Active Substance Abuse Research Articles

Examining the Impact of Coping Strategies on the Quality of Life in Children with Various Disabilities

Children with disabilities face unique challenges that affect their well-being and quality of life (QOL). This study explores the intersectionality of disability and coping strategies in Saudi Arabia, a context in which comprehensive research on this topic is scarce. Cultural barriers hinder research participation, and data on the prevalence of disabilities are limited. A cross-sectional design was used to capture the dynamic relationship between coping strategies and QOL. A stratified random sample of 369 children (aged 6-18 years) from diverse socioeconomic backgrounds was studied. QOL was measured using the short form-12 health survey to assess the physical and mental components. Coping strategies were assessed using the validated COPE inventory. A stepwise multiple regression analysis was performed to determine the association between QOL and coping strategies. The significance level was set at a P value of <0.05 throughout the analysis. The findings of this study revealed that participants with auditory problem have shown better QOL as compared to children with other disabilities. Participants with visual problems reported a greater use of emotional support, information support, positive reframing, acceptance, and religious coping. Children with autism were found to use only coping strategies. Participants with intellectual disabilities used behavioral and humorous coping strategies. Participants with auditory problems believed in active coping, denial, and substance abuse. Physical functioning, physical role, bodily pain, emotional role, and physical component summary were found to be significantly and negatively correlated with coping strategies, whereas general health, vitality, social functioning, and mental health were positively and significantly related to coping strategies. Stepwise multiple regression analysis revealed that emotional support, denial, behavioral disengagement, self-blame, religion, acceptance, humor, and substance abuse were significant predictors of QOL. Overall, the findings of this study emphasize the complexity of addressing the needs of disabled children and the importance of holistic and culturally sensitive approaches in rehabilitation and support programs.

Initiation of Paliperidone palmitate 3-monthly injectable in an acute inpatient psychiatric unit

Introduction The treatment of patients with severe psychotic disorders presents significant clinical challenges, and the choice of appropriate therapy is essential to ensure long-term stability1. In this context, long-acting injectable antipsychotics (LAIs) have emerged as a promising therapeutic option. LAIs were developed to counteract poor treatment adherence in patients with psychotic disorders2.Paliperidone palmitate 3-monthly injectable (PP3M) is a novel formulation of intramuscular injectable paliperidone palmitate with a significantly longer half-life than the once-monthly formulation.PP3M has shown a longer time to relapse and good safety and tolerability in many studies3.ObjectivesThe aim of this work was to describe the profile of patients initiating PP3M in an acute inpatient psychiatric unit.Methods A descriptive study was conducted on patients admitted to the acute psychiatric unit from January 2021 to December 2022. The sample included 23 inpatients who initiated PP3M during the admission. Data were collected regarding age, gender, diagnosis, substance abuse, previous antipsychotic treatment, antipsychotic treatment adherence and adverse effects during the admission.Results23 patients sample, with an average age of 44.04 years-old, 16 male and 7 female, diagnosed with psychotic disorder (22) and schizoaffective disorder (1). Out of the 23 patients, 7 had active substance abuse upon admission. Out of the total simple, 9 of them were prescribed LAIs, with 6 on PP1M (Paliperidone palmitate 1-monthly injectable), 2 on PP3M, and 1 on aripiprazole long-acting injection. Twelve were prescribed oral antipsychotics, including 4 on paliperidone, 4 on risperidone, 1 on aripiprazole, 1 on olanzapine, and 2 on other oral antipsychotics. Two patients did not have a previous antipsychotic prescription.Among the 23 patients, 17 of them did not have previous antipsychotic treatment adherence.5 out of the 23 patients experienced adverse effects, with 3 of them having extrapyramidal symptoms and 2 hyperprolactinemia.Upon discharge, 11 out of the 23 patients were prescribed antipsychotic monotherapy with PP3M.ConclusionsIn this sample, we observed that inpatients who initiated PP3M in an acute psychiatric unit were males, with psychotic disorders, lacked adherence to previous antipsychotic treatment. Most of them did not experience adverse effects with PP3M during admission.More research should be done to assess the use of PP3M in an acute inpatient psychiatric unit.REFERENCES1. Morris MT, Tarpada SP. Psychopharmacol Bull. 2017 May 15;47(2):42-52.2. Brasso, C., Bellino, S., Bozzatello, P., Montemagni, C., & Rocca, P. (2017). Neuropsychiatric Disease and Treatment,3. Edinoff AN, Doppalapudi PK, Orellana C, Ochoa C, Patti S, Ghaffar Y, Cornett EM, Kaye AJ, Viswanath O, Urits I, Kaye AM, Kaye AD. Front Psychiatry. 2021.Disclosure of InterestNone Declared

Survival and Disease Progression in Older Adult Patients With Cirrhosis: A Retrospective Study.

