Faculty Bibliography
Searched for:
school:SOM
Department/Unit:Child and Adolescent Psychiatry
Total Results:
11432
Psychiatric Consequences of Skin Conditions: Multiple Case Study Analysis with Literature Review
This review of current literature demonstrates the psychological implications of skin conditions. Skin conditions of varying severity can impact the quality of patients' lives and have psychiatric consequences. This impact provides a need for healthcare providers to consider the psychological implications of one's skin conditions and their effect on quality of life. The psychological challenges that arise from varying skin conditions show the potential need for both dermatological and psychiatric interventions. The following literature review details the psychiatric consequences of skin conditions under various conditions. It first looks at literature highlighting the psychiatric consequences experienced through various age ranges, from adults to adolescents and children. The paper then explores multiple skin conditions and their psychological effect before highlighting some of the interactions that stress has on the skin that could further exacerbate one's condition. Finally, it examines how patients characterize their experience with their skin condition and goes into some clinical case studies of patients with psychological implications as a result of their skin disorder. The paper also highlights the magnitude of dermatologic patients experiencing psychological conditions in conjunction with their skin conditions.
PMID: 35771406
ISSN: 1573-6709
CID: 5281282
Effects of Short Chain Fatty Acid Supplementation in Modulation of Gut Microbiome and T-Regulatory Cells in Health and New Onset Rheumatoid Arthritis [Meeting Abstract]
Background/Purpose: The gut microbiome and its metabolites are dysregulated in rheumatoid arthritis. Short chain fatty acids (SCFAs), microbial fermentation byproducts of certain gut microbes, induce regulatory T cells (Treg) that exhibit antiinflammatory properties. Unsurprisingly, SCFA are found at reduced levels in both murine models of RA and patients. The SCFA butyrate has been shown to increase levels of gut and circulating Treg and ameliorate inflammatory arthritis in murine models. Additionally, we previously noted that SCFA supplementation in WT mice led to significant perturbations in gut bacterial composition with a significant increase in SCFA-producing commensals. Similarly, others have shown that a high-fiber diet increases circulating levels of SCFAs and decreases pro-arthritogenic cytokines (Durholz et al. Nutrients. 2020). We therefore hypothesized that butyrate supplementation may promote favorable gut microbial changes and increase tolerogenic adaptive immune response in RA patients.
Method(s): We designed an ongoing, prospective, proof-of-principle study to determine the effects of butyrate supplementation in new-onset RA (NORA) patients. First, we evaluated the effects of butyrate supplementation in healthy subjects (n=7; 1 gm 3 times daily for 14 days). Next, we evaluated the effects of butyrate on new-onset RA (n=5; 1 gm 3 times daily for 30 days) compared to methotrexate (n=20). Clinical history and joint exam were performed at baseline and follow up. Peripheral blood and fecal samples were collected at baseline and follow up for flow cytometric analysis of Treg and 16s rRNA sequencing, respectively. Wilcoxon signed-rank test was used to compare differences in Treg before and after butyrate administration.
Result(s): Although butyrate supplementation in healthy subjects did not lead to significant community changes by 7 days, it did lead to a significant increase in the percentage of circulating CD4+CD25+FoxP3+ Treg (p=0.02) followed by a significant increase in highly activated CD39+ Treg by 14 days (p < 0.0001). Gut bacterial alpha diversity (Shannon index) was significantly lower in NORA patients compared to healthy subjects at baseline (p=0.04; wilcox-test). After butyrate supplementation, NORA alpha diversity increased to levels approaching those of healthy subjects, with a modest increase in abundance of both Firmicutes and Bacteroidetes. LDA Effect Size analysis recapitulated previous studies where healthy subjects had greater abundance of SCFA producing commensals compared to NORA.
