UT Southwestern School of Health Professions
Permanent URI for this collectionhttps://hdl.handle.net/2152.5/6691
Welcome to the UT Southwestern School of Health Profession’s electronic theses and dissertations (ETD) collection. (Note: The school was previously named the UT Southwestern School of Allied Health Sciences.)
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Print theses and dissertations from 1943 to 2004 are located in the Library's Special Collections and Archives (Room E3.314) and are available by appointment. (Note: Former students may request a digitized copy of their work by email, but other users may submit an Interlibrary Loan request.) For more information, contact archives@utsouthwestern.edu.
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Browsing UT Southwestern School of Health Professions by Author "Brewer-Mixon, Karen"
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Item The Effectiveness of Electroconvulsive Therapy for Major Depressive Disorder According to Patient Self-Report(2013-08-28) Metoyer, Melissa C.; Chiu, Chung-Yi; McClintock, Shawn Michael; Brewer-Mixon, KarenBACKGROUND: Major depressive disorder (MDD) is a common, typically recurrent, often chronic, and disabling disorder affecting approximately 14 million adults in the United States (US) each year. Electroconvulsive therapy (ECT) is a neurostimulation therapeutic intervention that is highly effective and most often used to treat certain psychiatric conditions, in particular MDD. Despite the proven effectiveness of using ECT to treat MDD there have been no other studies that have addressed methods of assessing the severity of depressive symptoms using patient self report instrument. SUBJECTS: Ninety-four participants, comprised of 58 (61.7%) females and 36 (38.3%) males who ranged from 20 to 85 years of age (M=51.76, SD=15.19) participated in this study. All subjects had a diagnosis of MDD and were treated with ECT over an average of 11 sessions on an inpatient or outpatient basis at the UT Southwestern Medical Center Zale Lipshy University Hospital (ZLUH, Dallas, TX). METHOD: The 16-item self-report version of the Quick Inventory of Depressive Symptomatology (QIDS-SR16) measure was used to determine the effectiveness of ECT in treating MDD. Data was acquired at baseline and after the end of the acute ECT treatment course. Paired t-tests were applied to determine if there were significant depression improvements and effect size (r) was calculated to determine the effect size between pre- and post- treatment scores on the Quick Inventory of Depressive Symptomatology-Self Report₁₆ total score and each domain score. RESULTS: The overall baseline average total score of QIDS-SR₁₆ (M=18, SD=4.34) for the study sample was in the severe range. After completion of the acute ECT course, the QIDS-SR₁₆ total score on average significantly decreased to the mild range (M=7.18, SD=4.74). The overall total QIDS-SR₁₆ score had a large effect size (E.S.) (E.S. (r) =.91; t = 20.98, df = 93, p =. 000). Consistent with this, the domain scores also had a large effect size. The E.S. (r)-scores from greatest to the least for the domain scores are mood (E.S. (r) =.88; t = 17.58, df = 93, p =.000), suicide (E.S. (r) =.83; t = 9.19, df = 93, p =.000), fatigue (E.S. (r) =.78; t = 12.13, df = 93, p=.000), self-outlook (E.S. (r) =.75; t = 11.07, df = 93, p =.000), concentration (E.S. (r) =.72; t = 10.03, df = 93, p =.000), sleep (E.S. (r) =.68; t = 8.96, df = 93, p =.000), loss of interest (E.S. (r) =.68; t = 14.58, df = 93, p = .000), psychomotor(E.S. (r) =.65; t = 8.35, df = 93, p = .000), and appetite change (E.S. (r) =.62; t = 7.74, df = 93, p = .000). Data revealed few differences between electrode configuration placements. The sad mood and suicide domains resulted in a greater decline in symptom ratings than the remaining seven domains over the course of an acute ECT treatment. DISCUSSION: The findings of the study are consistent with prior research suggesting that ECT is an effective treatment for MDD. Specifically, depressive symptoms as rated by self report showed a significant decrease from baseline to completion of the acute ECT course. The data from the QIDS-SR16 revealed an overall marked improvement in total depression severity, and in specific depressive domains including mood, suicidal ideation, energy, self-outlook and concentration/decision