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DeViva JC, McCarthy E, Fischer I, Pietrzak RH. Differences in the phenotypic expression of posttraumatic stress disorder symptoms in US military veterans with and without clinical insomnia. J Clin Sleep Med 2024; 20:345-351. [PMID: 38426846 PMCID: PMC11019204 DOI: 10.5664/jcsm.10872] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 10/11/2023] [Accepted: 10/11/2023] [Indexed: 03/02/2024]
Abstract
STUDY OBJECTIVES The goal of this study was to examine the phenotypic expression of posttraumatic stress disorder (PTSD) symptoms in veterans with probable PTSD and clinical insomnia relative to those with probable PTSD alone. METHODS Data were analyzed from the 2019-2020 National Health and Resilience in Veterans Study, which surveyed a nationally representative sample of 4,069 US military veterans. RESULTS A total of 3.9% of the full sample screened positive for probable PTSD and clinical insomnia and 3.2% for probable PTSD alone. Relative to veterans with probable PTSD alone, those with probable PTSD and clinical insomnia reported significantly greater severity of intrusions, avoidance, and anxious and dysphoric arousal symptoms. Post hoc analyses of individual symptoms revealed that trauma-related nightmares; flashbacks; trauma-related emotional and physiological reactivity; avoidance of trauma-related thoughts, feelings, and external reminders; exaggerated startle response; concentration difficulties; and trauma-related sleep difficulties differed between groups. A multivariable logistic regression analysis further revealed that trauma-related sleep difficulties, trauma-related physiological reactivity, and exaggerated startle response independently predicted probable PTSD and clinical insomnia relative to PTSD alone. CONCLUSIONS Results of this study suggest that trauma-related reactivity and arousal symptoms differentiate veterans with probable PTSD and clinical insomnia from those with probable PTSD alone. They further underscore the importance of utilizing nuanced models of PTSD symptom expression as part of assessment and treatment planning efforts in this population. CITATION DeViva JC, McCarthy E, Fischer I, Pietrzak RH. Differences in the phenotypic expression of posttraumatic stress disorder symptoms in US military veterans with and without clinical insomnia. J Clin Sleep Med. 2024;20(3):345-351.
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Affiliation(s)
- Jason C. DeViva
- Veterans Affairs Connecticut Health Care System, West Haven, Connecticut
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
| | | | - Ian Fischer
- US Department of Veterans Affairs National Center for PTSD, VA Connecticut Healthcare System, West Haven, Connecticut
| | - Robert H. Pietrzak
- Veterans Affairs Connecticut Health Care System, West Haven, Connecticut
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
- US Department of Veterans Affairs National Center for PTSD, VA Connecticut Healthcare System, West Haven, Connecticut
- Department of Social and Behavioral Sciences, Yale School of Public Health, Laboratory of Epidemiology and Public Health, New Haven, Connecticut
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Martin JL, DeViva J, McCarthy E, Gehrman P, Josephson K, Mitchell M, de Beer C, Runnals J. In-person and telehealth treatment of veterans with insomnia disorder using cognitive behavioral therapy for insomnia during the COVID-19 pandemic. J Clin Sleep Med 2023; 19:1211-1217. [PMID: 36859803 PMCID: PMC10315602 DOI: 10.5664/jcsm.10540] [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] [Received: 09/06/2022] [Revised: 02/22/2023] [Accepted: 02/23/2023] [Indexed: 03/03/2023]
Abstract
STUDY OBJECTIVES Cognitive behavioral therapy for insomnia (CBT-I) is the recommended first-line treatment for insomnia disorder. The goal of this study was to evaluate clinical benefits of CBT-I to veterans with insomnia disorder during the early months of the COVID-19 pandemic using an uncontrolled observational design. METHODS A cohort of 63 Veterans Affairs (VA) mental health providers delivered CBT-I to 180 veterans as part of an evidence-based psychotherapy training program and captured de-identified treatment outcome data through a data portal. The main patient outcomes were change in the Insomnia Severity Index (ISI) total score from the initial clinical assessment session to the last treatment session, response rate (% with ISI change > 7 from assessment to last session), and remission rate (% with ISI < 8 at the last session). We tested the noninferiority of telehealth only compared with at least 1 in-person session. RESULTS Fifty-six percent of veterans seen for an evaluation completed CBT-I treatment during the structured training program phase and completed an initial and final ISI. Among these veterans, ISI scores decreased by an average of 9.9 points from before to after treatment (P < .001), 66% experienced a clinically meaningful treatment response, and 43% experienced insomnia symptom remission. Benefits were similar whether the veteran received some in-person care or received CBT-I entirely via telehealth. CONCLUSIONS Findings suggest, regardless of treatment modality, CBT-I remained highly effective during the early months of the pandemic, which was a challenging time for both clinical providers and veterans in need of insomnia treatment. CITATION Martin JL, DeViva J, McCarthy E, et al. In-person and telehealth treatment of veterans with insomnia disorder using cognitive behavioral therapy for insomnia during the COVID-19 pandemic. J Clin Sleep Med. 2023;19(7):1211-1217.
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Affiliation(s)
- Jennifer L. Martin
- VA Greater Los Angeles Healthcare System, Geriatric Research, Education, and Clinical Center, Los Angeles, California
- David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Jason DeViva
- VA Connecticut Healthcare System, West Haven, Connecticut
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
| | - Elissa McCarthy
- Department of Veterans Affairs National Center for PTSD, White River Junction, Vermont
| | - Philip Gehrman
- Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania
- Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Karen Josephson
- VA Greater Los Angeles Healthcare System, Geriatric Research, Education, and Clinical Center, Los Angeles, California
| | - Michael Mitchell
- VA Greater Los Angeles Healthcare System, Geriatric Research, Education, and Clinical Center, Los Angeles, California
| | - Christopher de Beer
- Department of Veterans Affairs, Durham Healthcare System, Durham, North Carolina
| | - Jennifer Runnals
- Department of Veterans Affairs, Durham Healthcare System, Durham, North Carolina
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina
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Feng F, Ning Y, Xue Y, Friedl V, Hann D, Gibb B, Bergamaschi A, Guler G, Hazen K, Scott A, Phillips T, McCarthy E, Ellison C, Malta R, Nguyen A, Lopez V, Cavet R, Chowdhury S, Volkmuth W, Levy S. 69MO 5-Hydroxymethycytosine analysis reveals stable epigenetic changes in tumor tissue that enable cfDNA cancer predictions. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Carlson G, Saldana K, Kelly M, McGowan SK, DeViva J, McCarthy E, Pigeon W, Martin J. 0471 Identifying Trauma-Informed Adaptations to Cognitive Behavioral Therapy for Insomnia among Women Veterans: Results of an Expert Panel. Sleep 2022. [DOI: 10.1093/sleep/zsac079.468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Trauma-informed care is an emerging area of health services research. While trauma-focused care specifically targets symptoms of posttraumatic stress disorder (PTSD), trauma-informed care involves tailoring interventions to meet the unique needs of patients who have experienced trauma. Insomnia and PTSD are common comorbid disorders, but no known previous studies have identified trauma-informed adaptations to cognitive behavioral therapy for insomnia (CBT-I).
Methods
We identified PTSD clinical presentations that may interfere with the delivery of effective CBT-I and possible adaptations to standard CBT-I that may address these clinical presentations based on a literature review. We then incorporated trauma-informed adaptations into a 5-session CBT-I protocol. Four Veterans Affairs (VA) Expert Trainers in CBT-I were sent the trauma-informed CBT-I materials and rating forms. They were asked to rate the extent to which PTSD clinical presentations serve as barriers to CBT-I (1=low barrier; 5=high barrier), the feasibility of possible adaptations (1=low feasibility; 5=high feasibility), and to provide qualitative feedback. A 60-minute panel meeting was convened and aggregated data from rating forms were presented and discussed. We then revised the trauma-informed CBT-I materials. Panelists reviewed the revised trauma-informed CBT-I materials and completed post-panel rating forms.
Results
The highest-ranked clinical presentations based on rating forms and panel consensus included: sleep avoidance/nighttime arousal, sleep-related self-efficacy, substance/medication use to induce sleep, and safety behaviors intended to reduce nighttime arousal. Panel meeting consensus identified the following trauma-informed adaptations to CBT-I: PTSD-related nighttime hyperarousal psychoeducation, identification of alternatives to PTSD-related safety behaviors, nightmare psychoeducation, psychoeducation about PTSD avoidance in the context of substance/medication use, cognitive techniques, and behavioral tracking to challenge beliefs and avoidant behaviors. Panelists agreed the revised trauma-informed CBT-I materials adequately addressed the PTSD clinical presentations that may limit the effectiveness of standard CBT-I for patients with comorbid PTSD.
Conclusion
This was the first study to use an expert panel to identify trauma-informed adaptations to CBT-I. Trauma-informed adaptations, including supplemental materials, may improve CBT-I outcomes for patients with comorbid PTSD. Future studies should incorporate feedback from patients with insomnia and PTSD to refine trauma-informed adaptations to CBT-I further.
