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Padilla A.,University of Massachusetts Medical School | Benjamin S.,University of Massachusetts Medical School | Lewis-Fernandez R.,NYS Psychiatric Institute
Academic Psychiatry | Year: 2016

Objective: Culturally appropriate tools for patient assessment are needed to train psychiatric residents. An objective structured clinical examination (OSCE) can be a helpful tool for evaluating trainees in the psychiatry milestones pertaining to cultural competency. Methods: Seventeen psychiatry residents and fellows at the University of Massachusetts participated in two small-group OSCE exercises to learn cultural interviewing using the DSM-5 Cultural Formulation Interview. Trainee groups presented a cultural formulation and received feedback. Participants were surveyed about their comfort with cultural interviewing before and after the exercise. Results: Paired t tests (N = 16) showed that mean level of comfort with the Cultural Formulation Interview increased by a mean of 0.5 points after training (t = 3.16, df = 15, p < 01 95 % CI = 163-837). Discussion: The UMass culturally appropriate assessment OSCE enhanced psychiatric trainees' comfort with culturally appropriate interviewing using the Cultural Formulation Interview. © 2016 Academic Psychiatry.


Attia E.,Columbia University | Attia E.,NYS Psychiatric Institute | Attia E.,New York Medical College | Kaplan A.S.,University of Toronto | And 6 more authors.
Psychological Medicine | Year: 2011

Background Anorexia nervosa (AN) is a serious psychiatric illness associated with significant morbidity and mortality. There is little empirical support for specific treatments and new approaches are sorely needed. This two-site study aimed to determine whether olanzapine is superior to placebo in increasing body mass index (BMI) and improving psychological symptoms in out-patients with AN.Method A total of 23 individuals with AN were randomly assigned in double-blind fashion to receive olanzapine or placebo for 8 weeks together with medication management sessions that emphasized compliance. Weight, other physical assessments and measures of psychopathology were collected.Results End-of-treatment BMI, with initial BMI as a covariate, was significantly greater in the group receiving olanzapine [F(1, 20)=6.64, p=0.018]. Psychological symptoms improved in both groups, but there were no statistically significant group differences. Of the 23 participants, 17 (74%) completed the 8-week trial. Participants tolerated the medication well with sedation being the only frequent side effect and no adverse metabolic effects were noted.Conclusions This small study suggests that olanzapine is generally well tolerated by, and may provide more benefit than placebo for out-patients with AN. Further study is indicated to determine whether olanzapine may affect psychological symptoms in addition to BMI. © Cambridge University Press 2011.


Hwang R.,Center for Addiction and Mental Health | Souza R.P.,Center for Addiction and Mental Health | Tiwari A.K.,Center for Addiction and Mental Health | Zai C.C.,Center for Addiction and Mental Health | And 5 more authors.
Pharmacogenomics | Year: 2011

Aims: To investigate the possible association and gene-gene interaction effects of polymorphisms in NMDA receptor subunit (GRIN1, GRIN2A and GRIN2B) and dopamine receptor (DRD1, DRD2 and DRD3) genes with clozapine response. Materials & methods: GRIN1 rs11146020 (G1001C), GRIN2A GT-repeat and GRIN2B rs10193895 (G-200T) polymorphisms were tested for association in a Caucasian (n = 183) and an African-American (n = 49) sample using χ 2 and ANOVA tests. Logistic regression and two-way ANOVA were used to explore gene-gene interaction effects with dopamine receptor gene variants. Results & conclusion: This study does not support the involvement of the NMDA receptor subunit gene polymorphisms in clozapine response. All tests for an association were negative. Gene-gene interaction analyses however yielded promising leads, including an observed effect between DRD1 rs686 and DRD3 Ser9Gly polymorphisms on clozapine response (p = 0.002). © 2011 Future Medicine Ltd.


Shortreed S.M.,McGill University | Laber E.,University of Michigan | Lizotte D.J.,University of Michigan | Stroup T.S.,NYS Psychiatric Institute | And 2 more authors.
Machine Learning | Year: 2011

This paper highlights the role that reinforcement learning can play in the optimization of treatment policies for chronic illnesses. Before applying any off-the-shelf reinforcement learning methods in this setting, we must first tackle a number of challenges. We outline some of these challenges and present methods for overcoming them. First, we describe a multiple imputation approach to overcome the problem of missing data. Second, we discuss the use of function approximation in the context of a highly variable observation set. Finally, we discuss approaches to summarizing the evidence in the data for recommending a particular action and quantifying the uncertainty around the Q-function of the recommended policy. We present the results of applying these methods to real clinical trial data of patients with schizophrenia. © 2010 The Author(s).


