Community Treatment Centers Research Articles

Preferences for mental health treatment for post-partum depression among new mothers

BackgroundThe prevalence rate of postpartum depression (PPD) is 9 to 17% among mothers, with higher rates among low income and immigrant populations. Due to the negative effects of PPD symptoms on both the mother and baby, treating mothers with depression symptoms is of great importance. This study examined treatment preferences for PPD among Israeli mothers with and without PPD symptoms, specifically focusing on treatment centers, type of professional and mode of treatment, to help develop relevant policies to promote the health of mothers by reaching a deeper understanding of their preferences.Methods1000 mothers who attended Maternal Child Health Clinics (MCHCs) in Israel for their infant’s first medical exam participated in a cross-sectional survey.ResultsIn this sample, 8.4% of the participants suffered from PPD. Mothers with PPD compared to those without symptoms had lower economic status, were more likely to be single, to be first-time mothers, have an unemployed partner and to have immigrated to Israel. Mothers with PPD preferred private mental health practice and community treatment centers by mental healthcare professionals. They also preferred group interventions and personal psychotherapy rather than technology-based interventions.ConclusionsThe study findings support the formulation of mother-sensitive health policies based on understanding mothers’ preferences, and thus, help prepare treatment alternatives that will suit different groups of mothers with PPD, for the benefit of mothers, newborns, and families. Disseminating the results of this study among professionals as part of professional training, can promote appropriate treatment facilities and modes of care for mothers with PPD.

Pain, psychological flexibility, and continued substance use in a predominantly hispanic adult sample receiving methadone treatment for opioid use disorder

BackgroundWe explored pain, psychological flexibility, and continued substance use among 100 adults treated with methadone for opioid use disorder (OUD). All participants had co-occurring chronic pain. MethodsParticipants recruited from a community treatment center between 2009 and 2010 completed an interviewer-facilitated assessment. Chronic pain severity and interference, psychological flexibility (mindfulness, acceptance, values success), past 30-day substance use, and demographics were reported. We modeled a zero-inflated negative binomial regression to examine 1) the probability that an individual does not use illicit substances and 2) illicit substance use frequency among those expected to use. Pain severity and mindfulness were included as predictors in the logit (zero inflated) model. Pain interference, acceptance, and values success were included as predictors in the negative binomial (count) model. We controlled for age and gender in both models. ResultsParticipants were predominantly (84%) Hispanic, and 64% used an illicit substance least once in the past 30 days. Greater degree of mindfulness significantly predicted the probability that an individual does not continue to use illicit substances (OR = 1.59, p < 0.05). Lower degree of values success significantly predicted greater illicit substance use frequency among those likely to use (IRR = 0.72, p < 0.01). No other variables were associated with continued substance use. ConclusionsFindings suggest psychological flexibility is associated with continued substance use in this predominantly Hispanic sample of adults treated for OUD with co-occurring chronic pain. Study findings may have implications for how to address the treatment needs of this complex population.

An exploratory study of challenges and successes in implementing adapted family-based treatment in a community setting

Although family-based treatment (FBT) is accepted as the first-line treatment for adolescent anorexia nervosa, studies show that it is infrequently used by clinicians in community settings. To elucidate some of the barriers to implementing this evidence-based treatment, mixed (quantitative and qualitative) methods were used in this exploratory study to examine therapist experiences with FBT. Twelve clinicians (N = 12) at a community treatment center retrospectively reported on their experiences with FBT training and supervision in FBT. A subset of clinicians (n = 7) additionally completed a structured interview about their experiences in using FBT. Results demonstrate that therapists endorsed certain common misconceptions about FBT prior to training, but that negative beliefs about FBT decreased after its implementation in their setting. These findings suggest that increased education about evidence-based treatments may diminish negative stereotypes about such treatments, which may ultimately increase their uptake in community settings. Sustainability of FBT is discussed in the context of how this community setting incorporated FBT principles into their ongoing clinical practice.