Support (If Any)
VA HSR&D (RCS-20-191, Martin), NHLBI (K23HL143055, Martin)
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Affiliation(s)
- Gwendolyn Carlson
- VA Greater Los Angeles Healthcare System, Department of Mental Health; David Geffen School of Medicine, University of California, Los Angeles, California
| | - Kathryn Saldana
- VA Greater Los Angeles Healthcare System, Department of Mental Health
| | - Monica Kelly
- Geriatric Research, Education, and Clinical Center, VA Greater Los Angeles Healthcare System; David Geffen School of Medicine, University of California, Los Angeles, California
| | - Sarah Kate McGowan
- VA Greater Los Angeles Healthcare System, Department of Mental Health; David Geffen School of Medicine, University of California, Los Angeles, California
| | - Jason DeViva
- VA Connecticut Healthcare System; Yale School of Medicine, Department of Psychiatry
| | | | - Wilfred Pigeon
- Center of Excellence for Suicide Prevention, Canandaigua VA Medical Center; University of Rochester Medical Center, Department of Psychiatry
| | - Jennifer Martin
- Geriatric Research, Education, and Clinical Center, VA Greater Los Angeles Healthcare System; David Geffen School of Medicine, University of California, Los Angeles, California
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McAmis N, Mirabella A, McCarthy E, Cama C, Fogarasi M, Thomas L, Feinn R, Rivera-Godreau I. 142 Assessing Healthcare Provider Knowledge of Human Trafficking. Ann Emerg Med 2021. [DOI: 10.1016/j.annemergmed.2021.09.152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Overstreet C, DeViva JC, Amstadter A, McCarthy E, Southwick SM, Pietrzak RH. Resilience to traumatic stress in U.S. military veterans: Application of a novel classification approach in a nationally representative sample. J Psychiatr Res 2021; 140:301-307. [PMID: 34126424 DOI: 10.1016/j.jpsychires.2021.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 05/28/2021] [Accepted: 06/04/2021] [Indexed: 11/29/2022]
Abstract
Resilience has been of particular interest to researchers and clinicians focused on response to trauma. In the current study, we employed a novel, discrepancy-based psychiatric resilience (DBPR) analytic approach to operationalizing resilience and examined its relation to potentially protective psychosocial factors in a nationally representative sample of U.S. veterans (N = 2704). Cumulative lifetime trauma burden, severity of PTSD symptoms, and protective factors such as personality characteristics (e.g., conscientiousness), protective psychosocial characteristics (e.g., purpose in life), and social connectedness (e.g., secure attachment style) were assessed. PTSD Checklist (PCL) scores were regressed onto cumulative trauma burden for the entire sample and a predicted PCL score was generated for each veteran. Resilience was operationalized as a lower actual relative to predicted PCL score. Results of a relative importance analysis revealed that somatic symptoms (22.5% relative variance explained [RVE]), emotional stability (22.4% RVE), and a secure attachment style (14.1%) explained the majority of the variance in resilience scores. These results demonstrate the utility of a DBPR approach to operationalizing resilience in U.S. military veterans. They also identify potentially modifiable psychosocial factors that may be bolstered in prevention and treatment efforts designed to mitigate the negative effects of trauma and promote resilience in this population.
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Affiliation(s)
- Cassie Overstreet
- Department of Psychiatry, Yale University School of Medicine, 300 George St Ste 901, New Haven, CT, 06511, USA; National Center for Posttraumatic Stress Disorder, Clinical Neurosciences Division, VA Connecticut Healthcare System, 950 Campbell Avenue, West Haven, CT, 06516, USA.
| | - Jason C DeViva
- Department of Psychiatry, Yale University School of Medicine, 300 George St Ste 901, New Haven, CT, 06511, USA; VA Connecticut Healthcare System, 950 Campbell Avenue, West Haven, CT, 06516, USA
| | - Ananda Amstadter
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, 800 E. Leigh Street, Biotech One, Richmond, VA, 23298, Richmond, VA, USA
| | - Elissa McCarthy
- National Center for PTSD, 215 North Main St. White River Junction, Vermont, 05009, USA
| | - Steven M Southwick
- Department of Psychiatry, Yale University School of Medicine, 300 George St Ste 901, New Haven, CT, 06511, USA; National Center for Posttraumatic Stress Disorder, Clinical Neurosciences Division, VA Connecticut Healthcare System, 950 Campbell Avenue, West Haven, CT, 06516, USA
| | - Robert H Pietrzak
- Department of Psychiatry, Yale University School of Medicine, 300 George St Ste 901, New Haven, CT, 06511, USA; National Center for Posttraumatic Stress Disorder, Clinical Neurosciences Division, VA Connecticut Healthcare System, 950 Campbell Avenue, West Haven, CT, 06516, USA
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McCarthy E, DeViva JC, Southwick SM, Pietrzak RH. Self-rated sleep quality predicts incident suicide ideation in US military veterans: Results from a 7-year, nationally representative, prospective cohort study. J Sleep Res 2021; 31:e13447. [PMID: 34328228 DOI: 10.1111/jsr.13447] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 03/10/2021] [Revised: 06/29/2021] [Accepted: 07/04/2021] [Indexed: 11/30/2022]
Abstract
Sleep disturbance is a risk factor for future suicidal behaviours (e.g. suicidal ideation, suicide attempt, death by suicide), and military veterans are at increased risk for both poor sleep and death by suicide relative to civilians. The purpose of this study was to evaluate whether self-reported sleep quality was associated with risk of new-onset suicidal ideation in a 7-year prospective nationally representative cohort study of US military veterans. Multivariable logistic regression analyses were conducted to identify the relation between self-rated sleep quality and incident suicidal ideation in 2,059 veterans without current suicidal ideation or lifetime suicide attempt history at baseline. Relative importance analyses were then conducted to identify the relative variance explained by sleep quality and other significant determinants of incident suicidal ideation. A total of 169 (weighted 8.9%, 95% confidence interval =7.7%-10.3%) veterans developed suicidal ideation over the 7-year study period. Poor self-rated sleep quality was associated with a more than 60% greater likelihood of developing suicidal ideation (relative risk ratio = 1.62, 95% confidence interval = 1.11-2.36), even after adjustment for well-known suicide risk factors such as major depressive disorder. Relative importance analysis revealed that poor self-rated sleep quality accounted for 44.0% of the explained variance in predicting incident suicidal ideation. These results underscore the importance of assessing, monitoring and treating sleep difficulties as part of suicide prevention efforts in military veterans.
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Affiliation(s)
- Elissa McCarthy
- US Department of Veterans Affairs National Center for PTSD, White River Junction, VT, USA
| | - Jason C DeViva
- Veterans Affairs Connecticut Health Care System, West Haven, CT, USA.,Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | | | - Robert H Pietrzak
- Veterans Affairs Connecticut Health Care System, West Haven, CT, USA.,Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA.,US Department of Veterans Affairs National Center for PTSD, VA Connecticut Healthcare System, West Haven, CT, USA.,Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
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8
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McCarthy E, DeViva JC, Na PJ, Pietrzak RH. New-onset and exacerbated insomnia symptoms during the COVID-19 pandemic in US military veterans: A nationally representative, prospective cohort study. J Sleep Res 2021; 31:e13450. [PMID: 34327743 PMCID: PMC8420100 DOI: 10.1111/jsr.13450] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 07/12/2021] [Accepted: 07/14/2021] [Indexed: 12/30/2022]
Abstract
The COVID‐19 pandemic has had a negative impact on physical and mental health worldwide. While pandemic‐related stress has also been linked to increased insomnia, scarce research has examined this association in nationally representative samples of high‐risk populations, such as military veterans. We evaluated pre‐ and pandemic‐related factors associated with new‐onset and exacerbated insomnia symptoms in a nationally representative sample of 3,078 US military veterans who participated in the National Health and Resilience in Veterans Study. Veterans were surveyed in the USA in 11/2019 (pre‐pandemic) and again in 11/2020 (peri‐pandemic). The Insomnia Severity Index was used to assess severity of insomnia symptoms at the pre‐ and peri‐pandemic assessments. Among veterans without clinical or subthreshold insomnia symptoms pre‐pandemic (n = 2,548), 11.5% developed subthreshold (10.9%) or clinical insomnia symptoms (0.6%) during the pandemic; among those with subthreshold insomnia symptoms pre‐pandemic (n = 1,058; 26.0%), 8.0% developed clinical insomnia symptoms. Pre‐pandemic social support (21.9% relative variance explained), pandemic‐related stress related to changes in family relationships (20.5% relative variance explained), pre‐pandemic chest pain (18.5% relative variance explained) and weakness (11.1% relative variance explained), and posttraumatic stress disorder (8.2% relative variance explained) explained the majority of the variance in new‐onset subthreshold or clinical insomnia symptoms during the pandemic. Among veterans with pre‐pandemic subthreshold insomnia, pandemic‐related home isolation restrictions (59.1% relative variance explained) and financial difficulties (25.1% relative variance explained) explained the majority of variance in incident clinical insomnia symptoms. Taken together, the results of this study suggest that nearly one in five US veterans developed new‐onset or exacerbated insomnia symptoms during the pandemic, and identify potential targets for prevention and treatment efforts.
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Affiliation(s)
- Elissa McCarthy
- US Department of Veterans Affairs National Center for PTSD, White River Junction, VT, USA
| | - Jason C DeViva
- Veterans Affairs Connecticut Health Care System, West Haven, CT, USA.,Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Peter J Na
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Robert H Pietrzak
- Veterans Affairs Connecticut Health Care System, West Haven, CT, USA.,Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA.,US Department of Veterans Affairs National Center for PTSD, VA Connecticut Healthcare System, West Haven, CT, USA.,Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
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9
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DeViva JC, McCarthy E, Southwick SM, Tsai J, Pietrzak RH. The impact of sleep quality on the incidence of PTSD: Results from a 7-Year, Nationally Representative, Prospective Cohort of U.S. Military Veterans. J Anxiety Disord 2021; 81:102413. [PMID: 33991819 PMCID: PMC10693322 DOI: 10.1016/j.janxdis.2021.102413] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 11/20/2020] [Revised: 03/19/2021] [Accepted: 04/27/2021] [Indexed: 11/21/2022]
Abstract
Sleep and posttraumatic stress disorder (PTSD) have a complex relationship, with some studies showing that disrupted sleep is associated with subsequent development of PTSD. The purpose of the current study was to examine the relationship between sleep quality and the development of probable PTSD in U.S. veterans surveyed as part of the National Health and Resilience in Veterans Study, a 7-year, nationally representative, prospective cohort study with four waves of data collection. Sociodemographic, military, trauma, and clinical variables were entered into a multivariate analysis to examine independent determinants of new-onset PTSD. A total of 142 (7.3 %) veterans developed PTSD over the 7-year study period. Poor/fair sleep quality at Wave 1 was associated with 60 % greater likelihood of developing PTSD, with more than twice as many veterans who developed PTSD reporting poor sleep quality at Wave 1 (47.8 % vs. 20.7 %). Younger age, using the VA as a primary source of healthcare, greater traumas since Wave, and lifetime depression were additionally associated with this outcome. Results of this study underscore the importance of self-reported sleep quality as a potential risk factor for the development of PTSD in the U.S. veteran population.
