Publications by authors named "Melanie E Bennett"

37 Publications

SIGH, what's in a name? An examination of the factor structure and criterion validity of the (Structured Interview Guide for the) Hamilton Anxiety scale (SIGH-A) in a sample of African American adults with co-occurring trauma experience and heavy alcohol use.

Exp Clin Psychopharmacol 2021 Jul 22. Epub 2021 Jul 22.

Department of Psychiatry.

The Hamilton Anxiety Inventory (HAM-A) is one of the oldest and most commonly used anxiety rating scales in clinical research. Despite its ubiquity, no studies have examined the scale's underlying factor structure and criterion validity among Black and African American adults with psychopathology ( = 42.25, = 11.44). Therefore, we estimated a confirmatory factor analysis of the commercially available Structured Interview Guide for the Hamilton Anxiety scale (SIGH-A; Williams, 1996) among African American adults ( = 88; 43% female) with co-occurring heavy alcohol use and trauma-related symptoms. Next, we examined the criterion validity of its Psychic and Somatic factors and overall anxiety severity score from participants who completed a single screening session (i.e., cross-sectional analysis) for a larger study. Results indicated that a two-factor solution provided an adequate fit to the data. Regression analyses indicated that the total SIGH-A score, but not its subscales, significantly predicted posttraumatic stress disorder (PTSD) severity. Neither the SIGH-A subscales nor total scores were significant predictors of alcohol consumption. The current findings suggest that the SIGH-A factor structure among African American adults with alcohol and trauma-related conditions is similar to previous reports that have tested largely White samples but highlight potential shortcomings when its subscales are used independently. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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http://dx.doi.org/10.1037/pha0000508DOI Listing
July 2021

"Assessing the Psychometric Properties of the PROMIS Sleep Measures in Persons with Psychosis."

Sleep 2021 Jun 4. Epub 2021 Jun 4.

Department of Psychology, University of Maryland, College Park, Maryland, USA.

An accumulation of research has indicated that persons with psychotic disorders experience a variety of sleep disturbances. However, few studies have examined the psychometric properties of sleep assessments that are utilized in this population. We conducted two studies to examine the reliability and validity of the PROMISTM Sleep Disturbance and Sleep-Related Impairment scales in outpatient samples of persons with psychosis. In Study 1, we examined the internal consistency and convergent validity of the PROMIS sleep scales in individuals with various psychotic disorders (N = 98) and healthy controls (N = 22). The PROMIS sleep scales showed acceptable internal consistency and convergent validity in both healthy controls and individuals with psychotic disorders. In addition, replicating prior research, the PROMIS scales identified greater sleep disturbance and sleep-related impairment in participants with psychotic disorders compared to healthy controls. In Study 2, we examined the test-retest reliability (M = 358 days) of the PROMIS sleep scales in a subset (N = 37) of persons with psychotic disorders who previously participated in Study 1. We also assessed the relation between these self-report measures and actigraph sleep parameters. The results showed that PROMIS sleep measures demonstrated modest temporal stability in the current sample. Contrary to our hypothesis, there was a lack of correspondence between these scales and actigraph sleep parameters. Overall, these findings indicate that the PROMIS sleep scales are psychometrically sound measures for populations with psychosis and highlight the importance of utilizing a multi-method approach to assess sleep.
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http://dx.doi.org/10.1093/sleep/zsab140DOI Listing
June 2021

Outcomes for patients receiving telemedicine-delivered medication-based treatment for Opioid Use Disorder: A retrospective chart review.

Heroin Addict Relat Clin Probl 2021 ;23(2):5-12

Division of Addiction Research and Treatment, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD 21201, USA.

This report builds on a previous study that describes the collaboration between an urban academic medical center and a rural drug treatment center, the goal of which is to provide medication-based treatment to individuals with OUD via videoconferencing. We describe results of a retrospective chart review of 472 patients treated in the program between August 2015 and April 2019. We examined several demographic and substance use variables for individuals who consented to telemedicine treatment, retention in treatment over time, and opioid use over time to understand further the impact of prescribing buprenorphine and naltrexone via telemedicine to patients in a rural OUD treatment setting. Our findings support the effectiveness of prescribing medications via telemedicine. The inclusion of more than three times as many patients as in our prior report revealed retention rates and toxicology results that are comparable to face-to-face treatment. These findings have implications for policymakers and clinicians considering implementation of similar programs.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7861202PMC
January 2021

Relationships between chronic pain and mood symptoms among veterans with bipolar disorder.

J Affect Disord 2020 12 1;277:765-771. Epub 2020 Sep 1.

VA Capital Healthcare Network Mental Illness, Research, Education, and Clinical Center (MIRECC), Baltimore, MD 21201, United States; Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD 21201, United States.

Background: Chronic pain is highly prevalent among individuals with mood disorders. While much is known about the relationship between pain and unipolar depression, little is known about pain experiences among people with bipolar disorder. This pilot study addresses this gap by examining pain and its relationship to mood and functioning in a sample of US military veterans with bipolar disorder.

Methods: Qualitative interviews were conducted with 15 veterans with bipolar disorder and chronic pain who were recruited from outpatient services within a Veterans Affairs medical center.

Results: Veterans reported a bidirectional relationship between pain and bipolar depression. When discussing manic episodes, individuals' experiences varied between notable reductions in pain (usually in euphoric states), increases in pain (usually in angry/irritable states), and feeling disconnected from pain. Many reported that increased activity when manic contributed to worse pain after an episode. Veterans clearly articulated how these connections negatively affected their functioning and quality of life.

Limitations: This was a small, retrospective study that included a non-random sample of veteran participants from one VA medical center. All veterans were engaged in outpatient mental health care, so the majority reported that their mood has been well-stabilized through medications and/or psychotherapy.

Conclusions: Chronic pain experiences appear to be related to depressive and manic mood states and significantly affects functioning and quality of life in Veterans with bipolar disorder. This study highlights the need to assess chronic pain among veterans with bipolar disorder, as changes in mood could have significant implications for functioning and pain management.
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http://dx.doi.org/10.1016/j.jad.2020.08.069DOI Listing
December 2020

Sleep Problems and Social Impairment in Psychosis: A Transdiagnostic Study Examining Multiple Social Domains.

