- Email: [email protected]
4.58 Asthma and Obesity in Puerto Rican Youth With Posttraumatic Stress Disorder (PTSD)
NEW RESEARCH POSTERS 4.58 — 4.60
or disruptive behavioral disorder have a high level of PTSD symptom severity and this in turn is associated with an increased LOS.
ICP, S Supported by the 2015 APA Resident Research Psychiatric Scholars Fellowship http://dx.doi.org/10.1016/j.jaac.2017.09.273
4.58 ASTHMA AND OBESITY IN PUERTO RICAN YOUTH WITH POSTTRAUMATIC STRESS DISORDER (PTSD) Nuria A. Sabat e, MD, Ponce Research Institute, nsabate@ psm.edu; Ann Maldonado-Vazquez, MD, Ponce Health Sciences University, [email protected]; James Porter, PhD, Ponce Research Institute, jporter@psm. edu; Elsa B. Cardalda, PhD, Ponce Research Institute, [email protected]; Jos e V. Martınez, PhD, Ponce Research Institute, [email protected]; Pedro A. Castaing, MD, Ponce Research Institute, [email protected] Objectives: PTSD has been linked to the presence of other psychiatric and systemic pathologies. In Puerto Rican children, there is a high rate of both bronchial asthma and obesity, both of which have been associated with trauma exposure. There was a high frequency of reported pediatric pathologies in our previous study done with Puerto Rican youth who had been exposed to trauma and were receiving psychiatric services. The objective of this post hoc analysis is to identify the prevalence of asthma and obesity in a sample group of Puerto Rican youth with PTSD. Methods: A total of 246 medical charts of patients who met criteria for PTSD in our previous study were reviewed for documentation of bronchial asthma. BMI was calculated from data found in the medical charts. The presence of PTSD was defined by a score of 15 or more on the Child PTSD Symptom Scale (CPSS). Results: Bronchial asthma was found in 31 percent of the sample group. The high frequency of bronchial asthma documented contrasted with a previously reported prevalence of asthma (14%) in nonclinical youth population in Puerto Rico. In addition, a high prevalence of obesity was found (24%). This was found by calculating BMI using data documented in charts. However, documentation of a diagnosis of obesity was found in only one chart. An interesting finding was that male subjects presented with significantly more pediatric comorbidities (P < 0.02) than females. Conclusions: Our findings suggest that PTSD commonly occurs with bronchial asthma and obesity in our clinic, thus contributing to health disparities in this underserved population. Our findings of high frequencies of comorbid bronchial asthma and obesity are consistent with previous reports in trauma-exposed youth and testify to the multidimensional nature of trauma effects in the pediatric population. The significantly higher number of comorbidities in males may signal the impact of gender differences in pediatric comorbidities and warrant appropriate screening and preventive interventions in this at-risk population.
CM, OBE Supported by National Institute on Minority Health and Health Disparities Grant G12MD007579, the Ponce Health Sciences University Behavioral Research and Integrative Neuroscience Core, the Ponce Research Institute, the Puerto Rico Clinical and Translational Research Consortium Award 054MD007587-05, and the National Center for Advancing Translational Sciences Grant UL1TR000114 http://dx.doi.org/10.1016/j.jaac.2017.09.274
4.59 IMPROVING OUTCOMES FOR HOSPITALIZED CHILDREN AND ADOLESCENTS WITH SOMATIC SYMPTOM AND RELATED DISORDERS Valentina Cimolai, MD, Children’s National Medical Center, [email protected]; Finza Latif, MD, Children’s National Medical Center, fi[email protected] Objectives: Somatic symptom and related disorders (SSRD) is a clinical presentation where presenting physical symptoms or impairment cannot be fully explained by an identifiable physical disease and are driven by a psychological
JOURNAL OF THE AMERICAN ACADEMY OF CHILD & ADOLESCENT P SYCHIATRY VOLUME 56 NUMBER 10S OCTOBER 2017
process. The research and clinical literature on treatment of these disorders is limited and recommends a multidisciplinary approach with early involvement of psychiatry and/or psychology. However, in the absence of standardized treatment guidelines and published expert opinions, SSRD management varies between clinicians. Children and adolescents admitted to medical units with SSRD can be challenging for medical providers, and often psychiatry or psychology is consulted much later during admission once all medical investigations are completed. As a result, families often feel that they are being “handed off” by their providers and have low buy-in for psychological treatment. We conducted a survey to assess the current practices followed by providers at Children’s National Health System (CNHS) and whether a clinical pathway was needed to standardize the care of these patients. Methods: In February 2016, a 10-question online survey was emailed to the entire staff working at CNHS in Washington, DC. A total of 128 people completed the survey, of which 42 were physicians and 62 were nurses. Results: Providers (37%) were not familiar with the SSRD diagnosis, and 20 percent were only “somewhat familiar” only 11 percent of providers consulted psychiatry or psychology “always,” whereas 50 percent consulted psychiatry “sometimes.” Providers (13%) never communicated with outpatient providers, and 55 percent never communicated with schools before discharge. Ninetytwo percent of those surveyed felt that a protocol to guide management of patients with SSRD would be helpful. Conclusions: Less than half the hospital staff members at CNHS are familiar with the diagnosis of SSRD. Psychology and psychiatry are not always consulted on these cases, and there is lack of care coordination during hospitalization and upon discharge. Majority surveyed felt that a clinical pathway to help educate and guide providers on how to assess and treat SSRD in the inpatient setting effectively would be helpful. Based on this feedback a clinical pathway was developed in collaboration with physical medicine and rehabilitation, psychology, psychiatry, neurology, and child life.
