Objective Few studies targeting obesity in serious mental illness report clinically significant risk reduction, and none have been replicated within community settings or have demonstrated sustained outcomes after intervention withdrawal. This pragmatic clinical trial aims to replicate positive health outcomes demonstrated in a prior randomized effectiveness study of the In SHAPE program across urban community mental health organizations serving an ethnically diverse population. Methods Persons with serious mental illness and BMI>25 receiving services in three community mental health organizations were randomized to the 12-month In SHAPE program (health promotion coach and membership to a public fitness club) or to fitness club membership alone. Primary outcomes were weight and cardiorespiratory fitness (measured with the 6-Minute Walk Test) collected at baseline, 3-, 6-, 9-, 12-, and 18-months. Results Participants (N=210) were ethnically diverse (46% non-White) with mean baseline BMI=36.8±8.2. At 12-months In SHAPE (n=104) compared to a fitness club membership alone (n=106) contributed to greater reduction in weight and improved fitness. Primary outcomes were maintained at 18-months follow-up. Approximately half of In SHAPE participants (51% at 12-month program completion and 46% at 18-month follow-up) achieved clinically significant cardiovascular risk reduction (≥5% weight loss or >50 meter increase on the 6-Minute Walk Test). Conclusions Sustained weight loss and improved fitness can be achieved by community mental health organizations providing health promotion coaching and access to fitness facilities. Health promotion should be integrated into mental health services for persons with serious mental illness at risk for cardiovascular disease and early mortality.

Objectives This report describes one, two, and three-year outcomes of a combined psychosocial skills training and preventive health care intervention (Helping Older People Experience Success – HOPES) for older persons with serious mental illness. Design A randomized controlled trial compared HOPES to treatment as usual (TAU) for n=183 older adults (age≥50) with serious mental illness (mean age=60.2; 28% schizophrenia, 28% schizoaffective disorder, 20% bipolar disorder, 24% major depression). Setting Two community mental health centers in Boston, MA and one in Nashua, NH. Intervention Twelve months of weekly skills training classes, twice-monthly community practice trips, and monthly nurse preventive health care visits, followed by a 1-year maintenance phase of monthly sessions. Measurements Blinded evaluations of functioning, symptoms, and service use were conducted at baseline, one-year (end of the intensive phase), two-year (end of the maintenance phase), and three-year (12 months after the intervention) follow-up. Results HOPES compared to TAU was associated with improved community living skills and functioning, greater self-efficacy, lower overall psychiatric and negative symptoms, greater acquisition of preventive health care (more frequent eye exams, visual acuity, hearing tests, mammograms, and PAP smears) and nearly twice the rate of completed advance directives. No differences were found for medical severity, number of medical conditions, subjective health status, or acute service use at 3-year follow-up. Conclusions Skills training and nurse facilitated preventive health care for older adults with serious mental illness was associated with sustained long-term improvement in functioning, symptoms, self-efficacy, preventive health care screening, and advance care planning.

As the potential of smartphone apps and sensors for healthcare and clinical research continues to expand, there is a concomitant need for open, accessible, and scalable digital tools. While many current app platforms offer useful solutions for either clinicians or patients, fewer seek to serve both and support the therapeutic relationship between them. Thus, we aimed to create a novel smartphone platform at the intersection of patient demands for trust, control, and community and clinician demands for transparent, data driven, and translational tools. The resulting LAMP platform has evolved through numerous iterations and with much feedback from patients, designers, sociologists, advocates, clinicians, researchers, app developers, and philanthropists. As an open and free tool, the LAMP platform continues to evolve as reflected in its current diverse use cases across research and clinical care in psychiatry, neurology, anesthesia, and psychology. In this paper, we explore the motivation, features, current progress, and next steps to pair the platform for use in a new digital psychiatry clinic, to advance digital interventions for youth mental health, and to bridge gaps in available mental health care for underserved patient groups. The code for the LAMP platform is freely shared with this paper to encourage others to adapt and improve on our team's efforts.