Conclusion(s): In both health and new-onset RA, butyrate supplementation is associated with changes in human gut microbiota composition and in peripheral Treg abundance and markers of Treg activation. In preliminary analyses of this ongoing prospective study, butyrate increased gut microbial diversity in NORA, suggesting that gut microbial composition may shift towards a healthier level of diversity. As seen in murine models, butyrate also increased Treg in healthy subjects. We hypothesize that, in patients, butyrate will induce modifications in gut microbial communities that favor a regulatory adaptive immune response that may ultimately lead to better clinical response
Method(s): We designed an ongoing, prospective, proof-of-principle study to determine the effects of butyrate supplementation in new-onset RA (NORA) patients. First, we evaluated the effects of butyrate supplementation in healthy subjects (n=7; 1 gm 3 times daily for 14 days). Next, we evaluated the effects of butyrate on new-onset RA (n=5; 1 gm 3 times daily for 30 days) compared to methotrexate (n=20). Clinical history and joint exam were performed at baseline and follow up. Peripheral blood and fecal samples were collected at baseline and follow up for flow cytometric analysis of Treg and 16s rRNA sequencing, respectively. Wilcoxon signed-rank test was used to compare differences in Treg before and after butyrate administration.
Result(s): Although butyrate supplementation in healthy subjects did not lead to significant community changes by 7 days, it did lead to a significant increase in the percentage of circulating CD4+CD25+FoxP3+ Treg (p=0.02) followed by a significant increase in highly activated CD39+ Treg by 14 days (p < 0.0001). Gut bacterial alpha diversity (Shannon index) was significantly lower in NORA patients compared to healthy subjects at baseline (p=0.04; wilcox-test). After butyrate supplementation, NORA alpha diversity increased to levels approaching those of healthy subjects, with a modest increase in abundance of both Firmicutes and Bacteroidetes. LDA Effect Size analysis recapitulated previous studies where healthy subjects had greater abundance of SCFA producing commensals compared to NORA.
Conclusion(s): In both health and new-onset RA, butyrate supplementation is associated with changes in human gut microbiota composition and in peripheral Treg abundance and markers of Treg activation. In preliminary analyses of this ongoing prospective study, butyrate increased gut microbial diversity in NORA, suggesting that gut microbial composition may shift towards a healthier level of diversity. As seen in murine models, butyrate also increased Treg in healthy subjects. We hypothesize that, in patients, butyrate will induce modifications in gut microbial communities that favor a regulatory adaptive immune response that may ultimately lead to better clinical response
EMBASE:639965609
ISSN: 2326-5205
CID: 5513092
Clinical Presentation and Treatment of Early-Onset Behavior Disorders: The Role of Parent Emotion Regulation, Emotion Socialization, and Family Income
Parent emotion regulation and socialization have been linked to various aspects of child functioning. In the case of early-onset behavior disorders in particular, parent emotion regulation may be an important correlate of the coercive cycle implicated in early-onset behavior disorders thus, symptom presentation at baseline. Further, emotion socialization may be complicated by a pattern of parent-child interactions in which both supportive or unsupportive parenting behaviors in response to behavioral dysregulation may increase vulnerability for problem behavior in the future. Some work suggests standard Behavioral Parent Training may impact parent emotion regulation and socialization. Still little is known, however, about how such processes may vary by family income, which is critical given the overrepresentation of low-income children in statistics on early-onset behavior disorders. This study explored parent emotion regulation, socialization, and family income in a sample of socioeconomically diverse treatment-seeking families of young (3-8 years old) children. Findings suggest relations between parental emotion regulation, socialization, and child behavior although the pattern of associations differed at baseline and post-treatment and varied by family income. Clinical implications and future directions are discussed.
PMCID:9364231
PMID: 34378434
ISSN: 1552-4167
CID: 5401222
Longitudinal relationships among posttraumatic stress disorder symptom clusters in response to positive memory processing
BACKGROUND AND OBJECTIVES:Avoidance, inherent to posttraumatic stress disorder (PTSD) symptomatology, is theoretically and empirically linked to the maintenance of PTSD symptom severity. While research indicates traumatized individuals avoid positive and trauma memories, several PTSD treatments focus exclusively on traumatic memories. We examined the mediating role of PTSD's avoidance in the relationship between processing positive memories and PTSD cluster severity (intrusion, mood/cognitions, arousal). METHODS: = 22.52; 86.10% female) were randomly assigned to 3 conditions: narrating/processing, writing/processing, or control (same task across baseline [T0] and follow-up [T1]). RESULTS:Half-longitudinal mediation models indicated participation in the narrating vs. writing and control conditions predicted decreases in T1 intrusion severity via reduction in T1 avoidance severity. Similarly, participation in the narrating vs. writing and control conditions predicted decreases in T1 mood/cognitions' severity via reduction in T1 avoidance severity. Participation in the narrating vs. writing condition predicted decreases in T1 arousal severity via reduction in T1 avoidance severity. LIMITATIONS:Data was obtained from an analogue small-size sample of university students. In addition, sessions were only 6-8 days apart, with the processing component of each session lasting ∼30 min. CONCLUSIONS:Processing positive memories may relate to lower PTSD severity via a reduction in PTSD's avoidance, paralleling effects of processing trauma memories. Our findings support future investigations of the mechanisms underlying impacts of positive memory processing in the context of PTSD treatments.
