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Abstract: This study evaluated the impact of a direct-to-consumer (DTC) marketing video designed to educate the public about patients' rights to evidence-based mental health care (EBMHC). Participants ( N = 632) were randomly assigned to an active DTC video condition, a control video condition, or a control condition without a video. Participants who watched the DTC video ( vs . both control conditions) had significantly greater knowledge of patients' rights to EBMHC. Further, individuals who watched the DTC ( vs . control) video reported significantly greater comfort with accessing care and perceived their assigned video as significantly more culturally sensitive. However, participants who watched the DTC video were not significantly different from both control conditions on self-report measures of self-efficacy in working with a provider, likelihood of asking a provider about one's rights, treatment-seeking intentions, and self-stigma. Findings suggest the potential for a DTC video to promote knowledge of EBMHC, though its impact on help-seeking perceptions and intentions was less promising., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Artificial intelligence (AI) refers to computer-based methodologies that use data to teach a computer to solve pre-defined tasks; these methods can be applied to identify patterns in large multi-modal data sources. AI applications in inflammatory bowel disease (IBD) includes predicting response to therapy, disease activity scoring of endoscopy, drug discovery, and identifying bowel damage in images. As a complex disease with entangled relationships between genomics, metabolomics, microbiome, and the environment, IBD stands to benefit greatly from methodologies that can handle this complexity. We describe current applications, critical challenges, and propose future directions of AI in IBD., (Copyright © 2024 AGA Institute. All rights reserved.)

Background and study aims There is limited consensus on the optimal method for measuring disease severity in familial adenomatous polyposis (FAP). We aimed to systematically review the operating properties of existing endoscopic severity indices for FAP. Methods We searched MEDLINE, EMBASE, and the Cochrane Library from inception to February 2023 to identify randomized controlled trials (RCTs) that utilized endoscopic outcomes or studies that evaluated the operating properties of endoscopic disease severity indices in FAP. Results A total of 134 studies were included. We evaluated scoring indices and component items of scoring indices, such as polyp count, polyp size, and histology. Partial validation was observed for polyp count and size. The most commonly reported scoring index was the Spigelman classification system, which was used for assessing the severity of duodenal involvement. A single study reported almost perfect interobserver and intra-observer agreement for this system. The InSIGHT polyposis staging system, which was used for assessing colorectal polyp burden, has been partially validated. It showed substantial interobserver reliability; however, the intra-observer reliability was not assessed. Novel criteria for high-risk gastric polyps have been developed and assessed for interobserver reliability. However, these criteria showed a poor level of agreement. Other scoring indices assessing the anal transition zone, duodenal, and colorectal polyps have not undergone validation. Conclusions There are no fully validated endoscopic disease severity indices for FAP. Development and validation of a reliable and responsive endoscopic disease severity instrument will be informative for clinical care and RCTs of pharmacological therapies for FAP., Competing Interests: Conflict of Interest Disclosures: ALS: Nothing to disclose. HB: Nothing to disclose. AA: Nothing to disclose. JKM: Employee of Alimentiv Inc. AZ: Employee of Alimentiv Inc. JL: Employee of Alimentiv Inc. BGF: Received grant/research support from Millennium Pharmaceuticals, Merck, Tillotts Pharma AG, AbbVie, Novartis Pharmaceuticals, Centocor Inc., Elan/Biogen, UCB Pharma, Bristol-Myers Squibb, Genentech, ActoGenix, and Wyeth Pharmaceuticals Inc.; consulting fees from Millennium Pharmaceuticals, Merck, Centocor Inc., Elan/Biogen, Janssen-Ortho, Teva Pharmaceuticals, Bristol-Myers Squibb, Celgene, UCB Pharma, AbbVie, Astra Zeneca, Serono, Genentech, Tillotts Pharma AG, Unity Pharmaceuticals, Albireo Pharma, Given Imaging Inc., Salix Pharmaceuticals, Novonordisk, GSK, Actogenix, Prometheus Therapeutics and Diagnostics, Athersys, Axcan, Gilead, Pfizer, Shire, Wyeth, Zealand Pharma, Zyngenia, GiCare Pharma Inc., and Sigmoid Pharma; and speaker’s fees from UCB, AbbVie, and J&J/Janssen. VJ: Received consulting/advisory board fees from AbbVie, Alimentiv Inc, Arena pharmaceuticals, Asahi Kasei Pharma, Asieris, Astra Zeneca, Avoro Capital, Bristol Myers Squibb, Celltrion, Eli Lilly, Endpoint Health, Ferring, Flagship Pioneering, Fresenius Kabi, Galapagos, Gilde Healthcare, GlaxoSmithKline, Genentech, Gilead, Janssen, Merck, Metacrine, Mylan, Pandion, Pendopharm, Pfizer, Protagonist, Prometheus Biosciences, Reistone Biopharma, Roche, Sandoz, Second Genome, Sorriso pharmaceuticals, Takeda, Teva, Topivert, Ventyx, and Vividion; speaker’s fees from, Abbvie, Ferring, Bristol Myers Squibb, Galapagos, Janssen Pfizer Shire, Takeda, and Fresenius Kabi. CM: Received consulting fees from AbbVie, Alimentiv, Amgen, AVIR Pharma Inc, BioJAMP, Bristol Myers Squibb, Celltrion, Ferring, Fresenius Kabi, Janssen, McKesson, Mylan, Pendopharm, Pfizer, Prometheus Biosciences Inc., Roche, Sanofi, Takeda, and Tillotts Pharma; speaker's fees from AbbVie, Amgen, AVIR Pharma Inc, Alimentiv, Bristol Myers Squibb, Ferring, Fresenius Kabi, Janssen, Organon, Pendopharm, Pfizer, and Takeda; royalties from Springer Publishing; research support from Ferring and Pfizer. ED: Endoscopic equipment on loan from FujiFilm; research grant: FujiFilm; honoraria for consultancy from Olympus, Fujifilm, Ambu, and InterVenn; and speaker’s fees from Olympus, GI Supply, Norgine, IPSEN, PAION, and FujiFilm. JS: Consultant for Jansen Research and Development, Recursion Pharmaceuticals, Tempest Pharmaceuticals, and Alimentiv Inc., (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).)