2017 Bangladesh landslides: Physical rehabilitation perspective

This report characterizes traumatic rehabilitation injuries due to the 2017 Bangladesh landslides. Emergency care for rehabilitation conditions provided by field respondents, at receiving community treatment centers, district and at regional hospital(s) is described. Recommendations to improve rehabilitative care in future landslides are provided. Landslides are triggered by external processes including earthquakes, rainstorms, and slope disturbance by humans. Humans are highly vulnerable to the high energy forces of sliding earth and debris which can result in severe traumatic physical injury and death. Landslides triggered by torrential seasonal monsoon rain began early June 2017 and severely affected 42,000 persons in several hilly and coastal districts of Bangladesh. An electronic literature search was performed to identify relevant articles on landslides in Bangladesh, Southeast Asia, and other developing countries. Reports from government and non-governmental sources including relevant hospital admissions data were obtained and analyzed. Information was also obtained through personal communications with local health and emergency management officials and from local and international media sources The 2017 Bangladesh landslides resulted in 172 deaths and 11 missing persons. Thousands of persons received first aid from responding medical teams. Of the 194 persons admitted to district hospitals for severe injuries, 33.50% of injuries treated were musculoskeletal conditions. Twelve (12) persons with critical injuries including long bone fracture, spinal injury, and head injury were referred to a regional tertiary hospital for management by neurology, orthopedic surgery, physical Rehabilitation medicine and psychiatry specialists. Landslides can result in severe traumatic injuries. Rehabilitative treatment with involvement of physiatrists should be provided at all levels of emergency care. Specialized rehabilitation response teams should be employed in landslides and other severe natural disasters in Bangladesh.

The impact of relocation of chronic pain service from hospital setting to community centre on patient experience: a single-centre audit

The Lothian Chronic Pain Service relocated from a university teaching hospital (Western General Hospital (WGH)) to a community centre (Leith Community Treatment Centre (LCTC)) in 2015. Transportation and geographical location were noted by staff to be potential challenges that could negatively impact on the patient experience. The objective of this study is to evaluate how relocating pain clinic from an urban-based hospital to a peripheral community centre on patient experience. An assessment and audit of the impact of the relocation on the Patient-Reported Experience Measure (PREM) of pain services was conducted. Using a nationally developed questionnaire, the patient-reported experience from LCTC was prospectively collected in 2016 and was compared to historical data obtained from WGH in 2014 by National Health Service (NHS) Scotland. All patients attending Lothian Chronic Pain Service clinics were deemed eligible for the audit. Patient demographics were compared between the two data sets. The impact of patient deprivation on patient experience was investigated using the Scottish Index of Multiple Deprivation (SIMD16). Data from 111 patients from LCTC were compared to 206 patients from WGH. Percentage of patients rating care as 'excellent' was found to be significantly greater at LCTC than WGH (0.0049). However, overall patient rating of care from LCTC was not significantly different from WGH data and ratings were higher at LCTC. No correlation was found between patient deprivation and PREM. There is no clear evidence that PREM was negatively affected by the move from a university teaching hospital to a community setting. As this only reported experiences of patients who attended the service, further studies may be warranted to investigate the impact of patient nonattendance.

Development of Collaborative Drug Therapy Management and Clinical Pharmacy Services in an Outpatient Psychiatric Clinic

Collaborative drug therapy management (CDTM) is a written agreement that allows a pharmacist to initiate, modify, or continue pharmacotherapies under a physician’s scope of practice. While available literature pertaining to cardiometabolic and respiratory CDTM services is growing, publications are sparse in psychiatry, particularly outside Veterans Health Administration medical centers. A descriptive study was undertaken to demonstrate how a board-certified psychiatric pharmacist would begin organizing a protocol for clinical pharmacy services at an outpatient, community treatment center for mental health and substance abuse disorders. The primary CDTM service proposed was metabolic monitoring for atypical antipsychotics, though profile reviews for medication reconciliation, drug level monitoring, and insurance coverage were also considered. Potential obstacles identified and worked through during the project included pharmacist–prescriber relationships, federal and state law requirements, pharmacy informatics development, and pharmacy services billing. Discussions with both administrative and medical stakeholders across the health system were essential in helping a pharmacist detail professional qualifications, justify positive impacts on patient outcomes, and navigate these legal and financial issues. The systematic approach arrived at through the study addresses current literature gaps concerning how pharmacists can evolve their practices from ancillary to collaborative design by nature within psychiatric settings.