Background: Cirrhosis incidence in older adult patients has been increasing with limited data on their survival. This study is aimed at investigating the survival and disease progression in older adult patients with cirrhosis compared to younger patients. Methods: This is a retrospective single-center study. Patients aged above 50 with a confirmed diagnosis of cirrhosis based on biopsy, FibroSure test, splenomegaly, and low platelets < 120 × 109/L) or imaging findings including FibroScan were included. Patients with active substance abuse, transjugular intrahepatic portosystemic shunt (TIPS), prior spontaneous bacterial peritonitis (SBP), variceal hemorrhage, model for end-stage liver disease-Na (MELD - Na) ≥ 20, had liver transplantation, malignancy except for squamous cell carcinoma, and other comorbidities such as congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), and end-stage kidney disease with glomerular filtration rate (GFR) < 30 were excluded. Patients' records from the liver clinic were reviewed and demographics, laboratory, and compensation and decompensation status were collated. Patients were separated into two groups based on age 50-64 years and age ≥ 65. The primary endpoint was death, and the secondary endpoint was disease progression measured by the baseline to 12-month increase in MELD-Na score. The Kaplan-Meier analysis was conducted to compare the survival between the two groups. Cox regression analysis was performed to identify independent risk factors for poor survival. Results: A total of 191 patients diagnosed with cirrhosis met the inclusion and exclusion criteria. There were 80 patients aged 50-64 years and 111 patients aged ≥ 65 years. Significantly shorter survival times were seen among patients aged ≥ 65 years compared to those aged 50-64 years (73.3 ± 4.8 vs. 151.5 ± 22.7; p < .001). Age of diagnosis ≥ 65 years (p < 0.001), male gender (p = .013), body mass index (BMI) < 30 (p = 0.005), and decompensation (p = 0.008) were found to be independent risk factors for poor survival. MELD-Na scores increased significantly in 12 months of follow-up from baseline, but only in patients with decompensated cirrhosis (p = 0.013). Conclusions: Cirrhotic patients aged ≥ 65 years have significantly poor survival compared to younger patients. A prospective study is needed to further investigate the effect of age and obesity on survival and disease progression in older adult patients with cirrhosis.

Neuropsychiatric Symptoms and Microglial Activation in Patients with Alzheimer Disease

Neuropsychiatric symptoms are commonly encountered and are highly debilitating in patients with Alzheimer disease. Understanding their underpinnings has implications for identifying biomarkers and treatment for these symptoms. To evaluate whether glial markers are associated with neuropsychiatric symptoms in individuals across the Alzheimer disease continuum. This cross-sectional study was conducted from January to June 2023, leveraging data from the Translational Biomarkers in Aging and Dementia cohort at McGill University, Canada. Recruitment was based on referrals of individuals from the community or from outpatient clinics. Exclusion criteria included active substance abuse, major surgery, recent head trauma, safety contraindications for positron emission tomography (PET) or magnetic resonance imaging, being currently enrolled in other studies, and having inadequately treated systemic conditions. All individuals underwent assessment for neuropsychiatric symptoms (Neuropsychiatry Inventory Questionnaire [NPI-Q]), and imaging for microglial activation ([11C]PBR28 PET), amyloid-β ([18F]AZD4694 PET), and tau tangles ([18F]MK6240 PET). Of the 109 participants, 72 (66%) were women and 37 (34%) were men; the median age was 71.8 years (range, 38.0-86.5 years). Overall, 70 had no cognitive impairment and 39 had cognitive impairment (25 mild; 14 Alzheimer disease dementia). Amyloid-β PET positivity was present in 21 cognitively unimpaired individuals (30%) and in 31 cognitively impaired individuals (79%). The NPI-Q severity score was associated with microglial activation in the frontal, temporal, and parietal cortices (β = 7.37; 95% CI, 1.34-13.41; P = .01). A leave-one-out approach revealed that irritability was the NPI-Q domain most closely associated with the presence of brain microglial activation (β = 6.86; 95% CI, 1.77-11.95; P = .008). Furthermore, we found that microglia-associated irritability was associated with study partner burden measured by NPI-Q distress score (β = 5.72; 95% CI, 0.33-11.10; P = .03). In this cross-sectional study of 109 individuals across the AD continuum, microglial activation was associated with and a potential biomarker of neuropsychiatric symptoms in Alzheimer disease. Moreover, our findings suggest that the combination of amyloid-β- and microglia-targeted therapies could have an impact on relieving these symptoms.

1808. Treatment Adherence and Outcomes Associated with Partial Oral Therapy vs. Intravenous Therapy in Patients with Serious Staphylococcus aureus Infections: A Comparative Effectiveness Study

