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Sheitman A, Bello I, Montague E, Scodes J, Dambreville R, Wall M, Nossel I, Dixon L. Observed Trajectories of Cannabis Use and Concurrent Longitudinal Outcomes in Youth and Young Adults Receiving Coordinated Specialty Care for Early Psychosis. Schizophr Res 2024; 267:313-321. [PMID: 38608418 DOI: 10.1016/j.schres.2024.04.005] [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: 09/27/2023] [Revised: 01/31/2024] [Accepted: 04/01/2024] [Indexed: 04/14/2024]
Abstract
Cannabis use is present and persistent in young adults with early psychosis receiving Coordinated Specialty Care (CSC) in the United States. While CSC programs are effective in improving quality of life, helping individuals reach goals, and promoting recovery, cannabis use may limit the extent of these improvements. This study extended upon previous findings to examine trajectories of cannabis use among individuals with early psychosis. The sample consisted of 1325 CSC participants enrolled for more than one year at OnTrackNY and followed up to two years, categorized into three groups: no use, reduced use, and persistent use. Baseline demographic and clinical differences were compared across groups and associations between clinical and psychosocial outcomes at 12 months and 24 months were examined across groups. Of the sample, 40 % remained persistent users over two years while 12.8 % reduced their use. At baseline, persistent users were younger (p = 0.011), more likely to be male (p < 0.001), had lower education levels (p = 0.019), and were more likely to have had past legal issues prior to admission (p < 0.001) than non-users. At 2 years, persistent users had significantly worse symptom scores than non-users (p = 0.0003) and reduced users (p = 0.0004). These findings highlight the presence of persistent cannabis use being common in this population and the need to improve substance use treatment offered to allow more CSC participants to achieve improved outcomes.
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Affiliation(s)
- A Sheitman
- New York State Psychiatric Institute, 1051 Riverside Drive, New York 10032, NY, USA.
| | - I Bello
- New York State Psychiatric Institute, 1051 Riverside Drive, New York 10032, NY, USA; Department of Psychiatry, Columbia University Irving Medical Center, 1051 Riverside Drive, New York, NY 10032, USA
| | - E Montague
- Zucker Hillside Hospital, Northwell Health, 75-59 263rd St, Queens, NY 11004, USA
| | - J Scodes
- New York State Psychiatric Institute, 1051 Riverside Drive, New York 10032, NY, USA
| | - R Dambreville
- New York State Psychiatric Institute, 1051 Riverside Drive, New York 10032, NY, USA
| | - M Wall
- New York State Psychiatric Institute, 1051 Riverside Drive, New York 10032, NY, USA; Department of Psychiatry, Columbia University Irving Medical Center, 1051 Riverside Drive, New York, NY 10032, USA
| | - I Nossel
- New York State Psychiatric Institute, 1051 Riverside Drive, New York 10032, NY, USA; Department of Psychiatry, Columbia University Irving Medical Center, 1051 Riverside Drive, New York, NY 10032, USA
| | - L Dixon
- New York State Psychiatric Institute, 1051 Riverside Drive, New York 10032, NY, USA; Department of Psychiatry, Columbia University Irving Medical Center, 1051 Riverside Drive, New York, NY 10032, USA
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Shulman M, Choo TH, Scodes J, Pavlicova M, Novo P, Campbell ANC, Greiner M, Lee JD, Rotrosen J, Nunes EV. Secondary Analysis of Agreement Between Negative Timeline Follow Back Report and Negative Urine Toxicology in a Large Trial of Individuals with Opioid Use Disorder. J Addict Med 2023; 17:618-620. [PMID: 37788622 PMCID: PMC10593984 DOI: 10.1097/adm.0000000000001173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
OBJECTIVES Timeline follow-back (TLFB) is a self-report measure commonly used as a method of assessing historical drug use in both clinical and research settings. Our study considered rates of agreement between TLFB and an objective biological assay of opioid use. METHODS We calculated the rates of agreement between negative report of opioid use for the most recent 8 days on TLFB and urine toxicology (UTOX) results in a large multisite opioid use disorder treatment trial. RESULTS In total, 3986 assessments were provided by trial participants with both UTOX and TLFB during weeks 1 to 12, 2716 during weeks 13 to 24, and 325 at week 28. Rates of disagreement between negative TLFB and positive opioid UTOX were 2.33% of all assessments (21.68% of those with positive UTOX) over weeks 1 to 12, 2.06% of all assessment (25.00% of those with positive UTOX) over weeks 13 to 24, and 9.85% of all assessments (26.02% of those with positive UTOX) at week 28. CONCLUSIONS Negative TLFB seems to be generally associated with negative results on urine toxicology.
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Affiliation(s)
- Matisyahu Shulman
- New York State Psychiatric Institute
- Department of Psychiatry, Columbia University Medical Center
| | | | | | - Martina Pavlicova
- Department of Biostatistics, Mailman School of Public Health, Columbia University
| | - Patricia Novo
- Department of Population Health, New York University
| | - Aimee NC Campbell
- New York State Psychiatric Institute
- Department of Psychiatry, Columbia University Medical Center
| | - Miranda Greiner
- New York State Psychiatric Institute
- Department of Psychiatry, Columbia University Medical Center
| | - Joshua D Lee
- Department of Population Health, New York University
| | - John Rotrosen
- Department of Psychiatry, New York University School of Medicine
| | - Edward V Nunes
- New York State Psychiatric Institute
- Department of Psychiatry, Columbia University Medical Center
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Gruenewald T, Seeman TE, Choo TH, Scodes J, Snyder C, Pavlicova M, Weinstein M, Schwartz JE, Mukkamala R, Sloan RP. Cardiovascular variability, sociodemographics, and biomarkers of disease: the MIDUS study. Front Physiol 2023; 14:1234427. [PMID: 37693005 PMCID: PMC10484414 DOI: 10.3389/fphys.2023.1234427] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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] [Received: 06/07/2023] [Accepted: 08/09/2023] [Indexed: 09/12/2023] Open
Abstract
Introduction: Like heart rate, blood pressure (BP) is not steady but varies over intervals as long as months to as short as consecutive cardiac cycles. This blood pressure variability (BPV) consists of regularly occurring oscillations as well as less well-organized changes and typically is computed as the standard deviation of multiple clinic visit-to-visit (VVV-BP) measures or from 24-h ambulatory BP recordings (ABPV). BP also varies on a beat-to-beat basis, quantified by methods that parse variation into discrete bins, e.g., low frequency (0.04-0.15 Hz, LF). However, beat-to-beat BPV requires continuous recordings that are not easily acquired. As a result, we know little about the relationship between LF-BPV and basic sociodemographic characteristics such as age, sex, and race and clinical conditions. Methods: We computed LF-BPV during an 11-min resting period in 2,118 participants in the Midlife in the US (MIDUS) study. Results: LF-BPV was negatively associated with age, greater in men than women, and unrelated to race or socioeconomic status. It was greater in participants with hypertension but unrelated to hyperlipidemia, hypertriglyceridemia, diabetes, elevated CRP, or obesity. LF-diastolic BPV (DBPV), but not-systolic BPV (SBPV), was negatively correlated with IL-6 and s-ICAM and positively correlated with urinary epinephrine and cortisol. Finally, LF-DBPV was negatively associated with mortality, an effect was rendered nonsignificant by adjustment by age but not other sociodemographic characteristics. Discussion: These findings, the first from a large, national sample, suggest that LF-BPV differs significantly from VVV-BP and ABPV. Confirming its relationship to sociodemographic risk factors and clinical outcomes requires further study with large and representative samples.
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Affiliation(s)
- Tara Gruenewald
- Department of Psychology, Chapman University, Orange, CA, United States
| | - Teresa E. Seeman
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States
| | - Tse-Hwei Choo
- Mental Health Data Science Division, New York State Psychiatric Institute, New York, NY, United States
| | - Jennifer Scodes
- Mental Health Data Science Division, New York State Psychiatric Institute, New York, NY, United States
| | - Clayton Snyder
- Mental Health Data Science Division, New York State Psychiatric Institute, New York, NY, United States
| | - Martina Pavlicova
- Department of Biostatistics, Mailman School of Public Health, Columbia University Irving Medical Center, New York, NY, United States
| | | | - Joseph E. Schwartz
- Renaissance School of Medicine, Stony Brook University, New York, NY, United States
- Department of Medicine, Columbia University Irving Medical Center, New York, NY, United States
| | - Ramakrishna Mukkamala
- Swanson School of Engineering, University of Pittsburgh, Pittsburgh, PA, United States
| | - Richard P. Sloan
- Division of Behavioral Medicine, Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, United States
- New York State Psychiatric Institute, New York, NY, United States
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Justen M, Scodes J, Pavlicova M, Choo TH, Gopaldas M, Haeny A, Opara O, Rhee TG, Rotrosen J, Nunes EV, Hawk K, Edelman EJ. Homelessness and Treatment Outcomes Among Black Adults With Opioid Use Disorder: A Secondary Analysis of X:BOT. J Addict Med 2023; 17:463-467. [PMID: 37579110 PMCID: PMC10323031 DOI: 10.1097/adm.0000000000001125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE We sought to identify the sociodemographic and clinical characteristics associated with homelessnesss, and explore the relationship between homelessnesss and treatment outcomes among Black individuals. METHODS This is a secondary analysis of the subgroup of Black participants (n = 73) enrolled in "X:BOT," a 24-week multisite randomized clinical trial comparing the effectiveness of extended-release naltrexone versus sublingual buprenorphine-naloxone (n = 570). Outcomes included medication initiation, return to extramedical use of opioids assessed by both self-report and urine toxicology, and engagement in medications for opioid use disorder (MOUD) treatment at 28 weeks postrandomization. Descriptive statistics were performed. RESULTS Black participants were mostly unmarried and male, and about a third were aged 21-30 years. Among people experiencing homelessnesss, more were uninsured (45.5% [10/22] vs 19.6% [10/51]), unemployed (77.3% [17/22] vs 64.7% [33/51]), and reported alcohol (40.9% [9/22] vs 23.5% [12/51]) and sedative use (54.5% [12/22] vs 17.6% [9/51]) within the previous 30 days. Compared with housed Black individuals, a slightly higher proportion of Black individuals experiencing homelessnesss successfully initiated study medication (81.1% [18/22] vs 72.6% [37/51]); similar proportions returned to opioid use during the trial (68.2% [15/22] vs 68.6% [35/51]) and were engaged in MOUD at 28 weeks after trial entry (72.2% [13/18] vs 69.7% [23/33]) among participants located for follow-up. CONCLUSIONS These descriptive results among Black patients participating in a trial of MOUD suggest that efficacious MOUD is possible despite homelessnesss with additional clinical supports such as those provided by a clinical trial.
