Rafael A. Rivas-Vazquez

Current issues in anxiety and depression: Comorbid, mixed, and subthreshold disorders

Recent attention has been given to the high frequency of coexisting anxiety and depressive symptoms that has served to challenge the more traditional view that these two disorders are typically discrete syndromes. Furthermore, research suggests that less severe states of anxiety and depression continue to be overlooked, despite their capacity to produce significant psychosocial impairment. Given the implications for diagnostic and treatment outcome, psychologists need to be aware of the epidemiology, clinical presentations, and treatment strategies surrounding comorbid and subthreshold anxiety and depression. We review the literature, present issues related to these syndromes, and discuss the implications for diagnostic and clinical activities.

Neuropsychological Test Development and Normative Data on Hispanics

The development of culturally relevant psychological assessment tools and intervention procedures has not been commensurate with the rate of Hispanic population growth in the United States. The development of valid and reliable test measures for the assessment of this population must be based on empirical investigations. In this article, we present normative data on multiple measures from the Benton Laboratory and the Wisconsin Card Sorting Test. Results revealed equivalent findings for our Hispanic subjects and the English-speaking samples utilized in the original normative studies within the United States. We additionally review current trends and specific problems encountered in neuropsychological research with Hispanics, and suggest guidelines and directions for future research.

Mild cognitive impairment: new neuropsychological and pharmacological target

Mild cognitive impairment (MCI) is increasingly being conceptualized in the literature as a cognitive disturbance representing a transitional phase between normal aging and dementia. The operational definitions of MCI provide an opportunity for neuropsychologists to detect subtle deficit and monitor cognitive status sequentially in order to determine rate and degree of progression. More importantly, clinical and neuropsychological studies are needed that can better characterize which MCI patients are at greatest risk for conversion to dementia. Preliminary data has also designated MCI as a potential indicator for initiation of pharmacotherapy, with the objective of decelerating rate of progression to dementia. Current criteria and clinical issues related to MCI are discussed, with the objective of better familiarizing clinicians with this syndrome and fostering ongoing investigations.

Development of a spanish version of the Schwartz Outcome Scale-10: a brief mental health outcome measure.

The lack of culturally appropriate psychometric instruments for the assessment of cognitive and emotional functioning in minority populations has been a concern often discussed in the assessment literature. With the increased focus on the measurement of outcome in mental health treatment, the lack of appropriate instruments for minorities has become readily apparent in this venue as well. We report on the Spanish translation of a brief and reliable measure of psychological health and well-being that has been shown to be sensitive to treatment outcomes. The original and Spanish translated versions of this measure are highly correlated, providing clinicians and organizations with a instrument that can be used for assessment of psychological well-being and treatment outcomes with Hispanic patients.

A Relationship-Based Care Model for Jail Diversion

OBJECTIVE This study assessed the effectiveness of a postbooking jail diversion program for a homeless population with mental illness in South Florida, as measured by rate of arrests after admission to the program. The program (termed relationship-based care) is structured to ensure access to psychiatric and primary health care, delivered within a theoretical framework developed for working with this population. METHODS Data were reviewed from the Criminal Justice Information System in Miami-Dade County for 229 adults who were arrested and found to be appropriate for jail diversion. Data for 151 individuals who were consecutively diverted to the relationship-based care program were compared with data for a control group of 78 individuals who had been diverted to other programs in the community. Arrest rates for each participant during the year before diversion were compared with arrest rates for the year after diversion. In addition, for persons in the relationship-based care program, demographic data, type of homelessness (chronic or situational), and number of psychiatric contacts were analyzed to determine the impact of these variables on outcome. RESULTS A highly significant reduction in arrest rates for individuals diverted to the relationship-based care program was observed. However, the arrest rate for the control group remained nearly identical before and after diversion. For the relationship-based care group, prediversion arrest rates, duration of participation in the program, and number of psychiatric contacts accounted for a significant portion of the recidivism variance. CONCLUSIONS The relationship-based care model described here appears to be an effective strategy for reducing criminal recidivism. Length of participation in the program and involvement in psychiatric treatment were correlated with reduced arrest rates. Identifying individuals who are at risk of poor engagement in community services and subsequent premature departure remains a challenge.

