#e-diaries

[the-lecherous-light]

i thought this may be a fun thing to document after having waited so long, mostly for myself and mutuals but if other people get a kick out of this good for them, so here are the ways e has affected me, one week in: (note: i also went back on my ssris alongside this so some of this may be in conjunction to or alongside that)

- higher sensitivity to temperature, particularly heat, i used to take scaldingly hot showers and I stepped into my usual temp yesterday and almost screamed. same with washing my hands

- every two hours i want to lay down and cry, like wow the urge pops up a lot more, i still haven't indulged and i don't know why. also my response to people i love going through things, i just want to cry for them. kind of cute of me but also doesn't seem very helpful

- i feel like I have substantially less strength than i usually do, i have almost keeled over lifting things i normally have no problem with, but fuck knows if this is due to fatigue or lack of food, it was relatively inconsistent day to say before. i failed for five consecutive minutes to open a jar of pasta sauce yesterday and almost cried though

- the embodiment of go piss girl

- holy fuck what is the spirit of this ravenous succubus that has entered my body. i feel so pathetically horny it's ridiculous, it's like a constant mood for hours without any physical indicator necessarily but my brain is just screaming that i NEED to be bred or eaten alive or hurt till i cry or kissed gently while touched for hours but mainly eaten alive because i don't even know if intimacy would fix it. should probably try though. jerking off normally doesn't. and i'm so bad at keeping a lid on it and i feel the subbiest i've ever felt and it feels so humiliating and no i don't want someone to bully me and degrade me about it while the other dotes on me about it and tells me how cute it is i don't i don't i don't

[hushedmurmur]

November 22nd

7:00am

I had a real breakdown in a while.i pondered on the Question is it really worth it? Am I actually doing something here? Or am I just a fleeting existence like smoke who's at the mercy of the wind, I am at the mercy of fate!

[symtrend]

Tracking Impact of Botox Treatment

Summary. A 52-year old woman with traumatic brain injury (TBI) was treated with botulinum toxin (Botox) blocks to her neck muscles to manage her chronic intractable headache pain. SymTrend was an important element in supporting her treatment plan and monitoring results. SymTrend acted as a helpful memory aid as well, since she had difficulties concentrating and remembering events as a consequence of her TBI.

Background: Standard prescription medications had not been completely effective in reducing her pain. The treatment plan called for Botox blocks every 12 weeks. Her doctor recommended use of a custom SymTrend electronic diary to meet two objectives: 1) determine how much pain relief occurred and for how many weeks, and 2) determine if the pain reduction was accompanied by additional benefits such as decreased fatigue, improved concentration, and greater emotional well-being.

The major findings are these: 1) Headache Intensity: The user rates her headache (HA) intensity three times per day – in the morning, mid-day, and at bedtime – on a standard 0-10 point pain scale. Her last Botox injection was on 5/12/14. Her weekly average headache (HA) is plotted in Figure 1. Figure 1 indicates that her HAs post 5/12 decreased from a 4/5 rating to a 2/3 rating on 6 of 8 subsequent weeks. They returned to a 4 rating on week 8 and then continued to rise to a 5/6 rating by 8/10. Conclusion: There is a HA Botox benefit that is time-limited to 8 weeks, not 12 weeks (her current shot interval). 2) The Botox benefit extends beyond HA reduction; it also increases weekly average energy with the same time course. (See Figure 2). The correlation between weekly average HA and weekly average Energy increase is r = 0.87. 3) Botox HA reduction is also strongly correlated with decreases in: a. Distraction, r = 0.80 b. Dizziness, r = 0.73 c. Fogginess, r = 0.77 d. Irritability, r = 0.76 4) Botox HA reduction is not a panacea; it does not affect some of her symptoms. For example, her feelings of being overwhelmed have a markedly different weekly course (See Figure 3). Botox HA reduction is not only not correlated with reductions in feelings of being overwhelmed, r = 0.10, it is not correlated with reductions in balance, r = 0.15, or reductions in her pessimism, r = 0.37. 5) Botox HA reduction is associated with several more modest benefits than those reported in 3 above. HA reduction is associated with reductions in: a. Sadness, r = 0.52 b. Tension, r = 0.52 c. Anxiety, r = 0.47 6) She had shown an earlier correlation of sleep reduction with HA increase. By taking Ambien earlier, before retiring, she had reduced her morning HA intensity. She, however, did not sustain this earlier administration practice. Her current correlation between hours of sleep and weekly average HA is r = 0.22. Conjecture: The failed earlier Ambien administration compliance, plus the Botox benefit, have combined to reduce the impact of hours of sleep on HA reduction. Recommendation 1: Continue SymTrend to verify Botox benefit time course. Recommendation 2: Encourage earlier use of Ambien before retiring to achieve a morning HA reduction. Recommendation 3: Check for a greater impact of combining Recommendations 1 & 2.

