Publications by authors named "Paul S Nestadt"

24 Publications

  • Page 1 of 1

Consensus-Driven Priorities for Firearm Injury Education Among Medical Professionals.

Acad Med 2021 Jul 6. Epub 2021 Jul 6.

K. Hoops is assistant professor, Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland. J. Fahimi is associate professor, Department of Emergency Medicine, University of California, San Francisco School of Medicine and Institute for Health Policy Studies, San Francisco, California. L. Khoeur is a third-year medical student, University of California, San Francisco School of Medicine, San Francisco, California. C. Studenmund is a third-year medical student, University of California, San Francisco School of Medicine, San Francisco, California. C. Barber is senior researcher, Harvard T.H. Chan School of Public Health, Boston, Massachusetts. A. Barnhorst is associate professor, Department of Psychiatry and Behavioral Sciences and Department of Emergency Medicine, University of California, Davis School of Medicine, Davis, California. M.E. Betz is associate professor, Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado. C.K. Crifasi is assistant professor, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland. J.A. Davis is professor and associate dean for curriculum, Department of Medicine, University of California, San Francisco School of Medicine, San Francisco, California. W. Dewispelaere is a resident, Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado. L. Fisher is assistant professor, Department of Family and Community Medicine, University of Kansas School of Medicine, Wichita, Kansas. P.K. Howard is adjunct assistant professor, University of Kentucky, Lexington, Kentucky. A. Ketterer is clinical instructor, Department of Emergency Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts. E. Marcolini is assistant professor, Department of Emergency Medicine and Department of Neurology, Geisel School of Medicine at Dartmouth College, Hanover, New Hampshire. P.S. Nestadt is assistant professor, Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, and Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland. J. Rozel is associate professor, Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania. J.A. Simonetti is assistant professor, Department of Medicine, University of Colorado School of Medicine, and Veterans Health Administration, Aurora, Colorado. S. Spitzer is resident, Department of Surgery, Harvard Medical School and Brigham and Women's Hospital, Boston, Massachusetts. M. Victoroff is clinical professor, Department of Family Medicine, University of Colorado School of Medicine, Aurora, Colorado. B.H. Williams is associate professor, Department of Surgery, University of Chicago Pritzker School of Medicine and Biological Sciences, Chicago, Illinois. L. Howley is senior director of strategic initiatives and partnerships, Association of American Medical Colleges, Washington, DC. M.L. Ranney is associate professor, Department of Emergency Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island.

Purpose: Firearm injury is a leading cause of morbidity and mortality in the United States. However, many medical professionals currently receive minimal or no education on firearm injury or its prevention. The authors sought to convene a diverse group of national experts in firearm injury epidemiology, injury prevention, and medical education to develop consensus on priorities to inform the creation of learning objectives and curricula for firearm injury education for medical professionals.

Method: In 2019, the authors convened an advisory group that was geographically, demographically, and professionally diverse, composed of 33 clinicians, researchers, and educators from across the United States. They used the nominal group technique to achieve consensus on priorities for health professions education on firearm injury. The process involved an initial idea-generating phase, followed by a round-robin sharing of ideas and further idea generation, facilitated discussion and clarification, and the ranking of ideas to generate a prioritized list.

Results: This report provides the first national consensus guidelines on firearm injury education for medical professionals. These priorities include a set of crosscutting, basic, and advanced learning objectives applicable to all contexts of firearm injury and all medical disciplines, specialties, and levels of training. They focus on 7 contextual categories that had previously been identified in the literature: 1 category of general priorities applicable to all contexts and 6 categories of specific contexts, including intimate partner violence, mass violence, officer-involved shootings, peer (non-partner) violence, suicide, and unintentional injury.

Conclusions: Robust, data- and consensus-driven priorities for health professions education on firearm injury create a pathway to clinician competence and self-efficacy. With an improved foundation for curriculum development and educational program-building, clinicians will be better informed to engage in a host of firearm injury prevention initiatives both at the bedside and in their communities.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/ACM.0000000000004226DOI Listing
July 2021

Exome sequencing in obsessive-compulsive disorder reveals a burden of rare damaging coding variants.

Nat Neurosci 2021 Jun 28. Epub 2021 Jun 28.

Institute for Genomic Medicine, Columbia University Medical Center, New York, NY, USA.

Obsessive-compulsive disorder (OCD) affects 1-2% of the population, and, as with other complex neuropsychiatric disorders, it is thought that rare variation contributes to its genetic risk. In this study, we performed exome sequencing in the largest OCD cohort to date (1,313 total cases, consisting of 587 trios, 41 quartets and 644 singletons of affected individuals) and describe contributions to disease risk from rare damaging coding variants. In case-control analyses (n = 1,263/11,580), the most significant single-gene result was observed in SLITRK5 (odds ratio (OR) = 8.8, 95% confidence interval 3.4-22.5, P = 2.3 × 10). Across the exome, there was an excess of loss of function (LoF) variation specifically within genes that are LoF-intolerant (OR = 1.33, P = 0.01). In an analysis of trios, we observed an excess of de novo missense predicted damaging variants relative to controls (OR = 1.22, P = 0.02), alongside an excess of de novo LoF mutations in LoF-intolerant genes (OR = 2.55, P = 7.33 × 10). These data support a contribution of rare coding variants to OCD genetic risk.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1038/s41593-021-00876-8DOI Listing
June 2021

Peripartum complications associated with obsessive compulsive disorder exacerbation during pregnancy.

