5 results
COVID-19 outbreak and genomic investigation in an inpatient behavioral health unit
- Estefany Rios-Guzman, Alina G. Stancovici, Lacy M. Simons, Grace Barajas, Katia Glenn, Rachel T. Weber, Egon A. Ozer, Ramon Lorenzo-Redondo, Judd F. Hultquist, Maureen K. Bolon
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- Journal:
- Antimicrobial Stewardship & Healthcare Epidemiology / Volume 4 / Issue 1 / 2024
- Published online by Cambridge University Press:
- 29 April 2024, e62
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Background:
Inpatient behavioral health units (BHUs) had unique challenges in implementing interventions to mitigate coronavirus disease 2019 (COVID-19) transmission, in part due to socialization in BHU settings. The objective of this study was to identify the transmission routes and the efficacy of the mitigation strategies employed during a COVID-19 outbreak in an inpatient BHU during the Omicron surge from December 2021 to January 2022.
Methods:An outbreak investigation was performed after identifying 2 COVID-19-positive BHU inpatients on December 16 and 20, 2021. Mitigation measures involved weekly point prevalence testing for all inpatients, healthcare workers (HCWs), and staff, followed by infection prevention mitigation measures and molecular surveillance. Whole-genome sequencing on a subset of COVID-19-positive individuals was performed to identify the outbreak source. Finally, an outbreak control sustainability plan was formulated for future BHU outbreak resurgences.
Results:We identified 35 HCWs and 8 inpatients who tested positive in the BHU between December 16, 2021, and January 17, 2022. We generated severe acute respiratory coronavirus virus 2 (SARS-CoV-2) genomes from 15 HCWs and all inpatients. Phylogenetic analyses revealed 3 distinct but genetically related clusters: (1) an HCW and inpatient outbreak likely initiated by staff, (2) an HCW and inpatient outbreak likely initiated by an inpatient visitor, and (3) an HCW-only cluster initiated by staff.
Conclusions:Distinct transmission clusters are consistent with multiple, independent SARS-CoV-2 introductions with further inpatient transmission occurring in communal settings. The implemented outbreak control plan comprised of enhanced personal protective equipment requirements, limited socialization, and molecular surveillance likely minimized disruptions to patient care as a model for future pandemics.
61 Increased Apathy Post-Laser Ablation for Refractory Obsessive-Compulsive Disorder
- Hannah Hagy, Christopher Krause, Briana Hatton, Jon Grant, Peter Warnke, Maureen Lacy
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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. 846-847
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Objective:
Severe OCD is often nonresponsive to pharmacological and behavioral therapies and thus surgical interventions are emerging. Surgical interventions have proven to be efficacious for treating refractory OCD, however limited publications suggest 22–40% of patients experience transient apathy and disinhibition post-surgery (McLaughlin et al., 2021). Apathy is highly associated with the same brain regions, the prefrontal cortex, striatum, and thalamus, which have also been implicated in OCD symptoms (Le Heron et al., 2018). Prior research noting post-surgical changes in apathy in OCD either used physician observations or less precise surgical methods (i.e., gamma knife or radiofrequency ablation). Apathy has also been highly associated with depression and executive dysfunction (Raffard et al, 2020) and often not co-assessed in prior studies. The newest intervention, cutting-edge MR-guided laser interstitial thermal therapy (LITT), limits damage outside the region of interest by precise control of thermal application in real-time. Thus, the current case series aims to investigate objective patient-reported change in apathy, disinhibition, depression, and executive dysfunction following anterior capsulotomy via this newest surgical approach for OCD.
Participants and Methods:In this retrospective study, the responses of ten consecutive patients pre- and post-LITT on the following measures were examined: Frontal Systems Behavior Scale (FrSBe), Beck Depression Inventory-II (BDI-II), and Yale Brown Obsessive-Compulsive Scale (Y-BOCS). Reliable Change Index (RCI) was used to evaluate meaningful change in pre- and post-LITT self-reported levels of apathy, disinhibition, executive dysfunction, along with depressive symptoms. Per prior published guidelines, patient-reported Y-BOCS (range 0–40) scores were used to measure OCD symptoms with 24–34 % score reduction representing partial and 35% or greater score reduction representing full response (Pepper et al., 2019).