Front Psychiatry 2020 28;11:486. Epub 2020 May 28.

Department of Psychiatry, University of Maryland, Baltimore, Baltimore, MD, United States.

Psychotic disorders are characterized by profound social impairment. An accumulation of research has explored the contribution of symptoms, cognitive functioning, and behavioral skills deficits to this social dysfunction. Recent research indicates that sleep disturbance has significant social implications in nonclinical populations-this research suggests that sleep problems may also be relevant to understanding social impairment in psychosis. This study adopted a symptom-oriented dimensional approach to examine how sleep disturbance and sleep-related impairment are related to multiple social domains within a transdiagnostic sample (N = 90). This sample included individuals with a variety of psychotic disorders (n = 75) along with healthy non-clinical participants (n = 15) to ensure sampling across the full range of sleep problems and social functioning. Social domains spanned self-reported perceptions of social relationships, social functioning in the community, and behavioral assessments of social competence. We hypothesized that greater sleep disturbance and sleep-related impairment would be associated with more negative or problematic perceptions of social relationships (i.e., less social support, less companionship, and greater distress), poorer social functioning in the community, smaller social networks, and poorer behavioral ratings of social competency. Results supported these hypotheses indicating that sleep disturbance and sleep-related impairment have widespread deleterious impacts on perceptions of social relationships, social functioning, and competence. Sleep disturbance retained associations with perceptions of social relationships, social functioning, and social competence even after controlling for total symptoms or cognitive functioning. These findings indicate that sleep problems may have important implications for fully understanding the causes of social impairment in psychosis.
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http://dx.doi.org/10.3389/fpsyt.2020.00486DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7270336PMC
May 2020

Sleep disturbance and sleep-related impairment in psychotic disorders are related to both positive and negative symptoms.

Psychiatry Res 2020 Feb 7;286:112857. Epub 2020 Feb 7.

Department of Psychiatry, University of Maryland School of Medicine, 737 W. Lombard Street, Suite 551 Baltimore, MD 21201, USA; Department of Psychiatry, Baltimore VA Medical Center, 10 North Greene Street, Baltimore, MD 21201, USA.

A large literature indicates that sleep disturbances are associated with paranoia and other positive symptoms in psychotic disorders. However, few studies have examined the potential association between sleep disturbances and negative symptoms and the results have been inconsistent. The current study examined the hypothesis that sleep problems would be associated with more severe positive and negative symptoms in a transdiagnostic sample of individuals with psychosis (N = 90). Further, we examined whether sleep would be related to negative symptoms above and beyond the contribution of paranoia, other positive symptoms, and depression-anxiety. Results replicated prior research in finding that both sleep disturbance and sleep-related impairment were related to more severe paranoia, other positive symptoms and depression-anxiety. Consistent with our hypothesis, more severe sleep disturbance and sleep-related impairment were related to greater negative symptoms; this was evident across both motivation-pleasure deficits and diminished expression. Sleep variables remained significantly related to motivation-pleasure deficits even after controlling for other non-negative symptoms. These results indicate the broad symptom impact of sleep disturbances and may suggest a novel treatment target to improve negative symptoms.
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http://dx.doi.org/10.1016/j.psychres.2020.112857DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7416463PMC
February 2020

Personal Approach to Treatment Choices for HIV (PATCH): Randomized Controlled Trial of a Brief Motivational Enhancement Intervention to Improve Medication Adherence in Persons with HIV.

AIDS Behav 2020 Jun;24(6):1893-1902

Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA.

This pilot randomized controlled trial evaluated the feasibility and efficacy of a brief motivational enhancement intervention to improve adherence to antiretroviral therapy in persons with HIV called Personal Approach to Treatment Choices for HIV (PATCH). We compared PATCH to an active control condition on self-reported adherence, clinical outcomes, and psychosocial outcomes. Participants were 34 individuals (61.8% male, M = 47.1) receiving HIV-related services who were suboptimally engaged in care. Participants completed baseline measures, participated in either PATCH or a stress reduction skills control intervention, and completed post-treatment and 3-month follow-up assessments. Results revealed no differences between conditions on adherence or clinical outcomes. At post-treatment, PATCH participants reported greater improvements in alcohol use, psychiatric symptoms, subjective mental functioning, and emotion-focused coping; improvements in subjective mental functioning were maintained at 3-months. Results suggest that motivational enhancement interventions can improve psychosocial outcomes for people with HIV. That some improvements were not maintained at follow-up suggests that effects wane over time and longer treatment may be indicated for lasting effects.
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http://dx.doi.org/10.1007/s10461-019-02759-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7275292PMC
June 2020

Assessing Social Affiliative Behavior: A Comparison of in Vivo and Video Tasks.

Behav Ther 2018 11 19;49(6):1039-1047. Epub 2018 Mar 19.

University of Maryland, College Park.

Social affiliation, or engagement in positive social interactions, is often profoundly impaired in individuals with schizophrenia. Valid measures of social affiliation are needed to understand these impairments and their symptom and functional correlates; however, such measures are limited and have not been validated. This pilot study evaluated one such measure-the video-based Social Affiliation Interaction Task (SAIT)-and a novel in vivo behavioral measure, the Affiliative Conversation Task (ACT). Twenty participants with schizophrenia or schizoaffective disorder (SZ) and 35 nonpsychiatric controls (CT) completed both tasks and measures of negative symptoms and functioning. We explored group differences in social affiliation skills; convergent validity between social affiliation skill ratings from the two tasks; and concurrent validity with social affiliation skill ratings, negative symptoms, and functioning. SZ evidenced lower affiliation skill ratings than CT on the video SAIT, but not on the ACT, and the tasks displayed moderate convergent validity for affiliation skill ratings. Less affiliation skill in the SAIT was correlated with more negative symptoms and less functioning in the SZ group with medium effects, though the results were not significant. Findings suggest that the SAIT may be more sensitive to individual differences in skill level. Future research should continue to examine the SAIT for use in measuring affiliation skills.
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http://dx.doi.org/10.1016/j.beth.2018.03.006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7137772PMC
November 2018

Negative symptoms and the formation of social affiliative bonds in schizophrenia.