[symtrend]

When and How Should Behavioral Data Be Captured in the Classroom?

Recordings about classroom behavior are most accurate when done right after the behavior occurs. Recording at the end of a lesson is next most accurate and recording 3 hours later is the least accurate. These statements seem intuitive. However, a careful study described in a recent paper* found that many factors affect these differences in accuracy.

Methods: The study involved special educators recording about a single target behavior such as crying, eye poking, and "talk-outs". The educators noted the occurrence of the behavior either 1) right after it happened, 2) after the activity in which it happened finished, or 3) a few hours later. Recordings were made on paper forms. Four teachers participated and each recorded about two of their middle/junior high students. They received training on recording and treatment fidelity. Their recordings were compared to those made by one of the investigators using videotaped observations. The investigators randomly varied under which of the three conditions the teacher recorded for each of two recordings per day. Teachers recorded data on student performance across 15 days with 10 sessions for each condition.

Results: All four teachers met the necessary 85% agreement level for their data to be considered accurate for at least one student during either Conditions 1 or 2. Three teachers did not record accurate data for their other student during these same conditions. Each had higher levels of agreement among some conditions than others. Not all teachers consistently recorded accurate data for both of their students across conditions. An important factor impacting accuracy was the overall frequency of the behavior. Other factors that also had an impact include: treatment fidelity, medication or other treatment changes, and the salience of the behavior during the instruction.

Conclusions: The authors conclude: "Although immediate direct observation recording is espoused as the most accurate data recording method, teachers did not consider it the most feasible particularly because of the barriers they face when using this data recording method. Prior research provided evidence to suggest special educators can engage in accurate delayed recording; however, the delay between behavior occurrence and recording should be 30 min or less…Future research should consider choosing target behaviors that are less prone to salience and do not pose difficulties for teachers to maintain high levels of treatment integrity and reliable data recording (e.g., moderate frequency behaviors)."

Comment: The study did not include a condition with electronic data capture. SymTrend screens (above) can be used to capture data in the moment (left) or at the end of the lesson/3 hours later (right). When done in the moment the teacher taps the screen each time a behavior occurs and the screen then refreshes. This cannot be done as the teacher is doing a lesson; a second observer would enter the data. The teacher could use a "clicker" to record each time a behavior occurred and then enter the total on the screen on the right after the lesson is over. Teachers who have used SymTrend preferred the accuracy of data recording by paraprofessionals not immediately involved in the lesson. Transcription errors sometimes occurred when copying from paper tally sheets to screens like the one on the right. Transcription from clickers provided intermediate accuracy, when available.

* Jasper, AD and Taber Doughty, T. (2014) Special educators and data recording: What's delayed recording got to do with it? Focus on Autism and Other Developmental Disabilities. Published online 12 August 2014.

[symtrend]

Smartphone Intervention for Schizophrenia

A report of a successful trial with a real-time smartphone support system appeared recently in Schizophrenia Bulletin*. The study demonstrates the positive potential of care models that extend treatment beyond the confines of a clinic. The "FOCUS" intervention is for people with psychotic disorders who may have cognitive impairment, psychotic symptoms, negative symptoms, and/or low reading levels. Use of the system led to significant reductions in psychotic symptoms, depression, and general psychopathology.

