Search

The present study sought to emphasize the important role of Therapeutic Recreation in facilitating interprofessional therapeutic group programming in acute inpatient psychiatry. During a six-month timeframe in 2019, information on therapeutic programming and outcomes, group facilitators, types of groups offered, and unit participation was collected on two inpatient acute mental health inpatient units at a large academic hospital. Patient experiences when participating in therapeutic programming were also examined as outcome measures through anonymous patient surveys. The purposes of the study were, 1) to provide data that introduces a framework for and strengthens the role of recreation therapists as core treatment facilitators in acute inpatient settings, 2) to gain insight into the experiences of the individuals on the units who participate in therapeutic programming to determine efficacy, and 3) to provide pilot and feasibility data examining the novel collaboration between recreation therapy and psychology in the development and implementation of group Cognitive Behavioural Therapy (CBT) psychotherapeutic programming. Findings revealed patients were highly satisfied with therapeutic recreation programming as well as the new psychotherapeutic group interventions and attributed both as being important to their mental health treatment. This research highlights the value and need for investigative clinical research examining the utility of recreation therapists' roles in developing novel intervention programming, facilitating interdisciplinary collaboration, and enhancing patient experiences during acute psychiatry inpatient admissions. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the associations between cannabis use and neurocognitive functioning, including self-reported attention deficit hyperactivity disorder (ADHD) symptoms, in a large sample of emerging adults (ages 21–25) using a cross-sectional design. A secondary objective was to examine age of cannabis initiation as a moderator. Methods: Participants were high-risk drinking emerging adults (n = 598) reporting past-month cannabis use in the following categories: 1) non-users (i.e., never or not in the past month; n = 276), 2) occasional users (i.e., monthly or weekly users; n = 201), and 3) daily users (n = 121). Categorical comparisons were conducted on working memory, attention, behavioral inhibition, delay and probability discounting, verbal intelligence, and ADHD symptoms. Complementary dimensional analyses examined cannabis severity in relation to neurocognition using regressions. Covariates were age, race, sex, income, years of education, tobacco use, and alcohol use. Results: Frequency of cannabis use was significantly associated with poorer working memory performance, more impulsive delay discounting, and greater endorsement of ADHD symptoms, but not other domains. Effect sizes were small and poorer performance was selectively present among daily, not occasional, cannabis users. Earlier age of initiation was not independently or interactively associated with neurocognitive performance. Conclusions: Daily cannabis use was selectively adversely associated with aspects of memory, impulsivity, and subjective attentional functioning, but most cognitive indicators were not implicated, and evidence of amplification by earlier age of initiation was not observed. Ascertaining causal versus consequential roles of cannabis in neurocognitive functioning is an important priority. [ABSTRACT FROM AUTHOR]

Self-injurious behavior (SIB) has frequently been associated with psychiatric illness and neurological lesions as means of reducing tension or diverting from pain. However, these explanations did not capture the complexity of SIB in the case of Mr. X, a 62-year-old patient who ingested his fingers in his sleep where cognitive testing was valuable in informing diagnosis. Mr. X's SIB was severe enough that he had chewed beyond the middle phalanx for most of his fingers. Clinical symptoms included daytime sleepiness, hypnogogic hallucinations, and bradykinesia. His cognitive profile revealed declines in his intellectual functioning as well as visuospatial and executive deficits in the context of preserved attention, language, and memory. His cognitive and clinical presentation suggested that Mr. X had a neurodegenerative disorder, which may have contributed to his SIB. We believed that the most probable diagnosis may have been rapid eye movement behavioral sleep disorder in the context of Lewy bodies dementia. [ABSTRACT FROM AUTHOR]

