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Rohr J, Vahidy FS, Bartek N, Bourassa KA, Nanavaty NR, Antosh DD, Harms KP, Stanley JL, Madan A. Reducing psychiatric illness in the perinatal period: A review and commentary. World J Psychiatry 2023; 13:149-160. [PMID: 37123098 PMCID: PMC10130961 DOI: 10.5498/wjp.v13.i4.149] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 02/08/2023] [Accepted: 03/31/2023] [Indexed: 04/18/2023] Open
Abstract
This brief overview highlights the global crisis of perinatal psychiatric illness (PPI). PPI is a major contributor to many adverse pregnancy, childbirth, and childhood development outcomes. It contributes to billions of dollars in spending worldwide each year and has a significant impact on the individual, their family, and their community. It is also highly preventable. Current recommendations for intervention and management of PPI are limited and vary considerably from country to country. Furthermore, there are several significant challenges asso-ciated with implementation of these recommendations. These challenges are magnified in number and consequence among women of color and/or minority populations, who experience persistent and negative health disparities during pregnancy and the postpartum period. This paper aims to provide a broad overview of the current state of recommendations and implementation challenges for PPI and layout a framework for overcoming these challenges. An equity-informed model of care that provides universal intervention for pregnant women may be one solution to address the preventable consequences of PPI on child and maternal health. Uniquely, this model emphasizes the importance of managing and eliminating known barriers to traditional health care models. Culturally and contextually specific challenges must be overcome to fully realize the impact of improved management of PPI.
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Affiliation(s)
- Jessica Rohr
- Department of Psychiatry and Behavioral Health, Houston Methodist, Houston, TX 77030, United States
| | - Farhaan S Vahidy
- Department of Neurosurgery, Houston Methodist, Houston, TX 77030, United States
| | - Nicole Bartek
- Department of Psychiatry and Behavioral Health, Houston Methodist, Houston, TX 77030, United States
| | - Katelynn A Bourassa
- Department of Psychiatry and Behavioral Health, Houston Methodist, Houston, TX 77030, United States
| | - Namrata R Nanavaty
- Department of Psychiatry and Behavioral Health, Houston Methodist, Houston, TX 77030, United States
| | - Danielle D Antosh
- Department of Obstetrics and Gynecology, Houston Methodist, Houston, TX 77030, United States
| | - Konrad P Harms
- Department of Obstetrics and Gynecology, Houston Methodist, Houston, TX 77030, United States
| | - Jennifer L Stanley
- Department of Obstetrics and Gynecology, Houston Methodist, Houston, TX 77030, United States
| | - Alok Madan
- Department of Psychiatry and Behavioral Health, Houston Methodist, Houston, TX 77030, United States
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Rohr JC, Bourassa KA, Thompson DS, Fowler JC, Frueh BC, Weinstein BL, Petrosino J, Madan A. History of childhood physical abuse is associated with gut microbiota diversity among adult psychiatric inpatients. J Affect Disord 2023; 331:50-56. [PMID: 36933668 DOI: 10.1016/j.jad.2023.03.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 03/03/2023] [Accepted: 03/11/2023] [Indexed: 03/20/2023]
Abstract
BACKGROUND Traumatic life events are associated with the development of psychiatric and chronic medical illnesses. This exploratory study examined the relationship between traumatic life events and the gut microbiota among adult psychiatric inpatients. METHODS 105 adult psychiatric inpatients provided clinical data and a single fecal sample shortly after admission. A modified version of the Stressful Life Events Screening Questionnaire was used to quantify history of traumatic life events. 16S rRNA gene sequencing was used to analyze the gut microbial community. RESULTS Gut microbiota diversity was not associated with overall trauma score or any of the three trauma factor scores. Upon item-level analysis, history of childhood physical abuse was uniquely associated with beta diversity. Linear Discriminant Analysis Effect Size (LefSe) analyses revealed that childhood physical abuse was associated with abundance of distinct bacterial taxa associated with inflammation. LIMITATIONS This study did not account for dietary differences, though diet was highly restricted as all participants were psychiatric inpatients. Absolute variance accounted for by the taxa was small though practically meaningful. The study was not powered for full subgroup analysis based on race and ethnicity. CONCLUSIONS This study is among the first to demonstrate a relationship between childhood physical abuse and gut microbiota composition among adult psychiatric patients. These findings suggest that early childhood adverse events may have long-conferred systemic consequences. Future efforts may target the gut microbiota for the prevention and/or treatment of psychiatric and medical risk associated with traumatic life events.
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Affiliation(s)
- Jessica C Rohr
- Department of Psychiatry & Behavioral Health, Houston Methodist, Houston, TX, USA.
| | - Katelynn A Bourassa
- Department of Psychiatry & Behavioral Health, Houston Methodist, Houston, TX, USA
| | - Dominique S Thompson
- Department of Psychiatry & Behavioral Health, Houston Methodist, Houston, TX, USA; Department of Molecular Virology & Microbiology, Alkek Center for Metagenomics and Microbiome Research, Baylor College of Medicine, Houston, TX, USA
| | - J Christopher Fowler
- Department of Psychiatry & Behavioral Health, Houston Methodist, Houston, TX, USA; Houston Methodist Academic Institute, Houston, TX, USA; Department of Psychiatry, Weill Cornell Medical College, New York, NY, USA
| | | | - Benjamin L Weinstein
- Department of Psychiatry & Behavioral Health, Houston Methodist, Houston, TX, USA
| | - Joseph Petrosino
- Department of Molecular Virology & Microbiology, Alkek Center for Metagenomics and Microbiome Research, Baylor College of Medicine, Houston, TX, USA
| | - Alok Madan
- Department of Psychiatry & Behavioral Health, Houston Methodist, Houston, TX, USA; Houston Methodist Academic Institute, Houston, TX, USA; Department of Psychiatry, Weill Cornell Medical College, New York, NY, USA
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Constantinou MP, Frueh BC, Fowler JC, Allen JG, Madan A, Oldham JM, Fonagy P. Predicting depression outcomes throughout inpatient treatment using the general and specific personality disorder factors. Psychol Med 2022; 52:1838-1846. [PMID: 33028440 DOI: 10.1017/s003329172000361x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Clinical intuition suggests that personality disorders hinder the treatment of depression, but research findings are mixed. One reason for this might be the way in which current assessment measures conflate general aspects of personality disorders, such as overall severity, with specific aspects, such as stylistic tendencies. The goal of this study was to clarify the unique contributions of the general and specific aspects of personality disorders to depression outcomes. METHODS Patients admitted to the Menninger Clinic, Houston, between 2012 and 2015 (N = 2352) were followed over a 6-8-week course of multimodal inpatient treatment. Personality disorder symptoms were assessed with the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, 4th edition Axis II Personality Screening Questionnaire at admission, and depression severity was assessed using the Patient Health Questionnaire-9 every fortnight. General and specific personality disorder factors estimated with a confirmatory bifactor model were used to predict latent growth curves of depression scores in a structural equation model. RESULTS The general factor predicted higher initial depression scores but not different rates of change. By contrast, the specific borderline factor predicted slower rates of decline in depression scores, while the specific antisocial factor predicted a U shaped pattern of change. CONCLUSIONS Personality disorder symptoms are best represented by a general factor that reflects overall personality disorder severity, and specific factors that reflect unique personality styles. The general factor predicts overall depression severity while specific factors predict poorer prognosis which may be masked in prior studies that do not separate the two.
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Affiliation(s)
- Matthew P Constantinou
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - B Christopher Frueh
- Psychiatry and Behavioral Sciences, University of Texas Health Sciences Center, Houston, TX, USA
- Department of Psychology, University of Hawaii, Hilo, HI, USA
| | - J Christopher Fowler
- Psychiatry and Behavioral Sciences, University of Texas Health Sciences Center, Houston, TX, USA
- Houston Methodist Hospital, Houston, TX, USA
| | - Jon G Allen
- Psychiatry & Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Alok Madan
- Psychiatry and Behavioral Sciences, University of Texas Health Sciences Center, Houston, TX, USA
- Houston Methodist Hospital, Houston, TX, USA
| | - John M Oldham
- Psychiatry & Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
- The Menninger Clinic, Houston, TX, USA
| | - Peter Fonagy
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
- Psychiatry & Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
- The Menninger Clinic, Houston, TX, USA
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Amoura Z, Anders H, Rovin B, Zhao M, Malvar A, Hiromura K, Jones-Leone A, Gonzalez-Rivera T, Gilbride J, Madan A, Green Y, Roth D. Effets du belimumab (BEL) sur les paramètres rénaux chez les patients (pts) avec une néphropathie lupique (NL) active en rechute ou nouvellement diagnostiquée. Rev Med Interne 2022. [DOI: 10.1016/j.revmed.2022.03.260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Orme WH, Fowler JC, Bradshaw MR, Carlson M, Hadden J, Daniel J, Flack JN, Freeland D, Head J, Marder K, Weinstein BL, Madan A. Functional Rehabilitation: An Integrated Treatment Model for Patients With Complex Physical and Psychiatric Conditions. J Psychiatr Pract 2022; 28:193-202. [PMID: 35511095 DOI: 10.1097/pra.0000000000000623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The health care delivery system in the United States, structured to provide single-disease care, presents unique challenges for patients with complex physical and psychiatric comorbidities. Patients in these populations are often referred to multiple specialty clinics, encounter little continuity of care or collaboration among their providers, incur high health care costs, and experience poor treatment outcomes. Given these barriers, questions remain about the extent to which siloed and fragmented care, as opposed to the complex nature of the illnesses themselves, contribute to poor outcomes. If given the opportunity to receive well-integrated, consistent, and personalized care, can patients with historically difficult-to-treat comorbid medical and mental illnesses make progress? This article describes an innovative model of care called functional rehabilitation that is designed to address existing barriers in treatment. The functional rehabilitation program seeks to disrupt the escalating effects of interacting comorbidities by offering highly collaborative treatment from a small team of clinicians, personalized interventions using a shared decision-making framework, multipronged treatment options, colocation in a large hospital system, and significant 1:1 time with patients. The article includes a case example with longitudinal outcome data that illustrates how progress can be made with appropriate programmatic supports. Future research should examine the cost-effectiveness of this model of care.
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Fowler JC, Lamkin J, Allen JG, Madan A, Oldham JM, Petersen NJ, Frueh BC. Personality trait domains predict psychiatric symptom and functional outcomes. Psychotherapy (Chic) 2021; 59:38-47. [PMID: 34941338 DOI: 10.1037/pst0000421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
A review of high intensity, high dose mentalization-based inpatient psychiatric treatment indicated large effect-size reductions in symptoms of depression, anxiety, somatization, and improving emotion-regulation functioning (Allen et al., 2017). This study examined the impact of pathological personality traits has on baseline symptoms and functioning, as well as their impact on the longitudinal course in a large cohort of adult inpatient psychiatric sample (N = 804). The Personality Inventory for DSM-5 (PID-5; Krueger et al., 2012) was used to assess trait domains impact on longitudinal outcomes (anxiety, depression, somatic symptoms, and functional impairment) using hierarchical repeated measures modeling. Results indicate Negative Affectivity and Detachment were related to higher admission severity in all four outcome domains. Psychoticism was related to somatic symptoms, while Antagonism and Disinhibition were related to functional impairment. Paradoxically, when symptoms were plotted over 2-week intervals during hospitalization, patients with higher admission PID-5 trait scores exhibited greater improvement over time. The PID-5 appears to contribute to prediction of treatment outcome response above and beyond demographic and burden of illness. Importantly, the findings add to a growing body of literature indicating that impairments in personality traits do not preclude positive treatment response, particularly when treatments target pathological personality features. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Affiliation(s)
| | | | | | | | | | - Nancy J Petersen
- VA HSR&D Center for Innovations in Quality, Effectiveness, and Safety (IQUEST)
