Informing doctors of patient’s overdose death reduces opioid prescribing

Physicians are more likely to reduce the number and dose of opioids they prescribe after being informed one of their patients suffered a fatal overdose, according to a recent NIA-funded study.

In San Diego County, California, 861 clinicians prescribing to 170 people who experienced a fatal overdose were randomly assigned to a control group or a group that received a letter from the Chief Deputy Medical Examiner. The letter informed physicians of the deceased patient, outlined other overdose deaths in the county, and provided information on the state’s prescription drug monitoring program and Centers for Disease Control and Prevention guidelines on recommended safe prescribing strategies.

In the intervention group, milligram morphine equivalents in prescriptions decreased by 9.7 percent compared with the control group over 3 months after mailing letters. Physicians receiving letters were also 7 percent less likely to prescribe opioids to new patients. High-dose opioid prescribing was also reduced by 3–4.5% in the intervention group.

Physician prescribing behavior is influenced by notification of a single fatal overdose and suggests simple supportive letters such as the one used here can change behavior. This intervention is scalable and implementation at the county level in other areas of the country may enhance safe prescribing behavior.

Citation:
Doctor JN, Nguyen A, Lev R, Lucas J, Knight T, Zhao H, Menchine M. 2018. Opioid prescribing decreases after learning of a patient’s fatal overdose. Science 361(6402):588-590.

Mom’s cell phone use is related to infant social and emotional functioning

Mobile phone use is widespread and pervasive, but little is known about its impact on parent-infant interactions. In a recent NIMH-funded study, researchers found infants do not have the same engagement and positive affect when their mothers are distracted by mobile phone use.

Fifty infants aged 7.2 to 23.6 months completed a modified version of the Still Face Paradigm (SFP) along with their mothers. The three phases of SFP included free play (FP), where mother and infant play and interact; still face (SF), where mother withholds attention and is unresponsive; and reunion (RU), where mother resumes normal interaction. In this modified version, mothers used mobile devices during SF and also reported their typical mobile phone use and infant temperament. Infant behavior was coded for negative and positive affect, engagement with toys or mother, attempts to gain attention, and room exploration.

Infants of mothers who frequently use mobile phones did not show less negative affect or more positive affect during the SF phase, but did show less room exploration and less positive affect during SF. In the RU phase, more mobile phone use by mothers led to less recovery as evidenced by less engagement, room exploration, and positive affect. These findings remain even when controlling for individual differences in temperament. This study provides a novel, modified framework for assessing how mobile phone relates to mother–infant interactions and infant social–emotional functioning.

Citation:
Myruski S, Gulyayeva O, Birk S, Pérez-Edgar K, Buss KA, Dennis-Tiwary TA. 2018. Digital disruption? Maternal mobile device use is related to infant social-emotional functioning. Dev Sci 21(4):e12610.

Individual cognitive behavioral therapy improves anxiety in children

Individual cognitive behavioral therapy (CBT) is more effective than supportive child-centered therapy (CCT) in treating childhood anxiety disorders, according to a recent study funded by NIMH.

Youth aged 9–14 y with anxiety disorders (generalized, separation, and/or social anxiety) were randomized in a 2:1 ratio to receive either CBT (N = 90) or CCT (N = 43) over 16 sessions (with two parent sessions). CBT consisted of anxiety management skills and coping mechanisms, whereas CCT consisted of nondirective therapy focused on active listening, reflection, and discussing emotions. Outcomes measured included treatment response and recovery and emotional functioning post-treatment and at a 1-year follow-up.

Both groups benefited from treatment, but youth receiving CBT were more likely to fully recover, no longer meet criteria for diagnosed anxiety disorders, and no longer display residual symptoms (66.7 percent for CBT versus 46.5 percent for CCT). Those treated with CBT also responded better to negative life events in the second half of treatment. At one-year follow-up, a higher percentage of youth treated with CBT were still in recovery compared to those treated with CCT (82.2 percent for CBT versus 65.1 percent for CCT).

These findings suggest that CBT is more beneficial compared to supportive therapies in relief of symptoms and decrease in negative emotions over time. Future studies should examine if these findings are consistent in a community setting.

Citation:
Silk JS, Tan PZ, Ladouceur CD, Meller S, Siegle GJ, McMakin DL, Forbes EE, Dahl RE, Kendall PC, Mannarino A, Ryan ND. 2018. A randomized clinical trial comparing individual cognitive behavioral therapy and child-centered therapy for child anxiety disorders. J Clin Child Adolesc Psychol 47(4):542-554.