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Affiliation(s)
| | - Jennifer Scodes
- Department of Biostatistics, Brown University, Providence, RI, 02912, USA
- New York Psychiatric Institute, New York, NY, 10032, USA
| | - Martina Pavlicova
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, 10032, USA
| | - Tse-Hwei Choo
- Division of Mental Health Data Science, New York State Psychiatric Institute, New York, NY, 10032, USA
| | - Manesh Gopaldas
- New York State Psychiatric Institute, New York, NY, 10032, USA
- Columbia Irving Medical Center, New York, NY, 10032, USA
| | - Angela Haeny
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, 06510
| | - Onumara Opara
- New York State Psychiatric Institute, New York, NY, 10032, USA
| | - Taeho Greg Rhee
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, 06510
- VA New England Mental Illness, Research, Education and Clinical Center (MIRECC), VA Connecticut Healthcare System, West Haven, CT, 06516, USA
| | - John Rotrosen
- NYU Grossman School of Medicine, New York, NY, 10016, USA
| | - Edward V. Nunes
- New York State Psychiatric Institute, New York, NY, 10032, USA
- Columbia Irving Medical Center, New York, NY, 10032, USA
| | - Kathryn Hawk
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, 06510, USA
- Yale School of Public Health, New Haven, CT, 06510, USA
- Program in Addiction Medicine, Yale School of Medicine, New Haven, CT, 06510
| | - E. Jennifer Edelman
- Yale School of Public Health, New Haven, CT, 06510, USA
- Program in Addiction Medicine, Yale School of Medicine, New Haven, CT, 06510
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, 06510
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Tyler Rogers R, Marino L, Scodes J, Wall M, Nossel I, Dixon L. Prevalance and course of tobacco use among individuals receiving coordinated specialty care for first-episode psychosis. Early Interv Psychiatry 2023; 17:192-201. [PMID: 35751414 PMCID: PMC9789203 DOI: 10.1111/eip.13320] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Revised: 04/18/2022] [Accepted: 05/29/2022] [Indexed: 01/24/2023]
Abstract
AIM Tobacco use is decreasing among the general population, but persistent use among individuals in treatment for first-episode psychosis (FEP) remains a problem. This study aimed to measure the prevalence and course of tobacco use and explore the associations between tobacco use and clinical outcomes in a FEP sample located in New York State (NYS). METHODS Participants (N = 870) were from the OnTrackNY system of coordinated specialty care clinics in NYS. Participant data were collected at admission to the program and at every 3 months of follow-up using standardized forms based on reports from clients, client families and chart review. Course of tobacco use was categorized into four groups: no-use, cessation, persistent and initiation over 1 year of follow-up. RESULTS The prevalence of tobacco use was 12.8% at baseline and 19.9% at 1-year follow-up. Only 3.8% of tobacco users stopped by 1 year follow-up, and 4.9% initiated use. Urbanicity of clinic location (p < .001); age at admission (p = .044); gender (p = .015); ethnoracial group (p = .007); baseline education/employment status (p = .004); and baseline use of any non-tobacco substances (p < .001), including alcohol (p < .001) and cannabis (p < .001), were associated with tobacco course. Findings suggest an association between tobacco use and reduced improvement in symptoms. CONCLUSION Despite a lower prevalence of tobacco use among OnTrack participants than in other comparable samples, tobacco cessation was minimal and more individuals initiated tobacco use than ceased over the course of follow-up. Efforts to implement tobacco cessation interventions in coordinated specialty care are warranted, since tobacco use is associated with poor health outcomes.
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Affiliation(s)
- R. Tyler Rogers
- New York State Psychiatric Institute, New York, NY, 1051 Riverside Drive, New York, NY, USA 10032
| | - Leslie Marino
- New York State Psychiatric Institute, New York, NY, 1051 Riverside Drive, New York, NY, USA 10032
- Department of Psychiatry, Columbia University Irving Medical Center, 1051 Riverside Drive, New York, NY, USA 10032
| | - Jennifer Scodes
- New York State Psychiatric Institute, New York, NY, 1051 Riverside Drive, New York, NY, USA 10032
| | - Melanie Wall
- New York State Psychiatric Institute, New York, NY, 1051 Riverside Drive, New York, NY, USA 10032
- Department of Psychiatry, Columbia University Irving Medical Center, 1051 Riverside Drive, New York, NY, USA 10032
| | - Ilana Nossel
- New York State Psychiatric Institute, New York, NY, 1051 Riverside Drive, New York, NY, USA 10032
- Department of Psychiatry, Columbia University Irving Medical Center, 1051 Riverside Drive, New York, NY, USA 10032
| | - Lisa Dixon
- New York State Psychiatric Institute, New York, NY, 1051 Riverside Drive, New York, NY, USA 10032
- Department of Psychiatry, Columbia University Irving Medical Center, 1051 Riverside Drive, New York, NY, USA 10032
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Hefner K, Choo TH, Shmueli-Blumberg D, Pavlicova M, King J, Fishman M, Shulman M, Campbell A, Greiner M, Scodes J, Meyers-Ohki S, Novo P, Nunes E, Rotrosen J. Time-lagged association between counseling and/or 12-Step attendance with subsequent opioid use in a secondary analysis from a randomized, clinical trial of medications for opioid use disorder. Drug Alcohol Depend Rep 2022; 5:100100. [PMID: 36644220 PMCID: PMC9838184 DOI: 10.1016/j.dadr.2022.100100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 09/16/2022] [Accepted: 09/26/2022] [Indexed: 01/19/2023]
Abstract
Introduction Psychosocial support is recommended in conjunction with medication for opioid use disorder (MOUD), although optimal "dose," modality, and timing of participation is not established. This study comprised a secondary analysis of counseling and 12-Step attendance and subsequent opioid use in a MOUD randomized clinical trial. Methods The parent study randomly assigned 570 participants to receive buprenorphine-naloxone (BUP-NX, n=287) or extended-release injectable naltrexone (XR-NTX, n=283). Mixed-effects logistic regression models were fit with opioid use as the response variable, and a counseling/12-Step attendance predictor. Differences by treatment assignment were examined. Results Any counseling or 12-Step attendance was associated with reduced odds of opioid use at the subsequent visit, whether considered individually or aggregated across type. A continuous relationship was observed for 12-Step attendance (F(1,5083)=5.01, p=.025); with each additional hour associated with 13% (95% CI: 0.83, 0.90) reduction in odds of opioid use. The strength of this association grew over time. In the BUP-NX arm, group counseling was associated with a greater reduction in odds of opioid use than for XR-NTX, (OR=0.32 (95% CI: .22, 0.48) vs. OR=0.69 (95% CI: 0.43, 1.08)). For XR-NTX, 12-Step was associated with a greater reduction in odds of opioid use (OR=0.35 (95% CI: 0.22, 0.54) vs. OR=0.65 (95% CI: 0.47, 0.89) for BUP-NX)). Conclusions Psychosocial engagement has a proximal association with opioid use, the strength of that association may grow with dose and time. Alternatively, more motivated individuals may both attend more counseling/12-Step and have better treatment outcomes, or the relationship may be reciprocal.
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Affiliation(s)
- Kathryn Hefner
- NIDA Data and Statistics Center for the NIDA CTN, The Emmes Company, LLC, 401 N Washington St, Rockville, MD 20850, United States
| | - Tse-Hwei Choo
- Department of Psychiatry, Columbia University, United States
| | - Dikla Shmueli-Blumberg
- NIDA Data and Statistics Center for the NIDA CTN, The Emmes Company, LLC, 401 N Washington St, Rockville, MD 20850, United States
| | - Martina Pavlicova
- Department of Biostatistics, Mailman School of Public Health, Columbia University, United States
| | - Jacquie King
- NIDA Data and Statistics Center for the NIDA CTN, The Emmes Company, LLC, 401 N Washington St, Rockville, MD 20850, United States
| | | | - Matisyahu Shulman
- Department of Psychiatry, Columbia University, United States
- New York State Psychiatric Institute, United States
| | - Aimee Campbell
- Department of Psychiatry, Columbia University, United States
- New York State Psychiatric Institute, United States
| | - Miranda Greiner
- Department of Psychiatry, Columbia University, United States
- New York State Psychiatric Institute, United States
| | - Jennifer Scodes
- Department of Psychiatry, Columbia University, United States
- New York State Psychiatric Institute, United States
| | | | - Patricia Novo
- New York University Grossman School of Medicine, United States
| | - Edward Nunes
- Department of Psychiatry, Columbia University, United States
- New York State Psychiatric Institute, United States
| | - John Rotrosen
- New York University Grossman School of Medicine, United States
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Hasin DS, Shmulewitz D, Stohl M, Greenstein E, Aharonovich E, Petronis KR, Von Korff M, Datta S, Sonty N, Ross S, Inturrisi C, Weinberger ML, Scodes J, Wall MM. Diagnosing Prescription Opioid Use Disorder in Patients Using Prescribed Opioids for Chronic Pain. Am J Psychiatry 2022; 179:715-725. [PMID: 35702830 DOI: 10.1176/appi.ajp.21070721] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE The diagnostic criteria for opioid use disorder, originally developed for heroin, did not anticipate the surge in prescription opioid use and the resulting complexities in diagnosing prescription opioid use disorder (POUD), including differentiation of pain relief (therapeutic intent) from more common drug use motives, such as to get high or to cope with negative affect. The authors examined the validity of the Psychiatric Research Interview for Substance and Mental Disorders, DSM-5 opioid version, an instrument designed to make this differentiation. METHODS Patients (N=606) from pain clinics and inpatient substance treatment who ever received a ≥30-day opioid prescription for chronic pain were evaluated for DSM-5 POUD (i.e., withdrawal and tolerance were not considered positive if patients used opioids only as prescribed, per DSM-5 guidelines) and pain-adjusted POUD (behavioral/subjective criteria were not considered positive if pain relief [therapeutic intent] was the sole motive). Bivariate correlated-outcome regression models indicated associations of 10 validators with DSM-5 and pain-adjusted POUD measures, using mean ratios for dimensional measures and odds ratios for binary measures. RESULTS The prevalences of DSM-5 and pain-adjusted POUD, respectively, were 44.4% and 30.4% at the ≥2-criteria threshold and 29.5% and 25.3% at the ≥4-criteria threshold. Pain adjustment had little effect on prevalence among substance treatment patients but resulted in substantially lower prevalence among pain treatment patients. All validators had significantly stronger associations with pain-adjusted than with DSM-5 dimensional POUD measures (ratios of mean ratios, 1.22-2.31). For most validators, pain-adjusted binary POUD had larger odds ratios than DSM-5 measures. CONCLUSIONS Adapting POUD measures for pain relief (therapeutic intent) improved validity. Studies should investigate the clinical utility of differentiating between therapeutic and nontherapeutic intent in evaluating POUD diagnostic criteria.
