New Technologies for Improving Behavioral Health
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Telepsychiatry at the University of Virginia
An Overview of Telepsychiatry and the Experience at the University of Virginia August 2016 Anita Clayton, MD Chair Larry Merkel, MD, PhD; Department of Psychiatry What Do We Know About Telepsychiatry?* • It is given high marks for satisfaction by patients and rural practitioners, but less so by mental health professionals • It is as reliable as in-person as to clinical evaluation, diagnosis, and use of rating scales. • It is at least as effective as in-person treatment for depression and serious mental illness. • It may provide a higher level of care than in-person encounters. *References in accompanying manuscript UVA Telemedicine Partner Network University of Virginia Telemedicine Partner Sites Telehealth Education Sites Phases of Development • Phase I: 1998-2002 Individual Psychiatrists • Phase II: 2003-2007 Regularly Scheduled Service (2006 C&F Service begins) • Phase III: 2008-2011 PGY IV Elective • Phase IV: 2012-2016 Integrated into PGY III Training and use of APNPs, expansion to EDs Consultation Care Model • The local clinic identifies the cases • The patient is seen by us in consultation • We make recommendations • It is up to the local clinicians to act on these recommendations • They may contact us if there are problems or non-response • We may or may not see the patient again in follow-up as determined by the local clinician • Ad Hoc education and coordination Collaborative Care Model • A local clinician is identified as the contact person and oversees the mental health care (Behavioral Health Consultant) • They act as a bridge -
Eating Disorders Toolkit
NSW Eating Disorders Toolkit A PRACTICE-BASED GUIDE TO THE INPATIENT MANAGEMENT OF CHILDREN AND ADOLESCENTS WITH EATING DISORDERS NSW Ministry of Health 73 Miller Street NORTH SYDNEY NSW 2060 Tel. (02) 9391 9000 Fax. (02) 9391 9101 TTY. (02) 9391 9900 www.health.nsw.gov.au Produced by: NSW Ministry of Health This work is copyright. It may be reproduced in whole or in part for clinical use, study or training purposes subject to the inclusion of an acknowledgement of the source. It may not be reproduced for commercial usage or sale. Reproduction for purposes other than those indicated above requires written permission from the NSW Ministry of Health. © NSW Ministry of Health 2018 SHPN (MH) 170582 ISBN is 978-1-76000-743-0 Further copies of this document can be downloaded from the NSW Health webpage www.health.nsw.gov.au February 2018 ii NSW Health NSW Eating Disorders Toolkit Acknowledgements The Toolkit is a revision of the original Toolkit MH-CYP and CEDD would like to thank the whose development was facilitated by the former expert panel who assisted with the revision MH-Kids (now MH-Children and Young People) of this document: in conjunction with a variety of clinicians and academics throughout NSW, nationally and • Ms Danielle Maloney internationally. • Dr Sloane Madden • Ms Joanne Titterton This revision was facilitated by MH-Children and Young People (MH-CYP), of the Mental Health • Ms Mel Hart Branch, NSW Health and the Centre for Eating • Dr Julie Adamson and Dieting Disorders (CEDD), The Boden • Dr Michael Kohn Institute of Obesity, Nutrition, Exercise and Eating • Dr Rod McClymont Disorders, Sydney University. -
The COVID-19 Pandemic and Eating Disorders in Children, Adolescents
University of Calgary PRISM: University of Calgary's Digital Repository Libraries & Cultural Resources Open Access Publications 2021-04-16 The COVID-19 pandemic and eating disorders in children, adolescents, and emerging adults: virtual care recommendations from the Canadian consensus panel during COVID-19 and beyond Couturier, Jennifer; Pellegrini, Danielle; Miller, Catherine; Bhatnagar, Neera; Boachie, Ahmed; Bourret, Kerry; Brouwers, Melissa; Coelho, Jennifer S; Dimitropoulos, Gina; Findlay, Sheri... Journal of Eating Disorders. 2021 Apr 16;9(1):46 http://hdl.handle.net/1880/113266 Journal Article Downloaded from PRISM: https://prism.ucalgary.ca Couturier et al. Journal of Eating Disorders (2021) 9:46 https://doi.org/10.1186/s40337-021-00394-9 GUIDELINE Open Access The COVID-19 pandemic and eating disorders in children, adolescents, and emerging adults: virtual care recommendations from the Canadian consensus panel during COVID-19 and beyond Jennifer Couturier1,2* , Danielle Pellegrini1, Catherine Miller3, Neera Bhatnagar1, Ahmed Boachie4, Kerry Bourret5, Melissa Brouwers6, Jennifer S. Coelho7, Gina Dimitropoulos8, Sheri Findlay1,2, Catherine Ford9, Josie Geller7, Seena Grewal4, Joanne Gusella10, Leanna Isserlin6, Monique Jericho8, Natasha Johnson1,2, Debra K. Katzman4, Melissa Kimber1, Adele Lafrance11, Anick Leclerc2, Rachel Loewen12, Techiya Loewen13, Gail McVey4, Mark Norris6, David Pilon10, Wendy Preskow14, Wendy Spettigue6, Cathleen Steinegger4, Elizabeth Waite15 and Cheryl Webb1,2 Abstract Objective: The COVID-19 pandemic has -