Abstract Background Randomized trials found oral step-down therapy to be as effective as intravenous (IV) therapy for infective endocarditis and bone and joint infections. However, the comparative effectiveness of IV versus oral step-down therapy for deep seated Staphylococcus aureus infections outside of the clinical trial setting is unknown. The objectives of this study were to compare treatment adherence and clinical outcomes between these two approaches in clinical practice. Methods This was a retrospective comparative effectiveness study involving adults hospitalized at an academic, safety net hospital between January 2019 to June 2021 with bacteremia, endocarditis, osteomyelitis, or septic arthritis due to S. aureus. Based on initial treatment plans, patients were categorized and analyzed in two groups: all IV or IV followed by oral step-down therapy. The co-primary outcomes were antibiotic adherence (percent of planned course received) and the proportion who completed therapy. The key secondary outcome of clinical failure was a composite of all-cause mortality, recurrent or new metastatic site of S. aureus infection, or requirement of an unplanned source control procedure. Results Of 249 patients included, 101 were in the all IV and 148 were in the oral step-down groups. Indications for treatment were osteomyelitis (72%), complicated bacteremia (25%), endocarditis (22%), septic arthritis (11%), and uncomplicated bacteremia (8%). Active substance abuse was observed in 43% of the IV group and 55% in the oral group. Between the all IV and oral step-down groups, antibiotic adherence rates did not differ significantly (Table); antibiotic therapy was completed by 93% vs 87% of patients (p = 0.13), respectively. Clinical failure occurred in 25% of the all IV group and 26% of the oral step-down group (p = 0.87). The frequency of other secondary outcomes was similar between groups; however, hospital length of stay was significantly longer in the IV group (Table). Table 1 Note: data presented as n (%) unless otherwise specified *within 6 months of hospital admission date for index infection Conclusion In clinical practice, oral step-down therapy for serious S. aureus infections was associated with similar rates of treatment adherence and completion, clinical outcomes and less health care resource utilization compared with IV therapy. Our findings support use of oral step-down therapy as an effective alternative to IV therapy. Disclosures All Authors: No reported disclosures.

Higher body mass index is associated with worse hippocampal vasoreactivity to carbon dioxide.

Background and objectivesObesity is a risk factor for cognitive decline. Probable mechanisms involve inflammation and cerebrovascular dysfunction, leading to diminished cerebral blood flow (CBF) and cerebrovascular reactivity (CVR). The hippocampus, crucially involved in memory processing and thus relevant to many types of dementia, poses a challenge in studies of perfusion and CVR, due to its location, small size, and complex shape. We examined the relationships between body mass index (BMI) and hippocampal resting CBF and CVR to carbon dioxide (CVRCO2) in a group of cognitively normal middle-aged and older adults.MethodsOur study was a retrospective analysis of prospectively collected data. Subjects were enrolled for studies assessing the role of hippocampal hemodynamics as a biomarker for AD among cognitively healthy elderly individuals (age > 50). Participants without cognitive impairment, stroke, and active substance abuse were recruited between January 2008 and November 2017 at the NYU Grossman School of Medicine, former Center for Brain Health. All subjects underwent medical, psychiatric, and neurological assessments, blood tests, and MRI examinations. To estimate CVR, we increased their carbon dioxide levels using a rebreathing protocol. Relationships between BMI and brain measures were tested using linear regression.ResultsOur group (n = 331) consisted of 60.4% women (age 68.8 ± 7.5 years; education 16.8 ± 2.2 years) and 39.6% men (age 70.4 ± 6.4 years; education 16.9 ± 2.4 years). Approximately 22% of them (n = 73) were obese. BMI was inversely associated with CVRCO2 (β = −0.12, unstandardized B = −0.06, 95% CI −0.11, −0.004). A similar relationship was observed after excluding subjects with diabetes and insulin resistance (β = −0.15, unstandardized B = −0.08, 95% CI −0.16, −0.000). In the entire group, BMI was more strongly related to hippocampal CVRCO2 in women (β = −0.20, unstandardized B = −0.08, 95% CI −0.13, −0.02).DiscussionThese findings lend support to the notion that obesity is a risk factor for hippocampal hemodynamic impairment and suggest targeting obesity as an important prevention strategy. Prospective studies assessing the effects of weight loss on brain hemodynamic measures and inflammation are warranted.

Perceived stress, academic self-concept, and coping mechanisms among pharmacy students following a curricular revision

IntroductionPharmacy students experience high levels of perceived stress. Data regarding the impact of curricular revision on students' stress level are lacking. The primary objective of this study was to compare perceived stress, academic self-concept, and coping strategies between pharmacy students prior to and following a curricular revision. Secondary objectives included determining university resources used by students to deal with stress. MethodsStudents in the first, second, and third years of the pharmacy curriculum were asked to complete a survey, including the 14-item Perceived Stress Scale (PSS-14), Brief COPE, and Academic Self-Concept Scale (ASCS), and questions regarding use of university resources. Responses to the PSS-14, Brief COPE, and ASCS were compared to a student cohort prior to the curricular revision. ResultsPerceived stress was reduced to a small, statistically significant degree following a curricular revision. In both cohorts, increased stress was statistically significantly correlated with decreased academic self-concept. Students reported increased use of self-distraction, along with decreased use of active coping, substance abuse, and planning, as coping strategies when compared to the previous cohort. Approximately half of the student cohort reported no use of university resources. The most commonly used resources were financial aid and mental health services. ConclusionsPerceived stress decreased following the revision of a Doctor of Pharmacy curriculum. The most common coping strategies were positive and comparable with strategies reported by students in the former curriculum. The impact of curricular changes on student stress and the use of university resources in health professions students warrant further study.

