Friday Factoids: Study Identifies Two Genes that Boost the Risk for Post-Traumatic Stress Disorder

 

How much do you know about Post-Traumatic Stress Disorder? By now, it would appear that the general population has heard of this disorder and are aware of what it is at least on a fairly rudimentary level.

 

PTSD currently affects approximately 7 % of the population of the United States and has become a pressing health issue for veterans of war. Have you ever wondered about such variables as the threshold for what will cause PTSD? For instance, two people could experience the same motor vehicle collision, yet only one of them may develop PTSD symptoms. Why is that? Researchers from the University of California, Los Angeles (UCLA) have recently linked two gene variants to PTSD. This suggests that hereditary factors can influence an individual’s risk of developing PTSD. These new findings could provide a biologically based approach for diagnosing and treating PTSD more effectively. 

 

Dr. Armen Goenjian and his team discovered two genes, COMT and TPH-2, which are linked to PTSD. These two genes play important roles in brain function. COMT is an enzyme that degrades dopamine, a neurotransmitter that assists in regulating thinking, mood, attention, and behavior, as well as controlling the brain’s pleasure and reward centers. TPH-2 controls the production of serotonin, a brain hormone that regulates mood, alertness, and sleep–all areas that are disrupted by PTSD. Dr. Goenjian and his team found significant associations between variants of COMT and TPH-2 with symptoms of PTSD. This may be indicative that these genes contribute to both the onset and the persistence of PTSD.

 

The results yielded from the study suggest that individuals that carry the genetic variants of COMT and TPH-2 may be at a higher risk of developing PTSD after a traumatic event. Now that scientists have begun to develop new ways of assessing risk factors for PTSD, what benefits do you believe can come from it? Would examination of these two genes play a role in recruitment criteria for the armed forces? Let me know what you think.

 

References
Goenijian, A., Noble, E., Stenberg, A., Walling, D., Stepanyan, S., Dandekar, S., and Bailey, J. (2015). Association of COMT and TPH-2 genes with DSM-5 based PTSD symptoms. Journal of Affective Disorders, 172.

 

University of California, Los Angeles (UCLA), Health Sciences. (2015, January 9). Study identifies two genes that boost risk for post-traumatic stress disorder. ScienceDaily. Retrieved January 12, 2015 from www.sciencedaily.com/releases/2015/01/150109123321.htm

 

Faisal Roberts, MA
WKPIC Doctoral Intern

 

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Friday Factoid: Optimism is Heart Healthy!

 

By now most people are aware, at least to some degree, of things that are good for your heart.  Exercise? Check. Oatmeal? Done. Salmon? Affirmative. Managing Stress effectively? Why of course! Now let’s throw in a healthy dose of optimism for good measure! Results yielded from a new study conducted by the University of Illinois are suggestive that optimism can lead to improved heart health.

 

Led by Dr. Rosalba Hernandez, a professor of social work, the study examined more than 5,100 adults between the ages of 45 and 84. The construct of cardiovascular health was calculated by assessing seven dimensions: blood pressure, body mass index, fasting plasma glucose and serum cholesterol levels, dietary intake, physical activity, and tobacco use. These are the current metrics used by to American Heart Association to assess heath health. Each of these seven dimensions were rated either zero, one, or two (denoting poor, intermediate, and ideal scores, respectively) with higher scores corresponding with healthier heart states. To evaluate level of optimism, the participants completed surveys measuring mental health, levels of optimism, and physical health. In their results, a correlation was found between the participants’ total health score and their levels of optimism.

 

So it looks like we now have another reason to maintain a healthy, optimistic outlook on life!

 

Nauert, R. (2015). Optimism is heart healthy. Psych Central. Retrieved on January 12, 2015.

 

 

Faisal Roberts, M.A.
WKPIC Doctoral Intern

 

 

 

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Friday Factoid: Origin of New Year’s Resolutions

We are now a little past one week into the new year of 2015. Did you make a New Year’s Resolution? If so, how well have you done with keeping it? I have never personally made one, for reasons that I’m unsure of. I didn’t decide to never make them; I just haven’t for whatever reason. Thinking about all of this made me wonder about the origin of making resolutions. Where did this custom start? When beginning my search, I expected a myriad of contradicting answers with the specific origin being evasive and somewhat ambiguous. However, from the little research that I’ve conducted, the answer appears generally consistent amongst a few different sources.

