Department of Psychiatry and Behavioral Medicine

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Abnormal partitioning of hexokinase 1 suggests disruption of a glutamate transport protein complex in schizophrenia
(Elsevier, 2014) Shan, Dan; Mount, Daniel; Moore, Stephen; Haroutunian, Vahram; Meador-Woodruff, James H.; McCullumsmith, Robert E.; University of Alabama Birmingham; University of Alabama Tuscaloosa; Icahn School of Medicine at Mount Sinai
Excitatory amino acid transporter 2 (EAAT2) belongs to a family of Na+ dependent glutamate transporters that maintain a low synaptic concentration of glutamate by removing glutamate from the synaptic cleft into astroglia and neurons. EAAT2 activity depends on Na+ and K+ gradients generated by Na+/K+ ATPase and ATP. Hexokinase 1 (HK1), an initial enzyme of glycolysis, binds to mitochondrial outer membrane where it couples cytosolic glycolysis to mitochondrial oxidative phosphorylation, producing ATP utilized by the EAAT2/Na+/K+ ATPase protein complex to facilitate glutamate reuptake. In this study, we hypothesized that the protein complex formed by EAAT2, Na+/K+ ATPase and mitochondrial proteins in human postmortem prefrontal cortex may be disrupted, leading to abnormal glutamate transmission in schizophrenia. We first determined that EAAT2, Na+/K+ ATPase, HK1 and aconitase were found in both EAAT2 and Na+/K+ ATPase interactomes by immunoisolation and mass spectrometry in human postmortem prefrontal cortex. Next, we measured levels of glutamate transport complex proteins in subcellular fractions in the dorsolateral prefrontal cortex and found increases in the EAAT2B isoform of EAAT2 in a fraction containing extrasynaptic membranes and increased aconitase 1 in a mitochondrial fraction. Finally, an increased ratio of HK1 protein in the extrasynaptic membrane/mitochondrial fraction was found in subjects with schizophrenia, suggesting that HK1 protein is abnormally partitioned in this illness. Our findings indicate that the integrity of the glutamate transport protein complex may be disrupted, leading to decreased perisynaptic buffering and reuptake of glutamate, as well as impaired energy metabolism in schizophrenia. (C) 2014 Elsevier B. V. All rights reserved.
Accuracy of Machine Learning Algorithms for the Diagnosis of Autism Spectrum Disorder: Systematic Review and Meta-Analysis of Brain Magnetic Resonance Imaging Studies
(JMIR, 2019) Moon, Sun Jae; Hwang, Jinseub; Kana, Rajesh; Torous, John; Kim, Jung Won; Ewha Womans University; Daegu University; University of Alabama Tuscaloosa; Harvard University; Beth Israel Deaconess Medical Center; Harvard Medical School; University of Alabama Birmingham
Background: In the recent years, machine learning algorithms have been more widely and increasingly applied in biomedical fields. In particular, their application has been drawing more attention in the field of psychiatry, for instance, as diagnostic tests/tools for autism spectrum disorder (ASD). However, given their complexity and potential clinical implications, there is an ongoing need for further research on their accuracy. Objective: This study aimed to perform a systematic review and meta-analysis to summarize the available evidence for the accuracy of machine learning algorithms in diagnosing ASD. Methods: The following databases were searched on November 28, 2018: MEDLINE, EMBASE, CINAHL Complete (with Open Dissertations), PsycINFO, and Institute of Electrical and Electronics Engineers Xplore Digital Library. Studies that used a machine learning algorithm partially or fully for distinguishing individuals with ASD from control subjects and provided accuracy measures were included in our analysis. The bivariate random effects model was applied to the pooled data in a meta-analysis. A subgroup analysis was used to investigate and resolve the source of heterogeneity between studies. True-positive, false-positive, false-negative, and true-negative values from individual studies were used to calculate the pooled sensitivity and specificity values, draw Summary Receiver Operating Characteristics curves, and obtain the area under the curve (AUC) and partial AUC (pAUC). Results: A total of 43 studies were included for the final analysis, of which a meta-analysis was performed on 40 studies (53 samples with 12,128 participants). A structural magnetic resonance imaging (sMRI) subgroup meta-analysis (12 samples with 1776 participants) showed a sensitivity of 0.83 (95% CI 0.76-0.89), a specificity of 0.84 (95% CI 0.74-0.91), and AUC/pAUC of 0.90/0.83. A functional magnetic resonance imaging/deep neural network subgroup meta-analysis (5 samples with 1345 participants) showed a sensitivity of 0.69 (95% CI 0.62-0.75), specificity of 0.66 (95% CI 0.61-0.70), and AUC/pAUC of 0.71/0.67. Conclusions: The accuracy of machine learning algorithms for diagnosis of ASD was considered acceptable by few accuracy measures only in cases of sMRI use; however, given the many limitations indicated in our study, further well-designed studies are warranted to extend the potential use of machine learning algorithms to clinical settings.
