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Bernier LB, Foley JD, Salomaa AC, Scheer JR, Kelly J, Hoeppner B, Batchelder AW. Examining sexual minority engagement in recovery community centers. J Subst Use Addict Treat 2024; 161:209340. [PMID: 38494052 DOI: 10.1016/j.josat.2024.209340] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 02/14/2024] [Accepted: 02/21/2024] [Indexed: 03/19/2024]
Abstract
INTRODUCTION Research indicates that sexual minority (SM) individuals with alcohol and other drug use disorders may underutilize recovery resources generally but be more likely to use recovery community centers (RCCs). To inform recovery supports, this study characterized SM and heterosexual RCC members by demographics and clinical and recovery support service utilization. METHODS Cross-sectional secondary analyses compared SM and heterosexual RCC members in the northeastern U.S. (n = 337). Qualitative analyses coded the top three recovery facilitators. RESULTS Of the 337 participants (Meanage[SD] = 40.98[12.38], 51.8 % female), SM RCC members were more likely than heterosexuals to endorse lifetime psychiatric diagnoses and emergency department mental health treatment (p < .01). RCC service utilization and qualitatively derived recovery facilitators were mostly consistent across groups. CONCLUSIONS RCCs engaged SM individuals in recovery in ways consistent with heterosexuals. Despite otherwise vastly similar demographic characteristics across sexual identity, findings suggest a need for additional mental health resources for SM individuals in recovery.
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Affiliation(s)
- Lauren B Bernier
- Behavioral Medicine Program, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Jacklyn D Foley
- Behavioral Medicine Program, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA 02215, USA; The Fenway Institute, Fenway Health, Boston, MA, USA
| | - Anna C Salomaa
- Boston University School of Medicine, Boston, MA, USA; VA Boston Healthcare System, Boston, MA, USA
| | | | - John Kelly
- Behavioral Medicine Program, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA 02215, USA
| | - Bettina Hoeppner
- Behavioral Medicine Program, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Abigail W Batchelder
- Behavioral Medicine Program, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA 02215, USA; The Fenway Institute, Fenway Health, Boston, MA, USA; Boston University School of Medicine, Boston, MA, USA.
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Wirtz MR, Stanton AM, Manohar R, Labbe AK, Zvolensky MJ, Smits JAJ, Hoeppner B, O’Cleirigh C. The Relationship Between Cigarette Dependence and Cessation Methods: Implications for Smoking Cessation Among People With HIV. J Stud Alcohol Drugs 2023; 84:772-780. [PMID: 37219036 PMCID: PMC10600974 DOI: 10.15288/jsad.22-00318] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 05/08/2023] [Indexed: 05/24/2023] Open
Abstract
OBJECTIVE These analyses investigate how dependence may be related to cessation method choice and how this relationship may vary by subpopulation among people with HIV (PWH) who smoke cigarettes. METHOD PWH who smoke (N = 71) were recruited from clinics in Boston, MA. The Fagerström Test for Nicotine Dependence (FTND) and Smoking History Questionnaire (SHQ) were completed to assess for cigarette dependence, past-week cigarettes per day (CPD), and past cessation method use. Logistic regression examined the association between dependence and previous cessation methods for the whole sample, and moderation analyses assessed this relationship by age and race. RESULTS Higher FTND was associated with less use of behavioral modification methods (odds ratio [OR] = 0.658, 95% CI [0.435, 0.994], p = .047). Higher past-week CPD was associated with use of the American Cancer Society/American Lung Association (ACS/ALA) programs (OR = 1.159, 95% CI [1.011, 1.328], p = .035) and telephone counselling (OR = 1.142, 95% CI [1.006, 1.295], p = .040]). Older participants with more past-week CPD were more likely to have used the ACS/ALA programs (B = 0.0169, 95% CI [0.0008, 0.0331], p = .0401), and White participants with more past-week CPD were less likely to have tried to quit "cold turkey" (B = 0.1676, 95% CI [0.0027, 0.3326], p = .0464). CONCLUSIONS These preliminary results suggest that there is likely not a "one-size-fits-all" approach to cessation for PWH who smoke, especially within subpopulations (i.e., age and race). Implications include ensuring access to multiple cessation methods, identifying methods that could be culturally appropriate outside of the clinical intervention setting, and providing education and support on cessation methods offered.
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Affiliation(s)
- Megan R. Wirtz
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
- The Graduate Center, City University of New York, New York, New York
| | - Amelia M. Stanton
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
- Department of Psychological and Brain Sciences, Boston University, Boston, Massachusetts
- The Fenway Health Institute, Fenway Health, Boston, Massachusetts
| | - Rohin Manohar
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
| | - Allison K. Labbe
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Michael J. Zvolensky
- Department of Psychology, University of Houston, Houston, Texas
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, Texas
- HEALTH Institute, University of Houston, Houston, Texas
| | | | - Bettina Hoeppner
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Conall O’Cleirigh
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
- The Fenway Health Institute, Fenway Health, Boston, Massachusetts
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
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Cohen S, Nielsen T, Chou JH, Hoeppner B, Koenigs KJ, Bernstein SN, Smith NA, Perlman N, Sarathy L, Wilens T, Terplan M, Schiff DM. Disparities in Maternal-Infant Drug Testing, Social Work Assessment, and Custody at 5 Hospitals. Acad Pediatr 2023; 23:1268-1275. [PMID: 36754165 DOI: 10.1016/j.acap.2023.01.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [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: 06/30/2022] [Revised: 01/23/2023] [Accepted: 01/27/2023] [Indexed: 02/10/2023]
Abstract
OBJECTIVE To evaluate for disparities in peripartum toxicology testing among maternal-infant dyads across a hospital network and subsequent child protective services (CPS) involvement. METHODS Retrospective chart review of 59,425 deliveries at 5 hospitals in Massachusetts between 2016 and 2020. We evaluated associations between maternal characteristics, toxicology testing, and child welfare involvement with disproportionality risk ratios and hierarchical logistical regression. RESULTS Toxicology testing was performed on 1959 (3.3%) dyads. Younger individuals and individuals of color were more likely to be tested for cannabis use or maternal medical complications compared to white non-Hispanic individuals. Among those without a substance use disorder, age <25 (adjusted odds ratio [aOR] 2.81; 95% confidence interval [CI], 2.43-3.26), race and ethnicity (non-Hispanic Black (aOR 1.80; 95% CI, 1.52-2.13), Hispanic (aOR 1.23; 95% CI, 1.05-1.45), mixed race/other (aOR 1.40; 95% CI, 1.04, 1.87), unavailable race (aOR 1.92; 95% CI, 1.32-2.79), and public insurance (Medicaid [aOR 2.61; 95% CI, 2.27-3.00], Medicare [aOR 13.76; 95% CI, 9.99-18.91]) had increased odds of toxicology testing compared to older, white non-Hispanic, and privately insured individuals. The disproportionality ratios in testing were greater than 1.0 for individuals under 25 years old (3.8), Hispanic individuals (1.6), non-Hispanic Black individuals (1.8), individuals of other race (1.2), unavailable race (1.8), and individuals with public insurance (Medicaid 2.6; Medicare 10.6). Among dyads tested, race and ethnicity was not associated with CPS involvement. CONCLUSIONS Peripartum toxicology testing is disproportionately performed on non-white, younger, and poorer individuals and their infants, with cannabis use and medical complications prompting testing more often for patients of color than for white non-Hispanic individuals.
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Affiliation(s)
- Samuel Cohen
- MassGeneral Hospital for Children (S Cohen, JH Chou, L Sarathy, and DM Schiff), Boston, Mass; Department of Pediatrics, Boston Medical Center (S Cohen), Boston, Mass.
| | - Timothy Nielsen
- Children's Hospital Westmead Clinical School, Faculty of Medicine and Health, University of Sydney (T Nielsen), Sydney, Australia
| | - Joseph H Chou
- MassGeneral Hospital for Children (S Cohen, JH Chou, L Sarathy, and DM Schiff), Boston, Mass
| | - Bettina Hoeppner
- Department of Psychiatry, Harvard Medical School (B Hoeppner and T Wilens), Boston, Mass
| | - Kathleen J Koenigs
- BWH/MGH Integrated Residency Program in Obstetrics and Gynecology (KJ Koenigs and N Perlman), Boston, Mass
| | - Sarah N Bernstein
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology and Reproductive Biology, Massachusetts General Hospital (SN Bernstein), Boston, Mass
| | - Nicole A Smith
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology and Reproductive Biology, Brigham and Women's Hospital (NA Smith), Boston, Mass
| | - Nicola Perlman
- BWH/MGH Integrated Residency Program in Obstetrics and Gynecology (KJ Koenigs and N Perlman), Boston, Mass
| | - Leela Sarathy
- MassGeneral Hospital for Children (S Cohen, JH Chou, L Sarathy, and DM Schiff), Boston, Mass
| | - Timothy Wilens
- Department of Psychiatry, Harvard Medical School (B Hoeppner and T Wilens), Boston, Mass
| | | | - Davida M Schiff
- MassGeneral Hospital for Children (S Cohen, JH Chou, L Sarathy, and DM Schiff), Boston, Mass
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Feig EH, Madva EN, Millstein RA, Zambrano J, Amonoo HL, Longley RM, Okoro F, Huffman JC, Celano CM, Hoeppner B. Can positive psychological interventions improve health behaviors? A systematic review of the literature. Prev Med 2022; 163:107214. [PMID: 35998764 PMCID: PMC10141541 DOI: 10.1016/j.ypmed.2022.107214] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [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: 01/31/2022] [Revised: 06/06/2022] [Accepted: 08/17/2022] [Indexed: 10/15/2022]
Abstract
Positive psychological interventions (PPIs), which aim to cultivate psychological well-being, have the potential to improve health behavior adherence. This systematic review summarized the existing literature on PPI studies with a health behavior outcome to examine study methodology, quality, and efficacy. Of the 27 identified studies, 20 measured physical activity, eight measured medication adherence, seven measured diet, and three measured smoking (eight targeted multiple behaviors). Twenty studies were randomized controlled trials (RCTs; 13 fully powered), and seven had a single-arm design. Study samples were usually adults (n = 21), majority non-Hispanic white (n = 15) and female (n = 14), and with a specific disease (e.g., diabetes, n = 16). Most interventions combined a PPI with health behavior-focused content (n = 17), used a remote delivery method (n = 17), and received a moderate or low study quality rating. Overall, 19/27 studies found a health behavior improvement of at least medium effect size, while six of the 13 studies powered to detect significant effects were statistically significant. Of the behaviors measured, physical activity was most likely to improve (14/20 studies). In summary, PPIs are being increasingly studied as a strategy to enhance health behavior adherence. The existing literature is limited by small sample size, low study quality and inconsistent intervention content and outcome measurement. Future research should establish the most effective components of PPIs that can be tailored to different populations, use objective health behavior measurement, and robustly examine the effects of PPIs on health behaviors in fully powered RCTs.