Telepsychiatry: Overcoming Barriers to Implementation
Telepsychiatry: Overcoming barriers to implementation Providing treatment via videoconferencing can improve access to care lthough many states have substantial health services in urban areas, these services—particularly men- Atal health care—are relatively scarce in rural areas.1 Telepsychiatry, in which clinicians provide mental health care from a distance in real time by using interactive, 2-way, audio-video communication (videoconferencing), could mitigate workforce shortages that affect remote and un- derserved areas.2 Psychiatry is one of the biggest users of telemedicine, which refers to any combination of communi- cation technology and medicine.3-5 This article discusses tele- psychiatry’s effectiveness in providing psychiatric diagnosis and treatment, and the clinical implications of this technol- ogy, including improving access, cost, and quality of mental © OCEAN/CORBIS health services. Sy Atezaz Saeed, MD Professor and Chair Richard M. Bloch, PhD Outcomes comparable to face-to-face care Professor and Director of Research Telepsychiatry is used primarily in rural areas or correc- John M. Diamond, MD tional institutions or with underserved populations such Professor and Director as veterans with posttraumatic stress disorder or children. Division of Child and Adolescent Psychiatry Although the literature generally is weak, there has been • • • • more research on psychiatry than other medical special- Department of Psychiatric Medicine ties because psychiatric clinicians rely on mental status Brody School of Medicine examinations and verbal communications, not physical East Carolina University Greenville, NC exams. Telepsychiatry can be considered a part of an evolv- ing “connected health” system that offers many benefits to patients and clinicians (see the Table at CurrentPsychiatry. com). -
APA Provides Testimony for House
Testimony of the American Psychiatric Association On April 28, 2021 Submitted for the record to the U.S. House of Representatives Ways and Means Committee In reference to the HELP SUBCOMMITTEE HEARING: Charting the Path Forward for Telehealth Chairman Doggett, Ranking Member Nunes, and distinguished members of the Health Subcommittee of the House Ways and Means Committee, thank you for the opportunity to submit testimony for the record on behalf of the over 37,400 psychiatrists of the American Psychiatric Association (APA) for your April 28, 2021 hearing entitled “Charting the Path Forward on Telehealth.” The APA is dedicated to providing our physician members with education and training on the most modern evidence-based treatments to diagnose and treat patients with mental illness and substance use disorders (SUD). The APA and our members are focused on ensuring humane care and effective treatment for all persons with mental illness and SUD and are actively engaged in pursuing policies that affect our patients’ access to quality care. In our statement, we want to highlight data and policies related to the access of mental health and SUD care via telepsychiatry. During the COVID-19 pandemic, swift actions by Congress and the Administration have allowed many of our psychiatrists to transition from seeing most patients in person to delivering much of their psychiatric care via telepsychiatry. We have both Congress and the current and previous Administrations to thank for the lifting of geographic and site of service restrictions, including allowing patients to be seen in their homes, and allowing the use of clinically appropriate audio-only for telehealth when a patient lacks the technology, ability or the bandwidth for video. -
Neuroregulation
