Faculty Bibliography

BACKGROUND: The US Department of State estimates that there are between 4 and 27 million individuals worldwide in some form of modern slavery. Recent studies have demonstrated that 28% to 50% of trafficking victims in the United States encountered health care professionals while in captivity, but were not identified and recognized. This study aimed to determine whether an educational presentation increased emergency department (ED) providers' recognition of human trafficking (HT) victims and knowledge of resources to manage cases of HT. METHODS: The 20 largest San Francisco Bay Area EDs were randomized into intervention (10 EDs) or delayed intervention comparison groups (10 EDs) to receive a standardized educational presentation containing the following: background about HT, relevance of HT to health care, clinical signs in potential victims, and referral options for potential victims. Participants in the delayed intervention group completed a pretest in the period the immediate intervention group received the educational presentation, and all participants were assessed immediately before (pretest) and after (posttest) the intervention. The intervention effect was tested by comparing the pre-post change in the intervention group to the change in 2 pretests in the delayed intervention group adjusted for the effect of clustering within EDs. The 4 primary outcomes were importance of knowledge of HT to the participant's profession (5-point Likert scale), self-rated knowledge of HT (5-point Likert scale), knowledge of who to call for potential HT victims (yes/no), and suspecting that a patient was a victim of HT (yes/no). FINDINGS: There were 258 study participants from 14 EDs; 141 from 8 EDs in the intervention group and 117 from 7 EDs in the delayed intervention comparison group, of which 20 served as the delayed intervention comparison group. Participants in the intervention group reported greater increases in their level of knowledge about HT versus those in the delayed intervention comparison group (1.42 vs -0.15; adjusted difference = 1.57 [95% confidence interval, 1.02-2.12]; P < 0.001). Pretest ratings of the importance of knowledge about HT to the participant's profession were high in both groups and there was no intervention effect (0.31 vs 0.55; -0.24 [-0.90-0.42], P = 0.49). Knowing who to call for potential HT victims increased from 7.2% to 59% in the intervention group and was unchanged (15%) in the delayed intervention comparison group (61.4% [28.5%-94.4%]; P < 0.01). The proportion of participants who suspected their patient was a victim of HT increased from 17% to 38% in the intervention group and remained unchanged (10%) in the delayed intervention comparison group (20.9 [8.6%-33.1%]; P < 0.01). INTERPRETATION: A brief educational intervention increased ED provider knowledge and self-reported recognition of HT victims.

This article reviews the history of monoamine oxidase inhibitors (MAOIs) from their initial synthesis in the early 1900s until the present. The recognition of their potential psychiatric benefits came when the only available effective treatment for depressed patients was seizure therapy. The introduction of medications to treat depressive illness heralded an exciting new era of psychopharmacology; however, reports of paroxysmal hypertensive crises dampened enthusiasm. Dietary restrictions and drug interactions with MAOIs are now defined, but apprehension and a lack of familiarity cause infrequent prescribing of MAOIs despite their powerful effect across a wide range of psychiatric disorders. As demonstrated at Columbia University's Depression Evaluation Service, founded in 1977 by the late Frederic M. Quitkin, MD, MAOIs remain effective agents that should be considered for depressed or anxious patients who have not improved sufficiently following at least one prior treatment attempt with a different class of medication. The use of moclobemide and the selegiline transdermal system as primary treatments requires clarification.

A knowledgeable, experienced group of experts, willing to disagree, discuss the rationale and practice of monoamine oxidase inhibitor (MAOI) therapy. The goal is to provide a discussion pertinent to clinical practice. The moderator offered participation to researchers and clinicians highly experienced in MAOI therapy. Before the colloquy, all participants received a list of probable questions. Due to a lack of familiarity, physicians resist prescribing MAOI therapy-arguably the most effective treatment for mood and anxiety disorders, especially atypical depression. The dietary restrictions are humble compared to the risk of mood disorder. In any depression treatment algorithm, consider the early implementation of MAOI therapy.

Attention-deficit/hyperactivity disorder (ADHD) is a prevalent and chronic mental health condition that often results in substantial impairments throughout life. Although evidence-based pharmacological and psychosocial treatments exist for ADHD, effects of these treatments are acute, do not typically generalize into non-treated settings, rarely sustain over time, and insufficiently affect key areas of functional impairment (i.e., family, social, and academic functioning) and executive functioning. The limitations of current evidence-based treatments may be due to the inability of these treatments to address underlying neurocognitive deficits that are related to the symptoms of ADHD and associated areas of functional impairment. Although efforts have been made to directly target the underlying neurocognitive deficits of ADHD, extant neurocognitive interventions have shown limited efficacy, possibly due to misspecification of training targets and inadequate potency. We argue herein that despite these limitations, next-generation neurocognitive training programs that more precisely and potently target neurocognitive deficits may lead to optimal outcomes when used in combination with specific skill-based psychosocial treatments for ADHD. We discuss the rationale for such a combined treatment approach, prominent examples of this combined treatment approach for other mental health disorders, and potential combined treatment approaches for pediatric ADHD. Finally, we conclude with directions for future research necessary to develop a combined neurocognitive + skill-based treatment for youth with ADHD.