This study developed and validated the Telepsychology Facilitators Scale (TFS), a novel measure that uses the theory of reasoned action and technology acceptance model as frameworks to assess factors that influence psychologists' openness to using telepsychology. At the beginning of the COVID-19 pandemic, an online sample of 2,619 psychologists completed initial items considered for the TFS, along with a measure assessing their actual use of telepsychology. The sample was split in half, with a preliminary exploratory factor analysis ultimately revealing a 13-item general scale with four distinct subscales (Positive Attitudes, Facilitating Infrastructure, Organizational Support, and External Policies). Higher scores on each subscale positively correlated with psychologists' percentage of patient treatment conducted with telepsychology. The exploratory factor analysis subscale structure was subsequently supported via confirmatory factory analyses of a four-factor structure and bifactor structure (tested separately) with the other half of the sample, revealing adequate model fit for both models and similar convergent validity. The TFS may help the field assess the potential barriers and drivers of telepsychology use among psychologists and be used to inform future organizational and policy efforts to increase telepsychology implementation and use across health service settings. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Objective: Web-based cognitive bias modification for interpretation (CBM-I) can improve interpretation biases and anxiety symptoms but faces high rates of dropout. This study tested the effectiveness of web-based CBM-I relative to an active psychoeducation condition and the addition of low-intensity telecoaching for a subset of CBM-I participants., Method: 1,234 anxious community adults (Mage = 35.09 years, 81.2% female, 72.1% white, 82.6% not Hispanic) were randomly assigned at Stage 1 of a sequential, multiple-assignment randomized trial to complete five weekly sessions of CBM-I or psychoeducation on our team's public research website. After the first session, for Stage 2, an algorithm attempted to classify CBM-I participants as higher (vs. lower) risk for dropping out; those classified as higher risk were then randomly assigned to complete four brief weekly telecoaching check-ins (vs. no coaching)., Results: As hypothesized (https://doi.org/j2xr; Daniel, Eberle, & Teachman, 2020), CBM-I significantly outperformed psychoeducation at improving positive and negative interpretation biases (Recognition Ratings, Brief Body Sensations Interpretation Questionnaire) and anxiety symptoms (Overall Anxiety Severity and Impairment Scale, Anxiety Scale from Depression Anxiety Stress Scales-Short Form), with smaller treatment gains remaining significant at 2-month follow-up. Unexpectedly, CBM-I had significantly worse treatment dropout outcomes than psychoeducation, and adding coaching (vs. no coaching) did not significantly improve efficacy or dropout outcomes (notably, many participants chose not to interact with their coach)., Conclusions: Web-based CBM-I appears effective, but supplemental coaching may not mitigate the challenge of dropout. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Outpatient clinical notes are a rich source of information regarding drug safety. However, data in these notes are currently underutilized for pharmacovigilance due to methodological limitations in text mining. Large language models (LLMs) like Bidirectional Encoder Representations from Transformers (BERT) have shown progress in a range of natural language processing tasks but have not yet been evaluated on adverse event (AE) detection. We adapted a new clinical LLM, University of California - San Francisco (UCSF)-BERT, to identify serious AEs (SAEs) occurring after treatment with a non-steroid immunosuppressant for inflammatory bowel disease (IBD). We compared this model to other language models that have previously been applied to AE detection. We annotated 928 outpatient IBD notes corresponding to 928 individual patients with IBD for all SAE-associated hospitalizations occurring after treatment with a non-steroid immunosuppressant. These notes contained 703 SAEs in total, the most common of which was failure of intended efficacy. Out of eight candidate models, UCSF-BERT achieved the highest numerical performance on identifying drug-SAE pairs from this corpus (accuracy 88-92%, macro F1 61-68%), with 5-10% greater accuracy than previously published models. UCSF-BERT was significantly superior at identifying hospitalization events emergent to medication use (P < 0.01). LLMs like UCSF-BERT achieve numerically superior accuracy on the challenging task of SAE detection from clinical notes compared with prior methods. Future work is needed to adapt this methodology to improve model performance and evaluation using multicenter data and newer architectures like Generative pre-trained transformer (GPT). Our findings support the potential value of using large language models to enhance pharmacovigilance., (© 2024 The Authors. Clinical Pharmacology & Therapeutics © 2024 American Society for Clinical Pharmacology and Therapeutics.)

