Utility of center of pressure measures during obstacle crossing in prediction of fall risk in people with Parkinson’s disease

IntroductionPostural instability during walking and tripping over obstacles are the main causes of falls in people with Parkinson’s disease (PD). Preliminary limited evidence suggests that the length of the prospective follow-up period affects falls prediction in PD, with shorter periods leading to more accurate prediction. Thus, the primary aim of the present study was to test the performance of center of pressure (CoP) variables during obstacle crossing to predict fall risk in people with PD during subsequent periods of four, six, and 12 months. We also compared CoP variables during obstacle crossing between fallers and non-fallers.MethodsForty-two individuals with PD, in mild to moderate stages, completed the baseline obstacle crossing assessment and reported falls for 12 months. Participants walked at their self-selected pace and were instructed to cross an obstacle (half knee height) positioned in the middle of an 8-m long pathway. A force platform was used to analyze CoP parameters of the stance phase of the trailing limb (most affected limb). The ability of each outcome measure to predict fall risk at four, six, and 12 months was assessed using receiver operating characteristic curve analyses.ResultsTen individuals (23.8%) were considered fallers at four months, twelve individuals (28.5%) at six months, and twenty-one individuals (50%) at 12 months. CoP amplitude and CoP velocity in the mediolateral direction significantly predicted fall risk at four, six, and 12 months. As judged by the area under the curve, mediolateral CoP velocity showed the best performance at four months, while mediolateral CoP amplitude showed the best performance at six months. Fallers presented greater values of mediolateral CoP velocity and amplitude than non-fallers.ConclusionThese findings suggest that mediolateral CoP velocity and amplitude during obstacle crossing might be useful to predict fall risk in people with PD. Therefore, larger studies are encouraged.     

LGBTQ+ Addiction Research: An Analysis of the Journal of Addictions & Offender Counseling

Articles published in the Journal of Addictions & Offender Counseling (JAOC) from 1980 to 2018 were examined to see how LGBTQ+ issues are represented. This study also investigated whether sexual orientation and gender identity were reported in empirical studies in JAOC.     

Application of a self‐management intervention to improve data recording of educational care providers

The present study evaluated the effects of a self‐management intervention on scheduled data recording by classroom instructors at a school for children with intellectual disability and neurodevelopmental disorders. In a multiple baseline design across two classrooms, the instructors recorded student data according to an established protocol at the school and based on earlier training they had received. During intervention, the instructors self‐monitored implementation of data recording procedures that were prompted by a signal from an automated count‐down timer. The self‐management intervention increased scheduled data recording by participants in both classrooms to 90–100%, and these results were maintained at 1‐ and 2‐month follow‐up assessments. These findings add to the small literature concerning self‐managed approaches to training and performance improvement, extend application within educational settings, and suggest practical advantages for supporting competencies of care providers.     

Using Multiple Contexts and Retrieval Cues in Exposure-Based Therapy to Prevent Relapse in Anxiety Disorders

The benefits of exposure-based interventions for anxiety disorders are substantial but not stable for everyone, given that these interventions are often followed by relapse of symptoms. A body of research provides a background on how to add certain strategies in exposure-based therapy to prevent relapse in anxiety disorders. This review summarizes some of these strategies and provides clear-cut clinical implications. Studies that provide support for two types of strategies to prevent relapse have been reviewed—the use of multiple contexts and the use of retrieval cues. The use of multiple contexts reduces context and stimulus specificity of extinction learning during exposure, while the use of retrieval cues enhances memory (re)consolidation and retrieval after exposure. The described strategies to enhance the accessibility and therefore the retrievability of exposure-based learning to prevent relapse in anxiety disorders can be summarized as advice to conduct exposure under variable conditions. This way, the generalizability of what is learned during exposure to the patients’ daily life after treatment improves. Therefore, adding these strategies in the course of exposure-based treatment of anxiety disorders seems beneficial. However, future replications and translational studies are needed to verify ecological validity.     

Statewide Implementation of Cognitive Behavioral Therapy for Psychosis Through a Learning Collaborative Model

Cognitive Behavioral Therapy for Psychosis (CBTp) is an evidence-based psychotherapeutic intervention (EBPI) for adults with schizophrenia spectrum disorders that remains under-implemented in the United States (U.S.). There has been little empirical attention on implementation and dissemination strategies for this EBPI. The Learning Collaborative (LC) model is a method of implementing evidence-based practices across agencies and geographic regions that may facilitate CBTp implementation and dissemination in the US.We applied the LC model in an attempt to enhance the accessibility of CBTp in community mental health settings statewide. Providers (N = 56) from 12 agencies voluntarily participated in an in-person, CBTp workshop followed by 6 months of biweekly phone-based consultation sessions (Phase 1). Twenty-one providers opted to participate in an additional 6-month CBTp LC immediately following completion of the initial CBTp LC (Phase 2). Adoption, penetration, provider-perceived skill development, fidelity, as well as provider-perceived implementation barriers were re-assessed during and 6 months after completion of Phase 2.One year after the completion of the Phase 2 LC, 21% of the original trainee group across 3 of the 12 participating agencies continued to offer CBTp to clients. CBTp trainees were treating between one and two clients each. Self-assessed CBTp skills improved modestly over the Phase 2 consultation period. On average, both clinicians and supervisors reached an acceptable fidelity score on the sessions reviewed. Participating providers identified multiple barriers to CBTp implementation, including features of the training and consultation, the agency, the intervention itself, and psychosocial and clinical challenges associated with the client population.Few CBTp implementation studies have applied a framework to CBTp implementation. The authors adapted the LC model in an attempt to promote adoption of CBTp in community mental health clinics across a large, populous state with poor access to mental health services. Identified challenges and recommendations should be considered in future implementation efforts.     