Effectiveness of a live oral human rotavirus vaccine after programmatic introduction in Bangladesh: A cluster-randomized trial.

BackgroundRotavirus vaccines are now globally recommended by the World Health Organization (WHO), but in early 2009 WHO’s Strategic Advisory Group of Experts on Immunization reviewed available data and concluded that there was no evidence for the efficacy or effectiveness of a two-dose schedule of the human rotavirus vaccine (HRV; Rotarix) given early at 6 and 10 wk of age. Additionally, the effectiveness of programmatic rotavirus vaccination, including possible indirect effects, has not been assessed in low-resource populations in Asia.Methods and findingsIn Bangladesh, we cluster-randomized (1:1) 142 villages of the Matlab Health and Demographic Surveillance System to include two doses of HRV with the standard infant vaccines at 6 and 10 wk of age or to provide standard infant vaccines without HRV. The study was initiated November 1, 2008, and surveillance was conducted concurrently at Matlab Diarrhoea Hospital and two community treatment centers to identify children less than 2 y of age presenting with acute rotavirus diarrhea (ARD) through March 31, 2011. Laboratory confirmation was made by enzyme immunoassay detection of rotavirus antigen in stool specimens. Overall effectiveness of the HRV vaccination program (primary objective) was measured by comparing the incidence rate of ARD among all children age-eligible for vaccination in villages where HRV was introduced to that among such children in villages where HRV was not introduced. Total effectiveness among vaccinees and indirect effectiveness were also evaluated. In all, 6,527 infants were age-eligible for vaccination in 71 HRV villages, and 5,791 in 71 non-HRV villages. In HRV villages, 4,808 (73.7%) infants received at least one dose of HRV. The incidence rate of ARD was 4.10 cases per 100 person-years in non-HRV villages compared to 2.8 per 100 person-years in HRV villages, indicating an overall effectiveness of 29.0% (95% CI, 11.3% to 43.1%). The total effectiveness of HRV against ARD among vaccinees was 41.4% (95% CI, 23.2% to 55.2%). The point estimate for total effectiveness was higher against ARD during the first year of life than during the second (45.2% versus 28.9%), but estimates for the second year of life lacked precision and did not reach statistical significance. Indirect effects were not detected. To check for bias in presentation to treatment facilities, we evaluated the effectiveness of HRV against acute diarrhea associated with enterotoxigenic Escherichia coli; it was 4.0% (95% CI, −46.5% to 37.1%), indicating that bias likely was not introduced. Thirteen serious adverse events were identified among recipients of HRV, but none were considered related to receipt of study vaccine. The main limitation of this study is that it was an open-label study with an observed-only control group (no placebo).ConclusionsThe two-dose HRV rotavirus vaccination program significantly reduced medically attended ARD in this low-resource population in Asia. Protection among vaccinees was similar to that in other low-resource settings. In low-resource populations with high rotavirus incidence, large-scale vaccination across a wide population may be required to obtain the full benefit of rotavirus vaccination, including indirect effects.Trial registrationClinicalTrials.gov NCT00737503

Factors Associated with Fatal Outcomes Following Cholera-Like Syndrome in Far North Region of Cameroon: A Community-Based Survey.