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Thompson DS, Fowler JC, Bradshaw MR, Frueh BC, Weinstein BL, Petrosino J, Hadden JK, Madan A. Is the gut microbiota associated with suicidality? Non-significant finding among a large cohort of psychiatrically hospitalized individuals with serious mental illness. Journal of Affective Disorders Reports 2021. [DOI: 10.1016/j.jadr.2021.100266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Furie R, Rovin BH, Houssiau F, Contreras G, Curtis P, Madan A, Jones-Leone A, Okily M, Roth D. POS0689 A 6-MONTH OPEN-LABEL EXTENSION STUDY OF THE SAFETY AND EFFICACY OF INTRAVENOUS BELIMUMAB IN PATIENTS WITH LUPUS NEPHRITIS. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.1583] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:BLISS-LN (GSK Study BEL114054; NCT01639339), the largest lupus nephritis (LN) study to date, showed that intravenous (IV) belimumab (BEL) + standard therapy (ST) improved outcomes compared with ST alone in patients (pts) with active LN.1Objectives:To assess additional safety and efficacy data of BEL + ST in pts with LN in a 6-month open-label (OL) phase beyond 2 years of double-blind (DB) treatment in BLISS-LN.Methods:In this OL phase, eligible completers of the DB phase received monthly BEL 10 mg/kg IV + ST for 6 months. Endpoints: safety; Primary Efficacy Renal Response (PERR; uPCR ≤0.7; eGFR no worse than 20% below OL baseline eGFR or ≥60 ml/min/1.73 m2; no prohibited medications) and Complete Renal Response (CRR; uPCR <0.5; eGFR no worse than 10% below OL baseline eGFR or ≥90 ml/min/1.73 m2; no prohibited medications) at OL Week 28; proportion of pts with SLEDAI score <4; corticosteroid use; biomarkers. Analyses were based on observed data and summarised relative to the OL baseline (last value measured prior to the first dose of OL treatment).Results:We enrolled 257 pts (57.4% of pts in BEL114054) and treated 255 pts. All treated pts were included in the safety population (123 pts switched from placebo [PBO] to BEL; 132 pts remained on BEL). Efficacy was assessed in the safety population, excluding 1 pt due to non-compliance (mITT population; PBO to BEL: 122 pts; BEL to BEL: 132 pts). 96.5% of pts completed the OL phase; 3.5% withdrew, mainly due to adverse events (AE; 2.0%).Overall, 168/255 (65.9%) pts had ≥1 AE (76/123 [61.8%] PBO to BEL pts; 92/132 [69.7%] BEL to BEL pts); 15/255 (5.9%) pts had ≥1 serious AE (5/123 [4.1%] PBO to BEL pts; 10/132 [7.6%] BEL to BEL pts); 1 (0.8%) pt died in the PBO to BEL group.Proportions of PERR and CRR responders increased from OL baseline to OL Week 28 (Table 1. below)Proportions of pts who attained SLEDAI scores <4 increased from OL baseline to OL Week 28 in the BEL to BEL group and decreased in the PBO to BEL group. Among pts receiving average daily prednisone-equivalent doses of ≤5 mg or ≤7.5 mg dose was maintained from OL baseline to OL Week 28 (Table 1. below)In pts with autoantibodies at OL baseline, anti-dsDNA and anti-C1q levels decreased from OL baseline to OL Week 28 in both groups. Among pts with low C3/C4 levels at OL baseline, C3/C4 levels increased from OL baseline to OL Week 28 in both groups (Table 1. below)Conclusion:In this OL phase of BLISS-LN, proportions of PERR and CRR responders increased in both the BEL-naïve and BEL-experienced groups; and no new safety signals were observed. Improvements in biomarker levels were observed, especially in pts who switched from PBO to BEL.Funding:GSK.References:[1]Furie R, et al. N Engl J Med. 2020;383(12):1117-28.Table 1.Responses at OL baseline and OL Week 28 (mITT population, N=254)OL baseline*OL Week 28PBO to BEL(n=122)BEL to BEL(n=132)PBO to BEL(n=122)BEL to BEL(n=132)n122132118122PERR, n (%)73 (59.8)†93 (70.5)†79 (66.9)91 (74.6)CRR, n (%)44 (36.1)†63 (47.7)†57 (48.3)76 (62.3)SLEDAI score <4n122132120122Responders, n (%)44 (36.1)†64 (48.5)†40 (33.3)64 (52.5)Prednisone-equivalent dosen122132121128≤5 mg, n (%)59 (48.4)78 (59.1)60 (49.6)75 (58.6)≤7.5 mg, n (%)62 (50.8)85 (64.4)66 (54.5)83 (64.8)Anti-dsDNA (IU/ml)‡n85648161Median (IQR) levels107.0 (49.0, 212.0)65.5 (42.5, 126.5)--Median (IQR) % change from baseline---30.2 (-46.3, -6.8)-10.7 (-27.2, 9.1)Anti-C1q (U/ml)§n64605854Median (IQR) levels71.7 (36.6, 167.5)47.1 (33.0, 75.7)--Median (IQR) % change from baseline---23.0 (-41.5, 0.5)-16.5 (-33.0, 6.1)C3 (mg/dl)‖n45374435Median (IQR) levels78.0 (72.0, 83.0)80.0 (71.0, 84.0)--Median (IQR) % change from baseline--6.2 (-4.2, 14.6)4.7 (-4.8, 16.9)C4 (mg/dl)‖n18121811Median (IQR) levels7.5 (6.0, 8.0)7.0 (7.0, 8.5)--Median (IQR) % change from baseline--23.6 (11.1, 37.5)11.1 (0.0, 57.1)*DB Week 104 visit and the OL baseline visit were the same visit; †Post hoc analyses; ‡Among anti-dsDNA positive pts at OL baseline (≥30 IU/ml); §Among anti-C1q positive pts at OL baseline (≥22.2 U/ml); ‖Among pts with low C3 (<90 mg/dl)/C4 (<10 mg/dl) levels at OL baseline.Acknowledgements:Medical writing assistance was provided by Olga Conn, PhD, Fishawack Indicia Ltd., UK, part of Fishawack Health, and was funded by GSK.Disclosure of Interests:Richard Furie Consultant of: GSK, Grant/research support from: GSK, Brad H Rovin Consultant of: GSK, Frederic Houssiau Consultant of: GSK, Grant/research support from: UCB, Gabriel Contreras Consultant of: Genentech, Merck, Grant/research support from: Genentech, Merck, Paula Curtis Shareholder of: GSK, Employee of: GSK, Anuradha Madan Shareholder of: GSK, Employee of: GSK, Angela Jones-Leone Shareholder of: GSK, Employee of: GSK, Mohamed Okily Shareholder of: GSK, Employee of: GSK, David Roth Shareholder of: GSK, Employee of: GSK
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Abstract
This manuscript provides an overview of our efforts to implement an integrated electronic monitoring and feedback platform to increase patient engagement, improve care delivery and outcome of treatment, and alert care teams to deterioration in functioning. Patients First utilizes CareSense, a digital care navigation and data collection system, to integrate traditional patient-reported outcomes monitoring with novel biological monitoring between visits to provide patients and caregivers with real-time feedback on changes in symptoms such as stress, anxiety, and depression. The next stage of project development incorporates digital therapeutics (computerized therapeutic interventions) for patients, and video resources for primary care physicians and nurse practitioners who serve as the de facto front line for psychiatric care. Integration of the patient-reported outcomes monitoring with continuous biological monitoring, and digital supports is a novel application of existing technologies. Video resources pushed to care providers whose patients trigger a symptom severity alert is, to our knowledge, an industry first.
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Fowler JC, Carlson M, Orme WH, Allen JG, Oldham JM, Madan A, Frueh BC. Diagnostic accuracy of DSM-5 borderline personality disorder criteria: Toward an optimized criteria set. J Affect Disord 2021; 279:203-207. [PMID: 33059223 DOI: 10.1016/j.jad.2020.09.138] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 08/16/2020] [Accepted: 09/27/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The polythetic system used by the Diagnostic and Statistical Manual for Mental Disorders (DSM-5) for diagnosing borderline personality disorders (BPD) is far from optimal; however, accumulated research and clinical data are strong enough to warrant ongoing utilization. This study examined diagnostic efficiency of the nine DSM-IV BPD criteria, then explored the feasibility of an optimized criteria set in classifying BPD. METHODS Adults (N=1,623) completed the Structured Clinical Interviews for DSM-IV Axis II Disorders resulting in a BPD group (n=352) and an inpatient psychiatric control group (PC) with no personality disorders (n=1,271). Receiver operator characteristics and diagnostic efficiency statistics were calculated to ascertain the relative diagnostic efficiency of each DSM-5 BPD criterion in classifying BPD cases. RESULTS Affective instability (Criterion 6) evidenced the strongest capacity to differentiate the groups (AUC = .84, SE = .01, p < .0001). Abandonment fears (Criterion 1), unstable relationships (Criterion 2), identity disturbance (Criterion 3), impulsivity (Criterion 4), and chronic emptiness (Criterion 7) yielded good-to-moderate discrimination (AUC range = .75-.79). A composite index of these six criteria yielded excellent accuracy (AUC = .98, SE = .002, p < .0001), sensitivity (SN=.99), and specificity (SP=.90). CONCLUSIONS The current findings add to evidence that affective instability is a useful gate criterion for screening, and the optimized criteria set evidences equivalent accuracy to the original 9 criteria, with a substantial reduction in estimated heterogeneity (from 256 combinations with the original set to 42 combinations with the optimized set).
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Affiliation(s)
- J Christopher Fowler
- Houston Methodist Academic Institute, 6670 Bertner Ave, Houston, TX 77030; Weill Cornell Medical College, 1300 York Ave, New York, NY 10065; University of Texas Health Sciences Center, Houston, TX; Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030.
| | - Marianne Carlson
- Houston Methodist Academic Institute, 6670 Bertner Ave, Houston, TX 77030
| | - William H Orme
- Houston Methodist Academic Institute, 6670 Bertner Ave, Houston, TX 77030; University of Texas Health Sciences Center, Houston, TX
| | - Jon G Allen
- Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030
| | - John M Oldham
- Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030
| | - Alok Madan
- Houston Methodist Academic Institute, 6670 Bertner Ave, Houston, TX 77030; University of Texas Health Sciences Center, Houston, TX; Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030
| | - B Christopher Frueh
- University of Texas Health Sciences Center, Houston, TX; University of Hawaii, 200 West Kawili St., Hilo, HI 96720
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Orme W, Kapoor S, Frueh BC, Allen JG, Fowler JC, Madan A. Attachment Style Mediates the Relationship between Trauma and Somatic Distress among Individuals with Serious Mental Illness. Psychiatry 2021; 84:150-164. [PMID: 34293279 DOI: 10.1080/00332747.2021.1930427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Objective: Individuals with mental illnesses severe enough to require psychiatric hospitalization often have significant trauma histories, have developed maladaptive attachment styles, and experience comorbid somatic distress. Gaining an understanding about the interaction of such factors may lead to prioritizing interventions that target factors that mediate the relationship between trauma and adverse somatic distress. Prior research has examined various mediation models, but results have been mixed and conducted only on outpatient samples.Method: Participants (47.7% female) in a large sample (N = 2702) with a mean age of 34.62 (SD = 14.7) were enrolled in a specialist inpatient program and completed self-report measures pertaining to demographics, attachment insecurity, lifetime trauma exposure, and somatic distress within 72 hours of admission. The dimensions of attachment insecurity (i.e., attachment anxiety and attachment avoidance) were tested as parallel mediators in the relationship between lifetime trauma exposure and somatic distress.Results: The mediation analyses revealed that attachment anxiety and avoidance partially mediated the relationship between lifetime trauma exposure and somatic distress.Conclusions: These results are the first to date to implicate both attachment anxiety and avoidance as mediators between trauma exposure and somatic distress in a high acuity sample. Although the results do not imply causality, they do call attention to social-cognitive factors related to somatic distress and highlight the importance of considering attachment styles as a possible contributor to comorbid physical symptoms in patients with trauma exposure.
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Sasangohar F, Bradshaw MR, Carlson MM, Flack JN, Fowler JC, Freeland D, Head J, Marder K, Orme W, Weinstein B, Kolman JM, Kash B, Madan A. Adapting an Outpatient Psychiatric Clinic to Telehealth During the COVID-19 Pandemic: A Practice Perspective. J Med Internet Res 2020; 22:e22523. [PMID: 32936768 PMCID: PMC7546859 DOI: 10.2196/22523] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 09/04/2020] [Accepted: 09/14/2020] [Indexed: 01/05/2023] Open
Abstract
As the demand for telepsychiatry increases during the COVID-19 pandemic, the strengths and challenges of telepsychiatry implementation must be articulated to improve clinical practices in the long term. Currently, observations within US contexts are lacking; therefore, we report on the rapid implementation of telepsychiatry and workflow experiences in a psychiatric practice based within a large health care system in southeast Texas with a national catchment area. We discuss the logistics of the implementation, including modes of communication, scheduling, coordination, and capacity; the psychological effects of web-based services, including both the loss of the physical therapeutic environment and the unique interpersonal dynamics experienced in the virtual environment; and postadoption patterns of engagement with our services and with other clinical functions affected by the rapid adaptation to telemedicine. Our art therapy group programming serves as an applied case study, demonstrating the value of a well-managed web-based program (eg, patients were receptive and well-engaged, and they appreciated the continuity of accessible service) as well as the challenges (eg, the need for backup plans and technological fallbacks, managing interruptions and telecommunication learning curves, and working around the difference in resources for art and music therapy between a well-stocked clinical setting versus clients’ home spaces). We conclude from our experience that the overall strengths of telepsychiatry include receptive and well-engaged responses from patients as well as the expansion of boundaries, which provides a directly contextualized view into patients’ home lives. Challenges and corresponding recommendations include the need for more careful safety planning for high-risk patients; maintaining professional boundaries in the newly informal virtual setting; designing the physical space to both frame the patient encounter and maintain work-life balance for the therapist; allowing for delays and interruptions (including an initial acclimation session); and preserving interprofessional care team collaboration when the physical locations that normally facilitate such encounters are not accessible. We believe that careful observations of the strengths and challenges of telepsychiatry during this pandemic will better inform practices that are considering telepsychiatry adoption both within pandemic contexts and more broadly thereafter.
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Affiliation(s)
- Farzan Sasangohar
- Center for Outcomes Research, Houston Methodist Hospital, Houston, TX, United States
| | - Major R Bradshaw
- Behavioral Health Clinic, Houston Methodist Hospital, Houston, TX, United States
| | | | - James N Flack
- Behavioral Health Clinic, Houston Methodist Hospital, Houston, TX, United States
| | - James C Fowler
- Behavioral Health Clinic, Houston Methodist Hospital, Houston, TX, United States
| | - Diana Freeland
- Behavioral Health Clinic, Houston Methodist Hospital, Houston, TX, United States
| | - John Head
- Behavioral Health Clinic, Houston Methodist Hospital, Houston, TX, United States
| | - Kate Marder
- Behavioral Health Clinic, Houston Methodist Hospital, Houston, TX, United States
| | - William Orme
- Behavioral Health Clinic, Houston Methodist Hospital, Houston, TX, United States
| | - Benjamin Weinstein
- Behavioral Health Clinic, Houston Methodist Hospital, Houston, TX, United States
| | - Jacob M Kolman
- Center for Outcomes Research, Houston Methodist Hospital, Houston, TX, United States
| | - Bita Kash
- Center for Outcomes Research, Houston Methodist Hospital, Houston, TX, United States
| | - Alok Madan
- Behavioral Health Clinic, Houston Methodist Hospital, Houston, TX, United States
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Frueh BC, Madan A, Fowler JC, Stomberg S, Bradshaw M, Kelly K, Weinstein B, Luttrell M, Danner SG, Beidel DC. "Operator syndrome": A unique constellation of medical and behavioral health-care needs of military special operation forces. Int J Psychiatry Med 2020; 55:281-295. [PMID: 32052666 DOI: 10.1177/0091217420906659] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE U.S. military special operation forces represent the most elite units of the U.S. Armed Forces. Their selection is highly competitive, and over the course of their service careers, they experience intensive operational training and combat deployment cycles. Yet, little is known about the health-care needs of this unique population. METHOD Professional consultations with over 50 special operation forces operators (and many spouses or girlfriends) over the past 6 years created a naturalistic, observational base of knowledge that allowed our team to identify a unique pattern of interrelated medical and behavioral health-care needs. RESULTS We identified a consistent pattern of health-care difficulties within the special operation forces community that we and other special operation forces health-care providers have termed "Operator Syndrome." This includes interrelated health and functional impairments including traumatic brain injury effects; endocrine dysfunction; sleep disturbance; obstructive sleep apnea; chronic joint/back pain, orthopedic problems, and headaches; substance abuse; depression and suicide; anger; worry, rumination, and stress reactivity; marital, family, and community dysfunction; problems with sexual health and intimacy; being "on guard" or hypervigilant; memory, concentration, and cognitive impairments; vestibular and vision impairments; challenges of the transition from military to civilian life; and common existential issues. CONCLUSIONS "Operator Syndrome" may be understood as the natural consequences of an extraordinarily high allostatic load; the accumulation of physiological, neural, and neuroendocrine responses resulting from the prolonged chronic stress; and physical demands of a career with the military special forces. Clinical research and comprehensive, intensive immersion programs are needed to meet the unique needs of this community.