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Affiliation(s)
- Emily H Feig
- Department of Psychiatry, Massachusetts General Hospital, 55 Fruit St., Boston, MA 02114, USA; Harvard Medical School, 25 Shattuck St., Boston, MA 02115, USA.
| | - Elizabeth N Madva
- Department of Psychiatry, Massachusetts General Hospital, 55 Fruit St., Boston, MA 02114, USA; Harvard Medical School, 25 Shattuck St., Boston, MA 02115, USA
| | - Rachel A Millstein
- Department of Psychiatry, Massachusetts General Hospital, 55 Fruit St., Boston, MA 02114, USA; Harvard Medical School, 25 Shattuck St., Boston, MA 02115, USA
| | - Juliana Zambrano
- Department of Psychiatry, Massachusetts General Hospital, 55 Fruit St., Boston, MA 02114, USA; Harvard Medical School, 25 Shattuck St., Boston, MA 02115, USA
| | - Hermioni L Amonoo
- Harvard Medical School, 25 Shattuck St., Boston, MA 02115, USA; Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA 02115, USA; Department of Psychiatry, Brigham and Women's Hospital, 75 Francis St., Boston, MA 02115, USA
| | - Regina M Longley
- Department of Psychiatry, Massachusetts General Hospital, 55 Fruit St., Boston, MA 02114, USA
| | - Florence Okoro
- Department of Psychiatry, Massachusetts General Hospital, 55 Fruit St., Boston, MA 02114, USA
| | - Jeff C Huffman
- Department of Psychiatry, Massachusetts General Hospital, 55 Fruit St., Boston, MA 02114, USA; Harvard Medical School, 25 Shattuck St., Boston, MA 02115, USA
| | - Christopher M Celano
- Department of Psychiatry, Massachusetts General Hospital, 55 Fruit St., Boston, MA 02114, USA; Harvard Medical School, 25 Shattuck St., Boston, MA 02115, USA
| | - Bettina Hoeppner
- Department of Psychiatry, Massachusetts General Hospital, 55 Fruit St., Boston, MA 02114, USA; Harvard Medical School, 25 Shattuck St., Boston, MA 02115, USA
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Yeung A, Xie Q, Huang X, Hoeppner B, Jain FA, Tan EK, Mai X, Mischoulon D, Guo X. Effectiveness of Mindful Self-Compassion Training Supported by Online Peer Groups in China: A Pilot Study. Altern Ther Health Med 2021:AT6940. [PMID: 34559687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
CONTEXT Self-compassion training involves the cultivation of feelings of warmth and safety, presence, and interconnectedness. Mindful Self-Compassion (MSC) training in a group setting has been found to increase self-compassion, mindfulness, and emotional well-being. OBJECTIVE The current study intended to examine the outcomes of live, online, videoconference-based MSC training with online peer-support for nonclinical populations in different cities in China. DESIGN The research team designed a pre-post pilot study. SETTING The study took place at Renmin University in Beijing, China. PARTICIPANTS Participants were 253 Chinese individuals who were recruited from different regions in China through online advertisements. INTERVENTION Participants took part in online MSC training in a two-hour, group class each week for eight weeks and received support from online peer groups and through a half-day in-person retreat. OUTCOME MEASURES Self-report outcomes were obtained at baseline and postintervention, using the Self Compassion Scale (SCS) and the Compassion for Others Scale (CS) for primary outcomes, and the Depression, Anxiety, and Stress Scale (DASS-21), the Fear of Compassion Scale (FOCS), the Satisfaction with Life Scale (SWLS), the Subjective Happiness Scale (SHS), and the Cognitive and Affective Mindfulness Scale (CAMS-R), for secondary outcomes. A fixed effects model was used to test for within-group changes in the scales. RESULTS The online MSC program yielded a high retention rate. Of the 206 first-time participants, 179 (86.9%) attended six or more of the eight MSC sessions, and 183 (88.8%) completed the assessments at both baseline and postintervention. Of the 183 retained participants, 97.8% were female, with an average age of 37.8 ± 7.9; 94% had college or higher education. For all scales, the within-person changes occurred in the expected direction; positive attributes and experiences increased, while negative attributes and experiences decreased. CONCLUSIONS The study showed that first-time participants in China in an online MSC training that was supported by online peer groups had high attendance rates, high assessment completion, and favorable results. These preliminary outcomes suggest that future studies with more rigorous designs are warranted to further investigate online training with peer support as an effective and efficient approach to disseminate MSC training in China.
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Feeney A, Hock RS, Freeman MP, Flynn M, Hoeppner B, Iosifescu DV, Trivedi MH, Sanacora G, Mathew SJ, Debattista C, Ionescu DF, Fava M, Papakostas GI. The effect of single administration of intravenous ketamine augmentation on suicidal ideation in treatment-resistant unipolar depression: Results from a randomized double-blind study. Eur Neuropsychopharmacol 2021; 49:122-132. [PMID: 34090255 PMCID: PMC8338746 DOI: 10.1016/j.euroneuro.2021.04.024] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [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] [Received: 02/10/2021] [Revised: 04/26/2021] [Accepted: 04/30/2021] [Indexed: 11/28/2022]
Abstract
This study aimed to assess the effect of a single infusion of intravenous (IV) ketamine on suicidal ideation in patients with treatment-resistant depression (TRD). Patients with TRD were randomized in a double-blind fashion to a single infusion of IV ketamine or IV midazolam placebo. Suicidal ideation was measured using the Montgomery-Asberg Depression Rating Scale (MADRS) suicide item at 3, 5, 7, 14 and 30 days post infusion. Clinically significant suicidal ideation was defined as a MADRS suicide item score ≥2. Forty patients who received IV ketamine and 16 who received IV midazolam had suicide item scores of ≥2 at baseline (IV ketamine group mean 2.90±0.74; IV midazolam group 2.69±0.70). The mean suicide scores of these groups differed significantly from each other on day 30; the IV ketamine group had a lower mean score than controls (2.03±1.59 vs. 3.00±1.41, t-test p = 0.049; Hedges' g 0.71). Among patients with a suicide score of ≥2 at baseline and <2 at day 3, the two groups did not differ significantly on mean scores changes at days 3, 5, 7, 14 or 30. Recurrence of suicidal ideation was extensive in both treatment groups. A single infusion of IV ketamine may reduce suicidal ideation in TRD out to 30 days post infusion, but early anti-suicidal effects appear to diminish rapidly. This post-hoc analysis was not powered to compare different doses of ketamine. A single infusion of IV ketamine might have a role as an adjunct to standard treatments in patients with TRD and suicidal ideation. Trial registration: NCT01920555.
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Affiliation(s)
- Anna Feeney
- Clinical Trials Network and Institute, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA.
| | - Rebecca S Hock
- Clinical Trials Network and Institute, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Marlene P Freeman
- Clinical Trials Network and Institute, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA; Center for Women's Mental Health, Massachusetts General Hospital, Boston, MA
| | - Martina Flynn
- Clinical Trials Network and Institute, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Bettina Hoeppner
- Psychiatry Department, Massachusetts General Hospital, Boston, MA
| | - Dan V Iosifescu
- Clinical Research Division, Nathan Kline Institute for Psychiatric Research, Orangeburg, NY; Department of Psychiatry, New York University School of Medicine, New York, NY
| | - Madhukar H Trivedi
- Department of Psychiatry and Peter O'Donnell Jr. Brain Institute, University of Texas Southwestern Medical Center, Dallas, TX
| | | | - Sanjay J Mathew
- Menninger Department of Psychiatry & Behavioral Sciences, Baylor College of Medicine, Houston, TX; Michael E. Debakey VA Medical Center Mental Health Care Line, Houston, TX
| | | | | | - Maurizio Fava
- Clinical Trials Network and Institute, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - George I Papakostas
- Clinical Trials Network and Institute, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA
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Harris M, Joseph K, Hoeppner B, Wachman EM, Gray JR, Saia K, Wakeman S, Bair-Merritt MH, Schiff DM. A Retrospective Cohort Study Examining the Utility of Perinatal Urine Toxicology Testing to Guide Breastfeeding Initiation. J Addict Med 2021; 15:311-317. [PMID: 33060464 PMCID: PMC8044259 DOI: 10.1097/adm.0000000000000761] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE National guidelines advise against breastfeeding for women who use nonprescribed substances in the third trimester. This reduces the number of women who are supported in breastfeeding initiation despite limited evidence on the prognostic value of third trimester substance use. We sought to examine the degree to which prenatal nonprescribed substance use is associated with non-prescribed use postpartum. METHODS Retrospective cohort study of pregnant women with opioid use disorder on methadone or buprenorphine between 2006 and 2015. Nonprescribed use was defined by a positive urine drug testing (UDT). Sensitivity, specificity, positive predictive value, and negative predictive value were calculated comparing 3 prenatal periods with postpartum UDT results. Generalized estimating equations were used to examine the extent to which prenatal nonprescribed use was associated with postpartum use. RESULTS Included were 545 deliveries by 503 women. Mean age was 28.3 years, 88% were White/non-Hispanic, 93% had public insurance, and 43% received adequate prenatal care. The predictive value of UDT's 90 to 31 days before delivery, 30 to 0 days before delivery, and at delivery showed low sensitivity (44, 26, 27%, respectively) and positive predictive value (36, 36, 56%, respectively), but higher negative predictive value (80, 85, and 78%, respectively), P-values all <0.05. In the final adjusted model, only nonprescribed use at delivery was significantly associated with postpartum nonprescribed use. CONCLUSIONS Nonprescribed use at delivery was most strongly associated with postpartum use compared with earlier time periods currently prioritized in guidelines. In women with opioid use disorder prenatal UDT results alone are insufficient to guide breastfeeding decisions.
