Jordana Muroff

Racial differences in DSM diagnosis using a semi-structured instrument: the importance of clinical judgment in the diagnosis of African Americans.

Schizophrenia is diagnosed more frequently among African Americans while mood disorders are identified more often among whites. Such findings have raised serious questions about the accuracy of clinical judgment. This article analyzes data on 665 African American and white psychiatric inpatients using a semi-structured diagnostic instrument. The paper explores the relationship of patient race to schizophrenia, schizoaffective disorder, major depression, and bipolar disorder. The paper also explores the extent to which patient race is related to the manner in which clinicians link individual symptoms to diagnoses. Results indicate some significant race differences in diagnosis remain even when a semi-structured instrument and DSM criteria are used, whites, were more likely than African Americans to receive a diagnosis of bipolar disorder and less likely to be diagnosed with schizophrenia. There were no race differences in major depression. Some patterns of symptom attribution differed by race. The results are consistent with previous sociological research showing that patient race is related to diagnosis even when standardized diagnostic criteria are used. These findings underscore the importance of clinical judgment within the context of cross-race and cross-ethnic diagnosis. Clinical training programs must reduce ethnocentric bias by teaching the appropriate use of the socio-cultural information necessary to employ DSM-IVs Cultural Formulation.

Predictors of functional impairment in pediatric obsessive-compulsive disorder.

The current study examined factors associated with obsessive-compulsive disorder (OCD) related functional impairment among 99 youth with OCD. A trained evaluator administered the Childrens Yale-Brown Obsessive-Compulsive Scale, items assessing family accommodation, and a version of the Brown Assessment of Beliefs Scale that was modified for children. Youth completed the Child Obsessive-Compulsive Impact Scale-Child Version, Obsessive-Compulsive Inventory-Child Version, Multidimensional Anxiety Scale for Children, and Childrens Depression Inventory-Short Form. The childs parent completed the Child Obsessive-Compulsive Impact Scale-Parent Version. Results indicated that OCD symptom severity, depressive symptoms, and family accommodation were directly related to impairment, while insight was inversely related to functional impairment. Insight, family accommodation, and depressive symptoms predicted parent- and/or child-rated functional impairment above and beyond OCD symptom severity. Among symptom dimensions, contamination/cleaning and aggressive/checking symptoms were the only dimensions significantly associated with impairment. Assessment and treatment implications are discussed; specifically, we highlight how the variables of interest may impact clinical presentation and treatment course.

COGNITIVE BEHAVIORAL THERAPY FOR HOARDING DISORDER: A META‐ANALYSIS

Hoarding disorder (HD) is a new diagnosis in DSM‐5 (American Psychiatric Association, 2013). Cognitive‐behavioral therapy (CBT) appears promising for the treatment of HD, and has been tested in both individual and group settings.

Obsessive-compulsive disorder among African Americans and blacks of Caribbean descent: results from the National Survey of American Life.

Background: There is limited research regarding the nature and prevalence of obsessive‐compulsive disorder (OCD) among various racial and ethnic subpopulations within the United States, including African Americans and blacks of Caribbean descent. Although heterogeneity within the black population in the United States has largely been ignored, notable differences exist between blacks of Caribbean descent and African Americans with respect to ethnicity, national heritage, and living circumstances. This is the first comprehensive examination of OCD among African Americans and blacks of Caribbean descent. Methods: Data from the National Survey of American Life, a national household probability sample of African Americans and Caribbean blacks in the United States, were used to examine rates of OCD among these groups. Results: Lifetime and 12‐month OCD prevalence estimates were very similar for African Americans and Caribbean blacks. Persistence of OCD and rates of co‐occurring psychiatric disorders were very high and also similar between African American and Caribbean black respondents. Both groups had high levels of overall mental illness severity and functional impairment. Use of services was low for both groups, particularly in specialty mental health settings. Use of anti‐obsessional medications was also rare, especially among the Caribbean black OCD population. Conclusions: OCD among African Americans and Caribbean blacks is very persistent, often accompanied by other psychiatric disorders, and is associated with high overall mental illness severity and functional impairment. It is also likely that very few blacks in the United States with OCD are receiving evidence‐based treatment and thus considerable effort is needed to bring treatment to these groups. Depression and Anxiety, 2008. Published 2008 Wiley‐Liss, Inc.

Delivery of internet treatment for compulsive hoarding (D.I.T.C.H.)