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Affiliation(s)
- B Christopher Frueh
- Department of Psychology, University of Hawaii, Hilo, HI, USA.,Trauma and Resilience Center, Department of Psychiatry and Behavioral Sciences, University of Texas Health Sciences Center, Houston, TX, USA.,Department of Behavioral Health, Houston Methodist Hospital, Houston, TX, USA
| | - Alok Madan
- Trauma and Resilience Center, Department of Psychiatry and Behavioral Sciences, University of Texas Health Sciences Center, Houston, TX, USA.,Department of Behavioral Health, Houston Methodist Hospital, Houston, TX, USA
| | - J Christopher Fowler
- Trauma and Resilience Center, Department of Psychiatry and Behavioral Sciences, University of Texas Health Sciences Center, Houston, TX, USA.,Department of Behavioral Health, Houston Methodist Hospital, Houston, TX, USA
| | - Sasha Stomberg
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Major Bradshaw
- Trauma and Resilience Center, Department of Psychiatry and Behavioral Sciences, University of Texas Health Sciences Center, Houston, TX, USA.,Department of Behavioral Health, Houston Methodist Hospital, Houston, TX, USA
| | - Karen Kelly
- Department of Warfighter Performance, Naval Health Research Center, San Diego, CA, USA
| | - Benjamin Weinstein
- Trauma and Resilience Center, Department of Psychiatry and Behavioral Sciences, University of Texas Health Sciences Center, Houston, TX, USA.,Department of Behavioral Health, Houston Methodist Hospital, Houston, TX, USA
| | - Morgan Luttrell
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Sciences Center, Houston, TX, USA
| | - Summer G Danner
- Trauma and Resilience Center, Department of Psychiatry and Behavioral Sciences, University of Texas Health Sciences Center, Houston, TX, USA
| | - Deborah C Beidel
- Department of Psychology, University of Central Florida, Orlando, FL, USA
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Orme WH, Szczepanek AE, Allen JG, Oldham JM, Madan A, Frueh BC, Fowler JC. Lifetime and prospective associations among personality trait domains and suicide-related behaviors in patients with severe mental illness. J Affect Disord 2020; 266:492-497. [PMID: 32063548 DOI: 10.1016/j.jad.2020.01.182] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 01/09/2020] [Accepted: 01/31/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Despite extensive research and clinical efforts, the suicide rate in the United States continues to rise, driving the need for more research to identify latent factors that increase risk for suicide and to guide treatment decision-making. METHODS The current study examined a large cohort (N = 1,219) of high-risk psychiatric inpatients to explore associations between personality traits and suicide-related variables measured retrospectively (lifetime history prior to hospital admission) and prospectively (at discharge and 12-month follow-up). RESULTS Lifetime suicide-related behavior (SRB: combination of ideational severity, aborted, interrupted, actual attempts, and non-suicidal self-injury) was associated with age (younger), gender (female), and elevated scores on the Personality Inventory for DSM-5 (PID-5) negative affectivity, borderline trait composite score, and five-factor model traits of conscientiousness and neuroticism. Patients who manifested persistent suicidal ideation throughout a 6-8 week inpatient treatment (n = 162; 16.9%) tended to be younger, female, and to have elevated PID-5 borderline trait composite scores. Twelve-month post-discharge SRB was predicted by elevated PID-5 borderline trait composite scores. LIMITATIONS Personality traits accounted for a small amount of variance in the overall model, thus limiting prediction based on individual traits. CONCLUSIONS This large sample of high-risk inpatients with longitudinal outcomes provides a rare assessment of proximal personality traits in predicting lifetime SRB, persistent suicidal ideation observed during the course of a 6-8-week intensive inpatient treatment, and SRB outcomes within 12 months after discharge from hospitalization. Personality traits should be included in future attempts to create predictive algorithms that include relevant biological data (neuroimaging, genetic, microbiome).
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Affiliation(s)
- William H Orme
- Houston Methodist Behavioral Health, 6550 Fannin St Houston, TX 77030, USA; University of Texas McGovern School of Medicine, 1941 East Rd, Houston, TX 77054, USA.
| | | | - Jon G Allen
- Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA
| | - John M Oldham
- Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA
| | - Alok Madan
- Houston Methodist Behavioral Health, 6550 Fannin St Houston, TX 77030, USA; Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA; University of Texas McGovern School of Medicine, 1941 East Rd, Houston, TX 77054, USA
| | - B Christopher Frueh
- University of Texas McGovern School of Medicine, 1941 East Rd, Houston, TX 77054, USA; University of Hawaii, 200 West Kawili St., Hilo, HI 96720, USA
| | - J Christopher Fowler
- Houston Methodist Behavioral Health, 6550 Fannin St Houston, TX 77030, USA; Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA; University of Texas McGovern School of Medicine, 1941 East Rd, Houston, TX 77054, USA
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15
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Madan A, Thompson D, Fowler JC, Ajami NJ, Salas R, Frueh BC, Bradshaw MR, Weinstein BL, Oldham JM, Petrosino JF. The gut microbiota is associated with psychiatric symptom severity and treatment outcome among individuals with serious mental illness. J Affect Disord 2020; 264:98-106. [PMID: 32056780 DOI: 10.1016/j.jad.2019.12.020] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 12/09/2019] [Accepted: 12/13/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND Emerging evidence implicates the gut microbiota in central nervous system functioning via its effects on inflammation, the hypothalamic-pituitary axis, and/or neurotransmission. Our understanding of the cellular underpinnings of the brain-gut relationship is based almost exclusively on animal models with some small-scale human studies. This study examined the relationship between the gut microbiota and psychiatric symptom severity and treatment response among inpatients with serious mental illness. METHOD We collected data from adult inpatients (N = 111). Measures of diagnoses, suicide severity, trauma, depression, and anxiety were collected shortly after admission, while self-collected fecal swabs were collected early in the course of hospitalization and processed using 16S rRNA gene sequencing and whole genome shotgun sequencing methods. RESULTS Results indicate that depression and anxiety severity shortly after admission were negatively associated with bacterial richness and alpha diversity. Additional analyses revealed a number of bacterial taxa associated with depression and anxiety severity. Gut microbiota richness and alpha diversity early in the course of hospitalization was a significant predictor of depression remission at discharge. CONCLUSIONS This study is among the first to demonstrate a gut microbiota relationship with symptom severity among psychiatric inpatients as well as a relationship to remission of depression post-treatment. These findings are consistent with animal models and limited human studies as well as with the broader literature implicating inflammation in the pathophysiology of depression. These findings offer the foundation for further studies of novel therapeutic approaches to the treatment, prevention of, or recurrence of serious mental illness.
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Affiliation(s)
- A Madan
- Houston Methodist Hospital, Houston, TX, USA; Psychiatry and Behavioral Sciences, University of Texas Health Science Center at Houston, Houston, TX, USA.
| | - D Thompson
- Alkek Center for Metagenomics and Microbiome Research, Baylor College of Medicine, Houston, TX, USA
| | - J C Fowler
- Houston Methodist Hospital, Houston, TX, USA; Psychiatry and Behavioral Sciences, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - N J Ajami
- Alkek Center for Metagenomics and Microbiome Research, Baylor College of Medicine, Houston, TX, USA
| | - R Salas
- Psychiatry & Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA; Michael E DeBakey VA Medical, Houston, TX, USA; The Menninger Clinic, Houston, TX, USA
| | - B C Frueh
- Psychiatry and Behavioral Sciences, University of Texas Health Science Center at Houston, Houston, TX, USA; Department of Psychology, University of Hawaii, Hilo, USA
| | - M R Bradshaw
- Houston Methodist Hospital, Houston, TX, USA; Psychiatry and Behavioral Sciences, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - B L Weinstein
- Houston Methodist Hospital, Houston, TX, USA; Psychiatry and Behavioral Sciences, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - J M Oldham
- Psychiatry & Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA; The Menninger Clinic, Houston, TX, USA
| | - J F Petrosino
- Alkek Center for Metagenomics and Microbiome Research, Baylor College of Medicine, Houston, TX, USA
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Srivastava S, Bhalla S, Madan A. Shape memory alloy actuation of non-bonded piezo sensor configuration for bone diagnosis and impedance based analysis. Biomed Eng Lett 2019; 9:435-447. [PMID: 31799013 DOI: 10.1007/s13534-019-00128-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 07/12/2019] [Accepted: 08/01/2019] [Indexed: 10/26/2022] Open
Abstract
In the recent years, there has been a growing interest in research community towards the application of smart materials for bio-medical structural health monitoring. Amongst the smart materials, directly bonded piezo sensors (DBPS), based on the electro-mechanical impedance (EMI) technique, have been successfully employed for the above purpose. The principle behind the EMI technique is that high frequency excitations (typically > 30 kHz) generated by a surface bonded PZT patch are used to detect changes in structural drive point impedance caused by cracks or any other type of damage. Bone healing and damage have been shown to be successfully monitored using the DBPS. However, in most of the diagnostic cases of live human and animal subjects, directly bonding a PZT patch is always an irritant or hazard for a live subject. To circumvent direct bonding, the authors have developed and experimentally demonstrated a non-bonded piezo sensor (NBPS) configuration as a good alternative to DBPS while maintaining the effectiveness of measurement well within discernible limits. This paper presents further improvement in the NBPS configuration aiming at autonomous operation of the gripping mechanism using shape memory alloy (SMA) wires. The experiments are performed on replicas of femur bone in healthy and osteoporosis state. This paper shows the effective use of SMA clamping for bone identification and its damage assessment in comparison to earlier mechanical gripping using jubilee clamps. This paper also covers impedance based identification applied to SMA and clamp based NBPS configurations. In place of raw admittance signatures, effective drive point impedance is utilized for the purpose of bone diagnostics which provides a more realistic assessment of the condition of bone.
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Affiliation(s)
- Shashank Srivastava
- 1School of Engineering and Technology, Indira Gandhi National Open University, Maidan Garhi, New Delhi, 110068 India
| | - Suresh Bhalla
- 2Department of Civil Engineering, Indian Institute of Technology Delhi, Hauz Khas, New Delhi, 110016 India
| | - Alok Madan
- 2Department of Civil Engineering, Indian Institute of Technology Delhi, Hauz Khas, New Delhi, 110016 India
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17
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Dowdle LT, Borckardt JJ, Back SE, Morgan K, Adams D, Madan A, Balliet W, Hanlon CA. Sensitized brain response to acute pain in patients using prescription opiates for chronic pain: A pilot study. Drug Alcohol Depend 2019; 200:6-13. [PMID: 31071496 PMCID: PMC6914256 DOI: 10.1016/j.drugalcdep.2019.02.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 02/07/2019] [Accepted: 02/11/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Chronic opiate use leads to a sensitized behavioral response to acute pain, which in turn, leads to escalating doses of opiates. This study was designed to test the hypothesis that chronic opiate usage is also associated with a sensitized neurobiological response to acute pain in individuals that have used prescription opiates for 6 or more months. METHODS Fourteen patients with non-alcoholic chronic pancreatitis that have been taking prescription opiates for 6 or more months and 14 gender matched, non-opiate using controls were enrolled. Functional neuroimaging data was acquired while participants received blocks of thermal stimulation to their wrist (individually-tailored to their pain threshold). RESULTS Self-reported pain was significantly greater in opiate using patients (3.4 ± 3.4) than controls (0.2 ± 0.8: Brief Pain Inventory p < 0.005), however no significant difference between groups was observed in the individually-tailored pain thresholds. Opiate using patients evidenced a significantly greater response to pain than controls in two established nodes of the "Pain Matrix": somatosensory cortex (pFWE≤0.001) and anterior cingulate cortex (p ≤ 0.01). This response was positively correlated with prescribed morphine equivalent dosages (average: 133.5 ± 94.8 mg/day). CONCLUSION The findings suggest that in chronic pancreatitis patients, a dose of opiates that normalizes their behavioral response to acute pain is associated with an amplified neural response to acute pain. Further longitudinal studies are needed to determine if this neural sensitization hastens a behavioral tolerance to opiates or the development of an opioid use disorder.
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Affiliation(s)
- Logan T. Dowdle
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA,Department of Neurosciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Jeffrey J. Borckardt
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA,Center for Biomedical Imaging, Medical University of South Carolina, Charleston, South Carolina, USA,Ralph H. Johnson VA Medical Center, Charleston, South Carolina, USA
| | - Sudie E. Back
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA,Ralph H. Johnson VA Medical Center, Charleston, South Carolina, USA
| | - Katherine Morgan
- Department of Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - David Adams
- Department of Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Alok Madan
- Houston Methodist Behavioral Health, Houston, Texas, USA
| | - Wendy Balliet
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Colleen A. Hanlon
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA,Department of Neurosciences, Medical University of South Carolina, Charleston, South Carolina, USA,Center for Biomedical Imaging, Medical University of South Carolina, Charleston, South Carolina, USA,Ralph H. Johnson VA Medical Center, Charleston, South Carolina, USA
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18
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Standaert B, Dort T, Linden J, Madan A, Bart S, Chu L, Hayney MS, Kosinski M, Kroll R, Malak J, Meier G, Segall N, Schuind A. Usability of daily SF36 questionnaires to capture the QALD variation experienced after vaccination with AS03 A-adjuvanted monovalent influenza A (H5N1) vaccine in a safety and tolerability study. Health Qual Life Outcomes 2019; 17:80. [PMID: 31060567 PMCID: PMC6501410 DOI: 10.1186/s12955-019-1147-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 04/25/2019] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND This study aims to describe the short-term reactogenicity of the AS03-adjuvanted H5N1 vaccine expressed through adverse events (AEs) and quality-adjusted life-day (QALD) scores. The AEs are likely to be short-term and therefore the quality of life (QoL) questionnaire, SF-36v2, was administered daily to record changes over seven days. A more sensitive application of this instrument should allow for a better understanding of short-term tolerability of adjuvanted vaccines. METHODS Participants (N = 50) received a 2-dose vaccination schedule. Solicited (collected daily: days 0 to 7 [post dose 1] and 21 to 28 [post dose 2]) and unsolicited (collected weekly until day 21) AEs were collected via diary cards. The QoL questionnaires were completed daily (days 0-6) and weekly (days 0, 6, 21, 27) after dose one. Questionnaire data were transformed into SF-6D scores to report QALDs. It was hypothesized post-hoc that the QALD and daily AEs scores should correlate if discrete QoL-changes were captured. RESULTS Pain (92%) and muscle ache (66%) were the most commonly reported solicited local and general AEs respectively, neither increased in intensity nor in frequency after dose 2. No safety concerns were identified during the study. A correlation between the daily AEs and QALD scores existed (correlation coefficient, - 0.97 (p < 0.001)). The impact of the AEs scores on the QALD was marginal (- 0.02 max for one day). CONCLUSION Similarly with other H5N1 studies, no safety concern was identified throughout the study. Some time-limited variations in QALD-scores were reported. Our results imply that daily administration of the SF-36v2 captures changes in QALD-scores. TRIAL REGISTRATION ClinicalTrials.gov . NCT01788228. Registered 11 February 2013.
