Friday Factoids: Blood Test for Depression?

 

Results yielded from a new study from the Northwestern University indicate that researchers may be able to discern if adults have depression simply from blood tests. This may be groundbreaking news in the world of psychology, as it would be the first objective method that can screen for depression.

 

The study, led by Dr. Eva Redei, states that approximately 7 % of the population in the United States experiences depression; however, depression can often take many months–or in some cases, even years–to discover, diagnose, and treat. This can be problematic for both the individual experiencing depression, as well as their family and friends, as the longer the delay, the more difficult it can be to treat the depression.

 

The research team used a sample size of 64 adults (ages 21-79); 32 were diagnosed with depression, and 32 were not. The test worked by measuring the blood concentration of nine genetic indicators, referred to as “RNA markers.” RNA molecules in a cell are what interpret its genetic code. It then can execute the instructions from the DNA. In this study, RNA is isolated from the blood and measured. There are differences when comparing RNA levels between the depressed and non-depressed population. The test purportedly is 72-80 % effective, which the researchers state is similar to the effectiveness rates for the standard diagnostic clinical interviews.

 

Further testing is required in order to conclusively determine if this study will be able to maintain its reliability, but it appears to be an extremely valid start. It is amazing to think how technological advancements may benefit the world of psychology in the future.

 

 

Haelle, T. (2014, September).  Blood Test Spots Adult Depression: Study. HealthDay. Retrieved from http://health.usnews.com/healthnews/articles/2014/09/16/blood-test-spots-adult-depression-study

 

Faisal Roberts, MA
WKPIC Doctoral Intern

 

 

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Friday Factoids: Revisiting the Fundamentals

 

 

Book Recommendation: The Gift of Therapy by Irvin D. Yalon

 

As clinicians, once we get started in the field, we often spend our time and energy focusing on the more advanced clinical and counseling techniques. We learn the basics, then often move swiftly away from them in an attempt to refine our clinical skills and be more adept at working with more severe cases, as well as preparing ourselves for diagnostic, demographic, and pathologic diversity–which is a good thing. Yet clinicians can digress away from the place that they were in when they started in the field, which can include their reasons and motivations for choosing a career in the field.

 

 

The Gift of Therapy is an excellent way for seasoned clinicians to recapture some of the“magic” that they felt as a rookie in the field, idealistically hoping to transform the world into a tremendously better place one individual at a time. Additionally, it is an excellent place to start for those that are new in the field, and even those that are considering becoming a part of the field.

 

Faisal Roberts, MA
WKPIC Doctoral Intern

 

 

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Loving Farewell to our Class of 2013-2014

Photography by Will Battle

 

The time has come to bid our 2013-2014 intern class a fond farewell, and give them loud and hearty congratulations. Cindy Geil (left) will begin her post-doctoral employment at Pennyroyal Mental Health Center. David Wright will return to active duty military service in January, heading to join Alpha Company 187 Medical Battalion and take the Basic Officer Leadership Course at Joint Base San Antonio. Danielle McNeill will be staying with Western State Hospital, and we’re happy to have her!

 

Congratulations, all of you, and good luck!

 

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Friday Factoids: APA’s Psychotherapy Series is a Great Resource

 

 

APA’s Theories of Psychotherapy Series are like CliffsNotes for the different models of psychotherapy. The series has a book for many psychotherapy models written by master clinicians in that type of therapy. The books are affordable and concise, which makes them an excellent starting place when you want to learn more about a certain model or want to stay current on the different models popular today.

 

Current books include:

  • Acceptance and Commitment Therapy (Hayes & Lillis, 2012)
  • The Basic of Psychotherapy: An Introduction to Theory and Practice (Wampold, 2010)
  • Behavior Therapy (Antony & Roemer, 2011)
  • Brief Dynamic Therapy (Levenson, 2010)
  • Career Counseling (Savickas, 2011)
  • Cognitive Therapy (Dobson, 2012)
  • Cognitive-Behavioral Therapy (Craske, 2010)
  • Emotion-Focused Therapy (Greenberg, 2011)
  • Existential-Humanistic Therapy (Schneider & Krug, 2010)
  • Family Therapy (Doherty & McDaniel, 2010)
  • Feminist Therapy (Brown, 2010)
  • Interpersonal Psychotherapy (Frank & Levenson, 2011)
  • Narrative Therapy (Madigan, 2011)
  • Person-Centered Psychotherapies (Cain, 2010)
  • Psychoanalysis and Psychoanalytic Therapies (Safran, 2012)
  • Psychotherapy Integration (Stricker, 2010)
  • Rational Emotive Behavior Therapy (Ellis & Ellis, 2011)
  • Reality Therapy (Wubbolding, 2011)
  • Relational-Cultural Therapy (Jordan, 2010)

 

Danielle M. McNeill, M.S., M.A.
WKPIC Doctoral Intern

 

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Friday Factoids: Passing on the Wisdom

Here’s a list of must-knows when applying to our site, or coming to WKPIC for internship!