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Affiliation(s)
- Deborah S Hasin
- Department of Psychiatry, Columbia University Medical Center (Hasin, Shmulewitz, Aharonovich, Scodes, Wall) and New York State Psychiatric Institute (Hasin, Shmulewitz, Stohl, Greenstein, Aharonovich, Scodes, Wall), New York; Epidemiology, Pfizer, Inc., New York (Petronis); Kaiser Permanente Washington Health Research Institute, Seattle (Von Korff); Department of Anesthesiology, Rutgers University, Newark, N.J. (Datta); Department of Anesthesiology, Columbia University Medical Center, New York (Sonty, Weinberger); Department of Psychiatry, New York University, New York (Ross); Cornell University Medical College, New York (Inturrisi)
| | - Dvora Shmulewitz
- Department of Psychiatry, Columbia University Medical Center (Hasin, Shmulewitz, Aharonovich, Scodes, Wall) and New York State Psychiatric Institute (Hasin, Shmulewitz, Stohl, Greenstein, Aharonovich, Scodes, Wall), New York; Epidemiology, Pfizer, Inc., New York (Petronis); Kaiser Permanente Washington Health Research Institute, Seattle (Von Korff); Department of Anesthesiology, Rutgers University, Newark, N.J. (Datta); Department of Anesthesiology, Columbia University Medical Center, New York (Sonty, Weinberger); Department of Psychiatry, New York University, New York (Ross); Cornell University Medical College, New York (Inturrisi)
| | - Malka Stohl
- Department of Psychiatry, Columbia University Medical Center (Hasin, Shmulewitz, Aharonovich, Scodes, Wall) and New York State Psychiatric Institute (Hasin, Shmulewitz, Stohl, Greenstein, Aharonovich, Scodes, Wall), New York; Epidemiology, Pfizer, Inc., New York (Petronis); Kaiser Permanente Washington Health Research Institute, Seattle (Von Korff); Department of Anesthesiology, Rutgers University, Newark, N.J. (Datta); Department of Anesthesiology, Columbia University Medical Center, New York (Sonty, Weinberger); Department of Psychiatry, New York University, New York (Ross); Cornell University Medical College, New York (Inturrisi)
| | - Eliana Greenstein
- Department of Psychiatry, Columbia University Medical Center (Hasin, Shmulewitz, Aharonovich, Scodes, Wall) and New York State Psychiatric Institute (Hasin, Shmulewitz, Stohl, Greenstein, Aharonovich, Scodes, Wall), New York; Epidemiology, Pfizer, Inc., New York (Petronis); Kaiser Permanente Washington Health Research Institute, Seattle (Von Korff); Department of Anesthesiology, Rutgers University, Newark, N.J. (Datta); Department of Anesthesiology, Columbia University Medical Center, New York (Sonty, Weinberger); Department of Psychiatry, New York University, New York (Ross); Cornell University Medical College, New York (Inturrisi)
| | - Efrat Aharonovich
- Department of Psychiatry, Columbia University Medical Center (Hasin, Shmulewitz, Aharonovich, Scodes, Wall) and New York State Psychiatric Institute (Hasin, Shmulewitz, Stohl, Greenstein, Aharonovich, Scodes, Wall), New York; Epidemiology, Pfizer, Inc., New York (Petronis); Kaiser Permanente Washington Health Research Institute, Seattle (Von Korff); Department of Anesthesiology, Rutgers University, Newark, N.J. (Datta); Department of Anesthesiology, Columbia University Medical Center, New York (Sonty, Weinberger); Department of Psychiatry, New York University, New York (Ross); Cornell University Medical College, New York (Inturrisi)
| | - Kenneth R Petronis
- Department of Psychiatry, Columbia University Medical Center (Hasin, Shmulewitz, Aharonovich, Scodes, Wall) and New York State Psychiatric Institute (Hasin, Shmulewitz, Stohl, Greenstein, Aharonovich, Scodes, Wall), New York; Epidemiology, Pfizer, Inc., New York (Petronis); Kaiser Permanente Washington Health Research Institute, Seattle (Von Korff); Department of Anesthesiology, Rutgers University, Newark, N.J. (Datta); Department of Anesthesiology, Columbia University Medical Center, New York (Sonty, Weinberger); Department of Psychiatry, New York University, New York (Ross); Cornell University Medical College, New York (Inturrisi)
| | - Michael Von Korff
- Department of Psychiatry, Columbia University Medical Center (Hasin, Shmulewitz, Aharonovich, Scodes, Wall) and New York State Psychiatric Institute (Hasin, Shmulewitz, Stohl, Greenstein, Aharonovich, Scodes, Wall), New York; Epidemiology, Pfizer, Inc., New York (Petronis); Kaiser Permanente Washington Health Research Institute, Seattle (Von Korff); Department of Anesthesiology, Rutgers University, Newark, N.J. (Datta); Department of Anesthesiology, Columbia University Medical Center, New York (Sonty, Weinberger); Department of Psychiatry, New York University, New York (Ross); Cornell University Medical College, New York (Inturrisi)
| | - Samyadev Datta
- Department of Psychiatry, Columbia University Medical Center (Hasin, Shmulewitz, Aharonovich, Scodes, Wall) and New York State Psychiatric Institute (Hasin, Shmulewitz, Stohl, Greenstein, Aharonovich, Scodes, Wall), New York; Epidemiology, Pfizer, Inc., New York (Petronis); Kaiser Permanente Washington Health Research Institute, Seattle (Von Korff); Department of Anesthesiology, Rutgers University, Newark, N.J. (Datta); Department of Anesthesiology, Columbia University Medical Center, New York (Sonty, Weinberger); Department of Psychiatry, New York University, New York (Ross); Cornell University Medical College, New York (Inturrisi)
| | - Nomita Sonty
- Department of Psychiatry, Columbia University Medical Center (Hasin, Shmulewitz, Aharonovich, Scodes, Wall) and New York State Psychiatric Institute (Hasin, Shmulewitz, Stohl, Greenstein, Aharonovich, Scodes, Wall), New York; Epidemiology, Pfizer, Inc., New York (Petronis); Kaiser Permanente Washington Health Research Institute, Seattle (Von Korff); Department of Anesthesiology, Rutgers University, Newark, N.J. (Datta); Department of Anesthesiology, Columbia University Medical Center, New York (Sonty, Weinberger); Department of Psychiatry, New York University, New York (Ross); Cornell University Medical College, New York (Inturrisi)
| | - Stephen Ross
- Department of Psychiatry, Columbia University Medical Center (Hasin, Shmulewitz, Aharonovich, Scodes, Wall) and New York State Psychiatric Institute (Hasin, Shmulewitz, Stohl, Greenstein, Aharonovich, Scodes, Wall), New York; Epidemiology, Pfizer, Inc., New York (Petronis); Kaiser Permanente Washington Health Research Institute, Seattle (Von Korff); Department of Anesthesiology, Rutgers University, Newark, N.J. (Datta); Department of Anesthesiology, Columbia University Medical Center, New York (Sonty, Weinberger); Department of Psychiatry, New York University, New York (Ross); Cornell University Medical College, New York (Inturrisi)
| | - Charles Inturrisi
- Department of Psychiatry, Columbia University Medical Center (Hasin, Shmulewitz, Aharonovich, Scodes, Wall) and New York State Psychiatric Institute (Hasin, Shmulewitz, Stohl, Greenstein, Aharonovich, Scodes, Wall), New York; Epidemiology, Pfizer, Inc., New York (Petronis); Kaiser Permanente Washington Health Research Institute, Seattle (Von Korff); Department of Anesthesiology, Rutgers University, Newark, N.J. (Datta); Department of Anesthesiology, Columbia University Medical Center, New York (Sonty, Weinberger); Department of Psychiatry, New York University, New York (Ross); Cornell University Medical College, New York (Inturrisi)
| | - Michael L Weinberger
- Department of Psychiatry, Columbia University Medical Center (Hasin, Shmulewitz, Aharonovich, Scodes, Wall) and New York State Psychiatric Institute (Hasin, Shmulewitz, Stohl, Greenstein, Aharonovich, Scodes, Wall), New York; Epidemiology, Pfizer, Inc., New York (Petronis); Kaiser Permanente Washington Health Research Institute, Seattle (Von Korff); Department of Anesthesiology, Rutgers University, Newark, N.J. (Datta); Department of Anesthesiology, Columbia University Medical Center, New York (Sonty, Weinberger); Department of Psychiatry, New York University, New York (Ross); Cornell University Medical College, New York (Inturrisi)
| | - Jennifer Scodes
- Department of Psychiatry, Columbia University Medical Center (Hasin, Shmulewitz, Aharonovich, Scodes, Wall) and New York State Psychiatric Institute (Hasin, Shmulewitz, Stohl, Greenstein, Aharonovich, Scodes, Wall), New York; Epidemiology, Pfizer, Inc., New York (Petronis); Kaiser Permanente Washington Health Research Institute, Seattle (Von Korff); Department of Anesthesiology, Rutgers University, Newark, N.J. (Datta); Department of Anesthesiology, Columbia University Medical Center, New York (Sonty, Weinberger); Department of Psychiatry, New York University, New York (Ross); Cornell University Medical College, New York (Inturrisi)
| | - Melanie M Wall
- Department of Psychiatry, Columbia University Medical Center (Hasin, Shmulewitz, Aharonovich, Scodes, Wall) and New York State Psychiatric Institute (Hasin, Shmulewitz, Stohl, Greenstein, Aharonovich, Scodes, Wall), New York; Epidemiology, Pfizer, Inc., New York (Petronis); Kaiser Permanente Washington Health Research Institute, Seattle (Von Korff); Department of Anesthesiology, Rutgers University, Newark, N.J. (Datta); Department of Anesthesiology, Columbia University Medical Center, New York (Sonty, Weinberger); Department of Psychiatry, New York University, New York (Ross); Cornell University Medical College, New York (Inturrisi)
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8
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Rolin SA, Scodes J, Dambreville R, Nossel IR, Bello I, Wall MM, Scott Stroup T, Dixon LB, Appelbaum PS. Feasibility and Utility of Different Approaches to Violence Risk Assessment for Young Adults Receiving Treatment for Early Psychosis. Community Ment Health J 2022; 58:1130-1140. [PMID: 34981276 PMCID: PMC8723812 DOI: 10.1007/s10597-021-00922-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 11/17/2021] [Indexed: 12/24/2022]
Abstract
This pilot study examined violence risk assessment among a sample of young adults receiving treatment for early psychosis. In this study, thirty participants were assessed for violence risk at baseline. Participants completed follow-up assessments at 3, 6, 9 and 12 months to ascertain prevalence of violent behavior. Individuals were on average 24.1 years old (SD = 3.3 years) and predominantly male (n = 24, 80%). In this sample, six people (20%) reported engaging in violence during the study period. Individuals who engaged in violence had higher levels of negative urgency (t(28) = 2.21, p = 0.035) This study sought to establish the feasibility, acceptability, and clinical utility of violence risk assessment for clients in treatment for early psychosis. Overall, this study found that most individuals with early psychosis in this study (who are in treatment) were not at risk of violence. Findings suggest that violent behavior among young adults with early psychosis is associated with increased negative urgency.
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Affiliation(s)
- Stephanie A Rolin
- Department of Psychiatry, Columbia University Irving Medical Center, 1051 Riverside Drive, Suite 1300, New York, NY, 10032, USA.
- New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY, 10032, USA.
| | - Jennifer Scodes
- New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY, 10032, USA
| | - Renald Dambreville
- New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY, 10032, USA
| | - Ilana R Nossel
- Department of Psychiatry, Columbia University Irving Medical Center, 1051 Riverside Drive, Suite 1300, New York, NY, 10032, USA
- New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY, 10032, USA
| | - Iruma Bello
- Department of Psychiatry, Columbia University Irving Medical Center, 1051 Riverside Drive, Suite 1300, New York, NY, 10032, USA
- New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY, 10032, USA
| | - Melanie M Wall
- Department of Psychiatry, Columbia University Irving Medical Center, 1051 Riverside Drive, Suite 1300, New York, NY, 10032, USA
- New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY, 10032, USA
| | - T Scott Stroup
- Department of Psychiatry, Columbia University Irving Medical Center, 1051 Riverside Drive, Suite 1300, New York, NY, 10032, USA
- New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY, 10032, USA
| | - Lisa B Dixon
- Department of Psychiatry, Columbia University Irving Medical Center, 1051 Riverside Drive, Suite 1300, New York, NY, 10032, USA
- New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY, 10032, USA
| | - Paul S Appelbaum
- Department of Psychiatry, Columbia University Irving Medical Center, 1051 Riverside Drive, Suite 1300, New York, NY, 10032, USA
- New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY, 10032, USA
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9
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Na PJ, Scodes J, Fishman M, Rotrosen J, Nunes EV. Co-occurring Depression and Suicidal Ideation in Opioid Use Disorder: Prevalence and Response During Treatment With Buprenorphine-Naloxone and Injection Naltrexone. J Clin Psychiatry 2022; 83. [PMID: 35452194 DOI: 10.4088/jcp.21m14140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Objective: The concept of "deaths of despair" (suicide, overdose, and alcohol-related liver disease) highlights the importance of detecting and understanding the course of co-occurring depression in patients with opioid use disorder (OUD). Methods: In a 24-week trial of 570 patients with DSM-5-defined OUD randomized to buprenorphine-naloxone (BUP-NX) or extended-release naltrexone (XR-NTX) from January 2014 to January 2017, the prevalence of depression (assessed with Hamilton Depression Rating Scale [HDRS]) was examined at baseline and after 4 weeks of treatment, and the association between depression and relapse to opioid use was explored using logistic regression. Results: Among 473 patients who initiated medication, 14.2% (67/473) had moderate/severe depression (HDRS ≥ 17) and 34.9% (165/473) had mild depression (8 ≤ HDRS ≤ 16) at baseline. Patients with moderate/severe depression had more frequent histories of anxiety disorders and suicidal ideation. After 4 weeks of treatment, approximately two-thirds of participants with depression either responded (HDRS reduced ≥ 50% from baseline) or remitted (HDRS ≤ 7), with no significant differences between medication treatment groups. Those with moderate/severe depression were less likely to remit (52.8%; 28/53) compared to those with mild depression (76%; 98/129) at week 4 (OR = 0.43, 95% CI = 0.21-0.89, P = .02). Further, those who remitted at week 4 had lower, but not significantly different, risk of relapse to opioids compared to those who did not remit (OR = 0.55, 95% CI = 0.28-1.08, P = .08). Conclusions: Depression is common among patients with OUD and often remits after initiation of BUP-NX or XR-NTX, although when it does not remit it may be associated with worse opioid use outcome. Depression should be screened and followed during initiation of treatment and, when it does not remit, specific depression treatment should be considered. Trial Registration: ClinicalTrials.gov identifier: NCT02032433.
