Faculty Bibliography

Background: International data indicates that up to 20% of the world's children and adolescents have at least one mental health disorder. In the United States, nearly 50% of teenagers meet DSM criteria for a psychiatric disorder, and over 25% suffer from a "severe disorder." Mental health and substance use disorders remain two of the greatest contributors to the global disease burden. Typically, mental health professionals are not trained for pre-vention; however, over the past 50 years, the field of psychiatry has identified many practices that prevent and limit the severity of psychiatric disorders.
Objective(s): In this overview, we first address the great degree of cognitive, emotional, and behavioral suffering that children and adolescents face world-wide. We then describe how a health promotion/disease prevention model differs from typical mental health care. Finally, we describe a series of interventions at the individual, community, and societal levels that can be utilized to prevent and lessen the burden of mental illness.
Conclusion(s): Given our enhanced understanding of the prevalence of mental illness, the degree to which it interferes with healthy functioning, and the enormous global burden it causes, now is the time to engage psychiatrists and psychologists in health promotion and disease prevention. The field of psychiatry should begin to focus on designing and implementing mental health promotion and disease prevention programs, akin to those described here, to combat the onset, development, and progression of mental illness.
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Over the past decade, our field has observed rapidly rising rates of mental illness in children and adolescents. The numbers are sobering. Nearly 50% of teens 13 to 18 years of age meet DSM criteria for at least 1 disorder and 27.6% meet criteria for a "severe disorder."¹ Adverse childhood experiences affect more than 50% of children and predispose these individuals to not only academic and behavioral problems throughout their youth, but also future physical disability, such as obesity, hypertension, and diabetes, as adults.² By 14 years of age, accidents, suicide, and homicide assert themselves as the leading causes of death among our youth, accounting for more than 85% of the mortality among teens and young adults and holding fast to that ranking until 35 years of age.³ Most addictive behavior starts in adolescence, accounting for the 3 greatest causes of preventable death-smoking, obesity, and alcohol abuse-that take the lives of approximately 1 million adults in the United States annually.⁴ In addition, if there were ever a statistic to be held on the tip of every psychiatrist's tongue, it would be that 50% of all mental illnesses begin by 14 years of age and 75% begin by 24 years.⁵.

This review summarizes the available literature on the intersection of adolescent cannabis use and sleep disturbances, along with interventions for adolescent cannabis users who suffer sleep impairments. Adolescents are susceptible to various sleep disorders, which are often exacerbated by the use of substances such as cannabis. The relationship between cannabis and sleep is bidirectional. Interventions to improve sleep impairments among adolescent cannabis users to date have demonstrated limited efficacy, although few studies indicating the benefits of behavioral interventions-such as Cognitive Behavior Therapy for Insomnia or Mindfulness Based Stress Reduction-appear promising in the treatment of sleep disorders, which are present for users of cannabis. Further research is necessary to elucidate the precise mechanisms by which cannabis use coexists with sleep impairments, along with effective interventions for those users who suffer sleep difficulties.

OBJECTIVE: To examine the impact of a sleep course on sleep-related behaviors, mood, and anxiety in college students. PARTICIPANTS: Participants were 145 students enrolled in either the sleep course (n = 70) or a psychology course (n = 75); data were collected in September 2014, November 2014, and February 2015. METHODS: Sleep characteristics and symptoms of depression and anxiety were assessed using validated questionnaires and sleep logs. Linear, logistic and proportional odds regression models were used to test course effects. RESULTS: In November, sleep course students reported significant differences in sleep hygiene (SHI; p<0.001), perceived sleep latency (PSQI; p<0.05), and circadian sleep phase (MEQ; p<0.05), compared to controls. In February, the sleep course students maintained most of the aforementioned gains and reported fewer symptoms of depression (CES-D; p = 0.05) and anxiety (BAI; p<0.05). CONCLUSIONS: These positive preliminary results indicate that focused education has potential to improve sleep among college students.

