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26 Cognitive Correlates of Functional Assessment Tool in Veterans with Mild Traumatic Brain Injury
- Jillian M. Tessier, Gary Abrams, Tatjana Novakovic-Agopian
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 708-709
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Objective:
Limitations of traditional neuropsychological assessment include testing in a highly controlled environment designed to minimize distraction. While informative, it may not fully capture real-world cognitive functioning. This may be particularly important for individuals with mild traumatic brain injury (mTBI), a subset of whom report subtle challenges with complex cognitive functioning that are not consistently captured by neuropsychological assessment. The objective of this study was to extend previous work examining cognitive correlates of performance on functional assessment tool, the Goal Processing Sale (GPS), in a larger sample of Veterans with mTBI.
Participants and Methods:46 Veterans with chronic mTBI completed GPS and neuropsychological measures (mean age = 43.5; education = 15 years; 89% male). 93% of participants had clinically significant PTSD (PCL-M > 31). The GPS is an ecologically valid assessment in which participants plan and execute a complex task following specified rules under a time constraint. Performance is rated on a 0 (not able) to 10 (absolutely not a problem) scale in 8 domains: 1) Planning, 2) Initiation, 3) Self-Monitoring, 4) Maintenance of Attention, 5) Sequencing and Switching of Attention, 6) Flexible Problem Solving, 7) Task Execution, and 8) Learning and Memory. The GPS Overall Performance is average of 8 domain scores. Neuropsychological assessment data were scored using standardized norms and transformed into z-scores. Scores were averaged into 2 domains: 1) Overall Attention/Executive Function (4 subdomains: Working Memory [Auditory Consonant Trigrams, WAIS-III Letter Number Sequencing], Sustained Attention [Digit Vigilance Test], Inhibition [D-KEFS Stroop Inhibition], Mental Flexibility [Trail Making Test B, D-KEFS Stroop Inhibition Switching, Design Fluency Switching, Verbal Fluency Switching]) and 2) Overall Memory (2 subdomains: Total Recall [HVLT-R, BVMT-R], and Delayed Recall [HVLT-R, BVMT-R]).
Pearson correlation coefficients were used to determine relation between overall GPS and overall executive function performance, as well as 8 GPS subdomain and 8 neuropsychological domain/subdomain scores. To adjust for multiple comparisons, p < .01 was used.
Results:Overall GPS performance was statistically significantly related to Overall Attention/Executive Functioning and Overall Memory. Investigating further, multiple significant subdomain relations emerged. GPS Planning was related to Inhibition. GPS Self-Monitoring and GPS Task Execution were related to Mental Flexibility. GPS Maintenance of Attention and GPS Flexible Problem Solving were related to Mental Flexibility and Inhibition. GPS Sequencing and Switching of Attention was related to Mental Flexibility and Total Recall.
GPS Learning and Memory was related to Working Memory, Mental Flexibility, and Inhibition. GPS Initiation was not related to neuropsychological measures.
Conclusions:Current findings build upon prior work establishing validity of GPS functional assessment measure (Novakovic-Agopian et al., 2012). Seven of 8 GPS subdomains were related to at least one aspect of executive functioning assessed with neuropsychological measures, with the majority related to mental flexibility. Taken together, findings suggest that the GPS converges with traditional measures, offering a method to capture multiple aspects of executive functioning applied together. Further, it may also be useful tool capturing aspects of executive functioning in complex, ecologically-valid settings often not captured with traditional neuropsychological assessment.
26 Improvement in Executive Function Following Goal-Oriented Attentional Self-Regulation Training in Veterans with mTBI
- Rachel Santiago, Sky Raptentsetsang, Brian A Maruyama, Anna Hwang, Marissa Cassar, Gary Abrams, Pratik Mukherjee, Tatjana Novakovic-Agopian
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, p. 902
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Objective:
Goal-Oriented Attentional Self-Regulation (GOALS) is a cognitive rehabilitation training that targets difficulties with executive control functions. Prior research has found that GOALS training improves executive function, functional outcomes, and PTSD symptoms in Veterans with comorbid PTSD and TBI. The objective of this study is to assess the effects of GOALS training versus an active time-matched Behavioral Health Education (BHE) intervention in military Veterans with history of mTBI and executive function difficulties.
Participants and Methods:Thirty-four veterans with a history of mild TBI (>6 months post-injury) and cognitive difficulties were randomized to GOALS or BHE group intervention. GOALS is a cognitive rehabilitation intervention that incorporates mindfulness-based attention regulation training, and goal management strategies applied to participant-defined goals. It consists of ten 2-hour sessions administered in small group format, and three individual 1-hour sessions. The BHE group is a matched control condition that mirrors GOALS in terms of duration and level of involvement. Participants completed a comprehensive evaluation consisting of neuropsychological and ecologically valid functional performance measures of complex attention and executive function, before and after GOALS or BHE intervention. Overall neuropsychological attention/executive functioning included measures of working memory (Letter Number Sequencing, Auditory Consonant Trigrams), mental flexibility (Design & Verbal Fluency Switching, Trails B, Stroop Inhibition/Switching), inhibition (Stroop Inhibition), and sustained attention (Digit Vigilance). The Goal Processing Scale (GPS) was used to measure ecologically valid complex functional performance.