 

1.            Paula Halcomb, director of the Admissions Unit at WSH, is our resident restaurateur. If you want to know where to eat in the area, and even what to order when you get there, talk to Paula. She can also help you find obscure objects in the area, such as where to go when you want to buy used vinyl records.

 

2.            Dr. Ralph Greene at WSH is our very own statistician. He has helped a few of us out with our dissertation stats, but he doesn’t like to advertise.

 

3.            Dr. Susan Vaught, director of the psychology department at WSH and the internship director of clinical training, is a neuropsych genius. If you have a question about testing or a challenging case, just tell her the symptoms (one or two symptoms will do) and she will tell you exactly where the neurological damage is localized.

 

4.            Hopkinsville, KY is home to quit a few delicious and unique restaurants. It was surprising to find such good eats around our small town and these hidden jewels are must-haves for foodies.

•             Da Vinci Little Italian – European owner and chef serves authentic Italian food, which is seriously the best Italian food you will ever have outside of Italy. The restaurant stays packed on weekends so make a reservation.

•             Ferrell’s Hamburgers – Best hamburgers in town and for a good price.

•             El Bracero – Don’t waste your time trying to find your favorite Mexican restaurant, just go to Bracero. There are two locations, one in Hopkinsville and one in Clarksville, TN.

•             Whistle Stop Donuts – Bring these to work and you’ll soon favorite. There are two locations, one in Hopkinsville and one in Clarksville, TN.

 

5.            Clarksville, TN is a short drive south and home to many restaurants. Black Horse Pub & Brewery has amazing steaks and pizzas.

 

6.            Farmers’ Markets! There are two close by, one in downtown Hopkinsville that is open Wednesdays and Saturdays, and one in downtown Clarksville, TN that is open Saturdays.

 

7.            Contrary to popular belief, we are not land-locked. There are many parks with river access in the area, and two large lakes a short drive north. The Land Between the Lakes (LBL) recreational area has many water-sport and fishing opportunities. There are even trails for Jeeps/ATVs and a bison and elk reserve to tour.

 

8.            Culture! Despite the small town, there is much diversity in the area that we can probably attribute to the nearby large Army post, Fort Campbell, located in Oak Grove, KY and Clarksville, TN (yep, it’s that big). There are several museums in the area and you can enjoy great musicals and plays at Roxy Regional Theatre in Clarksville, TN.

 

9.            Most, if not all, staff at WSH can be bribed with food and/or coffee.

 

10.          The ladies at Pennyroyal Center in Greenville frequently have pot-luck lunches during the work week. Get ready for some yummy home-cooked food!

 

 

Danielle M. McNeill, M.S., M.A.
WKPIC Doctoral Intern

 

 

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Summary of Gianoli, Jane, O’Brien, & Ralevski (2012): Treatment for Comorbid Borderline Personality Disorder and Alcohol Use Disorders

 

Gianoli, Jane, O’Brien, & Ralevski (2012) explain that there is a high degree of comorbidity between borderline personality disorder (BPD) and alcohol use disorders (AUDs). Research has demonstrated that this pattern of comorbidity may be associated with poorer prognosis for these individuals. Three psychotherapies have been specifically developed for patients with borderline personality disorder and substance use disorders (SUDs), but only one of these (Dynamic Deconstructive Psychotherapy) has been tested among patients with dual diagnoses of BPD and AUDs. Of all substance-use disorders, alcohol use disorders (AUDs) including both alcohol abuse and alcohol dependence are the most common among individuals with borderline personality disorder.

 

Borderline personality disorder is present in approximately 1% to 1.6% of the general population and in about 20% of the psychiatric population. Borderline personality disorder is thought to be about three times more common among females than males but this gender difference has not always been proven in community-based studies. Data from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) suggest that among patients with a lifetime diagnosis of borderline personality disorder, 58.3% also had lifetime diagnoses of alcohol use disorders. Rates of co-occurrence of lifetime borderline personality disorder among patients with alcohol use disorders ranged from 9.8% to 14.7% in this same study. A study found that among individuals with borderline personality disorder, the prevalence rate of alcohol use disorders was 48.8% and among patients with alcohol use disorders, the prevalence rate of borderline personality disorder was 14.3%. Comorbidity rates are even higher among female psychiatric patients, with 59% of women with borderline personality disorder also carrying a lifetime diagnosis of either alcohol abuse or dependence. Individuals diagnosed with both borderline personality disorder and alcohol use disorder have worse outcomes compared to those with either borderline personality disorder or alcohol use disorder alone. Borderline personality disorder traits are significantly predictive of future problems associated with alcohol use, even after controlling for other Axis I disorders (including other current substance use disorders) and nonborderline personality disorders.