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Affiliation(s)
- Miriam Harris
- Grayken Center for Addiction, Boston Medical Center, Boston, MA, USA
- Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine and Boston Medical Center, Boston MA, USA
| | - Kathleen Joseph
- Department Emergency Medicine, University of Indiana, Indianapolis, IN, USA
| | - Bettina Hoeppner
- Research Recovery Institute, Department of Psychiatry, Massachusetts General Hospital, Boston MA, USA
| | - Elisha M. Wachman
- Division of Neonatology, Department of Pediatrics, Boston Medical Center, Boston, MA, USA
| | - Jessica R. Gray
- Department of Internal Medicine, Massachusetts General Hospital, Boston MA, USA
| | - Kelley Saia
- Department of Obstetrics and Gynecology, Boston Medical Center, Boston, MA, USA
| | - Sarah Wakeman
- Department of Pediatrics, Boston Medical Center, Boston, MA, USA
| | | | - Davida M. Schiff
- Division of General Academic Pediatrics, Massachusetts General Hospital for Children, Boston, MA, USA
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Fava M, Mazzone E, Freeman M, Flynn M, Judge H, Hoeppner B, Hock RS, Shui A, Macaluso M, Morrison MF, Carpenter LL, Shelton R, Zajecka J, Papakostas GI. Double-blind, placebo-controlled, proof-of-concept trial of a kappa-selective opioid receptor antagonist augmentation in treatment-resistant depression. Ann Clin Psychiatry 2020; 32:18-26. [PMID: 33125454 DOI: 10.12788/acp.0003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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] [Indexed: 11/20/2022]
Abstract
BACKGROUND Kappa-opioid antagonism may possess antidepressant properties. We assessed, in a proof-of-concept pilot trial among patients with major depressive disorder with inadequate response to antidepressants, the efficacy of adjunctive CERC-501 (formerly LY2456302), a kappaselective opioid receptor antagonist. METHODS In a Sequential Parallel Comparison Design study, patients were pre-randomized to: a) 10 mg/d of CERC-501 for 6 days, b) 20 mg/d of CERC-501 for 6 days, c) placebo for 3 days followed by 10 mg/d of CERC- 501 for 3 days, d) placebo for 3 days followed by 20 mg/d of CERC-501 for 3 days, or e) placebo for 6 days. RESULTS The study was terminated early by the National Institute of Mental Health due to slow enrollment (N = 8). The weighted mean difference of changes (drug vs placebo) in the 6-item Hamilton Depression Rating Scale (HAMD-6) (primary outcome measure) (1.28), Montgomery-Åsberg Depression Rating Scale (MADRS) (2.33), Perceived Stress Scale (1.01), Symptoms of Depression Questionnaire (9.17), Positive Affect Scale (PAS) (6.39), Symptom Questionnaire (SQ) Depression scale (2.94), SQ Anger- Hostility scale (1.67), and Patient-Reported Outcomes Measurement Information System Satisfaction with Participation in Discretionary Social Activities (4.67) scores were all numerically but not statistically greater for CERC-501 than for placebo. CONCLUSIONS Although the small sample size limits the ability to draw conclusions, results suggest that CERC-501 may have antidepressant effects. Additional studies are necessary to further explore these effects of CERC-501.
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Affiliation(s)
- Maurizio Fava
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02114 USA. E-MAIL:
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Salloum NC, Fava M, Hock RS, Freeman MP, Flynn M, Hoeppner B, Cusin C, Iosifescu DV, Trivedi MH, Sanacora G, Mathew SJ, Debattista C, Ionescu DF, Papakostas GI. Time to relapse after a single administration of intravenous ketamine augmentation in unipolar treatment-resistant depression. J Affect Disord 2020; 260:131-139. [PMID: 31494365 PMCID: PMC6803106 DOI: 10.1016/j.jad.2019.09.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [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: 04/29/2019] [Revised: 07/27/2019] [Accepted: 09/02/2019] [Indexed: 01/21/2023]
Abstract
OBJECTIVE To examine the rate and time to relapse for remitters and responders to ketamine in treatment-resistant depression (TRD). METHODS Subjects with TRD were randomized to a single infusion of one of several doses of intravenous ketamine, or midazolam. Using Kaplan-Meier survival function, the current report examines the rate and time to relapse, defined as MADRS ≥ 22, over a period of 30 days, in subjects who achieved remission (MADRS ≤ 10) or response (≥ 50% reduction in MADRS) on day three post-infusion of intravenous ketamine 0.1, 0.5, or 1.0 mg/kg. RESULTS Of the 60 randomized participants who received a single ketamine (0.1, 0.5, or 1.0 mg/kg) infusion, 19 (34%) met criteria for remission and 27 (48%) for response, on day 3 post-infusion. A numerical dose-response relationship was observed, with remitters/responders on ketamine 1.0 mg/kg having the lowest relapse rate, followed by ketamine 0.5 mg/kg and 0.1 mg/kg, respectively (% of remitters who relapsed by day 14: 38% with 1.0 mg/kg, 50% with 0.5 mg/kg, 100% with 0.1 mg/kg;% of responders who relapsed by day 14: 30% with 1.0 mg/kg, 50% with 0.5 mg/kg, 80% with 0.1 mg/kg). LIMITATIONS The sample size was small. No MADRS measurements at day one post-infusion. The study was not powered to assess differences in relapse prevention between different doses of ketamine. CONCLUSION Time to relapse after successful treatment with a single infusion of ketamine appears to follow a dose-response relationship, where higher dosage leads to increased time to relapse.
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Affiliation(s)
- Naji C Salloum
- Massachusetts General Hospital, Harvard Medical School, USA; Clinical Trials Network and Institute, Massachusetts General Hospital, USA.
| | - Maurizio Fava
- Massachusetts General Hospital, Harvard Medical School, USA; Clinical Trials Network and Institute, Massachusetts General Hospital, USA
| | - Rebecca S Hock
- Massachusetts General Hospital, Harvard Medical School, USA
| | - Marlene P Freeman
- Massachusetts General Hospital, Harvard Medical School, USA; Clinical Trials Network and Institute, Massachusetts General Hospital, USA
| | - Martina Flynn
- Massachusetts General Hospital, Harvard Medical School, USA; Clinical Trials Network and Institute, Massachusetts General Hospital, USA
| | | | - Cristina Cusin
- Massachusetts General Hospital, Harvard Medical School, USA
| | - Dan V Iosifescu
- New York University School of Medicine, Nathan Kline Institute, USA
| | | | | | - Sanjay J Mathew
- Baylor College of Medicine and Michael E. Debakey VA Medical Center, Houston, TX, USA
| | | | - Dawn F Ionescu
- Massachusetts General Hospital, Harvard Medical School, USA
| | - George I Papakostas
- Massachusetts General Hospital, Harvard Medical School, USA; Clinical Trials Network and Institute, Massachusetts General Hospital, USA
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10
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Kelly JF, Hoffman L, Vilsaint C, Weiss R, Nierenberg A, Hoeppner B. Peer support for mood disorder: Characteristics and benefits from attending the Depression and Bipolar Support Alliance mutual-help organization. J Affect Disord 2019; 255:127-135. [PMID: 31150942 PMCID: PMC6591033 DOI: 10.1016/j.jad.2019.05.039] [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] [Received: 12/10/2018] [Revised: 04/08/2019] [Accepted: 05/22/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND Mood disorders (MDs) are pervasive and debilitating psychiatric conditions. Many helpful psychological and psychopharmacological treatments exist, but MD's prevalence and chronicity often means relying purely on professional care can create financial strain on individuals and healthcare systems. Also, many individuals respond only partially to professionally-delivered medical/pharmacological interventions or are unable to tolerate or adhere to them. Peer-led mutual-help organizations (MHOs) have emerged and grown in the U.S. to extend and potentiate professional efforts or otherwise address needs unmet by professional care. The Depression and Bipolar Support Alliance (DBSA) is the largest of these, but beyond observational evidence, little is known about participation or benefits. Greater knowledge could inform the field regarding clinical and public health utility of peer-driven efforts. METHOD Community-based cross-sectional comparative investigation of MD individuals attending (N = 202) or not attending (N = 105) DBSA. Measures included demographics, clinical characteristics and clinical service use, and indices of symptomatology, functioning, quality of life (QOL), and psychological well-being. RESULTS Compared to non-DBSA participants, DBSA participants were more likely to be male and white and trended toward greater religious affiliation (p = 0.05). DBSA participants attended meetings about twice per month with two-thirds attending for more than one year. The DBSA cohort had a much higher proportion with bipolar I disorder and reported more lifetime and past 90-day use of acute, intensive, medical services and medications. There were no between-group differences on indices of QOL or psychological well-being, but within the DBSA group, greater DBSA attendance and involvement was associated with greater QOL and well-being, and less functional impairment. LIMITATIONS Cross-sectional design and regional sampling frame with unknown generalizability to national DBSA membership. CONCLUSION Given the grave impact of MDs and that DBSA is freely available it may fill an important clinical and public health need by attracting and engaging MD individuals with greater functional instability and impairment. The positive association found between greater active DBSA participation and improvements in functioning and well-being, while promising, requires longitudinal investigation to formally establish the causal direction of effects.