Assessment and Treatment of Emotion Regulation Impairment in Autism Spectrum Disorder Across the Life Span Current State of the Science and Future Directions
(WB Saunders, 2020) Beck, Kelly B.; Conner, Caitlin M.; Breitenfeldt, Kaitlyn E.; Northrup, Jessie B.; White, Susan W.; Mazefsky, Carla A.; University of Pittsburgh; University of Alabama Tuscaloosa
Emotion regulation (ER) is the ability to modify arousal and emotional reactivity to achieve goals and maintain adaptive behaviors. ER impairment in autism spectrum disorder (ASD) is thought to underlie many problem behaviors, co-occurring psychiatric symptoms, and social impairment, and yet is largely unaddressed both clinically and in research. There is a critical need to develop ER treatment and assessment options for individuals with ASD across the life span, given the multitude of downstream effects on functioning. This article summarizes the current state of science in ER assessment and treatment and identifies the most promising measurement options and treatments.
Association Between Hormonal Birth Control, Substance Use, and Depression
(Frontiers, 2022) Newman, Sharlene D.; University of Alabama Tuscaloosa
ObjectiveThe current study examined the impact of the use of hormonal birth control, cannabis (CB), and alcohol on depression symptoms. Study DesignSurvey data from 3,320 college-aged women collected over a 2-year period. Depression symptoms were assessed using the PHQ-9. ResultsIndividuals taking hormonal birth control (N = 998; age = 19.1 +/- 1.6 years) had lower overall depression scores than did those not taking birth control (N = 2,322; age = 19.1 +/- 1.8 years) with 15.2% of those not taking hormonal birth control had depressive symptoms while 12.1% of those in the birth control group had depressive symptoms. Additionally, those taking hormonal birth control had higher scores on the alcohol and CB use assessment. A between-subjects ANOVA with depression score as the dependent variable found significant effects hormonal birth control use, CB and alcohol use, as well as a significant interaction between CB use and hormonal birth control use. ConclusionsWhile there are some limitations (e.g., the between subjects design makes it such that there may be uncontrolled differences between groups), the results suggest that hormonal birth control use may help to reduce depressive symptoms. ImplicationsMore studies examining the impact of hormonal birth control and substance use on depression are required. The results suggest a potential interaction between CB and hormonal birth control use on depression symptoms that is not observed for alcohol. This implies that alcohol and CB may be linked to depression via different mechanisms.
Cost and effectiveness of one session treatment (OST) for children and young people with specific phobias compared to multi-session cognitive behavioural therapy (CBT): results from a randomised controlled trial
(BMC, 2022) Wang, Han-, I; Wright, Barry; Tindall, Lucy; Cooper, Cindy; Biggs, Katie; Lee, Ellen; Teare, M. Dawn; Gega, Lina; Scott, Alexander J.; Hayward, Emily; Solaiman, Kiera; Davis, Thompson; McMillan, Dean; Gilbody, Simon; Parrott, Steve; University of York - UK; University of Sheffield; Newcastle University - UK; University of Hull; Keele University; Louisiana State University; University of Alabama Tuscaloosa
Background In the UK, around 93,000 (0.8%) children and young people (CYP) are experiencing specific phobias that have a substantial impact on daily life. The current gold-standard treatment-multi-session cognitive behavioural therapy (CBT) - is effective at reducing specific phobia severity; however, CBT is time consuming, requires specialist CBT therapists, and is often at great cost and limited availability. A briefer variant of CBT called one session treatment (OST) has been found to offer similar clinical effectiveness for specific phobia as multi-session CBT. The aim of this study was to assess the cost-effectiveness of OST compared to multi-session CBT for CYP with specific phobias through the Alleviating Specific Phobias Experienced by Children Trial (ASPECT), a two-arm, pragmatic, multi-centre, non-inferiority randomised controlled trial. Methods CYP aged seven to 16 years with specific phobias were recruited nationally via Health and Social Care pathways, remotely randomised to the intervention group (OST) or the control group (CBT-based therapies) and analysed (n = 267). Resource use based on NHS and personal social services perspective and quality adjusted life years (QALYs) measured by EQ-5D-Y were collected at baseline and at six-month follow-up. Incremental cost-effectiveness ratio (ICER) was calculated, and non-parametric bootstrapping was conducted to capture the uncertainty around the ICER estimates. The results were presented on a cost-effectiveness acceptability curve (CEAC). A set of sensitivity analyses (including taking a societal perspective) were conducted to assess the robustness of the primary findings. Results After adjustment and bootstrapping, on average CYP in the OST group incurred less costs (incremental cost was -302.96 pound (95% CI -598.86 pound to -28.61)) pound and maintained similar improvement in QALYs (QALYs gained 0.002 (95% CI - 0.004 to 0.008)). The CEAC shows that the probability of OST being cost-effective was over 95% across all the WTP thresholds. Results of a set of sensitivity analyses were consistent with the primary outcomes. Conclusion Compared to CBT, OST produced a reduction in costs and maintained similar improvement in QALYs. Results from both primary and sensitivity analyses suggested that OST was highly likely to be cost saving.