PMID: 35738684
ISSN: 1873-7943
CID: 5344852
Author Correction: A multi-country test of brief reappraisal interventions on emotions during the COVID-19 pandemic
PMID: 36002766
ISSN: 2397-3374
CID: 5374292
Short Research Article: Impact of a prolonged lockdown on the symptoms of paediatric ADHD and common associated disorders
OBJECTIVE:Our objective is to explore the change in the severity of ADHD, ODD and anxiety during a two-month lockdown among children in France and the moderating role of behavioural regulation. METHOD:In 235 children with ADHD, the symptom severity of ADHD, ODD and anxiety was investigated one and two months after the beginning of lockdown, and one month after its end. Behavioural regulation skills were estimated with the Behaviour Regulation Index. RESULTS:ADHD, ODD and anxiety scores were increasing or decreasing depending on BRI. CONCLUSION:Baseline behavioural regulation skills may act as a moderating factor for the persistence of ADHD, ODD and anxiety symptoms related to the lockdown.
PMID: 34983079
ISSN: 1475-357x
CID: 5470382
Pregnant women with bipolar disorder who have a history of childhood maltreatment: Intergenerational effects of trauma on fetal neurodevelopment and birth outcomes
OBJECTIVES/OBJECTIVE:Intergenerational transmission of trauma occurs when the effects of childhood maltreatment (CM) influence the next generation's development and health; prenatal programming via maternal mood symptoms is a potential pathway. CM is a risk factor for bipolar disorder which is present in 1.8% of pregnant women. Mood symptoms are likely to increase during pregnancy, particularly for those with a history of CM. We examined whether there was evidence for intergenerational transmission of trauma in utero in this population, and whether maternal mood was a transmission pathway. METHODS:CM and maternal mood were self-reported by N = 82 pregnant women in treatment for bipolar disorder. Fetal heart rate variability (FHRV) was measured at 24, 30, and 36 weeks' gestation. Gestational age at birth and birth weight were obtained from medical charts. RESULTS:A cluster analysis yielded two groups, Symptom+ (18.29%) and Euthymic (81.71%), who differed on severe mood symptoms (p < 0.001) but not on medication use. The Symptom+ group had more CM exposures (p < 0.001), a trend of lower FHRV (p = 0.077), and greater birth complications (33.3% vs. 6.07% born preterm p < 0.01). Maternal prenatal mood mediated the association between maternal CM and birth weight in both sexes and at trend level for gestational age at birth in females. CONCLUSIONS:This is the first study to identify intergenerational effects of maternal CM prior to postnatal influences in a sample of pregnant women with bipolar disorder. These findings underscore the potential enduring impact of CM for women with severe psychiatric illness and their children.
