Try a new search

Format these results:

Searched for:

person:kehnm01

in-biosketch:yes

Total Results:

6


Implementing brief Dynamic Interpersonal Therapy (DIT) in a VA Medical Center

Chen, Cory K; Ingenito, Christine P; Kehn, Michelle M; Nehrig, Nicole; Abraham, Karen S
BACKGROUND: Given increasing mental health needs in the VA, identifying strategies to deliver new services is critical. AIMS: This paper describes the process of navigating provider, patient and systems barriers of an initiative to increase choice, access and quality of psychotherapy at the VA by incorporating an evidence-based short-term, psychodynamic psychotherapy. METHODS: Brief Dynamic Interpersonal Therapy (DIT) was selected as a viable model for implementation. Data were gathered on the process of implementation, barriers, Veterans seen, and access to psychodynamic psychotherapy. RESULTS: Nine psychologists and 22 masters level pre-doctoral psychology externs have delivered DIT to 73 Veterans. Veterans referred for psychodynamic psychotherapy annually increased 360%. Furthermore, DIT has become the dominant form of psychodynamic psychotherapy requested of the psychology service representing 70.1% of psychodynamic psychotherapy referrals. Strategies are presented for addressing: (1) provider ability, flexibility and motivation, (2) Veteran perception of relevance, distinctiveness and adaptability to complex presenting issues and (3) administrative support. CONCLUSIONS: Implementing an evidence-based short-term psychodynamic treatment option in the VA is feasible. VA mental health providers can be trained in brief psychodynamic psychotherapy and can successfully implement those approaches in VA settings. Finally, psychodynamic treatment approaches may serve as a promising alternative to currently available treatments.
PMID: 28699818
ISSN: 1360-0567
CID: 2646532

Adequacy of medical treatment among older persons with schizophrenia

Vahia, Ipsit V; Diwan, Shilpa; Bankole, Azziza O; Kehn, Michelle; Nurhussein, Mohammed; Ramirez, Paul; Cohen, Carl I
OBJECTIVE: This study used Krause's model of illness behavior in later life to examine factors associated with adequacy of medical treatment in a racially diverse sample of older patients (age 55 and over) with schizophrenia. METHODS: In a cross-sectional community study, 119 persons were identified from a sample of 198 persons with schizophrenia age 55 or older who developed the disorder before age 45; for comparison, 57 persons were identified from a group of 113 without the disorder. The groups were compared for treatment of one or more of four common medical disorders. Thirteen independent variables were inserted into Krause's model for the comparisons. A dependent variable was created to indicate whether persons received medication treatment for all of their medical disorders (high-treatment group). RESULTS: Significant differences were found between the schizophrenia and control groups in the proportion receiving treatment for the four physical conditions (.61 versus .83, respectively, p=.004). By logistic regression, four of 13 variables for the schizophrenia group were significantly associated (p<.01) with being in the high-treatment group: absence of depression, lower frequency of medical visits, fewer positive symptoms, and more negative symptoms. CONCLUSIONS: Although older patients with schizophrenia and their age peers had similar levels of physical disorders and rates of health visits, the former received less adequate treatment. More aggressive management of comorbid depression and positive symptoms of schizophrenia may help in improving the health of this population
PMID: 18678681
ISSN: 1557-9700
CID: 123550

Focus on geriatric psychiatry: schizophrenia in later life: clinical symptoms and social well-being

Cohen, Carl I; Vahia, Ipsit; Reyes, Pia; Diwan, Shilpa; Bankole, Azziza O; Palekar, Nikhil; Kehn, Michelle; Ramirez, Paul
The number of persons aged 55 and older with a diagnosis of schizophrenia is projected to double over the next 20 years. A tripartite classification system of early-onset schizophrenia, late-onset schizophrenia, and very-late-onset schizophrenia-like psychosis has been proposed. This column reviews recent findings on the outcome and associated features of clinical symptom and social well-being categories for older adults with early-onset schizophrenia
PMID: 18308900
ISSN: 1075-2730
CID: 123553

Factors affecting quality of life in a multiracial sample of older persons with schizophrenia