Disentangling the effects of attentional difficulties on fears of social evaluation and social anxiety symptoms: Unique interactions with sluggish cognitive tempo
(Pergamon, 2020) Fredrick, Joseph W.; Becker, Stephen P.; Kofler, Michael J.; Jarrett, Matthew A.; Burns, G. Leonard; Luebbe, Aaron M.; Miami University; Cincinnati Children's Hospital Medical Center; University of Cincinnati; Florida State University; University of Alabama Tuscaloosa; Washington State University
Although fears of negative and positive social evaluation are hallmark cognitive features of social anxiety, attentional difficulties may exacerbate the relation between fears of social evaluation and social anxiety. Thus, the goal of the current study was to test whether two different types of self-reported attentional difficulties, specifically sluggish cognitive tempo (SCT) and attention-deficit/hyperactivity disorder (ADHD) inattention symptoms, moderate the relation between fears of social evaluation and social anxiety. Participants (N = 4756; Mage = 19.28 years; 72.7% female) enrolled in five universities across the United States completed self-report measures of fears of negative and positive evaluation and psychopathology symptoms. Results indicated a significant two-way interaction of fear of negative evaluation and SCT in relation to social anxiety symptoms, as well as a significant two-way interaction of fear of positive evaluation and SCT in relation to social anxiety symptoms. In both instances, the associations between fears of negative and positive evaluation in relation to social anxiety became increasingly stronger at higher levels of SCT. Conversely, the interactions between fears of negative and positive evaluation with ADHD inattentive symptoms were non-significant. These results are the first to report that self-reported SCT, but not ADHD inattentive symptoms, exacerbate the relation between fears of social evaluation and social anxiety, and suggest that attentional difficulties characteristic of SCT may prolong engagement in fears.
Effect of Evidence-Based Supported Employment vs Transitional Work on Achieving Steady Work Among Veterans With Posttraumatic Stress Disorder A Randomized Clinical Trial
(American Medical Association, 2018) VA CSP 589 Vet Individual Place; University of Alabama Tuscaloosa; US Department of Veterans Affairs; Veterans Health Administration (VHA); VA Connecticut Healthcare System; VA North Texas Health Care System; University of Texas Southwestern Medical Center Dallas; University of South Florida; Yale University
IMPORTANCE Posttraumatic stress disorder (PTSD) often interferes with a person's ability to obtain or sustain employment, which leads to premature exit from the labor force and reduced income. OBJECTIVE To determine whether individual placement and support (IPS)-supported employment is more effective than stepwise vocational rehabilitation involving transitional work assignments at helping veterans with PTSD attain steady, competitive employment. DESIGN, SETTING, AND PARTICIPANTS The Veterans Individual Placement and Support Toward Advancing Recovery (VIP-STAR) study was a prospective, multisite, randomized clinical trial that included 541 unemployed veterans with PTSD at 12 Veterans Affairs medical centers. Data were collected from December 23, 2013, to May 3, 2017. Intent-to-treat analysis was performed. INTERVENTIONS Individual placement and support is a supported employment intervention that rapidly engages people with disabilities in community job development to obtain work based on their individual job preferences. Transitional work is a stepwise vocational rehabilitation intervention that assigns people temporarily to noncompetitive jobs as preparation for competitive employment in the community. MAIN OUTCOMES AND MEASURES A priori hypotheses were that, compared with those in transitional work, more participants in the IPS group would become steady workers (primary) and earn more income from competitive jobs (secondary) over 18 months. Steady worker was defined as holding a competitive job for at least 50% of the 18-month follow-up period. RESULTS A total of 541 participants (n = 271 IPS; n = 270 transitional work) were randomized. Mean (SD) age was 42.2 (11) years; 99 (18.3%) were women, 274 (50.6%) were white, 225 (41.6%) were African American, and 90 (16.6%) were of Hispanic, Spanish, or Latino ethnicity. More participants in the IPS group achieved steady employment than in the transitional work group (105 [38.7%] vs 63 [23.3%]; odds ratio, 2.14; 95% CI, 1.46-3.14). A higher proportion of IPS participants attained any competitive job (186 [68.6%] vs 154 [57.0%]; P = .005) and had higher cumulative earnings from competitive jobs (median [interquartile range] $7290 [$23 174] in IPS vs $1886 [$17 167] in transitional work; P = .004). CONCLUSIONS AND RELEVANCE This multisite trial demonstrated significantly greater effectiveness of IPS-supported employment over stepwise transitional work vocational rehabilitation for veterans living with chronic PTSD. The results provide supporting evidence for increasing access to IPS for veterans living with PTSD.
