Christina E. Newhill

Designing websites for persons with cognitive deficits: Design and usability of a psychoeducational intervention for persons with severe mental illness.

The purpose of this study was to develop an understanding of the design elements that influence the ability of persons with severe mental illness (SMI) and cognitive deficits to use a website, and to use this knowledge to design a web-based telehealth application to deliver a psychoeducation program to persons with schizophrenia and their families. Usability testing was conducted with 98 persons with SMI. First, individual website design elements were tested. Based on these results, theoretical website design models were used to create several alternative websites. These designs were tested for their ability to facilitate use by persons with SMI. The final website design is presented. The results indicate that commonly prescribed design models and guidelines produce websites that are poorly suited and confusing to persons with SMI. Our findings suggest an alternative model that should be considered when designing websites and other telehealth interventions for this population. Implications for future studies addressing the characteristics of accessible designs for persons with SMI and cognitive deficits are discussed.

A Clinical Trial to Test the Feasibility of a Telehealth Psychoeducational Intervention for Persons With Schizophrenia and Their Families: Intervention and 3-Month Findings

OBJECTIVE To evaluate the feasibility of a telehealth psychoeducation intervention for persons with schizophrenia and their family members. STUDY DESIGN Randomized controlled trial. PARTICIPANTS 30 persons with schizophrenia and 21 family members or other informal support persons. INTERVENTIONS Web-based psychoeducation program that provided online group therapy and education. MAIN OUTCOME MEASURES Measures for persons with schizophrenia included perceived stress and perceived social support; for family members, they included disease-related distress and perceived social support. RESULTS At 3 months, participants with schizophrenia in the intervention group reported lower perceived stress (p = .04) and showed a trend for a higher perceived level of social support (p = .06). CONCLUSIONS The findings demonstrate the feasibility and impact of providing telehealth-based psychosocial treatments, including online therapy groups, to persons with schizophrenia and their families.

Prevalence and Risk Factors for Client Violence toward Social Workers

The author reports findings from a random survey of National Association of Social Workers members from two states examining the prevalence, nature, and risk factors of client violence toward social workers. A majority of persons surveyed experienced client violence, with gender and setting as significant variables in determining risk. Implications for practice and policy are discussed.

Commonalities in social and non-social cognitive impairments in adults with autism spectrum disorder and schizophrenia.

Autism spectrum disorder (ASD) and schizophrenia are both conditions that are characterized by impairments in social and non-social cognition, yet commonalities in the magnitude and domains of cognitive deficits across these two conditions remain unclear. This study examined neurocognitive and social-cognitive functioning in 47 outpatients with schizophrenia, 43 verbal adults with ASD, and 24 healthy volunteers. A comprehensive neuropsychological battery assessing processing speed, attention, memory, and problem-solving domains was administered along with a social-cognitive battery of emotion processing. Results demonstrated large and significant impairments in emotion processing and neurocognition relative to healthy individuals in participants with autism (d=-.97 and -1.71, respectively) and schizophrenia (d=-.65 and -1.48, respectively). No significant differences were observed between those with ASD and schizophrenia on any cognitive domain assessed, and the areas of greatest impairment were identical across both disorders and included slowness in speed of processing and an inability to understand emotions. These findings indicate a high degree of similarity in the cognitive challenges experienced by verbal adults with autism and schizophrenia, and the potential need for trans-diagnostic remediation approaches to enhance cognition in these conditions.

Violent behavior in borderline personality.

Little is known about the nature and prevalence of interpersonal violence among individuals with borderline personality disorder (BPD). Employing a longitudinal, multi-site sample, this study examined the degree to which BPD constitutes a risk marker for future violent behavior, and describes the characteristics of violent individuals with BPD and the nature of their violence. Findings showed that 73% of BPD subjects engaged in violence during the one-year study period, and frequently exhibited co-morbid antisocial personality disorder (ASPD) and psychopathic characteristics. Reported violence was mostly characterized by disputes with acquaintances or significant others. Results also suggest that the shared variance among ASPD, psychopathy, and BPD served to diminish the independent predictive effect of BPD on violence. These findings point to violence as a serious and prevalent problem among individuals with BPD, for whom targeted violence reduction strategies that take into account ASPD and psychopathic co-morbidity must be developed.