NeuroRegulation Proceedings of the 2014 ISNR Conference Selected Abstracts of Conference Presentations at the 2014 International Society for Neurofeedback and Research (ISNR) 22nd Conference, Bayside San Diego, California, USA Copyright: © 2014. ISNR. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (CC-BY). KEYNOTE PRESENTATIONS Harnessing Brain Plasticity: The Future of Neurotherapeutics Adam Gazzaley, MD, PhD Neuroscience Imaging Center and Neuroscape Lab Principal Investigator, Gazzaley Lab, University of California, San Francisco, California, USA A fundamental challenge of modern society is the development of effective approaches to enhance brain function and cognition in both healthy and impaired individuals. For the healthy, this serves as a core mission of our educational system and for the cognitively impaired this is a critical goal of our medical system. Unfortunately, there are serious and growing concerns about the ability of either system to meet this challenge. I will describe an approach developed in our lab that uses custom-designed video games to achieve meaningful and sustainable cognitive enhancement (e.g., Anguera et al., 2013), as well the next stage of our research program, which uses video games integrated with technological innovations in software (e.g., brain computer interface algorithms, Neurofeedback, GPU computing) and hardware (e.g., virtual reality headsets, mobile EEG, transcranial electrical brain stimulation) to create a novel personalized closed-loop system. I will share with you a vision of the future in which video games serve as an underlying engine to enhance our brain’s information processing systems, thus reducing our reliance on non-specific drugs to treat neurological and psychiatric conditions and allowing us to better target our educational efforts. -
Perceptual-Cognitive Training Improves Biological Motion Perception: Evidence for Transferability of Training in Healthy Aging Isabelle Legault and Jocelyn Faubert
Cognitive neuroscience and neuropsychology 1 Perceptual-cognitive training improves biological motion perception: evidence for transferability of training in healthy aging Isabelle Legault and Jocelyn Faubert In our everyday life, processing complex dynamic scenes virtual space. We also had a control group trained on a such as crowds and traffic is of critical importance. Further, visual task and a third group without training. it is well documented that there is an age-related decline in The perceptual-cognitive training eliminated the difference complex perceptual-cognitive processing, which can be in BM perception between 4 and 16 m after only a few reversed with training. It has been suggested that a weeks, whereas the two control groups showed no specific dynamic scene perceptual-cognitive training transfer. This demonstrates that 3D-MOT training could be procedure [the three-dimensional multiple object tracking a good generic process for helping certain observers deal speed task (3D-MOT)] helps observers manage socially with socially relevant dynamic scenes. NeuroReport relevant stimuli such as human body movements as seen 00:000–000 c 2012 Wolters Kluwer Health | Lippincott in crowds or during sports activities. Here, we test this Williams & Wilkins. assertion by assessing whether training older observers on NeuroReport 2012, 00:000–000 3D-MOT can improve biological motion (BM) perception. Research has shown that healthy older adults require more Keywords: aging, biological motion, perceptual-cognitive training, three-dimensional multiple object tracking speed task, transferability distance in virtual space between themselves and a point- light walker to integrate BM information than younger Visual Psychophysics Perception Laboratory, School of Optometry, University of Montre´al, Montreal, Quebec, Canada adults. -
Pediatric Telepsychiatry Curriculum for Graduate Medical Education
Pediatric Telepsychiatry Curriculum Graduate Medical Education (GME) and Continuing Medical Education (CME) May 2020 AUTHORS Sandra M. DeJong, MD, MSc Cambridge Health Alliance/Harvard Medical School 1493 Cambridge Street, Cambridge MA 02139 [email protected] Members of the American Academy of Child and Adolescent Psychiatry (AACAP) Telepsychiatry Committee: Dan Alicata, MD Debbie Brooks, MD Shabana Khan, MD – Co -Chair Kathleen Myers, MD David Pruitt, MD – Co-Chair Ujjwal Ramtekkar, MD David Roth, MD Lan Chi ”Krysti” Vo, MD Additional Contributors: Bianca Busch, MD 2 TABLE OF CONTENTS Section Topic Page 2 Table of Contents…………………………………………. 3 3 Introduction………………………………………………… 4 4 Curriculum Overview……………………………….…….. 