Effects of Nativity, Length of Residence, and County-Level Foreign-Born Density on Mental Health Among Older Adults in the US
(Springer, 2016) Choi, Sunha; Kim, Giyeon; Lee, Sungkyu; University of Tennessee Knoxville; University of Alabama Tuscaloosa; Soongsil University
Using the 2004-2007 Medical Expenditure Panel Survey data that are linked to county-level data from the Area Health Resources Files, this study examined whether the healthy immigrant effect applies to mental health of foreign-born older adults. Additionally, testing a protective ethnic density effect on older foreign-born individuals' mental health, this study examined how the percentage of foreign-born population in the county affected the relationship between older adults' immigration status (U.S.-nativity and length of residence in the U.S.) and their mental health status. The sample included 29,011 individuals (level-1) from 920 counties (level-2) across 50 states and D.C. Using the Mental Component Summary of the Short-Form 12, the Kessler Index (K-6), and the Patient Health Questionnaire (PHQ-2), U.S.-born individuals (n = 24,225), earlier immigrants (aeyen15 years in the U.S.; n = 3866), and recent immigrants (< 15 years in the U.S.; n = 920) were compared. The results indicate that recent immigrants showed worse mental health on all three measures compared with U.S.-born individuals and on the K-6 and PHQ-2 compared with earlier immigrants. Higher county-level foreign-born densities were associated with worse mental health status of individuals. However, the significant interactions found in the full conditional multilevel models indicated that the high foreign-born density functioned as a risk factor for worse mental health only among recent immigrants but not among the U.S.-born. In conclusion, the results revealed the vulnerability of older recent immigrants, especially those living in the counties with high foreign-born densities.
Emergency department utilization among Medicaid beneficiaries with schizophrenia and diabetes: The consequences of increasing medical complexity
(Elsevier, 2014) Shim, Ruth S.; Druss, Benjamin G.; Zhang, Shun; Kim, Giyeon; Oderinde, Adesoji; Shoyinka, Sosunmolu; Rust, George; Morehouse School of Medicine; Emory University; Rollins School Public Health; University of Alabama Tuscaloosa; University of Missouri Columbia
Objective: Individuals with both physical and mental health problems may have elevated levels of emergency department (ED) service utilization either for index conditions or for associated comorbidities. This study examines the use of ED services by Medicaid beneficiaries with comorbid diabetes and schizophrenia, a dyad with particularly high levels of clinical complexity. Methods: Retrospective cohort analysis of claims data for Medicaid beneficiaries with both schizophrenia and diabetes from fourteen Southern states was compared with patients with diabetes only, schizophrenia only, and patients with any diagnosis other than schizophrenia and diabetes. Key outcome variables for individuals with comorbid schizophrenia and diabetes were ED visits for diabetes, mental health-related conditions, and other causes. Results: Medicaid patients with comorbid diabetes and schizophrenia had an average number of 7.5 ED visits per year, compared to the sample Medicaid population with neither diabetes nor schizophrenia (1.9 ED visits per year), diabetes only (4.7 ED visits per year), and schizophrenia only (5.3 ED visits per year). Greater numbers of comorbidities (over and above diabetes and schizophrenia) were associated with substantial increases in diabetes-related, mental health-related and all-cause ED visits. Most ED visits in all patients, but especially in patients with more comorbidities, were for causes other than diabetes or mental health-related conditions. Conclusion: Most ED utilization by individuals with diabetes and schizophrenia is for increasing numbers of comorbidities rather than the index conditions. Improving care in this population will require management of both index conditions as well as comorbid ones. (C) 2013 Elsevier B.V. All rights reserved.
Emotion Dysregulation is Substantially Elevated in Autism Compared to the General Population: Impact on Psychiatric Services
(Wiley, 2021) Conner, Caitlin M.; Golt, Josh; Shaffer, Rebecca; Righi, Giulia; Siegel, Matthew; Mazefsky, Carla A.; University of Pittsburgh; University of Alabama Tuscaloosa; Cincinnati Children's Hospital Medical Center; University of Cincinnati; Brown University; Maine Medical Center; Tufts University
Emerging evidence suggests that emotion regulation (ER) impairment in those with ASD is associated with poor mental health. This study used the Emotion Dysregulation Inventory, a new norm-referenced ER measure with clinical cut-offs, developed and validated in ASD and non-ASD samples, to establish rates of ER impairment and understand its association with psychiatric service use in ASD. Parents of 6-17 year olds in three well-characterized samples (nationally representative US n = 1,000; community ASD n = 1,169; inpatient ASD n = 567) completed a battery of questionnaires about their child. The prevalence of ER impairment was significantly higher in the ASD groups compared to the nationally representative sample and highest in the psychiatric Inpatient ASD group. The community ASD and inpatient ASD samples were four and seven times more likely, respectively, to exceed clinical cutoffs for emotional reactivity than the general US sample. Similarly, history of psychiatric hospitalization, recent emergency services use (police contact, emergency room visits, or in-home crisis evaluations for emotional or behavioral concerns in the past 2 months), and psychotropic medication prescriptions were significantly higher in the ASD groups. ER impairment was significantly associated with all forms of psychiatric service use, after controlling for demographics (age, sex, race), co-occurring intellectual disability, and ADHD symptoms. This is the first large-scale study to document substantially higher rates of ER impairment in youth with ASD compared to the general population. The importance of ER impairment is underscored by its association with higher utilization of inpatient, emergency, and medication services in ASD, after accounting for demographics and ADHD-related symptoms. Lay Summary This study compared problems with emotion regulation in large samples of youth with and without ASD. An ASD community sample had two to four times more youth with clinically elevated regulation impairments compared to youth without ASD. Emotion regulation impairment was also related to using psychiatric hospitalizations, emergency services, and medications in the ASD group. This study suggests that screening for emotion regulation difficulties in ASD is important and treatment may have a wide ranging impact.