Schizophr Res 2018 03 2;193:225-231. Epub 2017 Aug 2.

Department of Psychology, University of Maryland College Park, College Park, MD 20742, United States. Electronic address:

Negative symptoms in schizophrenia are characterized by deficits in normative experiences and expression of emotion, and they are associated with poor social functioning. Negative symptoms relating to deficits in motivation and pleasure may hinder the development of affiliative bonds. The current study used a novel procedure to examine the relation between negative symptoms and the development of social affiliation within a laboratory setting. Fifty-five men (35 controls; 20 with a schizophrenia spectrum disorder) completed three Social Affiliation Enhancement Tasks with an experimenter partner. Self-reported affiliation and affect ratings were assessed before and after the affiliative interaction. Across groups, social affiliation and positive affect increased following the interactive tasks. However, the schizophrenia group reported less positive and more negative affect than controls. Within individuals with schizophrenia, negative symptoms reflecting motivation and pleasure deficits and self-reported social anhedonia were associated with less affiliative feelings of interpersonal closeness and less willingness to interact. Additionally, these self-reported reactions to the interaction partner were significantly related to social functioning in the community. These findings indicate that though individuals with schizophrenia can form affiliative bonds, the extent to which this is possible may be limited by negative symptoms relating to motivation and pleasure. Additional research will be necessary to examine just how these negative symptoms interfere with social affiliation.
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http://dx.doi.org/10.1016/j.schres.2017.07.034DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5796871PMC
March 2018

Targets for the Treatment of Insomnia in Veterans With Serious Mental Illness.

J Psychiatr Pract 2017 07;23(4):270-280

KLINGAMAN and BENNETT: Department of Veterans Affairs, Capitol Health Care Network (VISN 5) and University of Maryland School of Medicine, Baltimore, MD MCCARTHY: University of Maryland, College Park, MD SCHWARTZ: Louisiana State University, Baton Rouge, LA GEHRMAN: Department of Veterans Affairs Medical Center and University of Pennsylvania School of Medicine, Philadelphia, PA.

Study Objectives: Insomnia is pervasive among people with serious mental illnesses (SMI) and has a profound negative impact on their psychiatric symptom management and recovery. However, little is known about the factors that affect severity of insomnia in those with SMI. In addition, very few studies have explored whether evidence-based interventions developed for those without SMI are appropriate for or applicable to individuals with SMI. The purpose of this study was to test the role of arousal, dysfunctional cognitions about sleep, and sleep-related behaviors in predicting severity of insomnia in a sample of 60 Veterans who were receiving care in Veterans Health Administration mental health and psychosocial rehabilitation programs and who reported subjective insomnia. In addition, information was collected regarding the types of insomnia treatments provided to these Veterans.

Methods: Participants completed assessments of insomnia severity and sleep-related arousal, behaviors, and cognitions. Medical records were reviewed to determine whether participants had been screened/assessed for insomnia and whether treatments for insomnia were provided before the date of referral to the study. Multiple regression was used to predict insomnia severity on the basis of these factors.

Results: Most participants (81.7%) reported moderate to severe insomnia, although only 3.3% had a diagnosis of insomnia in their medical records. Worry and helplessness about sleep were predictive of insomnia severity; better self-reported sleep hygiene and higher levels of arousal were also associated with greater severity of insomnia. Education about sleep hygiene and medication were the only types of insomnia treatment received.

Conclusions: Similar to insomnia among individuals without SMI, insomnia in Veterans with SMI is associated with dysfunctional sleep-related behaviors and cognitions. Many of the Veterans also lacked access to settings and resources conducive to healthy sleep. Veterans with SMI should be regularly assessed for insomnia. Research is needed concerning optimal evidence-based insomnia interventions for addressing behaviors and cognitions in this population in the context of these challenges.
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http://dx.doi.org/10.1097/PRA.0000000000000240DOI Listing
July 2017

Predictors of smoking cessation group treatment engagement among veterans with serious mental illness.

Addict Behav 2017 Dec 10;75:103-107. Epub 2017 Jul 10.

VA Capital Healthcare Network Mental Illness, Research, Education, and Clinical Center (MIRECC), Baltimore, MD 21201, United States; Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD 21201, United States. Electronic address:

High prevalence rates of tobacco use, particularly cigarettes, pose a serious health threat for individuals with serious mental illness (SMI), and research has demonstrated the effectiveness of pharmacotherapy and psychosocial interventions to reduce tobacco use in this group. However, few studies have considered predictors of tobacco cessation treatment engagement among individuals with SMI. The current study examined predictors of engagement in smoking cessation groups among veterans with SMI engaged in mental health services at three VA medical centers. All veterans were participating in a smoking cessation treatment study. Of 178 veterans who completed baseline assessments, 127 (83.6%) engaged in treatment, defined as attending at least three group sessions. Forty-one (N=41) predictors across five domains (demographics, psychiatric concerns, medical concerns, smoking history, and self-efficacy to quit smoking) were identified based on previous research and clinical expertise. Using backward elimination to determine a final multivariable logistic regression model, three predictors were found to be significantly related to treatment engagement: marital status (never-married individuals more likely to engage); previous engagement in group smoking cessation services; and greater severity of positive symptoms on the Brief Psychiatric Rating Scale. When included in the multivariable logistic regression model, the full model discriminates between engagers and non-engagers reasonably well (c statistic=0.73). Major considerations based on these findings are: individuals with SMI appear to be interested in smoking cessation services; and serious psychiatric symptomatology should not discourage treatment providers from encouraging engagement in smoking cessation services.
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http://dx.doi.org/10.1016/j.addbeh.2017.07.005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5616105PMC
December 2017

Treatment of substance use disorders in schizophrenia.

Am J Drug Alcohol Abuse 2017 07 9;43(4):377-390. Epub 2016 Aug 9.

c Department of Psychology , University of Maryland, College Park , College Park , MD , USA.