Background: Somatic symptom disorder (SSD) presents challenges to the healthcare system, including frequent medical visits, lack of symptom relief experienced by individuals with this condition, high associated medical costs, and patient dissatisfaction. This study examined the utility of a novel, low-barrier, brief cognitive behavioural therapy (CBT) group intervention for individuals with SSD. Methods: Participants were referred by their mental health providers or self-referral. Each participant underwent a telephone screen and in-person psychological and neuropsychological screen. Two cycles of the CBT-based group (n = 30), each consisting of six weekly two-hour sessions, were facilitated at a large outpatient mental healthcare facility in Ontario, Canada. The final sample consisted of 13 individuals of whom 11 completed the treatment. Clinical outcome measures were administered pre-, mid- and post-group, including the Generalized Anxiety Disorder–7, Perceived Stress Scale–4, Pain Self-Efficacy Questionnaire, Pain Disability Index, Revised Illness Perception Questionnaire, and sections of the Patient Health Questionnaire. Six healthcare utilization metrics were collected from electronic medical records at six months pre- and post-group. Paired samples t-tests were used to examine pre- to post-group differences in participants' somatic symptoms, psychological functioning, health, and degree of healthcare utilization. Results: When comparing pre- and post- group, we observed reductions in the mean scores for somatic symptom severity, depressive symptomatology, anxiety, perceived stress, and perceived disability related to pain. The change in depressive symptomatology yielded a small effect size (d = 0.30). Further, we observed downward trends across participants' pre- to post-group healthcare utilization, with small effect sizes observed for hospital admission (d = 0.36), days admitted to hospital (d = 0.47), and inpatient consults (d = 0.42). Differences between pre- and post-group measures of somatic symptom severity, psychological functioning, health, or healthcare utilization did not reach significance. Conclusions: Current findings provide support for the potential effectiveness of an abbreviated CBT group for individuals with SSD in reducing psychiatric symptomatology. Further research is recommended, including randomized control trials, cost-benefit analyses, and comparisons between abbreviated versus longer-duration treatment programs for SSD. Trial registration: Not applicable. [ABSTRACT FROM AUTHOR]

Objectives: A number of commonly used performance validity tests (PVTs) may be prone to high failure rates when used for individuals with severe neurocognitive deficits. This study investigated the validity of 10 PVT scores in justice-involved adults with fetal alcohol spectrum disorder (FASD), a neurodevelopmental disability stemming from prenatal alcohol exposure and linked with severe neurocognitive deficits. Method: The sample comprised 80 justice-involved adults (ages 19–40) including 25 with confirmed or possible FASD and 55 where FASD was ruled out. Ten PVT scores were calculated, derived from Word Memory Test, Genuine Memory Impairment Profile, Advanced Clinical Solutions (Word Choice), the Wechsler Adult Intelligence Scale – Fourth Edition (Reliable Digit Span and age-corrected scaled scores (ACSS) from Digit Span, Coding, Symbol Search, Coding – Symbol Search, Vocabulary – Digit Span), and the Wechsler Memory Scale – Fourth Edition (Logical Memory II Recognition). Results: Participants with diagnosed/possible FASD were more likely to fail any single PVT, and failed a greater number of PVTs overall, compared to those without FASD. They were also more likely to fail based on Word Memory Test, Digit Span ACSS, Coding ACSS, Symbol Search ACSS, and Logical Memory II Recognition, compared to controls (35–76%). Across both groups, substantially more participants with IQ <70 failed two or more PVTs (90%), compared to those with an IQ ≥70 (44%). Conclusions: Results highlight the need for additional research examining the use of PVTs in justice-involved populations with FASD. [ABSTRACT FROM AUTHOR]

High rates of substance misuse during emerging adulthood (~17-25 years of age, also referred to as young adulthood) require developmentally appropriate clinical programs. This article outlines: 1) the development of an evidence-informed young adult outpatient substance use program that takes a biopsychosocial patient-centred approach to care; 2) a quality improvement process and protocol; and 3) the patient characteristics of an initial cohort. Literature reviews, program reviews, environmental scans, and consultations with interested parties (including individuals with lived expertise) were used to develop the program. A 12-week measurement-based care program was developed comprising: 1) individual measurement-based care and motivational enhancement therapy sessions; 2) group programming focused on cognitive behavioural therapy, mindfulness, distress tolerance, and emotional regulation; 3) clinical consultations for diagnostic clarification and/or medication review; and 4) an independent Community Reinforcement Approach Family Training (CRAFT) group for loved ones. A measurement system was concurrently created to collect clinical and program evaluation data at six time points. In the first 21 months of the program, 152 young adults enrolled in the program (mean age = 21 years old, 47% female gender) primarily reporting treatment targets of cannabis (68%) and alcohol (63%) and almost all presenting with co-occurring mental health concerns (95%). The initial cohort who completed the program showed symptom improvements. Collectively, the program demonstrates the feasibility of developing an evidence-informed young adult substance use program using measurement-based care, but also the need for flexibility and ongoing monitoring to meet local needs. [ABSTRACT FROM AUTHOR]