Liver Transplantation – A Case Report

Liver transplantation is a treatment option for patients with End-stage Liver disease for whom all possible modes of surgical and medical treatment have been exhausted. The indications for Liver transplantation can be either acute or chronic liver disease. The absolute contra indications are active alcohol or substance abuse, severe cardiopulmonary or other co morbid conditions that would preclude meaningful recovery after transplant. Patients are listed on the waiting list according to their blood type and Model of End- Stage Liver Disease (MELD) score. The surgical procedure entails the excision of both donor and recipient livers and transplantation of the donor liver into the recipient (Orthotopic Liver Transplantation). This article gives an overview about liver transplantation and its management. A case report is presented and the nursing care has been discussed in detail.

Patient with a History of Active Substance Abuse Requesting Opioids for Chronic Pain

Health care providers face a considerable challenge when treating chronic pain patients with prescription opioid medications. Although indications exist for the use of these drugs, their addictive nature and street value render them high-risk targets for abuse, misuse, and diversion. All patients receiving opioids should, therefore, be screened for abuse potential before beginning opioid therapy, be required to sign an opioid agreement, and receive close monitoring throughout the course of their treatment. Patients who present with a history of active substance abuse are at higher risk for iatrogenic dependence and necessitate more frequent monitoring. Herein arise several ethical issues, such as the principle of justice, which mediates equitable treatment for all patients. This review discusses the disease underlying substance abuse and clinical manifestations thereof, as well as relevant pathophysiology, ethical issues, and guidelines for the safe treatment with opioids. This review contains 3 tables and 43 references. Key Words: addiction, ethics, opioids, safety, substance abuse

A One-Session Treatment of PTSD After Single Sexual Assault Trauma. A Pilot Study of the WONSA MLI Project: A Randomized Controlled Trial.

Sexual abuse is a crime with devastating health consequences. Accessible, acceptable and affordable treatment of PTSD after sexual abuse is important. In this pilot study, a one-session PTSD treatment and a modified perspective to PTSD treatment is introduced. The aim of the study was to test the efficacy of one session of Modified Lifespan Integration (MLI) on reduction of symptoms of PTSD in individuals with PTSD after one sexual assault. This was a single-center, individually randomized waitlist-controlled treatment study with 1:1 allocation, with the intervention of one 90 - 140 minutes session of MLI and with post-treatment follow-up at 3 weeks (time point two). All participants were females, mean age 24, with PTSD symptoms after one sexual assault during the past 5 years. Exclusion criteria were poor understanding of Swedish, multiple traumas, active substance abuse, active psychosis, ADHD, or autism spectrum disorder. Of 135 interested participants, 38 were finally included, 36 completed baseline measures and were included in the intent to treat analyses and 33 were analyzed per protocol. The primary outcome was the difference between the two trial arms in mean PTSD symptoms as measured by the Impact of Event Scale Revised (IES-R) at time point two. In the intervention arm, 72% no longer scored PTSD in per-protocol analysis, compared to 6% in the waiting list arm. IES-R scores were on average halved in the intervention arm (F=21.37, P<0.001), but were essentially unchanged in the waiting list arm. No adverse effects or drop-outs were seen. One session of Modified Lifespan Integration was an effective treatment with a low drop-out rate for females aged 15-65 with PTSD after one sexual assault. Provided that this result can be replicated, MLI should be offered to these patients in clinical settings. Registration number NCT03141047 was given 03/25/2016 at ClinicalTrials.gov (https://register.clinicaltrials.gov/).

Abstract C021: Characteristics of malignancy in lesbian, gay, bisexual, and transgender/transsexual (LGBT) population

Abstract Background: LGBT people account for 4.5% of adult population in U.S. and face multiple challenges across different aspects of life. Although malignancy is the second most common cause of death in the U.S., only few studies that analyzed the characteristics of malignancies in the LGBT community exist. We aim to provide an overview of malignancy affecting LGBT patients. Methods: A retrospective chart review of LGBT patients with a diagnosis of malignancy treated at Medstar Health Hospitals was performed. Natural language processing with strings was utilized to retrieve patient charts with ICD-9 and ICD-10 codes for LGBT status and cancer. Results: A total of sixty-one patients (pts) were identified; (5 lesbian female, 49 gay male, 6 female transgenders and 1 male transgender). The median age was 49 (range: 19-79). 30 pts (49%) were Caucasian, 26 (43%) were African American and 5 (8%) were Hispanic. Among the female transgender patients, 3 received hormonal therapy for gender change and no patient underwent surgery to change the biological gender. 18 pts had human immunodeficiency virus (HIV) infection, 1 pt hepatitis B virus (HBV), 2 pts hepatitis C virus (HCV), 8 pts HIV/HCV, 2 pts HIV/HBV, and 1 pt HIV/HBV/HCV. Among the patients with HIV infection (n=29), 26 (90%) were receiving anti-retroviral treatment at last follow-up. 27 (44%) pts were active smokers, 10 (16%) pts former smokers and 24 (40%) never smoker. 27 (44%) reported a history of substance abuse with 9 (15%) pts with active substance abuse and 25 (41%) never used it. Employment status was employed (n=32), unemployed (n=20), retired (n=6), and not available (n=3). Tumor types included anal squamous cell carcinoma (anal SCC; n=15), Non-Hodgkin lymphoma (NHL; n=12), non-small-cell lung cancer (NSCLC; n=9), colorectal cancer (CRC; n=7), Kaposi sarcoma (n=4), brain cancer (n=3), breast carcinoma, small-cell lung cancer and pancreatic cancer (2 each), prostate carcinoma, testicular carcinoma, head and neck cancer, Hodgkin lymphoma and mesothelioma (1 each). Among the HIV-infected patients, tumor types include [NHL n=8, anal SCC n=6, NSCLC n=4, CRC n=4, Kaposi sarcoma n=3, head and neck cancer =1, prostate cancer n=1, pancreatic cancer n=1, Hodgkin lymphoma n=1]. Among the anal SCC group (n=15), 6 pts had human papilloma (HPV)-associated cancer, while 1 pt had non-HPV associated cancer and HPV status was not available in 8 pts. Conclusion: LGBT people with cancer have a high incidence of chronic viral infection and appear to have distinct patterns of malignancy compared to those in the general population. Larger studies are needed to verify the findings and to understand unique challenges facing the LGBT population. Citation Format: Ghassan Al-Shbool, Saira Farid, Ahmad Nassar, Chul Kim. Characteristics of malignancy in lesbian, gay, bisexual, and transgender/transsexual (LGBT) population [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr C021.