 

Before New Year’s was celebrated in January, it was celebrated in what we now know as the month of March by the Babylonians nearly 4,000 years ago. This time period was chosen as the start of the New Year as it was the beginning of spring time when the leaves come back and the crops grow, hence why it was a logical choice for them (Blaire, 2006). The Babylonians made promises to their gods at the beginning of the year, with promises to repay their debts and return borrowed objects. The Romans changed New Year’s to January in 153 B.C. (Blaire, 2006), named after one of their gods, Janus, the two faced god that could look backward at the old year while simultaneously looking forward at the new year (Petro, 2015). As opposed to returning objects and repaying debts, their resolutions generally regarding treating each other better.  Today, New Year’s Resolutions can encompass a wide variety of areas, but with personal improvement being the center (Blaire, 2006; Petro, 2015). Common resolutions include those pertaining to fitness, finances, altruism, kindness, charity, volunteer work, career goals, reading habits, learning new skills, giving up vices, etc. 

 

What do you think of New Year’s Resolutions? Is it a great way to kick off the new year with a positive mentality? A pointless endeavor that leads people to feel bad when they invariably fail on their goals? Or somewhere in the middle? Either way, belated happy new years from all of us at WKPIC!

 

Blaire, Gary, R. (2006). The History of New Year’s Resolutions. As retrieved from: http://ezinearticles.com/?The-History-of-New-Years-Resolutions&id=245213

 

Petro, Bill. (2015). History of New Year’s Resolutions: Where Did They Begin?
As retrieved from: http://billpetro.com/history-of-new-years-resolutions

 

Faisal Roberts, MA
WKPIC Doctoral Intern

 

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Friday Factoid Catch-Up! Diabetes in Midlife Linked to Cognitive Decline 20 Years Later

 

New research from the John Hopkins Bloomberg School of Public Health reveals informative and quite honestly startling data regarding the correlation between diabetes in midlife and cognitive decline in older age. There is a strong correlation between the declination of cognitive processes such as memory, word recall, and executive functioning and the progression of dementia. Results yielded from the research suggest that diabetes tends to age the mind five years faster than the normative effects of aging. For example a 60-year-old with diabetes experiences a similar amount of cognitive decline as a 65-year-old without diabetes.

 

This study, led by Dr. Elizabeth Selvin, is thought to be the longest running study of its kind as it followed a cross-section of adults as they aged. For the study, Dr. Selvin used data from the Atherosclerosis Risk in Communities Study (ARIC), which began in 1987 and contains a participant pool of 15, 792 adults from four different states. The participants were evaluated (including a cognitive evaluation) four times, approximately three years apart, beginning in 1987. The participants were then seen a fifth and final time between 2011 and 2013. The researchers found that the participants with poorly controlled diabetes experienced cognitive decline that was 19 % worse than expected for their age group.

 

This research emphasizes the importance of a healthy lifestyle as it can potentially prevent diabetes and, now evidently, dementia. The cost of dementia nationwide was estimated to be approximately 159 billion dollars in 2010. With the fact that people are living longer than ever before, the cost of dementia is estimated to increase by an additional 80 billion dollars within the next 25 years. Dr. Selvin states that even if we could delay dementia for a few years, it could have a huge impact on the population in terms of both quality of life and healthcare costs. With America experiencing its highest obesity rates for both children and adults, it does not bode well regarding the estimated future prevalence of dementia. However, if this information is proliferated and embraced, it may have the potential to motivate people into adopting a healthier lifestyle to avoid the tragic fate of dementia.

 

Johns Hopkins Bloomberg School of Public Health. (2014, December 1). Diabetes in midlife linked to significant cognitive decline 20 years later. ScienceDaily. Retrieved January 5, 2015.

 

Faisal Roberts, MA
WKPIC Doctoral Intern

 

 

 

 

 

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Friday Factoid Catch-Up! What Exactly Is Boxing Day?

