Faculty Bibliography

Running marathons is an increasingly popular activity with an ever-increasing number of events and participants. Many participants declare that they pursue a variety of goals by running, namely, the maintenance of good health, the development of strength and improvement of fitness, the management of emotions, and the achievement of resilience and psychological wellbeing (PWB). The research has examined marathon running, like many other sports, and has studied various factors that reduce athletic performance, such as the experience of anxiety, and that enhance such performance, such as an increase in general wellbeing. This article reports the results of a study on the experience of competitive anxiety among 238 male marathon runners who participated in Seville's (Spain) 26th Marathon race on February 23, 2020, and investigates the relationship between anxiety and key dimensions of wellbeing as measured by the Spanish-adapted 20-item PWB Scale. We hypothesized that participating athletes who rated high on the dimensions of PWB would experience lower levels of competitive anxiety with respect to this race. We also proposed that PWB would function as a mediating factor with respect to the experience of anxiety. The results show, as hypothesized, that marathon running enhances wellbeing and reduces anxiety. The data showed significant negative correlations between four of five wellbeing dimensions and the three types of anxiety measured, namely, somatic anxiety, worry, and concentration-impairing anxiety. Other findings supported our hypothesis that wellbeing, as measured, functions as a mediating factor for the moderation of competitive anxiety. Generalization of these findings is limited by the fact that the low number of female participants recruited did not permit valid statistical analyses in this respect. It is known that both anxiety and wellbeing are subjects to variation by gender. The future inclusion of male and female subjects in equivalent studies will undoubtedly add valuable information concerning the dynamics of anxiety and wellbeing. The implications of these findings and the limitations of the study will be discussed.

Background: The Marathon runners must have the proper technical preparation to reach excellence and to achieve adequate psychological preparation for the race. Against this background, the current study aims to describe the implementation results of a cognitive-behavioral intervention based on psychological skills training for marathon runners. Methods: Fourteen amateur male marathoners with an average age of 30 (SD = 5.75) were trained with various emotional and cognitive control techniques to enhance their performance in competition. Various psychological variables, related to the subjects level of perceived stress, and to qualitative characteristics of their thoughts were measured before and after the target marathon race. Results were analyzed through non-parametric tests for two related samples. The Cohen's d effect size for single-group pretest-posttest repeated measures were also performed. Results: Statistical analysis reveals that, controlling for age and running experience, the intervention decreased significantly the level of perceived stress and the occurrence of negative thoughts before the race, during, and after the race. Conclusion: Training in cognitive control and relaxation techniques, as part of the psychological skills training could determine the quality of performance of marathon runners.

The Coronavirus Covid 19 (SARS-CoV-2) pandemic has produced terrible effects in the world economy and is shaking social and political stability around the world. The world of sport has obviously been severely affected by the pandemic, as authorities progressively canceled all level of competitions, including the 2020 Olympic Games in Tokyo. In Spain, the initial government-lockdown closed the Sports High-performance Centers, and many other sports facilities. In order to support athlete's health and performance at crises like these, an online questionnaire named RECOVID-19, was designed to assess how athletes were living their lives during such periods of home confinement. The main purpose of the questionnaire was to assess the impact of prolongued confinement on athlete's psychological, emotional, and behavioral performance. One thousand, two hundred forty-eight athletes participated in the survey. They had the fllowing characteristics: (Mean age = 22.31 ± 11.49, Female: 53%), who compete at National (N: 1017, Mean age = 21.58 ± 11.42, Female: 52%) and International level (N: 231, Mean age = 25.56 ± 11.22, Female: 57%). Results showed that during the confinement period, those athletes who lacked motivation reported a higher level of stressful thoughts, more behavioral problems, and greater emotional upheaval (anger, fatigue, tension, and depression). However, those athletes who accepted confinement measures as necessary, and were in favor of respecting the rules of social isolation, fostered positive emotional states such as feelings of friendship. In addition, the availability of some sport equipment together with the ability to continue some training, were (1) protective factors against emotional stress, lack of motivation and behavioral problems; and (2) they were associated with greater respect for, and adherence to, confinement rules. Gender differences, tested by multigroup analysis, revealed that coping activities were more often associated to negative emotional states among women, whereas the ongoing availability of training information and future conditions were equally protective factors for both genders. This study also showed that receiving coaching, support and completing frequent training routines seem to be valuable tools to prevent or reduce some of the harmful effects of isolation on athlete's emotional well-being. The conclusions derived from this research would possibly help sport authorities to design supporting policies and plans to support athletes and trainers in future disruptive health crises.

Successful outcomes after microsurgical reconstruction of the lower extremity include timely return to ambulation. Some combination of physical examination, ViOptix tissue oxygen saturation monitoring, and the implantable venous Doppler have shown promise in increasing sensitivity of current flap monitoring. We have incorporated this system into our postoperative monitoring protocol in an effort to initiate earlier dependency protocols. A prospective analysis of 36 anterolateral thigh free flap and radial forearm flaps for lower extremity reconstruction was performed. Indications for reconstruction were acute and chronic wounds, as well as oncologic resection. Twenty-three patients were able to ambulate and 3 were able to dangle their leg on the first postoperative day. One flap showed early mottling that improved immediately after elevation. After reelevation and return to baseline, the dependency protocol was successfully implemented on postoperative day 3. All flaps went on to successful healing. Physical examination, implantable venous Doppler, and ViOptix can be used reliably as an adjunct to increase the sensitivity of detecting poorly performing flaps during the postoperative progression of dependency.