An Investigation of Psychopathic Features Among Delinquent Girls Violence, Theft, and Drug Abuse

Although there has been intense interest in the application of the construct of psychopathy among juveniles, few studies have investigated psychopathic traits among adolescent females. To redress this, this study examines psychopathic features and tests their utility in predicting violent behavior, theft, and drug abuse in a statewide survey of 94 female juvenile offenders. Results indicate that interpersonal and affective facets of psychopathy, specifically narcissism and carefree nonplanfulness were significantly associated with violence and theft. Psychopathy features were not significantly associated with drug abuse. Study limitations and implications for future research are delineated.

Quality of Life for Persons Living with Schizophrenia: More Than Just Symptoms.

Quality of life is an important outcome for persons living with schizophrenia and for the treatment of schizophrenia. However, studies of quality of life among persons living with schizophrenia have focused primarily on the symptoms experienced by the individual. This study sought to determine the influence of unmet need and social support on the quality of life of individuals with schizophrenia. Thirty-two persons living in the community with schizophrenia or schizoaffective disorder were assessed on quality of life, psychopathology, unmet need and social support. Hierarchical regression analyses indicated that unmet need and social support are important contributors to the quality of life of a person with schizophrenia, even after controlling for symptoms. Implications for schizophrenia treatment are discussed.

A growth curve analysis of emotion dysregulation as a mediator for violence in individuals with and without borderline personality disorder.

Borderline personality disorder (BPD) is characterized by significant interpersonal conflict, however the factors that contribute to violence among this population are not well known. Individuals with BPD and other severe mental illnesses were followed in the community for 30 weeks post-inpatient discharge. Emotion dysregulation data and detailed measures of violence were collected every 10 weeks, along with measures of antisocial characteristics. Latent growth curve analyses were used to depict individual trajectories of emotion dysregulation throughout the course of the study, and the degree to which changes in emotion dysregulation mediated the risk-enhancing effect of BPD on subsequent interpersonal violence was assessed. Results showed that emotion dysregulation is a significant longitudinal mediator of violent behavior among individuals with BPD, and may serve as the primary mechanism that enhances risk for violence among this population. Implications for modifying existing treatment protocols to reduce interpersonal violence in this population are discussed.

Characterizing the longitudinal patterns of substance use among individuals diagnosed with serious mental illness after psychiatric hospitalization

AIM To characterize longitudinal patterns of substance use across a large sample of psychiatric patients discharged from inpatient admission, followed for 1-year post-hospitalization. DESIGN Prospective cohort study. SETTING Kansas City, MO, USA; Pittsburgh, PA, USA; Worcester, MA, USA. PARTICIPANTS Eight hundred and one schizophrenia-spectrum (n = 204), bipolar (n = 137) and depressive disorder (n = 460) patients from the MacArthur Violence Risk Assessment Study. MEASUREMENTS Symptoms, functioning, drug/alcohol use assessed by the Brief Psychiatric Rating Scale, the Global Assessment of Functioning, and substance use interviews. FINDINGS Patients used alcohol (67.0%; n = 540) and cannabis (30.0%; n = 237) more frequently than other substances up to 30 days before admission, and those with depressive and schizophrenia-spectrum used heroin more than individuals with bipolar (P = 0.023). Post-hospitalization, patients using alcohol (B = -0.15, P < 0.001) and cannabis (B = -0.27, P < 0.001) decreased, but patterns varied across diagnosis and genders. Patients using cannabis decreased at greater rates in depressive and schizophrenia-spectrum compared with bipolar (all P < 0.05), and more men used alcohol (B = 0.76, P < 0.001) and cannabis (B = 1.56, P < 0.001) than women. Cannabis (B = 1.65, P < 0.001) and alcohol (B = 1.04, P = 0.002) were associated with higher symptomatology; cannabis (B = -2.33, P < 0.001) and alcohol (B = -1.45, P = 0.012) were associated with lower functioning. CONCLUSIONS Substance use is frequent and associated with poor recovery in patients with serious mental illness recently discharged from psychiatric hospitalization. Addiction treatments personalized by diagnosis and gender may be effective for improving outcomes in people with serious mental illness.

Emotional Dysregulation: The Key to a Treatment Approach for Violent Mentally Ill Individuals

Prior research has suggested that psychopathy, substance abuse, and the presence of a personality disorder increase an individuals risk for violence toward others. Substantial clinical literature has established emotional dysregulation as a risk marker for violence toward self. It is hypothesized that emotional dysregulation may be an important component in a constellation of risk markers for violence toward others and may interact with psychopathy and substance abuse in individuals with personality disorders to enhance risk for violence. If these hypothesized relationships exist, it suggests that the development of an intervention approach which directly targets these factors may hold promise. A potential intervention approach based on dialectical behavioral therapy, with case illustrations, is provided.