Measurement-based care training curriculum in psychiatry residency programs: I: Description of the curriculum and demonstration of implementation

Aboraya, Ahmed; Nasrallah, Henry A.; Elswick, Daniel; Rastgar, Yasha; Berry, James H.; Hill, Cheryl D.; Justice, John; Wang, Zheng; Pearson, Nathan; Gallucci, Gerard; Figgs, Patricia; Hustead, Jeremy D.; Vogt, Joel; Zafar, Jawad; Dohar, Sheena; Looper, Robert; Guinan, Danielle; Elawady, Akram; Shah, Omar Javed; Lam, Mei Wai; Shagufta, Shanila; Schwartzman, Noah; Hamric, Eddie; Mayle, Lauren; Miller, Mark D.; Chandran, Dilip; Marshalek, Patrick; Moreland, Rachel A.; Tamang, Tenchee Lama; Mattancheril, Sunny; Berzingi, Sara

doi:10.12788/acp.0039

Cited by 14 publications

(19 citation statements)

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“…The scope of this observational study was to measure belief-updating mechanisms in a rare cohort of patients with TRD who were tested in their usual measurement-based care setting before and after receiving needed ketamine treatment . The results showed, in line with previous studies, that ketamine induced a rapid and sustained decrease in depressive symptoms.…”

Section: Discussionsupporting

confidence: 74%

“…Here, we asked (1) whether and through what computational mechanisms ketamine restores optimism biases in belief updating and (2) how such potential cognitive effects link to antidepressant effects. We tested these hypotheses by following a measurement-based care approach, which consisted of objectifying the clinical assessments and outcomes of patients undergoing ketamine treatment . We combined this approach with an observational assessment of clinical improvement and belief-updating behavior and then mathematically formalized observed effects by using a computational model inspired by reinforcement learning (RL) principles and mediation analysis.…”

Section: Introductionmentioning

confidence: 99%

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Evaluation of Early Ketamine Effects on Belief-Updating Biases in Patients With Treatment-Resistant Depression

et al. 2022

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ImportanceClinical research has shown that persistent negative beliefs maintain depression and that subanesthetic ketamine infusions induce rapid antidepressant responses.ObjectiveTo evaluate whether ketamine alters belief updating and how such cognitive effects are associated with the clinical effects of ketamine.Design, Setting, and ParticipantsThis study used an observational case-control protocol with a mixed-effects design that nested 2 groups by 2 testing time points. Observers were not blinded. Patients with treatment-resistant depression (TRD) and healthy volunteer participants aged 34 to 68 years were included. Patients with TRD were diagnosed with major depressive disorder or bipolar depression, had a Montgomery-Åsberg Depression Rating Scale score greater than 20, a Maudsley Staging Method score greater than 7, and failed to respond to at least 2 prior antidepressant trials. Exclusion criteria were any other psychiatric, neurological, or neurosurgical comorbidities, substance use or addictive disorders, and recreational ketamine consumption. Data were collected from January to February 2019 and from May to December 2019, and data were analyzed from January 2020 to July 2021.ExposuresPatients with TRD were observed 24 hours before single ketamine infusion, 4 hours after the infusion, and 4 hours after the third infusion, which was 1 week after the first infusion. Healthy control participants were observed twice 1 week apart without ketamine exposure.Main Outcomes and MeasuresMontgomery-Åsberg Depression Rating Scale score and belief updating after belief updating when patients received good news and bad news measured by a cognitive belief-updating task and mathematically formalized by a computational reinforcement learning model.ResultsOf 56 included participants, 29 (52%) were male, and the mean (SEM) age was 52.3 (1.2) years. A total of 26 patients with TRD and 30 control participants were included. A significant group × testing time point × news valence interaction showed that patients with TRD updated their beliefs more after good than bad news following a single ketamine infusion (controlled for age and education: β = −0.91; 95% CI, −1.58 to −0.24; t216 = −2.67; P = .008) than controls. Computational modeling showed that this effect was associated with asymmetrical learning rates (LRs) after ketamine treatment (good news LRs after ketamine, 0.51 [SEM, 0.04]; bad news LRs after ketamine 0.36 [SEM, 0.03], t25 = 3.8; P &lt; .001) and partially mediated early antidepressant responses (path a*b: β = −1.00 [SEM, 0.66]; t26 = −1.53; z = −1.98; P = .04).Conclusions and RelevanceThese findings provide novel insights into the cognitive mechanisms of the action of ketamine in patients with TRD, with promising perspectives for augmented psychotherapy for individuals with mood disorders.

