Students with Dual Diagnosis: Can School-Based Mental Health Services Play a Role?

ABSTRACT

This article describes and investigates initial findings from the Esperanza Mental Health Services (EMHS) Program, which is an intensive outpatient program that provides individual and group mental health services for students with “dual diagnosis” or developmental disabilities and co-occurring mental health problems. Previous research substantiates that the mental health needs of this population are significant, yet often go unaddressed in school settings. Preliminary outcomes for a sample of 61 children ages 4–22 suggest improvements in important school indicators, such as suspensions and absences during the year of program implementation, as well as positive changes in parent-reported mental health functioning. Lastly, parent satisfaction regarding these services and supports was high. The implications of these results for a proposed school-based mental health service delivery model within a multi-tiered system of prevention and intervention are discussed.     

Screening for Early Alzheimer's Disease: Is There Still a Role for the Mini-Mental State Examination?

Background: The objective of this study was to compare the performance of the Mini-Mental State Examination (MMSE) total score as well as item scores in separating 4 groups of elderly (55-85 years of age) subjects-normal controls, subjects with mild cognitive impairment (MCI), subjects with mild Alzheimer's disease, and subjects with depression.Method: The MMSE scores of 86 subjects (25 normal elderly controls, 26 subjects with MCI, 10 subjects with mild Alzheimer's disease, and 25 subjects with depression) were analyzed. Statistically significant differences between groups in both overall MMSE score and individual item scores were documented. Receiver operating characteristic curves were constructed to yield further data.Results: The overall MMSE scores of the mild Alzheimer's disease group were significantly below those of subjects in the control, MCI, and depression groups (p < .001). The overall MMSE scores of MCI subjects were significantly lower than those of control subjects (p = .005) but not different from those of subjects with depression. Furthermore, individual item responses were not significantly different between MCI subjects and controls. The delayed recall item scores were statistically lower in the mild Alzheimer's disease group versus the other 3 groups but did not separate the control, MCI, and depression groups from each other.Conclusion: The MMSE effectively separates those with mild Alzheimer's disease from the other 3 groups and MCI from normal aging, but it is relatively ineffective in separating normal elderly individuals from those with depression and individuals with MCI from those with depression. Measures other than the MMSE may need to be implemented to evaluate mental status to more effectively separate MCI from depression and depression from normal aging.     

Problematic Gaming and Subjective Well-Being: How Does Mindfulness Play a Role?

International Journal of Mental Health and Addiction - Video game use becomes problematic when it disrupts the ability to fulfill social and personal responsibilities. It has also been associated...     

Can patients with Alzheimer's disease learn a category implicitly?

Can a person with a damaged medial-temporal lobe learn a category implicitly? To address this question, we compared the performance of participants with mild Alzheimer's disease (AD) to that of age-matched controls in a standard implicit learning task. In this task, participants were first presented a series of objects, then told the objects formed a category, and then had to categorize a long sequence of test items [Knowlton B. J., Squire L. R. (1993). The learning of categories: parallel brain systems for item memory and category knowledge. Science, 262, 1747-1749]. We tested the hypotheses that: (1) both Control and AD participants would show evidence for implicit learning after the unwanted contribution of learning during test is removed; (2) the degree of implicit learning is the same for AD and Control participants; (3) training with exemplars that are highly similar to an unseen prototype will lead to better implicit category learning than training with exemplars that are less similar to a prototype. With respect to the first hypothesis, we found that both AD and Control participants performed better on tests of implicit learning than could be attributed to just learning on test trials. We found no clear means for evaluating our second hypothesis, and argue that comparisons of the degree of implicit learning between patient and control groups in this paradigm are confounded by the contribution of other memory systems. In line with the third hypothesis, only training with similar exemplars resulted in significant implicit category learning for AD participants.     

Can episodic memory tasks differentiate semantic dementia from Alzheimer's disease?

The performance of two groups of patients with semantic dementia (SD), with predominant right (SDR) and left temporal lobe atrophy (SDL), was contrasted with that of cases with probable Alzheimer's disease (AD) on a range of standard episodic memory tasks. While the SDL group achieved a good score on a composite visual, but not a verbal, episodic memory measure, the AD and SDR groups were equivalently impaired at visual and verbal memory. The SD, but not the AD, groups were, by definition, impaired on simple tests of semantic memory. Standard verbal episodic memory tests, therefore, failed to discriminate patients with SD from those with probable AD and even visual memory tests may result in misclassification of SDR cases.     

