Faculty Bibliography

Throughout life, rats emit ultrasonic vocalizations (USV) when confronted with an aversive situation. However, the conditions classically used to elicit USV vary greatly with the animal's age (isolation from the dam in infancy, versus nociceptive stimulation in adults). The present study is the first to characterize USV responses to the same aversive event throughout development. Specifically, infant, juvenile and adult rats were presented with mild foot-shocks and their USV frequency, duration, and relationship with respiration and behavior were compared. In juvenile and adult rats, a single class of USV is observed with an age-dependent main frequency and duration (30 kHz/400 ms in juveniles, 22 kHz/900 ms in adults). In contrast, infant rat USV were split into two classes with specific relationships with respiration and behavior: 40 kHz/300 ms and 66 kHz/21 ms. Next, we questioned if these infant USV were also emitted in a more naturalistic context by exposing pups to interactions with the mother treating them roughly. This treatment enhanced 40-kHz USV while leaving 66-kHz USV unchanged suggesting that the use of USV goes far beyond a signal studied in terms of amount of emission, and can inform us about some aspects of the infant's affective state.

BACKGROUND: ParentCorps is a family-centered enhancement to pre-kindergarten programming in elementary schools and early education centers. When implemented in high-poverty, urban elementary schools serving primarily Black and Latino children, it has been found to yield benefits in childhood across domains of academic achievement, behavior problems, and obesity. However, its long-term cost-effectiveness is unknown. METHODS: We determined the cost-effectiveness of ParentCorps in high-poverty, urban schools using a Markov Model projecting the long-term impact of ParentCorps compared to standard pre-kindergarten programming. We measured costs and quality adjusted life years (QALYs) resulting from the development of three disease states (i.e., drug abuse, obesity, and diabetes); from the health sequelae of these disease states; from graduation from high school; from interaction with the judiciary system; and opportunity costs of unemployment with a lifetime time horizon. The model was built, and analyses were performed in 2015-2016. RESULTS: ParentCorps was estimated to save $4387 per individual and increase each individual's quality adjusted life expectancy by 0.27 QALYs. These benefits were primarily due to the impact of ParentCorps on childhood obesity and the subsequent predicted prevention of diabetes, and ParentCorps' impact on childhood behavior problems and the subsequent predicted prevention of interaction with the judiciary system and unemployment. Results were robust on sensitivity analyses, with ParentCorps remaining cost saving and health generating under nearly all assumptions, except when schools had very small pre-kindergarten programs. CONCLUSIONS: Effective family-centered interventions early in life such as ParentCorps that impact academic, behavioral and health outcomes among children attending high-poverty, urban schools have the potential to result in longer-term health benefits and substantial cost savings.

Purpose The African American church has long been recognized as a valuable partner for health interventions in the community. While an extensive literature exists documenting the potential efficacy of diabetes education programs in church settings, there has yet to be an effort to leverage spiritual beliefs and practices to promote diabetes self-management and shared decision making within a faith-based framework that is culturally tailored to the African American church. The purpose of this article is to describe the translation of a clinic-based diabetes education program into faith-based education curriculum tailored for use in the African American church. Conclusions Themes extracted from focus groups and input from a faith-based community partner provided a methodical and patient-informed foundation for culturally tailoring and piloting a diabetes self-management curriculum for the African American church setting. This study illustrates how spirituality can be incorporated into interventions to enhance health promotion and behavioral change among African Americans with diabetes. Participants in our study described how religious beliefs play an active role in many aspects of diabetes care, including self-management behaviors, coping strategies, and patient/provider communication. In addition, this intervention can serve as a model for the development of patient-centered health interventions.

Objectives: The goal of this session is to provide practicing clinicians with valuable advanced knowledge on the epidemiology, pathophysiology, and pharmacological and behavioral treatment of insomnia as commonly seen among children, adolescents, and young adults with psychiatric conditions Methods: This session will include a comprehensive literature review and case-based presentations. Results: Dr. Lewin will present on epidemiology of insomnia and neurobehavioral consequences of insufficient sleep. Dr. Johnson will focus on sleep requirements throughout development and evaluation of insomnia. Physiology of sleep states and circadian rhythm will be covered by Dr. Baroni. In his two presentations, Dr. Shatkin will provide practical guidelines on the use of sleep education and hygiene, in addition to an overview of cognitive behavioral therapy for insomnia with children, adolescents, and young adults. Dr. Owens will review a systematic approach to using medications for the treatment of pediatric insomnia. Finally, Dr. Ivanenko will address common challenges in the treatment of sleep problems in mental health settings. Conclusions: Learning how to address sleep disorders using behavioral and pharmacological treatments will provide clinicians with essential tools for their psychiatric practice