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Affiliation(s)
- B Standaert
- GSK, 20 Avenue Fleming, 1300, Wavre, Belgium.
| | - T Dort
- Keyrus Management SA c/o GSK, Wavre, Belgium.,Present address: Biogen International GmbH, Baar, Switzerland
| | | | | | - S Bart
- Optimal Research LLC, Rockville, MD, USA
| | - L Chu
- Benchmark Research, Austin, TX, USA
| | - M S Hayney
- School of Pharmacy, University of Wisconsin-Madison, School of Medicine and Public Health, Madison, WI, USA
| | | | - R Kroll
- Seattle Women's: Health, Research, Gynecology, University of Washington, Seattle, WA, USA
| | - J Malak
- University of Wisconsin-Madison, Madison, WI, USA
| | - G Meier
- Eisai, Woodcliff Lake, NJ, USA
| | - N Segall
- Clinical Research Atlanta, Stockbridge, GA, USA
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Powers A, Madan A, Hilbert M, Reeves ST, George M, Nash MR, Borckardt JJ. Effects of Combining a Brief Cognitive Intervention with Transcranial Direct Current Stimulation on Pain Tolerance: A Randomized Controlled Pilot Study. Pain Med 2019; 19:677-685. [PMID: 28460127 DOI: 10.1093/pm/pnx098] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Objective Cognitive behavioral therapy has been shown to be effective for treating chronic pain, and a growing literature shows the potential analgesic effects of minimally invasive brain stimulation. However, few studies have systematically investigated the potential benefits associated with combining approaches. The goal of this pilot laboratory study was to investigate the combination of a brief cognitive restructuring intervention and transcranial direct current stimulation (tDCS) over the left dorsolateral prefrontal cortex in affecting pain tolerance. Design Randomized, double-blind, placebo-controlled laboratory pilot. Setting Medical University of South Carolina. Subjects A total of 79 healthy adult volunteers. Methods Subjects were randomized into one of six groups: 1) anodal tDCS plus a brief cognitive intervention (BCI); 2) anodal tDCS plus pain education; 3) cathodal tDCS plus BCI; 4) cathodal tDCS plus pain education; 5) sham tDCS plus BCI; and 6) sham tDCS plus pain education. Participants underwent thermal pain tolerance testing pre- and postintervention using the Method of Limits. Results A significant main effect for time (pre-post intervention) was found, as well as for baseline thermal pain tolerance (covariate) in the model. A significant time × group interaction effect was found on thermal pain tolerance. Each of the five groups that received at least one active intervention outperformed the group receiving sham tDCS and pain education only (i.e., control group), with the exception of the anodal tDCS + education-only group. Cathodal tDCS combined with the BCI produced the largest analgesic effect. Conclusions Combining cathodal tDCS with BCI yielded the largest analgesic effect of all the conditions tested. Future research might find stronger interactive effects of combined tDCS and a cognitive intervention with larger doses of each intervention. Because this controlled laboratory pilot employed an acute pain analogue and the cognitive intervention did not authentically represent cognitive behavioral therapy per se, the implications of the findings on chronic pain management remain unclear.
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Affiliation(s)
- Abigail Powers
- Psychiatry and Behavioral Sciences, Emory University, Atlanta, Georgia
| | - Alok Madan
- The Menninger Clinic, Houston, Texas.,Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas
| | | | | | - Mark George
- Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina.,Ralph Johnson VAMC, Charleston, South Carolina
| | - Michael R Nash
- University of Tennessee, Knoxville Department of Psychology
| | - Jeffrey J Borckardt
- Anesthesia and Perioperative Medicine.,Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina.,Ralph Johnson VAMC, Charleston, South Carolina
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20
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Fowler JC, Madan A, Frueh BC, Bradshaw M, Flack J, Weinstein B. Lessons learned while integrating patient-reported outcomes in a psychiatric hospital. Psychotherapy (Chic) 2019; 56:91-99. [DOI: 10.1037/pst0000174] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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21
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Kilincaslan A, Gunes A, Eskin M, Madan A. Linguistic adaptation and psychometric properties of the Columbia-Suicide Severity Rating Scale among a heterogeneous sample of adolescents in Turkey. Int J Psychiatry Med 2019; 54:115-132. [PMID: 30058463 DOI: 10.1177/0091217418791454] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVE The Columbia-Suicide Severity Rating Scale is a semistructured, interview-based assessment tool, which is increasingly being used for clinical and research purposes across the globe, despite its limited psychometric evaluation outside of English-speaking populations. The aim of this study was to linguistically adapt the measure and investigate reliability, validity, and factor structure of the Turkish version of the Columbia-Suicide Severity Rating Scale in a heterogeneous sample of psychiatric and nonpsychiatric outpatient adolescents. METHOD The study included four clinical groups: two psychiatric, nonsuicidal outpatient groups (depression group (N = 50) and nondepression group (N = 50)), suicidal group (N = 43), and nonpsychiatric general practitioners' group (N = 70). All participants were interviewed with the Columbia-Suicide Severity Rating Scale and suicidality module of the Mini International Neuropsychiatric Interview for children and adolescents. They also completed the Suicide Probability Scale, Child Depression Inventory, Beck Hopelessness Scale, and their parents filled in the Child Behavior Checklist. RESULTS The scale was found to be a solidly reliable measure with good internal consistency and agreement among interviewers. It correlated in the expected direction with self- and parent-report measures of associated constructs (e.g., depression) as well as suicidality. Consistent with the developers' intent of theoretical subscales, a three-factor solution (i.e., the severity of suicidal ideation, the intensity of suicidal ideation, and suicidal behavior) fit the data well, and it fit the data significantly better than the alternative models. Last, the Turkish Columbia-Suicide Severity Rating Scale successfully discriminated the adolescents with a recent history of suicide attempts from other clinical groups. CONCLUSION The Turkish version of the Columbia-Suicide Severity Rating Scale is a reliable and valid instrument to assess suicide risk among adolescents.
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Affiliation(s)
- Ayse Kilincaslan
- 1 Department of Child and Adolescent Psychiatry, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Adem Gunes
- 1 Department of Child and Adolescent Psychiatry, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Mehmet Eskin
- 2 Department of Psychiatry, Faculty of Medicine, Adnan Menderes University, Aydin, Turkey
| | - Alok Madan
- 3 Houston Methodist Behavioral Health, Houston, TX, USA
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22
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Fowler JC, Madan A, Allen JG, Oldham JM, Frueh BC. Differentiating bipolar disorder from borderline personality disorder: Diagnostic accuracy of the difficulty in emotion regulation scale and personality inventory for DSM-5. J Affect Disord 2019; 245:856-860. [PMID: 30699870 DOI: 10.1016/j.jad.2018.11.079] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 11/02/2018] [Accepted: 11/11/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Confusion abounds when differentiating the diagnoses of bipolar disorder (BD) from borderline personality disorder (BPD). This study explored the relative clinical utility of affective instability and self-report personality trait measures for accurate identification of BD and BPD. METHODS Receiver operator characteristics and diagnostic efficiency statistics were calculated to ascertain the relative diagnostic efficiency of self-report measures. Inpatients with research-confirmed diagnoses of BD (n = 341) or BPD (n = 381) completed the Difficulty in Emotion Regulation Scale (DERS) and Personality Inventory for DSM-5 (PID-5). RESULTS The total score for DERS evidenced relatively poor accuracy for differentiating the disorders (AUC = 0.72, SE = 0.02, p < .0001), while subscales of affective instability measures yielded fair discrimination (AUC range = 0.70-0.59). The PID-5 BPD algorithm (consisting of emotional lability, anxiousness, separation insecurity, hostility, depressivity, impulsivity, and risk taking) evidenced moderate-to-excellent accuracy (AUC = 0.83, SE = 0.04, p < .0001) with a good balance of specificity (SP = 0.79) and sensitivity (SN = 0.77). CONCLUSION Findings support the use of the PID-5 algorithm for differentiating BD from BPD. Furthermore, findings support the accuracy of the DSM-5 alternative model Criteria B trait constellation for differentiating these two disorders with overlapping features.
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Affiliation(s)
- J Christopher Fowler
- Houston Methodist Behavioral Health, 6550 Fannin St Houston, TX 77030, United States.
| | - Alok Madan
- Houston Methodist Behavioral Health, 6550 Fannin St Houston, TX 77030, United States
| | - Jon G Allen
- Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, United States
| | - John M Oldham
- Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, United States
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23
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Ambrosi E, Arciniegas DB, Curtis KN, Patriquin M, Spalletta G, Sani G, Frueh BC, Fowler JC, Madan A, Salas R. Resting-State Functional Connectivity of the Habenula in Mood Disorder Patients With and Without Suicide-Related Behaviors. J Neuropsychiatry Clin Neurosci 2019; 31:49-56. [PMID: 30282513 PMCID: PMC6697145 DOI: 10.1176/appi.neuropsych.17120351] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
The habenula is a small midbrain structure that is important for brain signaling and learning from negative events. Thus, the habenula is strongly connected to both the reward system and motor regions. Increasing evidence suggests a role for the habenula in the etiology of psychiatric disorders, including mood and substance use disorders. However, no studies to date have investigated habenular resting-state functional connectivity (rsFC) in suicide-related behaviors (SB). The authors enrolled 123 individuals with major depressive disorder (MDD) or bipolar disorder and a history of suicide-related behaviors (SB+), 74 individuals with MDD or bipolar disorder and a history of suicidal ideation but no history of SB (SB-), and 75 healthy control subjects (HC). A seed-based approach was used to identify regions showing different rsFC with the habenula followed by region of interest to region of interest post hoc comparisons. Compared with both the SB- and HC groups, the SB+ group showed higher connectivity between the left habenula and the left parahippocampal gyrus, the right amygdala, and the right precentral and postcentral gyri. Patients with mood disorders displayed higher rsFC between the left habenula and left middle temporal gyrus, the left angular gyrus, and the left posterior cingulate cortex, as well as lower rsFC between the right habenula and the left thalamus, when compared with HCs. These findings suggest that the habenula is involved in the neural circuitry of suicide. The higher habenular rsFC found in the SB+ group may mediate a dysfunction in the mechanism that links the habenula with motor activity and contextual associative processing.
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Affiliation(s)
- Elisa Ambrosi
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX,Beth K. and Stuart C. Yudofsky Division of Neuropsychiatry, Baylor College of Medicine, Houston, TX,IRCCS Santa Lucia Foundation, Department of Clinical and Behavioral Neurology, Rome, Italy
| | - David B Arciniegas
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX,Beth K. and Stuart C. Yudofsky Division of Neuropsychiatry, Baylor College of Medicine, Houston, TX
| | - Kaylah N Curtis
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX,Michael E DeBakey VA Medical Center, Houston TX, USA
| | - Michelle Patriquin
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX,Michael E DeBakey VA Medical Center, Houston TX, USA
| | - Gianfranco Spalletta
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX,Beth K. and Stuart C. Yudofsky Division of Neuropsychiatry, Baylor College of Medicine, Houston, TX,IRCCS Santa Lucia Foundation, Department of Clinical and Behavioral Neurology, Rome, Italy
| | - Gabriele Sani
- Neurosciences, Mental Health, and Sensory Organs Department (NESMOS), Sapienza University, Rome, School of Medicine and Psychology, Sant’ Andrea Hospital, Rome, Italy,Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA
| | | | - J Christopher Fowler
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX
| | - Alok Madan
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX
| | - Ramiro Salas
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX,Michael E DeBakey VA Medical Center, Houston TX, USA
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Fowler JC, Clapp JD, Madan A, Allen JG, Frueh BC, Fonagy P, Oldham JM. A naturalistic longitudinal study of extended inpatient treatment for adults with borderline personality disorder: An examination of treatment response, remission and deterioration. J Affect Disord 2018; 235:323-331. [PMID: 29665515 DOI: 10.1016/j.jad.2017.12.054] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Revised: 11/02/2017] [Accepted: 12/27/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Experts express reluctance to hospitalize patients with borderline personality disorder (BPD) for more than a few days, arguing that extended inpatient care leads to deterioration and adverse events. To date, there is no empirical support for these assertions. AIMS The current study examined the assumption of iatrogenic effects among BPD adults. METHODS Clinically significant and reliable change in symptoms, functional capacities, and adverse events were quantified for both inpatients with BPD (n = 245) and a well-matched inpatient reference (n = 220) sample. Latent growth curve (LGC) models were used to evaluate moderators of the trajectory of PHQ-9 depression scores over the course of hospitalization. RESULTS Large effect size improvements were observed in depression, anxiety, suicidal ideation and functional disability among patients with BPD (Cohen's d ≥ 1.0) and those in the reference sample (Cohen's d ≥ .80). Clinical deterioration and adverse events were rare (occurring in no more than 1.1% of BPD and reference patients on any outcome) with no difference across patient cohorts. BPD diagnosis failed to influence the trajectory of continuous depression severity. Rather, trait emotion dysregulation was associated with initial depression severity. CONCLUSIONS Twenty-five years ago it was assumed that adults with BPD could not benefit from psychiatric treatment. Today there are a number of effective evidence-based outpatient treatments for BPD, but beliefs about extended inpatient treatment have changed little. Current results indicate that extended inpatient treatment can result in significant and clinically meaningful symptomatic and functional improvement in BPD patients without iatrogenic effects.
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Affiliation(s)
- J Christopher Fowler
- The Menninger Clinic, 12301 Main Street, Houston, TX 77035, United States; Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, United States; Houston Methodist Hospital, United States.
| | - Joshua D Clapp
- University of Wyoming, 1000 E. University Ave., Laramie, WY 82071, United States
| | - Alok Madan
- The Menninger Clinic, 12301 Main Street, Houston, TX 77035, United States; Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, United States; Houston Methodist Hospital, United States
| | - Jon G Allen
- Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, United States
| | | | - Peter Fonagy
- Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, United States; University College London, Gower Street, London WC1E 6BT, United Kingdom
| | - John M Oldham
- Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, United States
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Madan A, Fowler JC, Patriquin MA, Salas R, Baldwin PR, Velasquez KM, Viswanath H, Molfese DL, Sharp C, Allen JG, Hardesty S, Oldham JM, Frueh BC. A Novel Approach to Identifying a Neuroimaging Biomarker for Patients With Serious Mental Illness. J Neuropsychiatry Clin Neurosci 2018; 29:275-283. [PMID: 28238273 DOI: 10.1176/appi.neuropsych.16090174] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Serious mental illness (SMI) is disabling, and current interventions are ineffective for many. This exploratory study sought to demonstrate the feasibility of applying topological data analysis (TDA) to resting-state functional connectivity data obtained from a heterogeneous sample of 235 adult inpatients to identify a biomarker of treatment response. TDA identified two groups based on connectivity between the prefrontal cortex and striatal regions: patients admitted with greater functional connectivity between these regions evidenced less improvement from admission to discharge than patients with lesser connectivity between them. TDA identified a potential biomarker of an attenuated treatment response among inpatients with SMI. Insofar as the observed pattern of resting-state functional connectivity collected early during treatment is replicable, this potential biomarker may indicate the need to modify standard of care for a small, albeit meaningful, percentage of patients.