In the fall of 2019, a much-publicized court case brought to national attention the issues of patient-doctor confidentiality when it comes to reporting the deaths of newborns in the United States. It is unclear whether the recent overturning of Roe v. Wade will lead to more cases like this. This article discusses issues of countertransference, as well as the ethical and legal implications were it to be a psychiatrist, in active treatment of such a patient, who would be required to make such a report. More specifically, as in the publicized court case, the patient could be a minor at the time, receiving treatment from a child psychiatrist. The implications of such a case include how countertransference affects the perception of fatal child neglect compared to intentional neonaticide; the ethical dilemma of generating a mandated report with the goal of child safety when such a report could lead to real legal consequences for a minor child; and considerations regarding continued treatment of a patient after such a report is made. It is likely that countertransference, shaped by attitudes toward mothers and idealized views on mothering, may play a large role in all these circumstances.

Background: The Mayo endoscopic subscore (MES) is an important quantitative measure of disease activity in ulcerative colitis. Colonoscopy reports in routine clinical care usually characterize ulcerative colitis disease activity using free text description, limiting their utility for clinical research and quality improvement. We sought to develop algorithms to classify colonoscopy reports according to their MES., Methods: We annotated 500 colonoscopy reports from 2 health systems. We trained and evaluated 4 classes of algorithms. Our primary outcome was accuracy in identifying scorable reports (binary) and assigning an MES (ordinal). Secondary outcomes included learning efficiency, generalizability, and fairness., Results: Automated machine learning models achieved 98% and 97% accuracy on the binary and ordinal prediction tasks, outperforming other models. Binary models trained on the University of California, San Francisco data alone maintained accuracy (96%) on validation data from Zuckerberg San Francisco General. When using 80% of the training data, models remained accurate for the binary task (97% [n = 320]) but lost accuracy on the ordinal task (67% [n = 194]). We found no evidence of bias by gender (P = .65) or area deprivation index (P = .80)., Conclusions: We derived a highly accurate pair of models capable of classifying reports by their MES and recognizing when to abstain from prediction. Our models were generalizable on outside institution validation. There was no evidence of algorithmic bias. Our methods have the potential to enable retrospective studies of treatment effectiveness, prospective identification of patients meeting study criteria, and quality improvement efforts in inflammatory bowel diseases., (© The Author(s) 2024. Published by Oxford University Press on behalf of Crohn’s & Colitis Foundation. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Purpose of Review: The purpose of this review is to summarize the current literature regarding youth suicidality (suicidal ideation, suicidal behavior, and completed suicide) in the context of disasters., Recent Findings: There are fewer studies that examine the effect of disasters on suicidality specifically in children and youth than studies that focus on adults or general population. Numerous studies have reported on the effect of disasters on youth mental health in general without zeroing in on suicide risk. Some variables that have shown to increase suicide risk in children and youth after disasters include female gender, age at the time of disaster exposure, dependence on adults, attachments to places and caregivers, family functioning, and vulnerability to mistreatment. Several studies have demonstrated that youth suicidality fluctuates in response to disasters, at times increasing immediately post-disaster and at other times decreasing immediately post-disaster followed by an increase later. Exposure to natural disasters (e.g., earthquakes, typhoons, hurricanes, wildfires, and extremes of temperature and humidity), man-made disasters (e.g., armed conflict, global warming, and pollution), and unique disasters (e.g., the COVID-19 pandemic) have had significant impact on suicidality in children and adolescents. Although there are several promising interventions to mitigate the post-disaster suicide risk among youth, there is no consensus on a single intervention that is superior to others. More research is needed to study youth suicide risk in the context of disasters and develop culturally appropriate and evidence-based interventions., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

This study evaluated the effectiveness of different recruitment messages for encouraging enrollment in a digital mental health intervention (DMHI) for anxiety among 1,600 anxious patients in a large healthcare system. Patients were randomly assigned to receive a standard message, or one of five messages designed to encourage enrollment: Three messages offered varying financial incentives, one message offered coaching, and one message provided consumer testimonials. Patients could then click a link in the message to visit the DMHI website, enroll, and start the first session. We examined the effects of message features and message length (short vs. long) on rates of site clicks, enrollment, and starting the first session. We also tested whether demographic and clinical factors derived from patients' electronic health records were associated with rates of enrollment and starting the first session to understand the characteristics of patients most likely to use DMHIs in this setting. Across messages, 19.4% of patients clicked a link to visit the DMHI website, but none of the messages were significantly associated with rates of site clicks, enrollment, or starting the first session. Females (vs. males) had a greater probability of enrollment. No other demographic or clinical variables were significantly associated with enrollment or starting the first session. Findings provide guidance for resource allocation decisions in larger scale DMHI implementations in healthcare settings., Competing Interests: Conflict of interest: None to report.