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Affiliation(s)
- Peter J Na
- Department of Psychiatry, New York University Grossman School of Medicine, New York, New York.,Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut.,VA Connecticut Health Care System, West Haven, Connecticut.,Corresponding author: Peter J. Na, MD, MPH, Yale University School of Medicine, 300 George St Ste 901, New Haven, CT 06511
| | | | - Marc Fishman
- Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Maryland Treatment Centers, Baltimore, Maryland
| | - John Rotrosen
- Department of Psychiatry, New York University Grossman School of Medicine, New York, New York
| | - Edward V Nunes
- New York State Psychiatric Institute, New York, New York.,Columbia University Irving Medical Center, New York, New York
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10
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Greiner MG, Shulman M, Scodes J, Choo TH, Pavlicova M, Opara O, Campbell ANC, Novo P, Fishman M, Lee JD, Rotrosen J, Nunes EV. Patient Characteristics Associated with Opioid Abstinence after Participation in a Trial of Buprenorphine versus Injectable Naltrexone. Subst Use Misuse 2022; 57:1732-1742. [PMID: 35975917 PMCID: PMC10044490 DOI: 10.1080/10826084.2022.2112230] [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] [Indexed: 10/15/2022]
Abstract
Background and Objectives: Better understanding of predictors of opioid abstinence among patients with opioid use disorder (OUD) may help to inform interventions and personalize treatment plans. This analysis examined patient characteristics associated with opioid abstinence in the X:BOT (Extended-Release Naltrexone versus Buprenorphine for Opioid Treatment) trial. Methods: This post-hoc analysis examined factors associated with past-month opioid abstinence at the 36-week follow-up visit among participants in the X:BOT study. 428 participants (75% of original sample) attended the visit at 36 weeks. Logistic regression models were used to estimate the probability of opioid abstinence across various baseline sociodemographics, clinical characteristics, and treatment variables. Results: Of the 428 participants, 143 (33%) reported abstinence from non-prescribed opioids at the 36-week follow-up. Participants were more likely to be opioid abstinent if randomized to XR-NTX (compared to BUP-NX), were on XR-NTX at week 36 (compared to those off OUD pharmacotherapy), successfully inducted onto either study medication, had longer time on study medication, reported a greater number of abstinent weeks, or had longer time to relapse during the 24-week treatment trial. Participants were less likely to be abstinent if Hispanic, had a severe baseline Hamilton Depression Rating (HAM-D) score, or had baseline sedative use. Conclusions: A substantial proportion of participants was available at follow-up (75%), was on OUD pharmacotherapy (53%), and reported past-month opioid abstinence (33%) at 36 weeks. A minority of patients off medication for OUD reported abstinence and additional research is needed exploring patient characteristics that may be associated with successful treatment outcomes.
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Affiliation(s)
- Miranda G Greiner
- Department of Psychiatry, New York State Psychiatric Institute and Columbia University Irving Medical Center, New York, New York, USA
| | - Matisyahu Shulman
- Department of Psychiatry, New York State Psychiatric Institute and Columbia University Irving Medical Center, New York, New York, USA
| | - Jennifer Scodes
- Department of Psychiatry, New York State Psychiatric Institute and Columbia University Irving Medical Center, New York, New York, USA
| | - Tse-Hwei Choo
- Department of Psychiatry, New York State Psychiatric Institute and Columbia University Irving Medical Center, New York, New York, USA
| | - Martina Pavlicova
- Department of Biostatistics, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Onumara Opara
- Department of Psychiatry, New York State Psychiatric Institute and Columbia University Irving Medical Center, New York, New York, USA
| | - Aimee N C Campbell
- Department of Psychiatry, New York State Psychiatric Institute and Columbia University Irving Medical Center, New York, New York, USA
| | - Patricia Novo
- Departments of Population Health and Psychiatry, New York University Grossman School of Medicine, New York, New York, USA
| | - Marc Fishman
- Department of Psychiatry, Johns Hopkins University School of Medicine and Maryland Treatment Centers, Baltimore, Maryland, USA
| | - Joshua D Lee
- Departments of Population Health and Psychiatry, New York University Grossman School of Medicine, New York, New York, USA
| | - John Rotrosen
- Departments of Population Health and Psychiatry, New York University Grossman School of Medicine, New York, New York, USA
| | - Edward V Nunes
- Department of Psychiatry, New York State Psychiatric Institute and Columbia University Irving Medical Center, New York, New York, USA
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11
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Zambrano J, Scodes J, Marino LA, Nossel I, Bello I, Ngo H, Dixon LB, van der Ven E. Predictors of Persistent Symptoms in People in Coordinated Specialty Care Services for Early Psychosis in New York State. Psychiatr Serv 2022; 73:92-95. [PMID: 34074148 PMCID: PMC8636503 DOI: 10.1176/appi.ps.202000821] [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] [Indexed: 01/03/2023]
Abstract
OBJECTIVE This study aimed to determine the prevalence and predictors of persistent transdiagnostic symptoms in the first year of enrollment in OnTrackNY, a coordinated specialty care (CSC) program for individuals with recent-onset nonaffective psychosis. METHODS Three groups were defined by using the Mental Illness Research, Education, and Clinical Centers Global Assessment of Functioning symptom subscale: persistently symptomatic, intermittent, and improving to moderate. The authors compared groups on baseline demographic characteristics, family and living situation, clinical measures, and pathways to care. RESULTS Of 1,129 eligible participants, 12% were persistently symptomatic through follow-up. Being medication nonadherent, being homeless, having a diagnosis of schizophrenia, and having a longer duration between symptom onset and program enrollment were predictive of persistent symptoms during the first year of CSC. CONCLUSIONS Findings suggest that despite intensive treatment, severe symptoms in young people with psychosis may persist because of economic barriers, treatment delays, and lack of stability.
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Affiliation(s)
- Juliana Zambrano
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York City (Zambrano, Marino, Nossel, Bello, Ngo, Dixon); New York State Psychiatric Institute, New York City (Scodes, Marino, Nossel, Bello, Ngo, Dixon); Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City (van der Ven); School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands (van der Ven)
| | - Jennifer Scodes
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York City (Zambrano, Marino, Nossel, Bello, Ngo, Dixon); New York State Psychiatric Institute, New York City (Scodes, Marino, Nossel, Bello, Ngo, Dixon); Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City (van der Ven); School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands (van der Ven)
| | - Leslie A Marino
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York City (Zambrano, Marino, Nossel, Bello, Ngo, Dixon); New York State Psychiatric Institute, New York City (Scodes, Marino, Nossel, Bello, Ngo, Dixon); Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City (van der Ven); School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands (van der Ven)
| | - Ilana Nossel
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York City (Zambrano, Marino, Nossel, Bello, Ngo, Dixon); New York State Psychiatric Institute, New York City (Scodes, Marino, Nossel, Bello, Ngo, Dixon); Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City (van der Ven); School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands (van der Ven)
| | - Iruma Bello
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York City (Zambrano, Marino, Nossel, Bello, Ngo, Dixon); New York State Psychiatric Institute, New York City (Scodes, Marino, Nossel, Bello, Ngo, Dixon); Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City (van der Ven); School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands (van der Ven)
| | - Hong Ngo
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York City (Zambrano, Marino, Nossel, Bello, Ngo, Dixon); New York State Psychiatric Institute, New York City (Scodes, Marino, Nossel, Bello, Ngo, Dixon); Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City (van der Ven); School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands (van der Ven)
| | - Lisa B Dixon
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York City (Zambrano, Marino, Nossel, Bello, Ngo, Dixon); New York State Psychiatric Institute, New York City (Scodes, Marino, Nossel, Bello, Ngo, Dixon); Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City (van der Ven); School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands (van der Ven)
| | - Els van der Ven
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York City (Zambrano, Marino, Nossel, Bello, Ngo, Dixon); New York State Psychiatric Institute, New York City (Scodes, Marino, Nossel, Bello, Ngo, Dixon); Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City (van der Ven); School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands (van der Ven)
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12
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Greiner MG, Shulman M, Choo TH, Scodes J, Pavlicova M, Campbell ANC, Novo P, Fishman M, Lee JD, Rotrosen J, Nunes EV. Naturalistic follow-up after a trial of medications for opioid use disorder: Medication status, opioid use, and relapse. J Subst Abuse Treat 2021; 131:108447. [PMID: 34098301 PMCID: PMC8556394 DOI: 10.1016/j.jsat.2021.108447] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 04/23/2021] [Accepted: 04/26/2021] [Indexed: 10/21/2022]
Abstract
AIM This report examined naturalistic opioid use outcomes and utilization of medications for opioid use disorder (MOUD) 36 weeks post-randomization in the National Drug Abuse Treatment Clinical Trials Network (CTN) Extended-Release Naltrexone (XR-NTX) versus Buprenorphine-Naloxone (BUP-NX) for Opioid Treatment trial (CTN-0051, X:BOT). DESIGN X:BOT was a multisite, randomized, 24-week comparative effectiveness trial of BUP-NX (N = 287) and XR-NTX (N = 283). Study medications were discontinued following treatment completion, relapse, or dropout. Participants were encouraged to continue MOUD. This report examined opioid use outcomes in 428 (75%) of the 570 participants who attended the 36-week follow-up visit. SETTING AND PARTICIPANTS Adults with opioid use disorder recruited from 8 community treatment programs across the United States. MEASUREMENTS Outcomes included medication status (on/off MOUD), type of MOUD (BUP-NX, XR-NTX, or methadone), abstinence from non-prescribed opioids, opioid use days, relapse, and other substance use 30 days prior to the 36-week visit. Relapse was defined as opioid use for 4 consecutive weeks or 7 consecutive days in the past month. Baseline and clinical variables included opioid use severity, intravenous drug use, study medication assignment, and induction status. FINDINGS Of the 428 participants who completed the 36-week visit, 225 (53%) of participants were receiving MOUD and 203 (47%) were not. Compared to those off medication, participants on medication had fewer opioid use days (4.4 days (SD 9.0) versus 9.8 days (SD 12.1)), fewer met relapse criteria (37 (16.4%) versus 79 (38.9%)), and reported less stimulant use (34 (15.2%) versus 56 (27.7%)) and sedative use (14 (6.3%) versus 31 (15.3%)). There was no difference in abstinence rates between those on or off MOUD. A greater proportion of participants on XR-NTX (47 (53.4%) of 88 participants) were abstinent from non-prescribed opioids compared to those on buprenorphine (28 (23.3%) of 120 participants). CONCLUSIONS Naturalistic outcomes data showed that despite potential barriers to continuing treatment in the community, about half of individuals were on opioid use disorder pharmacotherapy at follow-up and those on medication generally had better outcomes. Future research should explore barriers and facilitators to treatment retention in community settings; and developing interventions tailored to improve treatment engagement and adherence.
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Affiliation(s)
- Miranda G Greiner
- New York State Psychiatric Institute and Columbia University Irving Medical Center, 1051 Riverside Drive, New York, NY 10032, United States of America.
| | - Matisyahu Shulman
- New York State Psychiatric Institute and Columbia University Irving Medical Center, 1051 Riverside Drive, New York, NY 10032, United States of America.
| | - Tse-Hwei Choo
- New York State Psychiatric Institute and Columbia University Irving Medical Center, 1051 Riverside Drive, New York, NY 10032, United States of America.
| | - Jennifer Scodes
- New York State Psychiatric Institute and Columbia University Irving Medical Center, 1051 Riverside Drive, New York, NY 10032, United States of America.
| | - Martina Pavlicova
- Columbia University Mailman School of Public Health, 722 West 168th Street, New York, NY 10032, United States of America.
| | - Aimee N C Campbell
- New York State Psychiatric Institute and Columbia University Irving Medical Center, 1051 Riverside Drive, New York, NY 10032, United States of America.
| | - Patricia Novo
- New York University Grossman School of Medicine, 550 First Avenue, New York, NY 10016, United States of America.
| | - Marc Fishman
- Johns Hopkins University School of Medicine and Maryland Treatment Centers, 3800 Frederick Ave, Baltimore, MD 21229, United States of America
| | - Joshua D Lee
- New York University Grossman School of Medicine, 550 First Avenue, New York, NY 10016, United States of America.
| | - John Rotrosen
- New York University Grossman School of Medicine, 550 First Avenue, New York, NY 10016, United States of America.
| | - Edward V Nunes
- New York State Psychiatric Institute and Columbia University Irving Medical Center, 1051 Riverside Drive, New York, NY 10032, United States of America.