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Section: Discussionsupporting

confidence: 74%

Section: Introductionmentioning

confidence: 99%

Evaluation of Early Ketamine Effects on Belief-Updating Biases in Patients With Treatment-Resistant Depression

et al. 2022

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“…To capture more accurate reports of clinical symptoms, there have been significant efforts to institute measurement-based care (MBC) practices in behavioral health settings, with standardized clinical symptom assessments used to inform treatment decisions (e.g., Lewis et al, 2019). MBC has demonstrated improvement in clinical costs and outcomes, leading to large implementation efforts to expand MBC by psychologists (e.g., Wright et al, 2020), psychiatrists (e.g., Aboraya et al, 2018), and health care systems like the Veterans Health Administration (e.g., Resnick & Hoff, 2020).…”

mentioning

confidence: 99%

Peak-end bias in retrospective recall of depressive symptoms on the PHQ-9.

Horwitz¹,

Zhuo²,

Sen³

2023

Psychological Assessment

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Mental health care is built around patient recall and report of clinical symptoms. However, memories of events and experiences rely on cognitive heuristics that influence our recall. The peak-end bias, which refers to the tendency for the most intense and proximate aspects of an experience to disproportionately influence our memory, has been understudied in the context of mental health symptoms and may unduly influence self-reported symptoms, even in the context of standardized assessments. To determine whether the peak-end bias applies to the report of depressive symptoms on the standardized Patient Health Questionnaire–9 (PHQ-9) assessment, we compared two scores from daily mood assessments collected over a 2-week period from 4,322 medical interns (56% women; 60% non-Hispanic White). The peak-end-mood score, which averaged the single lowest and most recent mood scores over 2 weeks had a significantly stronger correlation with the PHQ-9 than the mean-mood score, which averaged all mood scores during the 2 weeks. Likelihood ratio tests and fit statistics provided further support that the peak-end-mood score was a significantly better predictor of depression than the mean-mood score. Results were consistent when limiting the sample to those with mild-to-severe depressive symptoms, and when only examining the two primary mood items as the dependent variable. These findings provide evidence for a modest peak-end recall bias for mood and depressive symptoms. There may be benefits to implementing intermittent assessment strategies to support clinical decision-making.

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“…Another suggestion for future research is evaluating the BASE-6’s appropriateness and psychometric properties within the adolescent population. Although there are various self-report measures that are well validated for youth, such as the Child Behavior Checklist (CBCL; Achenbach, 1991) and Symptom Checklist–90–Revised (SCL-90-R; Derogatis, 1977, 1994) or parent-reported measures such as Pediatric Symptom Checklist (PSC; Gardner et al, 1999), there could be still barriers to implement those measures into MBC considering their length (15+ items) and cost (Aboraya et al, 2018). Considering the limited implementation and research of MBC for youths compared with research with adults (Bickman et al, 2011), investigating and validating appropriate outcome measurement that encompasses overall psychological distress and adjustment is recommended.…”

Section: Discussionmentioning

confidence: 99%

Brief Adjustment Scale–6 for Measurement-Based Care: Psychometric Properties, Measurement Invariance, and Clinical Utility

Shin

Cooper

2022

Assessment

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The Brief Adjustment Scale–6 (BASE-6) was recently developed for measuring general psychological functioning within measurement-based care (MBC). The present study further evaluated psychometric properties, generalizability to race/ethnic populations, and clinical utility of the BASE-6. Three adult samples, Sample 1: online community participants ( n = 394); Sample 2: college students ( n = 249); Sample 3: outpatient clinic clients ( n = 80), were included. The results demonstrated a high level of internal consistency, good test–retest reliability, and convergent validity in all samples. The unidimensional structure of BASE-6 was confirmed and factorial invariance was established across groups. Finally, the BASE-6 captured change over time by demonstrating a large effect size of pre–post treatment changes and significant linear change in multilevel growth modeling. These results support the BASE-6 as a reliable and valid measure regardless of race/ethnicity and can sensitively detect clinical change over the course of the treatment. Thus, the BASE-6 appears to accurately monitor overall psychological adjustment.

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Measurement-based care training curriculum in psychiatry residency programs: I: Description of the curriculum and demonstration of implementation

Cited by 14 publications

References 0 publications

Evaluation of Early Ketamine Effects on Belief-Updating Biases in Patients With Treatment-Resistant Depression

Evaluation of Early Ketamine Effects on Belief-Updating Biases in Patients With Treatment-Resistant Depression

Peak-end bias in retrospective recall of depressive symptoms on the PHQ-9.

Brief Adjustment Scale–6 for Measurement-Based Care: Psychometric Properties, Measurement Invariance, and Clinical Utility

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