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Affiliation(s)
- Jason C DeViva
- Veterans Affairs Connecticut Health Care System, 950 Campbell Ave., West Haven, CT, 06516, United States; Department of Psychiatry, Yale School of Medicine, 300 George St., New Haven, CT, 06511, United States.
| | - Elissa McCarthy
- National Center for PTSD, 163 Veterans Drive, White River Junction, VT, 05009, United States
| | - Steven M Southwick
- Department of Psychiatry, Yale School of Medicine, 300 George St., New Haven, CT, 06511, United States
| | - Jack Tsai
- Department of Psychiatry, Yale School of Medicine, 300 George St., New Haven, CT, 06511, United States; U.S. Department of Veterans Affairs National Center on Homelessness among Veterans, 50 Irving ST. NW, Washington, DC, 20422, United States; School of Public Health, University of Texas Health Science Center at Houston, 1200 Pressler St., Houston, TX, 77030, United States
| | - Robert H Pietrzak
- Veterans Affairs Connecticut Health Care System, 950 Campbell Ave., West Haven, CT, 06516, United States; Department of Psychiatry, Yale School of Medicine, 300 George St., New Haven, CT, 06511, United States; U.S. Department of Veterans Affairs National Center for PTSD, VA Connecticut Healthcare System, 950 Campbell Ave., West Haven, CT, 06516, United States; Department of Social and Behavioral Sciences, Yale School of Public Health, Laboratory of Epidemiology and Public Health, 60 College St., New Haven, CT, 06510, United States
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10
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Byrne SP, McCarthy E, DeViva JC, Southwick SM, Pietrzak RH. Prevalence, risk correlates, and health comorbidities of insomnia in US military veterans: results from the 2019-2020 National Health and Resilience in Veterans Study. J Clin Sleep Med 2021; 17:1267-1277. [PMID: 33656983 PMCID: PMC8314657 DOI: 10.5664/jcsm.9182] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 01/26/2021] [Accepted: 01/27/2021] [Indexed: 12/11/2022]
Abstract
STUDY OBJECTIVES Veterans experience high levels of trauma, psychiatric, and medical conditions that may increase their risk for insomnia. To date, however, no known study has examined the prevalence, risk correlates, and comorbidities of insomnia in a nationally representative sample of veterans. METHODS A nationally representative sample of 4,069 US military veterans completed a survey assessing insomnia severity; military, trauma, medical, and psychiatric histories; and health and psychosocial functioning. Multivariable analyses examined the association between insomnia severity, psychiatric and medical comorbidities, suicidality, and functioning. RESULTS A total of 11.4% of veterans screened positive for clinical insomnia and 26.0% for subthreshold insomnia. Greater age and retirement were associated with a lower likelihood of insomnia. Adverse childhood experiences, traumatic life events, lower education and income were associated with greater risk for insomnia. A "dose-response" association was observed for health comorbidities, with increasing levels of insomnia associated with elevated odds of psychiatric and medical conditions (clinical vs no insomnia odds ratio = 1.8-13.4) and greater reductions in health and psychosocial functioning (clinical vs no insomnia Cohen's d = 0.2-0.4). The prevalence of current suicidal ideation was 3-5 times higher in veterans with clinical and subthreshold insomnia relative to those without insomnia (23.9% and 13.6% vs 4.5%, respectively). CONCLUSIONS Nearly 2 in 5 US veterans experience clinical or subthreshold insomnia, which is associated with substantial health burden and independent risk for suicidal ideation. Results underscore the importance of assessment, monitoring, and treatment of insomnia in veterans as they transition from the military.
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Affiliation(s)
- Simon P. Byrne
- Department of Psychiatry, Westmead Hospital, Sydney, Australia
| | - Elissa McCarthy
- US Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, White River Junction, Vermont
| | - Jason C. DeViva
- US Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
| | | | - Robert H. Pietrzak
- US Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut
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Mazza D, McCarthy E, Singh N, Carey M, Turner L, Harris M. "There's always something else": Patient perspectives on improving the implementation of obesity guidelines in general practice. Obes Res Clin Pract 2020; 14:437-442. [PMID: 32962956 DOI: 10.1016/j.orcp.2020.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 09/08/2020] [Accepted: 09/11/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The prevalence of obesity in Australia is rising. National guidelines for the management of overweight and obesity exist but our previous work demonstrates poor implementation of key elements in general practice. The aim of this study was to describe patient perspectives on the implementation of obesity guidelines in general practice. METHODS Qualitative study of 40 people living with obesity (PwO) who were recruited through general practices in Melbourne, Australia. PwO had a recorded BMI in the overweight range or above (>25), had attended a consultation in the last 6 months and had a diagnosis of at least one of the following: diabetes, kidney disease, hyperlipidemia, hypertension, or cardiovascular disease. Semi-structured telephone interviews were conducted with patients. Interviews were audio-recorded, transcribed verbatim and analysed thematically. RESULTS While a strong general practitioner (GP)-patient relationship enabled conversation to occur about weight management there was uncertainty as to whether patients or GPs should broach the topic of weight. Patients described complacency regarding their weight and often being unprepared to take up GP advice. Other health issues were felt to take precedence, and patients described inconsistent provision of information and resources to assist them in tackling their weight problems. CONCLUSIONS It is imperative to take into account patient perspectives on obesity management in general practice in order to improve health outcomes. This study provides valuable insights into how PwO can be better managed. Interventions should also include strategies to help patients maintain motivation in making lifestyle changes to support healthy weight loss.
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Affiliation(s)
- D Mazza
- Department of General Practice, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Australia.
| | - E McCarthy
- Department of General Practice, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Australia
| | - N Singh
- Department of General Practice, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Australia
| | - M Carey
- School of Medicine and Public Health, University of Newcastle, Australia
| | - L Turner
- Department of General Practice, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Australia
| | - M Harris
- School of Public Health and Community Medicine, University of New South Wales, Australia
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Petrakis I, Ralevski E, Arias AJ, DeNegre D, Newcomb J, Gianoli M, McCarthy E, Meshberg-Cohen S, Yoon G. Zonisamide as an Adjunctive Treatment to Cognitive Processing Therapy for Veterans With Posttraumatic Stress Disorder and Comorbid Alcohol Use Disorder: A Pilot Study. Am J Addict 2020; 29:515-524. [PMID: 32462773 DOI: 10.1111/ajad.13061] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 04/07/2020] [Accepted: 05/05/2020] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND AND OBJECTIVES There are high rates of comorbid alcohol use disorder (AUD) among those who have posttraumatic stress disorder (PTSD). Ideally, treatment for comorbidity should address both disorders simultaneously. Zonisamide, an anticonvulsant, may be effective in decreasing alcohol use and may attenuate symptoms of PTSD. Treatment strategies can include medication in combination with a proven evidence-based psychotherapy designed to treat PTSD, such as cognitive processing therapy (CPT). METHODS This 12-week pilot study was designed to test feasibility, acceptability, and preliminary efficacy of zonisamide (400 mg) as an adjunct to CPT for veterans with PTSD and comorbid AUD. Veterans (n = 24) with PTSD and current alcohol dependence were randomized in a 3:1 ratio to receive zonisamide or placebo in a double-blind fashion. All subjects received CPT enhanced to include sessions addressing drinking behavior. RESULTS Subjects overall reported a significant decrease in drinking outcomes, craving, and symptoms of PTSD. Zonisamide was well-tolerated and easily administered with CPT, which was also well-tolerated. Exploratory analysis of comparison of groups suggests there was no advantage of zonisamide vs placebo in drinking or PTSD outcomes. There was a numeric but nonsignificant higher rate of abstinence with zonisamide (50%) vs placebo (33%). CONCLUSION AND SCIENTIFIC SIGNIFICANCE The interpretation of the results is limited by the pilot nature of this study. The combination of psychosocial treatment with medication management mimics real-world treatment. In order to isolate the individual contributions of medication vs psychotherapy a much larger study would need to be conducted. (Am J Addict 2020;29:515-524).
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Affiliation(s)
- Ismene Petrakis
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut.,Department of Veterans Affairs, VA Connecticut Healthcare System, West Haven, Connecticut
| | - Elizabeth Ralevski
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut.,Department of Veterans Affairs, VA Connecticut Healthcare System, West Haven, Connecticut
| | - Albert J Arias
- Department of Psychiatry, Virginia Commonwealth University School of Medicine, Richmond, Virginia
| | - Diana DeNegre
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut.,Department of Veterans Affairs, VA Connecticut Healthcare System, West Haven, Connecticut
| | - Jenelle Newcomb
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut.,Department of Veterans Affairs, VA Connecticut Healthcare System, West Haven, Connecticut
| | - Mayumi Gianoli
- Department of Veterans Affairs, VA Connecticut Healthcare System, West Haven, Connecticut
| | - Elissa McCarthy
- National Center for Posttraumatic Stress Disorder, White River Junction VA Medical Center, White River Junction, Vermont
| | - Sarah Meshberg-Cohen
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut.,Department of Veterans Affairs, VA Connecticut Healthcare System, West Haven, Connecticut
| | - Gihyun Yoon
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut.,Department of Veterans Affairs, VA Connecticut Healthcare System, West Haven, Connecticut
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Boland PA, Quidwai ST, Mitru R, McCarthy E, Aremu M. Sigmoid Perforation Secondary to Accidental Ingestion of a Chicken Bone. Ir Med J 2020; 113:12. [PMID: 32298562] [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] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Presentation We describe an unusual presentation of sigmoid colon perforation secondary to an ingested chicken bone. Diagnosis The patient presented with a 4 day history of abdominal pain and distension. On examination there were signs of peritonism. Inflammatory markers were raised. Computed tomography revealed a linear density projecting through the wall of the colon. Treatment The patient underwent emergency laparotomy and a Hartmann's procedure. A chicken bone was found to be the causative foreign object. Conclusion Foreign body ingestion is an uncommon cause of sigmoid perforation which may mimic more common surgical presentations such as diverticulitis.