Molecular markers of neuroendocrine function and mitochondrial biogenesis associated with early life stress

ObjectiveGlucocorticoid receptor gene (NR3C1) promoter methylation influences cellular expression of the glucocorticoid receptor and is a proposed mechanism by which early life stress impacts neuroendocrine function. Mitochondria are sensitive and responsive to neuroendocrine stress signaling through the glucocorticoid receptor, and recent evidence with this sample and others shows that mitochondrial DNA copy number (mtDNAcn) is increased in adults with a history of early stress. No prior work has examined the role of NR3C1 methylation in the association between early life stress and mtDNAcn alterations. MethodsAdult participants (n = 290) completed diagnostic interviews and questionnaires characterizing early stress and lifetime psychiatric symptoms. Medical conditions, active substance abuse, and prescription medications other than oral contraceptives were exclusionary. Subjects with a history of lifetime bipolar, obsessive-compulsive, or psychotic disorders were excluded; individuals with other forms of major psychopathology were included. Whole blood mtDNAcn was measured using qPCR; NR3C1 methylation was measured via pyrosequencing. Multiple regression and bootstrapping procedures tested NR3C1 methylation as a mediator of effects of early stress on mtDNAcn. ResultsThe positive association between early adversity and mtDNAcn (p = .02) was mediated by negative associations of early adversity with NR3C1 methylation (p = .02) and NR3C1 methylation with mtDNAcn (p < .001). The indirect effect involving early adversity, NR3C1 methylation, and mtDNAcn was significant (95 % CI [.002, .030]). ConclusionsNR3C1 methylation significantly mediates the association between early stress and mtDNAcn, suggesting that glucocorticoid receptor signaling may be a mechanistic pathway underlying mtDNAcn alterations of interest for future longitudinal work.

A manual-based family intervention for families living with the consequences of traumatic injury to the brain or spinal cord: a study protocol of a randomized controlled trial

BackgroundAcquiring a traumatic injury constitutes a severe life change for the survivor, but also for the surrounding family. The paradigm of helping the family has primarily been on psychosocial interventions targeting caregivers. However, interventions including both survivor and caregivers should be an essential part of treatment, as the whole family’s functional level and mental health can be affected. The current study protocol presents a manualized family intervention for families living with traumatic injury to the brain (TBI) or spinal cord (tSCI). The objectives are to investigate if the intervention improves quality of life (QoL) and decreases burden. It is hypothesized that the family intervention improves problem-solving strategies and family dynamics, which will reduce the burden. This may improve the caregivers’ mental health, which will improve the support to the survivor and QoL.MethodsThe study is an interventional, two-arm, randomized controlled trial. During a 2-year period, a total of 132 families will be included. Participants will be recruited from East-Denmark. Inclusion criteria are (1) TBI or tSCI, (2) ≥ 18 years of age, (3) ≥ 6 months to ≤ 2 years since discharge from hospital, (4) ability to understand and read Danish, (5) cognitive abilities that enable participation, and (6) a minimum of one family member actively involved in the survivor’s life. Exclusion criteria are (1) active substance abuse, (2) aphasia, (3) prior neurologic or psychiatric diagnose, and (4) history of violence. Within each disease group, families will be allocated randomly to participate in an intervention or a control group with a ratio 1:1. The intervention groups receive the family intervention consisting of eight sessions of 90 min duration. Families in the control groups receive 2 h of psychoeducation. All participants complete questionnaires on QoL, self-perceived burden, family dynamics, problem-solving strategies, mental health, and resilience at pre-intervention, post-intervention, and 6-month follow up.ConclusionIf the intervention is found to have effect, the study will contribute with novel knowledge on the use of a manual-based intervention including the entire family. This would be of clinical interest and would help families living with the consequences of TBI or tSCI.Trials registrationClinicalTrials.gov, NCT03814876. Retrospectively registered on 24 January 2019.