Results:Post GOALS training, but not post BHE, participants significantly improved on measures of attention /executive function including overall performance (p=.02), working memory (p=.04), sustained attention (p=.03)., and inhibition (p=.01). On measures of complex functional task performance, post GOALS participants significantly improved in the domain of planning (p=.02).
Conclusions:GOALS training improved performance on neuropsychological and ecologically valid functional measures of complex attention and executive function in Veterans with mild TBI and cognitive difficulties. The current study highlights how mindfulness-based attention regulation and goalmanagement strategies applied to personal goals has positive effects across various outcomes. A percentage of individuals with mTBI continue to report persistent problems with cognition and daily functioning. Cognitive rehabilitation training such as GOALS may be beneficial for those with persistent difficulties following mTBI, even in chronic phase.
Cross-sectional examination of ultra-processed food consumption and adverse mental health symptoms
- Eric M Hecht, Anna Rabil, Euridice Martinez Steele, Gary A Abrams, Deanna Ware, David C Landy, Charles H Hennekens
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- Journal:
- Public Health Nutrition / Volume 25 / Issue 11 / November 2022
- Published online by Cambridge University Press:
- 28 July 2022, pp. 3225-3234
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Objective:
To explore whether individuals who consume higher amounts of ultra-processed food (UPF) have more adverse mental health symptoms.
Design:Using a cross-sectional design, we measured the consumption of UPF as a percentage of total energy intake in kilo-calories using the NOVA food classification system. We explored whether individuals who consume higher amounts of UPF were more likely to report mild depression, more mentally unhealthy days and more anxious days per month using multivariable analyses adjusting for potential confounding variables.
Setting:Representative sample from the United States National Health and Nutrition Examination Survey between 2007 and 2012.
Participants:10 359 adults aged 18+ without a history of cocaine, methamphetamine or heroin use.
Results:After adjusting for covariates, individuals with the highest level of UPF consumption were significantly more likely to report at least mild depression (OR: 1·81; 95 % CI1·09, 3·02), more mentally unhealthy (risk ratio (RR): 1·22; 95 % CI 1·18, 1·25) and more anxious days per month (RR: 1·19; 95 % CI 1·16, 1·23). They were also significantly less likely to report zero mentally unhealthy (OR: 0·60; 95 % CI 0·41, 0·88) or anxious days (OR: 0·65; 95 % CI 0·47, 0·90).
Conclusions:Individuals reporting higher intakes of UPF were significantly more likely to report mild depression, more mentally unhealthy and more anxious days and less likely to report zero mentally unhealthy or anxious days. These data add important information to a growing body of evidence concerning the potential adverse effects of UPF consumption on mental health.
The Eurasian strawberry blossom weevil, Anthonomus rubi (Herbst, 1795), is established in North America
- Michelle T. Franklin, Tracy K. Hueppelsheuser, Paul K. Abram, Patrice Bouchard, Robert S. Anderson, Gary A.P. Gibson
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- Journal:
- The Canadian Entomologist / Volume 153 / Issue 5 / October 2021
- Published online by Cambridge University Press:
- 23 June 2021, pp. 579-585
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We report the strawberry blossom weevil, Anthonomus rubi (Herbst, 1795) (Coleoptera: Curculionidae), a species native to Europe, Asia, and North Africa, as established in British Columbia, Canada. This is the first report of A. rubi in North America. We provide a diagnosis of the species and compare it with other species of the genus Anthonomus Germar in Canada. This species is a pest of plants in Rosaceae Jussieu, including economically important berries such as strawberries (Fragaria Linnaeus) and raspberries (Rubus idaeus Linnaeus), and of native berries of importance to Indigenous peoples in Canada. Female weevils oviposit eggs inside developing flower buds and sever flower stalks, facilitating larval development inside damaged buds and thus reducing fruit yields. Surveys to confirm the presence of A. rubi conducted in 2020 found the weevil to be well established in cultivated and wild hosts throughout the Greater Vancouver area and Fraser Valley, British Columbia. At least one species of parasitoid wasp in the genus Pteromalus Swederus (Hymenoptera: Pteromalidae) has been found in association with A. rubi in the province. Future investigations are required to understand the biology of A. rubi in its new range, assess its impact on berries, and develop management strategies.