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Affiliation(s)
- Alok Madan
- From the Menninger Clinic, Houston, Tex. (AM, CF, MAP, CS, JGA, SH, JMO, BCF); the Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Tex. (AM, JCF, MAP, RS, PRB, KMV, HV, DLM, JGA, SH, JMO); the Department of Psychology, University of Houston, Houston, Tex. (CS); and the Department of Psychology, University of Hawaii, Hilo, Hawaii (BCF)
| | - J Christopher Fowler
- From the Menninger Clinic, Houston, Tex. (AM, CF, MAP, CS, JGA, SH, JMO, BCF); the Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Tex. (AM, JCF, MAP, RS, PRB, KMV, HV, DLM, JGA, SH, JMO); the Department of Psychology, University of Houston, Houston, Tex. (CS); and the Department of Psychology, University of Hawaii, Hilo, Hawaii (BCF)
| | - Michelle A Patriquin
- From the Menninger Clinic, Houston, Tex. (AM, CF, MAP, CS, JGA, SH, JMO, BCF); the Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Tex. (AM, JCF, MAP, RS, PRB, KMV, HV, DLM, JGA, SH, JMO); the Department of Psychology, University of Houston, Houston, Tex. (CS); and the Department of Psychology, University of Hawaii, Hilo, Hawaii (BCF)
| | - Ramiro Salas
- From the Menninger Clinic, Houston, Tex. (AM, CF, MAP, CS, JGA, SH, JMO, BCF); the Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Tex. (AM, JCF, MAP, RS, PRB, KMV, HV, DLM, JGA, SH, JMO); the Department of Psychology, University of Houston, Houston, Tex. (CS); and the Department of Psychology, University of Hawaii, Hilo, Hawaii (BCF)
| | - Philip R Baldwin
- From the Menninger Clinic, Houston, Tex. (AM, CF, MAP, CS, JGA, SH, JMO, BCF); the Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Tex. (AM, JCF, MAP, RS, PRB, KMV, HV, DLM, JGA, SH, JMO); the Department of Psychology, University of Houston, Houston, Tex. (CS); and the Department of Psychology, University of Hawaii, Hilo, Hawaii (BCF)
| | - Kenia M Velasquez
- From the Menninger Clinic, Houston, Tex. (AM, CF, MAP, CS, JGA, SH, JMO, BCF); the Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Tex. (AM, JCF, MAP, RS, PRB, KMV, HV, DLM, JGA, SH, JMO); the Department of Psychology, University of Houston, Houston, Tex. (CS); and the Department of Psychology, University of Hawaii, Hilo, Hawaii (BCF)
| | - Humsini Viswanath
- From the Menninger Clinic, Houston, Tex. (AM, CF, MAP, CS, JGA, SH, JMO, BCF); the Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Tex. (AM, JCF, MAP, RS, PRB, KMV, HV, DLM, JGA, SH, JMO); the Department of Psychology, University of Houston, Houston, Tex. (CS); and the Department of Psychology, University of Hawaii, Hilo, Hawaii (BCF)
| | - David L Molfese
- From the Menninger Clinic, Houston, Tex. (AM, CF, MAP, CS, JGA, SH, JMO, BCF); the Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Tex. (AM, JCF, MAP, RS, PRB, KMV, HV, DLM, JGA, SH, JMO); the Department of Psychology, University of Houston, Houston, Tex. (CS); and the Department of Psychology, University of Hawaii, Hilo, Hawaii (BCF)
| | - Carla Sharp
- From the Menninger Clinic, Houston, Tex. (AM, CF, MAP, CS, JGA, SH, JMO, BCF); the Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Tex. (AM, JCF, MAP, RS, PRB, KMV, HV, DLM, JGA, SH, JMO); the Department of Psychology, University of Houston, Houston, Tex. (CS); and the Department of Psychology, University of Hawaii, Hilo, Hawaii (BCF)
| | - Jon G Allen
- From the Menninger Clinic, Houston, Tex. (AM, CF, MAP, CS, JGA, SH, JMO, BCF); the Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Tex. (AM, JCF, MAP, RS, PRB, KMV, HV, DLM, JGA, SH, JMO); the Department of Psychology, University of Houston, Houston, Tex. (CS); and the Department of Psychology, University of Hawaii, Hilo, Hawaii (BCF)
| | - Susan Hardesty
- From the Menninger Clinic, Houston, Tex. (AM, CF, MAP, CS, JGA, SH, JMO, BCF); the Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Tex. (AM, JCF, MAP, RS, PRB, KMV, HV, DLM, JGA, SH, JMO); the Department of Psychology, University of Houston, Houston, Tex. (CS); and the Department of Psychology, University of Hawaii, Hilo, Hawaii (BCF)
| | - John M Oldham
- From the Menninger Clinic, Houston, Tex. (AM, CF, MAP, CS, JGA, SH, JMO, BCF); the Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Tex. (AM, JCF, MAP, RS, PRB, KMV, HV, DLM, JGA, SH, JMO); the Department of Psychology, University of Houston, Houston, Tex. (CS); and the Department of Psychology, University of Hawaii, Hilo, Hawaii (BCF)
| | - B Christopher Frueh
- From the Menninger Clinic, Houston, Tex. (AM, CF, MAP, CS, JGA, SH, JMO, BCF); the Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Tex. (AM, JCF, MAP, RS, PRB, KMV, HV, DLM, JGA, SH, JMO); the Department of Psychology, University of Houston, Houston, Tex. (CS); and the Department of Psychology, University of Hawaii, Hilo, Hawaii (BCF)
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Madan A, Sharp C, Newlin E, Vanwoerden S, Fowler JC. Adolescents Are Less Satisfied with Inpatient Psychiatric Care than Their Parents: Does It Matter? J Healthc Qual 2018; 38:e19-28. [PMID: 25103571 DOI: 10.1111/jhq.12081] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Patient satisfaction is a commonly used measure of healthcare quality. Limited research exists among psychiatric inpatients, especially adolescents, who pose unique challenges. This study sought to (1) concurrently assess adolescents' and parents' satisfaction with treatment and (2) compare their perspectives' association with treatment outcomes. METHODS This exploratory study assessed discharged adolescents from a specialty psychiatric hospital. Adolescent patients and parents completed the Perceptions of Care survey (POC), a measure of patient satisfaction. Patients also completed the Youth Self-Report measure, while parents also completed the Child Behavior Checklist-both are used as measures of mental health treatment outcomes. RESULTS Adolescents and parents gave favorable overall ratings of care. Adolescents were more critical than their parents, and there was little agreement between them. Adolescents' ratings on the POC frequently related to outcomes, whereas parents' ratings rarely did. CONCLUSIONS Ratings of satisfaction with adolescent healthcare can vary depending on whether patients or caregivers are assessed. The discrepancy between them contains value: adolescents' perception may be a better gauge of treatment outcomes and may affect treatment adherence. Future research should examine adolescent-specific concerns in the context of satisfaction with care and relate them to longer term treatment outcomes.
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27
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Fowler JC, Madan A, Allen JG, Patriquin M, Sharp C, Oldham JM, Frueh BC. Clinical utility of the DSM-5 alternative model for borderline personality disorder: Differential diagnostic accuracy of the BFI, SCID-II-PQ, and PID-5. Compr Psychiatry 2018; 80:97-103. [PMID: 29069625 DOI: 10.1016/j.comppsych.2017.09.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 08/10/2017] [Accepted: 09/07/2017] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND With the publication of DSM 5 alternative model for personality disorders it is critical to assess the components of the model against evidence-based models such as the five factor model and the DSM-IV-TR categorical model. This study explored the relative clinical utility of these models in screening for borderline personality disorder (BPD). METHODS Receiver operator characteristics and diagnostic efficiency statistics were calculated for three personality measures to ascertain the relative diagnostic efficiency of each measure. A total of 1653 adult inpatients at a specialist psychiatric hospital completed SCID-II interviews. Sample 1 (n=653) completed the SCID-II interviews, SCID-II Questionnaire (SCID-II-PQ) and the Big Five Inventory (BFI), while Sample 2 (n=1,000) completed the SCID-II interviews, Personality Inventory for DSM5 (PID-5) and the BFI. RESULTS BFI measure evidenced moderate accuracy for two composites: High Neuroticism+ low agreeableness composite (AUC=0.72, SE=0.01, p<0.001) and High Neuroticism+ Low+Low Conscientiousness (AUC=0.73, SE=0.01, p<0.0001). The SCID-II-PQ evidenced moderate-to-excellent accuracy (AUC=0.86, SE=0.02, p<0.0001) with a good balance of specificity (SP=0.80) and sensitivity (SN=0.78). The PID-5 BPD algorithm (consisting of elevated emotional lability, anxiousness, separation insecurity, hostility, depressivity, impulsivity, and risk taking) evidenced moderate-to-excellent accuracy (AUC=0.87, SE=0.01, p<0.0001) with a good balance of specificity (SP=0.76) and sensitivity (SN=0.81). CONCLUSIONS Findings generally support the use of SCID-II-PQ and PID-5 BPD algorithm for screening purposes. Furthermore, findings support the accuracy of the DSM 5 alternative model Criteria B trait constellation for diagnosing BPD. Limitations of the study include the single inpatient setting and use of two discrete samples to assess PID-5 and SCID-II-PQ.
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Affiliation(s)
- J Christopher Fowler
- The Menninger Clinic, 12301 Main Street, Houston, TX 77035, United States; Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, United States.
| | - Alok Madan
- The Menninger Clinic, 12301 Main Street, Houston, TX 77035, United States; Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, United States
| | - Jon G Allen
- Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, United States
| | - Michelle Patriquin
- The Menninger Clinic, 12301 Main Street, Houston, TX 77035, United States; Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, United States
| | | | - John M Oldham
- Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, United States
| | - B Christopher Frueh
- Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, United States; University of Hawaii, 200 West Kawili St., Hilo, HI 96720, United States
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Borckardt JJ, Reeves ST, Milliken C, Carter B, Epperson TI, Gunselman RJ, Madan A, Del Schutte H, Demos HA, George MS. Prefrontal versus motor cortex transcranial direct current stimulation (tDCS) effects on post-surgical opioid use. Brain Stimul 2017; 10:1096-1101. [PMID: 28917592 DOI: 10.1016/j.brs.2017.09.006] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 08/24/2017] [Accepted: 09/03/2017] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Pain is often a complaint that precedes total knee arthroplasty (TKA), however the procedure itself is associated with considerable post-operative pain lasting days to weeks which can predict longer-term surgical outcomes. Previously, we reported significant opioid-sparing effects of motor cortex transcranial direct current stimulation from a single-blind trial. In the present study, we used double-blind methodology to compare motor cortex tDCS and prefrontal cortex tDCS to both sham and active-control (active electrodes over non-pain modulating brain areas) tDCS. METHODS 58 patients undergoing unilateral TKA were randomly assigned to receive 4 20-min sessions (a total of 80 min) of tDCS (2 mA) post-surgery with electrodes placed to create 4 groups: 1) MOTOR (n = 14); anode-motor/cathode-right prefrontal, 2) PREFRONTAL (n = 16); anode-left-prefrontal/cathode-right-sensory, 3) ACTIVE-CONTROL (n = 15); anode-left-temporal-occipital junction/cathode-medial-anterior-premotor-area, and 4) SHAM (n = 13); 0 mA-current stimulation using placements 1 or 2. Patient controlled analgesia (PCA; hydromorphone) use was tracked during the ∼72-h post-surgery. RESULTS Patients in the sham group and the active-control group used 15.4 mg (SD = 14.1) and 16.0 mg (SD = 9.7) of PCA hydromorphone respectively. There was no difference between the slopes of the cumulative PCA usage curves between these two groups (p = 0.25; ns). Patients in the prefrontal tDCS group used an average of 11.7 mg (SD = 5.0) of PCA hydromporhone, and the slope of the cumulative PCA usage curve was significantly lower than sham (p < 0.0001). However, patients in the motor tDCS group used an average of 19.6 mg (SD = 11.9) hydromorphone and the slope of the PCA use curve was significantly higher than sham (p < 0.0001). CONCLUSIONS Results from this double-blind cortical-target-optimization study suggest that anodal transcranial direct current stimulation (tDCS) over the left prefrontal cortex may be a reasonable approach to reducing post-TKA opioid requirements. Given the unexpected finding that motor cortex failed to produce an opioid sparing effect in this follow-up trial, further research in the area of post-operative cortical stimulation is still needed.
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Affiliation(s)
| | - Scott T Reeves
- Medical University of South Carolina, Charleston, SC, USA
| | - Cole Milliken
- Medical University of South Carolina, Charleston, SC, USA
| | - Brittan Carter
- Medical University of South Carolina, Charleston, SC, USA
| | | | | | | | - H Del Schutte
- Medical University of South Carolina, Charleston, SC, USA
| | - Harry A Demos
- Medical University of South Carolina, Charleston, SC, USA
| | - Mark S George
- Medical University of South Carolina, Charleston, SC, USA
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Curtis K, Viswanath H, Velasquez KM, Molfese DL, Harding MJ, Aramayo E, Baldwin PR, Ambrosi E, Madan A, Patriquin M, Frueh BC, Fowler JC, Kosten TR, Nielsen DA, Salas R. Increased habenular connectivity in opioid users is associated with an α5 subunit nicotinic receptor genetic variant. Am J Addict 2017; 26:751-759. [PMID: 28857330 DOI: 10.1111/ajad.12607] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Revised: 07/20/2017] [Accepted: 08/11/2017] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Opioid use disorder (OUD) is a chronic disorder with relapse based on both desire for reinforcement (craving) and avoidance of withdrawal. The aversive aspect of dependence and relapse has been associated with a small brain structure called the habenula, which expresses large numbers of both opioid and nicotinic receptors. Additionally, opioid withdrawal symptoms can be induced in opioid-treated rodents by blocking not only opioid, but also nicotinic receptors. This receptor co-localization and cross-induction of withdrawal therefore might lead to genetic variation in the nicotinic receptor influencing development of human opioid dependence through its impact on the aversive components of opioid dependence. METHODS We studied habenular resting state functional connectivity with related brain structures, specifically the striatum. We compared abstinent psychiatric patients who use opioids (N = 51) to psychiatric patients who do not (N = 254) to identify an endophenotype of opioid use that focused on withdrawal avoidance and aversion rather than the more commonly examined craving aspects of relapse. RESULTS We found that habenula-striatal connectivity was stronger in opioid-using patients. Increased habenula-striatum connectivity was observed in opioid-using patients with the low risk rs16969968 GG genotype, but not in patients carrying the high risk AG or AA genotypes. CONCLUSIONS We propose that increased habenula-striatum functional connectivity may be modulated by the nicotinic receptor variant rs16969968 and may lead to increased opioid use. SCIENTIFIC SIGNIFICANCE Our data uncovered a promising brain target for development of novel anti-addiction therapies and may help the development of personalized therapies against opioid abuse. (Am J Addict 2017;26:751-759).