Employment Outcomes From VA Vocational Services Involving Transitional Work for Veterans With a Diagnosis of Posttraumatic Stress Disorder
(American Psychological Association, 2019) VA CSP 589 VIP-STAR Investigators; University of Alabama Tuscaloosa; Yale University; US Department of Veterans Affairs; Veterans Health Administration (VHA); Edward Hines Jr. VA Hospital; University of Minnesota Twin Cities; Minneapolis VA Health Care System; VA Connecticut Healthcare System; Veterans Affairs Medical Center - Birmingham; VA North Texas Health Care System; San Francisco VA Medical Center
Objective: Transitional work (TW) for veterans with psychiatric disabilities is the predominant model of vocational rehabilitation in the Veterans Health Administration (VA). Although, on average, TW employment outcomes have been demonstrated to be inferior to supported employment. little is known about the potential subgroup of veterans for which TW may be most effective. This study of veterans with posttraumatic stress disorder (PTSD) examines differences in competitive employment outcomes and identifies characteristics of veterans who chose to engage in TW compared with those who did not. Method: A post hoc comparative subgroup analysis of veterans with PTSD randomly assigned to TW as part of a randomized controlled trial was conducted. Veterans were divided into 2 subgroups: those who engaged in TW (n = 141) and nonengagers (n = 129). Differences in baseline characteristics were examined and 18-month employment outcomes were compared. Results: There were no differences in 18-month employment outcomes between TW engagers and nonengagers. Compared with TW engagers, those that did not engage in TW were 2.5 times more likely to get a competitive job within the first 6 months and were less likely to obtain lower skilled jobs. Younger age, adequate housing, personal means of transportation, and recent work history factor into the odds of gaining and maintaining competitive work. Conclusions and Implications for Practice: Consistent with past research, engagement in TW did not result in improved long-term competitive employment outcomes for veterans with PTSD. Those who did not engage in TW were more likely to gain a competitive job within the first 6 months.
Energy intake estimation from counts of chews and swallows
(Elsevier, 2015) Fontana, Juan M.; Higgins, Janine A.; Schuckers, Stephanie C.; Bellisle, France; Pan, Zhaoxing; Melanson, Edward L.; Neuman, Michael R.; Sazonov, Edward; University of Alabama Tuscaloosa; University of Colorado Anschutz Medical Campus; Clarkson University; INRAE; Institut National de la Sante et de la Recherche Medicale (Inserm); Universite Paris 13; heSam Universite; Conservatoire National Arts & Metiers (CNAM); Children's Hospital Colorado; Michigan Technological University
Current, validated methods for dietary assessment rely on self-report, which tends to be inaccurate, timeconsuming, and burdensome. The objective of this work was to demonstrate the suitability of estimating energy intake using individually-calibrated models based on Counts of Chews and Swallows (CCS models). In a laboratory setting, subjects consumed three identical meals (training meals) and a fourth meal with different content (validation meal). Energy intake was estimated by four different methods: weighed food records (gold standard), diet diaries, photographic food records, and CCS models. Counts of chews and swallows were measured using wearable sensors and video analysis. Results for the training meals demonstrated that CCS models presented the lowest reporting bias and a lower error as compared to diet diaries. For the validation meal, CCS models showed reporting errors that were not different from the diary or the photographic method. The increase in error for the validation meal may be attributed to differences in the physical properties of foods consumed during training and validation meals. However, this may be potentially compensated for by including correction factors into the models. This study suggests that estimation of energy intake from CCS may offer a promising alternative to overcome limitations of self-report. (C) 2014 Elsevier Ltd. All rights reserved.
Examining US Public Early Intervention for Toddlers With Autism: Characterizing Services and Readiness for Evidence-Based Practice Implementation
(Frontiers, 2021) Aranbarri, Aritz; Stahmer, Aubyn C.; Talbott, Meagan R.; Miller, Marykate E.; Drahota, Amy; Pellecchia, Melanie; Barber, Angela B.; Griffith, Elizabeth McMahon; Morgan, Elizabeth H.; Rogers, Sally J.; University of California Davis; Michigan State University; University of Pennsylvania; Pennsylvania Medicine; University of Alabama Tuscaloosa; University of Colorado Anschutz Medical Campus; California State University Sacramento
As the rates of Autism Spectrum Disorder (ASD) increase and early screening efforts intensify, more toddlers with high likelihood of ASD are entering the United States' (US') publicly funded early intervention system. Early intervention service delivery for toddlers with ASD varies greatly based on state resources and regulations. Research recommends beginning ASD-specific evidence-based practices (EBP), especially caregiver-implemented intervention, as early as possible to facilitate the development of social-communication skills and general learning. Translating EBP into practice has been challenging, especially in low-resourced areas. The main goal of this study was to obtain a more comprehensive understanding of public early intervention system structure, service delivery practices, and factors influencing EBP use for children with ASD in the US. Participants (N = 133) included 8 early intervention state coordinators in 7 states, 29 agency administrators in those states, 57 early intervention providers from those agencies, and 39 caregivers of children with ASD receiving services from those providers. Online surveys gathered stakeholder and caregiver perspectives on early intervention services as well as organizational factors related to EBP implementation climate and culture. Stakeholders identified key intervention needs for young children with ASD. In general, both agency administrators and direct providers reported feeling somewhat effective or very effective in addressing most needs of children with ASD. They reported the most difficulty addressing eating, sleeping, family stress, and stereotyped behaviors. Data indicate that children from families with higher income received significantly higher service intensity. While administrators and providers reported high rates of high-quality caregiver coaching (>60%), caregivers reported low rates (23%). Direct providers with more favorable attitudes toward EBP had greater EBP use. In turn, provider attitudes toward EBP were significantly associated with implementation leadership and culture at their agency. Results suggest that publicly funded early intervention programs in the US require additional resources and training for providers and leaders to support improved implementation climate and attitudes toward ASD EBPs. Results also suggest that more state system support is needed to increase use of ASD-specific EBP use, including high-quality caregiver coaching, to better serve toddlers with ASD. Recommendations for implementation strategies are addressed.