People with serious mental illness are at disproportionate risk of COVID-19 morbidity and mortality because of high rates of risk factors that directly parallel those related to poor coronavirus outcomes, including smoking, chronic obstructive pulmonary disease, cardiovascular disease, and diabetes, along with housing instability, homelessness, food insecurity, and poverty. Community-based behavioral health organizations are also at risk of adverse outcomes because of dramatic declines in revenues and a diminished workforce.The State of Massachusetts has responded to this crisis by rapidly implementing a variety of policy, regulatory, and payment reforms. This column describes some of these reforms, which are designed to enhance remote telehealth delivery of care, ensure access to needed medications and residential care staff, and support the financial livelihood of communitybased behavioral health services.

The present study is the first to attempt to determine rates of panic attacks, especially 'somatically focused' panic attacks, panic disorder, symptoms of post-traumatic stress disorder (PTSD), and depression levels in a population of Rwandans traumatized by the 1994 genocide. The following measures were utilized: the Rwandan Panic-Disorder Survey (RPDS); the Beck Depression Inventory (BDI); the Harvard Trauma Questionnaire (HTQ); and the PTSD Checklist (PCL). Forty of 100 Rwandan widows suffered somatically focused panic attacks during the previous 4 weeks. Thirtyfive (87%) of those having panic attacks suffered panic disorder, making the rate of panic disorder for the entire sample 35%. Rwandan widows with panic attacks had greater psychopathology on all measures. Somatically focused panic-attack subtypes seem to constitute a key response to trauma in the Rwandan population. Future studies of traumatized non-Western populations should carefully assess not only somatoform disorder but also somatically focused panic attacks.

This study was a preliminary evaluation of biofeedback training of human subjects to control high-frequency EEG responses in the 35- to 45-Hz (40-Hz) and 21- to 31-Hz ranges. A total of 22 adult males divided into three groups were successfully trained for increases or suppression of 40-Hz EEG, or increases of 21- to 31-Hz EEG. Dissociation of rates of 40-Hz EEG recorded from scalp leads and 40-Hz EMG responses from prominent muscle contaminators, and partial dissociation of 40-Hz and 21- to 31-Hz EEG responses were noted. After biofeedback training, 8 subjects demonstrated increase and suppression of 40-Hz EEG without feedback. No consistent descriptors of subjective experiences accompanying EEG changes were reported by subjects in any of the groups. The study suggests the utility of biofeedback procedures in research on high-frequency EEG activity.

Thirty-five patients with 37 peripheral nerve sheath tumors (NST) (16 schwannomas, 11 neurofibromas, 5 plexiform and 1 diffuse neurofibroma, and 4 malignant NST) were studied respectively. The benign NST usually appeared on CT as well-defined oval, spherical or fusiform masses, centered at the expected anatomic location of a cranial, spinal, autonomic or peripheral nerve with characteristic displacement of adjacent muscles and blood vessels. None of the schwannomas appeared homogeneously hypodense on IV enhanced CT, whereas close to half of neurofibromas and plexiform neurofibromas were so. This fact, which had not been reported in the past, may be related to differences in inherent vascularity and blood-nerve barrier (fenestrated blood vessels) between schwannomas and neurofibromas and may be a useful distinguishing CT feature. The most reliable, though not infallible criterion of malignant NST was poor definition of their margins. Ninety-two per cent of NST (34 out of 37) were diagnosed or included in a limited differential pre-operatively.

Scientific and public interest in the effects of diet of behavior disorders has recently increased. This paper argues that (1) the experimental analysis of behavior offers an effective scientific methodology for assessing the effects of dietary substances on behavior problems, and that (2) such analysis permits behavioral consequences to be considered as an alternative treatment to dietary control. A case study of a 9-year-old retarded boy with autistic behaviors is presented. Suspected dietary substances were demonstrated to be effective influences on the child's behavior, whereas a simple behavior modification program improved his problem behaviors. Also discussed are issues and problems which arise in research on dietary effects on behavior and in selection of effective and ethical treatments.