PMID: 35319806
ISSN: 1399-5618
CID: 5200522
Journal of child psychology & psychiatry & allied disciplines. 2022:63(9):992-1001.DOI: 10.1111/jcpp.13554
A randomized controlled trial of technology-enhanced behavioral parent training: sustained parent skill use and child outcomes at follow-up
BACKGROUND:Early-onset (3-8 years old) disruptive behavior disorders (DBDs) have been linked to a range of psychosocial sequelae in adolescence and beyond, including delinquency, depression, and substance use. Given that low-income families are overrepresented in statistics on early-onset DBDs, prevention and early-intervention targeting this population is a public health imperative. The efficacy of Behavioral Parent Training (BPT) programs such as Helping the Noncompliant Child (HNC) has been called robust; however, given the additional societal and structural barriers faced by low-income families, family engagement and retention barriers can cause effects to wane with time. This study extends preliminary work by examining the potential for a Technology-Enhanced HNC (TE-HNC) program to improve and sustain parent skill proficiency and child outcomes among low-income families. METHODS:A randomized controlled trial with two parallel arms was the design for this study. A total of 101 children (3-8-years-old) with clinically significant problem behaviors from low-income households were randomized to HNC (n = 54) or TE-HNC (n = 47). Participants were assessed at pre-treatment, post-treatment, 3-month, and 6-month follow-ups. Primary outcomes were parent-reported and observed child behavior problems. Secondary outcomes included observed parenting skills use (ClinicalTrials.gov Identifier: NCT02191956). RESULTS:Primary analyses used latent curve modeling to examine treatment differences in the trajectory of change during treatment, maintenance of treatment gains, and levels of outcomes at the 6-month follow-up. Both programs yielded improvements in parenting skills and child problems at post-treatment. However, TE-HNC families evidenced greater maintenance of parent-reported and observed child behavior and observed positive parenting skills at the 6-month follow-up. CONCLUSIONS:Our findings contribute to an ongoing line of work suggesting that technology-enhanced treatment models hold promise for increasing markers of engagement in BPT and sustaining long-term outcomes among low-income families.
PMCID:9177891
PMID: 34888861
ISSN: 1469-7610
CID: 5401242
Journal of the American Academy of Child and Adolescent Psychiatry. 2022:61(9):1087-1105.DOI: 10.1016/j.jaac.2021.12.006
Review: Structural Racism, Children's Mental Health Service Systems, and Recommendations for Policy and Practice Change
OBJECTIVE:Racism is a public health crisis impacting children's mental health, yet mental health service systems are insufficiently focused on addressing racism. Moreover, a focus on interpersonal racism and on individual coping with the impacts of racism has been prioritized over addressing structural racism at the level of the service system and associated institutions. In this paper, we examine strategies to address structural racism via policies impacting children's mental health services. METHOD/METHODS:First, we identify and analyze federal and state policies focused on racism and mental health equity. Second, we evaluate areas of focus in these policies and discuss the evidence base informing their implementation. Finally, we provide recommendations for what states, counties, cities, and mental health systems can do to promote antiracist evidence-based practices in children's mental health. RESULTS:Our analysis highlights gaps and opportunities in the evidence base for policy implementation strategies including: mental health services for youth of color, interventions addressing interpersonal racism and bias in the mental health service system, interventions addressing structural racism, changes to provider licensure and license renewal, and development of the community health workforce. CONCLUSION/CONCLUSIONS:Recommendations are provided both within and across systems to catalyze broader systems transformation.
PMID: 34971730
ISSN: 1527-5418
CID: 5152092
State Policies that Impact the Design of Children's Mental Health Services: A Modified Delphi Study
To identify the state-level policies and policy domains that state policymakers and advocates perceive as most important for positively impacting the use of children's mental health services (CMHS). We used a modified Delphi technique (i.e., two rounds of questionnaires and an interview) during Spring 2021 to elicit perceptions among state mental health agency officials and advocates (n = 28) from twelve states on state policies that impact the use of CMHS. Participants rated a list of pre-specified policies on a 7-point Likert scale (1 = not important, 7 = extremely important) in the following policy domains: insurance coverage and limits, mental health services, school and social. Participants added nine policies to the initial list of 24 policies. The "school" policy domain was perceived as the most important, while the "social" policy domain was perceived as the least important after the first questionnaire and the second most important policy domain after the second questionnaire. The individual policies perceived as most important were school-based mental health services, state mental health parity, and Medicaid reimbursement rates. Key stakeholders in CMHS should leverage this group of policies to understand the current policy landscape in their state and to identify gaps in policy domains and potential policy opportunities to create a more comprehensive system to address children's mental health from a holistic, evidence-based policymaking perspective.
PMCID:9219374
PMID: 35737191
ISSN: 1573-3289
CID: 5282072