Antidepressants as First-Line Agents in the Current Pharmacotherapy of Anxiety Disorders

Anxiety disorders represent the most prevalent psychiatric disorders occurring in the general population, with a high degree of associated morbidity, functional impairment, and health care utilization. Each year, approximately 16 million people suffer from an anxiety disorder, while an additional 12 million report comorbidity of anxiety and at least one other psychiatric disorder (Kessler et al., 1994). Greenberg et al. (1999) estimated the 1990 annual cost of anxiety disorders in the United States to be approximately

Development and Application of a Brief Multi-faceted Tool for Evaluating Inpatient Psychiatric Care

42.3 billion, with roughly 88% (or

Application of the Multilingual Aphasia Examination-Spanish in the Evaluation of Hispanic Patients Post Closed-Head Trauma

37.1 billion) being spent on psychiatric and nonpsychiatric medical treatment and prescription pharmaceutical costs. More than half of these costs were attributable to nonpsychiatric medical expenditures, raising the possibility that many patients go undiagnosed or misdiagnosed and consequently may receive inappropriate or inefficient treatment. This indicates that much can be done to increase awareness of the appropriate detection and treatment of anxiety disorders, and psychologists, particularly those in primary care and other nonpsychiatric settings, can be highly instrumental in improving quality of care and of life. Over the last decade, there has been a shift in the order of medications considered as first-line treatments for anxiety disorders. This transition was largely initiated by the introduction and consolidation of the selective serotonin reuptake inhibitors (SSRIs)—fluoxetine, paroxetine, sertraline, fluvoxamine, and citalopram—in the treatment of depression, and by the subsequent extension of these agents beyond depression to various anxiety disorders, such as obsessive-com pulsive disorder and panic disorder. These agents increase the amount of serotonin available in the neuronal synapse by blocking the reuptake pump that reabsorbs serotonin into the presynaptic neuron. Other new and atypical

Assessment and treatment of social anxiety disorder

Increasingly, hospitals are expected to monitor and document service delivery variables, such as treatment outcome and patient satisfaction with care, which are thought to be associated with the quality of care received by patients. Documenting the patients collaboration in the treatment-planning process also has become more important. However, for many clinically oriented units, translating these expectations into a useable instrument and an efficient measurement procedure is a complex and difficult task. This paper outlines the development of a brief multi-faceted program evaluation instrument and assessment process for completing these tasks. The authors describe the rationale behind their approach to these measurement issues, and they introduce an instrument capable of effectively measuring both outcome and satisfaction. They also provide an overview of how they apply the instrument in their inpatient psychiatry service. The strengths and weakness of this assessment strategy are reviewed.

Selective serotonin reuptake inhibitor discontinuation syndrome: Understanding, recognition, and management for psychologists

Despite the rapid increase of Hispanics in the U.S., there continues to be a lack of adequate psychological assessment tools to examine Spanish-speaking patients with cognitive or neuropsychological disturbances. We investigated the clinical utility of the Multilingual Aphasia Examination-Spanish (MAE-S) in the evaluation of language functions of Hispanic subjects post-traumatic brain injury (TBI). The performance of 40 TBI patients was compared to that of 40 age-, gender-, and education-matched normal controls. Subject groups differed on the Visual Naming (VN), Controlled Oral Word Association (COWA), and Token Test subtests. The VN and COWA subtests were the best discriminators of group membership. Distribution of scores for the patient group on the Rating of Articulation scale additionally indicate subtle articulatory difficulties post-TBI. For all subtests, trauma severity per Glasgow Coma Scale was the best predictor of language performance, over and above the contribution of other clinical and demographic variables. These results are consistent with prior reports of dysphasia post-TBI and suggest that the MAE-S is a sensitive and accurate measure to assess language disturbances in Hispanic populations.