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Affiliation(s)
- John F. Kelly
- Recovery Research Institute, Massachusetts General Hospital and Harvard Medical School 151 Merrimac Street, Boston, MA 02114
| | - Lauren Hoffman
- Recovery Research Institute, Massachusetts General Hospital and Harvard Medical School 151 Merrimac Street, Boston, MA 02114
| | - Corrie Vilsaint
- Recovery Research Institute, Massachusetts General Hospital and Harvard Medical School 151 Merrimac Street, Boston, MA 02114
| | | | - Andrew Nierenberg
- Bipolar Clinical and Research Program, Massachusetts General Hospital and Harvard Medical School
| | - Bettina Hoeppner
- Recovery Research Institute, Massachusetts General Hospital and Harvard Medical School 151 Merrimac Street, Boston, MA 02114
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11
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Brown HE, Freudenreich O, Fan X, Heard SO, Goff D, Petrides G, Harrington AL, Kane JM, Judge H, Hoeppner B, Fava M, Perlis RH. Efficacy and Tolerability of Adjunctive Intravenous Sodium Nitroprusside Treatment for Outpatients With Schizophrenia: A Randomized Clinical Trial. JAMA Psychiatry 2019; 76:691-699. [PMID: 30916714 PMCID: PMC6583662 DOI: 10.1001/jamapsychiatry.2019.0151] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [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: 01/02/2023]
Abstract
IMPORTANCE Antipsychotic medications for the treatment of schizophrenia have limitations, and new treatments are needed. A prior pilot investigation suggested that adjunctive sodium nitroprusside (SNP) administered intravenously had rapid efficacy in the treatment of patients with schizophrenia. OBJECTIVE To determine the efficacy and tolerability of intravenous SNP infused at a rate of 0.5 μg/kg/min for 4 hours in patients with schizophrenia with some degree of treatment resistance. DESIGN, SETTING, AND PARTICIPANTS Multicenter, randomized, double-blind acute treatment study using a sequential parallel comparison design conducted in two 2-week phases at 4 academic medical centers beginning May 20, 2015, and ending March 31, 2017. Participants were adults 18 to 65 years of age with a diagnosis of schizophrenia as confirmed by the Structured Clinical Interview for DSM-IV, taking antipsychotic medication for at least 8 weeks, and had at least 1 failed trial of an antipsychotic medication within the past year. A total of 90 participants consented, 60 participants enrolled, and 52 participants were included in the analyses. A modified intent-to-treat analysis was used. INTERVENTIONS Participants were randomized in a 1:1:1 ratio to 1 of 3 treatment sequences: SNP and SNP, placebo and SNP, and placebo and placebo. The SNP and SNP group received SNP in phase 1 and SNP in phase 2 for the purpose of blinding, but the data from phase 2 were not included in the results. The placebo and SNP group received placebo in phase 1 and SNP in phase 2. If there was no response to placebo in phase 1, data from phase 2 were included in the analyses. The placebo and placebo group received placebo in both phases; if there was no response to placebo in phase 1, data from phase 2 were included in the analyses. MAIN OUTCOMES AND MEASURES Effectiveness of SNP compared with placebo in improving Positive and Negative Syndrome Scale (PANSS) total, positive, and negative scores across each 2-week phase. RESULTS Fifty-two participants (12 women and 40 men) were included in the study. In the SNP and SNP group, the mean (SD) age was 47.1 (10.5) years. In the placebo and SNP group, the mean (SD) age was 45.9 (12.3) years. In the placebo and placebo group, the mean (SD) age was 40.4 (11.0) years. There were no significant differences between the SNP and placebo groups at baseline or in change from baseline for PANSS-total (weighted β = -1.04; z = -0.59; P = .57), PANSS-positive (weighted β = -0.62; z = -0.93; P = .35), or PANSS-negative (weighted β = -0.12; z = -0.19; P = .85) scores. No significant differences in safety or tolerability measures were identified. CONCLUSIONS AND RELEVANCE Although intravenous SNP is well tolerated, it was not an efficacious adjunctive treatment of positive or negative symptoms of psychosis among outpatients with schizophrenia with prior history of treatment resistance. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT02164981.
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Affiliation(s)
- Hannah E. Brown
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston,Department of Psychiatry, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts
| | - Oliver Freudenreich
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Xiaoduo Fan
- Department of Psychiatry, UMass Memorial Health Care and UMass Medical School, Worcester, Massachusetts
| | - Stephen O. Heard
- Department of Anesthesiology and Perioperative Medicine, UMass Memorial Health Care and UMass Medical School, Worcester, Massachusetts
| | - Donald Goff
- Department of Psychiatry, NYU Langone Medical Center, New York, New York
| | - George Petrides
- Department of Psychiatry, The Zucker Hillside Hospital, Glen Oaks, New York
| | - Amy L. Harrington
- Department of Psychiatry, UMass Memorial Health Care and UMass Medical School, Worcester, Massachusetts
| | - John M. Kane
- Department of Psychiatry, The Zucker Hillside Hospital, Glen Oaks, New York,Center for Psychiatric Neuroscience, Feinstein Institute for Medical Research, Manhasset, New York,Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York,Department of Molecular Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
| | - Heidi Judge
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Bettina Hoeppner
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Maurizio Fava
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Roy H. Perlis
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston
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12
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Eddie D, Hoffman L, Vilsaint C, Abry A, Bergman B, Hoeppner B, Weinstein C, Kelly JF. Lived Experience in New Models of Care for Substance Use Disorder: A Systematic Review of Peer Recovery Support Services and Recovery Coaching. Front Psychol 2019; 10:1052. [PMID: 31263434 PMCID: PMC6585590 DOI: 10.3389/fpsyg.2019.01052] [Citation(s) in RCA: 165] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 04/24/2019] [Indexed: 12/05/2022] Open
Abstract
Peer recovery support services (PRSS) are increasingly being employed in a range of clinical settings to assist individuals with substance use disorder (SUD) and co-occurring psychological disorders. PRSS are peer-driven mentoring, education, and support ministrations delivered by individuals who, because of their own experience with SUD and SUD recovery, are experientially qualified to support peers currently experiencing SUD and associated problems. This systematic review characterizes the existing experimental, quasi-experimental, single- and multi-group prospective and retrospective, and cross-sectional research on PRSS. Findings to date tentatively speak to the potential of peer supports across a number of SUD treatment settings, as evidenced by positive findings on measures including reduced substance use and SUD relapse rates, improved relationships with treatment providers and social supports, increased treatment retention, and greater treatment satisfaction. These findings, however, should be viewed in light of many null findings to date, as well as significant methodological limitations of the existing literature, including inability to distinguish the effects of peer recovery support from other recovery support activities, heterogeneous populations, inconsistency in the definitions of peer workers and recovery coaches, and lack of any, or appropriate comparison groups. Further, role definitions for PRSS and the complexity of clinical boundaries for peers working in the field represent important implementation challenges presented by this novel class of approaches for SUD management. There remains a need for further rigorous investigation to establish the efficacy, effectiveness, and cost-benefits of PRSS. Ultimately, such research may also help solidify PRSS role definitions, identify optimal training guidelines for peers, and establish for whom and under what conditions PRSS are most effective.
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Affiliation(s)
- David Eddie
- Recovery Research Institute, Center for Addiction Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Lauren Hoffman
- Recovery Research Institute, Center for Addiction Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Corrie Vilsaint
- Recovery Research Institute, Center for Addiction Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Alexandra Abry
- Recovery Research Institute, Center for Addiction Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Brandon Bergman
- Recovery Research Institute, Center for Addiction Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Bettina Hoeppner
- Recovery Research Institute, Center for Addiction Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Charles Weinstein
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - John F. Kelly
- Recovery Research Institute, Center for Addiction Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
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13
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Salloum NC, Fava M, Freeman MP, Flynn M, Hoeppner B, Hock RS, Cusin C, Iosifescu DV, Trivedi MH, Sanacora G, Mathew SJ, Debattista C, Ionescu DF, Papakostas GI. Efficacy of intravenous ketamine treatment in anxious versus nonanxious unipolar treatment-resistant depression. Depress Anxiety 2019; 36:235-243. [PMID: 30597688 DOI: 10.1002/da.22875] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [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: 07/23/2018] [Revised: 10/03/2018] [Accepted: 12/01/2018] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE To examine the effect of high baseline anxiety on response to ketamine versus midazolam (active placebo) in treatment-resistant depression (TRD). METHODS In a multisite, double-blind, placebo-controlled trial, 99 subjects with TRD were randomized to one of five arms: a single dose of intravenous ketamine 0.1, 0.2, 0.5, 1.0 mg/kg, or midazolam 0.045 mg/kg. The primary outcome measure was change in the six-item Hamilton Rating Scale for Depression (HAMD6). A linear mixed effects model was used to examine the effect of anxious depression baseline status (defined by a Hamilton Depression Rating Scale Anxiety-Somatization score ≥7) on response to ketamine versus midazolam at 1 and 3 days postinfusion. RESULTS N = 45 subjects had anxious TRD, compared to N = 54 subjects without high anxiety at baseline. No statistically significant interaction effect was found between treatment group assignment (combined ketamine treatment groups versus midazolam) and anxious/nonanxious status on HAMD6 score at either days 1 or 3 postinfusion (Day 1: F(1, 84) = 0.02, P = 0.88; Day 3: F(1, 82) = 0.12, P = 0.73). CONCLUSION In contrast with what is observed with traditional antidepressants, response to ketamine may be similar in both anxious and nonanxious TRD subjects. These pilot results suggest the potential utility of ketamine in the treatment of anxious TRD.