 

 

Have you heard of Boxing Day?

 

December 26th is a holiday celebrated in England and many other countries (including Canada, where I am from!). Today, Boxing Day is similar to the American Black Friday (which is not celebrated in Canada). On Boxing Day in Canada, stores open early with many sales and deals. Just like here in the United States, people flock to stores and malls in huge numbers. However, historically, Boxing Day served a different purpose.

 

Unfortunately, Boxing Day seems to have lost its meaning and even the historical significance of the day is only theories. Some say that Boxing Day began in England in the Middle Ages as the servants’ day off (because they were required to work on Christmas Day).

 

Even this theory has two endings, as some people say that the servants made boxed lunches for the employers to eat while the servants took the day off and others say that the employers gave the servants gift boxes. Another theory entirely is that churches placed boxes where parishioners gave coins and the coins were given to the poor on Boxing Day.

 

Lemm, Elaine. (2014). What is Boxing Day? Why is it called Boxing Day?

 

 

Brittany M. Best, M.A.
WKPIC Doctoral Intern

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Happy New Year from WKPIC!

2015 Good Wishes

 

 

This is the view from my front porch in the spring and summer. As we head into the depths of winter, I’m sharing it, along with a favorite quote sent to me by dear friend, and wishing everyone reading this a fulfilling and wondrous 2015. For all the interns traveling for interviews, be safe, be confident, and be yourselves–and know that this is (and always has been) enough. You are the future of our field, and internships all over the country are looking forward to meeting you.

 

Sincerely,

Susan R. Vaught, Ph.D.
WKPIC Training Director

 

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Friday Factoid: Connection Between Work-Related Burnout and Depression

 

 

The International Journal of Stress Management found a link between atypical depression and work-related burnout. The researcher studied over 5,500 school teachers and discovered that 90% of those school teachers who were identified as burned out also met the diagnostic criteria for depression. Furthermore, he found that 63% of those individuals had atypical depression features.

 

What are typical depression features? According to the DSM-5, the criteria for the “with atypical features” specifier for Major Depressive Disorder or Persistent Depressive Disorder are as follows for (occurring during the majority of the days during an episode):

A. Mood reactivity (i.e. mood brightens in response to actual or potential positive events.

B. Two (or more) of the following:

1. Significant weight gain or increase in appetite.

2. Hypersomnia.

3. Leaden paralysis (i.e. heavy, leaden feelings in arms or legs).

4. A long-standing pattern of interpersonal rejection sensitivity (not limited to episodes of mood disturbance) that results in significant social or occupational impairment.

C. Criteria are not met for “with melancholic features” or “with catatonia” during the same episode.”

 

The researcher stated that the link between work-related burnout and depression has been “largely underestimated” and noted that the findings suggest that depressive symptoms may be “central concerns” in managing and working with burnout.

 

Nauert, R. (2014). Work burnout linked to atypical depression. PsychCentral.

 

Brittany Best, MA
WKPIC Doctoral Intern

 

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Factors Predicting Readmission to Inpatient Psychiatric Hospitals

Readmission to inpatient psychiatric hospitals within one year of discharge is approximately 40-50% (Bridge & Barb, 2004).  Given that most psychiatric conditions are characterized as having a chronic, relapsing course, readmission seems quite possible. Such prevalence and course of the illness indicates that readmission is a noteworthy concern, especially related to the impact on the patient’s life, as well as the cost on the health care system (Moss et al., 2014).  Additionally, readmission rates are often considered a quality of care indicator, reflecting the quality of care received while inpatient and the transition back to outpatient care (Simone, Taylor, Fung, & Kurdyak, 2013).  Consequently, readmission is often perceived negatively, at times a failure, in that the goal of discharge is for the patient to successfully reintegrate into the community.  Thus, understanding factors associated with readmission is vital and hopefully associated with the development of preventive measures.

 

This review will discuss findings from two studies, one conducted by Moss et al. (2014) in examining readmission over a period 180 days, and the other conducted by Callaly, Hyland, Trauer, Dodd, and Berk (2010) examining rapid readmission over a period of 28 days.

