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The EnTRy Program: Expanding Coordinated Specialty Care Beyond Early Psychosis
Fried, Jamie; McQuistion, Hunter L; Marrelli, Jon; Hampton, Melvin C; Wu, Lingwei; LeGeros, Alessandra; Lanina, Olga; Frankle, W Gordon
This study aims to evaluate the quality and potential clinical benefits of a novel program, called the Enhanced Treatment and Recovery (EnTRy) Program, which provides Coordinated Specialty Care (CSC) without limits on diagnosis, age, or treatment time to individuals with serious mental illnesses (SMI). To assess recovery of participants, we compared the baseline Substance Abuse and Mental Health Services Administration (SAMSHA) National Outcome Measures (NOMs) in patients enrolled in EnTRy to that at 6 months and 12 months. To explore whether EnTRy provided benefits over standard treatment, we compared the time engaged in treatment for the EnTRy cohort with that of a historic sample from the same clinical site. Participants were significantly less likely to have a psychiatric hospitalization in the past 30 days during follow-up assessment at 6 months (19% at baseline, 1% at 6 months, (χ2 (1, N = 1006) = 91, p<0.0001) and 12 months (16% at baseline, 1% at 12 months, χ2 (1, N = 486) = 37.633, p<0.0001). Participants were similarly less likely to have psychiatric emergency service encounters in the past 30 days at 6 months (18% at baseline, 1% at 6 months, χ2 (1, N = 1004) = 86.808, p < 0.0001) and at 12 months (16% at baseline, 2% at 12 months, χ2(1, N = 486) = 32.387, p= 0.0001). Patients enrolled in the EnTRy program remained engaged with care for significantly longer than a historical sample (p< 0.0001 by Mantel-Cox logrank) with a logrank hazard ratio of 2.0 (CI 1.65- 2.43). Age and diagnosis-unlimited CSC may be particularly effective for individuals with SMI who recently received hospital level care and may help maintain gains in individuals who have aged out of programs dedicated to first episode psychiatric illness.
PMID: 40622668
ISSN: 1573-2789
CID: 5890432
Improved Access to Behavioral Health Care for Patients in a Large New York City Behavioral Health Clinic by the Transition to Telemedicine
Reliford, Aaron; Zhang, Emily; Liu, Anni; Lanina, Olga; Williams, Sharifa Z; Sanichar, Navin; Khan, Shabana; Dapkins, Isaac; Frankle, William Gordon
OBJECTIVE/UNASSIGNED:To examine the transition to telemental health within the behavioral health program of a large federally qualified health center, The Family Health Centers at NYU Langone, in the 3 months following the onset of the COVID-19 pandemic-specifically impacts on show rates and access to care. METHODS/UNASSIGNED:Demographic and clinical information for all scheduled visits was collected for two time periods: the telemental health period, March 16, 2020-July 16, 2020 (46,878 visits, 5,183 patients), and a comparison period, March 15, 2019-July 16, 2019 (47,335 visits, 5,190 patients). Data collected included modality, appointments scheduled/completed/cancelled/no-showed, age, gender, race, language, and diagnosis. Generalized estimating equations with a compound symmetry correlation structure and logit link were used for analysis. RESULTS/UNASSIGNED:= 0.01), which was eliminated by implementation of telemental health. CONCLUSIONS/UNASSIGNED:This study supports the use telemental health to increase access for all patients, including those from under-represented, lower socioeconomic status backgrounds.
PMCID:12040568
PMID: 40308563
ISSN: 2692-4366
CID: 5834012
Patient and Clinician Satisfaction with the Early Implementation of Telemental Health Services in an Urban Behavioral Health Clinic During the COVID-19 Pandemic
Reliford, Aaron; Zhang, Emily; Lanina, Olga; Williams, Sharifa Z; Sanichar, Navin; Khan, Shabana; Dapkins, Isaac; Frankle, W Gordon
PMID: 36912813
ISSN: 1556-3669
CID: 5449312
Prevalence of Childhood Trauma in a Community-Based Mental Health Clinic
Sucich, James; Breitbart, Vicki; Williams, Sharifa; Sanichar, Navin; Candelaria-Arce, Erika; Frankle, W Gordon; Davison-Duffy, Sarah
A large number of individuals in the US have experienced childhood trauma. However, little is known about the prevalence of trauma in a diverse patient population entering treatment in a community mental health center. To assess early trauma in this population, the Adverse Childhood Experience (ACEs) questionnaire was administered to 856 participants over a nine-month period. 40% reported four or more ACEs. Among high scorers, emotional abuse, physical abuse and emotional neglect were the most prevalent ACE experiences. High mean ACE sum scores were observed among patients with PTSD, depression, impulse disorder and substance use disorder. Having a higher ACE sum score was associated with a greater number of co-occurring psychiatric disorders. Characterizing ACEs by patient sociodemographic attributes and psychiatric diagnoses extracted from the electronic medical records (EMR) can benefit therapeutic interventions. These findings indicate a need for creating more trauma-informed settings with knowledgeable, trained staff.
PMID: 36752932
ISSN: 1573-2789
CID: 5420862
Prefrontal and Striatal Dopamine Release Are Inversely Correlated in Schizophrenia
Frankle, W Gordon; Himes, Michael; Mason, N Scott; Mathis, Chester A; Narendran, Rajesh
BACKGROUND:The dopamine (DA) hypothesis postulates hyperactivity of subcortical DA transmission and hypoactivity of cortical DA in schizophrenia (SCH). Positron emission tomography provides the ability to assess this hypothesis in humans. However, no studies have examined the relationship between cortical DA and striatal DA in this illness. METHODS:C]NPA was also measured in these subjects. RESULTS:in the dorsal caudate (r = -0.71, p = .005). CONCLUSIONS:Subjects with SCH demonstrated deficits of DA release in cortical brain regions relative to HC subjects. Examining both cortical and striatal DA release in the same subjects demonstrated an inverse relationship between cortical DA release and striatal DA release in SCH not present in HC subjects, providing support for the current DA hypothesis of SCH.