Objectives: This study developed and pilot-tested an adaptation of Cognitive Bias Modification (CBM) to target two aspects of relational flexibility in couples: the ability to generate alternative perspectives, and the ability to respond nondefensively when alternative partner perspectives are raised within challenging relationship situations (referred to as flexibility in partner perspectives)., Methods: CBM-FlexC training materials were developed in Phase 1, and expert users (N = 4) and end-point users (N = 7) provided qualitative feedback. Feasibility and preliminary efficacy of CBM-FlexC were evaluated in Phase 2, using an online sample of distressed couples (N = 18). Using a multiple baseline design, participants completed three baseline assessments, six CBM-FlexC sessions over 2 weeks, and a 1-month follow-up., Results: CBM-FlexC training resulted in greater flexibility in partner perspectives, relationship satisfaction, and general psychological flexibility compared to baseline, and improvements were maintained 1-month after training when using mixed-effects models. However, analyses of reliable change (based on graphical inspection and the Reliable Change Index) indicated that most participants did not experience reliable improvement in flexibility in partner perspectives, or relationship satisfaction., Conclusion: This pilot study provides some positive signals regarding the potential efficacy of CBM-FlexC, while pointing to the need for further development to strengthen its effects., (© 2022 Wiley Periodicals LLC.)

Objective: This study examined whether variables related to unequal access to mental health resources (including Black and Latinx racial-ethnic group membership, lower education level, and lower number of community-level treatment providers, and facilities) were associated with current mental health treatment use; and, whether these variables moderated the likelihood that individuals would receive their preferred effective treatment., Methods: In a preregistered (osf.io/z28wr) study, 5626 individuals completed a mental health history form and measures of implicit and explicit beliefs about the effectiveness of therapy versus medication., Results: Individuals with more (vs. less) education were more likely to report current treatment use. Individuals who were Black/Latinx (vs. non-Latinx White) or who lived in a community with fewer (vs. more) providers sometimes had a lower probability of accessing preferred effective treatment, though results varied across implicit and explicit measures., Conclusions: Findings highlight the need to increase access to mental health resources among marginalized groups., (© 2022 Wiley Periodicals LLC.)

Technology-delivered interventions have the potential to help address the treatment gap in mental health care but are plagued by high attrition. Adding coaching, or minimal contact with a nonspecialist provider, may encourage engagement and decrease dropout, while remaining scalable. Coaching has been studied in interventions for various mental health conditions but has not yet been tested with anxious samples. This study describes the development of and reactions to a low-intensity coaching protocol administered to N = 282 anxious adults identified as high risk to drop out of a web-based cognitive bias modification for interpretation intervention. Undergraduate research assistants were trained as coaches and communicated with participants via phone calls and synchronous text messaging. About half of the sample never responded to coaches' attempts to schedule an initial phone call or did not answer the call, though about 30% completed the full intervention with their coach. Some anxious adults may choose technology-delivered interventions specifically for their lack of human contact and may fear talking to strangers on the phone; future recommendations include taking a more intensive user-centered design approach to creating and implementing a coaching protocol, allowing coaching support to be optional, and providing users with more information about how and why the intervention works., (Copyright © 2022. Published by Elsevier Ltd.)

The papers in this special issue make a compelling case for the value of digital mental health services (DMHS; including technology-based interventions, assessments, and prevention programs) to help address some of the currently unmet needs in mental health care. At the same time, the papers highlight the work that needs to be accomplished for DMHS to fulfill their promise. We review the papers' contributions in terms of (a) the imperative to increase access to evidence-informed, high-quality care, especially for underserved populations, both in the United States and globally; (b) ways to use DMHS to improve the ways that clinical care is provided to make treatment provision more effective and efficient; and (c) the current state of the research on DMHS for emotional disorders. We then consider lessons learned and recommendations to move the field forward, such as increasing (and making transparent) the research base on DMHS, adopting regulatory standards for DMHS, attending carefully to training issues for DMHS and best practices for dissemination and implementation, designing specifically for digital platforms, and being intentional about efforts to reduce disparities regarding who benefits from DMHS.

