Brain Function Assessment

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Brain Function Assessment

  1. 1. Brain Function Assessment and Emotional Profile of Young Persons with Substance Use Disorders Dr. Andrew M.H. Siu
  2. 2. Co-authors Dr. Alex Wong, Prof. Chetwyn Chan, The Hong Kong Polytechnic University Ms. Debby Wong, Mr. Charlie Chan, Caritas Youth & Community Service
  3. 3. Outline Model of Service for Young Persons with Substance Use Disorders Research: Brain Function Assessment  Emotional Profile: Depression & Anxiety  Motivation for Change
  4. 4. SERVICE FOR YOUNG PERSONS WHO ABUSE DRUGS
  5. 5. Design of Service Outreach (Disco, Night Club, Pub/Bar) Referral Brain Function & Emotional Evaluation + Motivational Interviewing Case Follow-up Peer Counseling Life Partnership Medical Check-up Health Monitoring, Drug Counseling, family Support, Emotions Management
  6. 6. Structure Organizations People Applied Cognitive Neuroscience Laboratory (ACNL) of PolyU Dr. Andrew Siu Dr. Alex Wong Prof. Chetwyn Chan The Caritas Youth and Community Service, A Journey of Awakening (Beat Drugs Fund) Ms. Debby Wong Mr. Charlie Chan Brain Function & Emotional Evaluation Motivational Interviewing Follow-up
  7. 7. Participants Age  Range: 14 – 25  M = 19.6 (SD = 2.8) Gender  Females (69.1%) Education  F3 or Below : 47.4%  F4 to F5: 49.5%  Above F5: 3.1%
  8. 8. Work Status Sales & Service, 16% Clerical,10% Catering& Food,9% Construction& Engineering, 5% Transportation & Logistics, 4%Beauty& Salon,2% Unemployed, 28% Student,26%
  9. 9. First Time They Take the Drug (n = 97) Drug First contact M SD Hallucinogin Cannabis (草) 15.2 2.1 Stimulant Cocaine (可樂) 17.9 2.4 MDMA: Ecstacy (搖頭丸) 15.1 1.8 Amphetamine (冰) 16.1 2.5 Tranquilizer Diazepam (5仔) 16.2 2.2 Triazol-lun (白瓜子) 15.2 1.6
  10. 10. First Time They Take the Drug (n = 97) Drug First Contact M SD Ketamine (K仔) 15.1 1.9 Others Cough medicine 15.8 1.9 Alcohol 13.6 2.8 Tobacco 13.0 2.2 Thinners, Cough tablets 15.2 1.8
  11. 11. BRAIN FUNCTION TESTING & MOTIVATIONAL INTERVIEWING
  12. 12. Brain Function Assessment We conducted a series of tests on selected brain function, e.g. processing speed, attention, memory, etc. The test package normally take 1.5 to 2 hours to complete (with rest periods in between). Compared with norms, 64.9 % of participants had at least one deficit among all the functions tested.
  13. 13. Brain Function Tests Processing Speed Symbol Digit Modalities Test Concentration Digit Vigilance Test Sustained attention Stroop Test Verbal Memory Chinese Auditory Verbal Learning Test Visual Memory Continuous Visual Memory Test Reasoning Test of Non-verbal Intelligence Test Verbal Fluency Verbal Fluency Test Figural Fluency Ruff Figural Fluency Test Mental Flexibility Trail Making Test Assessment Tools
  14. 14. Function Normal (%) Mild (%) Moderate (%) Severe (%) Has Deficit (%) Processing Speed 86.6 3.1 8.2 2.1 13.4 Concentration 69.1 15.5 9.3 6.2 31.0 Sustained attention 90.7 3.1 4.1 2.1 9.3 Verbal Memory 88.7 7.2 4.1 0 11.3 Visual Memory 77.3 5.2 15.5 2.1 22.8 Reasoning 94.8 3.1 2.1 0 5.2 Verbal Fluency 90.7 5.2 2.1 2.1 9.4 Figural Fluency 64.9 16.5 10.3 8.2 35.0 Mental Flexibility 91.8 4.1 3.1 1.0 8.2 Assessment Results
  15. 15. Brain Function Assessment Results
  16. 16. EMOTIONAL PROFILE: DEPRESSION & ANXIETY
  17. 17. Assessed using Beck Depression Inventory II According to cut-off scores, 62.2% are depressed. Overseas studies showed that 24 to 30 % of persons with substance abuse had depression Depression
  18. 18. Depression (BDI-II scores)
  19. 19. Anxiety • Assessed using State-Trait Anxiety Inventory (STAI) • 15.8% had anxiety symptoms in state scale. • Overseas studies showed that 16 to 20% of persons with substance abuse has anxiety disorders, many had Post- Traumatic Stress Disorders
