VISN 19 Mental Illness Research

Denver, CO, United States

VISN 19 Mental Illness Research

Denver, CO, United States
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Betz M.E.,Aurora University | Jones J.,Aurora College | Genco E.,VISN 19 Mental Illness Research | Carr D.B.,University of Washington | And 3 more authors.
Gerontologist | Year: 2016

Purpose of the Study: Widespread screening of older drivers, with in-depth evaluation only of those who screen positive ("tiered assessment"), might efficiently balance driver safety and mobility. To inform program development, we sought to examine the perspectives of older drivers and clinicians on the concept of tiered assessment in primary care settings. Design and Methods: Iterative focus groups and interviews with 33 community-dwelling current drivers aged =65 years and 8 primary care providers. We used inductive and deductive theme analysis to explore driver and clinician perspectives and to identify barriers and facilitators to establishing a tiered older driver assessment program in primary care settings. Results: Four dominant themes emerged. Two themes addressed the overall concept: (a) support for the concept of tiered older driver assessment and (b) concerns about the consequences of older driver assessment and how these could affect program viability. Two themes addressed screening: (c) tension inherent in using a generalized approach to the highly individualized issue of driving and (d) logistical considerations for screening in primary care settings. Implications: Standardized older driver screening and referral might improve clinician-driver communication, but screening should occur in a context that includes personalized mobility counseling. © The Author 2014.


Nadorff M.R.,Mississippi State University | Nadorff M.R.,Baylor College of Medicine | Salem T.,Mississippi State University | Winer E.S.,Mississippi State University | And 2 more authors.
Journal of Clinical Sleep Medicine | Year: 2014

Study Objectives: The purpose of the study was to examine whether insomnia symptoms and nightmares mediated the relation between alcohol use and suicide risk. Further, we examined whether this mediation was moderated by gender.Design: The study consisted of questionnaires administered online examining insomnia symptoms, nightmares, alcohol use, and suicide risk.Setting: University.Patients or Participants: 375 undergraduate students at a large, public university in the southeastern United States.Interventions: N/A.Measurements and Results: Results indicated that insomnia symptoms significantly mediated the relation between alcohol use and suicide risk; however, this mediation was moderated by gender. For women, there was both a direct effect of alcohol use on suicide risk as well as an indirect effect of alcohol use through insomnia symptoms increasing suicide risk. For men, there was no direct effect of alcohol use on suicide risk, but there was a significant indirect effect of alcohol use increasing suicide risk through insomnia symptoms. Nightmares were not related to alcohol use, and the association between nightmares and suicide risk was found to be independent of alcohol use.Conclusions: Insomnia symptoms are an important factor in explaining the mechanism by which alcohol use increases suicide risk.


PubMed | Aurora College, University of Washington, VISN 19 Mental Illness Research, Aurora University and Denver Health Medical Center
Type: Journal Article | Journal: The Gerontologist | Year: 2016

Widespread screening of older drivers, with in-depth evaluation only of those who screen positive (tiered assessment), might efficiently balance driver safety and mobility. To inform program development, we sought to examine the perspectives of older drivers and clinicians on the concept of tiered assessment in primary care settings.Iterative focus groups and interviews with 33 community-dwelling current drivers aged 65 years and 8 primary care providers. We used inductive and deductive theme analysis to explore driver and clinician perspectives and to identify barriers and facilitators to establishing a tiered older driver assessment program in primary care settings.Four dominant themes emerged. Two themes addressed the overall concept: (a) support for the concept of tiered older driver assessment and (b) concerns about the consequences of older driver assessment and how these could affect program viability. Two themes addressed screening: (c) tension inherent in using a generalized approach to the highly individualized issue of driving and (d) logistical considerations for screening in primary care settings.Standardized older driver screening and referral might improve clinician-driver communication, but screening should occur in a context that includes personalized mobility counseling.


Matarazzo B.B.,VISN 19 MIRECC Suicide Consultation Service and a Clinical Research Psychologist | Matarazzo B.B.,University of Colorado | Homaifar B.Y.,University of Colorado | Wortzel H.S.,VISN 19 Mental Illness Research
Journal of Psychiatric Practice | Year: 2014

This column is the fourth in a series describing a model for therapeutic risk management of the suicidal patient. Previous columns presented an overview of the therapeutic risk management model, provided recommendations for how to augment risk assessment using structured assessments, and discussed the importance of risk stratification in terms of both severity and temporality. This final column in the series discusses the safety planning intervention as a critical component of therapeutic risk management of suicide risk. We first present concerns related to the relatively common practice of using no-suicide contracts to manage risk. We then present the safety planning intervention as an alternative approach and provide recommendations for how to use this innovative strategy to therapeutically mitigate risk in the suicidal patient. © 2014 Lippincott Williams & Wilkins Inc.