Objective: This study examined the prevalence and cross-sectional correlates of past-month suicidal thoughts, suicide attempts, interrupted attempts, aborted attempts, and non-suicidal self-injury (NSSI) among patients seeking treatment at a partial hospitalization program (PHP)., Method: 1063 patients (54% female, 87% white, mean age = 33.6 years) receiving treatment at a PHP completed self-report questionnaires and the Columbia-Suicide Severity Rating Scale as part of routine clinical monitoring upon admission to the program. We examined demographic and clinical cross-sectional correlates of self-injurious thoughts and behaviors (SITBs) using descriptive statistics, ordinal regression, and logistic regression analyses., Results: In the past month, 44.6% of patients reported active suicidal thoughts, 5.6% reported a suicide attempt, 1.8% reported an interrupted attempt, 5.5% reported an aborted attempt, and 16.6% reported NSSI. Inpatient referral source (ORs = 2.45-5.28), minority sexual orientation (ORs = 1.43-6.94), and more Borderline Personality Disorder (BPD) symptoms (ORs = 1.09-1.23) were each associated with at least three of the five SITBs examined., Conclusions: This study highlights elevated rates of suicidal thoughts, suicide attempts, and NSSI in a partial hospital sample. Given that past attempts predict future attempts and death by suicide, support during the transition from inpatient to outpatient care via programs such as PHPs is needed. Patients referred from inpatient treatment, who identity as a sexual minority, and with more BPD symptoms may require additional support and safety monitoring. Further work is indicated to better understand how PHP patients' SITBs change during and after partial hospitalization., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Abstract: One exploratory study (N = 10,335) and one preregistered replication and extension study (N = 6648) evaluated implicit and explicit beliefs in the effectiveness of psychotherapy versus medication, and whether these beliefs vary as a function of demographics, mental health difficulties, and treatment experiences. Data were collected from a sample of visitors to a mental health research website who completed the Therapy vs. Medication Effectiveness Implicit Association Test (IAT). The IAT demonstrated evidence of convergent validity with two measures of explicit therapy versus medication effectiveness beliefs. Across both studies, individuals held greater implicit and explicit beliefs that therapy is more effective than medication, and individuals who were Black (versus all other races, excluding "other/unknown") and who had experienced past (versus current) mental health difficulties had stronger implicit and explicit beliefs in the effectiveness of therapy versus medication. More work is needed to understand how these differences in beliefs arise, as well as to evaluate the clinical utility of this novel measure., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Acid suppressants are widely-used classes of medications linked to increased risks of aerodigestive infections. Prior studies of these medications as potentially reversible risk factors for COVID-19 have been conflicting. We aimed to determine the impact of chronic acid suppression use on COVID-19 infection risk while simultaneously evaluating the influence of social determinants of health to validate known and discover novel risk factors. We assessed the association of chronic acid suppression with incident COVID-19 in a 1:1 case-control study of 900 patients tested across three academic medical centers in California, USA. Medical comorbidities and history of chronic acid suppression use were manually extracted from health records by physicians following a pre-specified protocol. Socio-behavioral factors by geomapping publicly-available data to patient zip codes were incorporated. We identified no evidence to support an association between chronic acid suppression and COVID-19 (adjusted odds ratio 1.04, 95% CI 0.92-1.17, P = 0.515). However, several medical and social features were positive (Latinx ethnicity, BMI ≥ 30, dementia, public transportation use, month of the pandemic) and negative (female sex, concurrent solid tumor, alcohol use disorder) predictors of new infection. These findings demonstrate the value of integrating publicly-available databases with medical data to identify critical features of communicable diseases., (© 2021. The Author(s).)

Background: Little is known about the everyday experiences of individuals transitioning from acute to outpatient psychiatric care, an important period of risk for mood symptom relapse. This study used ecological momentary assessment (EMA) to examine whether specific daily experiences were related to momentary affective states following discharge from a partial hospitalization program (PHP)., Methods: A sample of 114 adults (Mage = 36 years old, 52% female, 83% White) completed four brief EMA surveys every day for 2 weeks assessing intensity/type of stressful events and social contact, as well as positive/negative affect (PA/NA). Half of participants reported therapeutic skills use., Results: Stress severity ratings prospectively predicted increased NA. NA predicted spending less time with close relationships. However, interacting with close relationships predicted increased positive affect (PA). Finally, PA predicted spending time with more people. The use of two skills (behavioral activation and interpersonal effectiveness) was concurrently, but not prospectively, associated with improved affect., Conclusions: Examining daily experiences of individuals discharging from partial hospitalization provides important information about factors that may influence affective states during the transition from acute to outpatient care. Findings from this study can be used to help prepare patients for discharge and develop interventions for the post-acute period.

Background: Prior studies have established inconsistent associations between body weight and mental health. However, most work has relied on body mass index (BMI) and examination of a single mental health variable. The present study examined associations of BMI and waist circumference with multiple mental health variables in a transdiagnostic psychiatric sample., Methods: Nursing staff measured waist circumference and calculated the BMI of 742 adults (54.6% female, 45.4% male) presenting for psychiatric treatment. Participants completed the Patient Health Questionnaire (PHQ-9), Generalized Anxiety Disorder Scale (GAD-7), Behavior and Symptom Identification Scale (BASIS-24), and Mental Health Continuum-Short Form (MHC-SF) as part of standard clinical monitoring. Suicide risk was assessed using the clinician-administered Mini International Neuropsychiatric Interview (M.I.N.I.). For curve fit estimation regression models, we entered BMI and waist circumference as independent variables separately; we entered seven dependent variables separately: 1) depression, 2) anxiety, 3) substance use, 4) self-harm, 5) interpersonal functioning, 6) well-being, and 7) suicide risk., Results: Increased BMI was associated with decreased well-being and increased depression. Increased waist circumference was associated with worse interpersonal functioning. Non-linear (quadratic) associations were observed between weight and depression, substance use, self-harm, and suicide., Limitations: Most of the sample was White and only 2.6% was in the underweight category, limiting broad applicability of findings. Cross-sectional design precludes causal attributions., Conclusions: Given associations between well-being, depression, interpersonal functioning, substance use, self-harm, and suicide with weight, findings may be used to inform mental health treatment, particularly by tailoring interventions to high-risk weight categories (underweight, obese) in psychiatric populations., (Copyright © 2020. Published by Elsevier B.V.)