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Affiliation(s)
- Kaylah Curtis
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas.,Michael E DeBakey VA Medical Center, Houston, Texas
| | - Humsini Viswanath
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas
| | - Kenia M Velasquez
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas.,Michael E DeBakey VA Medical Center, Houston, Texas
| | - David L Molfese
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas.,Michael E DeBakey VA Medical Center, Houston, Texas
| | - Mark J Harding
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas.,Michael E DeBakey VA Medical Center, Houston, Texas
| | - Eduardo Aramayo
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas
| | - Philip R Baldwin
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas.,Michael E DeBakey VA Medical Center, Houston, Texas
| | - Elisa Ambrosi
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas.,The Menninger Clinic, Houston, Texas
| | - Alok Madan
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas.,The Menninger Clinic, Houston, Texas
| | | | | | - J Christopher Fowler
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas.,The Menninger Clinic, Houston, Texas
| | - Thomas R Kosten
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas.,Michael E DeBakey VA Medical Center, Houston, Texas.,Department of Neuroscience, Baylor College of Medicine, Houston, Texas
| | - David A Nielsen
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas.,Michael E DeBakey VA Medical Center, Houston, Texas
| | - Ramiro Salas
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas.,Michael E DeBakey VA Medical Center, Houston, Texas.,Department of Neuroscience, Baylor College of Medicine, Houston, Texas
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Mahoney JS, Mulder C, Hardesty S, Madan A. Integrating caring into patient-centered care through interprofessional education and ethics: The Caring Project. Bull Menninger Clin 2017; 81:233-246. [PMID: 28745943 DOI: 10.1521/bumc_2017_81_02] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
In an era of health care that is driven by biological and technical advances, there is a need to safeguard the caring component of care, the humanistic part of care. With this in mind, the authors constructed a Patient-Centered Caring model consisting of three overlapping constructs: delivering customer service, understanding the illness experience, and providing trauma-informed care. These practices operate within an interprofessional competency context. The authors describe an interprofessional educational project focused on understanding the illness experience and providing trauma-informed care to faculty, staff, and administrators in an inpatient psychiatric setting. The authors discuss the project through a number of ethical lenses that may help explicate the ethics of patient-centered care and caring and can be useful in the development of interprofessional competence.
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Affiliation(s)
- Jane S Mahoney
- Director of Nursing Practice and Research, The Menninger Clinic, and an associate professor, Menninger Department of Psychiatry & Behavioral Sciences, Baylor College of Medicine, Houston, Texas
| | - Cynthia Mulder
- Senior social worker and Director of Education and Training, The Menninger Clinic, Houston, Texas
| | - Susan Hardesty
- Clinical associate professor, Menninger Department of Psychiatry & Behavioral Sciences, Baylor College of Medicine
| | - Alok Madan
- McNair Scholar and a senior psychologist, The Menninger Clinic, and an associate Professor, Menninger Department of Psychiatry & Behavioral Sciences, Baylor College of Medicine
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Jimenez-Torres GJ, Wojna V, Rosario E, Hechevarría R, Alemán-Batista AM, Matos MR, Madan A, Skolasky RL, Acevedo SF. Assessing health-related resiliency in HIV+ Latin women: Preliminary psychometric findings. PLoS One 2017; 12:e0181253. [PMID: 28723939 PMCID: PMC5517021 DOI: 10.1371/journal.pone.0181253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Accepted: 06/28/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND HIV-associated vulnerabilities-especially those linked to psychological issues-and limited mental health-treatment resources have the potential to adversely affect the health statuses of individuals. The concept of resilience has been introduced in the literature to shift the emphasis from vulnerability to protective factors. Resilience, however, is an evolving construct and is measured in various ways, though rarely among underserved, minority populations. Herein, we present the preliminary psychometric properties of a sample of HIV-seropositive Puerto Rican women, measured using a newly developed health-related resilience scale. METHODS AND DESIGN The Resilience Scales for Children and Adolescents, an instrument with solid test construction properties, acted as a model in the development (in both English and Spanish) of the HRRS, providing the same dimensions and most of the same subscales. The present sample was nested within the Hispanic-Latino longitudinal cohort of women (HLLC), that is part of the NeuroAIDS Research Program at the University of Puerto Rico (UPR), Medical Sciences Campus (MSC). Forty-five consecutively recruited, HIV+ women from the HLLC completed a demographic survey, the HRRS, and the Beck Depression Inventory-I, Spanish version. RESULTS The results demonstrate excellent overall internal consistency for the total HRRS score (α = 0.95). Each of the dimensional scores also evidenced acceptable internal consistency (α ≥ 0.88). All the dimensional and subscale content validity indices were above the 0.42 cut-off. Analysis revealed a significant negative correlation between the HRRS total score and BDI-I-S (r(45) = -0.453, p < 0.003). CONCLUSION Albeit preliminary in nature, the present study provides support for the HRRS as a measure to assess resilience among individuals living with chronic medical conditions. Minority populations, especially non-English speaking ones, are understudied across the field of medicine, and when efforts are made to include these patient groups, measurement is rarely tailored to their unique cultural and linguistic experiences. The HRRS is a measure that addresses these notable voids in the medical literature.
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Affiliation(s)
- Gladys J. Jimenez-Torres
- The Menninger Clinic, Houston, TX, United States of America
- Psychiatry & Behavioral Sciences, Baylor College of Medicine, Houston, TX, United States of America
- Psychology Department, Ponce School of Medicine and Health Sciences, Ponce, PR, United States of America
| | - Valerie Wojna
- NeuroAIDS Research Program, University of Puerto Rico, San Juan, PR, United States of America
- Department of Internal Medicine, Neurology Division, University of Puerto Rico, San Juan, PR, United States of America
| | - Ernesto Rosario
- Psychology Department, Ponce School of Medicine and Health Sciences, Ponce, PR, United States of America
| | - Rosa Hechevarría
- NeuroAIDS Research Program, University of Puerto Rico, San Juan, PR, United States of America
- Physical Medicine and Rehabilitation, University of Puerto Rico, San Juan, PR, United States of America
| | - Ada M. Alemán-Batista
- School of Health Professions, University of Puerto Rico, San Juan, PR, United States of America
| | - Miriam Ríos Matos
- NeuroAIDS Research Program, University of Puerto Rico, San Juan, PR, United States of America
| | - Alok Madan
- The Menninger Clinic, Houston, TX, United States of America
- Psychiatry & Behavioral Sciences, Baylor College of Medicine, Houston, TX, United States of America
| | - Richard L. Skolasky
- School of Health Professions, University of Puerto Rico, San Juan, PR, United States of America
- Department of Orthopedic Surgery and Physical Medicine & Rehabilitation, Johns Hopkins University, Baltimore, MD, United States of America
| | - Summer F. Acevedo
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX, United States of America
- * E-mail:
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Ambrosi E, Arciniegas DB, Madan A, Curtis KN, Patriquin MA, Jorge RE, Spalletta G, Fowler JC, Frueh BC, Salas R. Insula and amygdala resting-state functional connectivity differentiate bipolar from unipolar depression. Acta Psychiatr Scand 2017; 136:129-139. [PMID: 28369737 PMCID: PMC5464981 DOI: 10.1111/acps.12724] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/01/2017] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Distinguishing depressive episodes due to bipolar disorder (BD) or major depressive disorder (MDD) solely on clinical grounds is challenging. We aimed at comparing resting-state functional connectivity (rsFC) of regions subserving emotional regulation in similarly depressed BD and MDD. METHOD We enrolled 76 in-patients (BD, n = 36; MDD, n = 40) and 40 healthy controls (HC). A seed-based approach was used to identify regions showing different rsFC with the insula and the amygdala. Insular and amygdalar parcellations were then performed along with diagnostic accuracy of the main findings. RESULTS Lower rsFC between the left insula and the left mid-dorsolateral prefrontal cortex and between bilateral insula and right frontopolar prefrontal cortex (FPPFC) was observed in BD compared to MDD and HC. These results were driven by the dorsal anterior and posterior insula (PI). Lower rsFC between the right amygdala and the left anterior hippocampus was observed in MDD compared to BD and HC. These results were driven by the centromedial and laterobasal amygdala. Left PI/right FPPC rsFC showed 78% accuracy differentiating BD and MDD. CONCLUSION rsFC of amygdala and insula distinguished between depressed BD and MDD. The observed differences suggest the possibility of differential pathophysiological mechanisms of emotional dysfunction in bipolar and unipolar depression.
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Affiliation(s)
- Elisa Ambrosi
- Beth K. and Stuart C. Yudofsky Division of Neuropsychiatry, Baylor College of Medicine, Houston, TX, USA,Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA,The Menninger Clinic, Houston TX, USA,IRCCS Santa Lucia Foundation, Department of Clinical and Behavioral Neurology, Rome, Italy
| | - David B Arciniegas
- Beth K. and Stuart C. Yudofsky Division of Neuropsychiatry, Baylor College of Medicine, Houston, TX, USA,Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Alok Madan
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA,The Menninger Clinic, Houston TX, USA
| | - Kaylah N Curtis
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA,Micheal E DeBakey VA Medical Center, Houston TX, USA
| | - Michelle A Patriquin
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA,The Menninger Clinic, Houston TX, USA
| | - Ricardo E Jorge
- Beth K. and Stuart C. Yudofsky Division of Neuropsychiatry, Baylor College of Medicine, Houston, TX, USA,Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA,Micheal E DeBakey VA Medical Center, Houston TX, USA
| | - Gianfranco Spalletta
- Beth K. and Stuart C. Yudofsky Division of Neuropsychiatry, Baylor College of Medicine, Houston, TX, USA,Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA,IRCCS Santa Lucia Foundation, Department of Clinical and Behavioral Neurology, Rome, Italy
| | - J Christopher Fowler
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA,The Menninger Clinic, Houston TX, USA
| | - B Christopher Frueh
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA,Department of Psychology, University of Hawaii, Hilo, HI
| | - Ramiro Salas
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA,Micheal E DeBakey VA Medical Center, Houston TX, USA,Corresponding Author: Ramiro Salas, PhD, Baylor College of Medicine, One Baylor Plaza – room A277 Houston, TX 77030, USA. ; TE 713-798-3502; Fax 713-798-4488
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Abstract
Individuals with serious mental illness (SMI) experience significant comorbid chronic pain (CP). Little is known about CP management in psychiatric inpatient settings. To address this gap in clinical practice, the authors developed CP management group psychotherapy for adult inpatients with SMI. In this report, the authors highlight (1) the theoretical underpinnings of and execution of the psychotherapy group, (2) the characteristics of participants in the pilot phase of the group, and (3) outcomes of group participants. Data were collected from 16 participants in the pain management psychotherapy group. The mean number of groups attended was two (SD = 1.7). Participants endorsed pain across five regions of the body with high pain intensity and severity. Improvements in depression, anxiety, somatic, and emotional regulation symptoms were evidenced during the course of treatment. CP group psychotherapy may be an effective modality to disseminate "best practices" and prevent diagnostic overshadowing for SMI patients.
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Affiliation(s)
- Patricia J Osborne
- VISN 2 South Mental Illness Research, Education, and Clinical Center, James J. Peters VA Medical Center, Bronx, New York.,Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York
| | | | - Yulia Landa
- VISN 2 South Mental Illness Research, Education, and Clinical Center, James J. Peters VA Medical Center, Bronx, New York.,Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jane Mahoney
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas
| | - Alok Madan
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas
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Fowler JC, Patriquin MA, Madan A, Allen JG, Frueh BC, Oldham JM. Incremental validity of the PID-5 in relation to the five factor model and traditional polythetic personality criteria of the DSM-5. Int J Methods Psychiatr Res 2017; 26:e1526. [PMID: 27670287 PMCID: PMC6877239 DOI: 10.1002/mpr.1526] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Revised: 07/12/2016] [Accepted: 08/05/2016] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND This study assessed the incremental validity of the Personality Inventory for DSM-5 (PID-5) beyond the impact of demographic, burden of illness, five-factor model of personality, and DSM-5 personality disorder criteria with respect to associations with admission psychiatric symptoms and functional disability. METHODS Psychiatric inpatients (N = 927) were administered the Big Five Inventory, PID-5, and personality disorder criteria counts. Prior treatment utilization, as well as baseline depression, anxiety, emotion regulation, and functional disability were administered within two days of the personality measures. Hierarchical regression models were used to explore the association of personality functioning with symptom functioning, emotion regulation and disability. RESULTS Neuroticism was associated with all symptom measures, providing further support for its relevance in clinical populations. Personality trait domains (negative affect, detachment, and psychoticism) from the PID-5 demonstrated incremental validity in predicting baseline symptom and disability functioning over and above demographic, burden of illness, and psychiatric comorbidity and five-factor model (FFM) personality traits. CONCLUSIONS Dimensional measures of personality functioning were consistently associated with baseline symptom functioning, supporting the relevance of personality functioning as it relates to psychiatric symptoms. The PID-5 uniquely contributed to the prediction of baseline symptom functioning, thus providing incremental validity over gold-standard personality trait measures.