Carmel J.B.,Burke Cornell Medical Research Institute | Carmel J.B.,City University of New York | Kim S.,Columbia University | Brus-Ramer M.,Columbia University | And 3 more authors.
European Journal of Neuroscience | Year: 2010

Rats are used to model human corticospinal tract (CST) injury and repair. We asked whether rats possess the ability to orient their paw to the reaching target and whether the CST mediates this skill, as it does in primates. To test this ability, called preshaping, we trained rats to reach for pieces of pasta oriented either vertically or horizontally. We measured paw angle relative to the target and asked whether rats used target information attained before contact to preshape the paw, indicating feed-forward control. We also determined whether preshaping improved with practice. We then selectively lesioned the CST in the medullary pyramid contralateral to the reaching forepaw to test whether preshaping relies on the CST. Rats significantly oriented their paw to the pasta orientation before contact, demonstrating feed-forward control. Both preshaping and reaching efficiency improved with practice, while selective CST lesion abrogated both. The loss of preshaping was greatest for pasta oriented vertically, suggesting loss of supination, as seen with human CST injury. The degree of preshaping loss strongly correlated with the amount of skill acquired at baseline, suggesting that the CST mediates the learned component of preshaping. Finally, the amount of preshaping lost after injury strongly correlated with reduced retrieval success, showing an important functional consequence for preshaping. We have thus demonstrated, for the first time, preshaping in the rat and dependence of this skill on the CST. Understanding the basis for this skill and measuring its recovery after injury will be important for studying higher-level motor control in rats. © 2010 The Authors. European Journal of Neuroscience © 2010 Federation of European Neuroscience Societies and Blackwell Publishing Ltd.


Martinez D.,NYS Psychiatric Institute | Narendran R.,NYS Psychiatric Institute
Current Topics in Behavioral Neurosciences | Year: 2010

Previous studies have shown that imaging with positron emission tomography (PET) and single photon emission computed tomography (SPECT) radiotracers that are specific for brain dopamine receptors can be used to indirectly image the change in the levels of neurotransmitters within the brain. Most of the studies in addiction have focused on dopamine, since the dopamine neurons that project to the striatum have been shown to play a critical role in mediating addictive behavior. These imaging studies have shown that increased extracellular dopamine produced by psychostimulants can be measured with PET and SPECT. However, there are some technical issues associated with imaging changes in dopamine, and these are reviewed in this chapter. Among these are the loss of sensitivity, the time course of dopamine pulse relative to PET and SPECT imaging, and the question of affinity state of the receptor. In addition, animal studies have shown that most drugs of abuse increase extracellular dopamine in the striatum, yet not all produce a change in neurotransmitter that can be measured. As a result, imaging with a psychostimulant has become the preferred method for imaging presynaptic dopamine transmission, and this method has been used in studies of addiction. The results of these studies suggest that cocaine and alcohol addiction are associated with a loss of dopamine transmission, and a number of studies show that this loss correlates with severity of disease. © Springer-Verlag Berlin Heidelberg 2009.


Korthuis P.T.,Oregon Health And Science University | Feaster D.J.,University of Miami | Gomez Z.L.,University of Miami | Das M.,University of California at San Francisco | And 9 more authors.
Addictive Behaviors | Year: 2012

Background: Injection drug use (IDU) is a primary vector for blood-borne infections. Awareness of Hepatitis C virus (HCV) infection status may affect risky injection behaviors. This study determines the prevalence of risky injection practices and examines associations between awareness of positive HCV status and risky injection behaviors. Methods: We surveyed individuals seeking treatment for substance use at 12 community treatment programs as part of a national HIV screening trial conducted within the National Drug Abuse Treatment Clinical Trials Network. Participants reported socio-demographic characteristics, substance use, risk behaviors, and HCV status. We used multivariable logistic regression to test associations between participant characteristics and syringe/needle sharing. Results: The 1281 participants included 244 (19.0%) individuals who reported injecting drugs in the past 6. months and 37.7% of IDUs reported being HCV positive. During the six months preceding baseline assessment, the majority of IDUs reported obtaining sterile syringes from pharmacies (51.6%) or syringe exchange programs (25.0%), but fewer than half of IDUs always used a sterile syringe (46.9%). More than one-third (38.5%) shared syringe/needles with another injector in the past 6. months. Awareness of positive HCV vs. negative/unknown status was associated with increased recent syringe/needle sharing (aOR 2.37, 95% CI 1.15, 4.88) in multivariable analysis. Conclusions: Risky injection behaviors remain prevalent and awareness of HCV infection was associated with increased risky injection behaviors. New approaches are needed to broadly implement HCV prevention interventions for IDUs seeking addiction treatment. © 2011 Elsevier Ltd.