J Obsessive Compuls Relat Disord 2021 Apr 22;29. Epub 2021 Mar 22.

Department of Mental Health, Johns Hopkins Bloomberg School of Public Health.

Prior research has shown that onset or exacerbation of OCD is associated with menstruation, pregnancy, and the post-partum period. However, the underlying cause is unclear. The goal of this study was to assess whether pregnancy and birth complications were associated with OCD symptoms exacerbation, among women with established OCD. Two-hundred and five (n=205) women with OCD retrospectively reported information on their physical and mental health during their first pregnancy. Over a third of the sample (34%) reported an exacerbation in their OCD symptoms. History of pregnancy and birth complications in the first pregnancy were similar between women who did and did not experience symptom exacerbation, with the exception of gestational diabetes, which was significantly more common among women who experienced exacerbation (7% vs 1%, p=0.03). In a multivariable logistic regression model, gestational diabetes remained significantly associated with exacerbation of OCD symptoms (OR=8.44 [95% CI 1.37-77.27]; p=0.03), even after adjusting for maternal age, OCD severity and treatment, premenstrual OCD symptom increase, stress during pregnancy, and major depression or anxiety disorder diagnosis during pregnancy. We discuss potential explanations for this link. These findings should be treated as hypothesis-generating and need to be replicated in a larger, prospective study.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jocrd.2021.100641DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8104308PMC
April 2021

Trends in substances involved in polysubstance overdose fatalities in Maryland, USA 2003-2019.

Drug Alcohol Depend 2021 Jun 12;223:108700. Epub 2021 Apr 12.

Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD, 21205, USA.

Background: The substances driving the overdose epidemic in the United States have changed over time. Since 2013, fentanyl-analogues have become the primary opioids driving the epidemic. Recently, polysubstance related deaths have come to the forefront of the epidemic. Therefore, we explored trends in polysubstance involvement in overdose fatalities in Maryland between 2003 and 2019.

Methods: We used records for the Maryland Office of the Chief Medical Examiner between 2003 and 2019. First, we assessed trends in the number of drugs (1, 2, 3+) involved in overdose fatalities over time. Then, we assessed linear and quadratic trends in nine substance categories using logistic regression.

Results: Overtime, the proportion of overdose deaths involving one (ß=-0.28, p < 0.001) or two (ß=-0.14, p < 0.001) drugs decreased, while deaths involving three or more drugs increased (ß = 0.31, p < 0.001). The involvement of most drugs decreased over the study period. Only cocaine (linear ß=-0.08, p < 0.001; quadratic ß = 0.29, p < 0.001) and fentanyl (linear ß = 1.67, p < 0.001; quadratic ß = 0.75, p < 0.0001) showed significant increases over time. Post hoc analyses showed that cocaine involvement only increased in the presence of fentanyl (linear ß = 1.41, p < 0.001; quadratic ß = 0.70, p < 0.001) and decreased when fentanyl was not present (linear ß=-0.81, p < 0.001; quadratic ß=-0.31, p < 0.001).

Conclusions: Polysubstance involvement in overdose fatalities has become more common over time in Maryland. Most individual substances became less common over time, while cocaine and fentanyl involvement increased. Unintentional fentanyl consumption through contaminated cocaine may be an increasingly important driver of deaths in Maryland, indicating the importance of implementing widespread harm reduction programs, especially drug checking.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.drugalcdep.2021.108700DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8113117PMC
June 2021

Contamination-related behaviors, obsessions, and compulsions during the COVID-19 pandemic in a United States population sample.

J Psychiatr Res 2021 06 1;138:155-162. Epub 2021 Apr 1.

Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA.

Background: Contamination-prevention behaviors such as mask wearing and physical distancing are crucial to reduce coronavirus transmission during the COVID-19 pandemic. We hypothesized that engagement in these behaviors could provoke obsessions and phobias in vulnerable individuals in the community.

Methods: A total of 2117 participants, systematically selected to represent the age, gender, and race distributions of the US population, completed an online survey that assessed demographic characteristics, clinical features, COVID-19 risks, and COVID-19 contamination-prevention behaviors. Logistic regression was used to estimate the magnitude of the relationships between the COVID-19 behavior score and clinically significant contamination obsessions, contamination compulsions, and pre-COVID-19 to current change in obsessive-compulsive symptom scores.

Results: The COVID-19 behavior score was significantly associated with contamination obsessions (odds ratio (OR) = 1.15, 95% CI = 1.12-1.16; p < 0.001) and contamination phobias (OR = 1.14, 95% CI = 1.12-1.16; p < 0.001). The COVID-19 behavior score also was associated with pre-pandemic to current increase in the overall obsessive-compulsive symptom score (OR = 1.16, 95% CI = 1.09-1.23; p < 0.001), as well as increase in obsessive-compulsive symptom score excluding washing items (OR = 1.13, 95% CI = 1.07-1.19; p < 0.001). The magnitude of these relationships did not appreciably change, after adjustment for other variables associated with the outcomes. Moreover, the relationship was significant in those with or without OCD, and in individuals with different levels of doubt and COVID-19 risk.

