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1 Associations Between Alcohol-Related Problems, Neuropsychological Measures, and Financial Exploitation Vulnerability in a Low-Drinking Sample of Cognitively Unimpaired Older Adults
- Aaron C Lim, Jennifer Herrera, Nathan Wei, Laura Fenton, Gali H Weissberger, Annie L Nguyen, Duke S Han
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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. 795-796
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Objective:
In recent years, rates of alcohol consumption and alcohol use disorder have steadily increased among adults age 60 and older. Large studies have demonstrated that moderate-to-heavy alcohol consumption (>7 drinks per week) is a risk factor for developing various types of dementias. The effects of alcohol-related problems on cognition are less clear, and are particularly understudied in older adults. Similarly, while there is an established link between worse cognition and financial exploitation vulnerability in older adults, no studies have examined relationships between alcohol-related problems and financial exploitation in this population. The current study therefore explores whether alcohol-related problems are associated with neuropsychological performance and financial exploitation vulnerability in a sample of older adults.
Participants and Methods:Participants were a community sample of cognitively unimpaired adults over the age of 50 (N = 55, Age M(SD) = 69.1(6.2), 74.5% female, Years of education M(SD) = 16.8(2.3)). Interested individuals were excluded if they reported current or past substance use disorders. Participants completed a laboratory visit that included a neuropsychological assessment. Measures included the NIH Cognition toolbox, CVLT-II, Digit Span, Trails A/B, Benson Complex Figure Recall, and Verbal Fluency: Phonemic and Semantic, from the Alzheimer’s Disease Centers’ Uniform Data Set (UDS) version 3. Participants completed the CAGE Alcohol Abuse Screening Tool and the Short Michigan Alcohol Screener Test - Geriatric Version (SMAST) to assess alcohol-related problems. Both measures are used as clinical screening tools to measure likelihood of a substance use disorder and produce a summary score (0-4 for CAGE, 010 for SMAST) tabulating symptoms of alcohol-related problems. Participants also completed the Perceived Financial Vulnerability Scale (PFVS) to assess financial exploitation vulnerability. As a significant number of participants reported no drinking and therefore no alcohol-related problems, negative binomial regressions were used to test associations between neuropsychological measures, financial exploitation vulnerability, and alcohol-related problems.
Results:After covarying for age and sex, SMAST was negatively associated with NIH toolbox total cognition (B(SE) = -.14(.07), p<.05) and marginally negatively associated with fluid cognition (B(SE) = -.07(.04), p=.06). Neither SMAST nor CAGE scores were significantly associated with performance on any other neuropsychological test (ps = .13-.99). SMAST was positively associated with financial exploitation vulnerability (B(SE) = .31(.16), p = .05); this effect remained significant after covarying for NIH total composite score in a secondary analysis.
Conclusions:In a community sample of cognitively unimpaired, low-drinking adults over the age of 50, more alcohol-related problems were associated with worse NIH toolbox cognition scores. Similarly, more alcohol-related problems were associated with greater financial exploitation vulnerability, and this relationship was not driven by worse cognition. These results suggest that even low amounts of drinking and alcohol-related problems may be associated with cognition and financial exploitation vulnerability in cognitively unimpaired older adults. This study also corroborates the use of the SMAST over the CAGE in older adult populations that may be more sensitive to cognitive changes.
Digital Psychoeducation for First Episode Psychosis
- Iman Ahmedani, Holly Lyle, Wei Han Lim
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- Journal:
- BJPsych Open / Volume 9 / Issue S1 / July 2023
- Published online by Cambridge University Press:
- 07 July 2023, p. S12
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Aims
Young people with their first episode of psychosis can feel lonely and isolated. Psychoeducation has been shown to increase patient insight, reduce the risk of relapse and forms part of the Quality Standards for Early Intervention in Psychosis Services. Our aim was to increase knowledge of psychosis in service users in an urban cohort by delivering psychoeducation in an interactive online format, due to the restrictions on socialising during the COVID-19 pandemic. We hoped this would serve to empower service users, allow them to connect with each other and offer hope through understanding.