This study demonstrates that most cholera deaths in this region of Cameroon occur out of hospital. This is a region which is prone to cholera, and interventions are needed to improve access to emergency medical care, especially during cholera outbreaks. Cameroon has experienced 14 cholera epidemics during the last 20 years, and these have had high case fatality rates. This study attempted to assess the effect of delays in seeking care and the locations of care as possible risk factors for cholera mortality. The study used data from a community-based survey regarding the circumstances of 97 fatal cases and 197 control (nonfatal) cases following a cholera-like syndrome in villages with cholera-like diseases during cholera outbreaks in Cameroon during 2009-2011. Deaths occurred in one of four environments: the community, in a temporary community treatment center (TCTC), in transit to a treatment center, or in a hospital (39%, 32%, 5%, and 24%, respectively). Using a case-control analysis, factors associated with deaths included the nonuse of a cholera treatment center, receiving health care in a TCTC instead of a hospital, and greater than 4 hours delay between the onset of symptoms and the decision to go to a treatment center (odds ratios of 17.1 [confidence interval (CI): 7.0-41.8], 2.5 [CI: 1.2-5.0], and 2.2 [CI: 1.0-4.6], respectively). During cholera epidemics, a higher proportion of deaths are still occurring in communities. The nonuse and delays in deciding to go a treatment center, and treatment at TCTC rather than a hospital were risk factors for death among patients with cholera-like syndrome in Cameroon. Informing people on community management of cholera-like syndrome and improving care in all health facilities are needed to reduce deaths during cholera epidemics.

Item analysis of the Leeds Dependence Questionnaire in community treatment centers.

The present study extends the item-level psychometric information of the Leeds Dependence Questionnaire (LDQ; Raistrick et al., 1994) that has been purported to measure psychological dependence and the International Statistical Classification of Diseases and Related Health Problems-10th edition substance dependence criteria. Prior research on the LDQ has not established item-level properties or the degree of differential item functioning (DIF) by gender and substance type. Principal component and Mokken scale analyses were used to assess unidimensionality and monotonicity of the responses to the scale items, respectively. Graphical and statistical methods examined the model-data fit of the graded response model and two-parameter logistic model of LDQ responses (n = 1,681) obtained from 2 community treatment centers. DIF analysis was performed on gender (men = 1,313, women = 353) and substance (alcohol = 821, opiates = 528) groups. The 2PL achieved the best model-data fit. Three items provided little information about standing on the underlying construct, indicating that they are likely not good indicators of the "pure" psychological construct the LDQ aims to measure. Overall, the LDQ offers the greatest precision in quantifying psychological dependence in a clinical sample along the lower to mid ranges of this construct. Uniform DIF was present in Item 7 of the dichotomized responses by substance (alcohol vs. opiates). DIF by gender was not found in any of the LDQ items. Recommendations include revising the scaling and discussing the need to obtain LDQ data from different levels of care and primary identified substance. (PsycINFO Database Record

The Other Side of Translational Biomarker Development: Taking MMN From Academic Labs to Real-World Community Treatment Centers

The Other Side of Translational Biomarker Development: Taking MMN From Academic Labs to Real-World Community Treatment Centers

Compulsory drug detention centers in East and Southeast Asia

Over the last three decades in response to a rise in substance use in the region, many countries in East and Southeast Asia responded by establishing laws and policies that allowed for compulsory detention in the name of treatment for people who use drugs. These centers have recently come under international scrutiny with a call for their closure in a Joint Statement from United Nations entities in March 2012. The UN's response was a result of concern for human rights violations, including the lack of consent for treatment and due process protections for compulsory detention, the lack of general healthcare and evidence based drug dependency treatment and in some centers, of forced labor and physical and sexual abuse (United Nations, 2012). A few countries have responded to this call with evidence of an evolving response for community-based voluntary treatment; however progress is likely going to be hampered by existing laws and policies, the lack of skilled human resource and infrastructure to rapidly establish evidence based community treatment centers in place of these detention centers, pervasive stigmatization of people who use drugs and the ongoing tensions between the abstinence-based model of treatment as compared to harm reduction approaches in many of these affected countries.

Some Psychosis Prescribing Not Concordant With Guidelines

However, some antipsychotic prescribing practices that do not follow guidelines may be clinically appropriate.

Measuring sleep disturbances in patients with alcohol use disorders: a short questionnaire suitable for routine practice.

