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Objective: Hypermobile Ehlers‐Danlos syndrome (hEDS) and hypermobility spectrum disorders (HSD) are characterized by joint hypermobility, joint subluxations and dislocations, hyperextensible skin, and chronic and progressive multiorgan comorbidities. Diagnosing hEDS and HSD is difficult because of variable phenotypes and unknown genetic etiology. In our clinic, we observed many patients with hEDS and HSD with a high serum level of unmetabolized folate, which suggests that hypermobility may be linked to methylenetetrahydrofolate reductase (MTHFR)–mediated folate metabolism. The present study aims to examine the prevalence of MTHFR polymorphisms, C677T and A1298C, among patients with hEDS and HSD. Methods: Clinical and demographic information of patients visiting our hypermobility clinic from January 2023 to July 2023 were retrospectively reviewed. Continuous variables were reported as mean ± SD and range, whereas categorical variables were reported as total count and percentage. Results: Among 157 patients, 93% of patients were female patients, 52.2% were diagnosed with hEDS, and 47.8% were diagnosed with HSD. Interestingly, 85% of the patients had MTHFR C677T and/or A1298C polymorphisms in heterozygous or homozygous state. MTHFR 677CT/TT genotype was present in 52.9% of cases, and 49.7% of patients had 1298AC/CC genotype. In addition,14% of patients with hypermobility exhibited MTHFR 677TT genotype, 10.2% showed 1298CC genotype, and 17.2% displayed combined heterozygosity, collectively representing 41.4% hypermobile patients with two copies of MTHFR variant alleles. Conclusion: There is a high prevalence of MTHFR polymorphisms among patients with hypermobility, which supports the hypothesis that hypermobility may be dependent on folate status. [ABSTRACT FROM AUTHOR]

Objectives: The cue-reactivity paradigm has been widely used to assess craving among cigarette smokers. Seeking to replicate and expand on previous virtual reality (VR) nicotine cue-reactivity research on nontreatment-seeking smokers, the current study compared subjective reports of craving for cigarettes when exposed to smoking (proximal and contextual) and neutral cues using VR in treatment-seeking and nontreatment-seeking cigarette smokers. Methods: Data from two previously published studies in nontreatment seekers from our group (Bordnick et al., 2004; Bordnick, Graap, Copp, Brooks, & Ferrer, 2005) were compared to results with 82 newly enrolled treatment-seeking smokers. Results: Overall, VR cues produced similar levels of craving for both treatment seekers and nontreatment seekers across the different cue environments. Specifically, craving was greater for both groups in smoking environments (paraphernalia and party) than those in the neutral environments. Conclusions: These findings provide strong evidence that VR is a useful tool that may be used by social workers and other clinical professionals to present smoking (proximal and contextual) cues for assessment and treatment and illustrate the utility of standardizing VR procedures to compare craving between different groups. (Contains 1 figure.)

Objective: Virtual reality (VR)-based cue reactivity has been successfully used for the assessment of drug craving. Going beyond assessment of cue reactivity, a novel VR-based treatment approach for smoking cessation was developed and tested for feasibility. Method: In a randomized experiment, 10-week treatment feasibility trial, 46 nicotine-dependent adults, completed the 10-week program. Virtual reality skills training (VRST) combined with nicotine replacement therapy (NRT) was compared to NRT alone. Participants were assessed for smoking behavior and coping skills during, at end of treatment, and at posttreatment follow-up. Results: Smoking rates and craving for nicotine were significantly lower for the VRST group compared to NRT-only group at the end of treatment. Self-confidence and coping skills were also significantly higher for the VRST group, and number of cigarettes smoked was significantly lower, compared to the control group at follow-up. Conclusions: Feasibility of VRST was supported in the current study. (Contains 2 tables and 3 figures.)

Cue reactivity assessments have been widely used to assess craving and attention to cues among cigarette smokers. Cue reactivity has the potential to offer insights into treatment decisions; however, the use of cue reactivity in treatment studies has been limited. This study assessed the feasibility of using a virtual reality-based cue reactivity assessment approach (VR-NCRAS) during treatment. In a clinical smoking cessation treatment study, 46 treatment-seeking nicotine-dependent adult smokers were assessed for cue reactivity at baseline, Week 4, and Week 10 of treatment. Measures of cue reactivity included subjective craving and attention to cues after exposure to two neutral and two smoking cue environments. Overall, feasibility of using VR-NCRAS was demonstrated and these findings support the use of the cue reactivity assessment during treatment, which can inform treatment decisions. (Contains 3 figures and 1 table.)

Since the early 1990s, intervention strategies designed to preserve the family system while serving children diagnosed with severe emotional disturbances (SED) have been on the rise. Many of these strategies sought to provide families with comprehensive approaches that link various agencies and services, thus providing a complete system of care. The term wraparound services was coined to describe these approaches. However, evaluation studies of the outcomes of these programs remains limited. In order to assess the impact of wraparound services, outcome evaluation programs need to be implemented and their feasibility assessed. This paper focuses on the feasibility and implementation of a computer-based field assessment system and the ability to provide empirically based feedback to the programs. In addition, an assessment of 15 participating children and families, comparing selected aspects of clinical functioning at intake and 6-month follow-up, is presented and discussed. (Contains 1 table.)