 

Moss et al. Review
Moss et al. (2014) conducted a study to determine predictors of readmission to a general psychiatry inpatient unit.  They note that given the deinstitutionalization of mental health care, hospital stays are often shorter and readmission is noted to be an indicator for future admissions.  In their literature review, Moss et al. indicated that history of previous admissions, length of stay, the presence of a psychiatric illness, substance abuse, personality disorder diagnosis, medical comorbidity, male gender, marital status, homelessness, unemployment, and first involuntary admission are all significant predictive factors for readmission.  Also, specific to service-related factors, access to follow-up care, community support, and being discharged against medical advice were predictive of readmission.

 

Purpose and Methods
Moss et al.’s (2014) study conducted a retrospective review of inpatient data over a 30 month period between 2006 and 2008 at a 35 bed teaching hospital.  They restricted readmission to within 180 days from the initial admission date.  The assessment instrument, Minimum Data Set-Mental health (MDS-MH), was administered upon admission and prior to discharge.  The MDS-MH collected data on 135 variables to capture demographic, health, and service related information.  Data from patients admitted during this time period were followed for 180 days monitoring for readmissions; resulting in identification of 758 (minus exclusions) discharges, with 190 patients diagnosed (DSM-IV criteria) with Schizophrenia and related disorders and 387 diagnosed with mood disorders.

 

Analyses and Results
A Cox regression analysis was used to analyze variables associated with time to readmission and possible covariates.  Based on the literature, Moss et al. (2014) identified variables as possible predictors:  age at admission, diagnosis of schizophrenia and related disorders, level of education, marital status, length of stay, gender, diagnosis of a personality disorder, substance abuse disorders, Global Assessment of Functioning (GAF) at discharge, maximum number of alcoholic drinks in one sitting, employment, income insurance assistance, history of ER visit, vocational, history of violence, number of psychiatric admission in past two years, and receiving a pass.

 

Within this sample, 21% (159) were readmitted within 180 days of discharge.  The sample was predominately male (45.3%), with an overall mean age of 39.6 (SD = 20.7).  The mean length of stay was 19.3 (SD = 21.2) days.  Covariates associated with time to readmission were receiving a pass, having one to two admissions in the past two years, and more than three psychiatric admissions in the past two years.  Other variables were not found to be significant.  In post hoc analyses, statistics indicate that the groups that did and did not receive a pass were not significantly different respective of diagnoses, but those with passes consisted of more men, longer lengths of stay, and higher GAF scores.

 

Discussion
Overall, results indicate that previous admissions were associated with readmission, in that patients with one to two admissions within the past two years were 15.6 times more likely to be readmitted, and those with greater than three admissions in the past two years were 24.2 times more likely to be readmitted.  Also, patients receiving a pass were 3.5 times more likely to be readmitted.  Though rationale for issuing passes are variable (i.e., ease transition back into the community, assess readiness for discharge), the literature suggests that the efficacy of such a practice is not well supported (Moss et al., 2014).  Unfortunately, the authors note that the use and purpose of the passes with these patients were unknown; however, Moss et al. (2014) contend that “the use of a pass does not fully mitigate the influence of these other factors” (Moss et al., 2014. P. 429).  Of note, they indicate the upon discharge participation in service related treatment was also unknown, which in the past has shown to significantly influence readmission.  Also, contrary to the literature, many factors previously associated with readmission were not significant in this study.  Concerning these findings and compared to the literature, Moss et al. (2014) conclude that specific predictive factors are not consistently associated with readmission.  Overall, previous admissions and use of passes prior to discharge were predictors of readmission at the facility sampled.