In 2012, Centers for Medicare and Medicaid Services (CMS) announced it would penalize any hospitals that had 30-day readmission rates for heart failure (HF) patients above 20%. Mather Hospital Northwell Health, a community teaching hospital, organized a proactive task force to meet these goals. We describe our hospital-wide Readmission Prevention in Heart Failure (RAP-HF) project. We focused on the following interventions: early identification of patients at risk for readmission, discipline-specific mitigation planning by the interdisciplinary rounding team, enhanced medication education for heart failure patients, education of family/caregivers on medication and heart failure symptoms, facilitation in scheduling of post-discharge follow up visits and hard-wired communication between hospital and post-discharge care providers. We saw a 25.53% decrease in 30-day readmission rates., Competing Interests: No potential conflict of interest was reported by the authors., (© 2020 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group on behalf of Greater Baltimore Medical Center.)

Intimate partner violence (IPV) exposure can increase alcohol use. Although African Americans use less alcohol compared with European Americans, African American women experience disparate rates of IPV, potentially intensifying their alcohol abuse. We used data from 171 African American women to test if IPV was related to alcohol abuse and if psychosocial factors-loneliness, embarrassment, fear of harm, hope, social support, childcare needs, and finances-mediated this link. IPV and alcohol abuse were related, and several factors were related to either IPV or alcohol abuse. Social support was related to both, and it mediated the IPV-alcohol abuse link, explaining women's alcohol abuse relating to IPV.

Background: Electronic cigarettes/e-cigarettes (ECs), or vaping, is currently the most popular form of smoking amongst youth in the United States. ECs are battery-powered devices that vaporize a liquid that comes in small cartridges, or pods, that contain various chemicals, nicotine, and an array of flavors that can be modified to include cannabinoids (THC). With increasing popularity, however, there is an epidemic of pulmonary and gastrointestinal illnesses associated with vaping in the continental U.S.A., Methods: We analyzed medical charts of three patients who were active users of ECs and presented with pneumonitis to our community medical center between January and August 2019., Results: We report three cases of vaping pneumonitis in young adults, ages 18 to 21, who presented with similar symptoms, profiles, imaging studies, and disease progression. The average length of stay was approximately one week, and all patients had an extensive work-up in addition to a relapsing and remitting course of their condition., Conclusions: Early recognition and diagnosis of vaping pneumonitis are essential in the treatment of the ongoing epidemic. Extensive unnecessary work up may lead to increased healthcare costs. Our case series echoes the concerns of the CDC such that ECs should be avoided, and those with any pulmonary or gastrointestinal symptoms should seek medical attention promptly.

Objective: Treatment utilization for psychiatric illness is low, perhaps influenced by limited consumer knowledge of evidence-based psychological treatments (EBPTs). To inform consumer-directed dissemination efforts, we characterized preferences, beliefs, and knowledge about specific EBPTs (cognitive behavioral therapy [CBT], dialectical behavior therapy [DBT], and acceptance and commitment therapy [ACT]); and examined potential sociodemographic and treatment history correlates., Method: Before receiving treatment at a psychiatric partial hospital, patients (n = 249) completed the Psychological Treatment Consumer Questionnaire., Results: Most (75%) patients felt responsible for being aware of psychotherapy options and that it was important to receive research-supported psychotherapy (80%), but were split on whether research (42%) or their provider's recommendation (58%) carried greater decisional weight. Most (93%) patients had heard of CBT (93%) and DBT (71%), but not ACT (35%). Prior exposure to these EBPTs increased the likelihood of recommending them to others., Conclusions: Findings support initiatives to enhance consumer familiarity with these EBPTs and inform dissemination efforts., (© 2019 Wiley Periodicals, Inc.)

Anxiety, depression, and stress are exceedingly common in patients with cardiovascular disease (CVD). They increase the risk of cardiac events and are associated with much worse outcomes. A causal relationships exists between anxiety/depression and adverse cardiac events such as acute myocardial infarction and sudden cardiac death. Various treatments, including psychologic therapies and pharmacotherapy, can used to treat patients with these disorders. This review discusses the epidemiology, pathogenesis, and treatment options for patients with CVD who suffer from these conditions and argues that they should be treated as concomitant risk factors for CVD.