Alzheimer's disease: cholesterol a menace?

Alzheimer's disease (AD) is the most prevalent neurodegenerative disease manifested by cognitive and memory deterioration, culminating in a spectrum of neuropsychiatric disturbances and the impairment of daily activities. AD is a multifactorial disease with a range of contributing factors which includes genes and diet. The magnitude of AD is reflected in the loss of individuality of the affected person and in the terminal course through which the disease develops. In this review, we aim to provide a background on AD and the contribution of cholesterol in the etiology of Alzheimer's. Cholesterol seems to be intimately linked with the generation of amyloid plaques, which is central to the pathogenesis of AD. Although there are conflicting reports on the role of cholesterol in AD, majority of the studies point out the positive association of cholesterol with AD.     

Suicide Risk Assessments: Which Suicide Risk Factors Psychiatric Residents Consider Significant?

Objective

Patients visiting the emergency department (ED) after a suicide attempt are generally assessed for suicide risk by psychiatric residents. Psychiatric residents'' competence in evaluating the risk posed by the patients who attempted suicide is critical to preventing suicide.

Methods

We investigated factors considered important by psychiatric residents when evaluating suicide risk. This study included 140 patients admitted to the ED after attempting suicide. Psychiatric residents rated patients'' severity of current and future suicide risk as low/moderate/high using the Brief Emergency Room Suicide Risk Assessment (BESRA). The association between each BESRA variable and level of suicide risk was analyzed.

Results

Many factors were commonly considered important in evaluating the severity of current and future suicide risk. However, the following factors were only associated with future suicide risk: female gender, having no religion, family psychiatric history, history of axis I disorders, having a will, harboring no regrets, and social isolation.

Conclusion

Psychiatric residents use diverse factors when assessing suicide risk. Psychiatric residents might put more emphasis on non-modifiable demographic and clinical factors, concrete evidence showing suicide determination, and social isolation to assess the risk of future suicide.     

Lexical Processing in Toddlers with ASD: Does Weak Central Coherence Play a Role?

This study investigated whether vocabulary delays in toddlers with autism spectrum disorders (ASD) can be explained by a cognitive style that prioritizes processing of detailed, local features of input over global contextual integration—as claimed by the weak central coherence (WCC) theory. Thirty toddlers with ASD and 30 younger, cognition-matched typical controls participated in a looking-while-listening task that assessed whether perceptual or semantic similarities among named images disrupted word recognition relative to a neutral condition. Overlap of perceptual features invited local processing whereas semantic overlap invited global processing. With the possible exception of a subset of toddlers who had very low vocabulary skills, these results provide no evidence that WCC is characteristic of lexical processing in toddlers with ASD.     

Effects of Being a Peer-Leader in an Eating Disorder Prevention Program: Can We Further Reduce Eating Disorder Risk Factors?

Studies regarding the effect of peer-leadership on peer-leaders in prevention programs remain extremely limited. In this study, 83 undergraduate sorority members, who previously participated in the program, served as peer-leaders for an eating disorder prevention program. Peer-leaders attended 9 hours of training and then led two 2-hour sessions. Leaders showed decreases (beyond participation in earlier studies) in dietary restraint, bulimic pathology, body dissatisfaction, and thin-ideal internalization from pre-training through 7-week follow up. Results from this exploratory study suggest that peer-leaders who participate in a program and subsequently lead it may experience additional benefits compared to participation in the program alone.     

Can Caregivers Independently Rate Cognitive and Behavioral Symptoms in Alzheimer's Disease Patients?: A Longitudinal Analysis

To examine whether informant-based assessments of patients with Alzheimer's disease (AD) can be used longitudinally to track patient functioning, the authors followed AD patients (N=153) and their caregivers over 1 year with the Relative's Assessment of Global Symptomatology-Elderly (RAGS-E) and the Alzheimer's Disease Assessment Scale-Cognitive Subscale (ADASc). Factor analysis of the RAGS-E yielded two subscales, Cognitive Functioning and Mood Disturbance. The cognitive subscale and ADASc correlated at all visits, whereas the mood subscale did not. After 12 months (n=62), the cognitive scale worsened at a rate similar to the ADASc, suggesting concurrent validity. Therefore, informant-based measures appear to be reliable and valid methods of identifying cognitive change in AD patients.     

Sleep and Epilepsy: A Key Role for Nitric Oxide?