Results:Seven patients (70%) were male, with a sample mean age of 38.4 (SD=13.6) and a mean of 14.6 (SD =2.27) years of education. Mean Y-BOCS score decreased from 32 (SD=5.3) before surgery to 18.8 (SD=11.1) after. Over 65% had partial or full response in OCD symptoms post-surgery. Six patients endorsed increased apathy, with others endorsing no change. Half of the non-responders reported this increase in apathy. The cohort remained relatively stable in disinhibition and executive dysfunction. Over half the cohort demonstrated a significant decrease in depressive symptoms. Interestingly, two of the non-responders and one responder endorsed increased apathy despite stable or improving depressive symptoms, disinhibition, and executive dysfunction.
Conclusions:Surgical interventions for psychiatric disorders are emerging quickly and being refined daily. In this cohort, anterior capsulotomy via LITT provided full or partial OCD recovery for most patients. However, most patients reported significant increases in apathy, despite experiencing a decrease in depressive symptoms, with stable disinhibition and executive dysfunction. Despite these promising improvements in OCD symptomatology via LITT, impact of surgery on apathy levels is clearly warranted using objective, quantifiable methods. As apathy has consistently been related to functional impairment and poorer quality of life, understanding this outcome is imperative in larger trials. Better understanding of this finding and underlying circuity will allow patients to be fully informed regarding this promising surgical intervention.
Evaluating 2 Year Outcome in Twins ≤ 30 Weeks Gestation at Birth: A Regional Perinatal Unit's Experience
- Elizabeth V. Asztalos, Jon F. R. Barrett, Maralyn Lacy, Maureen Luther
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- Journal:
- Twin Research / Volume 4 / Issue 6 / 01 December 2001
- Published online by Cambridge University Press:
- 21 February 2012, pp. 431-438
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With improved technology in assisted reproductive medicine, there has been an absolute increase in the numbers of twin pregnancies with an associated increase in perinatal mortality and morbidity. This increase in perinatal mortality and morbidity is largely due to a higher incidence of delivering preterm as compared to singletons. Twin pregnancies have their unique complications that include abnormal placental communication and discordant growth which are associated with perinatal mortality and morbidity. The objectives of this study were two-fold: i) to determine if the morbidity/mortality outcome at 18–24 months corrected age seen in a cohort of twins born between 24–30 weeks gestation was significantly different as compared to singleton preterm infants of the same gestation; and ii) to determine and evaluate any differences between monochorionic (MC) and dichorionic (DC) twins. Twins 24–30 weeks gestation at birth born between 01/01/97–30/06/99 were identified and prospectively followed to 18–24 months corrected age (c.a.). They were matched with a singleton infant of the same gender and within 1 week of the same gestation. Obstetrical, neonatal and neurodevelopmental data were gathered and analyzed. The primary outcome was death or the presence of a severe neurodevelopmental deficit at 18–24 months corrected age. Of the 56 sets of twins identified, 52 sets were followed prospectively with 101 infants available for matching. In this cohort, twin pregnancies had a lower incidence of pregnancy-induced hypertension and premature rupture of membranes than singletons (p < 0.05). The two groups were comparable in neonatal characteristics. The incidence of death or severe disability was 29.7% in twins vs. 22.8% in singletons (p = 0.337, Fisher's exact test). The major area of deficit was in the cognitive category for both groups, 9.9% vs. 7.9% respectively. MC twins made up 35.6%; DC twins 64.4%. Twin to twin transfusion syndrome (TTTS) occurred in 6.9%. Discordant growth occurred more frequently in MC pregnancies (p = 0.016). MC twins tended to be more premature, lower in birth weight, and experience neonatal morbidity in the form of patent ductus arteriosus and sepsis (p < 0.05) as compared to DC twins. However, the primary outcome of death or severe neurodevelopmental deficit at 18–24 months c.a. was not significantly different between the two groups, 38.9% (MC) vs. 24.6% (DC), (p = 0.173, Fisher's exact test). Neurodevelopmental morbidity or mortality in twins with TTTS was 42%. Mortality and severe neurodevelopmental morbidity were not significantly higher in twins as compared to singletons in this cohort. However, the trend is slightly higher in twins, which may have clinical significance. Though not statistically significant, the incidence of 38.9% in adverse outcome with MC twins may be clinically significant. With the number of twins steadily increasing, further monitoring is required to determine future directions in intervention and research. Early recognition of monochorionicity remains essential to optimize care and neurodevelopment for these infants.