Background: Substance use disorders (SUDs) represent a great barrier to functional recovery for individuals with schizophrenia. It is important to use research on treatment of SUDs in schizophrenia to guide treatment recommendations and program planning.

Objectives: We review studies of pharmacological and psychosocial interventions to treat SUDs in individuals with schizophrenia.

Methods: The criteria used to select studies for inclusion are (1) the percentage of the sample with a schizophrenia spectrum diagnosis is at least 25%; (2) participants have a comorbid SUD or problem use of substances; (3) an intervention for SUD is provided; (4) a substance use-related outcome is measured; and (5) the study design enabled examination of pre-post outcome measures including open label trials, nonrandomized evaluations (quasi-experimental designs, nonrandom assignment to groups), or randomized controlled trials.

Results: There are few psychopharmacology outcomes studies. Most have examined use of antipsychotic medications to treat SUDs in schizophrenia. Several trials have yielded positive findings for naltrexone in reducing drinking compared to placebo in this population. Motivational and cognitive-behavioral interventions are associated with decreased substance use in several trials.

Conclusion: Treatment for SUDs is feasible within a range of settings and acceptable to many individuals with schizophrenia. All individuals with schizophrenia should be offered brief or more extended psychosocial interventions that incorporate discussion of personal reasons to change and training in cognitive-behavioral strategies to reduce use, cope with cravings and stress, and avoid relapse. Future research must include larger samples, longitudinal designs, and similar outcome measures across studies.
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http://dx.doi.org/10.1080/00952990.2016.1200592DOI Listing
July 2017

Inefficient effort allocation and negative symptoms in individuals with schizophrenia.

Schizophr Res 2016 Feb 4;170(2-3):278-84. Epub 2016 Jan 4.

Department of Psychology, University of Maryland College Park, College Park, MD 20742, United States. Electronic address:

Negative symptoms like avolition and anhedonia are thought to involve difficulties with reward processing and motivation. The current study aimed to replicate and extend prior findings that individuals with schizophrenia display reduced willingness to expend effort for rewards and that such reduced effort is associated with negative symptoms, poor functioning, and cognitive impairment. The present study compared the effortful decision making of individuals with schizophrenia (n=48) and healthy controls (n=27) on the Effort Expenditure for Rewards Task (EEfRT). Individuals with schizophrenia chose a smaller proportion of hard tasks than healthy controls across all probability and reward levels with the exception of trials with a 12% probability and low or medium reward magnitude wherein both groups chose similarly few hard tasks. Contrary to expectations, in individuals with schizophrenia, greater negative symptoms were associated with making more effortful choices. Effortful decision making was unrelated to positive symptoms, depression, cognition, and functioning in individuals with schizophrenia. Our results are consistent with prior findings that revealed a pattern of inefficient decision making in individuals with schizophrenia relative to healthy controls. However the results did not support the hypothesized association of negative symptoms and reduced effort in schizophrenia and highlight prior inconsistencies in this literature. Future research is needed to understand what factors may be related to diminished effortful decision making in schizophrenia and the clinical significance of such performance deficits.
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http://dx.doi.org/10.1016/j.schres.2015.12.017DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4740196PMC
February 2016

Inefficient effort allocation and negative symptoms in individuals with schizophrenia.

Schizophr Res 2016 Feb 4;170(2-3):278-84. Epub 2016 Jan 4.

Department of Psychology, University of Maryland College Park, College Park, MD 20742, United States. Electronic address:

Negative symptoms like avolition and anhedonia are thought to involve difficulties with reward processing and motivation. The current study aimed to replicate and extend prior findings that individuals with schizophrenia display reduced willingness to expend effort for rewards and that such reduced effort is associated with negative symptoms, poor functioning, and cognitive impairment. The present study compared the effortful decision making of individuals with schizophrenia (n=48) and healthy controls (n=27) on the Effort Expenditure for Rewards Task (EEfRT). Individuals with schizophrenia chose a smaller proportion of hard tasks than healthy controls across all probability and reward levels with the exception of trials with a 12% probability and low or medium reward magnitude wherein both groups chose similarly few hard tasks. Contrary to expectations, in individuals with schizophrenia, greater negative symptoms were associated with making more effortful choices. Effortful decision making was unrelated to positive symptoms, depression, cognition, and functioning in individuals with schizophrenia. Our results are consistent with prior findings that revealed a pattern of inefficient decision making in individuals with schizophrenia relative to healthy controls. However the results did not support the hypothesized association of negative symptoms and reduced effort in schizophrenia and highlight prior inconsistencies in this literature. Future research is needed to understand what factors may be related to diminished effortful decision making in schizophrenia and the clinical significance of such performance deficits.
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http://dx.doi.org/10.1016/j.schres.2015.12.017DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4740196PMC
February 2016

Smoking Cessation in Individuals With Serious Mental Illness: A Randomized Controlled Trial of Two Psychosocial Interventions.

J Dual Diagn 2015 ;11(3-4):161-73

a VA VISN 5 Mental Illness Research, Education, and Clinical Center , Baltimore , Maryland , USA.

Objective: Smoking among individuals with serious mental illness is a critical public health problem. Although guidelines recommend bupropion for these smokers, many do not want to use medications for smoking cessation, express ambivalence about identifying a "quit date," and do not have access to behavioral smoking cessation services integrated with mental health care.

Methods: Individuals with serious mental illness who smoked 10 or more cigarettes per day (N = 178) were randomized to either a multifaceted behavioral group intervention or a supportive group intervention, both of which were integrated within outpatient mental health services at three VA medical centers. Participants attended twice-weekly meetings for 12 weeks, provided information on their smoking at each meeting, and completed baseline and post-treatment assessments conducted by an assessor who was blind to condition. Primary outcomes collected at post-treatment included 1-week abstinence, number of cigarettes smoked per day during the last week, and number of quit attempts during the treatment period. Outcomes examined for a subset of participants who attended at least one intervention meeting (n = 152) included smoking abstinence for 1-, 2-, and 4-week blocks during the treatment period. Analyses conducted on those participants who attended three or more intervention meetings (n = 127) included time to 50% reduction in the number of cigarettes smoked and time to first quit attempt.