2 - Psychiatric disorders of youth in detention
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- By Linda A. Teplin, Owen L. Coon Professor of Psychiatry and Behavioral Sciences; Director Psycho-Legal Studies Program Feinberg School of Medicine Northwestern University 710 N. Lake Shore Drive Room 900 Chicago, IL 60611 USA, Karen M. Abram, Assistant Professor, Feinberg School of Medicine Northwestern University, USA, Gary M. McClelland, Research Assistant Professor, Feinberg School of Medicine Northwestern University, USA, Amy A. Mericle, Postdoctoral Fellow, University of California, San Francisco School of Medicine, Department of Psychiatry, USA, Mina K. Dulcan, Osterman Professor of Psychiatry, Behavioral Sciences, and Pediatrics Feinberg School of Medicine Northwestern University, USA, Jason J. Washburn, Research Assistant Professor, Feinberg School of Medicine Northwestern University, USA, Shiraz Butt, Assistant Professor of Psychiatry, Rush University Medical Center Marshall Field IV Building 1720 West Polk Street Chicago, IL 60612 USA
- Edited by Carol L. Kessler, Columbia University, New York, Louis James Kraus, Rush University, Chicago
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- Book:
- The Mental Health Needs of Young Offenders
- Published online:
- 11 August 2009
- Print publication:
- 06 September 2007, pp 7-47
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Summary
A comprehensive understanding of the prevalence of psychiatric disorders among juvenile detainees is an important step toward meeting their needs. Although epidemiological data are key to understanding the psychiatric disorders of juvenile detainees, few empirical studies exist. This chapter lists studies published in the United States since 1990 that examined the diagnostic characteristics of incarcerated and detained juveniles. The Northwestern Juvenile Project was designed to overcome the methodological limitations in two ways. Four directions for future research are recommended: pathways to co-morbidity, studies of females in the juvenile justice system, longitudinal studies, and studies of vulnerability to posttraumatic stress disorder (PTSD) in high-risk youth. Research findings indicate that a substantial number of youth in detention need mental health services. However, providing services within the juvenile justice system poses a number of challenges: screening for mental health needs, providing services, community linkages, and avoid retraumatizing youth.
126 - Neurologic manifestations of endocrine disease
- from PART XVII - NEUROLOGICAL MANIFESTATIONS OF SYSTEMIC CONDITIONS
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- By Gary M. Abrams, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA, Cheryl A. Jay, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
- Edited by Arthur K. Asbury, University of Pennsylvania School of Medicine, Guy M. McKhann, The Johns Hopkins University School of Medicine, W. Ian McDonald, University College London, Peter J. Goadsby, University College London, Justin C. McArthur, The Johns Hopkins University School of Medicine
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- Book:
- Diseases of the Nervous System
- Published online:
- 05 August 2016
- Print publication:
- 11 November 2002, pp 2033-2043
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Summary
Neurological signs and symptoms occur in virtually every known endocrine disturbance. This chapter focuses primarily on the neurological manifestations of diseases of the thyroid and the adrenal glands. The neurological complications of parathyroid disease largely reflect disordered calcium metabolism and are discussed in Chapter 124. The numerous neurological complications of diabetes mellitus, hypoglycemia, and pancreatic disorders are also dealt with elsewhere. Neurological manifestations of the hypothalamus and pituitary disease are reviewed in Chapter 57. The endocrine disturbances associated with anorexia nervosa are considered in Chapter 54.
Neurological complications of thyroid disease
Hyperthyroidism
Neuropsychiatric disorders, seizures, and headaches
Neuropsychiatric symptoms are common in hyperthyroidism. Many patients complain of feeling nervous, anxious and restless. They note difficulty in concentration and a shortened attention span. Friends or relatives describe them as irritable or capricious. Frank psychoses are uncommon, but agitated depression has been reported in severe thyrotoxicosis (Logothetis, 1961). In elderly patients, an apathetic state with lethargy, depression (Ettigi & Brown, 1978) or cognitive impairment may occur (Martin & Deam, 1996). Although the mechanism by which thyroid hormone produces these mental changes is unknown, symptoms usually resolve when thyroid function is restored to normal.
In patients with the life-threatening forms of hyperthyroidism known as thyroid storm, agitated delirium progresses to lethargy and coma (Newcomer et al. 1983). Patients may have signs of bulbar palsy (see below) and convulsions can occur. There are serious systemic complications, including hyperpyrexia, tachycardia and other cardiac arrythmias, and a variety of electrolyte abnormalities. Treatment includes hydration, cooling, antithyroid medication, iodine, and corticosteroids (Tiegens & Leinung, 1995). Plasmapheresis may be useful (Newcomer et al., 1983).
Patients with epilepsy may show increased frequency of their seizures with hyperthyroidism. In some cases, hyperthyroidism is associated with a seizure disorder that disappears after the patient becomes euthyroid (Smith & Looney, 1983). In one study, nearly 10% of hyperthyroid patients had convulsions as their initial symptom (Jabbari & Huott, 1980); however, this figure is unusually high. The electroencephalogram in hyperthyroid patients may be moderately abnormal and returns with restoration of the euthyroid state (Leubscher et al., 1988)
Headache is a common symptom with hyperthyroidism.