- Email: [email protected]
6.20 BRIEF BEHAVIORAL THERAPY AND BUPROPION FOR SLEEP AND FATIGUE IN ADOLESCENTS AND YOUNG ADULTS WITH INFLAMMATORY BOWEL DISEASE
NEW RESEARCH POSTERS 6.19 – 6.21
Conclusions: Even though cognitive functions were found to be significantly lower in the CH group than the healthy group, learning and attention problems were found more often than intellectual disability. In addition, there were more externalizing problems than internalizing problems.
COG CON PSP http://dx.doi.org/10.1016/j.jaac.2016.09.338
6.19 PRADER-WILLI SYNDROME PSYCHOBEHAVIORAL PROFILE IN A CLINIC-BASED SAMPLE Dalia Hegazy Ali, MD, Psychiatry and Psychology, Sultan Bin Abdulaziz Humanitarian City, riyadh, banban, ring road north, Riyadh 64399, Saudi Arabia Objectives: Maladaptive behaviors and cognitive impairment can be considered to be main problems in patients with Prader–Willi Syndrome. Understanding difficulties underlying maladaptive behavior through early diagnosis and management allows tremendous improvement in the whole clinical picture. This study reports on the psychobehavioral deviations in a clinic-based sample group of Egyptian children with Prader–Willi syndrome (PWS) in relation to their genotype. Methods: We included 15 of 72 patients of both sexes, aged from 5–15 years, from the National Research Centre from 2009 to 2011. All patients were fulfilling the diagnostic threshold of modified list of Prader–Willi criteria. Detailed cytogenetic analysis was done using conventional cytogenetic analysis of peripheral blood lymphocytes and fluorescent in situ hybridization. Cognitive and psychological profile of patients were assessed using the following: 1) standard and semistructured psychiatric sheet and interview; 2) Wechsler Intelligence Scale for Children; 3) Child Behavior Checklist for youth ages 4–18 years; 4) Conner’s Parent Rating Scale-Revised, long version; and 5) Childhood Autism Rating Scale. Results: Patients (66.7 percent) were deletion positive, and 33.3 percent were negative. One hundred percent of the sample group were mentally subnormal. 26.3 percent had autistic symptoms, all were deletion negative, with P ¼ 0.004. High prevalence of inattention and hyperactivity, anxiety, social, cognitive, and behavioral problems were evident in the patients, manifested in more frequency and severity in nondeletion patients, with P values of 0.025, 0.04, 0.01, and 0.004, respectively. Conclusions: Cognitive and psychological challenges are a fixed part of the profiles of PWS patients. Some differences have been found within our study group genotypes, such as the higher prevalence of autistic features, hyperactivity, anxiety social, and behavioral problems within the nondeletion group, but nevertheless, they all complained from cognitive impairment and many behavioral difficulties. It is noteworthy that there were no statistically significant differences in either the clinical diagnostic criteria or in the IQ of the patients in the two genotypes. These results should be seen in the light our limitations and future recommendations for further studies.
CON ND OBE http://dx.doi.org/10.1016/j.jaac.2016.09.339
6.20 BRIEF BEHAVIORAL THERAPY AND BUPROPION FOR SLEEP AND FATIGUE IN ADOLESCENTS AND YOUNG ADULTS WITH INFLAMMATORY BOWEL DISEASE Eva Szigethy, MD, PhD, Psychiatry, Pediatrics and Medicine, University of Pittsburgh, Visceral Inflammation and Pain Center, 3708 Fifth Ave, Pittsburgh, PA 15222; Katheryn Mcauliff, BA; Meredith Strassburger, MA; Jana Hashash; Ashley Vachon, MD; Noelle M. Rode, BS; David J. Keljo, MD, PhD; Ada O. Youk, PhD; Miguel Regueiro, MD; David Binion, MD; Frank Lotrich, MD; Anne Germain, PhD; Martica Hall, PhD Objectives: Sleep disturbance and fatigue are common in Crohn’s disease (CD) with few effective treatment options. This study presents the first 2-phase open trial for insomnia and fatigue in young adults with CD: Phase 1) Brief
S210
www.jaacap.org