Factors influencing medical students and psychiatry residents in Ghana to consider psychiatry as a career option - a qualitative study
(Cambridge University Press, 2020) Agyapong, Vincent I. O.; Ritchie, Amanda; Doucet, Kacy; Agyapong-Opoku, Gerald; Shalaby, Reham; Hrabok, Marianne; Ulzen, Thaddeus; Osei, Akwasi; University of Alberta; Alberta Health Services (AHS); University of Calgary; University of Alabama Tuscaloosa
Background Currently, Ghana has 14 actively practicing psychiatrists and about 26 psychiatric residents for a population of over 28 million people. Previous research suggests a lack of interest by Ghanaian medical students and medical graduates in considering psychiatry as a career option. Objectives To examine the perception of medical students and psychiatry residents in Ghana about the barriers which hinder Ghanaian medical graduates from choosing careers in psychiatry and how these barriers could be overcome. Methods This was a cross-sectional qualitative study with data gathered using focus group discussion. Twenty clinical year medical students were selected through block randomization from the four public medical schools in Ghana and invited to participate in one of two focus group discussions. Also, four psychiatric residents were invited to participate in the focus group discussions. Results The main barriers identified by participants could be grouped under four main themes, namely: (a) myths and stigma surrounding mental health and patients, (b) negative perceptions of psychiatrists, (c) infrastructure and funding issues, (d) lack of exposure and education. To address the barriers presented, participants discussed potential solutions that could be categorized into five main themes, namely: (a) stigma reduction, (b) educating professionals, (c) addressing deficient infrastructure, (d) risk management, and (e) incentivizing the pursuit of psychiatry among students. Conclusion Health policy planners and medical training institutions could consider implementing proposed solutions to identify barriers as part of efforts to improve the psychiatrist to patient ratio in Ghana.
Food insecurity, mental distress and suicidal ideation in rural Africa: Evidence from Nigeria, Uganda and Ghana
(Sage, 2019) Sweetland, Annika Claire; Pala, Andrea Norcini; Mootz, Jennifer; Kao, Jennifer Chien-Wen; Carlson, Catherine; Oquendo, Maria A.; Cheng, Bryan; Belkin, Gary; Wainberg, Milton; Columbia University; University of Alabama Tuscaloosa; University of Pennsylvania; Pennsylvania Medicine; New York City Department of Health & Mental Hygiene
Background: In sub-Saharan Africa, mental and substance-related disorders account for 19% of all years lived with disability, yet the intersection between poverty and mental distress is poorly understood since most psychiatric research is conducted in high-income countries. Aims: To examine the prevalence of and associations between food insecurity, mental distress and suicidal ideation in three rural village clusters in sub-Saharan Africa. Method: Cross-sectional multivariate analysis of sociodemographic variables associated with mental distress and suicidal ideation in three countries. The sample included 1,142 individuals from three rural village clusters in Nigeria (n = 380), Uganda (n = 380) and Ghana (n = 382). Food insecurity was measured based on the number of months in the previous year that the respondent's family reported being 'unable to eat two square meals per day'. Mental distress was assessed using the Kessler non-specific psychological distress scale (K6) and suicidal ideation was measured using an item from PRIME-MD. Other sociodemographic variables included gender, age, literacy and occupation. Results: The prevalence of individuals with moderate or severe mental distress in Nigeria, Uganda and Ghana were higher than previously reported in the literature: 35.5%, 30.8% and 30.4%, respectively, and suicidal ideation rates were 29.7%, 21.3% and 10.9%. No differences were observed in mental distress between men and women in any of the sites. Being a farmer (vs student or other) was protective for mental distress in two sites (Uganda and Ghana) but no other social indicators, such as age, gender, literacy and food insecurity, were significantly associated with mental distress. Risk for suicidal ideation differed across sites: it was associated with food insecurity in Nigeria, female gender in Uganda, and older age in Uganda. Conclusions: Mental distress and suicidal ideation were highly prevalent in three settings of extreme poverty across all groups, in ways that were not always consistent with the global literature. These findings suggest that more research is needed in to better understand the social etiology of mental distress in sub-Saharan Africa.