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13
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Aharonovich E, Scodes J, Wall MM, Hasin DS. The relationship of frequency of cocaine use to substance and psychiatric disorders in the U.S. general population. Drug Alcohol Depend 2021; 227:108933. [PMID: 34358768 PMCID: PMC8464522 DOI: 10.1016/j.drugalcdep.2021.108933] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 06/21/2021] [Accepted: 06/23/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND In clinical trials of pharmacotherapy for substance use, abstinence is the primary endpoint accepted by regulatory agencies. However, this endpoint could be overly restrictive, impeding efforts to identify effective medications for cocaine use disorder. To examine non-abstinent gradations in cocaine use as potential indicators of improvement, we investigated the relationship of frequency of cocaine use to clinical correlates in national survey data. METHODS Lifetime cocaine users (n = 2501) were interviewed in the National Epidemiological Survey on Alcohol and Related Conditions (NESARC) in 2001-2002 and re-interviewed in 2004-2005. Adjusted odds ratios (aORs) indicated associations between heaviest frequency of cocaine use and use of other substances, DSM-IV substance use disorders, psychiatric disorders, and change between 2001-2002 and 2004-2005. The reference category for all aORs was non-users. RESULTS Greater lifetime cocaine use frequency was associated with lifetime cocaine, alcohol, and cannabis dependence (aOR for a linear trend = 2.80, 1.22, 1.22, respectively) and past-year cocaine, alcohol, and cannabis dependence (aOR = 1.78, 1.13, 1.16, respectively). Greater lifetime cocaine use frequency was associated with past-year depressive, panic, and generalized anxiety disorders (aOR = 1.07, 1.09, 1.12, respectively). Among cocaine users in 2001-2002, compared to the reference group using less than monthly, use ≥1x/week and use 1-3 times a month was associated with cocaine use disorder in 2004-2005 (aOR = 2.13 and aOR = 1.67, respectively). CONCLUSION Gradations in risk for dependence on cocaine, other substances and psychiatric disorders by frequency of cocaine use indicates a promising direction for more sensitive outcome measures of treatment effects on cocaine outcomes than binary indicators (e.g., any use vs. none). Study results add to findings suggesting that non-abstinent measures might be useful indicators of treatment efficacy in clinical trials.
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Affiliation(s)
- Efrat Aharonovich
- Department of Psychiatry, Columbia University Medical Center, New York, NY, USA; New York State Psychiatric Institute, New York, NY, USA.
| | | | - Melanie M Wall
- Department of Psychiatry, Columbia University Medical Center, New York, NY, USA; New York State Psychiatric Institute, New York, NY, USA; Department of Biostatistics, Columbia University Medical Center, New York, NY, USA
| | - Deborah S Hasin
- Department of Psychiatry, Columbia University Medical Center, New York, NY, USA; New York State Psychiatric Institute, New York, NY, USA; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
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14
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Lee R, Scodes J, van der Ven E, Alves-Bradford JM, Mascayano F, Smith S, Dixon L. Sociodemographic, clinical and help-seeking characteristics of homeless young people with recent onset of psychosis enrolled in specialized early intervention services. Early Interv Psychiatry 2021; 15:1044-1050. [PMID: 32875676 PMCID: PMC8237376 DOI: 10.1111/eip.13028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 07/03/2020] [Accepted: 08/02/2020] [Indexed: 11/30/2022]
Abstract
AIM To examine differences in demographic, clinical, social, functional and help-seeking characteristics of homeless vs housed individuals enrolled in specialized early intervention teams in the United States. METHODS Participants comprised 1349 individuals enrolled across 21 teams. Teams report individual-level data including homelessness status at admission. Bivariate differences between homeless and housed participants were analysed using Wilcoxon-rank, chi-square, Fisher-exact and t tests, as appropriate. RESULTS Approximately 5% of participants were homeless at admission. Homeless participants were less likely to be enrolled in school and/or employed (12.2% vs 43.4%); to have more involvement in the legal system (23.0% vs 6.2%); and to have had a more restrictive pathway to care, than housed participants. CONCLUSIONS Homeless young people with recent-onset psychosis have a substantially greater need for a diversity of services for psychosocial needs. Homeless individuals may also have a more adverse pathway to care and directed outreach to engage this population may be needed.
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Affiliation(s)
- Rufina Lee
- Hunter College Silberman School of Social Work, City University of New York, New York, New York
| | | | - Els van der Ven
- Columbia University Mailman School of Public Health, New York, New York
| | | | | | - Stephen Smith
- New York State Psychiatric Institute, New York, New York
| | - Lisa Dixon
- New York State Psychiatric Institute, New York, New York
- Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
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McElhiney MC, Rabkin JG, Wainberg ML, Finkel MR, Scodes J. Comparison of counseling methods to promote employment for HIV+ ADULTS. Work 2021; 69:981-995. [PMID: 34219692 DOI: 10.3233/wor-213529] [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] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Despite improved health and during a strong job market (pre-COVID-19), a substantial proportion of HIV+ adults remained unemployed. This study sought to provide time-limited counseling to promote employment goals. OBJECTIVE To determine whether behavioral activation (BA) or supportive counseling (SC), would be more effective in promoting vocational goals (full or part-time, paid or volunteer). METHODS The study included two groups: those with clinically significant fatigue, who were first treated with armodafinil. Once their fatigue diminished, they were enrolled in the counseling program. Those without fatigue were enrolled directly. Both BA and SC interventions were manualized, consisting of eight individual sessions plus a follow-up. RESULTS 116 participants entered counseling, including 87 assigned to BA and 29 to SC. Of these, 79 completed counseling or found a job by session eight. By follow-up, 51%of BA versus 41%of SC participants had found jobs, a non-significant difference either clinically or statistically. CONCLUSIONS Multiple issues contributed to difficulty in employment, including gaps in resumes, loss of contact with former colleagues, and uncertainty about career direction. Ongoing barriers included substance use, housing instability, ambivalence about forfeiting government benefits, as well as inadequately treated depression. Success in employment for about half of participants is, in this context, a reasonable outcome.
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Affiliation(s)
- Martin C McElhiney
- Department of Mood, Anxiety, Eating and Related Disorders New York State Psychiatric Institute New York, NY, USA.,Department of Psychiatry, College of Physicians and Surgeons, Columbia University Medical Center New York, NY, USA
| | - Judith G Rabkin
- Department of Mood, Anxiety, Eating and Related Disorders New York State Psychiatric Institute New York, NY, USA.,Department of Psychiatry, College of Physicians and Surgeons, Columbia University Medical Center New York, NY, USA
| | - Milton L Wainberg
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University Medical Center New York, NY, USA.,Department of Translational Epidemiology New York State Psychiatric Institute New York, NY, USA
| | - Madeline R Finkel
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University Medical Center New York, NY, USA
| | - Jennifer Scodes
- Department of Mental Health Data Science New York State Psychiatric Institute New York, NY, USA
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Fishman M, Wenzel K, Scodes J, Pavlicova M, Campbell ANC, Rotrosen J, Nunes E. Examination of Correlates of OUD Outcomes in Young Adults: Secondary Analysis From the XBOT Trial. Am J Addict 2021; 30:433-444. [PMID: 34075644 DOI: 10.1111/ajad.13176] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 04/16/2021] [Accepted: 04/16/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Opioid use disorder (OUD) treatment outcomes are poorer for young adults than older adults. Developmental differences are broadly implicated, but particular vulnerability factor interactions are poorly understood. This study sought to identify moderators of OUD relapse between age groups. METHODS This secondary analysis compared young adults (18-25) to older adults (26+) from a comparative effectiveness trial ("XBOT") that randomized (N = 570) participants to extended-release naltrexone or sublingual buprenorphine-naloxone. We explored the relationship between 25 prespecified patient baseline characteristics and relapse to regular opioid use by age group and treatment condition, using logistic regression. RESULTS Young adults (n = 111) had higher rates of 24-week relapse than older adults (n = 459) (70.3% vs 58.8%) and differed on a number of specific characteristics, including more smokers, more intravenous opioid use, and more cannabis use. No significant moderators predicted relapse, in either three-way or two-way interactions. CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE No baseline factors were identified as moderating the relationship between age group and opioid relapse, nor any interactions between baseline characteristics, age group, and treatment condition to predict opioid relapse. Poorer treatment outcomes for young adults are likely associated with multiple developmental vulnerabilities rather than any single predominant factor. Although not reaching significance, several characteristics (using heroin, smoking tobacco, high levels of depression/anxiety, or treatment because of family/friends) showed higher odds ratio point estimates for relapse in young adults than older adults. This is the first study to explore moderators of worse OUD treatment outcomes in young adults, highlighting the need to identify predictor variables that could inform treatment enhancements. (Am J Addict 2021;00:1-12).
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Affiliation(s)
- Marc Fishman
- Mountain Manor Treatment Center/Maryland Treatment Centers, Baltimore, Maryland.,Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Kevin Wenzel
- Mountain Manor Treatment Center/Maryland Treatment Centers, Baltimore, Maryland
| | - Jennifer Scodes
- Division of Mental Health Data Science, New York State Psychiatric Institute, New York, New York
| | - Martina Pavlicova
- Department of Biostatistics, Columbia University Mailman School of Public Health, New York, New York
| | - Aimee N C Campbell
- Department of Psychiatry, Columbia University Irving Medical Center, Columbia University Medical Center, New York State Psychiatric Institute, New York, New York
| | - John Rotrosen
- Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, New York, New York
| | - Edward Nunes
- Department of Psychiatry, Columbia University Irving Medical Center, Columbia University Medical Center, New York State Psychiatric Institute, New York, New York
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17
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Shmulewitz D, Aharonovich E, Witkiewitz K, Anton RF, Kranzler HR, Scodes J, Mann KF, Wall MM, Hasin D. The World Health Organization Risk Drinking Levels Measure of Alcohol Consumption: Prevalence and Health Correlates in Nationally Representative Surveys of U.S. Adults, 2001-2002 and 2012-2013. Am J Psychiatry 2021; 178:548-559. [PMID: 33472388 PMCID: PMC8222066 DOI: 10.1176/appi.ajp.2020.20050610] [Citation(s) in RCA: 15] [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] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Little is known about change over time in the prevalence of World Health Organization (WHO) risk drinking levels (very high, high, moderate, low) and their association with health conditions, overall and by gender. The authors used two sets of nationally representative U.S. survey data to determine whether changes over time varied by gender and to examine whether health conditions related to alcohol were associated with WHO risk drinking level within each survey, and whether these associations differed by gender. METHODS Data on current drinkers from the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC; N=26,655) and the 2012-2013 NESARC-III (N=25,659) were analyzed using logistic regression. Prevalence differences between surveys were estimated for each drinking level overall and by gender. Within each survey, prevalence differences by WHO risk drinking level were estimated for alcohol use disorder (AUD), drug use disorders, functional impairment, liver disease, and depressive and anxiety disorders. RESULTS In the 2012-2013 survey, the prevalences of moderate, high, and very high risk drinking were 5.9%, 3.2%, and 3.5%, respectively, representing significant increases from the prevalences in the 2001-2002 survey, which were 1.0%, 0.6%, and 0.9%, respectively. The increase for very high risk drinking among men (0.5%) was smaller than the increase among women (1.4%). Within both surveys, compared with low risk, health conditions were significantly associated with very high risk (range of prevalence differences, 2.2%-57.8%), high risk (2.6%-41.3%), and moderate risk (0.6%-29.8%) drinking. Associations were similar by gender, except that there were stronger effects for AUD in men and for functional impairment and depressive and anxiety disorders in women. CONCLUSIONS The increase in potentially problematic drinking levels among U.S. adults emphasizes the need for better prevention and treatment strategies. The study results support the validity of the WHO risk drinking levels, which show clinical utility as nonabstinent drinking reduction treatment goals. Such goals could engage more people in treatment, improving public health by decreasing personal and societal consequences of risk drinking.