PURPOSE: It has been suggested that nitric oxide (NO) is involved in sleep mechanisms and in the pathophysiology of epilepsy. Data are, however, controversial because it is not clear whether NO facilitates sleep or waking, or whether it exerts pro-or antiepileptic influences. METHODS: The question was considered through NO voltammetric measurements and electroencephalographic recordings performed in GAERS rats (Genetic Absence Epilepsy Rat from Strasbourg): an experimental model of "petit-mal" human disease. Regulatory processes of sleep and epilepsy were studied after administration of a NO synthase inhibitor [l-arginine-p-nitroanilide (l-ANA) 100 mg/kg i.p.], a NO donor (SIN-1 100 ng/2 microl i.c.v.), and the antiepileptic drugs used in clinic [valproate (VPA 200 mg/kg i.p.) and ethosuximide (ESM 100 mg/kg i.p.)]. RESULTS: In GAERS rats, spontaneous circadian organizations of spike-wave discharges and paradoxical sleep (PS) occur in an opposite way; spontaneous NO concentrations are higher during seizures than during wakefulness, slow-wave sleep, and PS, respectively. l-ANA induces a disappearance of NO peak, an epileptic induction, and a loss of PS while SIN-1 induces opposite effects. Antiepileptic effects of VPA and ESM are associated with a PS increase and a significant release of NO. CONCLUSIONS: These results indicate that NO could be, in GAERS rats, a central piece in the reciprocal inhibitory mechanisms regulating the induction of PS and spike-wave discharges. NO could prevent absence epilepsy and act as an antiepileptic substance in facilitating PS. Antiepileptic efficiency of VPA and ESM may work through their ability to release NO. A track for a new treatment of petit-mal disease in children can be envisioned.     

Distinguishing clinical depression from early Alzheimer's disease in elderly people: Can narrative analysis help?

Background: Differentiating the reversible cognitive symptoms associated with depression (DEP) from the irreversible dementia associated with early or mild Alzheimer's disease (AD) has proven to be challenging, particularly in elderly individuals. Most previous studies have focused on contrasting the cognitive profiles associated with these disorders, often yielding unreliable clinical differences. Although a limited set of studies have identified significant differences between DEP and early AD groups on both basic and high-level language production and comprehension tasks, none has included spoken discourse measures, and several limitations within these language studies indicate that further research is warranted.

Aims: This study examined whether depression is associated with a distinct pattern of discourse changes, and thus whether discourse analyses may help discriminate elderly individuals with DEP from those in the early stages of AD.

Methods & Procedures: Groups of elderly participants with DEP, mild AD, or no psychiatric or neurological diagnosis, who were matched for age and education level, completed a spoken narrative task and general cognition and high-level language tests. Quantitative, syntactic, and informativeness aspects of the discourse samples were analysed.

Outcomes & Results: Significant group differences were observed on the informativeness discourse measures, with AD participants producing less-informative samples than DEP and control participants. DEP and control groups did not significantly differ on any discourse variable.

Conclusions: Including discourse sampling and analyses, with a focus on informativeness, into comprehensive assessment protocols may lead to more accurate discrimination of DEP and early AD in the elderly.     

Can Healthy Lifestyle Modify Risk Factors for Dementia? Findings from a Pilot Community-Based Survey in Chennai (India) and Newcastle (UK)

Background: Currently there are no effective treatments available for dementia. Attention has turned to defining preventive strategies and identifying modifying effects of lifestyle, including physical activity, diet, alcohol intake and smoking, in reducing cognitive decline and overt memory problems in the elderly. Methods: In this study, we addressed the modifying aspects of various components of lifestyle in two ageing samples and explored the possible effects that exercise, diet and spiritual and religious beliefs have upon physical and mental health. A total of 251 subjects (128 in Chennai, India, and 123 in Newcastle, UK) filled in a questionnaire regarding their lifestyle habits. Data were analysed with χ(2) analysis. Results: Our findings highlight that spiritual and religious beliefs promoted good physical and mental health and were negatively associated with risk factors for dementia, such as high blood pressure, high cholesterol level and diabetes. Lifelong diet and physical activity also contributed to better overall well-being in both samples. Conclusions: Our study suggests substantial lifestyle variations between two urban populations in Chennai, India, and Newcastle-upon-Tyne, UK. Further detailed work is required to identify the lifestyle components that have the greatest impact on modifying the known risk factors for dementia.