Misaligned core body temperature rhythms impact cognitive performance of hospital shift work nurses
(Elsevier, 2019) Molzof, Hylton E.; Prapanjaroensin, Aoyjai; Patel, Vivek H.; Mokashi, Mugdha, V; Gamble, Karen L.; Patrician, Patricia A.; University of Alabama Birmingham; University of Alabama Tuscaloosa
Circadian rhythms greatly influence 24-h variation in cognition in nearly all organisms, including humans. Circadian clock impairment and sleep disruption are detrimental to hippocampus-dependent memory and negatively influence the acquisition and recall of learned behaviors. The circadian clock can become out of sync with the environment during circadian misalignment. Shift work represents a real-world model of circadian misalignment that can be studied for its physiological implications. The present study aimed to test the hypothesis that circadian misalignment disrupts vigilance and cognitive performance on occupationally relevant tasks using shift work as a model. As such, we sought to (1) explore the general effects of night- and day-shift worker schedules on sleep-wake parameters and core body temperature (CBT) phase, and (2) determine whether shift-type and CBT phase impact cognitive performance and vigilance at the end of a 12-h shift. We observed a sample of day-shift and night-shift hospital nurses over a 10-day period. At the end of three, consecutive, 12-h shifts (7 pm-7am or 7am-7 pm), participants completed a cognitive battery assessing vigilance, cognitive throughput, and medication calculation fluency (via an investigator developed and tested metric). Night-shift nurses exhibited significantly greater sleep fragmentation as well as a greater disparity between their wake-time and time of CBT minimum compared to day-shift nurses. Night-shift nurses exhibited significantly slower cognitive proficiency at the end of their shifts, even after adjustment for CBT phase. These results suggest that circadian disruption and reduced sleep quality both contribute to cognitive functioning and performance.
Neural responses to viewing human faces in autism spectrum disorder: A quantitative meta-analysis of two decades of research
(Pergamon, 2021) Ammons, Carla J.; Winslett, Mary-Elizabeth; Kana, Rajesh K.; University of Alabama Birmingham; Children's Healthcare of Atlanta (CHOA); Emory University; University of Alabama Tuscaloosa
The human face communicates a wealth of socially relevant information such as person identity, emotion, and intention. A consistent behavioral finding in autism spectrum disorder (ASD) is reduced attention to or difficulty drawing meaning from faces. However, neumimaging research into the neural correlates of face processing differences in ASD has returned mixed results. While many studies find hypo-activation or hypo-connectivity of core and extended face network regions, others show hyper-activation, equal activation, or even activation shifted to object-selective fusiform gyrus (FG) regions in ASD during face processing. This study consolidates two decades of literature to reveal common and consistent patterns of brain activation when viewing human faces in ASD. It also addresses whether face processing in ASD is routinely shifted to object-centric regions of the FG. To do so, we conducted an extensive search of the neuroimaging literature according to PRISMA guidelines. Peak activation coordinates from a final set of 23 studies, yielding a sample of 713 participants (338 ASD), were included for quantitative meta-analysis using Activation Likelihood Estimation (ALE). ASD within-group results across studies revealed a single activation cluster in the left FG, which presented laterally to the mid-fusiform sulcus (MFS). Typically developing groups displayed common activations across core and extended face network regions. Exploratory analysis of between group findings from the literature did not yield significant results. Overall, our results suggest that individuals with ASD consistently activate at least one typical face network region, the left FG, when processing faces and this activation is not routinely shifted to object-centric areas of the FG.
Neurocognitive mechanisms explaining the role of math attitudes in predicting children's improvement in multiplication skill
(Springer, 2021) Suarez-Pellicioni, Macarena; Demir-Lira, O. Ece; Booth, James R.; University of Alabama Tuscaloosa; University of Iowa; Vanderbilt University
Enhancing student's math achievement is a significant educational challenge. Numerous studies have shown that math attitudes can predict improvement in math performance, but no study has yet revealed the underlying neurocognitive mechanisms explaining this effect. To answer this question, 50 children underwent functional magnetic resonance imaging (fMRI) when they were 11 (time 1; T1) and 13 (time 2; T2) years old. Children solved a rhyming judgment and a single-digit multiplication task inside the scanner at T1. The rhyming task was used to independently define a verbal region of interest in the left inferior frontal gyrus (IFG). We focused on this region because of previous evidence showing math attitudes-related effects in the left IFG for children with low math skill (Demir-Lira et al., 2019). Children completed standardized testing of math attitudes at T1 and of multiplication skill both at T1 and T2. We performed a cluster-wise regression analysis to investigate the interaction between math attitudes and improvement in multiplication skill over time while controlling for the main effects of these variables, intelligence, and accuracy on the task. This analysis revealed a significant interaction in the left IFG, which was due to improvers with positive math attitudes showing enhanced activation. Our result suggests that IFG activation, possibly reflecting effort invested in retrieving multiplication facts, is one of the possible neurocognitive mechanism by which children with positive math attitudes improve in multiplication skill. Our finding suggests that teachers and parents can help children do better in math by promoting positive math attitudes.