Sleep disturbance constitutes a major risk factor for drinking relapse after alcohol withdrawal and necessitates regular follow-up. We reported previously that the sum-score of the 4 sleep items of the Hamilton Anxiety and Depression Scales (the Short Sleep Index [SSI]) constitutes a valid and simple sleep measurement tool. The objective of this study was to evaluate the psychometric features of the SSI relative to the lengthier Pittsburgh Sleep Quality Index (PSQI), which is widely used for measuring sleep disturbance in patients with alcohol use disorders during and after alcohol withdrawal. In this French, multicenter, cross-sectional survey, alcoholic patients were recruited in 2 academic hospitals and 1 community treatment center. Demographic data, alcohol history, and current consumption of alcohol and other abused substances were documented. The SSI and the PSQI questionnaires were completed in face-to-face interviews by a trained clinical research associate. A total of 257 patients were studied (88 females), with a mean age of 49 years (range: 24-80 years). The prevalence of sleep disturbance as measured by the PSQI and the SSI was 73.5% and 74.3%, respectively. The correlation between the 2 indices was strong (r = 0.764; 95% CI: 0.709-0.811), with negative and positive predictive values for the SSI (score > 1) of 71.2% and 89%, respectively, and an area under the receiver operating characteristic curve of 0.91 (95% CI: 0.85-0.92). The discriminant and convergent validity of the SSI was found to be noninferior to the PSQI. Compared to the PSQI, the SSI represents a quick, quantifiable, and reliable method that could help clinicians assess and manage sleep disturbance in alcoholic patients.

Prognostic subgroups for remission and response in the Coordinated Anxiety Learning and Management (CALM) trial.

Most patients with anxiety disorders receive treatment in primary care settings. Limited moderator data are available to inform clinicians of likely prognostic outcomes for individual patients. We identify baseline characteristics associated with outcome in adults seeking treatment for anxiety disorders. We conducted an exploratory moderator analysis from the Coordinated Anxiety Learning and Management (CALM) trial. In the CALM trial, 1,004 adults who met DSM-IV criteria for generalized anxiety disorder (GAD), panic disorder, social anxiety disorder, and/or posttraumatic stress disorder (PTSD) were randomized to usual care (UC) or a collaborative care intervention (ITV) of cognitive-behavioral therapy and/or pharmacotherapy between June 2006 and April 2008. Logistic regression was used to examine baseline characteristics associated with remission and response overall and by treatment condition. Receiver operating curve (ROC) analyses identified subgroups associated with similar likelihood of response and remission of global anxiety symptoms. Remission was defined as score < 6 on the 12-item Brief Symptom Inventory (BSI-12) anxiety and somatization subscales. Response was defined as at least 50% reduction on BSI-12, or meeting remission criteria. Randomization to ITV over UC was often the strongest predictor of outcome. Several baseline patient characteristics were associated with poor treatment outcome including comorbid depression, increased severity of underlying anxiety disorder(s) (P < .001), low socioeconomic status (perceived [P < .001] and actual [P < .05]), and limited social support (P < .001). Patient characteristics associated with particular benefit from ITV were being female (P < .05), increased depression (P < .01)/GAD severity (P < .05), and low socioeconomic status (P < .05). ROC analysis demonstrated prognostic subgroups with large differences in response likelihood. Further research should focus on the effectiveness of implementing the ITV intervention of CALM in community treatment centers where patients typically are of low socioeconomic status and may particularly benefit from ITV. ClinicalTrials.gov identifier: NCT00347269.

The 12 item W.H.O.D.A.S. as primary self report outcome measure in a correctional community treatment center for dually diagnosed patients.

The World Health Organization Disability Assessment Scale (WHODAS) is suggested as a measure of impairment in DSM-5. The measurement of impaired functioning is crucial in the rehabilitation of dually diagnosed, addiction and mental health, patients. This study is the first to look at the use of the 12 item self report WHODAS as the primary outcome in a community correctional treatment facility for dually diagnosed patients.100 (55 male; 73 white, 25 black, 2 hispanic) former inmates, age 36.1 ± 11.1, with psychiatric and addiction diagnoses were treated in an integrated program. The 12 item WHODAS was completed by the patients during the initial evaluation and repeated an average of 11.1 ± 2.7 weeks later. The Clinical Global Impression-Severity Scale (CGI) was completed at the same time by the psychiatrist, independently of the WHODAS. At initial assessment, the CGI showed moderate severity and the WHODAS showed severe disability. CGI and WHODAS were significantly correlated (R 0.48, p < 0.0001). After three months of treatment, both measures improved: CGI with 46% and WHODAS with 49%. The CGI showed mild severity and the WHODAS moderate disability. The change in CGI was correlated with the change in WHODAS (R 0.57, p < 0.0001). The WHODAS appears sensitive to clinical improvement related to shortterm treatment of a highly co-morbid dual diagnosis population.