Results: Sixteen participants achieved abstinence (11.8%), smoking quantity was significantly reduced (baseline M = 15.2, SD = 9.8 to post-treatment M = 7.5, SD = 7.7, p <.0001), and most reported making a quit attempt (n = 88, 72.7%). There were no differences by study condition on any abstinence or reduction outcomes. Significant reductions in number of cigarettes smoked generally took place within the first two weeks; however, these reductions did not often translate into abstinence.

Conclusions: Many participants reduced their smoking and sampled quitting during the study. Implementing smoking cessation services in mental health treatment settings is feasible and, if delivered in line with best practices, either a behavioral or a supportive approach can be helpful. Future research should examine ways to facilitate the transition from reduction to abstinence. This study was part of a clinical trial registered as NCT #00960375 at www.clinicaltrials.gov.
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http://dx.doi.org/10.1080/15504263.2015.1104481DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7258306PMC
October 2016

Sleep Disorders Among People With Schizophrenia: Emerging Research.

Curr Psychiatry Rep 2015 Oct;17(10):79

Mental Illness Research, Education, and Clinical Center (MIRECC), VA Capitol Health Care Network (VISN 5), 10 North Greene Street (Annex Suite 720), Baltimore, MD, 21201, USA,

Up to 80 % of individuals with schizophrenia spectrum disorders experience sleep disturbances, which impact physical and mental health, as well as quality of life. In this paper, we review and integrate emerging literature, published between 2012 and 2014, regarding approaches to diagnosis and treatment of major sleep disorders for people with schizophrenia spectrum disorders, including insomnia, obstructive sleep apnea (OSA), circadian rhythm dysfunction, and restless legs syndrome (RLS). We advocate for (1) the need to evaluate the utility of nonpharmacological approaches in people with schizophrenia spectrum disorders; (2) documentation of guidelines to assist providers in clinically tailoring such interventions when their clients experience positive, negative, and/or cognitive symptoms; (3) research on the best ways providers can capitalize on clients' self-identified needs and motivation to engage in sleep treatments through shared decision making; and (4) the importance of investigating whether and how mental health and sleep treatment services should be better connected to facilitate access for people with schizophrenia spectrum disorders. Assessment and tailored treatment of sleep disorders within mental health treatment settings has the potential to reduce sleep problems and improve functioning, quality of life, and recovery of this population.
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http://dx.doi.org/10.1007/s11920-015-0616-7DOI Listing
October 2015

Social affiliation and negative symptoms in schizophrenia: Examining the role of behavioral skills and subjective responding.

Schizophr Res 2015 Oct 31;168(1-2):491-7. Epub 2015 Jul 31.

VA Capitol Health Care Network (VISN 5) Mental Illness Research, Education, and Clinical Center (MIRECC), Baltimore, MD, United States; Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, United States.

Schizophrenia is characterized by profound impairment in the motivation for social affiliation. Negative symptoms are associated with such impairment but the contribution of behavioral skill deficits is unclear. In this study we utilized a novel video paradigm to assess performance-based affiliative behavioral skills in individuals with schizophrenia (N=48) and community controls (N=29). Individuals with schizophrenia displayed significant impairment in behavioral affiliative skills compared to controls; however, in response to the affiliative interaction the groups did not differ on self-reported affective responding, appraisal of the interaction partner, or desire to interact with the partner in the future. Importantly, within the patient group more severe negative symptoms (particularly those related to motivation and pleasure) were associated with poorer affiliative social skills and this relationship was independent of instrumental (non-social) skills, depression or positive symptoms. More severe negative symptoms were also associated with less positive affect in response to the interaction and less positive appraisals of the interaction partner. Self-reported social anhedonia was related to patients' diminished willingness to interact with the partner in the future. These results demonstrate that negative symptoms in schizophrenia are related to both affiliative skill deficits and less affiliative subjective responses to interaction partners.
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http://dx.doi.org/10.1016/j.schres.2015.07.019DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4762010PMC
October 2015

Implementing Coordinated Specialty Care for Early Psychosis: The RAISE Connection Program.

Psychiatr Serv 2015 Jul 16;66(7):691-8. Epub 2015 Mar 16.

Dr. Dixon, Ms. Mendon, Ms. Choi, Dr. Lieberman, and Dr. Essock are with the New York State Psychiatric Institute, New York City (e-mail: ). Dr. Dixon, Dr. Lieberman, and Dr. Essock are also with the Department of Psychiatry, Columbia University College of Physicians and Surgeons. Dr. Goldman, Dr. Bennett, and Dr. McNamara are with the Department of Psychiatry, University of Maryland School of Medicine, Baltimore. Dr. Wang is with the Division of Biostatistics, Mailman School of Public Health, Columbia University, New York City. Dr. Goldstein is with the Division of Services and Intervention Research, National Institute of Mental Health, Bethesda, Maryland. Dr. Lee is with the Silberman School of Social Work, Hunter College, City University of New York, New York City. This article is part of a special section on RAISE and other early intervention services. Marcela Horvitz-Lennon, M.D., M.P.H., served as guest editor of the special section.

Objective: The RAISE (Recovery After an Initial Schizophrenia Episode) Connection Program Implementation and Evaluation Study developed tools necessary to implement and disseminate an innovative team-based intervention designed to promote engagement and treatment participation, foster recovery, and minimize disability among individuals experiencing early psychosis. This article describes the treatment model and reports on service utilization and outcomes. It was hypothesized that individuals' symptoms and functioning would improve over time.

Methods: A total of 65 individuals in RAISE Connection Program treatment across two sites (Baltimore and New York City) were enrolled and received services for up to two years. Primary outcomes, including social and occupational functioning and symptoms, were evaluated. Trajectories for individuals' outcomes over time were examined with linear and quadratic mixed-effects models with repeated measures.

Results: Measures of occupational and social functioning improved significantly over time, symptoms declined, and rates of remission improved. Visits were most frequent during the first three months, with a mean±SD of 23.2±11.5 unduplicated staff encounters per quarter. Such encounters decreased to 8.8±5.2 in the final quarter of year 2.