8 5 Goals and Objectives……………………………….……. 10 6 Curriculum Outline…………………………………..……. 16 7 Curriculum Guide…………………………………………. 23 8 Evaluation Tools…………………………………………… 33 9 Evaluation and Dissemination of Curriculum……… 69 10 Acknowledgements………………………………………. 70 11 References…………………………………………………. 71 12 Appendix………………………………………………… 75 3 Section 3 INTRODUCTION This curriculum was developed using Kern’s 6-stage model of curriculum development. KERN’S 6-STAGE MODEL OF CURRICULUM DEVELOPMENT 1. Identification of the core need/problem and general needs assessment 2. Targeted needs assessment 3. Development of broad goals and measurable specific objectives 4. Development of educational content and method 5. Implementation 6. Evaluation and feedback at the level of the individual learner and the program Thomas, et al. 2016 PROBLEM IDENTIFICATION AND NEEDS ASSESSMENT The United States currently faces a dire shortage of child/adolescent psychiatrists (CAPs). While the estimated need is 30,000, only 8,000 CAPs are in practice nationally, and their mean age is 53 years. Most counties in the United States (US) have no CAPs, and the average wait time to see a CAP is 7.5 weeks (AACAP 2018). -
Combining 3D-MOT with Motor and Perceptual Decision- Making Tasks: Conception of a Life-Sized Virtual Perceptual- Cognitive Training Paradigm
bioRxiv preprint doi: https://doi.org/10.1101/511337; this version posted January 3, 2019. The copyright holder for this preprint (which was not certified by peer review) is the author/funder, who has granted bioRxiv a license to display the preprint in perpetuity. It is made available under aCC-BY-ND 4.0 International license. Combining 3D-MOT with motor and perceptual decision- making tasks: conception of a life-sized virtual perceptual- cognitive training paradigm Thomas Romeas*1,2,3,4, Romain Chaumillon2, David Labbé1,5, Jocelyn Faubert2,3 1Department of software and IT engineering, École de technologie supérieure (ÉTS), Montreal, Qc, Canada 2Faubert Lab, School of Optometry, Université de Montréal, Montreal, Qc, Canada 3Faubert Applied Research Center, Montreal, Qc, Canada 4Institut National du Sport du Québec (INS Québec), Montreal, Qc, Canada 5Laboratoire de recherche en imagerie et orthopédie (LIO), Centre de recherche du Centre hospitalier de l'Université de Montréal (CHUM), Montreal, Qc, Canada Correspondence and requests for materials should be addressed to: Thomas Romeas [email protected] bioRxiv preprint doi: https://doi.org/10.1101/511337; this version posted January 3, 2019. The copyright holder for this preprint (which was not certified by peer review) is the author/funder, who has granted bioRxiv a license to display the preprint in perpetuity. It is made available under aCC-BY-ND 4.0 International license. Combined perceptual-cognitive training Abstract: The present study introduces a virtual life-sized perceptual-cognitive paradigm combining three dimensional multiple object tracking (3D-MOT) with motor (Experiment 1) or perceptual (Experiment 2) decision-making tasks. -
The Use of Telepsychiatry in Reducing Hospitalizations And
Telepsychiatry In Rural Nursing Homes Andrew Rosenzweig MD, MPH Chief Medical Officer, Forefront TeleCare Assistant Clinical Professor, Brown University S Scope of Problem: Severe Unmet Need S Over 5,000 rural/HPSA SNFs S 75% of rural counties have no psychiatrist S According to CMS, one in five Medicare patients discharged from a hospital are readmitted within 30 days. S 2004 National Nursing Home Survey found that 40% of nursing home resident ED visits in the past 90 days were potentially preventable Scope of Problem (cont.) S Older adults account for 12-24% of all ER visits S ER personnel have limited geriatric training S 5% of elderly patients present to the ER for psychiatric reasons S Psychosis, agitation, depression, suicidality and substance abuse are the most common reasons for elderly ER visits, with dementia the most common diagnosis Definitions of Agitation and Aggression S Agitation: Inappropriate verbal, vocal, or motor activity not explained by apparent needs, confusion, medical condition, or social/environmental disturbance S Aggression: Hostile actions directed toward others, self, objects Can be verbal, physical, vocal, sexual Behaviors Reported in Agitation and Aggression S Agitation Physical: pacing, inappropriate robing/disrobing, trying to get to a different place, handling things inappropriately, restlessness, stereotypy Verbal: Complaining, requests for attention, negativism, repeated questions/phrases, screaming S Aggression Physical: hitting, kicking, pushing, scratching, tearing, biting, spitting Verbal: threats, accusations, name-calling, obscenities Delusions in Alzheimer’s Disease S Delusional thought content (eg, paranoia) is common (studies suggest 34% to 50% incidence) S My house is not my home S Common delusions S Strangers living in my home S Misidentification of people S Marital infidelity S People on TV are real S Patients, staff are trying to hurt me S Staff, family members are impersonators S People are stealing my things . -