Predictors of Treatment Completion in a Sample of Youth Who Have Experienced Physical or Sexual Trauma

Despite significant advances in knowledge and availability of evidence-based models for child traumatic stress, many children simply do not complete treatment. There remain notable gaps in the services research literature about treatment completion among youth, particularly those who have experienced trauma and related sequelae. This study investigated the linkages among child physical and sexual trauma, posttraumatic stress disorder (PTSD) symptomatology, and treatment completion utilizing a clinical sample drawn from a large database from community treatment centers across the United States specializing in childhood trauma. Results from regression analyses indicated that neither the experience of sexual nor physical trauma directly predicted successful treatment completion. The links between sexual trauma and treatment completion, however, were mediated by PTSD avoidance symptoms. Children and youth experiencing sexual trauma reported higher levels of avoidance symptoms that were, in turn, significantly associated with a lower likelihood of completing trauma-focused mental health treatment. Practice implications are discussed and include strategies for clinicians to intervene during pivotal points of treatment to improve rates of service utilization and treatment completion.

Clinician attitudes, social norms and intentions to use a computer-assisted intervention

The National Drug Abuse Treatment Clinical Trials Network (CTN) works to bridge the gap between research and practice and tested a Web-delivered psychosocial intervention (the Therapeutic Education System, TES) in 10 community treatment centers. Computer-assisted therapies, such as Web-delivered interventions, may improve the consistency and efficiency of treatment for alcohol and drug use disorders. Prior to the start of the study, we surveyed counselors (N=96) in participating treatment centers and assessed counselor attitudes, perceived social norms and intentions to use a Web-delivered intervention. Analysis of the intention to adopt a Web-delivered intervention assessed the influence of attitudes and perceived social norms. Perceived social norms were a significant contributor to clinician intention to adopt Web-based interventions while attitude was not. To promote successful implementation, it may be helpful to create social norms supportive of computer-assisted therapies.

Abstract LB-52: Relentless in the fight against blood cancer: the Leukemia &amp; Lymphoma Society

Abstract WHO WE ARE: The Leukemia &amp; Lymphoma Society (LLS) is the world's largest voluntary health organization dedicated to funding blood cancer research and providing education and patient services. Founded in 1949, we are relentless in pursuit of our mission: Cure leukemia, lymphoma, Hodgkin's disease and myeloma, and improve the quality of life of patients and their families. WHAT WE DO: Investing in blood cancer research: LLS has invested more than $814 million in research, approximately $76.6 million in fiscal year 2011 alone. Programs like the Specialized Center of Research (SCOR), and our Translational Research Program have directly contributed to many breakthrough cancer treatments. Research funded by LLS has led or contributed to advances such as chemotherapy, bone marrow and stem cell transplantation and new, targeted oral therapies. Providing critical information and support for patients and their families: We made 7.1 million contacts with patients, caregivers and healthcare professionals in fiscal year 2011, Advocating for issues impacting blood cancer patients: With more than 56,000 advocacy volunteers throughout the country, our voice is being heard by those responsible for legislation to fund blood cancer research and educational programs. WHY: An estimated 1,012,533 people in the United States are living with, or are in remission from, leukemia, Hodgkin lymphoma, non-Hodgkin lymphoma or myeloma.Approximately every four minutes, someone new is diagnosed with blood cancer. Approximately every 10 minutes, someone dies. Leukemia causes more deaths than any other cancer among children, adolescents and young adults under the age of 20. Lymphomas are the most common blood cancers and incidence increases with age. The survival rate for myeloma is only 41.1 percent. Incidence is more than twice as high among African Americans as for all other races. WHO WE SERVE: In addition to our national headquarters in White Plains, NY, we have a network of 59 local chapters across the United States and Canada. Our constituents live in urban, suburban, and rural communities, seek treatment at large comprehensive cancer centers and community clinics, and represent cultures from around the world. We work in partnership with community organizations, treatment centers, and government agencies to deliver quality cancer support services and to reach as many patients as we can in our region. We also work in partnership with other oncology and health organizations to meets the needs of the underserved people within our community. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr LB-52. doi:1538-7445.AM2012-LB-52