PMID: 35791965
ISSN: 1873-2402
CID: 5280342
Suspected Recurrence of Symptomatic COVID-19: Management During Inpatient Psychiatric Treatment [Case Report]
Zhang, Emily; Lequesne, Elizabeth; Rohs, Anne; Frankle, W Gordon
The widespread prevalence of coronavirus disease 2019 (COVID-19) means that inpatient psychiatric units will necessarily manage patients who have COVID-19 that is comorbid with acute psychiatric symptoms. We report a case of recurrence of respiratory symptoms and positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) reverse transcription-polymerase chain reaction (RT-PCR) testing in a patient on an inpatient psychiatric unit occurring 42 days after the initial positive SARS-CoV-2 RT-PCR test, 38 days after initial symptom resolution, and 30 days after the first of 3 negative SARS-CoV-2 RT-PCR tests. Over the course of the admission, the patient was safely initiated on clozapine. Recent literature on COVID-19's potential recurrence and neuropsychiatric effects is reviewed and implications for the management of COVID-19 on inpatient psychiatric units are discussed. In the era of COVID-19 and our still-developing understanding of this illness, psychiatrists' role as advocates and collaborators in our patients' physical health care has become even more critical.
PMID: 33656821
ISSN: 1538-1145
CID: 5221082
Imaging Cortical Dopamine Transmission in Cocaine Dependence: A [11C]FLB 457-Amphetamine Positron Emission Tomography Study
Narendran, Rajesh; Mason, Neale Scott; Himes, Michael L; Frankle, W Gordon
BACKGROUND:receptors and dopamine release in CDSs. METHODS:after amphetamine. RESULTS:receptors and less dopamine release in CDSs were not associated with performance on working memory and attention tasks. CONCLUSIONS:transmission involve the cortex in cocaine dependence. Further studies to understand the clinical relevance of these findings are warranted.
PMID: 32507390
ISSN: 1873-2402
CID: 4481092
In-patient psychiatry management of COVID-19: rates of asymptomatic infection and on-unit transmission
Zhang, Emily; LeQuesne, Elizabeth; Fichtel, Katherine; Ginsberg, David; Frankle, W Gordon
BACKGROUND:New York City's first case of SARS-associated coronavirus (SARS-CoV-2) disease 2019 (COVID-19) was identified on 1 March 2020, prompting rapid restructuring of hospital-based services to accommodate the increasing numbers of medical admissions. Non-essential services were eliminated but in-patient treatment of psychiatric illnesses was necessarily maintained. AIMS/OBJECTIVE:To detail the response of the NYU Langone Health in-patient psychiatric services to the COVID-19 outbreak from 1 March to 1 May 2020. METHOD/METHODS:Process improvement/quality improvement study. RESULTS:Over this time period, our two in-patient psychiatric units (57 total beds) treated 238 patients, including COVID-19-positive and -negative individuals. Testing for COVID-19 was initially limited to symptomatic patients but expanded over the 62-day time frame. In total, 122 SARS-CoV-2 polymerase chain reaction (PCR) tests were performed in 98 patients. We observed an overall rate of COVID-19 infection of 15.6% in the patients who were tested, with an asymptomatic positive rate of 13.7%. Although phased roll-out of testing impaired the ability to fully track on-unit transmission of COVID-19, 3% of cases were clearly identified as results of on-unit transmission. CONCLUSIONS:Our experience indicates that, with appropriate precautions, patients in need of in-patient psychiatric admission who have COVID-19 can be safely managed. We provide suggested guidelines for COVID-19 management on in-patient psychiatric units which incorporate our own experiences as well as published recommendations.
PMCID:7463133
PMID: 32867874
ISSN: 2056-4724
CID: 4582932
Distinguishing Schizophrenia Subtypes: Can Dopamine Imaging Improve the Signal-to-Noise Ratio?
Frankle, W Gordon; Narendran, Rajesh
PMID: 31908286
ISSN: 1873-2402
CID: 4257142
Failure to detect amphetamine-induced dopamine release in the cortex with [11 C]FLB 457 positron emission tomography (PET): Methodological considerations
Gertler, Joshua; Tollefson, Savannah; Jordan, Rehima; Himes, Michael; Mason, N Scott; Frankle, W Gordon; Narendran, Rajesh
Studies in nonhuman primates and humans have demonstrated that amphetamine-induced dopamine release in the cortex can be measured with [11 C]FLB 457 and PET imaging. This technique has been successfully used in recent clinical studies to show decreased dopamine transmission in the prefrontal cortex in schizophrenia and alcohol dependence. Here, we present data from a cohort of twelve healthy controls in whom an oral amphetamine challenge (0.5 mg kg-1 ) did not lead to a significant reduction in [11 C]FLB 457 BPND (i.e., binding potential relative to non-displaceable uptake). Two factors that likely contributed to the inability to displace [11 C]FLB 457 BPND in this cohort relative to successful cohorts are: (1) the acquisition of the baseline and post-amphetamine scans on different days as opposed to the same day and (2) the initiation of the post-amphetamine [11 C]FLB 457 scan at ∼ 5 hours as opposed to ∼ 3 hours following oral amphetamine. Furthermore, we show [11 C]FLB 457 reproducibility data from a legacy dataset to support greater variability in cortical BPND when the test and re-test scans are acquired on different days as compared to the same day. These results highlight the methodological challenges that continue to plague the field with respect to imaging dopamine release in the cortex.
PMID: 29876970
ISSN: 1098-2396
CID: 3144522