Background: Despite high rates of smartphone ownership in psychiatric populations, there are very little data available characterizing smartphone use in individuals with mental illness. In particular, few studies have examined the interest and use of smartphones to support mental health., Objective: This study aimed to (1) characterize general smartphone app and social media usage in an acute transdiagnostic psychiatric sample with high smartphone ownership, (2) characterize current engagement and interest in the use of smartphone apps to support mental health, and (3) test demographic and clinical predictors of smartphone use., Methods: The survey was completed by all patients attending an adult partial hospital program, with no exclusion criteria. The primary outcomes were frequency of use of general and mental health smartphone apps (smartphone use survey) and the frequency of social media use and phone-checking behavior (mobile technology engagement scale)., Results: Overall, 322 patients (aged mean 33.49, SD 13.87 years; 57% female) reported that their most frequently used app functions were texting, email, and social media. Younger individuals reported more frequent use across most types of apps. Baseline depression and anxiety symptoms were not associated with the frequency of app use. Participants reported health care, calendar, and texting apps as most supportive of their mental health and social media apps as most negatively affecting their mental health. Most patients reported an interest in (73.9% [238/322]) and willingness to use (81.3% [262/322]) a smartphone app to monitor their mental health condition. Less than half (44%) of the patients currently had a mental health app downloaded on their smartphone, with mindfulness and meditation apps being the most common type., Conclusions: The high interest in and willingness to use mental health apps, paired with the only moderate current reported usage, indicate a potential unmet treatment opportunity in psychiatric populations. There is potential to optimize non-mental health-specific apps to better support the needs of those with mental illness and to design a new wave of mental health apps that match the needs of these populations as well as the way they use smartphones in daily life., (©Courtney Beard, Alexandra L Silverman, Marie Forgeard, M Taylor Wilmer, John Torous, Thröstur Björgvinsson. Originally published in JMIR Mhealth and Uhealth (http://mhealth.jmir.org), 07.06.2019.)

Cognitive bias modification for interpretation (CBM-I) is an appealing augmentation to cognitive-behavioral therapy (CBT) because it targets cognitive bias efficiently via computerized training. Few studies have tested the combination of CBM-I and CBT, and none have translated lab-based CBM-I protocols to an acute psychiatric setting. The present study describes the development and implementation of CBM-I as an augmentation to a CBT-based partial hospital. We developed a transdiagnostic CBM-I based on the word-sentence association paradigm (WSAP), which reinforces individuals for endorsing benign interpretations and rejecting negative interpretations of ambiguous sentences. Over two iterations of development, we randomly assigned patients (N = 127; M age = 34.21; 58% female, 40% male, 2% nonbinary) to either CBM-I or a control group (Phase 1: neutral WSAP task; Phase 2: treatment as usual). CBM-I comprised daily sessions (10 minutes) completed during program hours, and number of sessions varied naturalistically according to patient length of stay. Primary outcomes included feasibility, acceptability, and target engagement (interpretation bias). CBM-I was feasible and acceptable to acute psychiatric patients, and successfully shifted interpretation for novel stimuli. Patient feedback suggested that participants viewed CBM-I as bolstering their primary CBT-based care. Exploratory analyses examining clinical benefit revealed a small between-group effect on anxiety severity (d = 0.378), but no group differences on depression outcomes (d = 0.008). Findings indicate that CBM-I is a feasible and acceptable augmentation to CBT-based partial hospital care. Future studies are warranted to determine who is most likely to benefit from this low-intensity approach., (Copyright © 2018. Published by Elsevier Ltd.)

Depression, anxiety, sleep disturbances and poor relationship functioning often co-occur with the confluence of these factors contributing to greater suicide risk. This study investigated whether the pathways between depression, anxiety, sleep disturbances, and relationship functioning differentiated patients with suicide attempt history from those with suicidal ideation history. Patients seeking partial hospital treatment for severe psychiatric symptoms (N = 180) completed interviews assessing psychiatric and suicidal symptom histories, and self-report measures of sleep behaviors, anxiety, depression, and relationship functioning. Multiple sleep behaviors were examined: duration, sleep onset latency, and bedtime. Bias-corrected bootstrap mediation and moderated mediation analyses with suicide attempt as the moderator were used to evaluate pathways between variables. Among patients with ideation and attempt history, (1) sleep onset latency significantly mediated the association between depression and relationship functioning and that between anxiety and relationship functioning; (2) relationship functioning significantly mediated the association between depression and sleep onset latency and that between anxiety and sleep onset latency. These pathways were not significant among patients with suicidal ideation only. No other sleep behaviors were related to study variables. The reciprocal relationship between disrupted sleep onset latency and poor relationship functioning was specifically linked to more severe psychiatric symptoms among acute patients with suicide attempt histories., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Objective: Despite a greater need for mental health treatment in individuals identifying as lesbian, gay, bisexual, queer, and other sexual minority identities (LGBQ+), no prior study has examined mental health treatment outcomes for LGBQ+ populations receiving standard care. We compared individuals identifying as LGBQ+ or heterosexual on treatment outcomes following a partial hospital program based on cognitive behavioral therapy (CBT) and dialectical behavior therapy (DBT)., Method: A total of 441 participants (19% LGBQ+; mean age = 34.42 years; 56% female, 42% male, 2% nonbinary) attending a partial hospital program completed measures at admission and discharge as part of standard care. We compared LGBQ+ and heterosexual individuals on symptom outcomes (24-item Behavior and Symptom Identification Scale, 7-item Generalized Anxiety Disorder Scale, 9-item Patient Health Questionnaire), program dropout due to inpatient hospitalization, clinical global improvement, and perceived quality of care, controlling for baseline characteristics using propensity score adjustment., Results: Controlling for baseline demographic and clinical variables and a 10% false discovery rate, LGBQ+ and heterosexual individuals did not differ on treatment outcomes. However, when examining sexual identity subgroups, bisexual individuals reported more self-injurious and suicidal thoughts and worse perceptions of care at posttreatment compared to all other sexual identities., Conclusions: Findings support the comparable effectiveness of CBT- and DBT-skills-based hospital treatment for LGBQ+ and heterosexual individuals overall but suggest specific treatment disparities for bisexual individuals. Future research is needed to establish the effectiveness of traditional evidence-based treatment in other settings and to determine whether LGBQ+ affirmative treatments for specific LGBQ+ subgroups are superior to traditional treatments. (PsycINFO Database Record, ((c) 2017 APA, all rights reserved).)