Macular Hole: Perceptual Wlling-In Across Central Scotomas ଝ
Vision Research 46 (2006) 4064–4070 www.elsevier.com/locate/visres Macular hole: Perceptual Wlling-in across central scotomas ଝ Walter Wittich a,¤, Olga Overbury a,b, Michael A. Kapusta a, Donald H. Watanabe c, Jocelyn Faubert b a Department of Ophthalmology, Sir Mortimer B. Davis Jewish General Hospital, Lady Davis Institute for Medical Research, Pavilion E-008, 3755 Cote-Sainte-Catherine, Montreal, Que., Canada H3T 1E2 b School of Optometry, University of Montreal, Canada c Concordia University, Department of Psychology, Montreal, Canada Received 17 May 2006; received in revised form 4 July 2006 Abstract The present study examined perceptual distortions of a vertical line before and after macular hole (MH) surgery in 25 eyes of 24 patients. Participants’ perceptual reports of distortions were classiWed as solid, bent right/left, thinned at the center, or broken. The major- ity of patients (72%) reported symmetrical distortions of the line pre-operatively. After surgery, participants with larger MHs were more likely to retain residual distortions. Of particular interest is the group reporting thinning of the line preoperatively, as the center should be perceptually missing. Examination of MH diameters in relation to the line perceptions indicated that the shape of the perceived line can be explained at the retinal level, while its continuity must be perceptually created at the cortical level. © 2006 Elsevier Ltd. All rights reserved. Keywords: Perceptual Wlling-in; Macular hole 1. Introduction chard, 1993). Furthermore, patients may be able to percep- tually Wll in the missing information and, with time, become Macular hole (MH) is an age-related visual pathology unaware of their deWcit (Safran, 1997; Safran & Landis, that creates a circular defect in the central area of the retina 1999). -
Deep Learning-Based Electroencephalography
DEEP LEARNING-BASED ELECTROENCEPHALOGRAPHY ANALYSIS: A SYSTEMATIC REVIEW Yannick Roy∗ Hubert Banville∗ Isabela Albuquerque Alexandre Gramfort Faubert Lab Inria MuSAE Lab Inria Université de Montréal Université Paris-Saclay INRS-EMT Université Paris-Saclay Montréal, Canada Paris, France & Université du Québec Paris, France [email protected] InteraXon Inc. Montréal, Canada Toronto, Canada Tiago H. Falk Jocelyn Faubert MuSAE Lab Faubert Lab INRS-EMT Université de Montréal Université du Québec Montréal, Canada Montréal, Canada ABSTRACT Context. Electroencephalography (EEG) is a complex signal and can require several years of train- ing, as well as advanced signal processing and feature extraction methodologies to be correctly interpreted. Recently, deep learning (DL) has shown great promise in helping make sense of EEG signals due to its capacity to learn good feature representations from raw data. Whether DL truly presents advantages as compared to more traditional EEG processing approaches, however, remains an open question. Objective. In this work, we review 156 papers that apply DL to EEG, published between Jan- uary 2010 and July 2018, and spanning different application domains such as epilepsy, sleep, brain- computer interfacing, and cognitive and affective monitoring. We extract trends and highlight inter- esting approaches from this large body of literature in order to inform future research and formulate recommendations. Methods. Major databases spanning the fields of science and engineering were queried to identify relevant studies published in scientific journals, conferences, and electronic preprint repositories. arXiv:1901.05498v2 [cs.LG] 20 Jan 2019 Various data items were extracted for each study pertaining to 1) the data, 2) the preprocessing methodology, 3) the DL design choices, 4) the results, and 5) the reproducibility of the experiments.