Psychiatric Profile of Patients Currently Listed for Kidney Transplantation: Evidence of the Need for More Thorough Pretransplant Psychiatric Evaluations

BackgroundPatients with end-stage renal disease are at increased risk for psychiatric and cognitive pathologies. Despite this, there is little standardization of the psychosocial and/or psychiatric evaluation of renal transplant candidates. The purpose of this study is to report the frequency of psychiatric and cognitive pathologies and corresponding psychiatric recommendations in a sample of patients actively listed for kidney transplant. MethodsWe performed a retrospective chart review of 104 patients listed for kidney transplant who underwent semistructured psychiatric assessments as part of a novel clinical protocol. Transplant psychiatry routinely administers brief screeners of cognitive functioning and health literacy, also collected from patients’ charts. ResultsThere were a number of primary psychiatric disorders, including active substance abuse. Even using a conservative cutoff, 52.4% of patients’ charts indicated evidence of cognitive impairment, and 28.9% indicated limited health literacy. In addition, there were numerous additional recommendations made within every category (educational, psychotherapeutic/psychiatric, cognitive, cessation of substance use, substance abuse treatment, and mobilizing support for transplant). With the exclusion of the recommendation for more education regarding the transplant process, most patients had at least 1 to 3 recommendations (n = 72, 69.2%). ConclusionsWe have identified a number of concerning psychosocial and psychiatric factors in patients who were evaluated and listed for kidney transplantation that can adversely impact transplant outcomes. The findings provide support for more in-depth and ongoing psychiatric assessments as standard clinical protocol for kidney transplant candidates.

338 Factors Associated With Colonoscopy No-Show Among African Americans in an Urban Safety-Net Hospital

INTRODUCTION: Colorectal cancer (CRC) is the most common cancer diagnosed in the United States, and the second leading cause of cancer-related deaths. The incidence and mortality rates of CRC in the United States have steadily declined over the past 10 years however, reductions have been strikingly much slower among African Americans (AA) who continue to have the highest mortality rate and lowest survival. Counterintuitively, AA reportedly have the highest rate of colonoscopy no-show (missed appointments). This study aimed to identify patient level factors and other characteristics that predict colonoscopy no-show in an urban safety net hospital. METHODS: We carried out a retrospective review of 161 electronic medical records (EMR) of patients scheduled for colonoscopy over a 2-week period in January 2017. We identified AA patients’ factors associated with colonoscopy appointment status (completed or missed) by using hierarchical multimodal regression. Patient factors examined include age, sex, race, residence, insurance status, substance abuse, psychiatric illness, comorbidities, positive FIT test, previous endoscopy, personal or family history of cancer. Microsoft Excel and STATA software were used for data management and analyses. Two-sided P-value &lt; 0.05 was considered statistically significant. RESULTS: Majority (88.4%) of the patients were African American, 5.5% Caucasians, 4.9% Hispanic, 1.2% are from “other” race. The mean age was 59 years (SD 8.3), AA no-show rate was 43%. 46.7% were male and 53.3% were female, 8.9% were less than 50 years while 91.1% were &gt;/= 50 years. Most patients (81.1%) were either unemployed or retired. 40.7% are uninsured, 9% were active substance abusers and 20% had a psychiatric illness. Patients on Medicaid were less likely to no-show when compared to the uninsured (P &lt; 0.05). Substance abusers were 5-times more likely to no-show (P &lt; 0.05). A personal history of cancer though not statistically significant was associated with reduced likelihood of no-show (P = 0.095) (data extraction is ongoing to increase sample size). CONCLUSION: Among African American patients, social and behavioral determinants of health are known to result in healthcare disparities. Increasing Medicaid funding and the use of a patient navigator for patients at high risk for no-show could reduce no-show rates, improve patient outcomes and reduce waste of resources associated with high no-show rates; and contribute to eliminating healthcare disparities.