Methods: FOCUS provides users with many prescheduled and on-demand tools. Thirty-three individuals used the system over a 1-month period, an average of 5.2 times/day. Every participant had screens for medication adherence. Participants and researchers selected two additional tools, based on preference and need, from those that help manage symptoms, mood, medications, social functioning and sleep. The screens on the top row in the graphic above are from the article; the screens below are from a similar untested application in SymTrend. Participants received training on the use of the application and on the Motorola Droid 4 phones. The system prompted users 3 times daily, on one of each of the 3 treatment targets. Once signaled, users can decide to engage or ignore the prompt. The system guides the user through a daily assessment and offers use of the pre-determined intervention. Users could also use other tools for support whenever they needed them. The app automatically uploaded response data to a secure study server when wireless connectivity is available. Researchers and authorized clinicians can view user responses continuously on a web-based dashboard.

Findings: Participants completed an acceptability/usability questionnaire after completion of the study. Ratings were very positive. Over 87% reported it was easy to and helped manage symptoms. Use of the system led to significant reductions in psychotic symptoms, depression, and general psychopathology. There were no significant changes in beliefs about medications or in sleep difficulties. The FOCUS system used in the study was a 1-month adjunct to in-person services; it has not been evaluated as a stand-alone system or for a longer period. There also was no control group for this study.

*Ben-Zeev, D, Brenner, CJ, Begale, M, Duffecy, J, Mohr, DC, and Mueser, KT. (2014) Feasibility, Acceptability, and Preliminary Efficacy of a Smartphone Intervention for Schizophrenia. Schizophrenia Bulletin, Mar 19 [Epub ahead of print]

[symtrend]

Coping, Daily Hassles, and Behavioral/Emotional Problems in Adolescents with High-Functioning Autism/Asperger Syndrome

Adolescents with High-Functioning Autism and Asperger Syndrome (HFA/AS) are more likely to experience stress than their neurotypical peers. They tend to derive stress from a greater number and more idiosyncratic variety of everyday events (daily hassles). Stress often triggers or worsens core symptoms of HFA/AS, such as stimming and rigid thinking. The coping strategies used by adolescents with HFA/AS to deal with daily hassles and the relationship between those strategies and behavioral/emotional problems were discussed in a recent article by the Australian group cited in July 12th's post*.

Methods: Adolescents 12-18 years of age used the group's mobiletype software, which is similar to SymTrend. The e-diary used enabled them to assess stressors and coping styles multiple times daily for two weeks (the screens above show how this might appear in a SymTrend e-diary). They reported on use of both behavioral and cognitive coping strategies:

1. Primary control engagement coping, e.g., "Talked to someone about it" (behavioral) and "I thought of ways to solve it" (cognitive). 2. Secondary control engagement coping, e.g., "Hung out with my friends to distract myself" (behavioral) and "I just gave up and accepted it" (cognitive). 3. Disengagement coping, e.g., "Drank alcohol or used drugs" (behavioral) and "I felt like it was someone else’s fault" (cognitive). 4. Involuntary engagement, e.g., "I felt it was all my fault" (cognitive). 5. Involuntary disengagement, e.g., "Didn’t do anything" (behavioral) and "My mind went blank, I couldn't think at all" (cognitive).

Parents and adolescents also completed paper questionnaires at the beginning and end of the study. These instruments included items about the adolescent's daily hassles and coping. They also asked about the incidence of behavior and emotional problems. A principle focus of one of their papers about this work was finding a link between coping strategies and the incidence of behavioral and emotional problems.

Results: Both parents and adolescents reported, in the Response to Stress Questionnaire (RSQ), that the adolescents used all forms of coping. The adolescents, however, reported less frequent use of each strategy in their e-diaries. More similarity between parent/child assessments was evident than is typically found in this type of study, but there were some differences. One important difference was that parents reported less frequent use of Strategy 2 "secondary control engagement coping" than the adolescents reported.