BACKGROUND: Studies have reported that females have widespread increases in regional cerebral blood flow, but the studies were relatively small and inconsistent. OBJECTIVE: Here we analyzed a healthy and very large psychiatric population to determine the effect of gender, using single photon emission computed tomography (SPECT). METHODS: Whole brain and region of interest (ROI) gender differences were analyzed in a total of 46,034 SPECT scans at baseline and concentration. The sample included 119 healthy subjects and 26,683 patients; a subset of 11,587 patients had complete diagnostic information. A total of 128 regions were analyzed according to the AAL Atlas, using ROI Extract and SPSS statistical software programs, controlling for age, diagnoses, and correcting for multiple comparisons. RESULTS: Compared to males, healthy females showed significant whole brain (p < 0.01) and ROI increases in 65 baseline and 48 concentration regions (p < 0.01 corrected). Healthy males showed non-significant increases in 9 and 22 regions, respectively. In the clinical group, there were widespread significant increases in females, especially in the prefrontal and limbic regions, and specific increases in males in the inferior occipital lobes, inferior temporal lobes, and lobule 7 and Crus 2 of the cerebellum. These findings were replicated in the subset of 11,587 patients with the effect of diagnoses removed. CONCLUSIONS: Our results demonstrated significant gender differences in a healthy and clinical population. Understanding these differences is crucial in evaluating functional neuroimaging and may be useful in understanding the epidemiological gender differences among psychiatric disorders.

BACKGROUND/OBJECTIVE: Almost no literature compares current approaches to teaching cultural issues across U.S. psychiatry residency programs; the authors addressed this comparison. METHODS: The authors administered semistructured interviews of 20 instructors with substantial experience in the teaching of cultural issues in U.S. psychiatry residency programs, regarding the content, teaching techniques, institutional context, and evaluation of their curricula over time. RESULTS: Approaches varied according to the local populations served and the background of the instructors, all of whom were either cross-trained in social sciences and humanities or were themselves ethnic, racial, or sexual minorities. Common themes emerged, including the use of experiential approaches, the lack of integration of cultural issues into clinical supervision or courses on other topics, and the absence of formal course evaluation. DISCUSSION: Findings indicate a need for integration of cultural concepts into a variety of settings throughout residency, for development of faculty who are cross-trained in social sciences and humanities, and for curriculum-evaluation strategies.

Introduction: Psychic Representation focused Psychotherapy (PRFP) is a new time limited dynamic psychotherapy for the treatment of Borderline Personality Disorder. It is a psychodynamic technique based on brief psychoanalytic psychotherapy principles. It is manualized and designed to be applied in the framework of public health care services. A randomized and controlled study with a sample of 53 patients was conducted to assess PRFP efficacy. This work presents the results for the first 44 trial completers at termination of treatment. Methods: Both groups, the experimental (n= 18) and control group (n= 26), received treatment as usual. The experimental group received an additional 20 (PRFP) sessions, conducted by four therapists with homogenous characteristics specifically trained in this technique. The main outcome variables measures were: Severity global index of SCL-90-R, Barrat Impulsivity Scale scores and Social Adaptation (SASS score). Baseline and final condition at termination was compared. Conclusions: Preliminary results showed significantly better outcomes for the experimental group in all the main variables measured and in most of the secondary ones. PRFP may represent an important contribution for the treatment of BPD patients. Follow-up assessment at 6 and 12 months is planned.

In response to the expanding public behavioral health care system, a network of 15 public-community psychiatry fellowships has developed over the past six years. The fellowship directors meet yearly to sustain and develop fellowships to recruit and retain psychiatrists in the public sector. This column describes five types of public-academic collaborations on which the fellowships are based. The collaborations focus on structural and fiscal arrangements; recruitment and retention; program evaluation, program research, and policy; primary care integration; and career development. These collaborations serve to train psychiatrists who will play a key role in the rapidly evolving health care system. (Psychiatric Services 63:851-854, 2012; doi: 10.1176/appi.ps.201200299).

Our objective was to ascertain in a prospective case series how often brain single photon emission computed tomography (SPECT) neuroimaging adds relevant information for diagnosis and/or treatment beyond current standard assessment tools in complex psychiatric cases. Charts of 109 consecutively evaluated outpatients from four psychiatrics clinics that routinely utilize SPECT imaging for complex cases were analyzed in two stages. In stage one, psychiatrists reviewed detailed clinical histories, mental status exams, and the structured clinical interview for DSM-IV, but not the results of SPECT studies, assigned a diagnosis based on DSM-IV criteria, and then developed a comprehensive treatment plan. In stage two, evaluators were given access to the SPECT studies for each patient. The addition of SPECT modified the diagnosis or treatment plan in 78.9% (n=86; rated level 2 or 3 change) of cases. The most clinically significant changes were undetected brain trauma (22.9%), toxicity patterns (22.9%) and the need for a structural imaging study (9.2%). Specific functional abnormalities were seen as follows that potentially could impact treatment: temporal lobe dysfunction (66.1%) and prefrontal hypoperfusion (47.7%). SPECT has the potential to add clinically meaningful information to enhance patient care beyond current assessment tools in complex or treatment resistant cases.