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Affiliation(s)
- P A Boland
- Department of Surgery, Connolly Hospital Blanchardstown, Dublin 15
| | - S T Quidwai
- Department of Radiology, Connolly Hospital Blanchardstown, Dublin 15
| | - R Mitru
- Department of Surgery, Connolly Hospital Blanchardstown, Dublin 15
| | - E McCarthy
- Department of Radiology, Connolly Hospital Blanchardstown, Dublin 15
| | - M Aremu
- Department of Surgery, Connolly Hospital Blanchardstown, Dublin 15
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14
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McCarthy E, DeViva JC, Norman SB, Southwick SM, Pietrzak RH. Self-assessed sleep quality partially mediates the relationship between PTSD symptoms and functioning and quality of life in U.S. veterans: Results from the National Health and Resilience in Veterans Study. ACTA ACUST UNITED AC 2019; 11:869-876. [DOI: 10.1037/tra0000436] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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15
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Malone F, McCarthy E, Delassus P, Buhk JH, Fiehler J, Morris L. Embolus Analog Trajectory Paths Under Physiological Flowrates Through Patient-Specific Aortic Arch Models. J Biomech Eng 2019; 141:2734765. [DOI: 10.1115/1.4043832] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Indexed: 01/10/2023]
Abstract
Atrial fibrillation (AF) is the most common irregular heartbeat among the world's population and is a major contributor to cardiogenic embolisms and acute ischemic stroke (AIS). However, the role AF flow plays in the trajectory paths of cardiogenic emboli has not been experimentally investigated. A physiological simulation system was designed to analyze the trajectory patterns of bovine embolus analogs (EAs) (n = 720) through four patient-specific models, under three flow conditions: steady flow, normal pulsatile flow, and AF pulsatile flow. It was seen that EA trajectory paths were proportional to the percentage flowrate split of 25–31% along the branching vessels. Overall, AF flow conditions increased trajectories through the left- (LCCA) and right (RCCA)-common carotid artery by 25% with respect to normal pulsatile flow. There was no statistical difference in the distribution of clot trajectories when the clot was released from the right, left, or anterior positions. Significantly, more EAs traveled through the brachiocephalic trunk (BCT) than through the LCCA or the left subclavian. Yet of the EAs that traveled through the common carotid arteries, there was a greater affiliation toward the LCCA compared to the RCCA (p < 0.05).
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Affiliation(s)
- F. Malone
- GMedTech, Department of Mechanical and Industrial Engineering, Galway-Mayo Institute of Technology, Galway H91 T8NW, Ireland e-mail:
| | - E. McCarthy
- GMedTech, Department of Mechanical and Industrial Engineering, Galway-Mayo Institute of Technology, Galway H91 T8NW, Ireland
| | - P. Delassus
- GMedTech, Department of Mechanical and Industrial Engineering, Galway-Mayo Institute of Technology, Galway H91 T8NW, Ireland
| | - J. H. Buhk
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, Hamburg 20246, Germany
| | - J. Fiehler
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, Hamburg 20246, Germany
| | - L. Morris
- GMedTech, Department of Mechanical and Industrial Engineering, Galway-Mayo Institute of Technology, Galway H91 T8NW, Ireland e-mail:
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Mazza D, McCarthy E, Carey M, Turner L, Harris M. "90% of the time, it's not just weight": General practitioner and practice staff perspectives regarding the barriers and enablers to obesity guideline implementation. Obes Res Clin Pract 2019; 13:398-403. [PMID: 31109793 DOI: 10.1016/j.orcp.2019.04.001] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 03/25/2019] [Accepted: 04/05/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To identify the views of GPs and general practice staff regarding barriers and enablers to implementation of obesity guideline recommendations in general practice. METHODS Twenty general practitioners (GPs) and 18 practice staff from inner-eastern Melbourne, Australia, participated in semi-structured telephone interviews. The interview schedule was informed by the Theoretical Domains Framework (TDF). Interviews were audio-recorded, transcribed verbatim and underwent thematic analysis. RESULTS Participants lacked familiarity with and knowledge of the NHMRC obesity guidelines. Barriers and enablers were predominantly related to five theoretical domains: (1) environmental context and resources, (2) knowledge, (3) emotion, (4) beliefs about consequences, and (5) motivation and goals. Time pressures in consultations, costs for the patient, reluctance to add to patient burden particularly in those with comorbidities such as mental health issues, lack of awareness about services to refer patients to and GPs' fear of embarrassing patients and losing them were significant barriers. Enablers included having a strong doctor-patient relationship and a sense of responsibility to the patient to address weight. CONCLUSIONS Obesity guidelines and policy makers need to better engage with issues of multimorbidity, socioeconomic disadvantage and workforce issues if recommendations are to be widely adopted in general practice. Tasksharing, teamwork and technology are potential solutions to some of the barriers. Patient perspectives and approaches to being able to overcome stigma and legitimise obesity management in primary care consultations could also assist.
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Affiliation(s)
- D Mazza
- Department of General Practice, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Australia.
| | - E McCarthy
- Department of General Practice, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Australia
| | - M Carey
- School of Medicine and Public Health, University of Newcastle, Australia
| | - L Turner
- Department of General Practice, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Australia
| | - M Harris
- School of Public Health and Community Medicine, University of New South Wales, Australia
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Abstract
Older adults have generally not been included in randomized clinical trials of psychotherapy for posttraumatic stress disorder (PTSD). Of the case reports and treatment outcome studies that have included those aged 55 and older, most did not include men with sexual abuse-related PTSD. This case report presents the successful application of Prolonged Exposure (PE) to a 58-year-old single, Caucasian noncombat U.S. Army veteran with severe, chronic PTSD related to several sexual assaults, including childhood sexual abuse. PE is a manualized, short-term, evidence-based psychotherapy for the treatment of PTSD which involves psychoeducation, breathing retraining, in vivo exposure, and imaginal exposure. PTSD and depressive symptoms demonstrated clinically meaningful improvement during the course of treatment. In addition, he experienced significant improvement in quality of life as well as meaning and purpose from baseline to posttreatment. Implications for clinically working with older men with untreated childhood sexual abuse-related PTSD later in life are presented. Future research directions are discussed.
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Affiliation(s)
| | - Joan M. Cook
- National Center for PTSD, White River Junction, VT, USA
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18
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Cook JM, Simiola V, McCarthy E, Ellis A, Wiltsey Stirman S. Use of Reflective Journaling to Understand Decision Making Regarding Two Evidence-Based Psychotherapies for PTSD: Practice Implications. ACTA ACUST UNITED AC 2018; 3:153-167. [PMID: 30906873 DOI: 10.1037/pri0000070] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
As part of a longitudinal investigation on implementation of 2 evidence-based psychotherapies (EBPs) for posttraumatic stress disorder, psychotherapists from 38 Department of Veterans Affairs residential treatment programs across the United States were asked to complete reflective journals every 4 months for a 1-year time period in regard to their successes and challenges in using prolonged exposure and cognitive processing therapy. This paper provides content analysis on the reflective journals of 24 of these providers. Five main themes were identified: EBPs are great but not sufficient for patients in residential treatment with chronic posttraumatic stress disorder and complicated life circumstances, and thus, more treatment is necessary after discharge. Modifications were made or thought needed for optimal outcome and successful delivery of these 2 EBPs; some providers blended aspects of prolonged exposure and cognitive processing therapy; what happens when providers and patients do not agree on choice of which EBP to first implement; and provider concerns on when to discontinue an EBP. Reflective journaling appears to be a promising way for trainers and treatment developers to gather important information about the clinical application and decision-making process for front-line providers, which may offer insight into how to improve EBP implementation and sustainability. Incorporating reflective journaling and strategies for accomplishing this into training, supervision, and consultation may also be 1 strategy for increasing feedback, expanding implementation, and informing ways to increase sustainability of EBPs in populations with multiple clinical and psychosocial needs.
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Affiliation(s)
- Joan M Cook
- Department of Psychiatry Yale School of Medicine and National Center for PTSD, West Haven, Connecticut
| | - Vanessa Simiola
- Department of Psychiatry, Yale School of Medicine and Kaiser Permanente, Honolulu, Hawaii
| | | | - Amy Ellis
- Institutional Center for Scientific Research, Albizu University, Miami, Florida
| | - Shannon Wiltsey Stirman
- Department of Psychiatry and Behavioral Sciences, National Center for PTSD, Palo Alto, California and Stanford University of Medicine
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19
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Ahola Kohut S, LeBlanc C, O'Leary K, McPherson AC, McCarthy E, Nguyen C, Stinson J. The internet as a source of support for youth with chronic conditions: A qualitative study. Child Care Health Dev 2018; 44:212-220. [PMID: 29082537 DOI: 10.1111/cch.12535] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [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: 05/30/2017] [Revised: 09/20/2017] [Accepted: 09/27/2017] [Indexed: 01/09/2023]
Abstract
BACKGROUND Adolescents living with chronic conditions often portray themselves as "healthy" online, yet use the Internet as one of their top sources of health information and social communication. There is a need to develop online support programs specific to adolescents with chronic conditions in order to provide a private space to discuss concerns. This paper endeavors to increase our understanding of the online support needs and wants of these adolescents and their interest in and preferences for an online support program. METHODS A qualitative descriptive study using semistructured interviews was completed. Stratified purposive sampling was utilized to ensure a representative sample based on age and diagnosis. English speaking adolescents (aged 12-18 years) diagnosed with a chronic condition were recruited from clinic and inpatient areas across 3 paediatric hospitals in Canada. RESULTS Thirty-three participants aged 15.3 ± 1.8 years (64% female) completed the study. The main topics identified were (a) the purpose of current online activity, (b) the benefits and challenges of existing online supports, and (c) a description of ideal online resources. The purpose of online activity was social networking, information, online gaming, and social support. When accessing health information online, participants prioritized websites that were easy to access and understand despite the trustworthiness of the site. The reported benefits and challenges varied across participants with many areas perceived as both a benefit and a challenge. The majority of participants were interested in participating in an online support program that included both accurate disease-related information and a community of other adolescents to provide social support. CONCLUSIONS Adolescents with chronic conditions are interested in online support that encompasses health information and social support that is flexible and easy to navigate. Findings can be used to develop or adapt existing online support programs for adolescents with chronic conditions to help increase engagement and utilization.