Background: Brief interventions for alcohol use disorder (AUD) are generally efficacious, albeit with variability in response. Resting state functional connectivity (rsFC) may characterize neurobiological indicators that predict the response to brief interventions and is the focus of the current investigation. Materials and Methods: Forty‐six individuals with AUD (65.2% female) completed a resting state functional magnetic resonance imaging (fMRI) scan immediately followed by a brief intervention aimed at reducing alcohol consumption. Positive clinical response was defined as a reduction in alcohol consumption by at least one World Health Organization (WHO) risk drinking level at 3‐month follow‐up. rsFC was analyzed using seed‐to‐voxel analysis with seed regions from four networks: salience network, reward network, frontoparietal network, and default mode network. Results: At baseline, responders had greater rsFC between the following seed regions in relation to voxel‐based clusters than non‐responders: (i) anterior cingulate cortex (ACC) in relation to left postcentral gyrus and right supramarginal gyrus (salience network); (ii) right posterior parietal cortex in relation to right ventral ACC (salience network); (iii) right interior frontal gyrus (IFG) pars opercularis in relation to right cerebellum and right occipital fusiform gyrus (frontoparietal); and (iv) right primary motor cortex in relation to left thalamus (default mode). Lower rsFC in responders vs. nonresponders was seen between the (i) right rostral prefrontal cortex in relation to left IFG pars triangularis (frontoparietal); (ii) right IFG pars triangularis in relation to right cerebellum (frontoparietal); (iii) right IFG pars triangularis in relation to right frontal eye fields and right angular gyrus (frontoparietal); and (iv) right nucleus accumbens in relation to right orbital frontal cortex and right insula (reward). Conclusions: Resting state functional connectivity in the frontoparietal, salience, and reward networks predicts the response to a brief intervention in individuals with AUD and could reflect greater receptivity or motivation for behavior change. [ABSTRACT FROM AUTHOR]

Objective: Alcohol misuse in college students represents a significant public health problem. Toward improving the understanding of determinants of collegiate alcohol misuse, the current study examined several dimensions of impulsivity in relation to hazardous drinking in college students.Method: A one-way, two-group, cross-sectional design was used to compare hazardous drinkers (HZD) with social drinkers (SOC). HZD drinkers were required to score 6 or more on the Alcohol Use Disorders Identification Test (AUDIT); SOC drinkers were required to score 1-5 on the AUDIT. The sample comprised 93 participants (56% HZD; 76% male) who were recruited from a medium-sized public university. Participants were assessed under neutral conditions using the Eysenck Impulsivity Questionnaire (EIQ), Delay Discounting Task (DDT), and Stanford Time Perspective Inventory (STPI).Results: Consistent with predictions, HZD participants exhibited significantly greater impulsivity on the EIQ-Impulsivity subscale (p < .001), the STPI-Present Hedonism subscale (p < .01), and the STPIFuture subscale (p < .01); however, no differences were evident on the DDT (p > .40). The HZD group also scored marginally higher than the SOC group on the EIQ-Venturesomeness subscale (p < .10).Conclusions: These findings suggest that greater impulsivity is associated with alcohol misuse in college students, most prominently in the area of propensity toward risk-taking and nonplanning (EIQ-Impulsivity subscale). The correspondence between these findings and previous studies, methodological considerations, and the need for prospective studies on impulsivity and alcohol misuse in college students are discussed. [ABSTRACT FROM AUTHOR]

Objective: The COVID-19 pandemic is a global health crisis that has created sudden and unique challenges within the field of clinical neuropsychology. Adapting neuropsychology services using teleneuropsychology models (e.g. video or telephone assessments) may not always be a viable option for all providers and settings. Based on the existing teleneuropsychology literature, we propose a "contactless" evidence-based inpatient test battery to be used for in-person assessments amenable to physical distancing. Method: In addition to the proposed test battery, we suggest a decision-making workflow process to help readers determine the appropriateness of the proposed methods given their patients' needs. Considerations for special populations (i.e. seniors, patients with brain injury, psychiatric patients), feedback, limitations of the proposed physical distancing approach, and future directions are also discussed. Conclusions: Our aim is that the suggested teleneuropsychology-informed battery and model may inform safe and practical neuropsychological inpatient assessments during the COVID-19 pandemic and other situations requiring contact precautions for infection prevention and control. [ABSTRACT FROM AUTHOR]