Practice patterns of US neurologists in patients with SPMS and PPMS

A modified Delphi process assessed current multiple sclerosis (MS) practice patterns for secondary and primary progressive MS (secondary progressive MS [SPMS] and primary progressive MS [PPMS]). In early 2011, 2 sequential, case-based surveys were administered to 75 US MS specialists to assess treatment practices and patient management. Respondents were from geographically diverse US academic (42%) and community (58%) treatment centers. There was consensus (≥75% agreement in responses) to switch disease-modifying therapies for a patient with SPMS with both MRI activity and disability progression (95%), but no consensus on treatment selection. For PPMS, responses supported diagnosis using spinal MRI (100%) and lumbar puncture (75%) and treatment initiation in patients with brain gadolinium-enhancing lesions with or without spinal cord lesions (85%); however, there was no consensus on treatment initiation with spinal cord lesions alone or initial therapy. The lack of agreement among US MS experts on the best treatment approaches for SPMS or PPMS highlights the need for effective therapies.

Community-Based Electrophysiological Abnormalities in Children With ADHD: Translating Research Findings into a Clinical Setting

Abstract Attention Deficit Hyperactivity Disorder (ADHD) is a highly prevalent disorder of childhood that is behaviorally characterized by repeated episodes of inattention, impulsivity, and hyperactivity. Selecting appropriate treatment based on presenting behavior can be challenging and usually requires timeintensive medication trials. Clinical and research communities agree there is a need for an objective method to both evaluate symptoms of ADHD and determine appropriate treatment options (Barkley, 2009). We are proposing the use of qEEGs (quantitative electroencephalograms) in patients presenting with ADHD symptomology to provide an objective assessment of underlying neuropathology that can aid in diagnostic clarification, thus offering targeted treatment approaches. Current studies have identified three abnormal electrophysiological clusters (Chabot &amp; Serfontein, 1996; Clarke, et al., 2001; Monastra, et al., 2001). This study was designed to examine these clusters of ADHD in a naturalistic sample to determine congruity between current research literature and frontline community treatment centers. We evaluated 30 pediatric patients (6–17 yrs) in a naturalistic psychiatric setting. As described in Konopka (2005), participants completed an initial baseline study to examine brain electrophysiology through qEEG. Electrophysiological clusters were defined by (Chabot &amp; Serfontein, 1996; Clarke, et al., 2001; Monastra, et al., 2001): cortical hypoarousal (excess theta), cortical hyperarousal (excess beta, decreased theta/ delta), and maturation lagged (excess delta/ theta). Neuroguide software and databases (Thatcher, 2009) were used for spectral analyses to convert raw EEG data to quantifiable form (qEEG). Fast Fourier Transformation was used to generate relative power maps for comparison of electrophysiological abnormalities. Comparisons were made for cortical activity levels of Delta, Theta, Alpha, and Beta. The database was used to statistically compare ADHD children to a control group (N=678), normed for gender, age, and handedness. Results show that children with ADHD exhibited abnormal electrophysiological activity in comparison to age and gender matched norms. While we found the previously documented electrophysiological groups, there was a disproportionately high degree of cortically hyperaroused children within the sample. Specifically, the overwhelming majority of our sample presented with excess relative beta in the central-parietal regions. Additionally we identified a novel electrophysiological group, which displayed concurrent excesses of fast (beta) and slow (theta) activity in relative frequencies. These findings illustrate discrepancies in ADHD populations studied in clinical centers and research laboratories. Given that there is agreement for the need of objective assessment tools and that imaging modalities provide promise (Chabot, Orgill, Crawford, Harris, &amp; Serfontein, 1999), there is also a need for continuity between research and clinical communities. This study provides an important objective diagnostic and treatment paradigm that can be highly informative for the direction of future studies.