Statewide evaluations of mental health services are colossal undertakings, reports of which are few in the published literature. Social workers are often called on to conduct program evaluations of both small- and large-scale mental health systems. A statewide evaluation system was implemented in the state of Georgia in 1999 to measure the impact of services on mental health, mental retardation, and substance abuse programs. This report delineates the evaluation of substance abuse services for the state of Georgia using the Addiction Severity Index. System-wide outcomes were assessed across 13 mental health regions, and 19 substance abuse programs participated. Consumers admitted to American Society of Addiction Medicine level II services were assessed at intake and 60 days posttreatment. Difficulties with the implementation of the statewide evaluation system, such as attrition, are identified and discussed. Recommendations for improving the evaluation system are also discussed. (Contains 1 table.)

Compared entrance and exit scores for 16 patients completing outpatient treatment for sex offenders. Statistically significant outcome measures and clinical improvements were obtained. Follow-up in 26 months yielded one reoffender. Results support the use of outpatient behavior therapy in reducing deviant sexual arousal and enhancing appropriate behavior. (Author/EMK)

This mixed-methods pilot investigation evaluated the use of virtual patient simulations for increasing self-efficacy and diagnostic accuracy for common behavioral health concerns within an integrated care setting. A two-by-three factorial design was employed to evaluate three different simulated training conditions with a sample of 22 Masters level behavioral health students. Results support engagement in virtual patient simulation training to increase students' self-efficacy in brief clinical assessment, and support the use of virtual patient simulations to improve diagnostic accuracy. Results further indicate that virtual patient simulations have sufficient levels of usability and acceptability as a tool for developing brief clinical interviewing skills, and that participants found this method of instruction to be a valuable adjunct to traditional classroom or field based training. Future directions and next steps for the integration of technology enhanced simulations in clinical social services education are explored. [ABSTRACT FROM AUTHOR]

Thirteen nicotine-dependent participants, in a controlled pilot trial were allowed to smoke ad libitum and then exposed to virtual reality (VR) smoking and VR neutral cues, to be compared on craving intensity. VR smoking cues were found to effectively increase subjective craving in nicotine preloaded, dependent smokers.

Understanding the effect of cultural values on depression and how social networks influence these relationships may be important in the treatment of substance-using, Mexican American populations. Latino cultural values, familismo, personalismo, fatalismo, and machismo, may be associated with depression among Latinos. The current study identified the association of traditional Latino values on depressive symptomatology among a sample of Mexican American heroin injectors. A cross-sectional research design and field-intensive outreach methodology were utilized to recruit 227 Mexican American men. Participants were categorized into depressed and nondepressed groups. Relations among cultural values and depression were examined using logistic regression. Findings indicate that drug-using men with higher familismo and fatalismo scores are protected against depressive symptomatology. Relations between familismo and depression seem to be moderated by having a drug use network. In addition, findings reveal that age is inversely related to depressive symptomatology. Young Mexican American heroin users who do not ascribe to traditional Latino values may be highly associated with depression and therefore more vulnerable to riskier drug use behaviors. Moreover, drug-using social networks may affect the protective nature of certain cultural values. Further research is needed to identify whether culturally tailored treatments can cultivate these values while simultaneously undermining the effect of substance-using social networks in order to reduce depression symptoms among this group of high-risk substance users. [ABSTRACT FROM AUTHOR]

Background: Smoking cessation may lead to depression in some smokers and result in increased risk of suicide. Objective: To compare the risk of suicide attempts/behaviors associated with different smoking cessation medications among schizophrenic patients. Methods: A retrospective cohort study was conducted using General Electric (GE) medical record database (1995-2011). The first day of being prescribed a smoking cessation medication defined as index date. Patients were followed up to one year from index date. Patients' suicide behaviors or attempts were identified through ICD-9 codes and E-codes. Cox proportional hazards model was applied to examine the association between smoking cessation medication and suicidal/self-injurious behaviors. Results: Our cohort consisted of 3925 patients with diagnosis of schizophrenia or schizoaffective disorder who initiated cessation medication. Among them, 104 (2.65%) had suicide attempts or behavior within one-year follow up. However, statistically significant difference in the risk of suicide attempts/behaviors was not detected across cessation regimens in the Cox proportional hazard analysis. Only comorbidity index was found to be associated with suicide, which showed that higher Charlson comorbidity index was associated with higher risks of suicide behav.ors within one year (HR = 1.15,95% Cl = 1.04-1.27). Conclusion: There were no significant differences in suicide attempts/behaviors with different cessation medications. [ABSTRACT FROM AUTHOR]