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OBJECTIVE: Lesbian, gay, bisexual, transgender (LGBT) and other sexual minority individuals are at higher risk than non-LGBT individuals for multiple psychiatric conditions and suicide. However, little is known regarding LGBT-specific training among psychiatric residents. The authors sought to characterize LGBT-specific training among adult psychiatry residency programs. METHODS: An anonymous, cross-sectional survey was electronically distributed to U.S.-based adult psychiatry program directors between February and April, 2018. Survey topics included program demographics, characteristics of LGBT-specific training, perceived barriers to implementation, and anticipated needs. RESULTS: Seventy-two program directors (30.8%) provided complete survey responses. Over half (55.6%) of these programs had ≤5 hours of LGBT-specific training (“lower-hour programs”). Lower- and higher-hour (>5 hours of LGBT-specific education) programs were similar on measured demographic variables, but lower-hour programs covered fewer LGBT-specific topics and program directors were more likely to report lack of interested or topic-expert faculty as a barrier to enhancing LGBT-specific training. CONCLUSIONS: Results of this survey suggest a need for the development and implementation of LGBT-specific educational curricula for use in U.S.-based adult psychiatry programs. In addition, future research may explore effective ways for programs to recruit, retain, and support teaching faculty with LGBT-specific expertise.

Aims Resilience is defined as the capacity for an individual to maintain normal functioning and resist the development of psychiatric disorders in response to stress and trauma. Although previous investigators have acknowledged the important role of resilience in those with substance use disorders, this is the first study to investigate the reliability, validity, and factor structure of the Connor-Davidson Resilience Scale (CD-RISC-25) in a sample of individuals with opioid use disorder (OUD). Additionally, we explored the relationship between trait resilience and the severity of drug-related problems. Methods Four hundred and three participants (22 % female) with OUD completed the CD-RISC-25, Beck Depression Inventory (BDI-II), and the self-report Addiction Severity Index (ASI). Confirmatory factor analysis (CFA) tested the originally proposed 5-factor solution of the CD-RISC-25. Results CFA results indicated that a 5-factor model of the CD-RISC-25 performed somewhat better than the 1-factor solution. Pearson correlation revealed a negative association between CD-RISC-25 (M = 75.82, SD = 15.78) and ASI drug-use composite score (M = .25, SD=-0.16), r=-0.148, p .01, and between CD-RISC-25 and BDI-II (M = 11.33, SD = 10.58), r=-.237, p .001. Conclusions Albeit providing only limited support for the original 5-factor structure, our results indicate that the scale may be useful for screening individuals with OUD who have a vulnerability to stress. Consistent with prior studies, higher resilience was associated with lower depression symptoms and addiction severity, further demonstrating the CD-RISC-25 ability to predict psychiatric stability. To inform the development of more targeted interventions, future studies should examine resilience longitudinally, in addition to exploring more comprehensive approaches to measuring resilience.

Aripiprazole may be an effective adjunctive treatment in outpatients with unipolar depression that has been refractory to treatment with SSRI or SNRI medication.Fifteen subjects with a current DSM-IV diagnosis of MDD which had not responded to SSRI or SNRI treatment were enrolled in a 12 week open-label study of aripiprazole with a maximum dose of 30 mg/day. Patients' current episode averaged 10.4+/-16.6 years, with a range of 3 months to 54 years. Baseline severity averaged 30.1+/-7.1 on HDRS-24, and 19.7+/-8.4 on BDI. Patients had been treated with a mean dose of 79.2+/-28.2 mg/day of fluoxetine equivalents for an average of 1 year prior to starting the study. Five subjects were on SNRI medications and 10 on SSRIs.Seven of 14 (50.0%) subjects were classified as treatment responders, as defined by at least 50% reduction in the HDRS-24 at week 12. Four subjects (28.6%) achieved remission, based on STAR D criteria (HDRS-17 scoreor=7). 26.7% (4/15) of subjects discontinued participation due to side effects. Two (40%) of 5 SNRI-treated subjects responded to aripiprazole augmentation.These findings support previous studies for the effectiveness of aripiprazole in augmenting SSRIs or SNRIs in treatment-resistant major depression.

This study examines the relative contributions of cumulative maternal trauma, substance use, depressive and posttraumatic stress diagnoses on parental abuse potential, punitiveness, and psychological and physical aggression in a sample of 176 urban mothers. Participants were categorized into four groups: substance use (n = 41), depressed (n = 40), comorbid (n = 47), and control (n = 48). Participants in the three diagnostic groups reported significantly greater interpersonal trauma exposure than did controls. Hierarchical regressions reveal that cumulative trauma is a significant predictor of all parenting outcomes, even after controlling for demographic and diagnostic variables. Substance use and depression are significantly related to abuse potential, and PTSD is significantly negatively related to physical discipline, with no other significant associations between diagnostic status and parenting outcomes. These findings add to an important growing literature examining the impact of cumulative trauma on parental functioning. Implications for future research and parenting interventions are discussed.

Based on increasing recognition that the therapeutic relationship is critical in psychotherapy, the goal of this study was to establish the psychometric properties of a suboutcome strategy that could identify important in-session events involving patient-therapist interactions. Ten third-party observers were calibrated on a circumplex measure of suboutcome, a shortened version of the Wiggins' Interpersonal Adjective Scale-Revised. These observers rated four sessions from each of 28 cases of short-term psychotherapy. Each session was rated by thirds and selected to represent each quartile of a 40-session treatment protocol. The major findings indicated adequate interrater reliability and evidence for criterion validity that suggested a predictive relationship of patient and therapist affiliation to ultimate outcome, especially as observed early in treatment.

Recently there has been increased concern about excessive restraint and seclusion on inpatient psychiatric units and the resulting injuries and deaths. Individual crisis management strategies may be one way to reduce restraint and seclusion, which may include active engagement of inpatients in behavioral coping plans.We developed a 5-question Coping Agreement Questionnaire (CAQ) asking inpatients for their preferences on how to prevent loss of control if they become agitated. Nurses completed the CAQ with each patient to find alternatives to restraint and seclusion. A total of 264 admissions were reviewed, with the following diagnoses: mood disorders (n = 111 [42%]), schizophrenia or other psychotic disorders (n = 69 [26%]), or substance use disorders (n = 58 [22%]). One hundred thirty-seven patients (52%) were male.Many CAQ answers differed by diagnosis, sex, age, and ethnicity. For example, when asked how staff could help if they were about to lose control, all groups rated "talk with me" highly, although substance abusers preferred to "sit by self in room." Adolescent patients were more often upset by not having visitors, whereas elderly patients reported being upset by having visitors. Overall, white patients gave more answers to CAQ questions than did black or Hispanic patients.The findings have implications for practice on 3 levels. First, overall implications for the milieu were suggested by patients' preferences. Second, responses that differed by group suggested that optimal case management strategies may vary according to population characteristics. Third, patients may be engaged on the basis of individual preferences as active partners in managing their behavior during inpatient hospitalization.