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Affiliation(s)
- Naji C Salloum
- Department of Psychiatry, Massachusetts General Hospital-Harvard Medical School, Boston, Massachusetts.,Clinical Trials Network and Institute, Massachusetts General Hospital, Boston, Massachusetts
| | - Maurizio Fava
- Department of Psychiatry, Massachusetts General Hospital-Harvard Medical School, Boston, Massachusetts.,Clinical Trials Network and Institute, Massachusetts General Hospital, Boston, Massachusetts
| | - Marlene P Freeman
- Department of Psychiatry, Massachusetts General Hospital-Harvard Medical School, Boston, Massachusetts.,Clinical Trials Network and Institute, Massachusetts General Hospital, Boston, Massachusetts
| | - Martina Flynn
- Department of Psychiatry, Massachusetts General Hospital-Harvard Medical School, Boston, Massachusetts.,Clinical Trials Network and Institute, Massachusetts General Hospital, Boston, Massachusetts
| | - Bettina Hoeppner
- Department of Psychiatry, Massachusetts General Hospital-Harvard Medical School, Boston, Massachusetts
| | - Rebecca S Hock
- Department of Psychiatry, Massachusetts General Hospital-Harvard Medical School, Boston, Massachusetts
| | - Cristina Cusin
- Department of Psychiatry, Massachusetts General Hospital-Harvard Medical School, Boston, Massachusetts
| | - Dan V Iosifescu
- Department of Psychiatry, Nathan Kline Institute, New York University School of Medicine, New York, New York
| | - Madhukar H Trivedi
- Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, Texas
| | - Gerard Sanacora
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
| | - Sanjay J Mathew
- Michael E. Debakey VA Medical Center, Baylor College of Medicine, Houston, Texas
| | - Charles Debattista
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
| | - Dawn F Ionescu
- Department of Psychiatry, Massachusetts General Hospital-Harvard Medical School, Boston, Massachusetts
| | - George I Papakostas
- Department of Psychiatry, Massachusetts General Hospital-Harvard Medical School, Boston, Massachusetts.,Clinical Trials Network and Institute, Massachusetts General Hospital, Boston, Massachusetts
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14
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Freeman MP, Papakostas GI, Hoeppner B, Mazzone E, Judge H, Cusin C, Mathew S, Sanacora G, Iosifescu D, DeBattista C, Trivedi MH, Fava M. Sex differences in response to ketamine as a rapidly acting intervention for treatment resistant depression. J Psychiatr Res 2019; 110:166-171. [PMID: 30641350 PMCID: PMC6360121 DOI: 10.1016/j.jpsychires.2019.01.010] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [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: 09/19/2018] [Revised: 01/03/2019] [Accepted: 01/07/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND While ketamine has been increasingly studied for treatment resistant depression (TRD), the impact of sex differences on treatment outcomes has not been well studied. The objective was to ascertain whether there were differences in response to a single administration of ketamine for TRD between men and women, and between pre- and post-menopausal women. METHODS A randomized, double-blind, placebo-controlled trial (N = 99; N = 50 male; N = 49 female) was conducted to investigate the efficacy of intravenous ketamine versus active placebo as augmentation of antidepressant therapy for TRD. Patients were assigned to one of five arms; one-time administration of ketamine of varying doses (i.e., 0.1, 0.2, 0.5, and 1.0 mg/kg), and one group receiving active placebo (intravenous midazolam). A priori-planned analyses were conducted to compare responses between women and men, as well pre-vs. postmenopausal women. RESULTS Analyses demonstrated no significant differences between women and men in terms of treatment response (F(1,80) = 0.06, p = 0.80). There were no significant differences in the frequency of adverse effects (AEs) reported by those assigned to ketamine treatment groups (p > 0.21 for all AEs reported more than once), although women reported more headaches (12% vs. 6%, p = 0.30) and nausea (10% vs. 6%, p = 0.47). In comparing pre-vs. postmenopausal women, no differences in efficacy were observed (F(1,76) = 0.36, p = 0.55). CONCLUSIONS Results do not support differential efficacy or tolerability of ketamine for the treatment of TRD between women and men, nor based on menopause status among women. However, larger trials with these a priori aims are needed to confirm these results.
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Affiliation(s)
| | | | | | | | | | | | - Sanjay Mathew
- Baylor College of Medicine/Michael E. Debakey VA Medical Center, USA
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15
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Kelly JF, Greene MC, Bergman B, Hoeppner B. Smoking cessation in the context of recovery from drug and alcohol problems: Prevalence, predictors, and cohort effects in a national U.S. sample. Drug Alcohol Depend 2019; 195:6-12. [PMID: 30557814 PMCID: PMC6359967 DOI: 10.1016/j.drugalcdep.2018.11.017] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 09/12/2018] [Accepted: 11/16/2018] [Indexed: 12/28/2022]
Abstract
BACKGROUND Tobacco and alcohol and other drug (AOD) use remain prominent risk factors for morbidity, mortality, and health care utilization. Moreover, these often cluster together within persons, exponentiating health risks. Little is known regarding if and when people resolving AOD problems stop smoking, who stops, and whether recent general population trends toward smoking cessation are evident also among persons more recently entering recovery. DESIGN AND PARTICIPANTS National cross-sectional sample resolving AOD problems (final sample n = 2002). ANALYSES Weighted smoking/cessation prevalence; logistic regressions; Hazard-models estimated time to smoking cessation overall, and for different cohorts entering recovery during one of three decades: a) 2006-2015; b) 1996-2005; c) 1986-1995. RESULTS Approximately 30% of U.S. adults in AOD recovery with a smoking history stopped smoking before entering recovery, 7% quit smoking and AOD use concurrently, 26% stopped after entering recovery; 37% still smoked. Among those quitting after entering recovery, the prevalence of smoking cessation 5- and 10-years later was 27.2% and 55.1% respectively for the 2006-2015 cohort and 14.9% and 34.5% in the 1986-1995 cohort; time to smoking cessation also was 60% shorter (5yrs vs. 8yrs). Time to smoking cessation was associated with education and income, but not 12-step participation or AOD treatment. CONCLUSIONS Smoking rates among those in AOD recovery are more than double that of the general population but those entering recovery in recent years are stopping and stopping sooner. It is plausible that public health-oriented tobacco policy measures and easier access to smoking cessation aids may be contributing to this salutary trend.
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Affiliation(s)
- John F. Kelly
- Recovery Research Institute, Massachusetts General Hospital and Harvard Medical School, 151 Merrimac Street, Boston, MA 02114, USA
| | - M. Claire Greene
- Johns Hopkins Bloomberg School of Public Health, 624 North Broadway, Baltimore, MD 21205, USA
| | - Brandon Bergman
- Recovery Research Institute, Massachusetts General Hospital and Harvard Medical School, 151 Merrimac Street, Boston, MA 02114, USA
| | - Bettina Hoeppner
- Recovery Research Institute, Massachusetts General Hospital and Harvard Medical School, 151 Merrimac Street, Boston, MA 02114, USA
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16
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Kelly JF, Kaminer Y, Kahler CW, Hoeppner B, Yeterian J, Cristello JV, Timko C. A pilot randomized clinical trial testing integrated 12-Step facilitation (iTSF) treatment for adolescent substance use disorder. Addiction 2017; 112:2155-2166. [PMID: 28742932 PMCID: PMC5673563 DOI: 10.1111/add.13920] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [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: 03/10/2017] [Revised: 04/11/2017] [Accepted: 06/19/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND AIMS The integration of 12-Step philosophy and practices is common in adolescent substance use disorder (SUD) treatment programs, particularly in North America. However, although numerous experimental studies have tested 12-Step facilitation (TSF) treatments among adults, no studies have tested TSF-specific treatments for adolescents. We tested the efficacy of a novel integrated TSF. DESIGN Explanatory, parallel-group, randomized clinical trial comparing 10 sessions of either motivational enhancement therapy/cognitive-behavioral therapy (MET/CBT; n = 30) or a novel integrated TSF (iTSF; n = 29), with follow-up assessments at 3, 6 and 9 months following treatment entry. SETTING Out-patient addiction clinic in the United States. PARTICIPANTS Adolescents [n = 59; mean age = 16.8 (1.7) years; range = 14-21; 27% female; 78% white]. INTERVENTION AND COMPARATOR The iTSF integrated 12-Step with motivational and cognitive-behavioral strategies, and was compared with state-of-the-art MET/CBT for SUD. MEASUREMENTS Primary outcome: percentage days abstinent (PDA); secondary outcomes: 12-Step attendance, substance-related consequences, longest period of abstinence, proportion abstinent/mostly abstinent, psychiatric symptoms. FINDINGS Primary outcome: PDA was not significantly different across treatments [b = 0.08, 95% confidence interval (CI) = -0.08 to 0.24, P = 0.33; Bayes' factor = 0.28). SECONDARY OUTCOMES during treatment, iTSF patients had substantially greater 12-Step attendance, but this advantage declined thereafter (b = -0.87; 95% CI = -1.67 to 0.07, P = 0.03). iTSF did show a significant advantage at all follow-up points for substance-related consequences (b = -0.42; 95% CI = -0.80 to -0.04, P < 0.05; effect size range d = 0.26-0.71). Other secondary outcomes did not differ significantly between treatments, but effect sizes tended to favor iTSF. Throughout the entire sample, greater 12-Step meeting attendance was associated significantly with longer abstinence during (r = 0.39, P = 0.008), and early following (r = 0.30, P = 0.049), treatment. CONCLUSION Compared with motivational enhancement therapy/cognitive-behavioral therapy (MET/CBT), in terms of abstinence, a novel integrated 12-Step facilitation treatment for adolescent substance use disorder (iTSF) showed no greater benefits, but showed benefits in terms of 12-Step attendance and consequences. Given widespread use of combinations of 12-Step, MET and CBT in adolescent community out-patient settings in North America, iTSF may provide an integrated evidence-based option that is compatible with existing practices.