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Affiliation(s)
- S Ahola Kohut
- Medical Psychiatry Alliance, Hospital for Sick Children, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - C LeBlanc
- Child Life Services, IWK Health Centre, Halifax, NS, Canada
| | - K O'Leary
- Child Life/Creative Arts Therapy, Hospital for Sick Children, Toronto, ON, Canada
| | - A C McPherson
- Bloorview Research Institute, Toronto, ON, Canada.,Dalla Lana School of Public Health & Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
| | - E McCarthy
- Child Health Evaluative Sciences, Hospital for Sick Children, Toronto, ON, Canada
| | - C Nguyen
- Child Health Evaluative Sciences, Hospital for Sick Children, Toronto, ON, Canada
| | - J Stinson
- Child Health Evaluative Sciences, Hospital for Sick Children, Toronto, ON, Canada.,Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
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20
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Scholz F, Fringuelli E, Bolton-Warberg M, Marcos-López M, Mitchell S, Prodhol P, Moffet D, Savage P, Murphy O'Sullivan S, O Connor I, McCarthy E, Rodger HD. First record of Tetramicra brevifilum in lumpfish (Cyclopterus lumpus, L.). J Fish Dis 2017; 40:757-771. [PMID: 27716959 DOI: 10.1111/jfd.12554] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2016] [Revised: 07/26/2016] [Accepted: 07/27/2016] [Indexed: 06/06/2023]
Abstract
A microsporidian species with 98.3-98.4% nucleotide identity to Tetramicra brevifilum (Journal of Fish Diseases, 3, 1980, 495) was diagnosed in lumpfish (Cyclopterus lumpus, L.) broodstock held at a breeding and rearing facility in western Ireland. The fish were wild-caught from the west coast of Ireland, and the first case was diagnosed one year after capture. Clinical signs included severe bloating, lethargy, exophthalmos, anorexia, white patches on the cornea and externally visible parasitic cysts on skin and fins. Necropsy revealed severe ascites, white nodules and vacuoles in all the internal organs and partial liquefaction of the skeletal muscle. On histological examination, microsporidian xenomas were observed in all internal organs, the skin, skeletal muscle, gills and the eyes. The microsporidian species was identified by molecular analysis and transmission electron microscopy. This is the first record of T. brevifilum infecting lumpfish, and the disease is considered to be of potential significance to the rising aquaculture industry of this species.
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Affiliation(s)
- F Scholz
- Vet-Aqua International, Oranmore Business Park, Oranmore, Co. Galway, Ireland
- Galway-Mayo Institute of Technology, Marine and Freshwater Research Centre, Galway, Ireland
| | - E Fringuelli
- Veterinary Sciences Division, Agri-food and Biosciences Institute of Northern Ireland, Stormont, Belfast, UK
| | - M Bolton-Warberg
- Carna Research Station, Ryan Institute, NUIG, Carna, Co. Galway, Ireland
| | - M Marcos-López
- Vet-Aqua International, Oranmore Business Park, Oranmore, Co. Galway, Ireland
- Galway-Mayo Institute of Technology, Marine and Freshwater Research Centre, Galway, Ireland
| | - S Mitchell
- Vet-Aqua International, Oranmore Business Park, Oranmore, Co. Galway, Ireland
| | | | - D Moffet
- Veterinary Sciences Division, Agri-food and Biosciences Institute of Northern Ireland, Stormont, Belfast, UK
| | - P Savage
- Veterinary Sciences Division, Agri-food and Biosciences Institute of Northern Ireland, Stormont, Belfast, UK
| | | | - I O Connor
- Galway-Mayo Institute of Technology, Marine and Freshwater Research Centre, Galway, Ireland
| | - E McCarthy
- Galway-Mayo Institute of Technology, Marine and Freshwater Research Centre, Galway, Ireland
| | - H D Rodger
- Vet-Aqua International, Oranmore Business Park, Oranmore, Co. Galway, Ireland
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21
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Cook JM, McCarthy E, Thorp SR. Older Adults with PTSD: Brief State of Research and Evidence-Based Psychotherapy Case Illustration. Am J Geriatr Psychiatry 2017; 25:522-530. [PMID: 28214073 DOI: 10.1016/j.jagp.2016.12.016] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [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: 10/05/2016] [Revised: 12/20/2016] [Accepted: 12/22/2016] [Indexed: 10/20/2022]
Abstract
Although lifetime exposure to potentially traumatic events among older adults is fairly high, rates of full-blown post-traumatic stress disorder (PTSD) are estimated at about 4.5%, a rate lower than that for middle-aged and young adults. Nevertheless, PTSD seems to be an under-recognized and under-treated condition in older adults. Assessment and treatment can be challenging in this population for various reasons, including potential cognitive or sensory decline and comorbid mental and physical disorders. This article provides highlights of the empirical research on PTSD in late life, including information on its effects on cognition and physical health. The bulk of this piece is spent on reviewing the theory, description of, and efficacy for an evidence-based psychotherapy, Prolonged Exposure (PE), for PTSD. A detailed successful application of PE with an older veteran with severe, chronic PTSD in the Department of Veterans Affairs Health Care System is presented. Evidence-based psychotherapy for PTSD can be safely and effectively used with older individuals.
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Affiliation(s)
- Joan M Cook
- Yale School of Medicine, New Haven, CT; National Center for PTSD, West Haven, CT.
| | | | - Steven R Thorp
- California School of Professional Psychology at Alliant International University, San Diego, CA; University of California, San Diego, CA
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22
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Ovejero D, Lim YH, Boyce AM, Gafni RI, McCarthy E, Nguyen TA, Eichenfield LF, DeKlotz CMC, Guthrie LC, Tosi LL, Thornton PS, Choate KA, Collins MT. Cutaneous skeletal hypophosphatemia syndrome: clinical spectrum, natural history, and treatment. Osteoporos Int 2016; 27:3615-3626. [PMID: 27497815 PMCID: PMC6908308 DOI: 10.1007/s00198-016-3702-8] [Citation(s) in RCA: 34] [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: 12/09/2015] [Accepted: 07/06/2016] [Indexed: 12/01/2022]
Abstract
UNLABELLED Cutaneous skeletal hypophosphatemia syndrome (CSHS), caused by somatic RAS mutations, features excess fibroblast growth factor-23 (FGF23) and skeletal dysplasia. Records from 56 individuals were reviewed and demonstrated fractures, scoliosis, and non-congenital hypophosphatemia that in some cases were resolved. Phosphate and calcitriol, but not skin lesion removal, were effective at controlling hypophosphatemia. No skeletal malignancies were found. PURPOSE CSHS is a disorder defined by the association of epidermal and/or melanocytic nevi, a mosaic skeletal dysplasia, and an FGF23-mediated hypophosphatemia. To date, somatic RAS mutations have been identified in all patients whose affected tissue has undergone DNA sequencing. However, the clinical spectrum and treatment are poorly defined in CSHS. The purpose of this study is to determine the spectrum of the phenotype, natural history of the disease, and response to treatment of hypophosphatemia. METHODS Five CSHS subjects underwent prospective data collection at clinical research centers. A review of the literature identified 45 reports that included a total of 51 additional patients, in whom the findings were compatible with CSHS. Data on nevi subtypes, bone histology, mineral and skeletal disorders, abnormalities in other tissues, and response to treatment of hypophosphatemia were analyzed. RESULTS Fractures, limb deformities, and scoliosis affected most CSHS subjects. Hypophosphatemia was not present at birth. Histology revealed severe osteomalacia but no other abnormalities. Skeletal dysplasia was reported in all anatomical compartments, though less frequently in the spine; there was no clear correlation between the location of nevi and the skeletal lesions. Phosphate and calcitriol supplementation was the most effective therapy for rickets. Convincing data that nevi removal improved blood phosphate levels was lacking. An age-dependent improvement in mineral abnormalities was observed. A spectrum of extra-osseous/extra-cutaneous manifestations that included both benign and malignant neoplasms was present in many subjects, though osteosarcoma remains unreported. CONCLUSION An understanding of the spectrum, natural history, and efficacy of treatment of hypophosphatemia in CSHS may improve the care of these patients.
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Affiliation(s)
- D Ovejero
- Skeletal Clinical Studies Unit, Craniofacial and Skeletal Disease Branch, National ADDRESSES, references BRACKETS, National Institute of Dental and Craniofacial Research, National Institutes of Health, 30 Convent Drive, Room 228, MSC 4320, Bethesda, MD, 20892-4320, USA
- Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain
| | - Y H Lim
- Department of Dermatology, Yale University School of Medicine, New Haven, CT, USA
| | - A M Boyce
- Skeletal Clinical Studies Unit, Craniofacial and Skeletal Disease Branch, National ADDRESSES, references BRACKETS, National Institute of Dental and Craniofacial Research, National Institutes of Health, 30 Convent Drive, Room 228, MSC 4320, Bethesda, MD, 20892-4320, USA
| | - R I Gafni
- Skeletal Clinical Studies Unit, Craniofacial and Skeletal Disease Branch, National ADDRESSES, references BRACKETS, National Institute of Dental and Craniofacial Research, National Institutes of Health, 30 Convent Drive, Room 228, MSC 4320, Bethesda, MD, 20892-4320, USA
| | - E McCarthy
- Department of Pathology, The Johns Hopkins University, Baltimore, MD, USA
| | - T A Nguyen
- Albert Einstein College of Medicine, Bronx, NY, USA
- Departments of Dermatology and Pediatrics, San Diego and Rady Children's Hospital, University of California, San Diego, CA, USA
| | - L F Eichenfield
- Departments of Dermatology and Pediatrics, San Diego and Rady Children's Hospital, University of California, San Diego, CA, USA
| | - C M C DeKlotz
- Division Dermatology, Department of Medicine and Department of Pediatrics, Georgetown University Medical Center, Washington, DC, USA
| | - L C Guthrie
- Skeletal Clinical Studies Unit, Craniofacial and Skeletal Disease Branch, National ADDRESSES, references BRACKETS, National Institute of Dental and Craniofacial Research, National Institutes of Health, 30 Convent Drive, Room 228, MSC 4320, Bethesda, MD, 20892-4320, USA
| | - L L Tosi
- Bone Health Program, Division of Orthopaedics and Sports Medicine, Children's National Health System, Washington, DC, USA
| | - P S Thornton
- Department of Endocrinology and Diabetes, Cook Children Medical Center, Fort Worth, TX, USA
| | - K A Choate
- Department of Dermatology, Yale University School of Medicine, New Haven, CT, USA
| | - M T Collins
- Skeletal Clinical Studies Unit, Craniofacial and Skeletal Disease Branch, National ADDRESSES, references BRACKETS, National Institute of Dental and Craniofacial Research, National Institutes of Health, 30 Convent Drive, Room 228, MSC 4320, Bethesda, MD, 20892-4320, USA.