Conclusions: The overall project was successful in that the treatment program was delivered and tools useful to other clinical settings were produced. The strengths of this study lie in the demonstrated feasibility of delivering the coordinated specialty care model and the associated high rates of engagement among individuals who are typically difficult to engage in treatment. Notwithstanding the lack of a built-in comparison group, participant outcomes were promising, with improvements comparable to those seen with other successful interventions.
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http://dx.doi.org/10.1176/appi.ps.201400281DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5637730PMC
July 2015

Practical Monitoring of Treatment Fidelity: Examples From a Team-Based Intervention for People With Early Psychosis.

Psychiatr Serv 2015 Jul 2;66(7):674-6. Epub 2015 Jan 2.

Dr. Essock, Dr. Nossel, and Dr. Dixon are with the New York State Psychiatric Institute and the Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York City (e-mail: ). Dr. McNamara, Dr. Bennett, Dr. Kreyenbuhl, and Dr. Goldman are with the Department of Psychiatry, University of Maryland School of Medicine, Baltimore. Dr. Buchanan is with the Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore. Ms. Mendon is with the New York State Psychiatric Institute, New York City. Marcela Horvitz-Lennon, M.D., M.P.H., is editor of this column. This column is part of a special section on RAISE and other early intervention services.

Mental health programs can address many components of fidelity with routinely available data. Information from client interviews can be used to corroborate these administrative data. This column describes a practical approach to measuring fidelity that used both data sources. The approach was used in the Recovery After an Initial Schizophrenia Episode (RAISE) Connection Program, a team-based intervention designed to implement evidence-based practices for people experiencing early psychosis suggestive of schizophrenia. Data indicated that the intervention was implemented as intended, including program elements related to shared decision making and a range of evidence-based clinical interventions.
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http://dx.doi.org/10.1176/appi.ps.201400531DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4490109PMC
July 2015

Smoking cessation in people with schizophrenia.

Curr Drug Abuse Rev 2013 Sep;6(3):180-90

Department of Psychiatry, University of Maryland School of Medicine, 737 West Lombard Street, Suite 551, Baltimore, Maryland, 21201, USA.

Objective: High rates of smoking and nicotine dependence have a profoundly negative impact on the health and well being of individuals with schizophrenia. Treating smoking is a critical step in improving the health and quality of life of people affected by this illness. This paper reviews the literature on smoking cessation interventions in schizophrenia and discusses potential barriers to effective treatment with this population.

Methods: The criteria used to select studies for inclusion were: (1) Sample included 50% or more individuals with schizophrenia spectrum diagnosis (SSD); (2) Some individual or group intervention for smoking cessation was provided; and (3) Some smoking-related outcome variable was measured (self-reported smoking, breath carbon monoxide, etc).

Results: Both pharmacologic and psychosocial smoking cessation treatments have been found to be useful in helping individuals with schizophrenia reduce and quit smoking in the short term. Few interventions have been found to be effective in promoting smoking abstinence in the long term.

Conclusions: Intervention development must include strategies to overcome barriers to smoking cessation that are most relevant to individuals with schizophrenia and focus on translating short term gains into long term abstinence.
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http://dx.doi.org/10.2174/18744737112059990011DOI Listing
September 2013

Impact of Family History in Persons With Dual Diagnosis.

J Dual Diagn 2013 Feb 27;9(1):30-38. Epub 2012 Nov 27.

University of Maryland-Baltimore County, Baltimore, Maryland, USA.

Objective: This study examined relationships among family history of alcohol, drug, and psychiatric problems and substance use severity, interpersonal relationships, and service use in individuals with dual diagnosis.

Methods: Data were collected with the family history section of the Addiction Severity Index administered as part of three studies of individuals with dual disorders (=413). Participants were categorized into family history risk groups for each problem domain based on the number of first and second degree relatives with alcohol, drug, or psychiatric problems.

Results: Rates of alcohol, drug, and psychiatric problems were high across family member categories and highest overall for siblings. Over two-thirds of the sample was categorized in the high-risk group in the alcohol problem domain, almost half of the sample was categorized as high-risk in the drug problem domain, and over a third of the sample was categorized as high-risk in the psychiatric problem domain. Across problem domains, individuals in the high-risk group reported more relationship problems with parents and siblings and higher rates of lifetime emotional, physical, and sexual abuse than did those in the low or moderate-risk groups.

Conclusions: Family history of alcohol, drug, and psychiatric problems is associated with greater rates of poor family relationships and history of abuse. Assessment of these different forms of family history in multiple family members can aid treatment providers in identifying individuals with dual disorders who may benefit from trauma-informed care as part of their overall mental health and substance abuse treatment services.
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http://dx.doi.org/10.1080/15504263.2012.744937DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3607460PMC
February 2013

The Motivation and Pleasure Scale-Self-Report (MAP-SR): reliability and validity of a self-report measure of negative symptoms.

Compr Psychiatry 2013 Jul 22;54(5):568-74. Epub 2013 Jan 22.

Department of Psychology, University of Maryland, College Park, MD 20742-4411, USA.

The Clinical Assessment Interview for Negative Symptoms (CAINS) is an empirically developed interview measure of negative symptoms. Building on prior work, this study examined the reliability and validity of a self-report measure based on the CAINS-the Motivation and Pleasure Scale-Self-Report (MAP-SR)-that assesses the motivation and pleasure domain of negative symptoms. Thirty-seven participants with schizophrenia or schizoaffective disorder completed the 18-item MAP-SR, the CAINS, and other measures of functional outcome. Item analyses revealed three items that performed poorly. The revised 15-item MAP-SR demonstrated good internal consistency and convergent validity with the clinician-rated Motivation and Pleasure scale of the CAINS, as well as good discriminant validity, with little association with psychotic symptoms or depression/anxiety. MAP-SR scores were related to social anhedonia, social closeness, and clinician-rated social functioning. The MAP-SR is a promising self-report measure of severity of negative symptoms.
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http://dx.doi.org/10.1016/j.comppsych.2012.12.001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4762003PMC
July 2013

Internalized stigma in schizophrenia: relations with dysfunctional attitudes, symptoms, and quality of life.