  20. 20. Anxiety (STAI scores) Trait (%) State (%) Normal 87.4 84.2 Mild 9.5 9.5 Moderate 3.1 5.3 Severe 0 1.0 Deficits Total 12.6 15.8
  21. 21. Motivational Interviewing Works by activating patients’ own motivation for change and adherence to treatment. Evocative: elicit what the client already has, (e.g. values, dreams, goals, personal & social resources), not what s/he hasn’t. Honoring patient autonomy Evocative Collaborative
  22. 22. Motivational Interviewing protocol 1. Present brain function assessment & emotional profile 2. Explain & clarify test results 3. Invite participant to give feedback & comments 4. Listen to how the participant interpret the results 5. Listen to Ambivalence and elicit Change Talk 6. Explore Change Talk and Summarize the big picture (forces of change) 7. Identify Key Struggles, Motivation for Change, and Stage of Change)
  23. 23. Report Booklet
  24. 24. 報告
  25. 25. Explanation on Brain Function
  26. 26.  「梗係唔可以集中精神去完成一件事,忽然間會遊咗去 唔知邊度。」 (Sustained Attention 注意力持久度)  Case 1: 「係公司點點下貨忽然間停咗落嚟, 遊晒魂,有幾次仲比同事拍我先 識回魂!」 Impact of Deficits on Daily Activities
  27. 27. MOTIVATION FOR CHANGE
  28. 28. Method Content analysis of interviews with 22 (around 30%) participants Analysis of cases by counselor Based on Motivational Interviewing & Stage of Change Model
  29. 29. MI Model Commitment Taking Steps Desire Ability Reasons Need Behavioral Change
  30. 30. Listen to Change Talk Commitment (PC, C)? Taking Steps (A, M)?  Behavior Change Desire What do you want, like, wish, hope? Ability What is possible? What can you do? Reasons Why change? What benefits? What risks? Need How important is this change? How much you like to do it?
  31. 31. Reasons for Drug Abuse (n = 22) Drug Abuse Family (n= 8) Peer Influence (n = 10) Manage Emotions (n = 7)
  32. 32. Motivation (Reasons) for Change Motivation for Change Finances (13.6%) Social Support (18.2%) Family: Love, Support & Pressure (45.5%) Health: (81.8%) Achievement: work or study (27.3%) Dating, Marriage, Motherhood (18.2%)
  33. 33. Stage of Change (n = 22) Precontemplation (n = 5; 22.7%) Contemplation (n = 12; 54.5%) Action(n = 2; 9.1%) Maintenance (n = 3; 13.6%)
  34. 34. Summary Drug abuse is associated with poor brain function and emotional health  64.9% of participants had at least one type of cognitive deficit.  Deficits in concentration, visual memory, & figural fluency are common  More than 60% of participants had depressive symptoms, 15% had anxiety symptoms.
  35. 35. Summary Cognitive deficits could have great impact on daily life or work functioning. Need to develop a set of cognitive training or compensation strategies for addressing cognitive deficits Need to address depression as co- morbid illness to drug abuse
  36. 36. Summary Clients need to develop alternative strategies in managing emotions Health, family issues, & emotions management issues are important foci in motivating client for change Many clients need assistance to move from Contemplation to Preparation and Action
  37. 37. Contributions 1. Establish a model of assessment addressing common cognitive & emotional issues in drug users 2. Provide an understanding of cognitive & emotional profile of young persons who abuse drugs 3. Discuss Service Implications
  38. 38. Reference Connors, G. J., Donovan, D. M., & DiClemente, C. C. (2001). Substance abuse treatment and the stages of change: Selecting and planning interventions. New York: The Guildford Press. Estroff, T. W. (Ed.) (2001) Manual of adolescent substance abuse treatment. Washington, DC: American Psychiatric Publishing, Inc. Rollnick, S., Miller, W. R., & Butler, C. C. (2008). Motivational interviewing in health care: helping patients change behavior. New York: The Guildford Press.

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