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23
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McCarthy E, Russell A, Kearney PM. Management of Patients with Subclinical Hypothyroidism in Primary Care. Ir Med J 2016; 109:346-347. [PMID: 26904793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Subclinical hypothyroidism (SCH) is defined as a raised serum thyroid stimulating hormone level with normal thyroxine. Despite a prevalence of up to 9% of the adult population there is widespread uncertainty on how to manage it. The aim of this study was to assess how older adults with SCH are managed in primary care. A retrospective case-note review was carried out on patients attending Mallow Primary Healthcare Centre. This study identified patients 65 years and over meeting the criteria for SCH in one year. The prevalence of SCH in this study was calculated as 2.9%. 22.2% of patients were treated with thyroxine. 6.1% of untreated patients progressed to clinical hypothyroidism within the study period while 18.2% spontaneously reverted to normal TSH levels.
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Moreno-Martinez D, Wilkinson FL, McCarthy E, Mahmoud AM, Alexander MY. 36 Endothelial microparticles: investigating their role on endothelial cells in vitro. Heart 2015. [DOI: 10.1136/heartjnl-2015-308734.36] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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25
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Sutcliffe J, Briggs J, Little M, McCarthy E, Wigham A, Bratby M, Tapping C, Anthony S, Patel R, Phillips-Hughes J, Boardman P, Uberoi R. Antibiotics in interventional radiology. Clin Radiol 2015; 70:223-34. [DOI: 10.1016/j.crad.2014.09.021] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2014] [Revised: 09/28/2014] [Accepted: 09/30/2014] [Indexed: 12/18/2022]
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McCarthy E, Kavanagh J, O'Donoghue Y, McCormack E, D'Arcy C, O'Keeffe SA. Phyllodes tumours of the breast: radiological presentation, management and follow-up. Br J Radiol 2014; 87:20140239. [PMID: 25270608 DOI: 10.1259/bjr.20140239] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE Phyllodes tumours (PTs) are rare neoplasms accounting for <1% of breast lesions. With increased breast awareness and screening programmes, smaller PTs are being detected. The purpose of this study was to determine the clinical, radiological and pathological presentation of PTs and to evaluate the role of imaging follow-up, for which there are no specific guidelines. METHODS A retrospective study of all patients diagnosed with PT in a symptomatic unit between January 2006 and March 2013 was carried out. Patients were identified using breast care and electronic patient record databases. RESULTS 53 patients with 54 lesions were diagnosed as having a PT. The median age was 27.5, 35.0 and 38.5 years for benign, borderline and malignant PT, respectively. Borderline and malignant PTs were larger than benign PTs, with mean sizes of 33 and 42 mm compared with 29 mm. 38% of PTs were labelled by the reporting radiologist as fibroadenomas, including two borderline PTs and one malignant PT. In 24% of cases, the radiologist raised the possibility of PT in the report. 17 patients (40%) developed a new fibroepithelial breast lesion during follow-up of which 4 were recurrent PTs. CONCLUSION Despite adequate surgical management, the development of further fibroepithelial lesions in the ipsilateral breast is common. 3-year clinical surveillance, with the addition of 6-monthly ultrasound is advised for females with initial borderline or malignant PT histology. ADVANCES IN KNOWLEDGE We propose a follow-up protocol with ultrasound based on the grade of the PT diagnosed for 3 years to detect recurrence.
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Affiliation(s)
- E McCarthy
- 1 Department of Radiology, St James's Hospital and Trinity College Dublin, Dublin, Ireland
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Wilson F, Durcan L, McCarthy E, O'Shea B, Coole A, Webb M, Johnston C, Gissane C. THE PREVALENCE OF PATELLAR TENDINOPATHY IN ELITE ACADEMY RUGBY; A CLINICAL AND IMAGING STUDY WITH 12 MONTH FOLLOW UP. Br J Sports Med 2014. [DOI: 10.1136/bjsports-2014-093494.300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Ralevski E, Gianoli MO, McCarthy E, Petrakis I. Quality of life in veterans with alcohol dependence and co-occurring mental illness. Addict Behav 2014; 39:386-91. [PMID: 23890764 DOI: 10.1016/j.addbeh.2013.06.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2012] [Revised: 04/24/2013] [Accepted: 06/05/2013] [Indexed: 10/26/2022]
Abstract
Quality of life is negatively impacted by diagnosis of mental illness. Those with mental illness report problems in physical, psychological, cognitive, social, and occupational functioning. This study was designed to examine changes in quality of life in veterans with dual diagnoses. All veterans participated in a treatment study designed to treat alcohol dependence with naltrexone, disulfiram, and the combination of naltrexone/disulfiram or placebo for 12 weeks. Quality of life was assessed before treatment and at the end of treatment. Quality of life improved for all veterans and the improvement was more significant for those who abstained from alcohol throughout treatment. Severity of psychiatric symptom was associated with worse quality of life. This study demonstrates the importance of addressing social functioning in veterans with dual diagnosis.
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Rosa C, McCarthy E, Duong K, Hoover G, Moorman G. First Report of the Spittlebug Lepyronia quadrangularis and the Leafhopper Latalus sp. as Vectors of the Elm Yellows Associated Phytoplasma, Candidatus Phytoplasma ulmi in North America. Plant Dis 2014; 98:154. [PMID: 30708602 DOI: 10.1094/pdis-06-13-0628-pdn] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Elm yellows (EY) is a lethal disease of American (Ulmus americana L.) and other elm species (1). On the Pennsylvania State University campus, EY, together with Dutch elm disease, has killed 82 of about 400 mature elms since 2007, the year of first EY detection. Candidatus Phytoplasma ulmi, associated with EY, has been reported to be transmitted by the whitebanded elm leafhopper Scaphoideus luteolus Van Duzee, the meadow spittlebug Philaenus spumarius L., and the leafhopper Allygus atomarius Fabricius (1) in North America, but correlation of these insects with EY in the eastern United States has not been reported. Three Cicadellidae collections using sweep nets and aspirators were performed from July to September 2012 on branches of an EY infected red elm (U. rubra Muh; 40°48.408'N, 77°52.208'W) and on vegetation within a 0.5 km radius. The red elm is in close proximity to trees, shrubs, and a managed meadow and has repeatedly tested positive for EY since 2007. During each collection, about 200 cicadellids were captured in BioQuip No-See-Um catch bags with cups, and the bags were hung around the red elm branches, forcing the insects to feed on the infected tree for 24 h. Insects were transferred to BugDorm rearing tents containing wild grasses, elm seedlings, cowpeas, celery, carrots, and basil, all grown from seed, and were kept for 3 weeks in a controlled environment chamber at 28°C and 70% humidity with a 16-h photoperiod. Insects easily recognized in the same species or individual insects of uncertain identity were then isolated for about 1 week in cages each containing one 6-month-old healthy American elm seedling (grown from seed in growth chamber). Up to 10 morphospecies were found in each collection, with 1 to 20 individuals per morphospecies. The total number of unique morphospecies used in the three transmission trials and later identified as different species was 8. Dead insects collected daily were stored in 80% ethanol and later identified to genus or species level. About 70% insect mortality was recorded, but about 60 individuals from each collection survived the change of diet and environment. After 3 months, individual elm seedlings were tested by RT-PCR (3) for the presence of phytoplasmas using universal primers fU5/rU3 (2). PCR products were visualized on 1.5% agarose gel, and if DNA was amplified, it was cloned and sequenced. Three of 30 seedlings tested positive for phytoplasmas and sequencing of the cloned products (24 clones were sequenced per transformation, per each of the three positive seedlings) confirmed that only Ca. P. ulmi was present in the 3 infected seedlings but not in the remaining 27 or in 46 unexposed control seedlings. The 3 seedlings were each exposed to a single insect and the same insects that were used in the transmission trial were identified. One spittlebug (Cercopidae) Lepyronia quadrangularis Say, one P. spumarius, and one leafhopper in the genus Latalus (Cicadellidae: Deltocephalinae) were identified as vectors. The phytoplasma-positive seedlings showed stunting and yellowing, and died shortly after testing. Other insects captured and identified in the survey were A. atomarius, Neophilaenus lineatus L., Metcalfa pruinosa Say, Amblysellus curtisii Fitch and individuals in the genera Draeculacephala, Elymana, Empoasca, Mesamia, Stroggylocephalus, and Ceratagallia. S. luteolus was not captured during this sampling but was captured on yellow sticky traps and in light traps in previous years at other locations on the campus. This is the first report suggesting that L. quadrangularis and Latalus sp. can serve as natural vectors of EY. References: (1) P. Herath et al. Plant Dis. 94:1355, 2010. (2) H. Lorenz et al. Phytopathology 85:771, 1995. (3) P. Margaria et al. Plant Dis. 91:1496, 2007.
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Affiliation(s)
- C Rosa
- Department of Entomology, The Pennsylvania State University, University Park
| | - E McCarthy
- Department of Entomology, The Pennsylvania State University, University Park
| | - K Duong
- Department of Biology, University of Kentucky, Lexington
| | - G Hoover
- Department of Entomology, The Pennsylvania State University, University Park
| | - G Moorman
- Department of Plant Pathology and Environmental Microbiology, The Pennsylvania State University, University Park
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O'Mahony N, McCarthy E, McDermott R, O'Keeffe S. Who's the doctor? Patients' perceptions of the role of the breast radiologist: a lesson for all radiologists. Br J Radiol 2012; 85:e1184-9. [PMID: 22932065 DOI: 10.1259/bjr/74006772] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE The aim of this study was to explore patients' perceptions of the role of the radiologist in their care. METHODS The questionnaire used was designed in conjunction with a psychologist who had an interest in oncology, and piloted. The final questionnaires were distributed to patients attending the breast clinic at St James's Hospital, Dublin, Ireland, from 1 March to 1 July 2011. Patients requiring imaging (mammography and/or ultrasound) were asked to complete the same questionnaire again after imaging procedures were performed. Paired t-tests were used to assess for changes in parameters, including ranking of members of the breast care team in order of perceived importance and levels of anxiety pre and post consultation with the radiologist. RESULTS 306 patients were recruited. 76% of patients thought that radiologists were radiographers and only 14% knew that radiologists were medical doctors. Nearly 40% of patients did not consider that radiologists had a role to play in their care. There was no statistically significant difference in the ranking of team members pre and post consultation. There was a significant improvement in patient anxiety levels after consultation with the breast radiologist, which is likely to be due to the patient learning the outcome of tests performed. CONCLUSION There is a lack of awareness amongst patients and amongst our colleagues in paramedical disciplines regarding the roles and responsibilities of the modern radiologist. ADVANCES IN KNOWLEDGE Radiology must act to increase public awareness so that future changes in the health service will reflect the scope and importance of the speciality.