MC, CON, SOM http://dx.doi.org/10.1016/j.jaac.2017.09.275
4.60 BORDERLINE PERSONALITY FEATURES IN ADOLESCENTS AND THEIR IMPACT ON CLINICAL OUTCOME Parna R. Prajapati, MD, MPH, University of Texas Southwestern Medical Center, [email protected]; Brandon Oscarson, University of Texas Southwestern Medical Center, [email protected]; Lindsey Jenkins, BA, University of Texas Southwestern Medical Center, [email protected]; Aleksandra Foxwell, PhD, University of Texas Southwestern Medical Center, [email protected]; Betsy D. Kennard, PsyD, University of Texas Southwestern Medical Center, [email protected]; Graham J. Emslie, MD, University of Texas Southwestern Medical Center, [email protected] Objectives: The current study’s aim is to examine the impact of borderline personality symptoms on clinical characteristics and treatment outcome in a sample group of suicidal adolescents being treated in an intensive outpatient program. Methods: Data were collected from an intensive outpatient program (IOP) for suicidal adolescents. Participants were between the ages of 13 and 17 years and presented for treatment after a recent suicidal attempt or severe worsening of suicidal ideation not meeting the inpatient admission criteria. The sample group for this research study included all participants who completed Borderline Personality Features Scale in Children (BPFSC)-11 between August 2015 and December 2016. BPFSC-11 is a shortened form of the original BPFSC developed from Personality Assessment Inventory (PAI). Demographic data (age, gender, ethnicity, race) and clinical (number of attempts, nonsuicidal selfinjury) characteristics were measured as part of a larger battery of intake measures. At baseline, all patients completed Concise Health Risk Tracking Scale Self-Report (CHRT-SR) and Quick Inventory of Depressive Symptomatology Self-Report (QIDS-SR, 16 items). Borderline personality symptoms as measured
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or disruptive behavioral disorder have a high level of PTSD symptom severity and this in turn is associated with an increased LOS.
ICP, S Supported by the 2015 APA Resident Research Psychiatric Scholars Fellowship http://dx.doi.org/10.1016/j.jaac.2017.09.273
4.58 ASTHMA AND OBESITY IN PUERTO RICAN YOUTH WITH POSTTRAUMATIC STRESS DISORDER (PTSD) Nuria A. Sabat e, MD, Ponce Research Institute, nsabate@ psm.edu; Ann Maldonado-Vazquez, MD, Ponce Health Sciences University, [email protected]; James Porter, PhD, Ponce Research Institute, jporter@psm. edu; Elsa B. Cardalda, PhD, Ponce Research Institute, [email protected]; Jos e V. Martınez, PhD, Ponce Research Institute, [email protected]; Pedro A. Castaing, MD, Ponce Research Institute, [email protected] Objectives: PTSD has been linked to the presence of other psychiatric and systemic pathologies. In Puerto Rican children, there is a high rate of both bronchial asthma and obesity, both of which have been associated with trauma exposure. There was a high frequency of reported pediatric pathologies in our previous study done with Puerto Rican youth who had been exposed to trauma and were receiving psychiatric services. The objective of this post hoc analysis is to identify the prevalence of asthma and obesity in a sample group of Puerto Rican youth with PTSD. Methods: A total of 246 medical charts of patients who met criteria for PTSD in our previous study were reviewed for documentation of bronchial asthma. BMI was calculated from data found in the medical charts. The presence of PTSD was defined by a score of 15 or more on the Child PTSD Symptom Scale (CPSS). Results: Bronchial asthma was found in 31 percent of the sample group. The high frequency of bronchial asthma documented contrasted with a previously reported prevalence of asthma (14%) in nonclinical youth population in Puerto Rico. In addition, a high prevalence of obesity was found (24%). This was found by calculating BMI using data documented in charts. However, documentation of a diagnosis of obesity was found in only one chart. An interesting finding was that male subjects presented with significantly more pediatric comorbidities (P < 0.02) than females. Conclusions: Our findings suggest that PTSD commonly occurs with bronchial asthma and obesity in our clinic, thus contributing to health disparities in this underserved population. Our findings of high frequencies of comorbid bronchial asthma and obesity are consistent with previous reports in trauma-exposed youth and testify to the multidimensional nature of trauma effects in the pediatric population. The significantly higher number of comorbidities in males may signal the impact of gender differences in pediatric comorbidities and warrant appropriate screening and preventive interventions in this at-risk population.