Objectives: This talk will review the clinical significance of symptoms of mood (emotional) dysregulation versus frank co-occurring mood disorders in adults with ADHD and examine evidence for the potential treatment of co-occurring mood disorders or symptoms of emotional dysregulation in adults with ADHD. Methods: Studies on co-occurring mood disorders and emotional dysregulation symptoms in adults with ADHD were surveyed and reviewed via PubMed search and cross-referencing from review articles/chapters. Results: Mood dysregulation has been shown to be a commonly occurring symptom in adults with ADHD and exists as a separate, unique factor compared with symptoms of inattention, hyperactivity/impulsivity, and executive dysfunction. The same factor analysis found that emotional dysregulation symptoms loaded highly on the combined subtype of ADHD or in cases that did not meet full ADHD criteria. Treatment studies have found that emotional dysregulation symptoms do generally respond to treatment with stimulants or with the nonstimulant, atomoxetine, but at approximately half the effect size of stimulants. Studies have shown high rates of mood disorders of bipolar disorder (10-15%), major depression (15-20%), and dysthymia (20%) in adults with ADHD. Furthermore, rates of ADHD are quite high in individuals with mood disorders. The available literature on treating ADHD and comorbid mood disorders is surprisingly scant. Bupropion has an extensive history of use as an antidepressant, and several studies have shown it to be an effective nonstimulant in ADHD, but studies have not systematically assessed its use when mood disorders or mood dysregulation co-occur with ADHD. A handful of studies have examined the addition of stimulant medications to patients with major depression treated with antidepressants. Conclusions: Clinicians should be aware of high rates of co-occurring mood disorders in adults with ADHD, and the reverse, as not identifying one of the comorbidities may result in incomplete treatment or negative outcomes. High rates of mood dysregulation symptoms have been reported in adults with ADHD, even though they are not part of the core ADHD symptoms in DSM-5

Objectives: Schools have long been recognized as major centers for provision of almost universally available health education and services. Seventy to 80 percent of children and adolescents who do receive mental healthcare do so in the school setting. School-based telepsychiatry is an underutilized modality to mitigate the limited access to mental health services for many youth, especially in rural communities. Methods: During the presentation, we will provide a review of the literature regarding use of school-based telepsychiatry. We will then review the design and implementation of the New York University (NYU) school-based telepsychiatry program in partnership with the New York State Office of Mental Health, highlighting key features. Results: We will report on the characteristics of the schools and patients participating in the NYU school-based telepsychiatry program. We will describe the experience of patients and trainees with school-based telepsychiatry, including impediments and successeswithassessment and treatment.Data will beprovided for school-based telepsychiatry services completed since the program was piloted. We will discuss demographics, diagnostic composition, and treatments conducted, as well as clinician and patient/family satisfaction with the modality. Conclusions: Schools are an ideal location for healthcare education and provision. Follow-up for mental health services in schools is much higher than in traditional community mental health facilities. School-based telepsychiatry is a modality that can be successfully implemented in underserved areas to significantly enhance the availability of needed mental health services for children and adolescents. Focus on education for psychiatric trainees in the modality and development of formal curricula is of outmost importance as the modality continues to gain increased utilization

BACKGROUND:Adults with bipolar disorder (BD) have higher rates of substance use disorders (SUDs) compared to the general population. SUD rates in young offspring/relatives of BD probands, as well as factors which drive those rates, are not as well-characterized. METHODS:We aimed to examine SUD prevalence among adolescent/young adult offspring and relatives of probands with and without BD. Data were collected from five sites in the US and Australia during 2006-2011. Youth offspring/relatives ("Relatives of BD probands;" n=267; mean age=16.8years; ±2.9S.D.), identified through a proband family member with DSM-IV BD (Type I or II), were compared to offspring/relatives of control probands ("relatives of control probands;" n=149; mean age=17.4years; ±2.9S.D.). Logistic regression with generalized estimating equations was used to compare the groups across a range of substance use and SUD variables. Odds ratios were calculated for lifetime prevalence of substance outcomes. RESULTS:Bivariate analyses showed DSM-IV SUDs were more prevalent among relatives of BD probands than among relatives of control probands (29% vs. 18%; p=0.01). Generalized estimating equation models showed BD mood and childhood-onset externalizing disorders in adolescent and young adult relatives to each significantly increase the odds (OR=2.80-3.17; p<0.02) for the development of several substance variables among all relatives, whereas the risk of SUDs in relatives was not increased when the relatives had no mood or externalizing disorders themselves. CONCLUSION:Relatives of BD probands with lifetime mood and externalizing disorders report more substance use/SUDs than relatives of control probands. In contrast, SUD outcomes in relatives of BD probands without mood or externalizing disorders were no different from control relatives without psychopathology. Early recognition and treatment of psychiatric disorders may lead to less substance use in this highly vulnerable population.

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.

PURPOSE: The purpose of this review was to synthesize current knowledge about anxiety among adolescent survivors of pediatric cancer and highlights areas for future research. METHODS: Systematic literature searches were conducted in five databases for articles published anytime before December 28, 2015. Manuscripts were reviewed by a team of six coders. Included manuscripts reported outcomes relevant to anxiety, worry, and post-traumatic stress in survivors of pediatric cancer (age at the time of study: 10-22 years) who were off treatment. RESULTS: Twenty-four articles met inclusion criteria. Included results were categorized into the following domains: post-traumatic stress, anxiety, cancer-related worry, and interventions. With the exception of post-traumatic stress, there was little research about anxiety in this population; however, studies generally indicated that adolescent survivors of pediatric cancer are at elevated risk for anxiety, post-traumatic stress symptoms, and cancer-related worry. CONCLUSIONS: This review provides preliminary evidence that anxiety is a relevant, but understudied, psychosocial outcome for adolescent survivors of pediatric cancer. More research is needed to better understand the presentation of anxiety in this population, its effect on survivors' quality of life, and possible areas for intervention.