16b - Psychopathological conditions in adults
- from Section II - Disorders
- Edited by Jacobus Donders, Scott J. Hunter, University of Chicago
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- Book:
- Principles and Practice of Lifespan Developmental Neuropsychology
- Published online:
- 07 May 2010
- Print publication:
- 14 January 2010, pp 455-468
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Summary
Introduction
With psychiatric disorders affecting nearly one-half of American adults at some point in their lifetime, it is important to consider the impact psychopathological conditions may have on neuropsychological function; this is particularly true as individuals entering adulthood and later, old age, are often at greater risk for the development of psychopathological conditions. Whereas several adult psychopathological conditions may present with some form of cognitive inefficiency, the present discussion focuses on three disorders with relatively well-characterized neuropsychological profiles in adulthood and old age: schizophrenia, bipolar disorder, and major depression. What follows is a description of the pathophysiological mechanisms of these conditions, their most salient cognitive manifestations during adulthood and old age, assessment issues which may arise in neuropsychological evaluation of individuals with these disorders, and a review of the effects of treatment of these conditions on cognitive function.
Schizophrenia
Adulthood-onset schizophrenia is a psychiatric illness characterized by a constellation of symptoms that may include psychosis, thought disorder, disorganized behavior, and some form of negative symptomatology (e.g. alogia, affective flattening, or avolition). The prevalence of schizophrenia after 15 years of age is estimated to be between 2.7 and 8.3 per 1000 [1]. Whereas the peak incidence for males and females occurs between 15 and 24 years of age, females appear to have a second peak during the decade between the ages of 55 and 64 years. This later peak appears to counterbalance the higher prevalence of early-onset schizophrenia among males.
Neurocognitive outcome after endoscopic third ventriculocisterostomy in patients with obstructive hydrocephalus
- MAUREEN LACY, MARTIN OLIVEIRA, EMILY AUSTRIA, M. DAVID FRIM
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- Journal:
- Journal of the International Neuropsychological Society / Volume 15 / Issue 3 / May 2009
- Published online by Cambridge University Press:
- 01 May 2009, pp. 394-398
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Obstructive hydrocephalus can be treated with an extracranial shunting system or, when the obstruction is between the posterior third ventricle and the fourth ventricular outflow tracts, by an endoscopic third ventriculocisternostomy (ETV). The placement of an extracranial shunting device entails significant long-term risk of infection and malfunction. This risk has led to the concept that ETV is preferable to shunting. While the long-term cognitive performance of shunted hydrocephalus patients has been extensively examined, the outcome of patients undergoing ETV has been studied only sparsely. Ten adults who had undergone ETV were entered into the study under institutional review board approval. Each patient underwent a neuropsychological testing battery that included testing within the domains of basic attention, verbal memory, visual memory, language, and executive functioning. Aggregate test scores showed a decrease in performance in the domains of memory and executive functioning when compared to normative data. The present study revealed persistent cognitive inefficiencies in memory and executive domains in patients post-ETV intervention. A larger longitudinal study considering the impact of prior shunting, presence of headaches, emotional status, and surgical complications will assist in elucidating the etiology and eventual treatment of these deficits. (JINS, 2009, 15, 394–398.)