behavior therapy for sleep in IBD (BBTS-I) over 4 weeks followed by Phase 2) maintenance BBTS-I alone or with bupropion (BUP) added over 8 weeks. Primary outcomes were improvement in sleep (Pittsburgh Sleep Quality Index; PSQI) and fatigue (Multidimensional Fatigue Inventory; MFI). Secondary outcomes were effects on depression (Hamilton Rating Scale; HRSD-minus sleep item), anxiety (HRSA-minus sleep item), and gastrointestinal symptoms (GIs). Methods: Over 18 mo, we screened all CD subjects aged 15-30 using PSQI and MFI in GI clinic. Those scoring > 6 on PSQI AND > 44 on MFI completed further assessment (T0). The BBTS-I consisted of 2-4 sessions of behavioral strategies (phase 1) followed by 0-5 maintenance sessions alone or with BUPSR (200-300mg) added if MFI > 44 at T1. Both groups were evaluated postphase 2(T3). C-reactive protein (CRP) was measured. Paired t-test was used to evaluate pre-post differences in phase 1 and mixed between-within ANOVA for phase 2. Results: Over 18 mo., 232 CD subjects were approached; 112 screened positive; 68 completed assessment and were offered BBTS-I. At T0, subjects were predominantly white, mean age 24 years, 6 percent female; 51 percent with elevated CRP, and 28 percent with GIs and low CRP. At T0: Mean PSQI 11 (SD 3); Mean MFI 64 (SD 13). 89.8 percent of participants completed BBTS-I. At T1 (n¼54), there was a decrease in PSQI (D4.9; p<.0001) and MFI (D11.5; p<.001) and also sig. improvements in HRSD, HRSA, and GIs, but not CRP. At T1, 44 subjects qualified for BUP. At T3 (n¼53), there were n¼30 in BBTS-I + BUP and n¼23 in BBTS-I group. There was a sig. (p<.001) change over time in PSQI (ES¼.63); MFI (ES¼.65), HRSD (ES¼.51) and HRSA (ES¼.41) with a significant group effect (BBTS-I >BBTS-I + BUP) for PSQI and MFI and (BBTS-I + BUP > BBTS-I) for HRSD. At T3, 48 percent of total subjects had low PSQI and MFI and 21 percent had high PSQI and MFI. Conclusions: BBTS-I is feasible and has promising effects in improving sleep, fatigue, mood and GI symptoms in IBD. Depression but not sleep or fatigue improved significantly more when BUP was added. Randomized controlled trials are needed to further develop treatment algorithms for neurobiological aspects of physical illness.
PYI P SLP Supported by the Crohns and Colitis Foundation of America http://dx.doi.org/10.1016/j.jaac.2016.09.340
6.21 LEARN THEN APPLY: INCREASED IMPACT OF FORMAL EDUCATION WITH CONSULTATION SUPPORT ON PRIMARY CARE PHYSICIAN KNOWLEDGE, SKILLS, AND CONFIDENCE IN CHILD MENTAL HEALTH CARE David L. Kaye, MD, Psychiatry, State University of New York at Buffalo, Erie County Medical Center, 462 Grider St. Dept of Psychiatry, Buffalo, NY 14215; Victor Fornari, MD; Michael A. Scharf, MD; Wanda Fremont, MD; Rachel Zuckerbrot, MD; Carmel Foley, MD; Teresa M. Hargrave, MD; Beth A. Smith, MD; James Wallace, MD; Jennifer N. Petras, MD; Sourav Sengupta, MD, MPH; Jennifer Singarayer, MD; Alex Cogswell, PhD; Ira Bhatia, MS; Peter S. Jensen, MD Objectives: Several large-scale child psychiatric collaborative care programs have been developed across the U.S in the past 10 years. Few studies have investigated the impact of these programs. This study provides data on the impact of CAP PC on PCP self-report of comfort and competence in assessing and managing mental health problems. Methods: CAP PC is a New York State Office of Mental Health funded child psychiatric access program that provides service to 90% of New York State. The program is a collaboration between 5 university-based child psychiatry divisions and opened on October 1, 2010. CAP PC consists of 3 broad efforts: formal education, linkage/referral assistance, and consultation support for primary care physicians. The flagship educational program is the REACH Institute-developed Mini-Fellowship in Child and Adolescent Mental Health, a 28 hour CME program. The consultation component utilizes a single toll-free phone line and maintains a website at www.cappcny.org. This study provides data from the annual survey results of PCPs participating in the program.