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Affiliation(s)
- John F Kelly
- Recovery Research Institute Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Yifrah Kaminer
- University of Connecticut Health Sciences Center, Farmington, CT, USA
| | | | - Bettina Hoeppner
- Recovery Research Institute Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Julie Yeterian
- Recovery Research Institute Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Julie V Cristello
- Recovery Research Institute Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Christine Timko
- VA Palo Alto Health Care System and Stanford University Medical School, Menlo Park, CA, USA
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17
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Pachas GN, Gilman J, Orr SP, Hoeppner B, Carlini SV, Grasser EB, Loebl T, Nino J, Pitman RK, Evins AE. Erratum to: Single dose propranolol does not affect physiologic or emotional reactivity to smoking cues. Psychopharmacology (Berl) 2015; 232:2029. [PMID: 25877745 DOI: 10.1007/s00213-015-3930-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 11/28/2022]
Affiliation(s)
- Gladys N Pachas
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
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18
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Pachas GN, Gilman J, Orr SP, Hoeppner B, Carlini SV, Loebl T, Nino J, Pitman RK, Evins AE. Single dose propranolol does not affect physiologic or emotional reactivity to smoking cues. Psychopharmacology (Berl) 2015; 232:1619-28. [PMID: 25413896 PMCID: PMC4404704 DOI: 10.1007/s00213-014-3797-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [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: 02/16/2014] [Accepted: 10/27/2014] [Indexed: 12/19/2022]
Abstract
BACKGROUND Smoking cue exposure reactivates salient smoking-related memories, triggering craving to smoke, a phenomenon associated with maintenance of smoking behavior and relapse after periods of abstinence. Acute β-adrenergic blockade with propranolol reduces physiologic reactivity during subsequent recollection of traumatic events by inhibiting reconsolidation of reactivated memories in a process called memory reconsolidation blockade. OBJECTIVE The objective of this study is to determine whether a single dose of propranolol prior to retrieval of smoking-related memories reduces subsequent physiologic reactivity to personally salient smoking imagery scripts in current smokers. METHODS Fifty-four overnight-abstinent, adult smokers received a single-dose propranolol or placebo prior to reactivation of smoking-related memories in a randomized, double-blind, placebo-controlled trial and resumed smoking afterward. One week later, skin conductance (SC), heart rate (HR), left corrugator electromyogram (EMG), self-reported emotional state, and craving were assessed following script-driven imagery with neutral and personalized smoking-related scripts. RESULTS Smoking scripts were associated with increased physiologic activation (SC, HR, EMG), craving, and negative emotional state compared with neutral scripts. Propranolol did not moderate the effect of script type on any outcome. CONCLUSION Personalized smoking script-driven imagery robustly increased physiologic activation, negative emotional state, and craving, and a single dose of propranolol prior to memory reactivation did not moderate this effect.
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Affiliation(s)
- Gladys N. Pachas
- Department of Psychiatry, Massachusetts General Hospital, Boston Massachusetts
- Harvard Medical School, Boston Massachusetts
| | - Jodi Gilman
- Department of Psychiatry, Massachusetts General Hospital, Boston Massachusetts
- Harvard Medical School, Boston Massachusetts
| | - Scott P. Orr
- Department of Psychiatry, Massachusetts General Hospital, Boston Massachusetts
- Harvard Medical School, Boston Massachusetts
| | - Bettina Hoeppner
- Department of Psychiatry, Massachusetts General Hospital, Boston Massachusetts
- Harvard Medical School, Boston Massachusetts
| | - Sara V. Carlini
- Department of Psychiatry, Massachusetts General Hospital, Boston Massachusetts
| | - Tsafrir Loebl
- Department of Psychiatry, Massachusetts General Hospital, Boston Massachusetts
| | - Johanna Nino
- Department of Psychiatry, Massachusetts General Hospital, Boston Massachusetts
| | - Roger K. Pitman
- Department of Psychiatry, Massachusetts General Hospital, Boston Massachusetts
- Harvard Medical School, Boston Massachusetts
| | - A. Eden Evins
- Department of Psychiatry, Massachusetts General Hospital, Boston Massachusetts
- Harvard Medical School, Boston Massachusetts
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19
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Wang R, Schoenfeld DA, Hoeppner B, Evins AE. Detecting treatment-covariate interactions using permutation methods. Stat Med 2015; 34:2035-47. [PMID: 25736915 DOI: 10.1002/sim.6457] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 02/21/2014] [Revised: 11/14/2014] [Accepted: 01/31/2015] [Indexed: 11/08/2022]
Abstract
The primary objective of a Randomized Clinical Trial usually is to investigate whether one treatment is better than its alternatives on average. However, treatment effects may vary across different patient subpopulations. In contrast to demonstrating one treatment is superior to another on the average sense, one is often more concerned with the question that, for a particular patient, or a group of patients with similar characteristics, which treatment strategy is most appropriate to achieve a desired outcome. Various interaction tests have been proposed to detect treatment effect heterogeneity; however, they typically examine covariates one at a time, do not offer an integrated approach that incorporates all available information, and can greatly increase the chance of a false positive finding when the number of covariates is large. We propose a new permutation test for the null hypothesis of no interaction effects for any covariate. The proposed test allows us to consider the interaction effects of many covariates simultaneously without having to group subjects into subsets based on pre-specified criteria and applies generally to randomized clinical trials of multiple treatments. The test provides an attractive alternative to the standard likelihood ratio test, especially when the number of covariates is large. We illustrate the proposed methods using a dataset from the Treatment of Adolescents with Depression Study.
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Affiliation(s)
- Rui Wang
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital and Harvard Medical School, 221 Longwood Avenue, MA 02115, Boston, U.S.A.; Department of Biostatistics, Harvard T. H. Chan School of Public Health, 655 Huntington Avenue, Boston, 02115, MA, U.S.A
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Chevalier L, Goldfarb E, Miller J, Hoeppner B, Gorrindo T, Birnbaum RJ. Gaps in preparedness of clergy and healthcare providers to address mental health needs of returning service members. J Relig Health 2015; 54:327-338. [PMID: 25112409 DOI: 10.1007/s10943-014-9917-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
To elucidate gaps in the preparedness of clergy and healthcare providers to care for service members (SM) with deployment-related mental health needs. Participants identified clinically relevant symptoms in a standardized video role play of a veteran with deployment-related mental health needs and discussed their preparedness to deal with SM. Clergy members identified suicide and depression most often, while providers identified difficulty sleeping, low energy, nightmares and irritability. Neither clergy nor providers felt prepared to minister to or treat SM with traumatic brain injury. Through a mixed methods approach, we identified gaps in preparedness of clergy and healthcare providers in dealing with the mental health needs of SM.
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Affiliation(s)
- Lydia Chevalier
- Department of Psychiatry, Massachusetts General Hospital (MGH), 1 Bowdoin Sq, Ste 744, Boston, MA, 02114, USA,
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21
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Labbe AK, Greene C, Bergman BG, Hoeppner B, Kelly JF. The importance of age composition of 12-step meetings as a moderating factor in the relation between young adults' 12-step participation and abstinence. Drug Alcohol Depend 2013; 133:541-7. [PMID: 23938074 PMCID: PMC3818368 DOI: 10.1016/j.drugalcdep.2013.07.021] [Citation(s) in RCA: 11] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Revised: 07/16/2013] [Accepted: 07/23/2013] [Indexed: 11/26/2022]
Abstract
BACKGROUND Participation in 12-step mutual help organizations (MHO) is a common continuing care recommendation for adults; however, little is known about the effects of MHO participation among young adults (i.e., ages 18-25 years) for whom the typically older age composition at meetings may serve as a barrier to engagement and benefits. This study examined whether the age composition of 12-step meetings moderated the recovery benefits derived from attending MHOs. METHOD Young adults (n=302; 18-24 years; 26% female; 94% White) enrolled in a naturalistic study of residential treatment effectiveness were assessed at intake, and 3, 6, and 12 months later on 12-step attendance, age composition of attended 12-step groups, and treatment outcome (Percent Days Abstinent [PDA]). Hierarchical linear models (HLM) tested the moderating effect of age composition on PDA concurrently and in lagged models controlling for confounds. RESULTS A significant three-way interaction between attendance, age composition, and time was detected in the concurrent (p=0.002), but not lagged, model (b=0.38, p=0.46). Specifically, a similar age composition was helpful early post-treatment among low 12-step attendees, but became detrimental over time. CONCLUSIONS Treatment and other referral agencies might enhance the likelihood of successful remission and recovery among young adults by locating and initially linking such individuals to age appropriate groups. Once engaged, however, it may be prudent to encourage gradual integration into the broader mixed-age range of 12-step meetings, wherein it is possible that older members may provide the depth and length of sober experience needed to carry young adults forward into long-term recovery.