Conclusions: Contamination safety measures are critical for reducing the spread of COVID-19 in the community. However, they may be related to the development of contamination-related symptoms and OCD in vulnerable individuals, complicating the diagnosis and treatment of mental disorders during this period.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jpsychires.2021.03.064DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8016179PMC
June 2021

Contamination-related behaviors, obsessions, and compulsions during the COVID-19 pandemic in a United States population sample.

J Psychiatr Res 2021 06 1;138:155-162. Epub 2021 Apr 1.

Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA.

Background: Contamination-prevention behaviors such as mask wearing and physical distancing are crucial to reduce coronavirus transmission during the COVID-19 pandemic. We hypothesized that engagement in these behaviors could provoke obsessions and phobias in vulnerable individuals in the community.

Methods: A total of 2117 participants, systematically selected to represent the age, gender, and race distributions of the US population, completed an online survey that assessed demographic characteristics, clinical features, COVID-19 risks, and COVID-19 contamination-prevention behaviors. Logistic regression was used to estimate the magnitude of the relationships between the COVID-19 behavior score and clinically significant contamination obsessions, contamination compulsions, and pre-COVID-19 to current change in obsessive-compulsive symptom scores.

Results: The COVID-19 behavior score was significantly associated with contamination obsessions (odds ratio (OR) = 1.15, 95% CI = 1.12-1.16; p < 0.001) and contamination phobias (OR = 1.14, 95% CI = 1.12-1.16; p < 0.001). The COVID-19 behavior score also was associated with pre-pandemic to current increase in the overall obsessive-compulsive symptom score (OR = 1.16, 95% CI = 1.09-1.23; p < 0.001), as well as increase in obsessive-compulsive symptom score excluding washing items (OR = 1.13, 95% CI = 1.07-1.19; p < 0.001). The magnitude of these relationships did not appreciably change, after adjustment for other variables associated with the outcomes. Moreover, the relationship was significant in those with or without OCD, and in individuals with different levels of doubt and COVID-19 risk.

Conclusions: Contamination safety measures are critical for reducing the spread of COVID-19 in the community. However, they may be related to the development of contamination-related symptoms and OCD in vulnerable individuals, complicating the diagnosis and treatment of mental disorders during this period.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jpsychires.2021.03.064DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8016179PMC
June 2021

Polysubstance Overdose Deaths in the Fentanyl Era: A Latent Class Analysis.

J Addict Med 2021 Mar 4. Epub 2021 Mar 4.

Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (JNP, SGS); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (KES, RM, PSN); Office of the Chief Medical Examiner, Baltimore, MD (DF); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (SGS); Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD (PSN).

Objectives: To elucidate the main latent classes of substances detected among overdose decedents, and latent class associations with age, sex, race, and jurisdiction of death in Maryland.

Methods: We used toxicology data from the Office of the Chief Medical Examiner of Maryland for all decedents. We analyzed all cases of drug overdose deaths that occurred from 2016 to 2018 (N = 6566) using latent class analysis and regression.

Results: Drug overdose deaths were concentrated in 2 of 24 counties in Maryland (Baltimore City and County). Fentanyl was involved in 71% of all drug overdose deaths, and the majority (76%) of these deaths included multiple substances. Three latent classes emerged: (1) fentanyl/heroin/cocaine (64%); (2) fentanyl/alcohol (18%); and (3) prescription drugs including opioids, benzodiazepines and antidepressants (18.0%). The fentanyl/heroin/cocaine class members were significantly younger (<30 years), female and White compared to the fentanyl/alcohol class, but more male and non-White than the prescription drugs class (all P < 0.05). Deaths in Baltimore City/County were more likely than in other locations to involve fentanyl/alcohol (P < 0.05).

Conclusions: The majority of fentanyl-involved overdose deaths in Maryland involved multiple substances, and several demographic and geographic differences in these patterns emerged. Geographically-targeted interventions that are tailored to reduce the harms associated with polysubstance use (including cocaine, alcohol, and prescription drugs) for different demographic groups are warranted.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/ADM.0000000000000823DOI Listing
March 2021

Risk-Based Temporary Firearm Removal Orders: A New Legal Tool for Clinicians.

Harv Rev Psychiatry 2021 Jan-Feb 01;29(1):6-9

From the Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine (Dr. Swanson); Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine (Dr. Nestadt); Department of Psychiatry and Behavioral Sciences, University of California, Davis (Dr. Barnhorst); Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health (Dr. Frattaroli).

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/HRP.0000000000000278DOI Listing
January 2021

Knowledge surrounding proper administration of antipsychotic orally disintegrating tablets.

Gen Hosp Psychiatry 2021 Jan-Feb;68:107-108. Epub 2020 Nov 18.

Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 733 N. Broadway, Baltimore, MD 21205, USA; Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205, USA.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.genhosppsych.2020.10.007DOI Listing
November 2020

Knowledge surrounding proper administration of antipsychotic orally disintegrating tablets.

Gen Hosp Psychiatry 2021 Jan-Feb;68:107-108. Epub 2020 Nov 18.

Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 733 N. Broadway, Baltimore, MD 21205, USA; Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205, USA.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.genhosppsych.2020.10.007DOI Listing
November 2020

Educational achievement and youth homicide mortality: a City-wide, neighborhood-based analysis.

Inj Epidemiol 2020 Jun 8;7(1):20. Epub 2020 Jun 8.

Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, MD, USA.

Background And Objective: Educational achievement, particularly among youth, may mitigate risk of exposure to violence and negative related health outcomes such as crime and gang activity. Few studies to date have examined relationships between education and youth homicide. The authors hypothesized association between educational achievement in grades 3 and 8 and youth homicide mortality.

Methods: Neighborhood-based, city-wide analysis was conducted of cross-sectional data regarding N = 55 neighborhoods in Baltimore, MD, extracted from Baltimore 2017 Neighborhood Health Profiles.

Results: Higher educational achievement (operationalized by reading proficiency) in third, but not eighth, grade was associated with reduced neighborhood youth homicide mortality rates in hierarchical linear regression, controlling for demographic and socioeconomic factors (ß = - 0.5082, p = 0.03), such that each 1.97% increase in proportion of students reading at an acceptable level was associated with one fewer neighborhood youth homicide per 100,000. Neighborhoods within the highest tertile of youth homicide mortality differed from those in the lowest tertile with fewer males (45% vs. 48%, p = 0.002), greater unemployment (17% vs. 8%, p < 0.001), familial poverty (35% vs. 16%, p < 0.001), and residents identifying as black or African-American (88% vs. 25%, p < 0.001). Causal mediation analysis demonstrated mediation effects of familial poverty and eighth grade educational achievement through third grade educational achievement (ACME = 0.151, p = 0.04; ACME = - 0.300, p = 0.03, respectively) with no significant direct effects.

Conclusions: Higher educational achievement (operationalized by reading proficiency) predicts reduced homicide mortality among Baltimore youth and appears to mediate effects of familial poverty on homicide mortality as well. This converges with literature highlighting the importance of education as a determinant of social capital and violence. Future policy-based interventions should target inequalities in educational achievement to mitigate homicide risk among youth in communities facing disparities in violent crime.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s40621-020-00246-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7278079PMC
June 2020

Educational achievement and youth homicide mortality: a City-wide, neighborhood-based analysis.

Inj Epidemiol 2020 Jun 8;7(1):20. Epub 2020 Jun 8.

Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, MD, USA.

Background And Objective: Educational achievement, particularly among youth, may mitigate risk of exposure to violence and negative related health outcomes such as crime and gang activity. Few studies to date have examined relationships between education and youth homicide. The authors hypothesized association between educational achievement in grades 3 and 8 and youth homicide mortality.

Methods: Neighborhood-based, city-wide analysis was conducted of cross-sectional data regarding N = 55 neighborhoods in Baltimore, MD, extracted from Baltimore 2017 Neighborhood Health Profiles.

Results: Higher educational achievement (operationalized by reading proficiency) in third, but not eighth, grade was associated with reduced neighborhood youth homicide mortality rates in hierarchical linear regression, controlling for demographic and socioeconomic factors (ß = - 0.5082, p = 0.03), such that each 1.97% increase in proportion of students reading at an acceptable level was associated with one fewer neighborhood youth homicide per 100,000. Neighborhoods within the highest tertile of youth homicide mortality differed from those in the lowest tertile with fewer males (45% vs. 48%, p = 0.002), greater unemployment (17% vs. 8%, p < 0.001), familial poverty (35% vs. 16%, p < 0.001), and residents identifying as black or African-American (88% vs. 25%, p < 0.001). Causal mediation analysis demonstrated mediation effects of familial poverty and eighth grade educational achievement through third grade educational achievement (ACME = 0.151, p = 0.04; ACME = - 0.300, p = 0.03, respectively) with no significant direct effects.

Conclusions: Higher educational achievement (operationalized by reading proficiency) predicts reduced homicide mortality among Baltimore youth and appears to mediate effects of familial poverty on homicide mortality as well. This converges with literature highlighting the importance of education as a determinant of social capital and violence. Future policy-based interventions should target inequalities in educational achievement to mitigate homicide risk among youth in communities facing disparities in violent crime.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s40621-020-00246-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7278079PMC
June 2020

Educational achievement and youth homicide mortality: a City-wide, neighborhood-based analysis.

Inj Epidemiol 2020 Jun 8;7(1):20. Epub 2020 Jun 8.

Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, MD, USA.

Background And Objective: Educational achievement, particularly among youth, may mitigate risk of exposure to violence and negative related health outcomes such as crime and gang activity. Few studies to date have examined relationships between education and youth homicide. The authors hypothesized association between educational achievement in grades 3 and 8 and youth homicide mortality.

Methods: Neighborhood-based, city-wide analysis was conducted of cross-sectional data regarding N = 55 neighborhoods in Baltimore, MD, extracted from Baltimore 2017 Neighborhood Health Profiles.