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Affiliation(s)
- J. Christopher Fowler
- The Menninger ClinicHoustonTexasUSA
- Menninger Department of Psychiatry & Behavioral MedicineBaylor College of MedicineHoustonTexasUSA
| | - Michelle A. Patriquin
- The Menninger ClinicHoustonTexasUSA
- Menninger Department of Psychiatry & Behavioral MedicineBaylor College of MedicineHoustonTexasUSA
| | - Alok Madan
- The Menninger ClinicHoustonTexasUSA
- Menninger Department of Psychiatry & Behavioral MedicineBaylor College of MedicineHoustonTexasUSA
| | - Jon G. Allen
- The Menninger ClinicHoustonTexasUSA
- Menninger Department of Psychiatry & Behavioral MedicineBaylor College of MedicineHoustonTexasUSA
| | - B. Christopher Frueh
- The Menninger ClinicHoustonTexasUSA
- Menninger Department of Psychiatry & Behavioral MedicineBaylor College of MedicineHoustonTexasUSA
- Department of PsychologyUniversity of HawaiiHiloHawaiiUSA
| | - John M. Oldham
- The Menninger ClinicHoustonTexasUSA
- Menninger Department of Psychiatry & Behavioral MedicineBaylor College of MedicineHoustonTexasUSA
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Allen JG, Fowler JC, Madan A, Ellis TE, Oldham JM, Frueh BC. Discovering the impact of psychotherapeutic hospital treatment for adults with serious mental illness. Bull Menninger Clin 2017; 81:1-38. [DOI: 10.1521/bumc.2017.81.1.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Jon G. Allen
- The Menninger Clinic, Houston, Texas
- Baylor College of Medicine, Houston, Texas
| | | | - Alok Madan
- The Menninger Clinic, Houston, Texas
- Baylor College of Medicine, Houston, Texas
| | - Thomas E. Ellis
- The Menninger Clinic, Houston, Texas
- Baylor College of Medicine, Houston, Texas
| | - John M. Oldham
- The Menninger Clinic, Houston, Texas
- Baylor College of Medicine, Houston, Texas
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Fowler JC, Clapp JD, Madan A, Allen JG, Frueh BC, Oldham JM. An Open Effectiveness Trial of a Multimodal Inpatient Treatment for Depression and Anxiety Among Adults With Serious Mental Illness. Psychiatry 2017; 80:42-54. [PMID: 28409715 DOI: 10.1080/00332747.2016.1196072] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE This prospective open effectiveness trial examined symptom change trajectories and rates of remission from depression and anxiety in an intensive multimodal inpatient treatment for adults with serious mental illness (SMI). Patient baseline characteristics were examined as mediators/moderators of treatment response. METHODS Adult inpatients with SMI (N = 994) completed an average of 39 days of inpatient treatment. Latent growth curve (LGC) methods were used to model symptom trajectories, estimating expected remission based on individual patterns of change observed across the sample. RESULTS Absolute reductions in symptoms were substantial, with large effect size improvements for both depression (d = 1.21, 95% CI [1.13, 1.29]) and anxiety (d = 1.13, 95% CI [1.05, 1.21]). For those presenting with elevated depressive symptoms (Patient Health Questionnaire-Depression ≥ 5.0; 87.5% of the sample), 46.9% evidenced remission from admission to discharge. Among patients presenting with significant anxiety (Patient Health Questionnaire-Generalized Anxiety Disorder Screener ≥ 5.0; 84.5% of the sample), 50.0% evidenced remission from admission to discharge. Mediation analyses revealed that depression and anxiety severity decreased more rapidly with increasing age and initial levels of experiential avoidance. CONCLUSIONS Rates of remission of depression and anxiety were greater than anticipated in this large cohort of adult SMI inpatients and may be related to intensity and length of hospitalization.
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Janice Jimenez-Torres G, Weinstein BL, Walker CR, Christopher Fowler J, Ashford P, Borckardt JJ, Madan A. A study protocol for a single-blind, randomized controlled trial of adjunctive transcranial direct current stimulation (tDCS) for chronic pain among patients receiving specialized, inpatient multimodal pain management. Contemp Clin Trials 2016; 54:36-47. [PMID: 28039022 DOI: 10.1016/j.cct.2016.12.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Revised: 12/23/2016] [Accepted: 12/24/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Available treatments for chronic pain (CP) are modestly effective or associated with iatrogenic harm. Transcranial direct current stimulation (tDCS) is a non-invasive brain stimulation technique that may be an effective, adjunctive treatment to non-opioid therapies. In this randomized control trial (RCT), we compare adjunctive active versus sham tDCS among patients in a multimodal inpatient pain management program. The primary objectives of the RCT are to improve pain tolerance and subjective pain experience. METHODS AND DESIGN Patients admitted to the Pain Management Program at The Menninger Clinic in Houston, Texas are eligible for this trial. Eighty-four participants will be randomized (1:1) into a single-blind, 2×12 (group×time) controlled trial. A battery-powered direct and constant current stimulator (Soterix Medical Inc. 2014) delivers anodal stimulation over the left dorsolateral prefrontal cortex (DLPFC) and cathodal stimulation over the right DLPFC. Active tDCS is applied by supplying a 2mA current for 20min/session over 10 sessions. Participants complete self-report and performance-based assessments on a weekly basis just prior to brain stimulation. Self-report assessments are collected via Chronic Pain Tracker version 3.6, an iPad interfaced application. The performance-based pain tolerance task is completed through the cold presser task. DISCUSSION Interventions with cross-symptomatic therapeutic potential are absolutely essential in the context of CP, in which psychiatric comorbidity is the norm. Modalities that can be used in tandem with evidence-based, non-opioid therapies have the potential to have a synergistic effect, resulting in increased effectiveness of what have been modestly effective treatments to date.
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Affiliation(s)
- G Janice Jimenez-Torres
- The Menninger Clinic, Houston, TX, United States; Psychiatry & Behavioral Sciences, Baylor College of Medicine, Houston, TX, United States
| | - Benjamin L Weinstein
- The Menninger Clinic, Houston, TX, United States; Psychiatry & Behavioral Sciences, Baylor College of Medicine, Houston, TX, United States
| | - Cory R Walker
- The Menninger Clinic, Houston, TX, United States; Psychiatry & Behavioral Sciences, Baylor College of Medicine, Houston, TX, United States
| | - J Christopher Fowler
- The Menninger Clinic, Houston, TX, United States; Psychiatry & Behavioral Sciences, Baylor College of Medicine, Houston, TX, United States
| | | | - Jeffrey J Borckardt
- Anesthesia and Perioperative Medicine, Medical University of South Carolina, Charleston, SC, United States; Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, SC, United States; Ralph H. Johnson Veterans' Affairs Medical Center, Charleston, SC, United States
| | - Alok Madan
- The Menninger Clinic, Houston, TX, United States; Psychiatry & Behavioral Sciences, Baylor College of Medicine, Houston, TX, United States.
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Gosnell SN, Velasquez KM, Molfese DL, Molfese PJ, Madan A, Fowler JC, Christopher Frueh B, Baldwin PR, Salas R. Prefrontal cortex, temporal cortex, and hippocampus volume are affected in suicidal psychiatric patients. Psychiatry Res Neuroimaging 2016; 256:50-56. [PMID: 27685801 PMCID: PMC9694115 DOI: 10.1016/j.pscychresns.2016.09.005] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 09/12/2016] [Accepted: 09/13/2016] [Indexed: 11/20/2022]
Abstract
Suicide is a leading cause of death in America, with over 40,000 reported suicides per year. Mental illness is a major risk factor for suicidality. This study attempts to validate findings of volumetric differences from studies on suicidality. Psychiatric inpatients classified as having mildly severe or severe depression were separated into two groups: suicide attempted in the past two months (SA; n=20), non-suicidal control group (DA; n=20); these patients were all depressed and not significantly different for age, gender, race, marital status, education level, anxiety level, and substance abuse. Healthy controls (HC; n=20) were not significantly different from the suicidal groups for age and gender. Volunteers underwent MRI to assess volumes of cortical lobes, corpus callosum, and subcortical regions of interest, including the thalamus, insula, limbic structures, and basal ganglia. The right hippocampal volume of the SA group was significantly reduced compared to healthy controls. The frontal and temporal lobe volumes of the SA group were significantly decreased compared to the DA group. These volumetric reductions confirm previous findings and support the hypothesis that fronto-temporal function may be altered in suicidal patients.
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Affiliation(s)
- Savannah N Gosnell
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX 77030, USA
| | - Kenia M Velasquez
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX 77030, USA; Michael E DeBakey VA Medical Center, Houston, TX 77030, USA
| | - David L Molfese
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX 77030, USA; Michael E DeBakey VA Medical Center, Houston, TX 77030, USA
| | - Peter J Molfese
- Department of Psychological Sciences, University of Connecticut, Mansfield, CT 06269, USA
| | - Alok Madan
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX 77030, USA; The Menninger Clinic, Houston, TX 77030, USA
| | - James C Fowler
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX 77030, USA; The Menninger Clinic, Houston, TX 77030, USA
| | - B Christopher Frueh
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX 77030, USA; The Menninger Clinic, Houston, TX 77030, USA; The University of Hawaii at Hilo, HI 96720, USA
| | - Philip R Baldwin
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX 77030, USA; Michael E DeBakey VA Medical Center, Houston, TX 77030, USA
| | - Ramiro Salas
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX 77030, USA; Michael E DeBakey VA Medical Center, Houston, TX 77030, USA; Department of Neuroscience, Baylor College of Medicine, Houston, TX 77030, USA.
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Sharp C, Fowler JC, Salas R, Nielsen D, Allen J, Oldham J, Kosten T, Mathew S, Madan A, Frueh BC, Fonagy P. Operationalizing NIMH Research Domain Criteria (RDoC) in naturalistic clinical settings. Bull Menninger Clin 2016; 80:187-212. [DOI: 10.1521/bumc.2016.80.3.187] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Madan A, Frueh BC, Allen JG, Ellis TE, Rufino KA, Oldham JM, Fowler JC. Psychometric Reevaluation of the Columbia-Suicide Severity Rating Scale: Findings From a Prospective, Inpatient Cohort of Severely Mentally Ill Adults. J Clin Psychiatry 2016; 77:e867-73. [PMID: 27464320 DOI: 10.4088/jcp.15m10069] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Accepted: 10/26/2015] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Accurate prediction of suicide remains elusive due to lack of predictive measures. Given the Columbia-Suicide Severity Rating Scale's (C-SSRS) emerging "gold-standard" status for risk assessment, studies are needed to assess its psychometric properties, particularly predictive validity. The current study adds to the limited literature by assessing the C-SSRS's internal consistency, factor structure, concurrent validity, and predictive validity. METHODS In this longitudinal study of 1,055 adults with DSM-IV diagnoses consecutively admitted to a specialized psychiatric hospital between July 1, 2012, and June 30, 2014, patients completed standardized assessments, including the C-SSRS, at admission and 2, 12, and 24 weeks postdischarge. RESULTS The C-SSRS evidenced excellent internal consistency (ordinal α = .95). Principal components analysis (PCA) revealed a 2-factor solution, accounting for 65.3% of the variance across items. The severity of ideation and behavioral items loaded onto the first factor, and the intensity of ideation items loaded onto the second factor. The total score, factors, and the most severe ideation single item were moderately correlated with other measures of suicidality (0.27 ≤ r ≤ 0.58; P < .0001). The summary score from the ideation/behavior factor was found to be modestly correlated with any suicide-related behavior within the 6 months following hospitalization. Receiver operator characteristics indicated that the C-SSRS performed adequately in correctly classifying any suicide-related behavior within 6 months of discharge from the hospital (AUC = 0.757, P < .001) with the total score and summary score from the ideation/behavior factor providing the best balance between sensitivity (0.694) and specificity (0.652-0.674). CONCLUSIONS This study is the first to assess the factor structure of the C-SSRS in a large, high-risk sample. The measure has solid psychometric properties and merits use as a suicide risk assessment measure.
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Affiliation(s)
- Alok Madan
- 12301 South Main St, Houston, TX 77035. .,The Menninger Clinic, Houston, Texas, USA.,Department of Psychiatry & Behavioral Sciences, Baylor College of Medicine, Houston, Texas, USA
| | - B Christopher Frueh
- The Menninger Clinic, Houston, Texas, USA.,Department of Psychology, University of Hawaii, Hilo
| | - Jon G Allen
- The Menninger Clinic, Houston, Texas, USA.,Department of Psychiatry & Behavioral Sciences, Baylor College of Medicine, Houston, Texas, USA
| | - Thomas E Ellis
- The Menninger Clinic, Houston, Texas, USA.,Department of Psychiatry & Behavioral Sciences, Baylor College of Medicine, Houston, Texas, USA
| | - Katrina A Rufino
- The Menninger Clinic, Houston, Texas, USA.,Department of Psychology, University of Houston-Downtown, Houston, Texas, USA
| | - John M Oldham
- The Menninger Clinic, Houston, Texas, USA.,Department of Psychiatry & Behavioral Sciences, Baylor College of Medicine, Houston, Texas, USA
| | - J Christopher Fowler
- The Menninger Clinic, Houston, Texas, USA.,Department of Psychiatry & Behavioral Sciences, Baylor College of Medicine, Houston, Texas, USA
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Madan A, Borckardt JJ, Balliet WE, Barth KS, Delustro LM, Malcolm RM, Koch D, Willner I, Baliga P, Reuben A. Neurocognitive status is associated with all-cause mortality among psychiatric, high-risk liver transplant candidates and recipients. Int J Psychiatry Med 2015; 49:279-95. [PMID: 26078395 DOI: 10.1177/0091217415589304] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Judicious selection of potential liver transplant candidates and close monitoring of progress are essential to successful outcomes. Pretransplant psychosocial evaluations are the norm, but the relationship between psychosocial (and neurocognitive status) and longer term medical outcomes is understudied. This exploratory study sought to examine the relationship between objective measures of pretransplant psychosocial and neurocognitive status and service utilization, transplant status, and all-cause mortality. METHODS This retrospective chart review examined outcomes among 108 psychiatric, high-risk liver transplant candidates up to four years following initial evaluation. Predictor variables of outcomes included demographic, medical, neurocognitive, psychological, and mental health treatment variables. RESULTS Transplant status and neurocognitive functioning were independently associated with all-cause mortality. None of the other variables were associated with outcomes. CONCLUSIONS Better neurocognitive functioning in high-risk liver transplant candidates may allow for greater involvement in medical care and/or compliance with treatment recommendations. More aggressive assessment and management of neurocognitive dysfunction may improve outcomes. Objective measures identified significant psychopathology typical of liver transplant candidates but were not associated with outcomes; engagement in specialized mental health care may have attenuated this relationship. Further study is needed to better understand the relationship between psychosocial functioning and outcomes.