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Affiliation(s)
- Dvora Shmulewitz
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA,New York State Psychiatric Institute, New York, NY, USA
| | - Efrat Aharonovich
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA,New York State Psychiatric Institute, New York, NY, USA
| | - Katie Witkiewitz
- Department of Psychology, University of New Mexico, Albuquerque, NM, USA
| | - Raymond F Anton
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Henry R Kranzler
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA,Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania
| | | | - Karl F Mann
- Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Melanie M Wall
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA,New York State Psychiatric Institute, New York, NY, USA,Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Deborah Hasin
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA,New York State Psychiatric Institute, New York, NY, USA,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | -
- Department of Psychiatry, Columbia University Irving Medical Center, New York (Shmulewitz, Aharonovich, Wall, Hasin); New York State Psychiatric Institute, New York (Shmulewitz, Aharonovich, Scodes, Wall, Hasin); Department of Psychology, University of New Mexico, Albuquerque (Witkiewitz); Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston (Anton); Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Kranzler); Crescenz Veterans Affairs Medical Center, Philadelphia (Kranzler); Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany (Mann); Department of Biostatistics (Wall) and Department of Epidemiology (Hasin), Mailman School of Public Health, Columbia University, New York
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18
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Simpson HB, Foa EB, Wheaton MG, Gallagher T, Gershkovich M, Schmidt AB, Huppert JD, Campeas RB, Imms PA, Cahill SP, DiChiara C, Tsao SD, Puliafico AC, Chazin D, Asnaani A, Moore K, Tyler J, Steinman SA, Sanchez-LaCay A, Capaldi S, Snorrason I, Turk-Karan E, Vermes D, Kalanthroff E, Pinto A, Hahn CG, Xu B, Van Meter PE, Katechis M, Scodes J, Wang Y. Maximizing remission from cognitive-behavioral therapy in medicated adults with obsessive-compulsive disorder. Behav Res Ther 2021; 143:103890. [PMID: 34089924 DOI: 10.1016/j.brat.2021.103890] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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: 12/11/2020] [Revised: 03/31/2021] [Accepted: 05/18/2021] [Indexed: 12/27/2022]
Abstract
Practice guidelines for adults with obsessive-compulsive disorder (OCD) recommend augmenting serotonin reuptake inhibitors (SRIs) with exposure and ritual prevention (EX/RP). However, fewer than half of patients remit after a standard 17-session EX/RP course. We studied whether extending the course increased overall remission rates and which patient factors predicted remission. Participants were 137 adults with clinically significant OCD (Yale-Brown Obsessive Compulsive Scale [Y-BOCS] score ≥18) despite an adequate SRI trial (≥12 weeks). Continuing their SRI, patients received 17 sessions of twice-weekly EX/RP (standard course). Patients who did not remit (Y-BOCS ≤12) received up to 8 additional sessions (extended course). Of 137 entrants, 123 completed treatment: 49 (35.8%) remitted with the standard course and another 46 (33.6%) with the extended course. Poorer patient homework adherence, more Obsessive-Compulsive Personality Disorder (OCPD) traits, and the Brain-Derived Neurotrophic Factor (BDNF) Val66MET genotype were associated with lower odds of standard course remission. Only homework adherence differentiated non-remitters from extended course remitters. Extending the EX/RP course from 17 to 25 sessions enabled many (69.3%) OCD patients on SRIs to achieve remission. Although behavioral (patient homework adherence), psychological (OCPD traits), and biological (BDNF genotype) factors influenced odds of EX/RP remission, homework adherence was the most potent patient factor overall.
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Affiliation(s)
- Helen B Simpson
- Department of Psychiatry, Columbia University, New York, NY, 10032, USA; New York State Psychiatric Institute, New York, NY, 10032, USA.
| | - Edna B Foa
- Center for the Treatment and Study of Anxiety, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Michael G Wheaton
- New York State Psychiatric Institute, New York, NY, 10032, USA; Barnard College, Columbia University, New York, NY, 10027, USA
| | - Thea Gallagher
- Center for the Treatment and Study of Anxiety, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Marina Gershkovich
- Department of Psychiatry, Columbia University, New York, NY, 10032, USA; New York State Psychiatric Institute, New York, NY, 10032, USA
| | - Andrew B Schmidt
- Department of Psychiatry, Columbia University, New York, NY, 10032, USA; New York State Psychiatric Institute, New York, NY, 10032, USA
| | | | - Raphael B Campeas
- Department of Psychiatry, Columbia University, New York, NY, 10032, USA; New York State Psychiatric Institute, New York, NY, 10032, USA
| | - Patricia A Imms
- Center for the Treatment and Study of Anxiety, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Shawn P Cahill
- University of Wisconsin-Milwaukee, Milwaukee, WI, 53201, USA
| | - Christina DiChiara
- Center for the Treatment and Study of Anxiety, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, 19104, USA; Center for Anxiety and Behavior Therapy, Bryn Mawr, PA, 19010, USA
| | - Steven D Tsao
- Center for the Treatment and Study of Anxiety, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, 19104, USA; Center for Anxiety and Behavior Therapy, Bryn Mawr, PA, 19010, USA
| | - Anthony C Puliafico
- Department of Psychiatry, Columbia University, New York, NY, 10032, USA; New York State Psychiatric Institute, New York, NY, 10032, USA
| | - Daniel Chazin
- Center for the Treatment and Study of Anxiety, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Anu Asnaani
- Center for the Treatment and Study of Anxiety, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, 19104, USA; Department of Psychology, University of Utah, Salt Lake City, UT, 84112, USA
| | - Kelly Moore
- Center for the Treatment and Study of Anxiety, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, 19104, USA; Rutgers University/Biomedical Health Sciences New Brunswick, NJ, 08854, USA
| | - Jeremy Tyler
- Center for the Treatment and Study of Anxiety, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Shari A Steinman
- Department of Psychiatry, Columbia University, New York, NY, 10032, USA; New York State Psychiatric Institute, New York, NY, 10032, USA; Department of Psychology, WVU, Morgantown, WV, 26506, USA
| | - Arturo Sanchez-LaCay
- Department of Psychiatry, Columbia University, New York, NY, 10032, USA; New York State Psychiatric Institute, New York, NY, 10032, USA
| | - Sandy Capaldi
- Center for the Treatment and Study of Anxiety, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Ivar Snorrason
- Department of Psychiatry, Columbia University, New York, NY, 10032, USA; New York State Psychiatric Institute, New York, NY, 10032, USA; McLean Hospital/Harvard Medical School, Belmont, MA, 02478, USA
| | - Elizabeth Turk-Karan
- Center for the Treatment and Study of Anxiety, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Donna Vermes
- Department of Psychiatry, Columbia University, New York, NY, 10032, USA; New York State Psychiatric Institute, New York, NY, 10032, USA
| | | | - Anthony Pinto
- Department of Psychiatry, Columbia University, New York, NY, 10032, USA; New York State Psychiatric Institute, New York, NY, 10032, USA; Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, The Zucker Hillside Hospital, Glen Oaks, NY, 11004, USA
| | - Chang-Gyu Hahn
- Center for the Treatment and Study of Anxiety, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Bin Xu
- Department of Psychiatry, Columbia University, New York, NY, 10032, USA
| | - Page E Van Meter
- Department of Psychiatry, Columbia University, New York, NY, 10032, USA; New York State Psychiatric Institute, New York, NY, 10032, USA
| | - Martha Katechis
- Department of Psychiatry, Columbia University, New York, NY, 10032, USA; New York State Psychiatric Institute, New York, NY, 10032, USA
| | - Jennifer Scodes
- New York State Psychiatric Institute, New York, NY, 10032, USA
| | - Yuanjia Wang
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, 10032, USA
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Montgomery L, Winhusen T, Scodes J, Pavlicova M, Twitty D, Campbell ANC, Wang AL, Nunes EV, Rotrosen J. Reductions in tobacco use in naltrexone, relative to buprenorphine-maintained individuals with opioid use disorder: Secondary analysis from the National Drug Abuse Treatment Clinical Trials Network. J Subst Abuse Treat 2021; 130:108489. [PMID: 34118716 DOI: 10.1016/j.jsat.2021.108489] [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] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 04/10/2021] [Accepted: 05/18/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Smoking prevalence in individuals with opioid use disorder (OUD) is over 80%. Research suggests that opioid use significantly increases smoking, which could account for the strikingly low smoking-cessation rates observed in both methadone- and buprenorphine-maintained patients, even with the use of first-line smoking-cessation interventions. If opioids present a barrier to smoking-cessation, then better smoking outcomes should be observed in OUD patients treated with extended-release naltrexone (XR-NTX, an opioid antagonist) compared to those receiving buprenorphine (BUP-NX, a partial opioid agonist). METHODS The current study is a secondary analysis of a 24-week, multi-site, open-label, randomized clinical trial conducted within the National Drug Abuse Treatment Clinical Trials Network comparing the effectiveness of XR-NTX vs. BUP-NX for adults with OUD. Longitudinal mixed effects models were used to determine if there was a significant reduction in cigarette use among daily smokers successfully inducted to treatment (n = 373) and a subset of those who completed treatment (n = 169). RESULTS Among daily smokers inducted onto OUD medication, those in the XR-NTX group smoked fewer cigarettes per day (M = 11.36, SE = 0.62) relative to smokers in the BUP-NX group (M = 13.33, SE = 0.58) across all study visits, (b (SE) = -1.97 (0.55), p < .01). Results were similar for the treatment completers. CONCLUSIONS OUD patients treated with XR-NTX reduced cigarette use more than those treated with BUP-NX, suggesting that XR-NTX in combination with other smoking cessation interventions might be a better choice for OUD smokers interested in reducing their tobacco use.
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Affiliation(s)
- LaTrice Montgomery
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, 3131 Harvey Avenue, Cincinnati, OH 45229, USA; Center for Addiction Research, University of Cincinnati College of Medicine, 3230 Eden Avenue, Cincinnati, OH 45267, USA.
| | - Theresa Winhusen
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, 3131 Harvey Avenue, Cincinnati, OH 45229, USA; Center for Addiction Research, University of Cincinnati College of Medicine, 3230 Eden Avenue, Cincinnati, OH 45267, USA
| | - Jennifer Scodes
- Division of Mental Health Data Science, New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, USA
| | - Martina Pavlicova
- Department of Biostatistics, Columbia University Mailman School of Public Health, 722 W 168th St, New York, NY 10032, USA
| | - Dylanne Twitty
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, 3131 Harvey Avenue, Cincinnati, OH 45229, USA; Center for Addiction Research, University of Cincinnati College of Medicine, 3230 Eden Avenue, Cincinnati, OH 45267, USA
| | - Aimee N C Campbell
- Department of Psychiatry, Columbia University Irving Medical Center and New York State Psychiatric Institute, 1051 Riverside Drive, Unit 120, New York, NY 10032, USA
| | - An Li Wang
- Addiction Institute of Addiction of Mount Sinai, Department of Psychiatry, Icahn School of Medicine at Mount Sinai, 1399 Park Ave, New York, NY 10029, USA
| | - Edward V Nunes
- Department of Psychiatry, Columbia University Irving Medical Center and New York State Psychiatric Institute, 1051 Riverside Drive, Unit 120, New York, NY 10032, USA
| | - John Rotrosen
- Department of Psychiatry, NYU Grossman School of Medicine, One Park Avenue, New York, NY 10016, USA
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Simone M, Scodes J, Mason T, Loth K, Wall MM, Neumark-Sztainer D. Shared and non-shared risk and protective factors of binge eating and binge drinking from adolescence to young adulthood. J Health Psychol 2021; 26:805-817. [PMID: 31014132 PMCID: PMC6813845 DOI: 10.1177/1359105319844588] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This study aimed to elucidate the shared and non-shared behavioral, sociocultural, and personal risk factors underlying binge eating and binge drinking among a sample (n = 1764) of participants from Project EAT at baseline and 10-year follow-up. Longitudinal and cross-sectional analyses revealed a range of risk factors associated with binge eating and binge drinking at 10 years, which varied by gender. The results revealed that risks associated with binge eating and binge drinking often differed, and thus full-scale dual preventive interventions for concurrent binge eating and binge drinking may be less effective. However, general prevention and intervention programs may emphasize shared risk factors.