Results: Higher educational achievement (operationalized by reading proficiency) in third, but not eighth, grade was associated with reduced neighborhood youth homicide mortality rates in hierarchical linear regression, controlling for demographic and socioeconomic factors (ß = - 0.5082, p = 0.03), such that each 1.97% increase in proportion of students reading at an acceptable level was associated with one fewer neighborhood youth homicide per 100,000. Neighborhoods within the highest tertile of youth homicide mortality differed from those in the lowest tertile with fewer males (45% vs. 48%, p = 0.002), greater unemployment (17% vs. 8%, p < 0.001), familial poverty (35% vs. 16%, p < 0.001), and residents identifying as black or African-American (88% vs. 25%, p < 0.001). Causal mediation analysis demonstrated mediation effects of familial poverty and eighth grade educational achievement through third grade educational achievement (ACME = 0.151, p = 0.04; ACME = - 0.300, p = 0.03, respectively) with no significant direct effects.

Conclusions: Higher educational achievement (operationalized by reading proficiency) predicts reduced homicide mortality among Baltimore youth and appears to mediate effects of familial poverty on homicide mortality as well. This converges with literature highlighting the importance of education as a determinant of social capital and violence. Future policy-based interventions should target inequalities in educational achievement to mitigate homicide risk among youth in communities facing disparities in violent crime.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s40621-020-00246-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7278079PMC
June 2020

Assessment of Physician Self-reported Knowledge and Use of Maryland's Extreme Risk Protection Order Law.

JAMA Netw Open 2019 12 2;2(12):e1918037. Epub 2019 Dec 2.

Department of Psychiatry and Behavioral Science, The Johns Hopkins School of Medicine, Baltimore, Maryland.

Importance: On October 1, 2018, Maryland's extreme risk protection order (ERPO) law took effect. This was the first ERPO law in the United States to authorize clinicians to initiate a civil court process to temporarily prohibit people behaving dangerously and at risk of engaging in violence from purchasing and possessing firearms. This is the first publication reporting results from a survey of physicians about ERPOs.

Objectives: To assess Maryland physicians' knowledge, past use, and likely future use of ERPOs, and to identify barriers to physicians' use of ERPOs and strategies to address those barriers.

Design, Setting, And Participants: This survey study conducted at The Johns Hopkins Hospital in Baltimore, Maryland, surveyed physicians, including emergency medicine physicians, pediatricians, and psychiatrists, using a 15-question online instrument between June 15, 2019, and July 1, 2019. Data analysis was performed in July 2019.

Exposure: Maryland's ERPO law.

Main Outcomes And Measures: Knowledge, use, and likely use of ERPOs, barriers to use, and strategies to address those barriers.

Results: Ninety-two of 353 physicians invited (26.1%) completed the survey; 1 respondent reported having filed an ERPO petition. Sixty-six respondents (71.7%) described themselves as not at all familiar with ERPOs. After reading a brief description of the ERPO law, 85 respondents (92.4%) indicated that they encounter patients whom they would consider for an ERPO at least a few times per year. Fifty-five respondents (59.8%) reported that they would be very or somewhat likely to file an ERPO petition when they identify a qualifying patient. Respondents identified time as the main barrier to using ERPOs (not enough time to complete paperwork, 57 respondents [62.6%]; not enough time to attend hearing at courthouse, 64 respondents [70.3%]), followed by concern that filing an ERPO would negatively affect their relationship with the patient (36 respondents [39.6%]). Having a coordinator to manage the process (80 respondents [87.0%]), training (79 respondents [85.9%]), participating in court hearings remotely (68 respondents [73.9%]), and having access to legal counsel (59 respondents [64.1%]) were all selected by large majorities of respondents as strategies to address barriers to ERPO use.

Conclusions And Relevance: Awareness of ERPOs among physicians in the sample was low. Physicians are treating patients who would qualify for an ERPO, and respondents in the sample indicated a willingness to use ERPOs. Training, providing access to legal counsel, designating a clinician to process petitions, and allowing clinicians to participate remotely in court hearings were strategies respondents identified to address barriers to ERPO use. These survey findings identify concrete solutions for addressing barriers to physician use of ERPOs.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1001/jamanetworkopen.2019.18037DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6991220PMC
December 2019

Assessment of Physician Self-reported Knowledge and Use of Maryland's Extreme Risk Protection Order Law.

JAMA Netw Open 2019 12 2;2(12):e1918037. Epub 2019 Dec 2.

Department of Psychiatry and Behavioral Science, The Johns Hopkins School of Medicine, Baltimore, Maryland.

Importance: On October 1, 2018, Maryland's extreme risk protection order (ERPO) law took effect. This was the first ERPO law in the United States to authorize clinicians to initiate a civil court process to temporarily prohibit people behaving dangerously and at risk of engaging in violence from purchasing and possessing firearms. This is the first publication reporting results from a survey of physicians about ERPOs.

Objectives: To assess Maryland physicians' knowledge, past use, and likely future use of ERPOs, and to identify barriers to physicians' use of ERPOs and strategies to address those barriers.

Design, Setting, And Participants: This survey study conducted at The Johns Hopkins Hospital in Baltimore, Maryland, surveyed physicians, including emergency medicine physicians, pediatricians, and psychiatrists, using a 15-question online instrument between June 15, 2019, and July 1, 2019. Data analysis was performed in July 2019.

Exposure: Maryland's ERPO law.

Main Outcomes And Measures: Knowledge, use, and likely use of ERPOs, barriers to use, and strategies to address those barriers.