making. IMPLICATIONS: The research has some limitations. the present study only recruited patients from one hospital, which may limit the generalizability of the findings. This was a naturalistic study based on a clinical database. There could have been possible comorbidities (both medical and neuropsychiatric) that could have affected outcome. The switch of electrode placement was non-systematic and based on physician judgment and not based on the study’s criteria.Item Emotional Control and Reaction Time in Children with Internalizing Disorders and Attention-Deficit Hyperactivity Disorder(2016-12-16) Turner, Melissa Dawn; Wilkinson-Smith, Alison; Brewer-Mixon, Karen; Rose, LindseyBACKGROUND: Prior literature indicates that children with slower reaction times on neurocognitive attention measures are more likely to respond more slowly to stop signals in real world situations. Taking longer to respond may also suggest a tendency to take longer to process emotional cues in real time, thus possibly resulting in vulnerability towards emotional dyscontrol. The present study examined differences between reaction time and the parental ratings of emotional control and internalizing symptomatology in three distinct pediatric populations: those with Attention-Deficit Hyperactivity Disorder (ADHD), those with internalizing disorders such as anxiety and depression, and those with comorbid ADHD and internalizing disorders. SUBJECTS: A sample of 64 children and adolescents who were patients at the Neuropsychology Service at Children's Medical Center Dallas Texas from November 2011 through July 2014 was derived. All patients received neuropsychological evaluations and were assessed for attentional and emotional disorders. METHOD: Approval for the study was obtained from the Institutional Review Board at UT Southwestern Medical Center. Data was obtained via examination of medical records. Reaction time was measured via the Conners' Continuous Performance Test II (CPT II) Overall Hit Reaction Time (RT) variable. Parent rating forms from the Behavior Rating Inventory of Executive Function (BRIEF) Emotional Control subscale (EC) and the Behavioral Assessment Scale for Children, Second Edition (BASC-2) Internalizing Problems Composite score (IP) were used as a measure of participants' emotional control capacity. A multivariate analysis of covariance (MANCOVA) was employed to assess for significant differences between all three groups for CPT II RT, BRIEF EC, and BASC-2 IP, controlling for age, education, sex, and race. RESULTS: The MANCOVA yielded a significant overall model for group [F (6, 26) = 6.89, p < .01], controlling for age (p = .08), education (p < .01), sex (p = .13), and race (p = .02). There was a significant main effect for CPT II RT [F (2) = 8.31, p < .01] and BASC-2 IP [F (2) = 3.96, p < .04], with respectable effect sizes (η2 = .56 and .35, respectively). There was a moderately significant main effect for BRIEF EC [F (2) = 3.65, p = .051] with a moderate effect size (η2 = .33). Post hoc analyses revealed significant differences between the internalizing disorder and comorbid groups (p = .048) for CPT II RT, with slower reaction times in the internalizing disorders than comorbid groups. Significant differences were also observed between the ADHD and internalizing disorders groups (p < .01) as well as between the ADHD and comorbid groups (p = .03) for BASC-2 IP, with greatest elevation in the internalizing disorders, followed by the comorbid and ADHD groups. There were significant differences between the ADHD and the internalizing disorder groups (p = .04) as well as between the ADHD and comorbid groups (p = .01) for BRIEF EC. Of note, mean CPT II RT performance was in the normal range across the groups. All other pairwise comparisons were nonsignificant. DISCUSSION: In this study we explored associations between cognitive inefficiency and emotional dysregulation in order to further our understanding of the ways in which emotional and executive functions are related. We focused on differences between groups of three specific populations (i.e., ADHD, internalizing disorders and comorbid ADHD and internalizing disorders). The co-occurrence of ADHD and internalizing disorders may have important implications for assessment and treatment. Results such as these could be useful in determining whether treating one type of