CM, OBE Supported by National Institute on Minority Health and Health Disparities Grant G12MD007579, the Ponce Health Sciences University Behavioral Research and Integrative Neuroscience Core, the Ponce Research Institute, the Puerto Rico Clinical and Translational Research Consortium Award 054MD007587-05, and the National Center for Advancing Translational Sciences Grant UL1TR000114 http://dx.doi.org/10.1016/j.jaac.2017.09.274
4.59 IMPROVING OUTCOMES FOR HOSPITALIZED CHILDREN AND ADOLESCENTS WITH SOMATIC SYMPTOM AND RELATED DISORDERS Valentina Cimolai, MD, Children’s National Medical Center, [email protected]; Finza Latif, MD, Children’s National Medical Center, fi[email protected] Objectives: Somatic symptom and related disorders (SSRD) is a clinical presentation where presenting physical symptoms or impairment cannot be fully explained by an identifiable physical disease and are driven by a psychological
JOURNAL OF THE AMERICAN ACADEMY OF CHILD & ADOLESCENT P SYCHIATRY VOLUME 56 NUMBER 10S OCTOBER 2017
process. The research and clinical literature on treatment of these disorders is limited and recommends a multidisciplinary approach with early involvement of psychiatry and/or psychology. However, in the absence of standardized treatment guidelines and published expert opinions, SSRD management varies between clinicians. Children and adolescents admitted to medical units with SSRD can be challenging for medical providers, and often psychiatry or psychology is consulted much later during admission once all medical investigations are completed. As a result, families often feel that they are being “handed off” by their providers and have low buy-in for psychological treatment. We conducted a survey to assess the current practices followed by providers at Children’s National Health System (CNHS) and whether a clinical pathway was needed to standardize the care of these patients. Methods: In February 2016, a 10-question online survey was emailed to the entire staff working at CNHS in Washington, DC. A total of 128 people completed the survey, of which 42 were physicians and 62 were nurses. Results: Providers (37%) were not familiar with the SSRD diagnosis, and 20 percent were only “somewhat familiar” only 11 percent of providers consulted psychiatry or psychology “always,” whereas 50 percent consulted psychiatry “sometimes.” Providers (13%) never communicated with outpatient providers, and 55 percent never communicated with schools before discharge. Ninetytwo percent of those surveyed felt that a protocol to guide management of patients with SSRD would be helpful. Conclusions: Less than half the hospital staff members at CNHS are familiar with the diagnosis of SSRD. Psychology and psychiatry are not always consulted on these cases, and there is lack of care coordination during hospitalization and upon discharge. Majority surveyed felt that a clinical pathway to help educate and guide providers on how to assess and treat SSRD in the inpatient setting effectively would be helpful. Based on this feedback a clinical pathway was developed in collaboration with physical medicine and rehabilitation, psychology, psychiatry, neurology, and child life.
MC, CON, SOM http://dx.doi.org/10.1016/j.jaac.2017.09.275
4.60 BORDERLINE PERSONALITY FEATURES IN ADOLESCENTS AND THEIR IMPACT ON CLINICAL OUTCOME Parna R. Prajapati, MD, MPH, University of Texas Southwestern Medical Center, [email protected]; Brandon Oscarson, University of Texas Southwestern Medical Center, [email protected]; Lindsey Jenkins, BA, University of Texas Southwestern Medical Center, [email protected]; Aleksandra Foxwell, PhD, University of Texas Southwestern Medical Center, [email protected]; Betsy D. Kennard, PsyD, University of Texas Southwestern Medical Center, [email protected]; Graham J. Emslie, MD, University of Texas Southwestern Medical Center, [email protected] Objectives: The current study’s aim is to examine the impact of borderline personality symptoms on clinical characteristics and treatment outcome in a sample group of suicidal adolescents being treated in an intensive outpatient program. Methods: Data were collected from an intensive outpatient program (IOP) for suicidal adolescents. Participants were between the ages of 13 and 17 years and presented for treatment after a recent suicidal attempt or severe worsening of suicidal ideation not meeting the inpatient admission criteria. The sample group for this research study included all participants who completed Borderline Personality Features Scale in Children (BPFSC)-11 between August 2015 and December 2016. BPFSC-11 is a shortened form of the original BPFSC developed from Personality Assessment Inventory (PAI). Demographic data (age, gender, ethnicity, race) and clinical (number of attempts, nonsuicidal selfinjury) characteristics were measured as part of a larger battery of intake measures. At baseline, all patients completed Concise Health Risk Tracking Scale Self-Report (CHRT-SR) and Quick Inventory of Depressive Symptomatology Self-Report (QIDS-SR, 16 items). Borderline personality symptoms as measured
www.jaacap.org
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