Results: Ninety-two of 353 physicians invited (26.1%) completed the survey; 1 respondent reported having filed an ERPO petition. Sixty-six respondents (71.7%) described themselves as not at all familiar with ERPOs. After reading a brief description of the ERPO law, 85 respondents (92.4%) indicated that they encounter patients whom they would consider for an ERPO at least a few times per year. Fifty-five respondents (59.8%) reported that they would be very or somewhat likely to file an ERPO petition when they identify a qualifying patient. Respondents identified time as the main barrier to using ERPOs (not enough time to complete paperwork, 57 respondents [62.6%]; not enough time to attend hearing at courthouse, 64 respondents [70.3%]), followed by concern that filing an ERPO would negatively affect their relationship with the patient (36 respondents [39.6%]). Having a coordinator to manage the process (80 respondents [87.0%]), training (79 respondents [85.9%]), participating in court hearings remotely (68 respondents [73.9%]), and having access to legal counsel (59 respondents [64.1%]) were all selected by large majorities of respondents as strategies to address barriers to ERPO use.

Conclusions And Relevance: Awareness of ERPOs among physicians in the sample was low. Physicians are treating patients who would qualify for an ERPO, and respondents in the sample indicated a willingness to use ERPOs. Training, providing access to legal counsel, designating a clinician to process petitions, and allowing clinicians to participate remotely in court hearings were strategies respondents identified to address barriers to ERPO use. These survey findings identify concrete solutions for addressing barriers to physician use of ERPOs.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1001/jamanetworkopen.2019.18037DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6991220PMC
December 2019

Assessment of Physician Self-reported Knowledge and Use of Maryland's Extreme Risk Protection Order Law.

JAMA Netw Open 2019 12 2;2(12):e1918037. Epub 2019 Dec 2.

Department of Psychiatry and Behavioral Science, The Johns Hopkins School of Medicine, Baltimore, Maryland.

Importance: On October 1, 2018, Maryland's extreme risk protection order (ERPO) law took effect. This was the first ERPO law in the United States to authorize clinicians to initiate a civil court process to temporarily prohibit people behaving dangerously and at risk of engaging in violence from purchasing and possessing firearms. This is the first publication reporting results from a survey of physicians about ERPOs.

Objectives: To assess Maryland physicians' knowledge, past use, and likely future use of ERPOs, and to identify barriers to physicians' use of ERPOs and strategies to address those barriers.

Design, Setting, And Participants: This survey study conducted at The Johns Hopkins Hospital in Baltimore, Maryland, surveyed physicians, including emergency medicine physicians, pediatricians, and psychiatrists, using a 15-question online instrument between June 15, 2019, and July 1, 2019. Data analysis was performed in July 2019.

Exposure: Maryland's ERPO law.

Main Outcomes And Measures: Knowledge, use, and likely use of ERPOs, barriers to use, and strategies to address those barriers.

Results: Ninety-two of 353 physicians invited (26.1%) completed the survey; 1 respondent reported having filed an ERPO petition. Sixty-six respondents (71.7%) described themselves as not at all familiar with ERPOs. After reading a brief description of the ERPO law, 85 respondents (92.4%) indicated that they encounter patients whom they would consider for an ERPO at least a few times per year. Fifty-five respondents (59.8%) reported that they would be very or somewhat likely to file an ERPO petition when they identify a qualifying patient. Respondents identified time as the main barrier to using ERPOs (not enough time to complete paperwork, 57 respondents [62.6%]; not enough time to attend hearing at courthouse, 64 respondents [70.3%]), followed by concern that filing an ERPO would negatively affect their relationship with the patient (36 respondents [39.6%]). Having a coordinator to manage the process (80 respondents [87.0%]), training (79 respondents [85.9%]), participating in court hearings remotely (68 respondents [73.9%]), and having access to legal counsel (59 respondents [64.1%]) were all selected by large majorities of respondents as strategies to address barriers to ERPO use.

Conclusions And Relevance: Awareness of ERPOs among physicians in the sample was low. Physicians are treating patients who would qualify for an ERPO, and respondents in the sample indicated a willingness to use ERPOs. Training, providing access to legal counsel, designating a clinician to process petitions, and allowing clinicians to participate remotely in court hearings were strategies respondents identified to address barriers to ERPO use. These survey findings identify concrete solutions for addressing barriers to physician use of ERPOs.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1001/jamanetworkopen.2019.18037DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6991220PMC
December 2019

Assessment of Physician Self-reported Knowledge and Use of Maryland's Extreme Risk Protection Order Law.

JAMA Netw Open 2019 12 2;2(12):e1918037. Epub 2019 Dec 2.

Department of Psychiatry and Behavioral Science, The Johns Hopkins School of Medicine, Baltimore, Maryland.

Importance: On October 1, 2018, Maryland's extreme risk protection order (ERPO) law took effect. This was the first ERPO law in the United States to authorize clinicians to initiate a civil court process to temporarily prohibit people behaving dangerously and at risk of engaging in violence from purchasing and possessing firearms. This is the first publication reporting results from a survey of physicians about ERPOs.

Objectives: To assess Maryland physicians' knowledge, past use, and likely future use of ERPOs, and to identify barriers to physicians' use of ERPOs and strategies to address those barriers.

