Sarah Edwards

Reluctance to seek help and the perception of anxiety and depression in the United kingdom: a pilot vignette study.

We investigated if reluctance to seek help could be explained by how people perceive an illness. Participants were members of the general public who had experienced mental health problems, for which approximately half had sought professional help. We asked them to rate the problems of 2 vignette characters using the Brief Illness Perception Questionnaire (BIPQ). Participants who had sought help were more likely to see the problems of the vignette characters as having more serious consequences and to understand their problems better, compared with those who had not sought help. The depression vignette character was seen as having a problem that was more serious but less amenable to treatment compared with the anxiety vignette character. Compared with men, women were likely to be more aware of the consequences and chronicity of depression. We conclude illness perceptions may help explain reluctance to seek help and discuss implications for encouraging consultation.

Supporting the Transition from Inpatient Hospitalization to School

The School Transition Program (STP) is a 3-month intervention developed to address the unique needs of youth transitioning back to school from an inpatient psychiatric hospitalization. The STP focuses on promoting communication across school, home, and hospital. It includes psychoeducation, emotional support for caregivers, and the creation of transition plans in collaboration with school staff and families. Matching interventions to the academic, social, emotional/behavioral needs of these youth and increasing support to their caregivers has the potential to ease stress, reduce challenges and promote success during and after the transition period.

Integrative Model of the Relationship Between Sleep Problems and Risk for Youth Substance Use

A burgeoning literature implicates sleep problems in risk for adolescent substance misuse as well as a negative prognostic indicator of substance abuse treatment response. Mechanisms underlying the relationship between sleep problems and propensity to abuse substances during this phase of development have yet to be elucidated. Many questions also remain about this relationship given the paucity of integrative models and data from prospective studies with a pre-drug exposure baseline. Our integrative, temporal model theorizes that sleep problems may increase propensity to substance misuse through interactions with emotion dysregulation and cognitive deficits. Stress exposure may exacerbate this confluence of factors, and ongoing hormonal and brain changes during puberty may also contribute to the relationship between stress and risk for substance misuse. Finally, substance use itself worsens sleep problems and further dysregulates emotion and cognition, promoting an escalating pattern of use. If sleep problems increase risk for substance misuse and treatment intractability, greater attention to causes of sleep problems in young people would have significant preventive and/or ameliorative implications given the malleability of these functions.

Does Early Mentorship in Child and Adolescent Psychiatry Make a Difference? The Klingenstein Third-Generation Foundation Medical Student Fellowship Program

ObjectiveThere is a critical shortage of child and adolescent psychiatrists in the United States. Increased exposure, through mentorship, clinical experiences, and research opportunities, may increase the number of medical students selecting child and adolescent psychiatry (CAP) as a career choice.MethodBetween 2008 and 2011, 241 first-year participants of a program to increase exposure to CAP, funded by the Klingenstein Third-Generation Foundation (KTGF) at 10 medical schools completed baseline surveys assessing their opinions of and experiences in CAP, and 115 second-year participants completed follow-up surveys to reflect 1 year of experience in the KTGF Program.ResultsStudents reported significantly increased positive perception of mentorship for career and research guidance, along with perceived increased knowledge and understanding of CAP.ConclusionsResults suggest that the KTGF Program positively influenced participating medical students, although future studies are needed to determine whether these changes will translate into more medical students entering the field of CAP.

The Family Value of Information, Community Support, and Experience Study: Rationale, Design, and Methods of a "Family-Centered" Research Study.

Abstract The Patient Protection and Affordable Care Act focuses on improving consumer engagement and patient-centered care. This article describes the design and rationale of a study targeting family engagement in pediatric mental health services. The study is a 90-day randomized trial of a telephone-delivered Family Navigator services versus usual care for parents of Medicaid-insured youth younger than 13 years with serious mental illness. Youth are identified through a pediatric antipsychotic medication preauthorization program. Family Navigators offer peer support to empower and engage parents in their childs recovery. Outcomes include parent report of empowerment, social support, satisfaction with child mental health services, and child functioning as well as claims-based measures of psychotherapy service utilization and antipsychotic medication dosage. The focus on “family-centered” care in this study is strongly supported by the active role of consumers in study design and implementation.

Case 2: fatigue and abnormal behavior in a 17-year-old boy.

1. Dina Sztein, MD, MPH 2. Carol Vidal, MD, MPH 3. Amy Lowe, MD 4. Sarah Edwards, DO 1. Department of Psychiatry and Department of Child and Adolescent Psychiatry, University of Maryland, Baltimore, MD. A 17-year-old boy presents to the emergency department with nausea and abdominal pain of 1-day duration. He has had 3 episodes of emesis, along with intermittent epigastric abdominal pain, fever, and a sore throat. Two weeks ago, he began to have decreased energy. In addition, his parents report decreased appetite and oral intake for more than a year. The patient was diagnosed as having nephrotic syndrome at age 3 years. He subsequently had several flairs of proteinuria treated successfully with prednisone. At age 5 years, he began daily treatment with immunosuppressants and prednisone as needed for flairs; however, he had not received any corticosteroids for 18 months before the current hospitalization. At age 14 years, he presented with a similar episode of weakness, nausea, and abdominal pain, was diagnosed as having adrenal insufficiency by an adrenocorticotropic hormone (ACTH) stimulation test, and discharged with a 4-day prednisone taper. After the corticosteroid taper, on subsequent testing he was found to have normal adrenal function. After this hospitalization, his grades began to decline, and he developed psychiatric symptoms. He was anxious, avoided food for fear of poisoning, thought he had “special powers,” and believed he was “The One.” He was referred by his nephrologist to a psychiatrist for a diagnosis of schizophrenia, which was supported by a comprehensive psychological evaluation. On examination in the emergency department, his blood pressure is 100/55 mm Hg with a pulse of 120 beats per minute. His weight has decreased from the 90th percentile to the 49th percentile during the last 6 months. He does not appear to be in acute distress, and his physical examination …