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Affiliation(s)
- N O'Mahony
- Department of Radiology, St. James's Hospital, Dublin, Ireland.
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Bertisch S, Wells RE, Smith M, McCarthy E. P04.24. Use of relaxation techniques and complementary and alternative medicine by adults with insomnia symptoms: results from a national survey. Altern Ther Health Med 2012. [PMCID: PMC3373607 DOI: 10.1186/1472-6882-12-s1-p294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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McCarthy E, Mahony NO, Guiney M, Ryan JM. Successful catheter directed thrombolysis of IVC and renal vein occlusive thrombus. Ir Med J 2011; 104:311-312. [PMID: 22256445] [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] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Thrombus formation is a recognised complication of IVC filter placement, however IVC and bilateral renal vein occlusion secondary to thrombus is much less common. We present a case of infrahepatic caval and bilateral renal vein occlusion secondary to thrombosis of a suprarenal IVC filter. With progressive clinical deterioration and failure of conservative medical management the patient underwent successful mechanical disruption and catheter directed thrombolysis.
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Affiliation(s)
- E McCarthy
- Department of Radiology, St James's Hospital, Dublin 8.
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Abstract
There is a high rate of co-occurring alcohol dependence (AD) in individuals with posttraumatic stress disorder (PTSD). Cognitive processing therapy (CPT) is an effective treatment for individuals diagnosed with PTSD. CPT-Cognitive (CPT-C) is a modified form of CPT. This case report describes a 12-week course of CPT-C treatment, enhanced to address heavy alcohol use, in a combat veteran with PTSD and co-occurring AD. By treatment end, the veteran demonstrated clinically significant improvement in both PTSD symptoms and alcohol-related problems and sustained these gains 12-weeks posttreatment. The results indicate promise for the use of CPT-C, enhanced for heavy alcohol use, for individuals diagnosed with PTSD and AD.
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McCarthy E, Walsh C. Radiation dose of PET/CT. Ir Med J 2011; 104:93. [PMID: 21667618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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Abstract
Post-traumatic stress disorder (PTSD) is a chronic and disabling psychiatric disorder with an estimated lifetime prevalence of 7.8%. Co-morbid alcohol dependence is a common clinical occurrence with important clinical considerations. For example, in individuals with both PTSD and alcohol dependence, the symptoms of PTSD tend to be more severe, and there is evidence that these individuals are more prone to alcohol use relapse than non-co-morbid individuals. Co-morbidity of PTSD and alcohol dependence is also associated with a higher rate of psychosocial and medical problems and higher utilization of inpatient hospitalization than either disorder alone. This article highlights the epidemiology of alcohol dependence in PTSD and reviews the evidence for effective treatments. Management of these individuals requires an understanding of the epidemiology and an awareness of treatment interventions, which include both psychosocial treatments (e.g. Seeking Safety, Concurrent Treatment of PTSD and Cocaine Dependence, Transcend, Trauma Recovery and Empowerment Model) and pharmacotherapy (e.g. selective serotonin reuptake inhibitors [SSRIs] and topiramate). Effective treatment of co-morbid PTSD and alcohol dependence may include a combination of these psychosocial and pharmacological interventions. The key element seems to be to ensure an adequate intervention for each disorder administered collaboratively.
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Affiliation(s)
- Elissa McCarthy
- VA Connecticut Healthcare System, Newington, Connecticut, USA
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Relf V, Good B, Hanrahan JP, McCarthy E, Forbes AB, deWaal T. Temporal studies on Fasciola hepatica in Galba truncatula in the west of Ireland. Vet Parasitol 2010; 175:287-92. [PMID: 21111536 DOI: 10.1016/j.vetpar.2010.10.010] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2010] [Revised: 09/28/2010] [Accepted: 10/11/2010] [Indexed: 11/18/2022]
Abstract
The population dynamics and prevalence of Fasciola hepatica in Galba truncatula were investigated on the Teagasc hill sheep farm in Country Mayo, Ireland from August 2006 until March 2008. Galba truncatula (n=974) were collected at fortnightly intervals in 4 snail habitats on the farm, their relative density and mean monthly rainfall and temperature were recorded. Snail abundance was associated with rainfall and temperature. G. truncatula abundance was generally low during winter 2006/2007 (December 2006-February 2007), mid spring and summer 2007 (April-July) and late autumn and winter 2007/2008 (October 2007-February 2008). Overall, two peaks in G. truncatula abundance were evident during the study period, an early spring (March) and late summer/autumn (late August-October) peak. Seasonal differences were observed in the prevalence of F. hepatica in G. truncatula, the greatest prevalence was evident in 2007 during the summer (25%) and autumn (16%). Two seasonal transmission peaks, as evident by the presence of mature infections in snails, one in summer/autumn and the other in late winter/early spring. Not unsurprising, cercariae (28%) and rediae (29%) were the predominant developmental stages observed in mature and pre-adult snails respectively. Worthy of note in this study, cercariae were also evident in pre-adult snails. The present study highlights the influence of milder temperatures and wetter conditions on both snail and fluke development. If the trend in mild and wet weather conditions continues, there is the potential for an increase in the number of G. truncatula habitats and ultimately the prevalence of fasciolosis in grazing livestock in Ireland.
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Affiliation(s)
- V Relf
- School of Agriculture, Food Science and Veterinary Medicine, University College Dublin, Ireland
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Marra JV, McCarthy E, Lin HJ, Ford J, Rodis E, Frisman LK. Effects of social support and conflict on parenting among homeless mothers. Am J Orthopsychiatry 2009; 79:348-356. [PMID: 19839672 DOI: 10.1037/a0017241] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Research has shown that having a supportive social network is generally beneficial for individuals, particularly those who are homeless or at risk of homelessness. However, conflict within these networks may diminish the positive effects of social support on well-being, and these effects may be felt acutely within a vulnerable population with multiple needs. This study examined the impact of conflict and social support on parenting behaviors in a sample of mothers who are homeless and were involved in a study of case management interventions of varying intensity. We found that women who reported high emotional and instrumental social support self-reported greater improvements in parenting consistency over time than those who reported lower levels of support. However, three-way interactions showed that conflict in support networks was a risk factor for harsh parenting practices among participants who reported lower levels of instrumental social support. Results suggest that social support may enhance homeless mothers' ability to provide consistent parenting, but that these benefits may be undermined if conflict occurs in combination with limited levels of instrumental social support.
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Affiliation(s)
- Jaime V Marra
- James A. Haley Tampa Veterans Administration Medical Center and Department of Psychology, University of Connecticut, USA.
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McCarthy E, Dandade NA, Bennett CL. Veterans with prostate cancer talking about life experiences (VA T.A.L.E.S.)—A pilot study. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.16124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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McCarthy E, Brennan PC. Viewing conditions for diagnostic images in three major Dublin hospitals: a comparison with WHO and CEC recommendations. Br J Radiol 2003; 76:94-7. [PMID: 12642276 DOI: 10.1259/bjr/92036272] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Accurate interpretation of X-ray images is dependent on image viewing conditions. A recent study in Ireland demonstrated that even with the advent of digital departments the majority of images are still viewed using viewing boxes. This investigation aimed to measure average viewing box brightness, percentage uniformity and ambient light levels in radiology and radiographer viewing areas and wards within three major Dublin hospitals. The results were compared with published recommendations by the World Health Organization and Commission of the European Communities. Following analysis of more than 4650 measurements, it was shown that mean values for average viewing box brightness for all departments failed to achieve recommended levels. Only one third of areas met the most lenient guideline for percentage uniformity. Ambient lighting was shown to be unacceptable for ward areas. For all three parameters, radiology areas generally fared best, with wards gaining the poorest scores. Following a 3 min cleaning regimen of viewing boxes, the average brightness and percentage uniformity were improved in 100% and 80%, respectively, of viewing boxes, but average brightness values remained below recommended levels. The importance of comprehensive quality assurance programmes for viewing boxes has been highlighted so that visualization of images is not reduced to sub-optimal levels. The need for consistent and more informative recommendations has been emphasized.
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Affiliation(s)
- E McCarthy
- UCD School of Diagnostic Imaging, Herbert Avenue, Dublin 4, Ireland
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McCarthy E, Tarrier N, Gregg L. The nature and timing of seasonal affective symptoms and the influence of self-esteem and social support: a longitudinal prospective study. Psychol Med 2002; 32:1425-1434. [PMID: 12455941 DOI: 10.1017/s0033291702006621] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [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: 11/06/2022]
Abstract
BACKGROUND Seasonal affective disorder (SAD) is characterized by recurrent episodes of depression occurring regularly with the onset of winter. METHOD The study was a prospective naturalistic follow-up of the emergence of symptoms of seasonal depression with the passage of time and change in seasons. Participants were screened during summer for SAD. Participants were excluded if they were depressed (BDI > 14) during the summer reruitment. Eligible participants prospectively monitored their mood and anxiety by completing the BDI and BAI every 2 weeks from 1 September through to the 31 March. RESULTS Forty-five participants met criterion for SAD were included in the final data analyses. Depression scores rose gradually over the 30 week period reaching a peak median score around weeks 22 to 24 (January-February). The 'hallmark' physiological symptoms (changes in sleep, appetite and fatigue) emerged earlier in the winter period than cognitive symptoms. The emergence of anxiety symptoms was highly correlated with depressive symptoms, although the median anxiety scores did not reach a clinically significant level. Low self-esteem and poor perceived social support were significantly related to an earlier onset in the emergence of depressive symptoms. Both these factors together resulted in the speediest onset of depression. Poor perceived social support, but not low self-esteem, was associated with earlier emergence of anxiety symptoms. CONCLUSIONS Physiological symptoms may activate negative cognitions in individuals with risk factors of low self-esteem and poor social support so that the disorder is precipitated earlier and is of longer duration.
