Joanne DeSanto Iennaco

A Review of Ecological Factors Affecting Inpatient Psychiatric Unit Violence: Implications for Relational and Unit Cultural Improvements

This review examines the research on ecologic factors that may contribute to or lessen the likelihood of inpatient unit violence. Understanding these factors can provide psychiatric inpatient unit staff with valuable therapeutic relational and cultural strategies to decrease violence. International and US studies from OVID Medline, CINAHL, and PsycInfo that evaluated aggression and violence on psychiatric inpatient units between 1983 and 2008 were included in this review. The review revealed that violence results from the complex interactions among the patient, staff, and culture of the specific unit. Inpatient psychiatric staff can decrease the potential for violence by using therapeutic relationship strategies such as using good communication skills, advocating for clients, being available, having strong clinical assessment skills, providing patient education, and collaborating with patients in treatment planning. Cultural improvements include providing meaningful patient activities and appropriate levels of stimulation and unit staffing.

Effects of Externally Rated Job Demand and Control on Depression Diagnosis Claims in an Industrial Cohort

This study examined whether externally rated job demand and control were associated with depression diagnosis claims in a heavy industrial cohort. The retrospective cohort sample consisted of 7,566 hourly workers aged 18–64 years who were actively employed at 11 US plants between January 1, 1996, and December 31, 2003, and free of depression diagnosis claims during an initial 2-year run-in period. Logistic regression analysis was used to model the effect of tertiles of demand and control exposure on depression diagnosis claims. Demand had a significant positive association with depression diagnosis claims in bivariate models and models adjusted for demographic (age, gender, race, education, job grade, tenure) and lifestyle (smoking status, body mass index, cholesterol level) variables (high demand odds ratiou2009=u20091.39, 95% confidence interval: 1.04, 1.86). Control was associated with greater risk of depression diagnosis at moderate levels in unadjusted models only (odds ratiou2009=u20091.47, 95% confidence interval: 1.12, 1.93), while low control, contrary to expectation, was not associated with depression. The effects of the externally rated demand exposure were lost with adjustment for location. This may reflect differences in measurement or classification of exposure, differences in depression diagnosis by location, or other location-specific factors.

Use of medical insurance claims data for occupational health research.

Objective: The objective of this study was to demonstrate that health claims data, widely available due to the unique nature of the U.S. healthcare system, can be linked to other relevant databases such as personnel files and exposure data maintained by large employers. These data offer great potential for occupational health research. Methods: In this article, we describe the process for linking claims data to industrial hygiene exposure data and personnel files of a single large employer to conduct epidemiologic research. Results: Our results demonstrate the ability to replicate previously published findings using commonly maintained data sets and illustrate methodological issues that may arise as newer hypotheses are tested in this way. Conclusions: Health claims files offer potential for epidemiologic research in the United States, although the full extent and guidelines for successful application await further clarification through empiric research.

Diagnosing adult attention‐deficit hyperactivity disorder: the importance of establishing daily life contexts for symptoms and impairments

This integrative literature review examines the complexity of diagnosing attention-deficit hyperactivity disorder (ADHD) in adults with regard to the presence of symptoms and comorbidities common to mood, anxiety and other disorders. In adults, symptoms are often masked by the patients learned compensatory mechanisms. Misdiagnosis, and subsequent treatment, can moderate common symptoms without relieving the core difficulties of inattention, hyperactivity and impulsivity. This review was conducted to identify methods of improving diagnostic clarity. The literature reveals the importance of evaluating both retrospective and current symptoms and impairments in the context of the individuals life. Careful, nuanced assessment of the relationship between symptom expression and impairment in daily living offers diagnostic clarity. Symptoms common to multiple disorders will be distinguished by illuminating the context in which they arise and are experienced. Well-supported assessments, sensitive to the context in which symptoms and impairments present, will result in greater diagnostic accuracy, better treatment outcomes and enhanced quality of life. Accurate diagnoses will contribute to the understanding of adult ADHD and remind both clinicians and the public that this disorder is often present in adults as well as children.

Psychopharmacology of pediatric bipolar disorder.

This comprehensive literature review incorporates research studies evaluating the effectiveness of psychotropic medications in children and adolescents with pediatric bipolar disorder. Research articles were obtained using Medline. Open-label studies, prospective and retrospective chart reviews and randomized controlled trials evaluating the effectiveness of medication in pediatric bipolar disorder with greater than ten subjects are included in this article. Antipsychotics, anticonvulsants and lithium as monotherapy, as well as their use in combination treatment, were evaluated to determine their effectiveness in pediatric bipolar disorder. Clinical recommendations of medication and management strategies are made from a synthesis of the data. In addition, adherence concerns caused by adverse effects and nonresponse as they impact physical and mental health are addressed.