internalizing symptomatology may improve the other, and can allow providers to make more informed decisions about how to better assist children with comorbid conditions.Item The Exploratory Study of Consumers' Experience of Using Food Pantries and Their Self-Sufficiency and Quality of Life(2013-09-10) Sims, Candice M.; Chiu, Chung-Yi; Brewer-Mixon, Karen; McClintock, Shawn MichaelBACKGROUND: Food insecurity and consumers' chronic dependence on social welfare designed for emergency use has raised concern for food banks and food pantry directors who are interested in consumers' experience of using food pantries and their self-sufficiency during the period of relying on food pantries. In addition to knowing the demographic and socioeconomic status of consumers, there is still a need to understand consumers' satisfaction with food pantry services, experience of using a food pantry, self-sufficiency, motivation, and quality of life. These subjects were addressed in the present study. SUBJECTS: From 12 randomly selected food pantries in the greater Dallas area that are serviced by the North Texas Food Bank, 151consumers were surveyed, which included 112 females and 39 males. There were 51 Caucasians, 70 African Americans, 28 Hispanics and 2 other races/ethnicities. The average age of consumers surveyed was 44.45 (Range= 20-65, SD = 20.65). Additionally, a total of 28 surveys were completed by food pantry directors. The total sample included 17 female and 11 male directors. The average age of directors surveyed was 55.65 (Range= 27-69, SD= 12.82). Only 1 director (3.6%) reported being of Hispanic/Latino or Spanish origin. Twenty-three directors (82.1%) were Caucasian, three (10.7%) were African American, and one (3.6%) reported being American Indian or Alaska Native. METHODS: A descriptive research design was used. SPSS 19.0 was used to analyze the data. The following scales were used: Consumer Demographic Questionnaire, Food Pantry Services Questionnaire, Service Satisfaction Questionnaire, Food Pantry Use Reason Questionnaire, Service Perception and Emotion Questionnaire, Dependence Questionnaire, Stages of Change in Employment, Work Intention Scale, Life Crisis Solution Questionnaire, Kessler Psychological Distress Scale, and the SF-12. RESULTS: Around 40% (n=58) of consumers had a high school diploma and less than 11th grade education. Forty-seven consumers (31.1%) were currently unemployed and 40 (26.5%) unable to work. Thirty-nine consumers' income came from SSI (25.8%) and 23 consumers' (15.2%) income came from SSDI. Eighty-seven consumers' (57.6%) annual household income was under $11,999. Overall, consumers were satisfied with food pantry services and felt appreciated and relieved when receiving services and food. There was no significant difference of service satisfaction evaluation between directors and consumers. Their motivation of returning to work and being self-sufficient was moderate. Consumers' quality of life was significantly lower than the general population. However, there was a very significant difference in the way consumers and directors rated food pantry use reason importance (t(53.85)= -9.65, p = .000), with consumers' overall ratings being significantly lower than directors. DISCUSSION: Studies have shown that demographic factors such as household income, race, gender, marital status, employment and accessibility of social welfare are mediating factors for food insecurity and poverty. All of these factors contribute to increased reliance on food pantry services. The responses from consumers regarding their dependence on food pantries has supported the fact that consumers need assistance in finding good paying jobs, education in learning to budget, and classes where job skills can be learned. Additionally, in order to best serve food pantry consumers and to meet the ultimate goal of encouraging self-sufficiency, food pantry directors must understand their consumers' quality of life and the factors that contribute to it. IMPLICATIONS: The ability of the food bank's top-down approach to promote self-sufficiency has been questioned. Developing community initiatives that promote self-sufficiency through community development brings accountability and pride back into the community. At the center of this facilitation is the much-needed strong leadership of the directors, serving as life coaches to consumers.Item