The use of Strategies 1 and 2 above did not correlate with the presence of behavioral and emotional problems. The other three types of coping strategies were all individually associated with behavior and emotional problems. The perceived frequency of hassles was not a significant predictor of behavior and emotional problems, when based on the self-reported RSQ data, but was a factor influencing the use of Strategy 3, based on mobiletype data.

Conclusion: Given the high rates of behavioral and emotional problems in this population, the authors feel that a valuable target for interventions would be to address their styles of coping with stress.

*Khor, AS, Melvin, GA, Reid, SC, Gray, KM. (2014) Coping, Daily Hassles, and Behavior and Emotional Problems in Adolescents with High-Functioning Autism/Asperger’s Disorder. J. Autism Dev Disord. 44: 593-608.

Khor, AS, Gray, KM, Reid, SC, Melvin, GA (2014) Feasibility and validity of ecological momentary assessment in adolescents with high-functioning autism and Asperger’s disorder. J. Adolescence. 37: 37-46.

[symtrend]

Self-monitoring Using Mobile Phones in the Early Stages of Adolescent Depression A study conducted in Australia* found that self-monitoring of daily activities, mood, and stress on mobile phones resulted in greater emotional self-awareness, which in turn decreased depressive symptoms. The authors see mobile self-monitoring as a first step, preventive measure for teens at risk.

Sample: Participants were between 14 and 24 years with mild or more mental health concerns. The study had two groups: Intervention (monitored mood, stress, and daily activities) and Comparison (monitored only daily activities).

Procedure: Participants used mobiletype, a program developed by the Murdoch Children's Research Institute on phones lent to them. They were prompted to complete an entry by a beep within four blocks of time. Data were uploaded to a website. Intervention participants recorded: current activities, location, companions, mood, recent stressful events, responses to stressful events, alcohol/cannabis use, sleep, exercise and diet. Comparison participants only recorded current activities, location, companions, sleep, exercise and meals. The doctors who recruited the patients could view the data with the patients.

Findings: Those who monitored mood, stress, and coping strategies increased awareness of emotions. An increase in emotional self-awareness was associated with a decrease in depressive symptoms.

Conclusions: "Self-monitoring techniques may provide an alternative to watchful waiting as a first-step intervention in the stepped-care approach. Mobile phones are ideally suited to this purpose." Use of the mobiletype program can help young people understand and manage mild depressive symptoms. Detailed information about patients' recent mental health status is available to clinicians in an easy-to-read format, Tracking the data saves time in appointments and allows progression to more intensive second-step interventions when needed. Young people often do not recognize mental health problems and instead attend clinics for somatic complaints rather than mental health symptoms. "Self-monitoring by young people with underlying somatic complaints may increase their emotional self-awareness and help them initiate treatment for depression."

*Kauer, SD, Reid, SC, Crooke, AHD, Khor, A, Hearps, SJC, Jorm, AF, et al., (2012) Self-monitoring using mobile phones in the early states of adolescent depression: randomized controlled trial. Journal of Medical Internet Research, 14(3), e67.

[symtrend]

Teachers May Not Detect Over-Medication When teachers rate their students at the same time students rate themselves, evidence of problems with mental status, mood, and/or medication side effects may appear. An earlier post (3/19/14) demonstrated a case where a teen had a "covert" depression, undetected by his teacher. The chart above is data of a 19-year old girl with Autism and a seizure disorder in the same class as the previous case. She was on four medications and rated herself as sleepy (filled circles, middle graph) much more often than her teacher rated her (open circles). On other measures of sadness and nervousness she usually rated herself more positively than her teacher. In a busy classroom, a student who is quiet may be viewed as well behaved and attentive. When the school nurse and doctor reviewed this student's medical record. They saw that all of her medications had sleepiness as a potential side effect. They contacted her pediatrician and prescribing psychiatrist and informed them about the student's sleepiness. Her medication regimen changed. Unfortunately, tracking did not continue after that change because it happened over the summer.