 

There are surprisingly few treatments that have been developed or tested for concurrently treating borderline personality disorder and alcohol use disorders. Several randomized studies have found that targeting personality traits in brief coping skills interventions is effective in reducing alcohol and illicit substance use. An approach called, Personality-Guided Treatment for Alcohol Dependence (PETAD), was created that integrates cognitive therapy for addictive behaviors with strategic interventions for maladaptive personality features. Compared to those receiving standard cognitive therapy, those in the PETAD condition were more likely to stay in treatment, and had significantly more days of alcohol abstinence at their six-month follow-up visit. In another study, Linehan et al. (1999) examined the efficacy of Dialectical Behavior Therapy (DBT) with patients with borderline personality disorder and substance use disorders. In this particular study, patients were randomized to one year of either DBT-S or treatments as usual (TAU). At the 16-month follow-up, DBT-S patients reported better social and global adjustment compared to the TAU group.

 

Another psychotherapy has been developed for the concurrent treatment of personality disorders and substance use disorders called Dual Focus Schema Therapy (DFST). Unlike DBT-S, DFST was developed for the treatment of a broader range of personality disorders that are often comorbid with SUDs and AUDs. DFST includes a 24-week, manual-guided, individual cognitive-behavioral therapy integrating relapse prevention techniques while addressing chronic, maladaptive personality functioning and coping styles. The efficacy of DFST for specifically treating patients with borderline personality disorder and alcohol use disorder is unknown, but there are some encouraging findings regarding its efficacy among patients with dual diagnoses of personality disorders and SUDs. Both DBT-S and DFST appear to be promising approaches for the concurrent treatment of borderline personality disorder and substance use disorders.

 

The only form of psychotherapy that has been specifically tested for the concurrent treatment of borderline personality disorder and alcohol use disorders is Dynamic Deconstructive Psychotherapy (DDP), a time-limited, manual-based treatment based on object-relations theory, deconstructive philosophy and neurocognitive research. Analyses from a study comparing DDP and TAU found no significant differences between groups during the course of the study, however, there were statistically significant improvements found over time on measures of parasuicide behavior, alcohol misuse, and proportion of patients needing institutional care for those receiving DDP but not for those receiving TAU.

 

In summary, DBT-S and DFST appear to have only modest effects on drinking behavior. Further research is clearly needed for all three psychotherapies. It will be important for future studies to explore the effectiveness of these psychotherapies not only in bigger samples, but also in samples of patients with dual diagnoses specifically of borderline personality disorder and alcohol use disorders.

 

In treating individuals with alcohol use disorders, the main objective is relapse prevention. Thus, pharmacological strategies usually involve medications that deter alcohol use by moderating craving and/or producing adverse reactions when alcohol is consumed. The FDA approved medications for alcohol relapse prevention are disulfiram [acetaldehyde dehydrogenase (ALDH-1 and -2 inhibitor)], oral and injectable naltrexone (mu-opioid antagonist), and acamprosate (NMDA receptor modulator). Differentially, there are no FDA approved medications for the treatment of borderline personality disorder. Nevertheless, psychotropic medications, namely antidepressants, anticonvulsants, and antipsychotics, are often used to manage the anger, impulsivity and mood lability that are characteristic of borderline personality disorder. Of these medications, anticonvulsants, namely topiramate and lamotrigine, and second-generation antipsychotics, specifically aripiprazole and olanzapine, appear to be the most helpful. Antidepressants, although most commonly prescribed for patients with borderline personality disorder are only modestly effective in managing symptoms of borderline personality disorder. There are no published studies that have explored medication options to concurrently manage symptoms of borderline personality disorder and decrease alcohol consumption. A study was conducted utilizing disulfiram with individuals with borderline personality disorder and alcohol disorder. Two of the eight patients remained completely abstinent under supervised disulfiram therapy over their respective treatment period (4.5 and 14 months). These studies provided evidence that relapse prevention medications may be similarly effective in reducing alcohol consumption for individuals with and without comorbid borderline personality disorder. However, neither study reported on changes in borderline personality disorder symptoms. Therefore, while relapse prevention medications may help to control alcohol use, there is no evidence that they effectively manage borderline personality disorder symptoms. There is also emerging evidence that anticonvulsants and second-generation antipsychotics are most effective in the management of borderline personality disorder symptoms. Interestingly, the very same medications may be helpful in the treatment of alcohol use disorders. Of these classes of medications, most support has been found for topiramate and aripiprazole, however, encouraging findings have also been reported for lamotrigine and olanzapine.