OBJECTIVE: The Child and Adolescent Mental Health Studies (CAMS) program is housed in a Liberal Arts undergraduate college of a large research university. Psychiatrists, clinical psychologists, and social workers at the university's medical center teach the courses. The purpose of this study is to evaluate the extent to which CAMS encourages graduates of the program to pursue a career in child and adolescent mental health (CAMH). METHODS: In 2015-2016, graduates of the CAMS program were invited to participate in a mixed methods study. In addition to statistical analyses, qualitative thematic analyses were performed to interpret free-text responses. RESULTS: Forty-five percent (314/702) of invited graduates completed the online survey. Interviews were conducted with 11% (34/314) of participants by study staff over the phone. Quantitative results suggested that 81% (149/185) of participants enrolled in educational programs after graduation due to an interest in CAMH. A significantly higher proportion of the total sample (t = 3.661, p < .001) reported that they changed their career goals while undergraduate students compared to those who did so after graduation. Results of qualitative interviews with 34 participants uncovered five key themes unique to CAMS that may explain the program's influence on graduates' career choices and career development: practitioners-as-instructors, instructor mentorship, novel course content, experiential learning opportunities, and career training and skills. CONCLUSIONS: Quantitative and qualitative results indicated that teaching college undergraduate students about CAMH encourages them to set career goals within the field. These findings suggest the utility of implementing similar programs at other undergraduate colleges.

Objectives: It is estimated that 25 percent of children and adolescents suffer from a sleep problem at some point before entering adulthood. Research shows that over 95 percent of child and adolescent psychiatrists prescribe at least one sleep medication monthly, yet numerous studies show that cognitive behavioral therapy for insomnia (CBT-I) works just as well as medication, is extremely cost effective, and has longer-lasting benefits. Unfortunately, however, most child and adolescent psychiatrists are not trained in CBT-I. This workshop will teach participants when and for whom CBT-I is an appropriate form of treatment intervention; the six primary components of CBT-I; and how to design CBT-I treatment plans for a variety of child, adolescent, and young adult patients diagnosed with insomnia. Methods: This workshop will be based upon a comprehensive literature review and the clinical expertise of the instructors. In advance of the workshop, registered participants will be sent a variety of standardized rating scales so that they may begin to assess their own sleep and that of select patients in preparation for learning CBT-I in the workshop. Results: CBT-I consists of an easily taught series of evidence-based skills that are portable and time and cost effective. The goals of CBT-I are to alter the factors that perpetuate insomnia and include: 1) behavioral training in stimulus control, sleep restriction, and sleep hygiene; 2) cognitive training in managing dysfunctional thoughts and maladaptive behaviors related to sleep, such as unrealistic expectations and rumination over the consequences of insomnia; and 3) physiological factors, such as hyperarousal and somatic and mental tension. Conclusions: This workshop will provide instruction in the use of CBT-I for children, adolescents, and adults, and practitioners will be guided through a series of applied exercises to enhance and practice their therapeutic skills

Objectives: CBT for insomnia (CBT-I) in adolescents and young adults is a brief intervention that includes both behavioral and psychological procedures. At the end of this presentation, participants will be able to 1) describe when and for whom CBT-I is an appropriate form of treatment intervention; 2) provide practical guidelines for conducting CBT-I, including stimulus control, sleep restriction, cognitive restructuring, and sleep hygiene; and 3) practice arousal reduction and biofeedback for the treatment of insomnia. Methods: This session will provide a comprehensive literature review, lecture, and discussion. Results: Medications for the treatment of insomnia are sometimes necessary but most often are insufficient to fully address the problem. CBT-I, by contrast, represents an easily taught series of skills that are portable and time and cost effective. The utility of CBT-I has been repeatedly demonstrated for adults and adolescents. The goal of CBT-I is to alter the factors that perpetuate insomnia and include the following: 1) behavioral factors, such as poor sleep habits, and irregular sleep schedules; 2) psychological factors, such as unrealistic expectations, and rumination over the consequences of insomnia; and 3) physiological factors, such as hyperarousal and somatic and mental tension. CBT-I is indicated for primary and secondary insomnia in adolescents and adults and can be delivered on a one on one basis; in groups; and via telephone, telemedicine, and video. This presentation will describe the use of CBT-I and necessary adjustments when applying these techniques with children. Participants will practice arousal reduction and biofeedback techniques. Conclusions: The use of cognitive-behavior therapy for insomnia will be described, and participants will engage in a series of applied exercises to enhance their therapeutic skills