J OURNAL
OF THE
AMERICAN ACADEMY OF CHILD & ADOLESCENT P SYCHIATRY VOLUME 55 NUMBER 10S OCTOBER 2016
Conclusions: Even though cognitive functions were found to be significantly lower in the CH group than the healthy group, learning and attention problems were found more often than intellectual disability. In addition, there were more externalizing problems than internalizing problems.
COG CON PSP http://dx.doi.org/10.1016/j.jaac.2016.09.338
6.19 PRADER-WILLI SYNDROME PSYCHOBEHAVIORAL PROFILE IN A CLINIC-BASED SAMPLE Dalia Hegazy Ali, MD, Psychiatry and Psychology, Sultan Bin Abdulaziz Humanitarian City, riyadh, banban, ring road north, Riyadh 64399, Saudi Arabia Objectives: Maladaptive behaviors and cognitive impairment can be considered to be main problems in patients with Prader–Willi Syndrome. Understanding difficulties underlying maladaptive behavior through early diagnosis and management allows tremendous improvement in the whole clinical picture. This study reports on the psychobehavioral deviations in a clinic-based sample group of Egyptian children with Prader–Willi syndrome (PWS) in relation to their genotype. Methods: We included 15 of 72 patients of both sexes, aged from 5–15 years, from the National Research Centre from 2009 to 2011. All patients were fulfilling the diagnostic threshold of modified list of Prader–Willi criteria. Detailed cytogenetic analysis was done using conventional cytogenetic analysis of peripheral blood lymphocytes and fluorescent in situ hybridization. Cognitive and psychological profile of patients were assessed using the following: 1) standard and semistructured psychiatric sheet and interview; 2) Wechsler Intelligence Scale for Children; 3) Child Behavior Checklist for youth ages 4–18 years; 4) Conner’s Parent Rating Scale-Revised, long version; and 5) Childhood Autism Rating Scale. Results: Patients (66.7 percent) were deletion positive, and 33.3 percent were negative. One hundred percent of the sample group were mentally subnormal. 26.3 percent had autistic symptoms, all were deletion negative, with P ¼ 0.004. High prevalence of inattention and hyperactivity, anxiety, social, cognitive, and behavioral problems were evident in the patients, manifested in more frequency and severity in nondeletion patients, with P values of 0.025, 0.04, 0.01, and 0.004, respectively. Conclusions: Cognitive and psychological challenges are a fixed part of the profiles of PWS patients. Some differences have been found within our study group genotypes, such as the higher prevalence of autistic features, hyperactivity, anxiety social, and behavioral problems within the nondeletion group, but nevertheless, they all complained from cognitive impairment and many behavioral difficulties. It is noteworthy that there were no statistically significant differences in either the clinical diagnostic criteria or in the IQ of the patients in the two genotypes. These results should be seen in the light our limitations and future recommendations for further studies.
CON ND OBE http://dx.doi.org/10.1016/j.jaac.2016.09.339
6.20 BRIEF BEHAVIORAL THERAPY AND BUPROPION FOR SLEEP AND FATIGUE IN ADOLESCENTS AND YOUNG ADULTS WITH INFLAMMATORY BOWEL DISEASE Eva Szigethy, MD, PhD, Psychiatry, Pediatrics and Medicine, University of Pittsburgh, Visceral Inflammation and Pain Center, 3708 Fifth Ave, Pittsburgh, PA 15222; Katheryn Mcauliff, BA; Meredith Strassburger, MA; Jana Hashash; Ashley Vachon, MD; Noelle M. Rode, BS; David J. Keljo, MD, PhD; Ada O. Youk, PhD; Miguel Regueiro, MD; David Binion, MD; Frank Lotrich, MD; Anne Germain, PhD; Martica Hall, PhD Objectives: Sleep disturbance and fatigue are common in Crohn’s disease (CD) with few effective treatment options. This study presents the first 2-phase open trial for insomnia and fatigue in young adults with CD: Phase 1) Brief
S210
www.jaacap.org