Psychiatry Res 2013 Jan 17;205(1-2):43-7. Epub 2012 Sep 17.

Department of Psychology, University of Maryland, College Park, MD, USA.

Internalized stigma refers to the process by which individuals with mental illness apply negative stereotypes to themselves, expect to be rejected by others, and feel alienated from society. Though internalized stigma has been hypothesized to be associated with maladaptive cognitions and expectations of failure, this relationship with dysfunctional attitudes has not been fully examined. In the present study, 49 individuals with schizophrenia or schizoaffective disorder completed the Internalized Stigma of Mental Illness Scale (ISMI; Ritsher et al., 2003) in addition to measures tapping defeatist performance beliefs, beliefs regarding low likelihood of success and limited resources, negative symptoms, depression, and quality of life. Consistent with prior research, internalized stigma was correlated with depression and quality of life but not with negative symptoms. Further, internalized stigma was correlated with both measures of dysfunctional attitudes. After controlling for depressive symptomatology, the relationship between internalized stigma and beliefs regarding low likelihood of success and limited resources remained significant, and though the correlation between defeatist performance beliefs and internalized stigma was no longer significant, it was of a similar magnitude. Overall, these data suggest that dysfunctional attitudes play a role in internalized stigma in individuals with schizophrenia, indicating a possible point of intervention.
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http://dx.doi.org/10.1016/j.psychres.2012.08.040DOI Listing
January 2013

Patterns and Predictors of Changes in Substance Use in Individuals with Schizophrenia and Affective Disorders.

J Dual Diagn 2012 Feb;8(1):2-12

Department of Psychiatry, University of Maryland School of Medicine.

OBJECTIVE: This study examined patterns and predictors of changes in substance use over one year in individuals with schizophrenia and affective disorders. We examined patterns of cocaine use over time, baseline predictors of continued cocaine use over one year, and predictors of transitions into and out of drug use and treatment. METHODS: We recruited 240 individuals with schizophrenia and affective disorders who met DSM-IV criteria for current cocaine dependence or cocaine dependence in early full or sustained full remission, and assessed them five times over twelve months. RESULTS: There was no change over time in either the proportion of the sample with at least one day of cocaine use in the past month or in the average number of days of cocaine use among those who reported any use. Baseline variables tapping actual substance use were found to predict a decreased likelihood of cocaine use. Several variables tapping actual substance use - including self- reported use of cocaine, positive urinalysis for marijuana, and positive urinalysis for cocaine - were predictive of transitions into and out of outpatient substance abuse treatment. Readiness to change variables such as self-efficacy and temptation to use drugs showed different predictive patterns for the schizophrenia and affective disorder groups. CONCLUSIONS: These findings illustrate how drug use may show a cyclical pattern for those with serious mental illness, in which more severe use - characterized by greater frequency of use and associated problems - is followed by decreased use over time.
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http://dx.doi.org/10.1080/15504263.2012.647466DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3327483PMC
February 2012

Screening for negative symptoms: preliminary results from the self-report version of the Clinical Assessment Interview for Negative Symptoms.

Schizophr Res 2012 Mar 21;135(1-3):139-43. Epub 2012 Jan 21.

Department of Psychology, University of Maryland, College Park, MD 20742-4411, United States.

Though negative symptoms in schizophrenia are associated with a host of deleterious outcomes (e.g., White et al., 2009), not all individuals with schizophrenia suffer from negative symptoms (e.g., Blanchard et al., 2005). Thus, methods to quickly screen and identify patients for more intensive clinical interview assessments may have significant clinical and research utility. The present study is a preliminary examination of the reliability and validity of a self-report version of the newly developed Clinical Assessment Interview for Negative Symptoms (CAINS; Blanchard et al., 2011; Forbes et al., 2010; Horan et al., 2011). The CAINS-SR is a 30-item self-report measure that assesses Experiential (avolition, anhedonia, asociality) and Expressive (blunted affect, alogia) domains of negative symptoms. Participants (N = 69) completed the CAINS-SR questionnaire and were evaluated with symptom interviews using the CAINS and other non-negative symptom interviews that assessed psychotic, affective, and other symptoms. The Experience subscale of the CAINS-SR demonstrated good internal consistency, convergent validity, and discriminant validity, while the poorer psychometric properties of the Expression subscale suggest that self-report of negative symptoms should focus on the experiential domain. Overall, preliminary findings indicate that the CAINS-SR (addressing experiential deficits) may be a useful complement to the clinician-rated interview measure. Future research on the sensitivity and specificity of the CAINS-SR will determine its suitability as a screening measure.
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http://dx.doi.org/10.1016/j.schres.2011.12.007DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7201303PMC
March 2012

Negative expectancy appraisals and defeatist performance beliefs and negative symptoms of schizophrenia.

Psychiatry Res 2011 Aug 24;189(1):43-8. Epub 2011 Jun 24.

Department of Psychology, University of Maryland College Park, Biology-Psychology Building, College Park, MD 20742, USA.

Negative symptoms have clear functional implications in schizophrenia and are typically unresponsive to current treatments. The cognitive model of negative symptoms suggests that dysfunctional beliefs are influential in the development and maintenance of negative symptoms and schizophrenia. The current study reports on a preliminary investigation of a new measure of Negative Expectancy Appraisals (specifically beliefs about limited probability of success and perception of limited cognitive resources), and also evaluates whether dysfunctional beliefs are more closely linked to particular subdomains of negative symptoms. Sixty two individuals with schizophrenia completed measures of dysfunctional beliefs and were rated on negative symptoms. Analyses indicated that the endorsement of beliefs regarding low expectations for success and perception of limited resources (Negative Expectancy Appraisals) are robustly associated with diminished experience negative symptoms (avolition, asociality, and anhedonia), but are not associated with negative symptoms reflecting diminished expressivity (blunted affect, alogia). Similarly, Defeatist Performance Beliefs are modestly related to diminished experience, but not diminished expression, negative symptoms. Negative Expectancy Appraisals were also robustly linked to depressive symptoms. Results from the current study provide evidence that dysfunctional beliefs are clearly relevant to consider in relation to negative symptoms, and may represent a fruitful treatment target.
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http://dx.doi.org/10.1016/j.psychres.2011.05.032DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3156874PMC
August 2011

Predictors of initiation and engagement in substance abuse treatment among individuals with co-occurring serious mental illness and substance use disorders.