Bankole, Azziza O; Cohen, Carl I; Vahia, Ipsit; Diwan, Shilpa; Kehn, Michelle; Ramirez, Paul M
OBJECTIVE: There have been few studies of quality of life (QOL) among older persons with schizophrenia. The authors used an adaptation of Lehman's QOL model to examine factors that impact QOL in a multiracial urban sample of older persons with schizophrenia. METHODS: The schizophrenia group consisted of 198 community-dwelling persons aged 55 years and older who developed schizophrenia before age 45 years. A community comparison group (N = 113) was recruited using randomly selected block-groups. The QOL model consisted of four variable sets (demographic, objective, clinical, and subjective) comprising 19 independent variables. The dependent variable was the Quality of Life Index (QLI). RESULTS: The schizophrenia group had a significantly lower QLI score than the comparison group (21.7 versus 24.2; t = -5.36, df = 362, p = 0.001). Within the schizophrenia group, in bivariate analyses, 11 of 19 variables were significantly related to QLI. In regression analysis, six variables were significantly associated with the QLI: fewer depressive symptoms, more cognitive deficits, fewer acute life stressors, fewer medication side effects, lower financial strain, and better self-rated health. The model explained 55% of the variance in QLI, with the demographic, objective, psychiatric illness, and subjective variable sets accounting for 6%, 35%, 9%, and 5% of the variance, respectively. With the exception of the demographic set, each of the variable sets added significant variance. CONCLUSION: Our data confirmed earlier reports that older persons with schizophrenia have lower self-reported quality of life than their age-matched peers. Our findings suggest that the factors impacting on QOL are potentially ameliorable and therefore provide an opportunity to enhance the well-being of this population
PMID: 18056820
ISSN: 1064-7481
CID: 123554

Depression in older adults with schizophrenia spectrum disorders: prevalence and associated factors

Diwan, Shilpa; Cohen, Carl I; Bankole, Azziza O; Vahia, Ipsit; Kehn, Michelle; Ramirez, Paul M
RATIONALE: Although depression is common in older adults with schizophrenia, it has not been well studied. The authors examine those factors that are related to depression in a multiracial urban sample of older persons with schizophrenia. METHODS: The schizophrenia group consisted of 198 persons aged 55 or older who lived in the community and developed schizophrenia before age 45. Persons with substantial cognitive impairment were excluded from the study. A community comparison group (N = 113) was recruited using randomly selected census tract data. The authors adapted George's Social Antecedent Model of Depression, which consists of six categories comprising 16 independent variables, and used a dichotomous dependent variable based on a Center for Epidemiologic Studies Depression Scale cutoff score of > or = 16. RESULTS: The schizophrenia group had significantly more persons with clinical depression than the community comparison group (32% versus 11%, respectively; chi(2) = 28.23, df = 1, p = 0.001). Bivariate analysis revealed that eight of the 16 variables were significantly related to clinical depression in the schizophrenia group. In logistic regression, six variables retained significance: physical illness (odds ratio [OR] = 1.60, 95% confidence interval [CI], 1.17-2.18), quality of life (OR = 0.84, 95% CI, 0.76-0.93), presence of positive symptoms (OR = 1.12, 95% CI, 1.02-1.21), proportion of confidants (OR = 0.03, 95% CI, 0.01-0.39), copes by using medications (OR = 2.12, 95% CI, 1.08-4.13), and copes with conflicts by keeping calm (OR = 1.34, 95% CI, 1.03-1.74). CONCLUSION: Consistent with earlier studies of schizophrenia in older persons, the authors found physical health, positive symptoms, and several nonclinical variables to be associated with depression. Potential points for intervention include strengthening social supports, improving physical well-being, more aggressive treatment of positive symptoms, and increasing the recognition and treatment of depression
PMID: 18056817
ISSN: 1064-7481
CID: 123555

Assessing quality of life in older persons with schizophrenia

Cohen, Carl I; Ramirez, Paul M; Kehn, Michelle; Magai, Carol; Eimicke, Joseph; Brenner, Ronald
OBJECTIVE: There have been few studies of quality of life (QOL) indicators in older schizophrenic persons, and these studies have used narrow measures of QOL. The authors sought to demonstrate that self-appraisals of QOL are useful and valid in older schizophrenic persons. A second aim was to provide provisional support for a model of QOL in this population. METHODS: The sample was 99 community-dwelling schizophrenic persons age 55+ and a community-comparison group (N=84). Using the Quality of Life Index (QLI), they compared the variable sets of their model (Objective, Subjective, and Psychiatric domains) for the schizophrenic and the community samples to determine whether the explained variance in the QLI was equivalent between groups for each of the three variable sets. To assess the model of QOL, for the entire sample, the global scale score of the QLI was regressed on three predictor variable sets, the three demographic covariates, and group membership. RESULTS: All of the group differences were considered 'small effect sizes.' There were no significant differences between groups in the individual-variable regression coefficients. For the entire sample, when the QLI was regressed on the three predictor variable sets simultaneously, the model explained 61% of the variance in the QLI, and group membership was not significant. CONCLUSIONS: The analyses demonstrated the reliability and validity of the QLI in older schizophrenic persons and supported its validity by producing results comparable to general-community residents. The overall model was highly significant and should serve as basis for future studies of QOL
PMID: 14609806
ISSN: 1064-7481
CID: 123566