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Affiliation(s)
- Allison K. Labbe
- MGH Center for Addiction Medicine, 60 Staniford Street, Boston, MA 02114, United States
| | - Claire Greene
- MGH Center for Addiction Medicine, 60 Staniford Street, Boston, MA 02114, United States
| | - Brandon G. Bergman
- MGH Center for Addiction Medicine, 60 Staniford Street, Boston, MA 02114, United States
| | - Bettina Hoeppner
- MGH Center for Addiction Medicine, 60 Staniford Street, Boston, MA 02114, United States
| | - John F. Kelly
- MGH Center for Addiction Medicine, 60 Staniford Street, Boston, MA 02114, United States
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Topor DR, Swenson L, Hunt J, Birmaher B, Strober M, Yen S, Hoeppner B, Case B, Hower H, Weinstock LM, Ryan N, Goldstein B, Goldstein T, Gill MK, Axelson D, Keller M. Manic symptoms in youth with bipolar disorder: factor analysis by age of symptom onset and current age. J Affect Disord 2013; 145:409-12. [PMID: 23021377 PMCID: PMC3535567 DOI: 10.1016/j.jad.2012.06.024] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [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: 02/01/2012] [Revised: 05/31/2012] [Accepted: 06/12/2012] [Indexed: 12/11/2022]
Abstract
BACKGROUND Factor analysis has been used to identify potential clinical subtypes of mania in pediatric bipolar disorder. Results vary in the number of factors retained. The present study used a formal diagnostic instrument to examine how symptoms of mania in young people are expressed, depending on age of symptom onset and current age. METHODS Trained clinicians completed the Schedule of Affective Disorders and Schizophrenia for School-Age Children (K-SADS) Mania Rating Scale (MRS) with parents of 163 children with child-onset of symptoms (before age 12), 94 adolescents with child-onset of symptoms, and 90 adolescents with adolescent-onset of symptoms (after age 12). Factor analysis of symptom ratings during the most severe lifetime manic episode was performed for each age group. RESULTS Symptom factor structures were established for each age group. Two factors were evident for children with child-onset of symptoms ("activated/pleasure seeking" and "labile/disorganized"), one factor was present for adolescents with child-onset of symptoms ("activated/pleasure seeking/disorganized") and two factors were evident for adolescents with adolescent-onset of symptoms ("activated/pleasure seeking" and "disorganized/psychotic"). The factor structures for children with child-onset and adolescents with adolescent-onset of symptoms were highly similar, with the latter factor structure including psychotic symptoms. LIMITATIONS Limitations include reliance on retrospective parent report and potential issues with generalizability. CONCLUSIONS Findings suggest mania symptomatology is largely similar when examined by both age of onset and current age, with some notable differences. Specifically, psychotic symptoms begin emerging as a distinct factor in adolescents with adolescent-onset of symptoms.
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Affiliation(s)
- David R. Topor
- VA Boston Healthcare System, Boston, MA and Department of Psychiatry, Harvard Medical School, Boston, MA
| | - Lance Swenson
- Department of Psychology, Suffolk University, Boston, MA
| | - Jeffrey Hunt
- Department of Psychiatry and Butler and Bradley Hospitals, The Warren Alpert Medical School of Brown University, Providence, RI
| | - Boris Birmaher
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Michael Strober
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA
| | - Shirley Yen
- Department of Psychiatry and Butler and Bradley Hospitals, The Warren Alpert Medical School of Brown University, Providence, RI
| | - Bettina Hoeppner
- Department of Psychiatry and Butler and Bradley Hospitals, The Warren Alpert Medical School of Brown University, Providence, RI
| | - Brady Case
- Department of Psychiatry and Butler and Bradley Hospitals, The Warren Alpert Medical School of Brown University, Providence, RI
| | - Heather Hower
- Department of Psychiatry and Butler and Bradley Hospitals, The Warren Alpert Medical School of Brown University, Providence, RI
| | - Lauren M. Weinstock
- Department of Psychiatry and Butler and Bradley Hospitals, The Warren Alpert Medical School of Brown University, Providence, RI
| | - Neal Ryan
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Benjamin Goldstein
- University of Toronto, Faculty of Medicine, Department of Psychiatry, Sunnybrook Health Services Centre, Assistant Professor of Psychiatry
| | - Tina Goldstein
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Mary Kay Gill
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - David Axelson
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Martin Keller
- Department of Psychiatry and Butler and Bradley Hospitals, The Warren Alpert Medical School of Brown University, Providence, RI
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Abstract
OBJECTIVE Following successful smoking cessation, smokers with schizophrenia are vulnerable to relapse shortly after treatment discontinuation. Our objective was to assess the feasibility and effectiveness of a 12-month relapse prevention intervention in recently abstinent smokers with schizophrenia. METHOD Adult outpatient smokers with schizophrenia received weekly cognitive behavioral therapy groups, bupropion slow release, transdermal nicotine patch, and nicotine gum or lozenge for three months. Subjects with seven-day point prevalence abstinence at month 3 received an additional 12 months (months 4-15) of therapy with bupropion, transdermal nicotine patch, and nicotine gum/lozenge in conjunction with relapse prevention-based cognitive behavioral therapy groups that were held weekly in month 4, biweekly in months 5-6, and monthly in months 7-15. RESULTS Seventeen of 41 participants (41.5%) attained biochemically verified self-report of seven-day point prevalence abstinence at the end of three months of treatment and entered relapse prevention treatment. There was an 81% attendance rate at relapse prevention groups. At the end of the 12-month relapse prevention phase (month 15 overall), 11 of 17 (64.7%) demonstrated biochemically verified seven-day point prevalence abstinence, and 10 of 17 (58.8%) reported four-week continuous abstinence. Almost one quarter of the sample (23.5%) demonstrated long-term prolonged abstinence through the end of the trial. There were no clinically detected cases of psychiatric symptom exacerbation. One participant, who was managed as an outpatient, self-reported psychiatric symptom exacerbation in the interim period between study visits. CONCLUSIONS Extended duration smoking cessation treatment is well-tolerated and may improve smoking outcomes for recently abstinent smokers with schizophrenia. Controlled trials are warranted.
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Affiliation(s)
- Corinne Cather
- Schizophrenia Program, Massachusetts General Hospital and Harvard Medical School ; Center for Addiction Medicine, Massachusetts General Hospital and Harvard Medical School ; Department of Psychiatry of the Massachusetts General Hospital and Harvard Medical School
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Abstract
AIMS Evidence indicates that Alcoholics Anonymous (AA) participation reduces relapse risk but less is known about the mechanisms through which AA confers this benefit. Initial studies indicate self-efficacy, negative affect, adaptive social networks and spiritual practices are mediators of this effect, but because these have been tested in isolation, their relative importance remains elusive. This study tested multiple mediators simultaneously to help determine the most influential pathways. DESIGN Prospective, statistically controlled, naturalistic investigation examined the extent to which these previously identified mechanisms mediated AA attendance effects on alcohol outcomes controlling for baseline outcome values, mediators, treatment, and other confounders. SETTING Nine clinical sites within the United States. PARTICIPANTS Adults (n = 1726) suffering from alcohol use disorder (AUD) initially enrolled in a randomized study with two arms: aftercare (n = 774); and out-patient (n = 952) comparing three out-patient treatments (Project MATCH). MEASUREMENTS AA attendance during treatment; mediators at 9 months; and outcomes [percentage of days abstinent (PDA) and drinks per drinking day (DDD)] at 15 months. FINDINGS Among out-patients the effect of AA attendance on alcohol outcomes was explained primarily by adaptive social network changes and increases in social abstinence self-efficacy. Among more impaired aftercare patients, in addition to mediation through adaptive network changes and increases in social self-efficacy, AA lead to better outcomes through increasing spirituality/religiosity and by reducing negative affect. The degree to which mediators explained the relationship between AA and outcomes ranged from 43% to 67%. CONCLUSION While Alcoholics Anonymous facilitates recovery by mobilizing several processes simultaneously, it is changes in social factors which appear to be of primary importance.
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Affiliation(s)
- John F. Kelly
- Center for Addiction Medicine, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, 60 Staniford St., Suite 120, Boston, MA 02114
| | - Bettina Hoeppner
- Center for Addiction Medicine, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, 60 Staniford St., Suite 120, Boston, MA 02114
| | - Robert L. Stout
- Decision Sciences Institute/PIRE, 1005 Main St., Pawtucket, RI 02860-7802
| | - Maria Pagano
- Case Western Reserve University, 10900 Euclid Ave., Cleveland, OH 44106
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Pachas GN, Cather C, Pratt SA, Hoeppner B, Nino J, Carlini SV, Achtyes ED, Lando H, Mueser KT, Rigotti NA, Goff DC, Evins AE. Varenicline for Smoking Cessation in Schizophrenia: Safety and Effectiveness in a 12-Week, Open-Label Trial. J Dual Diagn 2012; 8:117-125. [PMID: 22888309 PMCID: PMC3414422 DOI: 10.1080/15504263.2012.663675] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [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: 10/28/2022]
Abstract
OBJECTIVES: Varenicline was approved by the FDA in 2006. In 2009, based largely on case reports, the FDA issued a warning of possible adverse neuropsychiatric effects including depression and suicidal thoughts and behavior for varenicline and bupropion. Prospective trials of varenicline have not reported increased incidence of psychiatric adverse events other than sleep disturbance, but smokers with major mental illness have been excluded from large prospective trials of varenicline to date. We sought to evaluate the effect of a standard open-label 12-week varenicline trial on prospectively assessed safety and smoking outcomes in stable, treated adults with schizophrenia spectrum disorder and nicotine dependence. METHODS: One-hundred-and-twelve stable outpatients who smoked >10 cigarettes/day participated in a 12-week, open-label, smoking cessation trial of varenicline and weekly group cognitive behavioral therapy. Participants took varenicline for 4 weeks before attempting cessation. Trained raters collected safety and smoking outcome data weekly. RESULTS: Participants demonstrated improved psychotic symptoms, depressive symptoms and nicotine withdrawal symptoms from baseline to week 12 or early termination. At the end of 12 weeks open label treatment, the 14- and 28-day continuous abstinence rates were 47.3 and 34%, respectively. Expired CO declined significantly during treatment in those who did not achieve abstinence. CONCLUSIONS: This prospective study suggests that varenicline may be well-tolerated and effective for smoking cessation in combination with group CBT in stable outpatients with schizophrenia, a group with high rates of smoking and smoking-attributable morbidity and mortality.