Fallon B.A.,NYS Psychiatric Institute | Coffino S.W.,Columbia University | Brenner C.,Lamont Doherty Earth Observatory
Clinical Infectious Diseases | Year: 2014

Background. As the incidence of Lyme disease (LD) has increased, a number of " Lyme specialty laboratories" have emerged, claiming singular expertise in LD testing. We investigated the degree of interlaboratory variability of several LD serologic tests - whole cell sonicate (WCS) enzyme-linked immunosorbent assay (ELISA), immunoglobulin M (IgM) and immunoglobulin G (IgG) Western blots (WBs), and an ELISA based on the conserved sixth region of variable major protein-like sequence expressed (C6) - that were performed at 1 university laboratory, 1 commercial laboratory, and 2 laboratories that specialize in LD testing. Methods. Serum samples from 37 patients with posttreatment Lyme syndrome, as well as 40 medically healthy controls without prior LD, were tested independently at the 4 laboratories. Results. In general, there was little difference among the laboratories in the percentage of positive test results on the ELISAs and IgG WBs, although the number of discordant results was often high. When in-house criteria for positivity were used at the 2 specialty laboratories, specificity at 1 laboratory declined considerably on both the IgM and IgG WBs. The Centers for Disease Control and Prevention (CDC) 2-tiered criteria improved overall concordance. At the 2 laboratories that performed the C6 ELISA, the percentage of positive tests was comparable to that of the WCS ELISA while providing higher specificity. The IgM WB performed poorly in our patient population of individuals with later-stage illness, a result consistent with previous studies. Conclusions. Although there was surprisingly little difference among the laboratories in percentage of positive results on most assays using CDC criteria, interlaboratory variability was considerable and remains a problem in LD testing. © The Author 2014. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved.


LeBeau R.T.,University of California at Los Angeles | Mischel E.R.,University of California at Los Angeles | Simpson H.B.,NYS Psychiatric Institute | Mataix-Cols D.,King's College London | And 3 more authors.
Journal of Obsessive-Compulsive and Related Disorders | Year: 2013

There will be several changes to the diagnosis of obsessive-compulsive and related disorders (OCRDs) in DSM-5. Several disorders, including body dysmorphic disorder (BDD), hoarding disorder (HD), trichotillomania (hair-pulling disorder) (TTM), and excoriation (skin-picking) disorder (SPD), will be included alongside obsessive compulsive disorder (OCD) in a distinct diagnostic category of OCRDs. Also, dimensional assessments of psychopathology will be included to supplement traditional categorical diagnoses. The DSM-5 subworkgroup on obsessive-compulsive spectrum disorders developed a set of brief self-rated scales for BDD, HD, TTM, and SPD that are consistent in content and structure, reflect DSM-5 criteria, and can be used by clinicians to help generate a dimensional severity rating for the disorders. In the present paper, we discuss the scales' creation and examine their psychometric properties in a large non-clinical sample (n=296). The scales each demonstrated a single factor structure, strong internal consistency (α=.80-.89), convergent validity (rs=.74-.92), and significantly higher total scores in individuals who indicated the presence of the respective disorder's core symptom on a binary diagnostic screener (Cohen's d=0.57-2.18). The results provide support for further evaluation of these scales in clinical samples and take an important step toward the integration of standardized dimensional measurement into DSM-5. © 2013.


PubMed | NYS Psychiatric Institute and University of Massachusetts Medical School
Type: Journal Article | Journal: Academic psychiatry : the journal of the American Association of Directors of Psychiatric Residency Training and the Association for Academic Psychiatry | Year: 2016

Culturally appropriate tools for patient assessment are needed to train psychiatric residents. An objective structured clinical examination (OSCE) can be a helpful tool for evaluating trainees in the psychiatry milestones pertaining to cultural competency.Seventeen psychiatry residents and fellows at the University of Massachusetts participated in two small-group OSCE exercises to learn cultural interviewing using the DSM-5 Cultural Formulation Interview. Trainee groups presented a cultural formulation and received feedback. Participants were surveyed about their comfort with cultural interviewing before and after the exercise.Paired t tests (N=16) showed that mean level of comfort with the Cultural Formulation Interview increased by a mean of 0.5 points after training (t=3.16, df=15, p<01 95% CI=163-837).The UMass culturally appropriate assessment OSCE enhanced psychiatric trainees comfort with culturally appropriate interviewing using the Cultural Formulation Interview.

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