 

Callaly et al. Review

 

Purpose and Methods
Callaly et al. (2010) examined personal characteristics, characteristics of the initial admission, as well as characteristics of follow-up care after the initial admission to identify patients at high risk for readmission.  Their reference period for readmission was 28 days, for which same-day admissions were excluded.  The population for the study was from an integrated community and acute inpatient hospital with 20 adult beds for psychiatric admission.  During the period of the study (2005-2006) there were 635 admissions, with a 12% to 13% readmission rate.  Callaly et al. (2010) examined 26 variables associated with increased rapid readmission; though all variables were not listed, those selected were said to be consistent with the literature, as well as inclusive of data obtained from the Health of the Nation Outcome Scales (HoNOS) and information regarding follow-up care.  The sample consisted of 54 patients with consecutive readmission and 61 patients chosen at random of whom were not readmitted.  Data were analyzed through simple comparison and logistic regression.

 

Results
The trend of readmission indicated that of the patients who were readmitted, 45% were readmitted within 7 days, 68% readmitted within 14 days, and 91% readmitted in 21 days.  Comparison data between the readmitted group and the non-readmitted group indicated that patients who were readmitted were more likely to have had an admission the previous year, were more likely to be on Disability support, and were less likely to have had a discharge plan in place.  Further, patients who received follow-up care within seven days were more likely to be readmitted.  A notable data trend was that patients with Borderline Personality Disorder or who were unemployed were more likely to be readmitted.  The authors note no significant difference between the groups respective of sex, discharge facility, age on onset for psychiatric care, and recent history of substance use or criminal involvement.   There were also no significant differences in HoNOS scores between groups.

 

Of the variables examined, seven factors that were significantly (or nearly significant) different between the two groups were entered in to a multiple logistical regression analysis.  Results indicate that the number of previous admissions, having no discharge plan in place or sent to the patient’s general physician, and contact with community mental health within seven days were associated with early readmission.  Finally, to examine the relationship further, these results were entered into a forward stepwise regression, which again indicated that number of admissions in the previous year, no discharge plan being sent, and contact within first seven days after discharge were all significant predictors of rapid readmission.

 

Discussion
The authors note that low treatment efficacy within the inpatient setting, poor discharge planning, and inadequate follow-up care may contribute to early readmission.

 

 

Unfortunately, the literature specific to identifying predictors for readmission are at times contradictory, and may be specific to the setting or region being studied.  Overall, the most consistent and strongest predictor in Callaly et al. (2010) was the number of prior admissions.  They highlight the importance of discharge planning, in that more preparation, especially for those with previous admissions, may be beneficial to the patient. Even still, the factors associated with rapid readmission are complex; and consequently, the interrelatedness of the factors associated with readmission may reflect reasons for rapid relapse.  In short, the authors recommend to further examine after care of those who are not readmitted in order to identify factors associated with readmission of comparable others.

 

General Conclusion
As noted by both sets of authors, readmission to a psychiatric facility is complex and multidimensional.  The literature indicates many potential factors are associated with readmission, but as Moss et al. (2014) and Callaly et al. (2010) both note, the findings are at times contradictory.  It appears that significant differences within the literature are related to diverse service characteristics and divergent sample characteristics being studied.  Therefore, differences create unique and perhaps limited generalizability of the findings, making it difficult to act proactively regarding preventative patient care.  The purpose of identifying predictive factors should be in regard to preventing readmission and providing the best care or after care for the patient.  For practical use, identifying factors within a comparable setting may be useful to understanding readmission patterns for a particular type of facility.

 

Overall, in both studies, and consistent with the literature, having previous hospital admissions increases the likelihood of readmission.  As noted by Callaly et al. (2010), examining discharge planning and after care may be necessary to direct intervention.  Yet, patient treatment compliance also becomes a critical factor, in that increased efforts for after care or discharge planning may be attempted, but ultimately rests on the participation of the client.  Even still, having the knowledge and awareness of potential high-risk patients for readmission may prompt practitioners to emphasize such trends upon discharge to the patient.   Finally, given the diverse findings throughout the literature makes it difficult to consistently identify factors associated with readmission.  Since readmission in not only detrimental to the patient but is often viewed as a quality indicator for the service provider, efforts to identify these variables should be continued.

 

References
Bridge, J. A., & Barb, R. P. (2004). Reducing hospital readmission in depression and Schizophrenia: Current evidence. Current Opinion in Psychiatry, 17, 505–511.