 

Borderline personality disorder and alcohol use disorders are highly comorbid and this type of comorbidity has been associated with particularly negative prognosis. Yet, there are very few treatments that concurrently treat symptoms of both borderline personality disorder and alcohol use disorders. There have been three psychotherapies that have been designed to concurrently treat borderline personality disorder and substance use disorders. However, only one (Dynamic Deconstructive Psychotherapy) has been specifically evaluated for the concurrent treatment of borderline personality disorder and alcohol use disorders, and although it may be effective in reducing symptoms of borderline personality disorder, its efficacy in reducing alcohol consumption over time may be comparable to treatment as usual. There is evidence that some anticonvulsants and antipsychotics may significantly reduce anger (one core symptom of borderline personality disorder), and some like lamotrigine have been shown to reduce other core symptoms of borderline personality disorder including impulsivity and mood lability. Other studies have suggested that the same medications may also reduce alcohol craving and consumption in patients with alcohol use disorders/problems alone. Considering these results, further study of the role of anticonvulsants and second-generation antipsychotics is warranted, and further studies aimed at exploring other treatments that simultaneously treat both symptoms of borderline personality disorder and alcohol disorder are recommended. (Gianoli, Jane, O’Brien, & Ralevski, 2012)

 

Gianoli, M. O., Jane, J.S., O’Brien, E., & Ralevski (2012). Treatment for comorbid borderline personality disorder and alcohol use disorders: A review of the evidence and future recommendations. Experimental and Clinical Psychopharmacology, 12 (4). 333-344.

 

Cindy A. Geil, M.A.
WKPIC Doctoral Intern

 

 

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Friday Factoids: The Skills System

 

 

Julie F. Brown has modified DBT techniques for use with individuals with intellectual disabilities. The Skills System is comprised of skills and tools for effectively managing emotions, thoughts, and actions. Her guide for clinicians, The Skills System Instructor’s Guide: An Emotion Regulation Skills Curriculum for All Learning Abilities (2011) can be purchased through Amazon.

 

See her website www.theskillssystem.com for more information about this practical approach. Several psychologists in our department have been trained on this system and are finding it extremely useful in our work at the hospital.

 

 

Danielle M. McNeill, M.S., M.A.
Doctoral Intern
Western State Hospital

 

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Site Visit Scheduled

 

 

WKPIC is happy to announce the scheduling of our APA site visit, on December 8-9, 2014.  Thanks to the many, many folks who have helped us to get this far in the process. Fingers crossed, and positive thoughts!

 

 

 

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Friday Factoids: New Synthetic Drug Alert

 

 

A dangerous new drug has been associated with several deaths in Indiana. The drug “N-bomb” (25i-NBOMe) is a synthetic substance considered easy to manufacture and classified as a hallucinogen similar to LSD. The substance takes many forms including white powder, brown powder, or liquid that is then mixed with alcohol or energy drinks or placed on blotter paper.

 

There are many reports that dealers are selling the substance as LSD, when in fact they are selling the more lethal “N-bomb.” Side effects can last approximately 15 hours and include hallucinations, confusion, panic, paranoia, euphoria, anxiety, agitation, depression, violence, and death.

 

This substance is particularly dangerous because fatality can result from one dose, not just an overdose. The DEA classified this substance as a Schedule I substance in November 2013. The drug appears to be more popular among teens and young adults.

 

Danielle M. McNeill, M.S., M.A.
Doctoral Intern
Western State Hospital

 

 

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Friday Factoids: Good Resource for Treatment Planning

 

Developing specific and detailed treatment plans can be challenging when you are a new clinician. The Complete Adult Psychotherapy Treatment Planner, Fifth Edition (Jongsma, 2014) is a great resource that incorporates evidence-based interventions for 43 presenting problems.

 

This is a good place to start when wanting to tailor treatment plans for each individual client. The Practice Planners series has other adult treatment resources, The Adult Psychotherapy Progress Notes Planner (Jongsma, 2014) and Adult Psychotherapy Homework Planner (Jongsma, 2014), and similar resources for other populations including Child, Adolescent, Older Adult, Severe and Persisting Mental Illness, Personality Disorder, Co-Occurring Disorders, Addiction, Couples, Family, Group, Suicidal and Homicidal Risk, and Crisis Counseling and Traumatic Events.

 

Danielle McNeill, M.S., M.A.
WKPIC Doctoral Intern

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