and conceptual relevance for understanding the role, candidate mechanisms, and therapeutic targets of cognitive-behavioral therapy for adult ADHD, particularly the cognitive component.

Background Despite a diverse range of curricular advancements to address the difficult transition from classroom learning to clinical training during medical education, hurdles persist. A 4-week course was designed at the Philadelphia College of Osteopathic Medicine (PCOM) to make this transition easier. Objectives To determine whether PCOM students’ comfort and preparedness increased after taking a 4-week clinical transition course before third-year clinical clerkships, and to determine whether faculty perceptions of student preparedness and comfort were improved after participation in the course compared with previous third-year students. Methods Second-year osteopathic medical students at PCOM participated in a 4-week course, Introduction to Clinical Clerkship (I2C). The course included 16 small-group exercises, which all took place before students began their third-year clerkship rotations. The exercises in the course extended beyond the skills learned during their classroom years. Students were given a pre- and postcourse survey to evaluate their comfort level with 58 different aspects of clinical practice. Participating faculty were surveyed to evaluate their perception of student preparedness and comfort compared with previous third-year students who had not undergone the exercise. Results After completing the I2C course, third-year osteopathic medical students (n=232) reported increased comfort with 57 of the 58 learning objectives and each of the 5 coded clinical competency areas (patient assessment, effective communication, hospital logistics, procedural skills, and core knowledge) (P Conclusion Within the 5 competencies, students on average felt more comfortable and were perceived by faculty as better prepared than previous students who had not taken the I2C course. The establishment of a preclinical transition exercise appears to help bridge the gap between the preclinical and clinical years. This learning model allows medical students to feel both more comfortable and better prepared throughout the transition from classroom learning to clinical rotations.

Objective The objective of this survey was to obtain mental health professional perspectives on cognitive-behavioral therapy (CBT) for opioid use disorder (OUD) treatment. Methods Respondents (N = 84) rated components of CBT for their efficacy in OUD treatment. Ratings were reported for the overall sample, by degree completed, and by clinicians versus nonclinicians. Respondents also ranked additional therapeutic strategies that might enhance the efficacy of CBT for OUD. Results Respondents rated treatment alliance/rapport, coping skills, and motivational interviewing as the most effective CBT components for OUD. Forms and worksheets were rated as the least effective component. The most beneficial additions to CBT for OUD would be mindfulness, peer support, and medication adherence strategies. Finally, the survey responses suggested that addressing co-morbid mental health disorders and life stressors may be important within CBT treatment for OUD.

Introduction To date, research on differences in sleep complaints between patients with different subtypes of ADHD has been mixed. On balance, the evidence tends towards ADHD-Combined Presentation (ADHD-C) being associated with more severe sleep and sleep-related daytime complaints than ADHD-Primarily Inattentive (ADHD-I). In order to further assess this issue a surveillance study was undertaken in an active ADHD clinic by adding a comprehensive sleep disorders screener (SDS-CL-25) to the clinical intake procedures. These data were used to ascertain whether the two subtypes differ for any of 13 sleep disorders symptoms. Methods Subjects (n = 132; 83 male, 49 female, mean age 32.8, age range 18-79), presenting to the clinic for evaluation for ADHD were given the SDS-CL-25. The SDS-CL-25 is a 25-item instrument developed to screen for multiple sleep disorders at one time (problems are endorsed on a Likert-scale; 0 = never and 4 = more than 5x/week). Endorsements greater than 3x/week were counted as positive for the symptom and less than three days per week was considered negative. Percent per group was compared using Chi Square Analyses. Cumulative morbidity means were also analyzed using t-tests. The subtype, ADHD-I (n=71) and ADHD-C (N=61), was established using EMR records. Results No significant differences between patients with ADHD-I and ADHD-C were detected. Conclusion The lack of finding in the present analysis may reflect a lack of difference or a failure to detect differences based on the small sample sizes or lack of statistical control for likely confounders (age, sex, illness severity or chronicity, SES status, etc.). Analyses are ongoing. Support No support was provided for this abstract.