Callaly, T., Hyland, M., Trauer, T., Dodd, S., & Berk, M. (2010). Readmission to an acute psychiatric unit within 28 days of discharge: Identifying those at risk. Australian Health Review, 34(3),  282-228.

Moss, J., Li, A., Tobin, J., Weinstein, I. A., Harimoto, T., & Lanctoto, K. L. (2014). Predictors of readmission to a psychiatry impatient unit. Comprehensive Psychiatry, 55, 426-430.

Vigod, S. N., Taylor, V. H., Fung, K., & Kurdyak, P. A. (2013). Within-hospital readmission: An indicator of readmission after discharge from psychiatric hospitalization. Canadian Journal of Psychiatry, 58(8), 476-481.

 

Dannie S. Harris, M.A., M.A., M.A.Ed., Ed.S.
Practicum Trainee

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Friday Factoids: Making Better Choices with Holiday Food

 

 

With Thanksgiving behind us and the next holiday season coming up, many of us would like to avoid the extra pounds of holiday feasts! Psychcentral.com provided “5 Simple Steps to Avoid Overeating this Holiday Season.”

 

Acknowledging that most of us ignore our willpower over the holiday season, they created simple steps to help us make better choices with our food this holiday season.

 

These steps include:

 

1.  “Look at the food that is tempting you.” The author stated that looking at the food and recognizing that eating it is our choice is step number 1.

 

2.  “Imagine eating it.” He said that it’s okay to let your mouth water as you imagine eating and tasting the food, but make sure you keep going down these steps!

 

3.   “Now, imagine the food going down your throat and into your gut, where it will sit for the next several hours.” That thought might ruin the mouth watering! The author says to think about how your energy level will be and what your stomach will feel like after eating the food.

 

4.   “Ask yourself the question, “Do I want to feel how this food will make me feel?” Many of us struggle with mindless eating. We eat without thinking, which allows us to eat foods we wouldn’t normally eat and eat more than we would like to.

 

5.  “Make a choice.” If the answer to question 4 is “Yes” then go ahead! If the answer to question 4 is “No” it’s time to walk away.

 

The author stated that the purpose of this activity is to anticipate the feelings before you even eat the food. He wants us to think with our whole body (mind, stomach, taste buds) rather than just our taste buds.

 

He also highlighted that “self-sabotage” can be an issue for people and recommended this video to understanding self-sabotage and helping stop it!

 

Bundrant, M. (December 8, 2014). 5 Simple Steps to Avoid Overeating this Holiday Season. PsychCentral.com.

 

Brittany Best
WKPIC Doctoral Intern

 

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Friday Factoid: Vitamin D Has a Mental Health Connection

 

An article from U.S. News & World Report wrote about the importance of vitamin D and how our lives could depend on it! The article noted that some studies suggest that half of the world’s population has a vitamin D

deficiency. They went on to discuss the conditions to which vitamin D deficiency can lead including cancer, heart disease, multiple sclerosis, tuberculosis, brittle bones, the common cold, and depression. A study released in August noted a link between vitamin D deficiency and increased risk of developing Alzheimer’s. Furthermore, a study published this week even found a link between low levels of vitamins D and risk of early death. The article quoted John Cannell, found of the Vitamin D Council who stated, “Thirty-seven different tissues in the human body utilize vitamin D and need it for adequate functioning.”

How can you get enough vitamin D?

 

1.     The sun! Although the article stated that production of vitamin D from the sun

 

decreases with age and those individuals with darker skin need more sun exposure for sufficient levels of vitamin D. Furthermore, sunscreen decreases the production of vitamin D (Sunscreen is very important! There are other ways to get vitamin D. Read on!)

 

2.     Some foods: egg (especially egg yolks), fatty fish (e.g. salmon, mackerel, and tuna), fo

 

rtified cow’s milk, fortified cereals and bread products.

 

3.     Supplements. According to the article, 800 international units of vitamin D per day is typically advised. It is possible to take in too much vitamin D, so do your research!

 

 

 

Woodham, C. (November 20, 2014). Are you getting enough vitamin D? U.S. News & World Report Health.

 

Brittany Best,
WKPIC Intern

 

 

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