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Jones N, Basaraba C, Piscitelli S, Jewell T, Nossel I, Bello I, Mascayano F, Scodes J, Marino L, Wall M, Dixon LB. Clients' Preferences for Family Involvement and Subsequent Family Contact Patterns Within OnTrackNY Early Psychosis Services. Psychiatr Serv 2021; 72:399-407. [PMID: 33530730 DOI: 10.1176/appi.ps.202000241] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Little is known about clients' preferences for family involvement and subsequent family contact in naturalistic, community-based coordinated specialty care (CSC) settings. The study's primary goal was to characterize clients' preferences and longitudinal patterns of family contact with providers across the OnTrackNY network in New York. METHODS Clinical administrative data collected at 3-month intervals and spanning 21 OnTrackNY CSC sites were used to analyze the preferences of 761 clients at baseline (unconditional involvement, conditional involvement, or no involvement) and patterns of family contact with program staff (always, sometimes, never, or early discharge) and their correlates during the initial 12-month service period. Data from clients discharged before 12 months were included for comparison. RESULTS At baseline, most clients requested some form of family involvement (unconditional, 59%; conditional, 35%; and none, 6%). Within each 3-month assessment period, rates of family contact ranged from 73% to 84%. Variables associated with both client preferences and contact patterns included baseline insurance status, housing status, race, frequency of family contact, and employment. Clients' preferences for no or conditional family involvement were associated with higher rates of early discharge (i.e., before 1 year). CONCLUSIONS Structuring family involvement around clients' preferences did not appear to negatively affect family contact, and for some clients, it seemed to bolster such contact. Additional mixed-methods research is needed to deepen the understanding of the contexts and reasoning underlying both client preferences for family involvement and subsequent levels of family contact.
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Affiliation(s)
- Nev Jones
- Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa (Jones); Division of Behavioral Health Services and Policies, New York State Psychiatric Institute, New York City (Basaraba, Piscitelli, Jewell, Nossel, Bello, Mascayano, Scodes, Marino, Wall, Dixon). Editor Emeritus Howard H. Goldman, M.D., Ph.D., served as decision editor on the manuscript
| | - Cale Basaraba
- Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa (Jones); Division of Behavioral Health Services and Policies, New York State Psychiatric Institute, New York City (Basaraba, Piscitelli, Jewell, Nossel, Bello, Mascayano, Scodes, Marino, Wall, Dixon). Editor Emeritus Howard H. Goldman, M.D., Ph.D., served as decision editor on the manuscript
| | - Sarah Piscitelli
- Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa (Jones); Division of Behavioral Health Services and Policies, New York State Psychiatric Institute, New York City (Basaraba, Piscitelli, Jewell, Nossel, Bello, Mascayano, Scodes, Marino, Wall, Dixon). Editor Emeritus Howard H. Goldman, M.D., Ph.D., served as decision editor on the manuscript
| | - Thomas Jewell
- Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa (Jones); Division of Behavioral Health Services and Policies, New York State Psychiatric Institute, New York City (Basaraba, Piscitelli, Jewell, Nossel, Bello, Mascayano, Scodes, Marino, Wall, Dixon). Editor Emeritus Howard H. Goldman, M.D., Ph.D., served as decision editor on the manuscript
| | - Ilana Nossel
- Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa (Jones); Division of Behavioral Health Services and Policies, New York State Psychiatric Institute, New York City (Basaraba, Piscitelli, Jewell, Nossel, Bello, Mascayano, Scodes, Marino, Wall, Dixon). Editor Emeritus Howard H. Goldman, M.D., Ph.D., served as decision editor on the manuscript
| | - Iruma Bello
- Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa (Jones); Division of Behavioral Health Services and Policies, New York State Psychiatric Institute, New York City (Basaraba, Piscitelli, Jewell, Nossel, Bello, Mascayano, Scodes, Marino, Wall, Dixon). Editor Emeritus Howard H. Goldman, M.D., Ph.D., served as decision editor on the manuscript
| | - Franco Mascayano
- Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa (Jones); Division of Behavioral Health Services and Policies, New York State Psychiatric Institute, New York City (Basaraba, Piscitelli, Jewell, Nossel, Bello, Mascayano, Scodes, Marino, Wall, Dixon). Editor Emeritus Howard H. Goldman, M.D., Ph.D., served as decision editor on the manuscript
| | - Jennifer Scodes
- Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa (Jones); Division of Behavioral Health Services and Policies, New York State Psychiatric Institute, New York City (Basaraba, Piscitelli, Jewell, Nossel, Bello, Mascayano, Scodes, Marino, Wall, Dixon). Editor Emeritus Howard H. Goldman, M.D., Ph.D., served as decision editor on the manuscript
| | - Leslie Marino
- Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa (Jones); Division of Behavioral Health Services and Policies, New York State Psychiatric Institute, New York City (Basaraba, Piscitelli, Jewell, Nossel, Bello, Mascayano, Scodes, Marino, Wall, Dixon). Editor Emeritus Howard H. Goldman, M.D., Ph.D., served as decision editor on the manuscript
| | - Melanie Wall
- Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa (Jones); Division of Behavioral Health Services and Policies, New York State Psychiatric Institute, New York City (Basaraba, Piscitelli, Jewell, Nossel, Bello, Mascayano, Scodes, Marino, Wall, Dixon). Editor Emeritus Howard H. Goldman, M.D., Ph.D., served as decision editor on the manuscript
| | - Lisa B Dixon
- Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa (Jones); Division of Behavioral Health Services and Policies, New York State Psychiatric Institute, New York City (Basaraba, Piscitelli, Jewell, Nossel, Bello, Mascayano, Scodes, Marino, Wall, Dixon). Editor Emeritus Howard H. Goldman, M.D., Ph.D., served as decision editor on the manuscript
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Bao Y, Li Y, Jeng PJ, Scodes J, Papp MA, Humensky JL, Wall M, Lee R, Ancker JS, Pincus HA, Smith TE, Dixon LB. Design of a Payment Decision-Support Tool for Coordinated Specialty Care for Early Psychosis. Psychiatr Serv 2021; 72:180-185. [PMID: 33267653 PMCID: PMC8317229 DOI: 10.1176/appi.ps.202000129] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
A strengthened evidence base and earmarked federal funding have spurred the implementation of coordinated specialty care (CSC) for people experiencing early psychosis. However, existing funding mechanisms are insufficient and unsustainable to support population-wide deployment of CSC. This article describes the design framework of an innovative payment model for CSC that includes a bundled case rate payment and an optional outcome-based payment. To assist CSC payer and provider organizations in designing payment systems tailored to local preferences and circumstances, the research team is developing a decision-support tool that allows users to define design choices and provide input. The authors document the analytical algorithms underlying the tool and discuss how it could be further developed or expanded for CSC and other behavioral health interventions that feature an interdisciplinary team of clinicians and nonclinical professionals, public education and outreach, patient centeredness, and a recovery orientation.
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Affiliation(s)
- Yuhua Bao
- Department of Population Health Sciences (Bao, Jeng, Papp, Ancker) and Department of Psychiatry (Bao), Weill Cornell Medicine, New York City; Department of Population Health Science and Policy and Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York City (Li); New York State Psychiatric Institute, New York City (Scodes, Humensky, Wall, Pincus, Smith, Dixon); Department of Psychiatry, Irving Medical Center (Scodes, Humensky, Wall, Pincus, Smith, Dixon), and Department of Biostatistics, Mailman School of Public Health (Wall), Columbia University, New York City; Silberman School of Social Work at Hunter College, City University of New York, New York City (Lee)
| | - Yan Li
- Department of Population Health Sciences (Bao, Jeng, Papp, Ancker) and Department of Psychiatry (Bao), Weill Cornell Medicine, New York City; Department of Population Health Science and Policy and Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York City (Li); New York State Psychiatric Institute, New York City (Scodes, Humensky, Wall, Pincus, Smith, Dixon); Department of Psychiatry, Irving Medical Center (Scodes, Humensky, Wall, Pincus, Smith, Dixon), and Department of Biostatistics, Mailman School of Public Health (Wall), Columbia University, New York City; Silberman School of Social Work at Hunter College, City University of New York, New York City (Lee)
| | - Philip J Jeng
- Department of Population Health Sciences (Bao, Jeng, Papp, Ancker) and Department of Psychiatry (Bao), Weill Cornell Medicine, New York City; Department of Population Health Science and Policy and Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York City (Li); New York State Psychiatric Institute, New York City (Scodes, Humensky, Wall, Pincus, Smith, Dixon); Department of Psychiatry, Irving Medical Center (Scodes, Humensky, Wall, Pincus, Smith, Dixon), and Department of Biostatistics, Mailman School of Public Health (Wall), Columbia University, New York City; Silberman School of Social Work at Hunter College, City University of New York, New York City (Lee)
| | - Jennifer Scodes
- Department of Population Health Sciences (Bao, Jeng, Papp, Ancker) and Department of Psychiatry (Bao), Weill Cornell Medicine, New York City; Department of Population Health Science and Policy and Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York City (Li); New York State Psychiatric Institute, New York City (Scodes, Humensky, Wall, Pincus, Smith, Dixon); Department of Psychiatry, Irving Medical Center (Scodes, Humensky, Wall, Pincus, Smith, Dixon), and Department of Biostatistics, Mailman School of Public Health (Wall), Columbia University, New York City; Silberman School of Social Work at Hunter College, City University of New York, New York City (Lee)
| | - Michelle A Papp
- Department of Population Health Sciences (Bao, Jeng, Papp, Ancker) and Department of Psychiatry (Bao), Weill Cornell Medicine, New York City; Department of Population Health Science and Policy and Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York City (Li); New York State Psychiatric Institute, New York City (Scodes, Humensky, Wall, Pincus, Smith, Dixon); Department of Psychiatry, Irving Medical Center (Scodes, Humensky, Wall, Pincus, Smith, Dixon), and Department of Biostatistics, Mailman School of Public Health (Wall), Columbia University, New York City; Silberman School of Social Work at Hunter College, City University of New York, New York City (Lee)
| | - Jennifer L Humensky
- Department of Population Health Sciences (Bao, Jeng, Papp, Ancker) and Department of Psychiatry (Bao), Weill Cornell Medicine, New York City; Department of Population Health Science and Policy and Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York City (Li); New York State Psychiatric Institute, New York City (Scodes, Humensky, Wall, Pincus, Smith, Dixon); Department of Psychiatry, Irving Medical Center (Scodes, Humensky, Wall, Pincus, Smith, Dixon), and Department of Biostatistics, Mailman School of Public Health (Wall), Columbia University, New York City; Silberman School of Social Work at Hunter College, City University of New York, New York City (Lee)
| | - Melanie Wall
- Department of Population Health Sciences (Bao, Jeng, Papp, Ancker) and Department of Psychiatry (Bao), Weill Cornell Medicine, New York City; Department of Population Health Science and Policy and Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York City (Li); New York State Psychiatric Institute, New York City (Scodes, Humensky, Wall, Pincus, Smith, Dixon); Department of Psychiatry, Irving Medical Center (Scodes, Humensky, Wall, Pincus, Smith, Dixon), and Department of Biostatistics, Mailman School of Public Health (Wall), Columbia University, New York City; Silberman School of Social Work at Hunter College, City University of New York, New York City (Lee)
| | - Rufina Lee
- Department of Population Health Sciences (Bao, Jeng, Papp, Ancker) and Department of Psychiatry (Bao), Weill Cornell Medicine, New York City; Department of Population Health Science and Policy and Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York City (Li); New York State Psychiatric Institute, New York City (Scodes, Humensky, Wall, Pincus, Smith, Dixon); Department of Psychiatry, Irving Medical Center (Scodes, Humensky, Wall, Pincus, Smith, Dixon), and Department of Biostatistics, Mailman School of Public Health (Wall), Columbia University, New York City; Silberman School of Social Work at Hunter College, City University of New York, New York City (Lee)
| | - Jessica S Ancker
- Department of Population Health Sciences (Bao, Jeng, Papp, Ancker) and Department of Psychiatry (Bao), Weill Cornell Medicine, New York City; Department of Population Health Science and Policy and Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York City (Li); New York State Psychiatric Institute, New York City (Scodes, Humensky, Wall, Pincus, Smith, Dixon); Department of Psychiatry, Irving Medical Center (Scodes, Humensky, Wall, Pincus, Smith, Dixon), and Department of Biostatistics, Mailman School of Public Health (Wall), Columbia University, New York City; Silberman School of Social Work at Hunter College, City University of New York, New York City (Lee)