This study tested the effectiveness of an existing private online CBT-based group intervention designed to help people with hoarding. Web-group participants were hypothesized to show more improvement in hoarding symptoms over time compared to those placed on a naturalistic waitlist. This web-based self-help group (N = 106 members, N = 155 waitlisted) includes a formal application process and requires that participants post action steps and progress at least once monthly. Members have access to educational resources on hoarding, cognitive strategies, and a chat-group. Potential research participants were invited to complete an anonymous web-based survey about their hoarding behaviors and clinical improvement on five occasions (3 months apart). The sample was mainly middle-aged, female and White. Regression analyses show that Recent members reported greater improvement and less clutter at 6 months (than Waitlist). Long-term members reported milder hoarding symptoms than Recent ones, suggesting benefits from group participation over time. All members showed reductions in clutter and hoarding symptoms over 15 months. Less posting activity was associated with greater hoarding severity. Online CBT-based self-help for hoarding appears to be a promising intervention strategy that may extend access to treatment. Evaluating the benefits of internet self-help groups is critical given growing popularity of and demand for web-based interventions.

GROUP COGNITIVE AND BEHAVIORAL THERAPY AND BIBLIOTHERAPY FOR HOARDING: A PILOT TRIAL

Group cognitive behavioral treatments (GCBTs) for hoarding have produced modest benefits. The current study examined whether the outcomes of a specialized GCBT improve upon bibliotherapy (BIB) for hoarding, as part of a stepped care model. We also explored whether additional home assistance enhanced GCBT outcomes.

The role of race in diagnostic and disposition decision making in a pediatric psychiatric emergency service

OBJECTIVE We investigated the influence of race/ethnicity in diagnostic and disposition decision-making for children and adolescents presenting to an urban psychiatric emergency service (PES). METHOD Medical records were reviewed for 2991 child and adolescent African-American, Hispanic/Latino and white patients, treated in an urban PES between October 2001 and September 2002. A series of bivariate and binomial logistic regression analyses were used to delineate the role of race in the patterns and correlates of psychiatric diagnostic and treatment disposition decisions. RESULTS Binomial logistic regression analyses reveal that African-American (OR=2.28, P<.001) and Hispanic/Latino (OR=2.35, P<.05) patients are more likely to receive psychotic disorders and behavioral disorders diagnoses (African American: OR=1.66, P<.001; Hispanic/Latino: OR=1.36, P<.05) than white children/adolescents presenting to PES. African-American youth compared to white youth are also less likely to receive depressive disorder (OR=0.78, P<.05), bipolar disorder (OR=.44, P<.001) and alcohol/substance abuse disorder (OR=.18, P<.01) diagnoses. African-American pediatric PES patients are also more likely to be hospitalized (OR=1.50, P<.05), controlling for other sociodemographic and clinical factors (e.g., Global Assessment of Functioning). CONCLUSIONS The results highlight that nonclinical factors such as race/ethnicity are associated with clinical diagnostic decisions as early as childhood suggesting the pervasiveness of such disparities.

Cognitive behavior therapy for hoarding disorder: follow-up findings and predictors of outcome.

A cognitive‐behavioral model of hoarding posits deficits in information processing, maladaptive beliefs about and attachments to possessions that provoke distress and avoidance, and positive emotional responses to saving and acquiring that reinforce these behaviors. A 26‐session individual cognitive‐behavioral therapy (CBT) based on this model showed significant reductions in hoarding symptoms and large effect sizes (Steketee et al.[1]).

You Can't Recover From Suicide: Perspectives on Suicide Education in MSW Programs

Suicide is a profound worldwide public health problem that has received increased attention in recent years. The major federal response, the National Strategy for Suicide Prevention, calls for more suicide education for mental health professionals, including social workers. Little is known about the amount of suicide education in MSW curricula nationwide. This study presents quantitative findings from 2 national surveys of MSW deans and directors and of MSW faculty on suicide education and qualitative findings from a series of faculty focus groups. Results suggest that MSW students receive 4 or fewer hours of suicide education in graduate school, and most deans and faculty do not have plans to increase suicide content. Barriers include lack of faculty expertise, crowded curricula, and other educational priorities. Implications are discussed.

Phenomenology and correlates of insight in pediatric obsessive–compulsive disorder

Obsessive-compulsive disorder (OCD) is marked by the presence of obsessions and/or compulsions that cause significant interference in an individuals life. Insight regarding symptoms in youth with OCD may affect accurate assessment, acceptance and motivation for treatment, tolerance of negative valence states (i.e., fear) and treatment outcome, so assessment of this construct and associated clinical characteristics is important. Accordingly, the current study sought to expand the literature on symptom insight by examining multi-informant ratings of insight from children, parents, and clinicians simultaneously and its relationship to varied clinical characteristics. One-hundred and ten treatment-seeking youth with a primary diagnosis of OCD, aged 6-17, participated in the study along with a parent/guardian. The nature of symptom conviction, fixity of ideas, and perceptions about the cause of the problems were important indicators in assessing child insight and resulted in a comprehensive, psychometrically-sound measure of insight. Insight was generally not strongly associated with clinical characteristics. Poor insight was moderately associated with less resistance of obsessive-compulsive symptoms, increased externalizing symptoms, and ordering symptoms. Overall, this study contributes further information into the nature and correlates of insight in youth with OCD, and provides a psychometrically sound approach for its assessment.