Neurophysiologic evidence for increased retrieval suppression among negative ruminators
(Wiley, 2020) Nair, Aarti; Eyer, Joshua C.; Faust, Mark E.; Loma Linda University; University of Alabama Tuscaloosa; University of North Carolina; University of North Carolina Charlotte
Introduction Events (e.g., seeing a familiar face) may initiate retrieval of associated information (e.g., person's name), but not all cue-initiated memory retrieval is welcome (e.g., trauma). Retrieval suppression refers to the ability to halt unwanted retrieval, and any erosion of memory associations in response to repeatedly excluding a memory from consciousness. The current study sought to examine event-related potential (ERP, averaged scalp electrical recordings) correlates of inhibitory cognitive control of memory retrieval and any linkage of such control to ruminative memory styles. Methods Participants (N = 23) first learned face-picture pairings. ERPs were then recorded as they viewed face cues while either bringing the associated picture to mind (think trial), or not allowing the associated picture to come to mind (no-think trial). Results Emotional valence of learned pictures (negative versus neutral) modulated a posterior (P1, 100-150 ms) ERP associated with attention to the face cue. Memory strategy (think versus no-think) modulated a frontal (P3, 350-450 ms) associated with alerting of the need to control retrieval. Both valence and strategy worked in combination to modulate a late posterior (LC, 450-550 ms) ERP associated with successful memory retrieval. Brooding, a negative form of rumination, was found to be positively correlated with the LC ERP. Conclusion The results suggest early separation of emotional and strategic control of retrieval, but later combined control over access to working memory. Moreover, the positive correlation of brooding and the LC suggest that individuals who are high in application of perseverative strategies to memory retrieval will show greater modulation of the retrieval-related LC ERP.
An organization- and category-level comparison of diagnostic requirements for mental disorders in ICD-11 and DSM-5
(Wiley, 2021) First, Michael B.; Gaebel, Wolfgang; Maj, Mario; Stein, Dan J.; Kogan, Cary S.; Saunders, John B.; Poznyak, Vladimir B.; Gureje, Oye; Lewis-Fernandez, Roberto; Maercker, Andreas; Brewin, Chris R.; Cloitre, Marylene; Claudino, Angelica; Pike, Kathleen M.; Baird, Gillian; Skuse, David; Krueger, Richard B.; Briken, Peer; Burke, Jeffrey D.; Lochman, John E.; Evans, Spencer C.; Woods, Douglas W.; Reed, Geoffrey M.; Columbia University; Heinrich Heine University Dusseldorf; Universita della Campania Vanvitelli; University of Cape Town; South African Medical Research Council; University of Ottawa; University of Queensland; World Health Organization; University of Ibadan; University of Zurich; University of London; University College London; US Department of Veterans Affairs; Veterans Health Administration (VHA); VA Palo Alto Health Care System; Stanford University; Universidade Federal de Sao Paulo (UNIFESP); Guy's & St Thomas' NHS Foundation Trust; University of Hamburg; University Medical Center Hamburg-Eppendorf; University of Connecticut; University of Alabama Tuscaloosa; University of Miami; Marquette University
In 2013, the American Psychiatric Association (APA) published the 5th edition of its Diagnostic and Statistical Manual of Mental Disorders (DSM-5). In 2019, the World Health Assembly approved the 11th revision of the International Classification of Diseases (ICD-11). It has often been suggested that the field would benefit from a single, unified classification of mental disorders, although the priorities and constituencies of the two sponsoring organizations are quite different. During the development of the ICD-11 and DSM-5, the World Health Organization (WHO) and the APA made efforts toward harmonizing the two systems, including the appointment of an ICD-DSM Harmonization Group. This paper evaluates the success of these harmonization efforts and provides a guide for practitioners, researchers and policy makers describing the differences between the two systems at both the organizational and the disorder level. The organization of the two classifications of mental disorders is substantially similar. There are nineteen ICD-11 disorder categories that do not appear in DSM-5, and seven DSM-5 disorder categories that do not appear in the ICD-11. We compared the Essential Features section of the ICD-11 Clinical Descriptions and Diagnostic Guidelines (CDDG) with the DSM-5 criteria sets for 103 diagnostic entities that appear in both systems. We rated 20 disorders (19.4%) as having major differences, 42 disorders (40.8%) as having minor definitional differences, 10 disorders (9.7%) as having minor differences due to greater degree of specification in DSM-5, and 31 disorders (30.1%) as essentially identical. Detailed descriptions of the major differences and some of the most important minor differences, with their rationale and related evidence, are provided. The ICD and DSM are now closer than at any time since the ICD-8 and DSM-II. Differences are largely based on the differing priorities and uses of the two diagnostic systems and on differing interpretations of the evidence. Substantively divergent approaches allow for empirical comparisons of validity and utility and can contribute to advances in the field.

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