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Proeschold-Bell RJ, Hoeppner B, Taylor B, Cohen S, Blouin R, Stringfield B, Muir AJ. An interrupted time series evaluation of a hepatitis C intervention for persons with HIV. AIDS Behav 2011; 15:1721-31. [PMID: 21191643 DOI: 10.1007/s10461-010-9870-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Accurate HCV knowledge is lacking among high-risk groups, including people with HIV/AIDS (PLWHA). Liver disease primarily due to HCV has emerged as a serious cause of mortality among PLWHA. We used an Interrupted Time Series design to evaluate a social-ecologically based intervention for PLWHA, where an infectious disease clinic serving a six-county intervention area was monitored before (7 months) and after (17 months) intervention onset. The intervention included education of PLWHA and medical providers, HIV/HCV support groups, and adaptation of the patient chart top sheet to include HCV test information. Clinic-level outcomes were assessed prospectively every other week for 2 years by interviewing patients (n = 259) with clinic appointments on assessment days. Abrupt, gradual and delayed intervention effects were tested. Weighted regression analyses showed higher average HCV knowledge and a higher prevalence of patients reporting HCV discussion with their medical providers after intervention onset. A delayed effect was found for HCV awareness, and a gradually increasing effect was found for knowing one's HCV status. Other communities may consider adopting this intervention. Additional HCV interventions for PLWHA with HIV are needed.
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Thiele J, Steinberg T, Hoeppner B, Wienhold S, Wagner S, Dienemann D, Fischer R. Histo- and immunomorphometry of megakaryopoiesis in chronic myeloid leukemia with myelofibrosis and so-called primary (idiopathic) osteo-myelofibrosis/-sclerosis. Anal Cell Pathol 1990; 2:215-27. [PMID: 2275869] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
A morphometric study was performed on trephine biopsies of bone marrow in patients with chronic myeloid leukemia (CML) accompanied by myelofibrosis and in so-called primary (idiopathic) osteomyelofibrosis/-sclerosis (OMF) to evaluate distinctive features of megakaryopoiesis. The periodic acid Schiff reaction (PAS) and a monoclonal antibody against glycoprotein IIIa were employed for the identification of megakaryocytes including precursor cells and Gomori's silver impregnation to determine the density of argyrophilic fibers. All patients with CML revealed a slight to moderate degree of medullary fibrosis and were compared with early hyperplastic stages of OMF showing an identical fiber count. Statistical analysis disclosed that distinctive features existed between these two subgroups. Amongst these variables were sizes of megakaryocytes and corresponding nuclei, frequency of bare nuclei, emperipolesis and numbers of isolated nuclear fragments as well as the circular deviation of cell and nuclear perimeters. Immunomorphometry also included immature elements (pro- and megakaryoblasts) of the megakaryocyte series. Consequently higher cell counts were calculable in both groups combined with smaller sizes and a more rounded aspect of nuclei. However, following immunostaining, significant differences in several megakaryocytic parameters (frequency, size, shape of nuclei) were still demonstrable between CML and OMF cases.
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Affiliation(s)
- J Thiele
- Institute of Pathology, University of Cologne, FRG
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Thiele J, Hoeppner B, Wienhold S, Schneider G, Fischer R, Zankovich R. Osteoclasts and bone remodeling in chronic myeloproliferative disorders. A histochemical and morphometric study on trephine biopsies in 165 patients. Pathol Res Pract 1989; 184:591-9. [PMID: 2780431 DOI: 10.1016/s0344-0338(89)80164-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
In 165 patients with chronic myeloproliferative disorders (CMPD) a morphometric and histochemical study was performed on trephine biopsies of the bone marrow to elucidate osseous remodeling by assessment of trabecular bone area (planimetry) and number of osteoclasts. Osteoclastic elements were identified by the tartrate-resistant acid phosphatase method. In addition to control specimens (n = 20) subtypes of CMPD included chronic myeloid leukemia (CML, n = 65), primary (essential) thrombocythemia (PTH, n = 25), polycythemia vera rubra (P. vera, n = 25) and agnogenic myeloid metaplasia (AMM, n = 50). AMM was discriminated into a so-called early hyperplastic stage without gross myelofibrosis (n = 19) and an overt or advanced stage showing fibro-osteosclerotic changes (n = 31). Total area of trabecular bone and counts for osteoclasts (uni- and multi-nucleated cells as well as a-nuclear cytoplasmic fragments) were not significantly increased in CML, PTH, P. vera and in the initial hypercellular stages of AMM. In contrast to these results, in advanced stages of AMM there was a significant increase in total bone area associated with a high count for all osteoclastic elements and apparently also an increased number of osteoblasts. It is speculated that the marked increase in osteoclastic-osteoblastic elements in late stages of AMM possibly reflects an imbalance of calcitriol (1.25-dihydroxyvitamin D 3) on skeletal homeostasis. This abnormal osseous remodeling may be mediated by the atypical megakaryocytic proliferation in this disorder, which is always a conspicuous feature of bone marrow biopsies.
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Affiliation(s)
- J Thiele
- Institute of Pathology, University of Cologne, FRG
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Thiele J, Hoeppner B, Zankovich R, Fischer R. Histomorphometry of bone marrow biopsies in primary osteomyelofibrosis/-sclerosis (agnogenic myeloid metaplasia)--correlations between clinical and morphological features. Virchows Arch A Pathol Anat Histopathol 1989; 415:191-202. [PMID: 2503923 DOI: 10.1007/bf00724905] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Histomorphometry was performed on representative trephine biopsies of the bone marrow on admission of 50 patients (21 male, 29 female - age 67 years) with so-called primary osteomyelofibrosis/-sclerosis (OMF) not preceded by any other subtype of chronic myeloproliferative disorders. This study was firstly aimed at testing correlations between histological features (amount of haematopoiesis, cytological aspects of megakaryocytes, density of reticulin and collagen fibres and degree of osteosclerosis) and laboratory data, as well as spleen size and duration of relevant prediagnostic symptoms. Secondly, we concentrated on a discrimination of OMF patients into two subgroups according to bone marrow morphology and clinical variables. Statistical evaluation of histomorphometric variables and haematological findings disclosed that there was a progressive fibro-osteosclerotic process in the evolution of disease features. Increase in medullary fibrosis was significantly paralleled by an abnormal or pleomorphic megakaryopoiesis in the bone marrow: there was an increase in irregularity of perimeters for megakaryocytes and naked nuclei combined with smaller sizes of these elements including the nuclei. Additionally, there was a greater number of pycnotic bare nuclei. A number of morphometric features (density of fibres, degree of osteosclerosis, amount of haematopoiesis) were associated with corresponding clinical data (spleen size, length of preclinical history). By consideration of a set of basic histomorphometric variables our cohort of 50 patients could be divided into an early hyperplastic subtype with no or minimal medullary reticulin and another group with conspicuous fibrotic and osteosclerotic alterations of the bone marrow. It was noticeable that we found no significant correlation between amount of haematopoiesis or marrow cellularity with splenomegaly. This result suggests that splenic haematopoiesis (myeloid metaplasia) may represent an autonomous or neoplastic process and not only compensation for a failing fibro-osteosclerotic bone marrow.
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Affiliation(s)
- J Thiele
- Institute of Pathology, University of Cologne, Federal Republic of Germany
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Thiele J, Schneider G, Hoeppner B, Wienhold S, Zankovich R, Fischer R. Histomorphometry of bone marrow biopsies in chronic myeloproliferative disorders with associated thrombocytosis--features of significance for the diagnosis of primary (essential) thrombocythaemia. Virchows Arch A Pathol Anat Histopathol 1988; 413:407-17. [PMID: 3140482 DOI: 10.1007/bf00716989] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
A histomorphometric analysis was performed on trephine biopsies of the bone marrow in 55 patients with chronic myeloproliferative disorders (CMPDs) and marked thrombocytosis (platelet count exceeding 600 x 10(9)/l). This study aimed at discriminating primary (essential) thrombocythaemia (PTH) from the various other subtypes of CMPDs presenting with thrombocytosis. Following the diagnostic requirements postulated by the Polycythemia-vera-Study-Group for PTH and polycythaemia vera rubra (P.vera) and the generally accepted criteria for the establishment of chronic myeloid leukaemia (CML) and agnogenic myeloid metaplasia (AMM), our cohort of 55 patients was divided into the following subgroups: CML (16 cases), P.vera (11 cases), AMM (13 cases) and finally PTH (15 cases). Histomorphometric measurements revealed that PTH was distinguishable from the other subtypes of CMPDs with respect to several histological variables: patients with PTH had a normal amount of neutrophilic granulo- and erythrocytopoiesis as well as a non-increased content of reticulin (argyrophilic) fibers in contrast to the findings in CML, P.vera and of course AMM. Moreover, sizes of megakaryocytes and their nuclei were significantly greater in PTH and internalization of haematopoietic cells (emperipolesis) was more frequently encountered in comparison with the other subtypes of CMPDs. Deviation of the circular perimeter of megakaryocyte shape was most prominently expressed in CML and AMM, and consequently generated an increased number of a-nuclear cytoplasmic fragments. In contrast to this feature aberration of the nuclei from a circular outline occurred in a less pronounced way in CML, but was excessive in P.vera, AMM and PTH. Our morphometric evaluation demonstrates that certain histological features may serve as a valuable aid in discriminating PTH from the other occasionally thrombocythaemic subtypes of CMPDs.
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Affiliation(s)
- J Thiele
- Institute of Pathology, University of Cologne, Federal Republic of Germany
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