MethodsAppropriate service users aged 18–35 years were recruited from the caseload with the support of care coordinators, with 28 participating overall over a period of ten months. One-hour Zoom sessions of 2–4 participants were facilitated by a junior doctor. Each session consisted of a mix of teaching about basic neuroscience, including brain structure and the dopamine hypothesis theory, interspersed with factual quiz questions and opportunities for free-form answers in ‘thought clouds’. These explored feelings and experiences associated with psychosis. Data were also collected quantitatively in the form of anonymous self-rated pre- and post- session questionnaires on a 10-point Likert scale. These included self-reported questions about the understanding of the brain, psychosis, symptoms, medications and fear associated with the illness. Engagement was increased through the creation of flyers and reminder messages.
ResultsThought clouds constructed during the sessions described feelings such as ‘panic’, ‘unease’, ‘dreamy’ and ‘broken reality’. On average over all sessions, there was an increase of 1.2 points in understanding of the brain, 2.6 points in understanding of ‘psychosis’, 2 points in understanding of how symptoms relate to the brain, 1.8 points in the belief that psychosis can be managed with therapy, 1.5 points in the belief that psychosis can be managed by medication, and unfortunately a 0.1 point increase in fear of the disease – perhaps associated with increased knowledge of the disease process. Encouragingly, 91% of final responses in the sessions were positive, demonstrating hopefulness.
ConclusionWe have demonstrated that innovative digital psychoeducation sessions provide a highly effective way to deliver information to young people with psychosis whilst also allowing connection with peers. This model represents a great learning opportunity for trainees, and could be easily replicated in other geographical locations, or mental health conditions. We have also invited and encouraged co-production with service users.
Improving access to the physical health clinic in a community first-episode psychosis service
- Zena Tansley-Ahmed, Wei Han Lim
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- Journal:
- BJPsych Open / Volume 7 / Issue S1 / June 2021
- Published online by Cambridge University Press:
- 18 June 2021, p. S224
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Aims
Physical health outcomes are poor for patients with severe mental illness as demonstrated by the significant mortality gap present globally.[1] Access to and engagement with care is a key factor underpinning this disparity.[2] The Early Intervention in Psychosis service works with young people from 14-35 experiencing a first episode of psychosis in the community. Within the service, difficulties in engagement have been reflected in the high ‘no-show’ rates observed in the Foundation Year 2 trainee doctor-led physical health clinic. This quality improvement project aimed to reduce the ‘did not attend’ (DNA) rate in the physical health clinic by 20% in order to improve patient outcomes, particularly in the context of their physical health.
MethodThe project took place between September and November 2020, over the course of 10 weeks. A driver diagram was constructed to identify key influencing factors and subsequent change ideas. In order to implement each of these changes, three cycles within the Plan, Do, Study, Act (PDSA) ramp framework were completed. These consisted of phone reminders within 48 hours of appointments, a teaching session for staff alongside the distribution of an accompanying information leaflet and increased flexibility in clinic times with opportunistic appointments. The change ideas were cumulative with each cycle lasting a duration of seventeen days.
ResultThe baseline DNA rate was calculated based on the preceding month and found to be 55%. Following cycle one of the project, there was a significant reduction in DNA rates to 30% although this remained relatively stable at 33% after cycle two. By the end of cycle three when all interventions had been introduced, the DNA rate had dropped to 22%. As such, a total drop in DNA rate of over 30% was achieved which surpassed the initial aim of the project.
ConclusionThe outcomes of this project demonstrate that the introduction of even simple measures can lead to positive change. Successful implementation of these changes requires teamwork and a culture of openness and flexibility. Feedback from team members, particularly care coordinators, also indicated better resulting engagement of clients with the service overall, suggesting potential for both improved mental and physical health outcomes. Next steps for this project may involve not only continued implementation of established changes but also service user input and scope for virtual consultations particularly in light of current COVID-19 restrictions.