BACKGROUND: Resting-state functional magnetic resonance imaging (R-fMRI) is a promising tool in clinical application, especially in presurgical mapping for neurosurgery. This study aimed to investigate the sensitivity and specificity of R-fMRI in the localization of hand motor area in patients with brain tumors validated by direct cortical stimulation (DCS). We also compared this technique to task-based blood oxygenation level-dependent (BOLD) fMRI (T-fMRI). METHODS: R-fMRI and T-fMRI were acquired from 17 patients with brain tumors. The cortex sites of the hand motor area were recorded by DCS. Site-by-site comparisons between R-fMRI/T-fMRI and DCS were performed to calculate R-fMRI and T-fMRI sensitivity and specificity using DCS as a "gold standard". R-fMRI and T-fMRI performances were compared statistically RESULTS: A total of 609 cortex sites were tested with DCS and compared with R-fMRI findings in 17 patients. For hand motor area localization, R-fMRI sensitivity and specificity were 90.91 and 89.41 %, respectively. Given that two subjects could not comply with T-fMRI, 520 DCS sites were compared with T-fMRI findings in 15 patients. The sensitivity and specificity of T-fMRI were 78.57 and 84.76 %, respectively. In the 15 patients who successfully underwent both R-fMRI and T-fMRI, there was no statistical difference in sensitivity or specificity between the two methods (p = 0.3198 and p = 0.1431, respectively) CONCLUSIONS: R-fMRI sensitivity and specificity are high for localizing hand motor area and even equivalent or slightly higher compared with T-fMRI. Given its convenience for patients, R-fMRI is a promising substitute for T-fMRI for presurgical mapping.

In the JCPP Virtual Issues series, editors are invited to look back over our catalogue and identify papers that illustrate the journal's influence on the emergence of specific fields within the broader domains of child psychology and psychiatry. This virtual issue(1,2) focuses specifically on the last 30 years of attention-deficit/hyperactivity disorder (ADHD) research. While the journal has published papers on nearly every aspect of this condition our initial scoping exercise highlighted a particular impact in two areas: neuropsychology and behavioural genetics. Here we address the JCPPs contribution to contemporary understanding of the neuropsychology of ADHD. We are planning to put together a further Virtual Issue on behavioural genetics in the near future.

Historians of science continue to debate the importance of individual inspiration and personal creativity as fuel in the engine of scientific progress. While true that, in general, scientific knowledge advances cautiously by careful experimentation, painstaking observation and the gradual accumulation of evidence occasionally a field of enquiry can be revolutionised by a single, perhaps simple, yet inspired and profound insight. Such breakthroughs are most likely to occur when an individual moves outside the intellectual tramlines that normally constrain scientific thinking, leaving them able to look at old evidence in new and original ways. The reception of such original insights by the research community varies considerably, of course. Some insights may be 'too original' - a step too far in what is normally an incremental journey of discovery. Some ideas, enthusiastically accepted initially, may burn out before making any real impression. Other ideas revolutionize a field - producing a cascade of hypotheses and lines of enquiry that lead to new discoveries which permanently change the scientific landscape. The issue of scientific creativity was very much in my mind when reading through the papers slated to appear in the current journal number. One article in particular, by Pannekoeke and colleagues on intrinsic brain organisation in depressed adolescents, initiated a chain of thought that led me to my focus for this editorial. A development that provides perhaps the most compelling recent example of the transformative power of individual inspiration in the field of cognitive neuroscience - a development which is also beginning to have profound implications for models of childhood mental disorders.

PURPOSE/OBJECTIVE:Transgender and gender nonconforming people who fulfill diagnostic criteria for autism spectrum disorders (ASDs) often present to mental health providers with concerns that are distinct from those without ASDs. Gender Dysphoria (GD) and ASDs have been proposed to share etiologic mechanisms and there is evidence that ASDs may be more common in transgender and gender nonconforming people. We explore the impact of ASD characteristics on individual gender identity, expression, and the process of psychotherapy. METHOD/METHODS:The authors present two case studies of high-functioning individuals with ASD and GD diagnoses. RESULTS:The limited ability to articulate an inner experience, deficits in Theory of Mind (ToM), along with the intolerance of ambiguity as a manifestation of the cognitive rigidity characteristic of ASDs, may present special difficulties to gender identity formation and consolidation and create challenges in psychotherapy. CONCLUSIONS:The authors suggest that ASDs do not preclude gender transition and that individuals with high-functioning ASDs are capable of making informed decisions regarding their medical care and life choices. The authors also consider possible challenges and suggest techniques for assisting such clients in exploring their gender identities.