Design, Setting, And Participants: This survey study conducted at The Johns Hopkins Hospital in Baltimore, Maryland, surveyed physicians, including emergency medicine physicians, pediatricians, and psychiatrists, using a 15-question online instrument between June 15, 2019, and July 1, 2019. Data analysis was performed in July 2019.

Exposure: Maryland's ERPO law.

Main Outcomes And Measures: Knowledge, use, and likely use of ERPOs, barriers to use, and strategies to address those barriers.

Results: Ninety-two of 353 physicians invited (26.1%) completed the survey; 1 respondent reported having filed an ERPO petition. Sixty-six respondents (71.7%) described themselves as not at all familiar with ERPOs. After reading a brief description of the ERPO law, 85 respondents (92.4%) indicated that they encounter patients whom they would consider for an ERPO at least a few times per year. Fifty-five respondents (59.8%) reported that they would be very or somewhat likely to file an ERPO petition when they identify a qualifying patient. Respondents identified time as the main barrier to using ERPOs (not enough time to complete paperwork, 57 respondents [62.6%]; not enough time to attend hearing at courthouse, 64 respondents [70.3%]), followed by concern that filing an ERPO would negatively affect their relationship with the patient (36 respondents [39.6%]). Having a coordinator to manage the process (80 respondents [87.0%]), training (79 respondents [85.9%]), participating in court hearings remotely (68 respondents [73.9%]), and having access to legal counsel (59 respondents [64.1%]) were all selected by large majorities of respondents as strategies to address barriers to ERPO use.

Conclusions And Relevance: Awareness of ERPOs among physicians in the sample was low. Physicians are treating patients who would qualify for an ERPO, and respondents in the sample indicated a willingness to use ERPOs. Training, providing access to legal counsel, designating a clinician to process petitions, and allowing clinicians to participate remotely in court hearings were strategies respondents identified to address barriers to ERPO use. These survey findings identify concrete solutions for addressing barriers to physician use of ERPOs.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1001/jamanetworkopen.2019.18037DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6991220PMC
December 2019

Trichotillomania comorbidity in a sample enriched for familial obsessive-compulsive disorder.

Compr Psychiatry 2019 10 31;94:152123. Epub 2019 Aug 31.

Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, United States of America. Electronic address:

Background: This study addresses the strength of associations between trichotillomania (TTM) and other DSM-IV Axis I conditions in a large sample (n = 2606) enriched for familial obsessive-compulsive disorder (OCD), to inform TTM classification.

Methods: We identified participants with TTM in the Johns Hopkins OCD Family Study (153 families) and the OCD Collaborative Genetics Study, a six-site genetic linkage study of OCD (487 families). We used logistic regression (with generalized estimating equations) to assess the strength of associations between TTM and other DSM-IV disorders.

Results: TTM had excess comorbidity with a number of conditions from different DSM-IV chapters, including tic disorders, alcohol dependence, mood disorders, anxiety disorders, impulse-control disorders, and bulimia nervosa. However, association strengths (odds ratios) were highest for kleptomania (6.6), pyromania (5.8), OCD (5.6), skin picking disorder (4.4), bulimia nervosa (3.5), and pathological nail biting (3.4).

Conclusions: TTM is comorbid with a number of psychiatric conditions besides OCD, and it is strongly associated with other conditions involving impaired impulse control. Though DSM-5 includes TTM as an OCD-related disorder, its comorbidity pattern also emphasizes the impulsive, appetitive aspects of this condition that may be relevant to classification.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.comppsych.2019.152123DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6980465PMC
October 2019

Trichotillomania comorbidity in a sample enriched for familial obsessive-compulsive disorder.

Compr Psychiatry 2019 10 31;94:152123. Epub 2019 Aug 31.

Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, United States of America. Electronic address:

Background: This study addresses the strength of associations between trichotillomania (TTM) and other DSM-IV Axis I conditions in a large sample (n = 2606) enriched for familial obsessive-compulsive disorder (OCD), to inform TTM classification.

Methods: We identified participants with TTM in the Johns Hopkins OCD Family Study (153 families) and the OCD Collaborative Genetics Study, a six-site genetic linkage study of OCD (487 families). We used logistic regression (with generalized estimating equations) to assess the strength of associations between TTM and other DSM-IV disorders.

Results: TTM had excess comorbidity with a number of conditions from different DSM-IV chapters, including tic disorders, alcohol dependence, mood disorders, anxiety disorders, impulse-control disorders, and bulimia nervosa. However, association strengths (odds ratios) were highest for kleptomania (6.6), pyromania (5.8), OCD (5.6), skin picking disorder (4.4), bulimia nervosa (3.5), and pathological nail biting (3.4).

Conclusions: TTM is comorbid with a number of psychiatric conditions besides OCD, and it is strongly associated with other conditions involving impaired impulse control. Though DSM-5 includes TTM as an OCD-related disorder, its comorbidity pattern also emphasizes the impulsive, appetitive aspects of this condition that may be relevant to classification.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.comppsych.2019.152123DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6980465PMC
October 2019

Analysis of shared heritability in common disorders of the brain.

Science 2018 06;360(6395)

Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, USA.