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Affiliation(s)
- E McCarthy
- Academic Division of Clinical Psychology, School of Psychiatry and Behavioural Sciences, University of Manchester
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Tyler W, Barrett T, Frassica F, McCarthy E. Skin metastasis from conventional giant cell tumor of bone: conceptual significance. Skeletal Radiol 2002; 31:166-70. [PMID: 11935202 DOI: 10.1007/s00256-001-0455-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [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] [Received: 09/18/2001] [Revised: 09/28/2001] [Accepted: 10/31/2001] [Indexed: 02/02/2023]
Abstract
A conventional giant cell tumor of the proximal femur recurred twice locally and developed pulmonary nodules. The lung lesions were felt to be an example of "benign" metastases. Eight months after the initial presentation, the patient developed a single skin nodule on the contralateral leg. Histologic features of the skin nodule showed conventional giant cell tumor identical to the bone lesion. This nodule is a manifestation of arterial metastasis typical of any malignant tumor and seemingly contradicts the concept of "benign" metastasis.
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Affiliation(s)
- W Tyler
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Abstract
Reliability and concurrent validity of the Movement Assessment Battery for Children were evaluated with a sample of 106 boys and girls, distributed into four age groups: 5-6 yr. (n = 20), 7-8 yr. (n = 20), 9-10 yr. (n = 46), and 11-12 yr. (n = 20). Test-retest reliability of the Movement Assessment Battery for Children, estimated using intraclass correlation coefficients, was high across all age groups, and concurrent validity yielded moderate Pearson correlation coefficients between the Move ment battery and long and short forms of the Bruininks-Oseretsky Test of Motor Proficiency. These results support the use of the Movement battery as a measure of motor ability in children, ages 5 to 12 years.
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Affiliation(s)
- R V Croce
- Department of Kinesiology, University of New Hampshire, Durham 03824, USA.
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Abstract
The purpose of this study was to prefabricate a new combined composite (chimeric) flap that consists of four different tissues. The tissues were prefabricated around two independent pedicles that ultimately join as a single main pedicle. In the inguinal area of 36 rats, the saphenous and the superficial inferior epigastric (SIE) pedicles were dissected and prepared as vascular carriers. A fascial graft and a local muscle flap were wrapped around the saphenous pedicle. The SIE pedicle was then implanted under the abdominal skin to supply a future skin flap. An ear cartilage graft was also inserted under the abdominal skin and adjacent to the implanted SIE pedicle. After allowing 2-, 4-, 6-, and 12-week prefabrication periods in different groups of nine animals, the prefabricated tissues were raised around two pedicles nourished by the femoral pedicle and then transferred. Flap survival was assessed by observation, microangiography and histology. The skin flaps showed survival rates of 52 +/- 17% (mean +/- standard error of the mean), 64 +/- 16%, 86 +/- 11%, and 100 +/- 0% of the total areas in the 2-, 4-, 6-, and 12-week prefabricated flaps respectively. None of the control grafts that were prepared on the contralateral side survived totally. A significant difference was found between the 12- and 2-week (p < 0.008), 12- and 4-week (p < 0.02), and 6- and 2-week (p < 0.05) prefabrication groups. Histologically, fascial and cartilage grafts, and portions of muscle were viable in the 2- and 4-week groups. Also, noticeable necrosis was found in the skin flaps in these groups. The muscle showed mild (at 2, 4, and 6 weeks) and moderate (at 12 weeks) atrophy. After prefabrication for 6 weeks, all tissues demonstrated good survival. This study shows that a combined composite flap can be prefabricated successfully in rats after a 6-week period of prefabrication.
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Affiliation(s)
- A Atabey
- The Johns Hopkins University, School of Medicine, Division of Plastic, Reconstructive and Maxillofacial Surgery, Baltimore, MD, USA
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Tarrier N, Kinney C, McCarthy E, Humphreys L, Wittkowski A, Morris J. Two-year follow-up of cognitive--behavioral therapy and supportive counseling in the treatment of persistent symptoms in chronic schizophrenia. J Consult Clin Psychol 2000; 68:917-22. [PMID: 11068978] [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: 02/18/2023]
Abstract
The article reports the 2-year follow-up of patients suffering persistent symptoms of schizophrenia who entered a single blind randomized controlled trial. Patients were randomly allocated to cognitive-behavioral therapy (CBT) plus routine care (RC), supportive counseling (SC) plus RC, or RC alone. Treatment took place over 3 months, and follow-up was made 12 and 24 months after treatment finished. Sixty-one patients were available to the 2-year follow-up and assessed for positive and negative symptoms and clinical improvement; all of the 87 patients who entered the trial were assessed for relapse over the follow-up period. On all measures, patients who received RC alone did significantly worse at 2 years. There were no significant differences at 2 years between the CBT and SC groups.
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Affiliation(s)
- N Tarrier
- Academic Division of Clinical Psychology, University of Manchester, United Kingdom.
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Tarrier N, Wittkowski A, Kinney C, McCarthy E, Morris J, Humphreys L. Durability of the effects of cognitive-behavioural therapy in the treatment of chronic schizophrenia: 12-month follow-up. Br J Psychiatry 1999; 174:500-4. [PMID: 10616627 DOI: 10.1192/bjp.174.6.500] [Citation(s) in RCA: 117] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Persistent drug-resistant psychotic symptoms are a pervasive problem in the treatment of schizophrenia. AIMS To evaluate the durability of the treatment effects of cognitive-behavioural therapy for chronic schizophrenia one year after treatment termination. METHOD A comparison of clinical outcomes was made at one-year follow-up from a randomised trial of cognitive-behavioural therapy, supportive counselling and routine care alone in the treatment of chronic schizophrenia. RESULTS Seventy out of the 72 patients (97%) who completed treatment were assessed at follow-up. There were significant differences between the three groups when positive and negative symptoms were analysed by means of ANCOVAs. Between-group comparisons indicated significant differences between cognitive-behavioural therapy and routine care at follow-up for positive symptoms. There was a trend towards significance for both cognitive-behavioural therapy and supportive counselling to be superior to routine care alone on negative symptoms. CONCLUSIONS At 12-month follow-up the significant advantage of cognitive-behavioural therapy compared to routine care alone remained.
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Affiliation(s)
- N Tarrier
- Department of Clinical Psychology, School of Psychiatry and Behavioural Science, University of Manchester.
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Abstract
A liveborn and subsequently thriving child was delivered abdominally from a pregnancy in a rudimentary noncommunicating uterine horn. This is the 13th English language report of neonatal survival from such an unusual and life-threatening situation. The case presents some 'clues' in the history and a review of the literature suggests that the previously reported bleak outlook for these pregnancies can now be tempered with cautious optimism. Ultrasound diagnosis of Müllerian abnormalities during pregnancy remains difficult but has been reported in several other cases in the literature and may become more common in the future.
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Affiliation(s)
- E McCarthy
- Department of Obstetrics and Gynaecology, Monash Medical Centre, Victoria
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Sellwood W, Thomas CS, Tarrier N, Jones S, Clewes J, James A, Welford M, Palmer J, McCarthy E. A randomised controlled trial of home-based rehabilitation versus outpatient-based rehabilitation for patients suffering from chronic schizophrenia. Soc Psychiatry Psychiatr Epidemiol 1999; 34:250-3. [PMID: 10396166 DOI: 10.1007/s001270050140] [Citation(s) in RCA: 10] [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: 10/28/2022]
Abstract
BACKGROUND Outpatient-based treatments for patients suffering from chronic schizophrenia inadvertently exclude a significant proportion of subjects because they are often too poorly motivated to attend for treatment. In addition there are also concerns about whether the skills that are learnt in a hospital setting will generalize to situations when the individuals are at home. This study attempted to redress some of these potential deficiencies and followed on from an earlier local study which found that a community-based team met more of the needs of patients suffering from chronic schizophrenia. METHOD Seventy-five patients suffering from chronic schizophrenia were allocated randomly to receive traditional outpatient-based or home-based rehabilitation from a clinical psychologist and an occupational therapist. They were assessed before and after 9 months of treatment on a range of clinical, social and quality of life outcomes. Distress to carers was also assessed. Readmission to hospital was recorded for each subject. RESULTS There were significant reductions in socially embarrassing behaviour (SBS), increases in interpersonal functioning and recreational activities and a trend for quality of life to improve in the home-based group. There were fewer admissions in the home-based group but the differences, although financially substantial, were not statistically significant. CONCLUSIONS The home-based rehabilitation service was well received by the majority of patients suffering from chronic schizophrenia and led to some improvement in social behaviour, interpersonal functioning, recreational activities and quality of life.
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Affiliation(s)
- W Sellwood
- Department of Psychiatry, University Hospital of South Manchester, UK
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McCarthy E. European and Irish paediatric services. Ir Med J 1999; 92:311. [PMID: 10394760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
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Affiliation(s)
- M A Bhimani
- Department of Orthopaedic Surgery, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA
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Perry A, Tarrier N, Morriss R, McCarthy E, Limb K. Randomised controlled trial of efficacy of teaching patients with bipolar disorder to identify early symptoms of relapse and obtain treatment. BMJ 1999; 318:149-53. [PMID: 9888904 PMCID: PMC27688 DOI: 10.1136/bmj.318.7177.149] [Citation(s) in RCA: 297] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To determine the efficacy of teaching patients with bipolar disorder (manic-depressive psychosis) to identify early symptoms of relapse and seek prompt treatment from health services. DESIGN Single blind randomised controlled trial with matching on four baseline variables using a minimisation algorithm. SETTING Mental health services in four NHS trusts (one teaching, three non-teaching). SUBJECTS 69 patients with bipolar disorder who had had a relapse in the previous 12 months. INTERVENTIONS Seven to 12 individual treatment sessions from a research psychologist plus routine care or routine care alone. MAIN OUTCOME MEASURES Time to first manic or depressive relapse, number of manic or depressive relapses, and social functioning examined by standardised interviews every six months for 18 months. RESULTS 25th centile time to first manic relapse in experimental group was 65 weeks compared with 17 weeks in the control group. Event curves of time to first manic relapse significantly differed between experimental and control groups (log rank 7.04, df=1, P=0.008), with significant reductions in the number of manic relapses over 18 months (median difference 30% (95% confidence interval 8% to 52%), P=0.013). The experimental treatment had no effect on time to first relapse or number of relapses with depression, but it significantly improved overall social functioning (mean difference 2.0 (0.7 to 3.2), P=0.003) and employment (mean difference 0.7 (0.1 to 1.3), P=0.030) by 18 months. CONCLUSION Teaching patients to recognise early symptoms of manic relapse and seek early treatment is associated with important clinical improvements in time to first manic relapse, social functioning, and employment.
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Affiliation(s)
- A Perry
- Department of Clinical Psychology, University of Manchester, Withington Hospital, Manchester M20 8LR
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