Context: The use of standardized patients (SPs) promotes and enhances interpersonal skill sets of medical students and provides a critical opportunity for students to display their relational competence during simulated patient encounters. Objective: To investigate whether SPs’ ratings of osteopathic medical students’ empathy and interpersonal skills correlate with students’ self-rated empathy. Methods: The study used a cross-sectional quantitative design. After SP encounters, first-, second-, and third-year osteopathic medical students self-rated empathy using the Jefferson Scale of Empathy medical student version. Standardized patients also assessed students’ empathy using the Jefferson Scale of Patient Perceptions of Physician Empathy and interpersonal skills using the Professionalism Assessment Ratings Scale. Results: Of 780 first-, second-, and third-year students, 717 students returned the survey (91.9%). In total, 383 students were women (53.4%) and 334 were men (46.6%). Of 717 SP encounters, SPs returned surveys for 648 encounters (90.3%). Ratings from SPs regarding their perceptions of osteopathic medical students’ empathetic abilities and interpersonal skills did not correlate with students’ self-rated empathy scores. Second- and third-year students were perceived by SPs as having better-developed empathetic and interpersonal skill sets when compared with first-year students. Results of SPs’ ratings indicated that the higher the interpersonal skills, the higher the SP-perceived empathy for students across all years (r=0.66; P Conclusion: Students’ self-rated empathy did not correlate with SP-perceived empathy. However, the findings validated that students’ core relational competencies increase as they progress through medical school.

The current chart review study examined the relationship between self-reported cognitive distortions, attention-deficit/hyperactivity disorder (ADHD) symptoms, and co-occurring symptoms of depression and anxiety in a clinical sample of adults diagnosed with ADHD. Thirty subjects completed inventories measuring cognitive distortions, ADHD, anxiety, depression, and hopelessness as part of the standard diagnostic evaluation protocol used in a university-based outpatient clinic specializing in adult ADHD. A series of correlational analyses were conducted to assess the relationship between self-reported cognitive distortions, ADHD, anxiety, depression, and hopelessness. Results indicated a significant, positive correlation between self-reported cognitive distortions and ADHD. Responses to individual items on the measure of cognitive distortions were tabulated to identify the prevalence of specific cognitive distortion categories, with Perfectionism emerging as the most frequently endorsed. Further clinical implications of these findings are discussed.

Introduction It is commonly observed in clinical settings that patients with ADHD regularly present with comorbid “sleep disturbances”. In the absence of broad based sleep disorders assessments, it is thought that this represents Delayed Sleep Phase Disorder (DSPD). Recently, a surveillance study was undertaken in a university-based, outpatient specialty clinic for adults with ADHD, by adding a comprehensive sleep disorders screener (SDS-CL-25) to the clinical intake procedures. These data were used to ascertain which sleep disorders symptoms are common in this clinical cohort. Methods SDS-CL-25 data were collected in 150 subjects (93/57 male/female, mean age 32.8, age range 18-79). The SDS-CL-25 is a 25 item instrument developed to screen for 13 sleep disorders at one time (Sleep Dx symptoms are endorsed on Likert-scales; 0 [never] 4 [>5x/week]). For the purposes of this study, the percentage of subjects endorsing frequent symptomatology (sum of the percent of endorsements for columns 3 & 4)was calculated per symptom. Sums of >20% were considered, a priori, to be of clinical significance. Results Patients endorsed: increased fatigue (59%); SL or WASO or EMA’s >30 minutes (40%; 26%; 21%, respectively); late preferred time to bed (31%); work & school limits sleep opportunity (30%); variable time to and out of bed (27%); and snoring (21%). The average percent endorsement was 15% (range 0-59%). Conclusion These results suggest that, consistent with clinical observations, adult patients diagnosed with ADHD frequently endorse late preferred time to bed, variable sleep wake schedules, work/school limitations on sleep opportunity, and sleep onset problems that are accompanied by daytime fatigue. This constellation of symptoms is consistent with the notion that patients with ADHD tend to have comorbid DSPD. The high prevalence of middle and late insomnia was unexpected and suggests that Insomnia Disorder (proper) may also be a feature of ADHD. Support No support was provided for this abstract.

Introduction It is well documented that sleep continuity (i.e., SC [ability to initiate and/or maintain sleep]) worsens with age. It is unclear whether problem endorsement and/or daytime dysfunction show similar age-related trends. Accordingly, an analysis was undertaken to assess whether initial, middle, and/or late insomnia all exhibit age related change and whether problem endorsement and/or daytime dysfunction show comparable age-related changes. Methods The study utilized a cross-sectional group design in an archival/community dataset (www.sleeplessinphilly.com). This dataset (N=932) was comprised of adults between 18 and 89 years of age with self-reported sleep complaints. Participants were categorized as: Young Adults (18-29 years); Adults (30-44 years); Middle Age Adults (45-64 years); and Older Adults (65-89 years). Age groups were matched to the Older Adults group (n=233) by sex, race, and BMI. ANOVAs with Bonferroni corrections (alpha = .001), and contingency analyses were performed to assess for age group differences. Results It was found that, as expected, SC worsens with age but that this was limited to middle and late insomnia. Further, problem endorsement increased with age (except for SL) but sleep-related daytime dysfunction did not (except for concentration issues). Conclusion These results have several implications. Methodologically speaking, when evaluating the effects and/or correlates of SC, it may be wise to concomitantly assay “is this a problem for you” and “does this affect your daytime function”, as SC can occur without perceived daytime consequences, especially in older adults. Conceptually speaking, the observed discordance requires further exploration. In the past, it has been argued that sleep need is reduced in older adults. While this is a reasonable hypothesis (no need, no functional consequence), it remains to be demonstrated that older adults require less sleep. Support