Disorders of the brain can exhibit considerable epidemiological comorbidity and often share symptoms, provoking debate about their etiologic overlap. We quantified the genetic sharing of 25 brain disorders from genome-wide association studies of 265,218 patients and 784,643 control participants and assessed their relationship to 17 phenotypes from 1,191,588 individuals. Psychiatric disorders share common variant risk, whereas neurological disorders appear more distinct from one another and from the psychiatric disorders. We also identified significant sharing between disorders and a number of brain phenotypes, including cognitive measures. Further, we conducted simulations to explore how statistical power, diagnostic misclassification, and phenotypic heterogeneity affect genetic correlations. These results highlight the importance of common genetic variation as a risk factor for brain disorders and the value of heritability-based methods in understanding their etiology.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1126/science.aap8757DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6097237PMC
June 2018

Analysis of shared heritability in common disorders of the brain.

Science 2018 06;360(6395)

Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, USA.

Disorders of the brain can exhibit considerable epidemiological comorbidity and often share symptoms, provoking debate about their etiologic overlap. We quantified the genetic sharing of 25 brain disorders from genome-wide association studies of 265,218 patients and 784,643 control participants and assessed their relationship to 17 phenotypes from 1,191,588 individuals. Psychiatric disorders share common variant risk, whereas neurological disorders appear more distinct from one another and from the psychiatric disorders. We also identified significant sharing between disorders and a number of brain phenotypes, including cognitive measures. Further, we conducted simulations to explore how statistical power, diagnostic misclassification, and phenotypic heterogeneity affect genetic correlations. These results highlight the importance of common genetic variation as a risk factor for brain disorders and the value of heritability-based methods in understanding their etiology.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1126/science.aap8757DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6097237PMC
June 2018

Analysis of shared heritability in common disorders of the brain.

Science 2018 06;360(6395)

Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, USA.

Disorders of the brain can exhibit considerable epidemiological comorbidity and often share symptoms, provoking debate about their etiologic overlap. We quantified the genetic sharing of 25 brain disorders from genome-wide association studies of 265,218 patients and 784,643 control participants and assessed their relationship to 17 phenotypes from 1,191,588 individuals. Psychiatric disorders share common variant risk, whereas neurological disorders appear more distinct from one another and from the psychiatric disorders. We also identified significant sharing between disorders and a number of brain phenotypes, including cognitive measures. Further, we conducted simulations to explore how statistical power, diagnostic misclassification, and phenotypic heterogeneity affect genetic correlations. These results highlight the importance of common genetic variation as a risk factor for brain disorders and the value of heritability-based methods in understanding their etiology.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1126/science.aap8757DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6097237PMC
June 2018

Genome Wide Association Study (GWAS) between Attention Deficit Hyperactivity Disorder (ADHD) and Obsessive Compulsive Disorder (OCD).

Front Mol Neurosci 2017 23;10:83. Epub 2017 Mar 23.

Unit on Statistical Genomics, National Institute of Mental Health, National Institutes of Health (NIH) Bethesda, MD, USA.

The aim of this study was to identify any potential genetic overlap between attention deficit hyperactivity disorder (ADHD) and obsessive compulsive disorder (OCD). We hypothesized that since these disorders share a sub-phenotype, they may share common risk alleles. In this manuscript, we report the overlap found between these two disorders. A meta-analysis was conducted between ADHD and OCD, and polygenic risk scores (PRS) were calculated for both disorders. In addition, a protein-protein analysis was completed in order to examine the interactions between proteins; -values for the protein-protein interaction analysis was calculated using permutation. None of the single nucleotide polymorphisms (SNPs) reached genome wide significance and there was little evidence of genetic overlap between ADHD and OCD.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3389/fnmol.2017.00083DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5362635PMC
March 2017

Resilience in the third year of medical school: a prospective study of the associations between stressful events occurring during clinical rotations and student well-being.

Acad Med 2009 Feb;84(2):258-68

Mount Sinai School of Medicine, New York, NY 10029, USA.

Purpose: In the third year of medical school students are exposed to many stressful and potentially traumatic events, including witnessing patient suffering or death, personal mistreatment, and poor role modeling by physicians. These experiences may explain increases in anxiety and depression during medical school. However, to date this has not been studied.

Method: The present study prospectively measured stressful clerkship events occurring during the 2006-2007 academic year in third-year medical students of the Mount Sinai School of Medicine (n = 125), using surveys completed monthly. Students labeled stressful events traumatic if they met the trauma criteria of the Diagnostic and Statistical Manual of Mental Disorders, fourth edition. The authors measured anxiety, depression, and posttraumatic stress symptoms at the beginning and end of the year and twice during the year. At year's end they also measured students' personal growth.

Results: Class participation varied from 106 (85%) at baseline to 82 (66%) at endpoint. Most students (101; 81%) completed at least one monthly survey. Many students reported exposure to trauma as well as personal mistreatment and poor role modeling by superiors. Trauma exposure was positively associated with personal growth at year's end. In contrast, exposure to other stressful events was positively associated with endpoint levels of depression and other stress symptoms.

Conclusions: Trauma exposure was common but not associated with poor outcomes by year's end, which suggests that students were resilient. Nonetheless, unprofessional behavior by resident and attending physicians might have adverse effects on the well-being of students.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/ACM.0b013e31819381b1DOI Listing
February 2009