behavior therapy for sleep in IBD (BBTS-I) over 4 weeks followed by Phase 2) maintenance BBTS-I alone or with bupropion (BUP) added over 8 weeks. Primary outcomes were improvement in sleep (Pittsburgh Sleep Quality Index; PSQI) and fatigue (Multidimensional Fatigue Inventory; MFI). Secondary outcomes were effects on depression (Hamilton Rating Scale; HRSD-minus sleep item), anxiety (HRSA-minus sleep item), and gastrointestinal symptoms (GIs). Methods: Over 18 mo, we screened all CD subjects aged 15-30 using PSQI and MFI in GI clinic. Those scoring > 6 on PSQI AND > 44 on MFI completed further assessment (T0). The BBTS-I consisted of 2-4 sessions of behavioral strategies (phase 1) followed by 0-5 maintenance sessions alone or with BUPSR (200-300mg) added if MFI > 44 at T1. Both groups were evaluated postphase 2(T3). C-reactive protein (CRP) was measured. Paired t-test was used to evaluate pre-post differences in phase 1 and mixed between-within ANOVA for phase 2. Results: Over 18 mo., 232 CD subjects were approached; 112 screened positive; 68 completed assessment and were offered BBTS-I. At T0, subjects were predominantly white, mean age 24 years, 6 percent female; 51 percent with elevated CRP, and 28 percent with GIs and low CRP. At T0: Mean PSQI 11 (SD 3); Mean MFI 64 (SD 13). 89.8 percent of participants completed BBTS-I. At T1 (n¼54), there was a decrease in PSQI (D4.9; p<.0001) and MFI (D11.5; p<.001) and also sig. improvements in HRSD, HRSA, and GIs, but not CRP. At T1, 44 subjects qualified for BUP. At T3 (n¼53), there were n¼30 in BBTS-I + BUP and n¼23 in BBTS-I group. There was a sig. (p<.001) change over time in PSQI (ES¼.63); MFI (ES¼.65), HRSD (ES¼.51) and HRSA (ES¼.41) with a significant group effect (BBTS-I >BBTS-I + BUP) for PSQI and MFI and (BBTS-I + BUP > BBTS-I) for HRSD. At T3, 48 percent of total subjects had low PSQI and MFI and 21 percent had high PSQI and MFI. Conclusions: BBTS-I is feasible and has promising effects in improving sleep, fatigue, mood and GI symptoms in IBD. Depression but not sleep or fatigue improved significantly more when BUP was added. Randomized controlled trials are needed to further develop treatment algorithms for neurobiological aspects of physical illness.
PYI P SLP Supported by the Crohns and Colitis Foundation of America http://dx.doi.org/10.1016/j.jaac.2016.09.340
6.21 LEARN THEN APPLY: INCREASED IMPACT OF FORMAL EDUCATION WITH CONSULTATION SUPPORT ON PRIMARY CARE PHYSICIAN KNOWLEDGE, SKILLS, AND CONFIDENCE IN CHILD MENTAL HEALTH CARE David L. Kaye, MD, Psychiatry, State University of New York at Buffalo, Erie County Medical Center, 462 Grider St. Dept of Psychiatry, Buffalo, NY 14215; Victor Fornari, MD; Michael A. Scharf, MD; Wanda Fremont, MD; Rachel Zuckerbrot, MD; Carmel Foley, MD; Teresa M. Hargrave, MD; Beth A. Smith, MD; James Wallace, MD; Jennifer N. Petras, MD; Sourav Sengupta, MD, MPH; Jennifer Singarayer, MD; Alex Cogswell, PhD; Ira Bhatia, MS; Peter S. Jensen, MD Objectives: Several large-scale child psychiatric collaborative care programs have been developed across the U.S in the past 10 years. Few studies have investigated the impact of these programs. This study provides data on the impact of CAP PC on PCP self-report of comfort and competence in assessing and managing mental health problems. Methods: CAP PC is a New York State Office of Mental Health funded child psychiatric access program that provides service to 90% of New York State. The program is a collaboration between 5 university-based child psychiatry divisions and opened on October 1, 2010. CAP PC consists of 3 broad efforts: formal education, linkage/referral assistance, and consultation support for primary care physicians. The flagship educational program is the REACH Institute-developed Mini-Fellowship in Child and Adolescent Mental Health, a 28 hour CME program. The consultation component utilizes a single toll-free phone line and maintains a website at www.cappcny.org. This study provides data from the annual survey results of PCPs participating in the program.
J OURNAL
OF THE
AMERICAN ACADEMY OF CHILD & ADOLESCENT P SYCHIATRY VOLUME 55 NUMBER 10S OCTOBER 2016