Correlation Between Levels of Conflict and Containment on Acute Psychiatric Wards: The City-128 Study

OBJECTIVE Attainment of safe, calm inpatient psychiatric wards that are conducive to positive therapeutic care is crucial. On such wards, rates of coerced medication, seclusion, manual restraint and other types of containment are comparatively low, and, usually, rates of conflict-for example, aggression, substance use, and absconding-are also low. Sometimes, however, wards maintain low rates of containment even when conflict rates are high. This study investigated wards with the counterintuitive combination of low containment and high conflict or high containment and low conflict. METHODS The authors conducted a secondary analysis of cross-sectional data collected from 136 acute psychiatric wards across England in 2004-2005. The wards were categorized into four groups on the basis of median splits of containment and conflict rates: high conflict and high containment, high conflict and low containment, low conflict and low containment, and low conflict and high containment. Features significantly associated with these ward types were identified. RESULTS Among the variables significantly associated with the various typologies, some-for example, environmental quality-were changeable, and others-such as social deprivation of the area served-were fixed. High-conflict, low-containment wards had higher rates of male staff and lower-quality environments than other wards. Low-conflict, high-containment wards had higher numbers of beds. High-conflict, high-containment wards utilized more temporary staff as well as more unqualified staff. No overall differences were associated with low-conflict, low-containment wards. CONCLUSIONS Wards can make positive changes to achieve a low-containment, nonpunitive culture, even when rates of patient conflict are high.

Cognitive behavioral therapy for insomnia in stable heart failure: Protocol for a randomized controlled trial

BACKGROUNDnChronic insomnia is associated with disabling symptoms and decrements in functional performance. It may contribute to the development of heart failure (HF) and incident mortality. In our previous work, cognitive-behavioral therapy for insomnia (CBT-I), compared to HF self-management education, provided as an attention control condition, was feasible, acceptable, and had large effects on insomnia and fatigue among HF patients.nnnOBJECTIVESnThe purpose of this randomized controlled trial (RCT) is to evaluate the sustained effects of group CBT-I compared with HF self-management education (attention control) on insomnia severity, sleep characteristics, daytime symptoms, symptom clusters, functional performance, and health care utilization among patients with stable HF. We will estimate the cost-effectiveness of CBT-I and explore the effects of CBT-I on event-free survival (EFS).nnnMETHODSnTwo hundred participants will be randomized in clusters to a single center parallel group (CBT-I vs. attention control) RCT. Wrist actigraphy and self-report will elicit insomnia, sleep characteristics, symptoms, and functional performance. We will use the psychomotor vigilance test to evaluate sleep loss effects and the Six Minute Walk Test to evaluate effects on daytime function. Medical record review and interviews will elicit health care utilization and EFS. Statistical methods will include general linear mixed models and latent transition analysis. Stochastic cost-effectiveness analysis with a competing risk approach will be employed to conduct the cost-effectiveness analysis.nnnDISCUSSIONnThe results will be generalizable to HF patients with chronic comorbid insomnia and pave the way for future research focused on the dissemination and translation of CBT-I into HF settings.

Positive aspects of having had cancer: A mixed-methods analysis of responses from the American Cancer Society Study of Cancer Survivors-II (SCS-II)

This study focused on understanding positive aspects of cancer among a large, national sample of survivors, 2, 5, and 10 years postcancer diagnosis, who responded to the American Cancer Society Study of Cancer Survivors ‐ II (SCS‐II) survey “Please tell us about any positive aspects of having cancer.”

A randomized study on the effect of modified behavioral activation treatment for depressive symptoms in rural left-behind elderly

Abstract Objective: To evaluate the effectiveness of a modified behavioral activation treatment (MBAT) intervention on reducing depressive symptoms in rural left-behind elderly. Method: This is a randomized study registered in Chinese Clinical Trial Registry (ChiCTR-IOR-17011289). Eighty rural left-behind elderly people who had a Geriatric Depression Scale (GDS) score between 11 and 25 were randomly assigned to the intervention (nu2009=u200940) and control group (nu2009=u200940). The intervention group received both MBAT and regular treatment for 8 weeks while the control group received regular treatment. Both groups were assessed with the GDS, Beck Anxiety Inventory (BAI), and Oxford Happiness Questionnaire (OHQ) at baseline, immediately post-intervention, and at 3 months post-intervention. Results: There were a total of 73 participants that completed the intervention. The scores of GDS and BAI decreased significantly, but the scores of OHQ increased significantly in the intervention group after 8 sessions of MBAT (Pu2009<u2009.01). The reduction in depression symptoms after the intervention was maintained at the 3-month follow-up. Significant differences in GDS, BAI, and OHQ scores were observed between the intervention group and the control group (Pu2009<u2009.01). Conclusion: MBAT produced a significantly greater reduction in depressive symptoms than regular care in rural left-behind elderly. Clinical or methodological significance of this article: A modified behavioral activation (BA) psychotherapy can significantly reduce the recurrence and seriousness of depression symptoms in the left-behind elderly with mild to moderate depression. This study also suggests that further study of the MBAT as an intervention will provide a direction for the management of mental health in rural left-behind elders.

Positive Aspects of Having Had Cancer: A Mixed-methods Analysis of Responses from the American Cancer Society Survivors of Cancer-II Studies

This study focused on understanding positive aspects of cancer among a large, national sample of survivors, 2, 5, and 10 years postcancer diagnosis, who responded to the American Cancer Society Study of Cancer Survivors ‐ II (SCS‐II) survey “Please tell us about any positive aspects of having cancer.”