Purpose: To evaluate and compare the diagnostic accuracy of global and sector analyses for detection of early visual field (VF) damage using the retinal nerve fiber layer (RNFL) reference databases of the Spectralis (Heidelberg Engineering, Heidelberg, Germany) and Cirrus (Carl Zeiss Meditec, Dublin, CA) spectral-domain optical coherence tomography (SD OCT) devices., Methods: Healthy subjects and glaucoma suspects from the Diagnostic Innovations in Glaucoma Study (DIGS) and African Descent and Glaucoma Evaluation Study (ADAGES) with at least 2 years of follow-up were included. Global and sectoral RNFL measures were classified as within normal limits, borderline (BL), and outside normal limits (ONL) on the basis of the device reference databases. The sensitivity of ONL classification was estimated in glaucoma suspect eyes that developed repeatable VF damage., Results: A total of 353 glaucoma suspect eyes and 279 healthy eyes were included. A total of 34 (9.6%) of the glaucoma suspect eyes developed VF damage. In glaucoma suspect eyes, Spectralis and Cirrus ONL classification was present in 47 eyes (13.3%) and 24 eyes (6.8%), respectively. The sensitivity of the global RNFL ONL classification among eyes that developed VF damage was 23.5% for Cirrus and 32.4% for Spectralis. The specificity of within-normal-limits global classification in healthy eyes was 100% for Cirrus and 99.6% for Spectralis. There was moderate to substantial agreement between Cirrus and Spectralis classification as ONL., Conclusions: The Spectralis and Cirrus reference databases have a high specificity for identifying healthy eyes and good agreement for detection of eyes with early glaucoma damage., (Copyright © 2016 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)

Bowel preparation using large volume of polyethylene glycol (PEG) solutions is often poorly tolerated. Therefore, there are ongoing efforts to develop an alternative bowel cleansing regimen that should be equally effective and better tolerated. The aim of this study was to assess the efficacy of lubiprostone (versus placebo) plus PEG as a bowel cleansing preparation for colonoscopy. Our study was a randomized, double-blind placebo-controlled design. Patients scheduled for screening colonoscopy were randomized 1:1 to lubiprostone (group 1) or placebo (group 2) plus 1 gallon of PEG. The primary endpoints were patient's tolerability and endoscopist's evaluation of the preparation quality. The secondary endpoint was to determine any reduction in the amount of PEG consumed in the lubiprostone group compared with the placebo group. One hundred twenty-three patients completed the study and were included in the analysis. There was no difference in overall cleanliness. The volume of PEG was similar in both the groups. The volume of PEG approached significance as a predictor of improved score for both the groups (P = 0.054). Lubiprostone plus PEG was similar to placebo plus PEG in colon cleansing and volume of PEG consumed. The volume of PEG consumed showed a trend toward improving the quality of the colon cleansing.

Background: Optic nerve head drusen (ONHD) are calcific deposits buried or at the surface of the optic disc. Although ONHD may be associated with progressive visual field defects, the mechanism of drusen-related field loss is poorly understood. Methods for detecting and imaging disc drusen include B-scan ultrasonography, fundus autofluorescence, and optical coherence tomography (OCT). These modalities are useful for drusen detection but are limited by low resolution or poor penetration of deep structures. This review was designed to assess the potential role of new OCT technologies in imaging ONHD., Evidence Acquisition: Critical appraisal of published literature and comparison of new imaging devices to established technology., Results: The new imaging modalities of enhanced depth imaging optical coherence tomography (EDI-OCT) and swept source optical coherence tomography (SS-OCT) are able to provide unprecedented in vivo detail of ONHD. Using these devices it is now possible to quantify optic disc drusen dimensions and assess integrity of neighboring retinal structures, including the retinal nerve fiber layer., Conclusions: EDI-OCT and SS-OCT have the potential to allow better detection of longitudinal changes in drusen and neural retina and improve our understanding of drusen-related visual field loss.