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Affiliation(s)
- A Madan
- The Menninger Clinic, Houston, TX, USA Department of Psychiatry & Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - J J Borckardt
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - W E Balliet
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - K S Barth
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - L M Delustro
- Department of Psychology, East Tennessee State University, Johnson City, TN, USA
| | - R M Malcolm
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - D Koch
- Department of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - I Willner
- Department of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - P Baliga
- Department of Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - A Reuben
- Department of Medicine, Medical University of South Carolina, Charleston, SC, USA
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Allen JG, Madan A, Fowler JC. Reliability and validity of the Stressful Life Events Screening Questionnaire among inpatients with severe neuropsychiatric illness. Bull Menninger Clin 2015; 79:187-202. [DOI: 10.1521/bumc.2015.79.3.187] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Fowler JC, Patriquin M, Madan A, Allen JG, Frueh BC, Oldham JM. Early identification of treatment non-response utilizing the Patient Health Questionnaire (PHQ-9). J Psychiatr Res 2015; 68:114-9. [PMID: 26228409 DOI: 10.1016/j.jpsychires.2015.06.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Revised: 06/19/2015] [Accepted: 06/20/2015] [Indexed: 01/05/2023]
Abstract
BACKGROUND Treatment non-response among high-risk, psychiatric patients exposes those suffering to suicidal risk as well as persistent social and occupational difficulties. Strategies for identification of treatment non-response are limited. AIMS Diagnostic efficiency of a self-report, cross-cutting symptom measure was assessed as a marker of treatment non-response. METHOD 835 inpatients at a specialist psychiatric hospital completed the Patient Health Questionnaire - Depression (PHQ-9) at admission and every two weeks during hospitalization. RESULTS For patients admitted with severe depression (PHQ-9 ≥ 20), results indicated good accuracy of 2-week PHQ-9 change score in identifying treatment non-response (AUC = 0.80, SE = 0.04, p < .0001; sensitivity = 85%; specificity = 73%; OR = 14.91). CONCLUSIONS The search for predictors of non-response to psychiatric treatment has a long and generally unfulfilled history. The PHQ-9 change score holds promise as a cost-effective test with comparable diagnostic characteristics to other medical tests.
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Affiliation(s)
- J Christopher Fowler
- The Menninger Clinic, 12301 Main Street Houston, TX 77035, USA; Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA.
| | - Michelle Patriquin
- The Menninger Clinic, 12301 Main Street Houston, TX 77035, USA; Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA
| | - Alok Madan
- The Menninger Clinic, 12301 Main Street Houston, TX 77035, USA; Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA
| | - Jon G Allen
- The Menninger Clinic, 12301 Main Street Houston, TX 77035, USA; Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA
| | - B Christopher Frueh
- The Menninger Clinic, 12301 Main Street Houston, TX 77035, USA; University of Hawaii, Department of Psychology, 200 West Kawili St., Hilo, HI 96720, USA
| | - John M Oldham
- The Menninger Clinic, 12301 Main Street Houston, TX 77035, USA; Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA
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Madan A, Oldham JM, Gonzalez S, Fowler JC. Reducing Adverse Polypharmacy in Patients With Borderline Personality Disorder: An Empirical Case Study. Prim Care Companion CNS Disord 2015; 17:14m01760. [PMID: 26693036 PMCID: PMC4664564 DOI: 10.4088/pcc.14m01760] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Accepted: 03/10/2015] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVE Polypharmacy is common and especially challenging in the context of borderline personality disorder in light of impulsivity and self-harm associated with the disorder, risk of adverse drug-drug interactions, and financial burden. Reduction in polypharmacy could be conceptualized as a high priority in the treatment of borderline personality disorder. This case aims to demonstrate that potential. METHOD This case report presents outcomes data for an individual with borderline personality disorder during the course of an extended psychiatric hospitalization. Symptomatic change is based on the Patient Health Questionnaire Somatic, Anxiety, and Depression Symptoms scales and World Health Organization 5-Item Well-Being Index. Change in polypharmacy is presented both in terms of absolute number and complexity of the medication regimen. Clinical outcomes data are provided at 2, 12, and 24 weeks postdischarge. RESULTS During a 56-day hospitalization, the patient demonstrated clinical improvement across clinical domains-all occurred within the context of reduced number (43%) and complexity (40%) of her medication regimen. Symptomatic improvement was sustained up to 6 months postdischarge. CONCLUSIONS Despite good intentions, polypharmacy can be associated with iatrogenic harm and contribute to functional impairment, especially in the context of borderline personality disorder, in which symptomatic fluctuations are part of the illness itself. A reduction in the patient's high-risk polypharmacy during treatment represents a noteworthy treatment outcome in and of itself. Additional measures of medication risk and liability have the potential to become markers of clinical effectiveness.
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Affiliation(s)
- Alok Madan
- The Menninger Clinic and Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas
| | - John M Oldham
- The Menninger Clinic and Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas
| | - Sylvia Gonzalez
- The Menninger Clinic and Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas
| | - J Christopher Fowler
- The Menninger Clinic and Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas
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Fowler JC, Madan A, Allen JG, Ellis T, Mahoney J, Hardesty S, Frueh BC, Oldham JM. Improvement in health-related quality of life among adults with serious mental illness receiving inpatient treatment: a prospective cohort study. J Clin Psychiatry 2015; 76:e632-8. [PMID: 26035197 DOI: 10.4088/jcp.14m09041] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Accepted: 05/21/2014] [Indexed: 10/23/2022]
Abstract
OBJECTIVE This study examined changes in health-related quality of life in adult inpatients with serious mental illness engaged in a 6- to 8-week intensive treatment program. METHOD Admission and discharge assessment with the MOS 36-item Short-Form Health Survey was completed (June 2010-June 2012) for 410 adults aged 18-68 years. Paired t tests and effect size estimates were calculated for the overall sample, and reliable change index scores and clinical significance were calculated to estimate individual-level response and recovery rates. Hierarchical stepwise regression analyses were conducted to explore patient pretreatment characteristics, including total number of DSM-IV-TR diagnoses, that influence treatment response. RESULTS Large effect size improvements were demonstrated for the Mental Component Summary score (Cohen d = 1.5), including subjective ratings of vitality (Cohen d = 1.1), social functioning (Cohen d = 1.3), role-emotional functioning (Cohen d = 1.3), and mental health (Cohen d = 1.3). Equivocal findings for change in physical health were demonstrated, with the majority of patients demonstrating no significant change in function (t409 = 0.14, P = .89) but approximately equal numbers of patients demonstrating improvement and deterioration. The pretreatment characteristic of a tendency to be interpersonally distant, cold, and disengaged was predictive of a poorer outcome on Mental Component Summary treatment response (P < .001). CONCLUSIONS In light of a heavy burden of illness and high psychiatric comorbidity of this sample, treatment response was generally positive for improvement in mental health functioning. This study adds to a growing body of evidence indicating robust treatment response even for those with serious mental illness when treatment is intensive and multimodal.
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Madan A, Walker CR, Weinstein B, Fowler JC. Pharmacogenomics in practice: a case report of personalized inpatient psychiatric care. Pharmacogenomics 2015; 16:433-9. [DOI: 10.2217/pgs.15.9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Given variable response to psychotropic intervention, this case highlights the potential of pharmacogenomics to inform medical decision-making in a male with atypical psychosis and depression with longer-standing attentional difficulties. Likely because of his specific COMT polymorphism and intermediate metabolizing liver enzymes, when the patient's stimulant medications were titrated to affect for attentional needs, he became psychotic secondary to a hyperdopaminergic state. Past prescriptions of dopaminergic antidepressant agents (e.g., bupropion) likely would have exacerbated further the problem. The patient's serotonin transporter polymorphism also potentially was associated with SSRI inefficacy and increased side effects. Knowledge of the patient's genetically influenced departure from average response allowed for personalization of pharmacology with clinical improvement across measures of functioning.
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Affiliation(s)
- Alok Madan
- The Menninger Clinic, 12301 South Main Street, Houston, TX 77035, USA
- Menninger Department of Psychiatry & Behavioral Sciences, Baylor College of Medicine, Houston, TX 77030, USA
| | - Cory R Walker
- The Menninger Clinic, 12301 South Main Street, Houston, TX 77035, USA
- Menninger Department of Psychiatry & Behavioral Sciences, Baylor College of Medicine, Houston, TX 77030, USA
| | - Benjamin Weinstein
- The Menninger Clinic, 12301 South Main Street, Houston, TX 77035, USA
- Menninger Department of Psychiatry & Behavioral Sciences, Baylor College of Medicine, Houston, TX 77030, USA
| | - J Christopher Fowler
- The Menninger Clinic, 12301 South Main Street, Houston, TX 77035, USA
- Menninger Department of Psychiatry & Behavioral Sciences, Baylor College of Medicine, Houston, TX 77030, USA
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Barman KD, Madan A, Garg VK, Goel K, Khurana N. Unusual Presentation of Necrotic Erythema Nodosum Leprosum on Scalp: A Case Report. Indian J Lepr 2015; 87:23-26. [PMID: 26591847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Lepra reactions are acute episodes occurring during the disease process of leprosy and are of 2 types: type 1 or reversal reaction and type 2 reaction or erythema odosumleprosum (ENL). In the episodes of lepra reaction several parts are affected including face and extremities like oral cavity. In the present case report we reported a rare case of lepromatous leprosy with necrotic ENL involving scalp apart from the usual sites. A 58 year old married male presented to us with complaints of spontaneous onset, recurrent eruption of multiple reddish raised painful lesions. Biopsy from the infiltrated skin over the back showed atrophic epidermis, free Grenz zone, diffuse and periadnexal macrophage granulomas with predominant mononuclear infiltrate, appandageal atrophy, fibrosis around the neural structures and leukocytoclastic vasculitis. Fites stain showed strong positivity for M. leprae. His routine blood investigations showed anemia (Hb = 7.8 gm%), neutrophil leukocytosis (TLC = 17,600, DLC = P66L28M4E2) and raised ESR (80 mm in the first hour). These bullous and necrotic lesions in leprosy may be a manifestation of severe type II reactions in patients with very high bacillary load.
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Madan A, Fowler JC. Consistency and coherence in treatment outcome measures for borderline personality disorder. Borderline Personal Disord Emot Dysregul 2015; 2:1. [PMID: 26401304 PMCID: PMC4579515 DOI: 10.1186/s40479-014-0022-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Accepted: 12/23/2014] [Indexed: 11/19/2022] Open
Abstract
There is little consensus regarding outcomes assessment in borderline personality disorder treatment trials, making comparisons of results and meta-analytic studies difficult and far less generalizable. The current article highlights a range of measures frequently employed and puts forth a set of recommendations for a core battery of outcome measures in BPD treatment efforts. The proposed core battery aims to be comprehensive while minimizing patient burden, clinician time and costs. The relative brevity of the proposed core battery would engender flexibility for adding specific processes and outcome measures unique to targeted interventions and treatment models.
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Affiliation(s)
- Alok Madan
- The Menninger Clinic, 12301 South Main Street, Houston, TX 77035 USA ; Department of Psychiatry & Behavioral Sciences, Baylor College of Medicine, Houston, TX USA
| | - J Christopher Fowler
- The Menninger Clinic, 12301 South Main Street, Houston, TX 77035 USA ; Department of Psychiatry & Behavioral Sciences, Baylor College of Medicine, Houston, TX USA
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Wedin S, Madan A, Correll J, Crowley N, Malcolm R, Karl Byrne T, Borckardt JJ. Emotional eating, marital status and history of physical abuse predict 2-year weight loss in weight loss surgery patients. Eat Behav 2014; 15:619-24. [PMID: 25241076 DOI: 10.1016/j.eatbeh.2014.08.019] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Revised: 07/24/2014] [Accepted: 08/21/2014] [Indexed: 11/26/2022]
Abstract
BACKGROUND Weight loss surgery (WLS) is an effective weight loss treatment for individuals with severe obesity. Psychosocial factors can affect short-term WLS outcomes. This study sought to identify psychosocial predictors of medium-term outcomes. METHODS In this prospective study, 250 consecutive WLS candidates were evaluated between January 1, 2010 and December 31, 2010. Each completed baseline medical, surgical, and psychological evaluations as part of standard of care. Two hundred and four patients had surgery (81.6%). Successful surgical outcome was defined as ≥50% excess weight loss two years post-surgery. RESULTS Comparison of study sample (n=80) and those lost to follow-up (n=124) revealed negligible differences across baseline characteristics. At follow-up, 60% (n=48) of the sample was classified as a success with an average of 72.58% (std dev=13.01%) excess weight lost. The remaining 40% (n=32) was classified as a failure with an average of 33.98% (std dev=13.19%) excess weight lost. Logistic regression revealed that pre-surgical marital status, emotional eating, and history of physical abuse were independently associated with outcome variables, p<0.05. CONCLUSIONS Being married, perhaps as a proxy for social support, is associated with 6.9 times increased odds of medium-term WLS success and emotionally driven disordered eating patterns are associated with 7.4 times increased odds of medium-term WLS success. A history of physical abuse is associated with an 84% decreased odds of successful medium-term outcomes. Further research that studies both the quality and impact of spousal support on weight loss as well as longer-term effects of emotional eating on outcomes is needed. Addressing longer-standing consequence of abuse may improve WLS outcomes.
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Affiliation(s)
- Sharlene Wedin
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President Street, Charleston, SC 29425, United States.
| | - Alok Madan
- The Menninger Clinic, 12301 South Main St., Houston, TX 77035, United States; Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, United States
| | - Jennifer Correll
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President Street, Charleston, SC 29425, United States
| | - Nina Crowley
- Bariatric Surgery Program, Medical University of South Carolina, 25 Courtenay Dr, Charleston, SC 29425, United States
| | - Robert Malcolm
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President Street, Charleston, SC 29425, United States
| | - T Karl Byrne
- Bariatric Surgery Program, Medical University of South Carolina, 25 Courtenay Dr, Charleston, SC 29425, United States
| | - Jeffrey J Borckardt
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President Street, Charleston, SC 29425, United States
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Madan A, Borckardt JJ, Grubaugh AL, Danielson CK, McLeod-Bryant S, Cooney H, Herbert J, Hardesty SJ, Frueh BC. Efforts to reduce seclusion and restraint use in a state psychiatric hospital: a ten-year perspective. Psychiatr Serv 2014; 65:1273-6. [PMID: 25022602 DOI: 10.1176/appi.ps.201300383] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The authors previously demonstrated an 82.3% reduction in seclusion and restraint use at an inpatient psychiatric facility, largely attributable to changes to the physical environment. This study investigated whether the reduction was sustained over time. METHODS This follow-up study examined archival data by using a longer preintervention baseline phase and examined the sustainability of intervention gains in the absence of a research agenda. Over ten years, 3,040 seclusion and restraint incidents were analyzed across 254,491 patient-days. RESULTS The extended baseline phase (N=38 months) exhibited a linear trend upward in seclusion and restraint use, and the formal intervention period and subsequent follow-up periods (N=82 months) showed a stabilization effect (p<.001). CONCLUSIONS The findings suggest that reduction in seclusion and restraint use is sustainable, and judicious use of seclusion and restraint can become the new normative practice-even in the face of potentially disruptive administrative and environmental changes.
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