Mild Traumatic Brain Injury Rehabilitation: A Model for ADHD Treatment(2016-11-18) Yates, Ashley Nicole; Silver, Cheryl H.; Brewer-Mixon, Karen; Fulbright, Richard L.Attention Deficit Hyperactivity Disorder (ADHD) is a condition that affects approximately 4.4% of adults in the U.S. (Kessler et al., 2006) and is most commonly treated with psychopharmacological interventions. More recently, non-pharmacological interventions have been developed for ADHD. Cognitive Behavioral Therapy (CBT) has emerged as an efficacious treatment for ADHD and typically consists of training compensatory strategies and the use of external aids. The aims of this thesis were to examine the similarities between ADHD and mild Traumatic Brain Injury (mTBI) as well as review treatment options for mTBI and discuss their possible usefulness in treating ADHD. Based on the literature reviewed, there were striking similarities of deficits between ADHD and mTBI, specifically in the executive functioning of both. It is hypothesized that treatment for mTBI could also be beneficial for ADHD. Currently, some of the techniques used to treat ADHD and mTBI overlap. However in, cognitive rehabilitation (CR) for TBI, there is more emphasis on remediation of deficits compared to treatment of ADHD. Also, cognitive tasks for mTBI are more often completed in a real-life setting or as close to a real-life setting as possible. At this time, the literature regarding cognitive rehabilitation specific to mTBI is somewhat limited because it continues to be a growing field of literature. However, CR in general may be a beneficial treatment for the executive functioning deficits that also commonly affect ADHD.Item Predictors of Persistent Neurobehavioral Symptoms in Adolescents with Mild Traumatic Brain Injury Using a Novel Clinical Tool(2021-07-23) Wright, Brittany Nicole; Brewer-Mixon, Karen; Cullum, C. Munro; Juengst, Shannon B.; Krumwiede, Kimberly Hoggatt; Terhorst, Lauren; Wilmoth, Kristin MichellePersistent post-concussion symptoms in adolescents are non-specific and poorly understood. A small percentage of adolescents (roughly 20%) will experience persistent symptoms following mTBI that can be disruptive in many areas of daily functioning. Including measures in assessment that are specific to adolescents but capture symptoms beyond injury may lead to more insight as to why some adolescents experience persistent symptoms. Moreover, identifying predictors of persistent symptoms could aid in management and evaluation of symptoms. The current set of studies was designed to validate a measurement tool for adolescents and identify predictors of persistent symptoms in a cohort of adolescents with mTBI. Study 1 was designed to further validate a tool (the BAST-A), which assesses persistent emotional and behavioral symptoms in adolescents. Another aim was to develop ordinal to continuous normed scores to aid in clinical interpretation. When assessing the psychometric indicators of the tool, both the Negative Affect and Fatigue and Executive and Social Function subscales performed well. However, the Risk Behaviors subscale performed poorly in this sample of adolescents with sports-related concussion. Specifically, Risk Behaviors was not able to distinguish different severity levels in the sample. Results from this study suggest further psychometric validation of the BAST-A in adolescents with mTBI. The aim of Study 2 was to utilize the ordinal to continuous normed scores in the first study to assess if a combination of predictors was associated with persistent neurobehavioral symptoms in adolescents with mTBI. A combination of pre-injury and injury predictors was significantly associated with self-reported Negative Affect and Fatigue symptoms (F (8,93) =6.09, p<.001) and Executive and Social Function symptoms (F (8,93) = 2.18, p=.036). Due to limitations within the Risk Behaviors subscale, binary (Yes/No) outcomes were used. A combination of pre-injury and injury factors was also significantly associated with self-reported Risk Behaviors [χ2(8) = 18.84, p=.016]. Across subscales, total number of recent life stressors remained a significant predictor of persistent symptoms. The results from this study indicated that a combination of injury-related and personal factors is predictive of persistent symptoms and that recent life stressors contribute to the experience of these symptoms.