Homaifar B.Y.,VISN 19 Mental Illness Research | Homaifar B.Y.,University of Colorado at Denver | Brenner L.A.,VISN 19 Mental Illness Research | Brenner L.A.,University of Colorado at Denver | And 3 more authors.
Rehabilitation Psychology | Year: 2012

Objective: The aim of this pilot study was to explore the relationship between executive dysfunction and suicidal behavior in two groups of participants: (Group 1, n = 18) veterans with traumatic brain injury (TBI) and a history of at least one suicide attempt (SA), and (Group 2, n = 29) veterans with TBI and no history of SA. Controlling for the severity of TBI, it was hypothesized that participants in Group 1 would perform more poorly than those in Group 2 on measures of executive functioning. Design: The primary outcome variable was decision making as assessed by performance on the Iowa Gambling Task (IGT). Secondary outcome variables included laboratory-measured impulsivity as measured by the Immediate and Delayed Memory Test (IMT/DMT), abstract reasoning as measured by the Wisconsin Card Sorting Test (WCST), and aggression as measured by the Lifetime History of Aggression (LHA) scale. Results: Among those in Group 1, time between TBI and first suicide attempt postinjury varied widely (months to nearly 30 years). Only the WCST perseverative errors score differed significantly between individuals with and without histories of one or more suicide attempts (SAs). Conclusion: Suggestions for future study of SA among those with TBI are provided. When working with individuals with TBI, clinicians are encouraged to incorporate suicide risk assessment into their practice. Augmenting this process with a measure of perseveration may be beneficial. © 2012 American Psychological Association.


Walter K.H.,Trauma Recovery Center | Dickstein B.D.,Trauma Recovery Center | Barnes S.M.,VISN 19 Mental Illness Research | Barnes S.M.,University of Colorado at Denver | And 2 more authors.
Journal of Traumatic Stress | Year: 2014

Cognitive processing therapy (CPT) is a leading cognitive-behavioral treatment for posttraumatic stress disorder (PTSD) and a front-line intervention according to the U.S. Department of Veterans Affairs treatment guidelines. The original CPT protocol entails the creation of a written trauma account and use of cognitive therapy. Cognitive processing therapy-cognitive therapy only (CPT-C) does not involve a written account and in a previous study resulted in faster symptom improvement and fewer dropouts than standard CPT. This study sought to replicate these findings by comparing the effectiveness of CPT to CPT-C in a sample of 86 U.S. male veterans receiving treatment in a PTSD residential program for individuals with a history of traumatic brain injury. CPT and CPT-C were delivered in a combined individual and group format as part of a comprehensive, interdisciplinary treatment program. Outcomes were self- and clinician-reported PTSD and self-reported depression symptoms. Multilevel analysis revealed no significant difference for PTSD symptoms, but did show a greater decrease in depression at posttreatment (d = 0.63) for those receiving CPT. When an experiment-wise α correction was applied, this effect did not remain significant. © 2014.


Shi X.-F.,University of Utah | Kondo D.G.,University of Utah | Kondo D.G.,VISN 19 Mental Illness Research | Sung Y.-H.,University of Utah | And 6 more authors.
Bipolar Disorders | Year: 2012

Objectives: To compare the concentrations of high-energy phosphorus metabolites associated with mitochondrial function in the frontal lobe of depressed adolescents with bipolar disorder (BD) and healthy controls (HC). Methods: We used in vivo phosphorus-31 magnetic resonance spectroscopy (31P-MRS) at 3 Tesla to measure phosphocreatine (PCr), beta-nucleoside triphosphate (β-NTP), inorganic phosphate (Pi), and other neurometabolites in the frontal lobe of eight unmedicated and six medicated adolescents with bipolar depression and 24 adolescent HCs. Results: Analysis of covariance, including age as a covariate, revealed differences in PCr (p=0.037), Pi (p=0.017), and PCr/Pi (p=0.002) between participant groups. Percentage neurochemical differences were calculated with respect to mean metabolite concentrations in the HC group. Post-hoc Tukey-Kramer analysis showed that unmedicated BD participants had decreased Pi compared with both HC (17%; p=0.038) and medicated BD (24%; p=0.022). The unmedicated BD group had increased PCr compared with medicated BD (11%; p=0.032). The PCr/Pi ratio was increased in unmedicated BD compared with HC (24%; p=0.013) and with medicated BD (39%; p=0.002). No differences in β-NTP or pH were observed. Conclusions: Our results support the view that frontal lobe mitochondrial function is altered in adolescent BD and may have implications for the use of Pi as a biomarker. These findings join volumetric studies of the amygdala, and proton MRS studies of n-acetyl aspartate in pointing to potential differences in neurobiology between pediatric and adult BD. © 2012 John Wiley and Sons A/S.