Addict Behav 2011 May 10;36(5):439-47. Epub 2010 Dec 10.

Department of Epidemiology & Public Health, University of Maryland School of Medicine, 660 West Redwood Street,Baltimore, MD 21201, USA.

Research has documented the significant challenges of engaging individuals with comorbid serious mental illness (SMI) and substance use disorders (SUDs) in substance abuse treatment. To date it is unclear which factors predict treatment initiation and engagement in this group of individuals with SUDs. In this study we conducted two analyses using data from a randomized trial of substance abuse treatment in outpatients with SMI: the first examining predictors (collected during screening) of completing an initial intake assessment and the second examining predictors (collected during the intake assessment) of becoming engaged in treatment. Results indicated that males and those with schizophrenia spectrum diagnoses were less likely to complete the intake assessment. Participants who reported more positive feelings about their family were more likely to engage in substance abuse treatment. Participants who were recently arrested were less likely to engage in treatment. Those who met criteria for current drug dependence were less likely to engage in treatment. Overall, these findings are a useful step in determining factors that predict substance abuse treatment initiation and engagement in individuals with SMI and SUDs.
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http://dx.doi.org/10.1016/j.addbeh.2010.12.001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3046338PMC
May 2011

Smoking history and motivation to quit in smokers with schizophrenia in a smoking cessation program.

Schizophr Res 2011 Mar 26;126(1-3):277-83. Epub 2010 Nov 26.

VA Capitol Network (VISN 5) Mental Illness, Research Education and Clinical Center (MIRECC), VA Maryland Health Care System (VAMHCS), 10 N. Greene St., Baltimore, MD 21201, USA.

Objective: The present study sought to better understand the relationships among smoking history, motivation to change, and smoking cessation outcomes in people with schizophrenia who smoke.

Method: We examined smoking and quit history, negative consequences due to smoking, readiness to change, smoking temptation, and confidence to quit in a sample of people diagnosed with schizophrenia or schizoaffective disorder according to DSM-IV criteria who were participating in a larger randomized trial of bupropion SR and a psychoeducational intervention for smoking cessation. Data were collected from June 2003 to May 2005.

Results: At baseline, participants reported high levels of nicotine dependence and daily smoking, as well as multiple recent and lifetime quit attempts that were generally brief in nature. Participants were most concerned about the health effects of smoking and endorsed reasons for smoking related to coping with negative affect and boredom. Most participants reported wanting to quit smoking, but the sample generally reported low levels of confidence in their ability to quit. During the course of participation in the intervention, self-efficacy to quit increased while temptation to smoke decreased; however readiness to quit remained unchanged.

Conclusion: Smoking cessation programs for people with schizophrenia should focus on teaching coping skills for negative affect, boredom, and specific "high risk situations" for smoking in addition to education, medication, or nicotine replacement therapy. Further, cessation efforts may benefit from directly addressing low self-efficacy for quitting, rather than readiness for change alone, among people with schizophrenia.
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http://dx.doi.org/10.1016/j.schres.2010.10.030DOI Listing
March 2011

Examination of the inventory of drug use consequences with individuals with serious and persistent mental illness and co-occurring substance use disorders.

Am J Drug Alcohol Abuse 2009 ;35(5):385-90

Department of Psychiatry, University of Maryland School of Medicine, Baltimore, 21201, USA.

Background: The Inventory of Drug Use Consequences (InDUC) ( [1] ) is a 50-item measure that evaluates lifetime and recent consequences of substance use.

Objectives: This study examined the psychometric properties of a modified version of the Inventory of Drug Use Consequences (InDUC-M) in individuals with serious and persistent mental illness (SPMI) and co-occurring substance use disorders (SUDs).

Methods: We examined self-reported consequences in the sample, evaluated internal consistency, identified items for a brief form of the InDUC-M, and explored relationships with indicators of substance use severity.

Results: InDUC-M Lifetime and Recent subscales showed good internal consistency and were related to other measures of substance use and problems. A brief version of the InDUC-M Recent (SIP-M) showed excellent internal consistency and was highly correlated with both Lifetime and Recent subscales.

Conclusion: The InDUC-M and the SIP-M performed well in individuals with SPMI and SUDs.

Conclusion And Scientific Significance: Overall, these findings are a useful first step in determining the utility of the InDUC-M in people with SPMI and SUDs.
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http://dx.doi.org/10.1080/00952990903177228DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4479121PMC
May 2010

Neurocognitive characteristics of individuals with schizophrenia and cocaine dependence: comparison of currently dependent and remitted groups.

J Nerv Ment Dis 2009 Aug;197(8):631-4

Veterans Affairs Capitol Health Care Network Mental Illness, Research, Education, and Clinical Center, Baltimore, MD, USA.

Several investigations of cognitive functioning in individuals with schizophrenia and co-occurring cocaine use have yielded mixed results when compared with samples with schizophrenia only. However, no studies have specifically compared remitted and current cocaine dependence in schizophrenia. Such an analysis could help clarify the degree and type of cognitive impairment associated with cocaine dependence in schizophrenia. Two samples of individuals with schizophrenia - those with current cocaine dependence (n = 72) and those with cocaine dependence in remission (n = 48) were compared on a brief neuropsychological test battery. Parallel current dependent and remitted samples with affective disorder (n = 65 and n = 55) were also included in the analyses. Results yielded few neuropsychological differences between remitted and current dependent states across the SZ and AD groups. These findings suggest that cognitive impairment may be relatively static in these populations.
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http://dx.doi.org/10.1097/NMD.0b013e3181b08bf4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2777610PMC
August 2009
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