Identifying Barriers to the Treatment of Chronic Hepatitis C Infection

Background and Aims: Chronic hepatitis C (CHC) viral infection has a major impact on our health care system. The emergence of direct-acting antiviral agents (DAA) has made treatment simple (oral), efficacious, and safe. However, treatment is expensive and access is variable. Despite great treatment outcomes, only a minority of patients with CHC receive antiviral therapy. This study identifies the barriers to treatment in CHC infection. Methods: Study recruited all hepatitis C antibody-positive patients between 2012 and 2016 from a large academic teaching hospital in New York City. Demographic information, clinical data, and insurance information were reviewed. Statistical analysis performed with OR and p < 0.05 reported. Result: A total of 1,548 patients with hepatitis C antibody-positive titer were included in the initial analysis. One thousand and twenty-four patients were forwarded to the final analysis after exclusion of 524 patients (for distant resolved hepatitis C viral [HCV] infection [n = 42], patients cured with interferon-based regimens [n = 94], patients with comorbid conditions [n = 176], and patients with an incomplete medical chart [n = 212]). In the intention to treat cohort of 1,024 patients, 204 patients achieved a sustained virological response after receiving DAAs (n = 204/1,024 – 20%). The majority of patients had not received DAAs (n = 816/1,024 patients – 80%). Multiple factors resulted in hepatitis C viral infection (HCV) patients not receiving DAAs including the following primary factors: (a) lost to follow-up clinic visits and poor adherence to clinic appointments (n = 548 [67%]; p value <0.0001), (b) active substance abuse (alcoholism and IV drug abuse; n = 165 [20%]; p value 0.22), (c) patients with significant psychiatric illness (n = 103 [12.7%]; p value 0.015), and subgroup analysis revealed that 188 (188/1,024 – 12%) patients had human immunodeficiency virus-1 (HIV-1) and HCV coinfection. Majority of HCV/HIV coinfected patients had not received DAAs (n = 176 [97%]; p value <0.0001, OR 4.46). The etiology of nontreatment in coinfected HIV/HCV patients was 73.3% poor adherence, 11.5% active substance abuse including alcohol and IV drug use, and 9% significant psychiatric illness and 6.2% multiple reasons for not receiving HCV treatment. Conclusion: Multifactorial barriers are preventing hepatitis C patients from receiving effective DAA therapy. Primary factors include poor compliance, substance abuse, and significant psychiatric illness, with significant overlap between these groups. Subgroup analysis showed a substantial number of high-risk patients with HIV/HCV coinfection did not receive DAA therapy. A multidisciplinary clinic approach with a hepatologist, ID physicians, social worker, and behavioral health psychologist and case manager should provide a solution to improve diagnosis and treatment with DAA.

Impact of Respiratory Compromise in Inpatient Interventional Radiology Procedures with Moderate Sedation in the United States

Background Despite increased use of moderate sedation in interventional radiology (IR), patient reactions to moderate sedation are difficult to predict. The rate, risk factors, and burden of respiratory compromise in patients who undergo IR procedures with moderate sedation in the United States are poorly understood. Purpose To identify risk factors and quantify the clinical and economic burden of respiratory compromise in inpatient IR procedures in the United States. Materials and Methods Primary inpatient IR procedures with moderate sedation conducted from October 1, 2012, to September 30, 2015, were analyzed by using a retrospective claims database. Exclusions included age younger than 18 years, use of anesthesia, pre-existing cardiac or respiratory arrest, and respiratory failure. Respiratory compromise was defined as use of naloxone or flumazenil, nonmechanical or cardiopulmonary resuscitation, or endotracheal intubation on the day of the IR procedure. Propensity score matching was performed to risk adjust patients for cost and outcomes analysis, including hospital and intensive care unit (ICU) length of stay, invasive mechanical ventilation, and death before hospital discharge. Results This study analyzed 525 151 patients (mean age, 60 years ± 17 [standard deviation]; 278 576 women). Respiratory compromise occurred in 1.0% (5235 of 525 151) of patients, predicted by long-term opioid therapy or active substance abuse (odds ratio [OR], 2.7; P < .001), age 65 years or older (OR, 1.4; P < .001), and sleep apnea (OR, 1.3; P < .001). Risk-adjusted patients with respiratory compromise compared with patients without respiratory compromise had $6904 higher costs (P < .001), 1.1-day longer hospital length of stay (P < .001), and higher rates of ICU admission (69.7% [3125 of 5235] vs 25.5% [1333 of 5235], respectively; P < .001), invasive mechanical ventilation (33.6% [1758 of 5235] vs 1.6% [85 of 5235], respectively; P < .001), and death (27.1% [1421 of 5235] vs 3.2% [166 of 5235], respectively; P < .001). Conclusion In the United States, respiratory compromise in interventional radiology procedures with moderate sedation contributes to worse clinical outcomes and higher costs. Respiratory compromise risk factors including long-term opioid therapy or active substance abuse, age 65 years or older, and sleep apnea should be preassessed and used to help guide intraprocedural monitoring to prevent respiratory compromise, improve patient outcomes, and reduce costs. © RSNA, 2019 See also the editorial by Rosen and Walz in this issue. Online supplemental material is available for this article.