The relationship between religion and health-related behaviours in patients with borderline personality disorder

With addictive disorders frequently co-occurring among patients with borderline personality disorder (BPD), exploring factors that may influence health-related behaviours, like religious involvement, is important. This study assesses whether religious involvement is associated with smoking and alcohol use disorders (AUDs) in BPD subjects. This study used data from Wave 2 of the National Epidemiological Survey on Alcohol and Related Conditions (NESARC), which used the Alcohol Use Disorder and Associated Disabilities Interview Schedule–DSM-IV (AUDADIS-IV) as its assessment instrument. The AUDADIS-IV assessed personality disorders, tobacco usage, the presence of AUDs, and religious involvement. Attending a place of worship and weekly or more frequent worship attendance were significantly associated with reduced likelihood of current smoking and AUDs among BPD subjects. AUDs were also significantly less common in those reporting higher subjective religiousness. In conclusion, people with BPD who are religiously inclined are less likely to engage in addictive behaviours, specifically smoking and AUDs.     

Presenting concerns of emerging adults seeking treatment at an early intervention outpatient mood and anxiety program

This study examined presenting concerns and characteristics of emerging adults (EAs) seeking treatment at an early intervention program for mood and anxiety disorders to better understand presenting concerns when treatment is needed. During an intake assessment conducted by a social worker or clinical psychologist, participants (N = 548; 62% female, 38% male) reported their top three current life concerns, which were analyzed qualitatively using thematic analysis. Participants completed a battery of questionnaires assessing demographic information, symptomatology, and daily functioning. Females presented with significantly higher levels of anxiety, and both females and younger individuals (age 16–18) presented with significantly higher levels of depression compared to males and older individuals (age 19–26), respectively. The two most commonly reported presenting concerns were problems in interpersonal relationships and academics, and females were more likely to report academic concerns than males. The majority of participants reported seeking help for a wide range of problems commonly faced by EAs (83.7%), and participants rarely expressed concerns about particular symptoms of mood and/or anxiety disorders (16.3%). EAs and those supporting EAs may benefit from learning when psychosocial concerns are indicative of mental health challenges warranting professional attention.     

Translation of the 12-step alcoholic anonymous from English language to Yoruba language and its application within the Yoruba culture among patients with alcohol use disorder in Nigeria

ABSTRACT

The aims of this study were to translate the English version of the 12-step alcoholic anonymous (AA) to the Yoruba version and to compare among patients with alcohol use disorders (AUDs), which version would be associated with a higher participation in AA. After an initial translation of the English version of the AA to Yoruba version, 200 participants with AUDs were randomised into either group, matched by age and gender and enrolled in the 12-step programme for six months. Compared to the Yoruba group, the proportion of participants retained in treatment in the English AA group was significantly lower between baseline and at six months, OR?=?.45, 95% CI (.26–.83). The Yoruba 12-step AA has the potential of mitigating the language barrier the English version poses to individuals with limited ability in the English language because participants felt more connected with God.     

Gender Differences in Victimization and the Relation to Personality Disorders in Forensic Psychiatry

Gender differences in victimization were retrospectively examined in 218 male and 218 female patients who have been admitted to one of four Dutch forensic psychiatric hospitals between 1984 and 2014. Case files were studied and variables relating to victimization and psychopathology were coded. It was found that the prevalence rates of victimization were higher among female patients than among male patients, both during childhood and adulthood. Childhood sexual abuse was found to be more prevalent among women than men, however, no differences were found for emotional and physical abuse or neglect during childhood. Women with a history of emotional or sexual abuse were significantly more often diagnosed with borderline personality disorder than women without childhood victimization. Men with a history of physical abuse were significantly more often diagnosed with antisocial personality disorder than men without childhood victimization. Clinical and policy implications of this study for forensic practice are discussed.     

Does impaired socioemotional functioning account for behavioral dysexecutive disorders? Evidence from a transnosological study

Behavioral dysexecutive disorders are highly prevalent in patients with neurological diseases but cannot be explained by cognitive dysexecutive impairments. In fact, the underlying mechanisms are poorly understood. Given that socioemotional functioning underlies appropriate behavior, socioemotional impairments may contribute to the appearance of behavioral disorders. To investigate this issue, we performed a transnosological study.

Seventy-five patients suffering from various neurological diseases (Alzheimer’s disease (AD), Parkinson’s disease (PD), frontotemporal lobar degeneration, and stroke) were included in the study. The patients were comprehensively assessed in terms of cognitive and behavioral dysexecutive disorders and socioemotional processes (facial emotion recognition and theory of mind). As was seen for cognitive and behavioral dysexecutive impairments, the prevalence of socioemotional impairments varied according to the diagnosis. Stepwise logistic regressions showed that (i) only cognitive executive indices predicted hypoactivity with apathy/abulia, (ii) theory of mind impairments predicted hyperactivity–distractibility–impulsivity and stereotyped/perseverative behaviors, and (iii) impaired facial emotion recognition predicted social behavior disorders. Several dysexecutive behavioral disorders are associated with an underlying impairment in socioemotional processes but not with cognitive indices of executive functioning (except for apathy). These results strongly suggest that some dysexecutive behavioral disorders are the outward signs of an underlying impairment in socioemotional processes.