Wortzel H.S.,VISN 19 Mental Illness Research | Wortzel H.S.,Aurora University | Arciniegas D.B.,Aurora University
Current Treatment Options in Neurology | Year: 2012

• Cognitive impairment is a common consequence of traumatic brain injury (TBI) and a substantial source of disability. Across all levels of TBI severity, attention, processing speed, episodic memory, and executive function are most commonly affected. • The differential diagnosis for post-traumatic cognitive impairments is broad, and includes emotional, behavioral, and physical problems as well as substance use disorders, medical conditions, prescribed and self-administered medications, and symptom elaboration. Thorough neuropsychiatric assessment for such problems is a prerequisite to treatments specifically targeting cognitive impairments. • First-line treatments for post-traumatic cognitive impairments are nonpharmacologic, including education, realistic expectation setting, environmental and lifestyle modifications, and cognitive rehabilitation. • Pharmacotherapies for post-traumatic cognitive impairments include uncompetitive N-methyl-D-aspartate receptor (NMDA) antagonists, medications that directly or indirectly augment cerebral catecholaminergic or acetylcholinergic function, or agents with combinations of these properties. • In the immediate post-injury period, treatment with uncompetitive NMDA receptor antagonists reduces duration of unconsciousness. The mechanism for this effect may involve attenuation of neurotrauma-induced glutamate-mediated excitotoxicity and/or stabilization of glutamate signaling in the injured brain. • During the subacute or late post-injury periods, medications that augment cerebral acetylcholinergic function may improve declarative memory. Among responders to this treatment, secondary benefits on attention, processing speed, and executive function impairments as well as neuropsychiatric disturbances may be observed. During these post-injury periods, medications that augment cerebral catecholaminergic function may improve hypoarousal, processing speed, attention, and/or executive function as well as comorbid depression or apathy. • When medications are used, a "start-low, go-slow, but go" approach is encouraged, coupled with frequent reassessment of benefits and side effects as well as monitoring for drugdrug interactions. Titration to either beneficial effect or medication intolerance should be completed before discontinuing a treatment or augmenting partial responses with additional medications. © Springer Science+Business Media, LLC 2012.


Olson-Madden J.H.,VISN 19 Mental Illness Research | Olson-Madden J.H.,University of Colorado at Denver | Forster J.E.,University of Colorado at Denver | Huggins J.,VISN 19 Mental Illness Research | Schneider A.,VISN 19 Mental Illness Research
Journal of Head Trauma Rehabilitation | Year: 2012

OBJECTIVES:: To describe various characteristics of veterans with co-occurring histories of traumatic brain injury (TBI) and substance use disorder (SUD) for purposes of hypothesis generation. STUDY DESIGN:: Archival data collected over a period of 4 years. PARTICIPANTS:: Sixty-five veterans across eras of service with confirmed histories of TBI and SUD. METHODS:: Demographic and TBI information were obtained from an archival clinical database. Electronic medical records were reviewed for mental health utilization, psychiatric diagnoses, self-directed violence, and risk-taking behaviors. RESULTS:: In addition to a SUD, veterans were reported to have an average of 3 additional psychiatric diagnoses and a median of 3 TBIs per person. All utilized various mental health services in addition to substance use treatment. Individuals were found to have engaged in a variety of risky behaviors. There were significant associations between suicidal ideation and assaultive behaviors, as well as between suicide attempt and impulsivity. CONCLUSIONS:: This study describes a sample of veterans with co-occurring histories of TBI, SUD, risk-taking behaviors, and self-directed violence. More research is needed to examine these complex interrelationships and to identify specific risk factors for intervention/prevention strategies. © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins.


PubMed | Nova Southeastern University and VISN 19 Mental Illness Research
Type: Journal Article | Journal: Rehabilitation psychology | Year: 2016

This Rehabilitation Measures Database summary provides a review of the psychometric properties of the HADS in individuals with TBI. A full review of the HADS as well as reviews of over 330 other instruments can be found at www.rehabmeasures.org.

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