1264-P: Predictors of Success in Usual and Intensive Specialty Diabetes Programs

Intensive management (IM) is recognized as an important approach in treatment of poorly controlled diabetes. However, it is unknown what factors determine response to usual diabetes specialty care (UC) vs. IM and understanding these will improve allocation of costly resources. We sought to identify predictors of response in UC and IM, a high-resource 6-month service designed for those who fail UC that includes telemedicine, remote data sharing, and in-person visits. A response metric was defined as an A1c reduction of &amp;gt;/=0.5 within 12 months of the initial visit. We analyzed two groups with baseline A1c &amp;gt;8: 1) UC patients referred to a diabetes specialty clinic between 12/2016 and 8/2017 (N= 163) and 2) IM patients, who were referred after failing metric between 10/2015 and 6/2018 (N=62). The majority met metric (UC-Met: 74%, IM-Met: 61%). In UC and IM, there were no differences between those who met metric and those who did not in age, gender, race or ethnicity. The UC-Met vs. UC-Notmet were similar across quality parameters (SBP, statin prescription, LDL), prior A1c pattern (peak and nadir A1c), and the presence of cognitive impairment. However, IM-Notmet had more cognitive dysfunction (20% vs. 2.6%, p=0.04) and substance abuse (16% vs. 5%, p=0.35) than IM-Met. Those in IM-Met had a lower A1c nadir in the last decade (6.87 vs. 7.26, p=0.04). Prevalence of psychiatric disease was high in both IM groups (60% IM-Notmet and 53% IM-Met). In conclusion, specialty diabetes services delivered via UC was effective in 74% of patients. The majority of those who fail to achieve clinically significant A1c lowering benefit from resource-intensive programs, especially those who achieved lower A1c levels in the past. However, cognitive impairment and active substance abuse appear to be risk factors for lack of response to high intensity programs, suggesting that resources designed to manage these conditions should be prioritized in affected individuals with diabetes. Disclosure K.L. Del Valle: None. A. Grizales: None. M. Donahue: None. A. Turchin: Advisory Panel; Self; Monarch Medical Technologies. Research Support; Self; Eli Lilly and Company. Stock/Shareholder; Self; Brio Systems. M.E. McDonnell: None.

Prospective study of variables associated with nonadherence to psychotherapy

Background: The identification of factors associated with nonadherence to psychotherapy would allow a better prevention of this problem.Aim: To investigate factors associated with nonadherence in psychotherapy, its possible effect on outcomes, and reasons for therapy dropout.Method: Prospective analytic observational study of patients who initiated psychotherapy (N = 144). Sociodemographic, general clinical, treatment-related, subjective, psychological, psychopathologic, and outcome variables were evaluated at baseline and 1, 3, 6, and 12 months later. Objective nonadherence (dropout and irregularity), subjective nonadherence (poor patient engagement), and global nonadherence (combination of both) were analyzed.Results: Global nonadherence was 66%. Global nonadherence was associated with substance use or abuse (OR = 2.64) and younger age (OR = 0.97). Objective nonadherence was associated with active working status (OR = 4.11), younger age (OR = 1.04) and substance use or abuse (OR = 2.35). Subjective nonadherence was associated with worse insight in psychotherapy (OR = 0.95) and poor pharmacologic adherence (OR = 0.55). Contextual reasons (25.8%) were the most commonly reported cause of dropout. Time in psychotherapy was associated with outcome variables.Conclusions: Nonadherence to psychotherapy is frequent. To reduce nonadherence in psychotherapy, specific interventions for reducing substance use and abuse, measures aimed at facilitating access to Community Mental Health Units, and enhancing insight in psychotherapy should be implemented.

Predictors of Neuropsychiatric Adverse Events with Smoking Cessation Medications in the Randomized Controlled EAGLES Trial.

Pre-treatment factors that increase smokers' risk of experiencing neuropsychiatric adverse events (NPSAEs) when quitting smoking are unknown. To identify baseline smoker characteristics beyond the history of mental illness that predict which participants were more likely to experience moderate to severe NPSAEs in EAGLES. A prospective correlational cohort study in the context of a multinational, multicenter, double-blind, randomized trial. Smokers without (N = 3984; NPC)/with (N = 4050; PC) histories of, or current clinically stable, psychiatric disorders including mood (N = 2882; 71%), anxiety (N = 782; 19%), and psychotic (N = 386; 10%) disorders. Bupropion, 150mg twice daily, or varenicline, 1mg twice daily, versus active control (nicotine patch, 21mg/day with taper) and placebo for 12weeks with 12-week non-treatment follow-up. Primary safety outcome was the incidence of a composite measure of moderate/severe NPSAEs. Associations among baseline demographic/clinical characteristics and the primary safety endpoint were analyzed post hoc via generalized linear regression. The incidence of moderate to severe NPSAEs was higher among smokers in the PC (238/4050; 5.9%) than in the NPC (84/3984; 2.1%). Three baseline characteristics predicted increased risk for experiencing clinically significant NPSAEs when quitting regardless of carrying a psychiatric diagnosis: current symptoms of anxiety (for every ~ 4-unit increase in HADS anxiety score, the absolute risk of occurrence of the NPSAE endpoint increased by 1% in both PC and NPC); prior history of suicidal ideation and/or behavior (PC, 4.4% increase; P = 0.001; NPC, 4.1% increase; P = 0.02), and being of White race (versus Black: PC, 2.9% ± 0.9 [SE] increase; P = 0.002; and NPC, 3.4% ± 0.8 [SE] increase; P = 0.001). Among smokers with psychiatric disorders, younger age, female sex, history of substance use disorders, and proxy measures of nicotine dependence or psychiatric illness severity also predicted greater risk. There were no significant interactions between these characteristics and treatment. Smokers with unstable psychiatric disorders or with current, active substance abuse were excluded from the study. Irrespective of cessation pharmacotherapy use, smokers attempting to quit were more likely to experience moderate to severe NPSAEs if they reported current anxiety or prior suicidal ideation at baseline and were White. In smokers with a psychiatric history, female sex, younger age, and greater severity of nicotine dependence were also predictive. ClinicalTrials.gov Identifier: NCT01456936.