This study sought to examine high school students’ self-reported drinking behaviors following the introduction of flavored malt beverages, also known as alcopops, to the US market. We hypothesized that adolescents’ reported drinking behaviors would be significantly altered following the introduction of alcopops in the US. A cross-sectional time series Youth Risk Behavior Survey data set was created from publicly available data collected by the Centers for Disease Control and Prevention (N = 60,426) and used to conduct secondary data analysis, using an interrupted time series quasi-experimental design. Segmented regression analyses estimated how much the introduction of alcopops in the US affected drinking behaviors, whether the effects were immediate and/or delayed, and whether there may have been other factors than the intervention that could explain the effects. Respondents aged ≥18 years had statistically significant increases in three drinking behaviors after alcopops were introduced. Binge drinking i...

The interface between professional psychology and primary care medicine has begun to burgeon. This specialty area has challenged psychologists to rethink their roles, functions, and modalities of professional practice. Primary care psychology, as a model for integrating psychology and medicine, is at the forefront of the health care reform movement, rooted in the interest to deliver more efficient and effective health care. As specialty areas, in light of patient needs, primary care medicine and primary care psychology are interdependent and intertwined. The primary care medicine model is distinctively characterized as being a patient-centered approach. Primary care physicians (PCPs) confront problems on a daily basis for which 8 of the top 10 leading gauges of health are essentially behavioral in nature. Moreover, mental health problems are highly prevalent in primary care. The missing link has been the lack of primary care psychology to attend to these ongoing challenges and to shore up the breadth of services provided by the PCP. This chapter provides a historical overview of primary care medicine and psychology and reviews critical tasks confronting psychologists in attempting to meet this important challenge. Five common behavioral health problems and five medical problems seen in primary care settings are reviewed with a focus on clinical manifestation and prevalence, assessment and diagnostic issues, potential treatments, and points of collaboration between primary care psychologists and PCPs. Future directions are also addressed. Keywords: primary care psychology; interprofessional collaboration; integrated health care; biopsychosocial model

The Willoughby Personality Schedule (WPS) was subjected to Item Analysis, Coefficient Alpha Reliability Analysis, Factor Analysis and parametric tests for sex and age differences to assess its psychometric qualities. A set of norms for adult neurotics was also developed. The WPS items were all shown to be significantly related to total WPS score and to converge into a unitary construct: hypersensitivity to interpersonal situations. The potential clinical and research uses for the WPS in assertion and social skills training are discussed.

Insomnia is a broad concept embracing various forms of objective and/or purely phenomenological sleep disturbance. Clinically, the term insomnia usually refers to a chronic inability to initiate and maintain adequate sleep (Bootzin & Nicassio, 1978; Sleep Disorders Classification Committee, 1979; Williams, Karacan, & Hursch, 1974). That sleep disturbance is, without a doubt, a common clinical complaint is supported by a variety of research surveys. Weiss, Kasinoff, & Bailey (1962) reported that 15% of a sample of 110 Air Force personnel complained of some sort of sleep disturbance. Later, in an epidemiological survey (Williams, Karacan, & Hursch, 1974) of 1,645 people in the general population in one county in Florida, 45% of the sample reported experiencing difficulties in initiating and maintaining sleep. More recently, others (Kales, Bixler, Lee, Healy, & Slye, 1974; Montgomery, Perkins, & Wise, 1975; Webb, 1975) have observed that approximately 10% to 15% of the population complain of mild or occasional insomnia, and an additional 10% to 15% suffer severe and frequent insomnia. Finally, what appears to be an alarming amount of prescribed sleep medication (i.e., tranquilizers and hypnotics) in the United States alone provides further, albeit indirect, confirmation of the preva

The construct validity of the Willoughby Personality Schedule (WPS) as an index of social anxiety was established in the present study. The WPS correctly identifies social phobics from controls in 88% of the cases.