| | - Harold Alan Pincus
- Department of Population Health Sciences (Bao, Jeng, Papp, Ancker) and Department of Psychiatry (Bao), Weill Cornell Medicine, New York City; Department of Population Health Science and Policy and Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York City (Li); New York State Psychiatric Institute, New York City (Scodes, Humensky, Wall, Pincus, Smith, Dixon); Department of Psychiatry, Irving Medical Center (Scodes, Humensky, Wall, Pincus, Smith, Dixon), and Department of Biostatistics, Mailman School of Public Health (Wall), Columbia University, New York City; Silberman School of Social Work at Hunter College, City University of New York, New York City (Lee)
| | - Thomas E Smith
- Department of Population Health Sciences (Bao, Jeng, Papp, Ancker) and Department of Psychiatry (Bao), Weill Cornell Medicine, New York City; Department of Population Health Science and Policy and Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York City (Li); New York State Psychiatric Institute, New York City (Scodes, Humensky, Wall, Pincus, Smith, Dixon); Department of Psychiatry, Irving Medical Center (Scodes, Humensky, Wall, Pincus, Smith, Dixon), and Department of Biostatistics, Mailman School of Public Health (Wall), Columbia University, New York City; Silberman School of Social Work at Hunter College, City University of New York, New York City (Lee)
| | - Lisa B Dixon
- Department of Population Health Sciences (Bao, Jeng, Papp, Ancker) and Department of Psychiatry (Bao), Weill Cornell Medicine, New York City; Department of Population Health Science and Policy and Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York City (Li); New York State Psychiatric Institute, New York City (Scodes, Humensky, Wall, Pincus, Smith, Dixon); Department of Psychiatry, Irving Medical Center (Scodes, Humensky, Wall, Pincus, Smith, Dixon), and Department of Biostatistics, Mailman School of Public Health (Wall), Columbia University, New York City; Silberman School of Social Work at Hunter College, City University of New York, New York City (Lee)
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23
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Shulman M, Choo TH, Scodes J, Pavlicova M, Wai J, Haenlein P, Tofighi B, Campbell ANC, Lee JD, Rotrosen J, Nunes EV. Association between methadone or buprenorphine use during medically supervised opioid withdrawal and extended-release injectable naltrexone induction failure. J Subst Abuse Treat 2021; 124:108292. [PMID: 33771287 DOI: 10.1016/j.jsat.2021.108292] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 01/13/2021] [Accepted: 01/13/2021] [Indexed: 01/04/2023]
Abstract
BACKGROUND Extended-release naltrexone (XR-NTX) is an effective maintenance treatment for opioid use disorder, but induction from active opioid use is a challenge as individuals must complete detoxification before induction. We aimed to determine whether use of methadone or buprenorphine, long acting agonist opioids commonly used for detoxification, were associated with decreased likelihood of induction onto XR-NTX. METHODS We performed a secondary analysis of a large open-label randomized trial of buprenorphine versus XR-NTX for treatment of individuals with opioid use disorder recruited from eight short term residential (detoxification) units. This analysis only included individuals randomized to the XR-NTX arm of the trial (N = 283). The method of detoxification varied according to usual practices at each inpatient program. Logistic regression models estimating the log-odds of induction onto XR-NTX were fit, with detoxification regimen received as the predictor. RESULTS In the unadjusted logistic regression model, detoxification drug received (either methadone or buprenorphine) was significantly associated with decreased likelihood of induction onto XR-NTX compared to receiving non-opioid detoxification (Overall: P < 0.001); buprenorphine vs non-opioid detoxification: OR (95% CI) = 0.32 (0.15-0.67); methadone vs non-opioid detoxification: OR (95% CI) = 0.23 (0.11-0.46). After controlling for site as a random effect, the association of detoxification drug with induction success lost statistical significance. CONCLUSIONS Use of agonist medication during detoxification was associated with XR-NTX induction failure. Medication choice was determined by each site's clinical practice and therefore this association could not be separated from other site level variables. CLINICAL TRIAL REGISTRATION NCT02032433.
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Affiliation(s)
- Matisyahu Shulman
- New York State Psychiatric Institute, United States of America; Department of Psychiatry, Columbia University Medical Center, United States of America.
| | - Tse-Hwei Choo
- New York State Psychiatric Institute, United States of America
| | - Jennifer Scodes
- New York State Psychiatric Institute, United States of America
| | - Martina Pavlicova
- Department of Biostatistics, Mailman School of Public Health, Columbia University, United States of America
| | - Jonathan Wai
- New York State Psychiatric Institute, United States of America; Department of Psychiatry, Columbia University Medical Center, United States of America
| | - Patrick Haenlein
- Department of Psychiatry, Columbia University Medical Center, United States of America
| | - Babak Tofighi
- Department of Population Health, New York University, United States of America
| | - Aimee N C Campbell
- New York State Psychiatric Institute, United States of America; Department of Psychiatry, Columbia University Medical Center, United States of America
| | - Joshua D Lee
- Department of Population Health, New York University, United States of America
| | - John Rotrosen
- Department of Psychiatry, New York University School of Medicine, United States of America
| | - Edward V Nunes
- New York State Psychiatric Institute, United States of America; Department of Psychiatry, Columbia University Medical Center, United States of America
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24
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Kerner N, Cohen H, Scodes J, Bell S, Goldberg TE, Westwood A, Devanand DP. Understanding the effect of fatigue on the association between sleep disturbances and cognitive function ability among cognitively impaired older adults. Alzheimers Dement 2020. [DOI: 10.1002/alz.040590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Nancy Kerner
- Columbia University New York NY USA
- New York State Psychiatric Institute New York NY USA
| | - Hannah Cohen
- New York State Psychiatric Institute New York NY USA
| | | | - Sophie Bell
- New York State Psychiatric Institute New York NY USA
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25
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Fishman M, Wenzel K, Scodes J, Pavlicova M, Lee JD, Rotrosen J, Nunes E. Young Adults Have Worse Outcomes Than Older Adults: Secondary Analysis of a Medication Trial for Opioid Use Disorder. J Adolesc Health 2020; 67:778-785. [PMID: 32873500 PMCID: PMC7683373 DOI: 10.1016/j.jadohealth.2020.07.038] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [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: 05/23/2020] [Revised: 07/17/2020] [Accepted: 07/23/2020] [Indexed: 12/15/2022]
Abstract
PURPOSE Young adults are disproportionately affected by the current opioid crisis. Although medications for opioid use disorder are broadly effective, with reductions in morbidity and mortality, the particular effectiveness of medications for opioid use disorder among young adults is less well understood. METHODS This secondary analysis compared young adults (aged 18-25 years) with older adults (aged ≥26 years) in a large comparative effectiveness trial ("XBOT") that randomized subjects to extended-release naltrexone or sublingual buprenorphine-naloxone for 6 months. Opioid relapse was defined by opioid use over four consecutive weeks or seven consecutive days, using urine testing and self-report. RESULTS Among subjects in the intention-to-treat sample (n = 570, all randomized participants), a main effect of age group was found, with higher relapse rates among young adults (70.3%) compared with older adults (58.2%), with an odds ratio of 1.72 (95% confidence interval = 1.08-2.70), p = .02. In the per-protocol sample (n = 474, only participants who started medication), relapse rates were higher among young adults (66.3%) compared with older adults (50.8%), with an odds ratio of 1.91 (95% confidence interval = 1.19-3.06). Among the intention-to-treat sample, survival analysis revealed a significant time-by-age group interaction (p = .01) with more relapse over time in young adults. No significant interactions between age and medication group were detected. CONCLUSIONS Young adults have increased rates of relapse compared with older adults, perhaps because of vulnerabilities that increase their risk for treatment dropout and medication nonadherence, regardless of medication assignment. These results suggest that specialized, developmentally informed interventions may be needed to improve retention and successful treatment of opioid use disorder among young adults.
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Affiliation(s)
- Marc Fishman
- Mountain Manor Treatment Center/Maryland Treatment Centers, Baltimore, Maryland; Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland.
| | - Kevin Wenzel
- Mountain Manor Treatment Center/Maryland Treatment Centers 3800 Frederick Ave, Baltimore, MD 21229 USA,Corresponding Author. Marc Fishman. Phone: +1-410-233-1400. Fax: 410-233-0009
| | - Jennifer Scodes
- New York State Psychiatric Institute Division of Mental Health Data Science 1051 Riverside Dr., NY, NY 10032 USA
| | - Martina Pavlicova
- NYU Grossman School of Medicine Department of Psychiatry 1 Park Ave, NY, NY 10016 USA
| | - Joshua D Lee
- NYU Grossman School of Medicine Department of Psychiatry 1 Park Ave, NY, NY 10016 USA
| | - John Rotrosen
- NYU Grossman School of Medicine Department of Psychiatry 1 Park Ave, NY, NY 10016 USA
| | - Edward Nunes
- Columbia University Mailman School of Public Health, Department of Biostatistics 722 West 168th St. NY, NY 10032 USA
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26
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Haeny AM, Montgomery L, Burlew AK, Campbell ANC, Scodes J, Pavlicova M, Rotrosen J, Nunes E. Extended-release naltrexone versus buprenorphine-naloxone to treat opioid use disorder among black adults. Addict Behav 2020; 110:106514. [PMID: 32619868 PMCID: PMC7433932 DOI: 10.1016/j.addbeh.2020.106514] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Revised: 05/16/2020] [Accepted: 06/12/2020] [Indexed: 10/24/2022]
Abstract
Few studies examine the effectiveness of treatments for opioid use disorder (OUD) among Black individuals despite recent evidence suggesting opioid overdose death rates are, in some cases, highest and increasing at a faster rate among Black people compared to other racial/ethnic groups. This secondary analysis study investigated treatment preference, retention, and relapse rates amongst a subgroup of 73 Black participants with OUD (81% male, mean age 39.05, SD = 11.80) participating in a 24-week multisite randomized clinical trial ("X:BOT") comparing the effectiveness of extended-release naltrexone (XR-NTX) and sublingual buprenorphine-naloxone (BUP-NX) between 2014 and 2017. Chi-square analyses were used to investigate treatment preference assessed at baseline, and logistic regression analyses were used to investigate differences in the odds of retention and relapse assessed over the 24-week course of treatment between treatment groups. Our findings suggest no differences in preference for XR-NTX versus BUP-NX. However, similar to the parent trial, there was an induction hurdle such that only 59.5% of those randomized to XR-NTX successfully initiated medication compared to 91.6% of those randomized to BUP-NX (OR = 0.13, 95% CI = 0.04, 0.52). No significant differences were found in treatment retention (intention-to-treat: OR = 1.19, 95% CI = 0.43, 3.28; per-protocol [i.e., those who initiated medication]: OR = 0.60, 95% CI = 0.20, 1.82) or relapse rates between treatment groups (intention-to-treat: OR = 1.53, 95% CI = 0.57, 4.13; per-protocol: OR = 0.69, 95% CI = 0.23, 2.06). Although there is a significant initiation hurdle with XR-NTX, once inducted, both medications appear similar in effectiveness, but as in the main study, dropout rates were high. Future research is needed on how to improve adherence.
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Affiliation(s)
- Angela M Haeny
- Yale School of Medicine, Department of Psychiatry, 34 Park St., New Haven, CT 06511, United States.
| | - LaTrice Montgomery
- University of Cincinnati, Department of Psychiatry and Behavioral Neuroscience, 3131 Harvey Avenue., Cincinnati, OH 45229, United States
| | - A Kathleen Burlew
- University of Cincinnati, Department of Psychology, 2600 Clifton Ave., Cincinnati, OH 45221, United States
| | - Aimee N C Campbell
- Columbia University Irving Medical Center, Department of Psychiatry and New York State Psychiatric Institute, 1051 Riverside Dr., New York, NY 10032, United States
| | - Jennifer Scodes
- Columbia University Irving Medical Center, Department of Psychiatry and New York State Psychiatric Institute, 1051 Riverside Dr., New York, NY 10032, United States
| | - Martina Pavlicova
- Columbia University Irving Medical Center, Department of Psychiatry and New York State Psychiatric Institute, 1051 Riverside Dr., New York, NY 10032, United States
| | - John Rotrosen
- New York University Grossman School of Medicine, One Park Ave., New York, NY 10016, United States
| | - Edward Nunes
- Columbia University Irving Medical Center, Department of Psychiatry and New York State Psychiatric Institute, 1051 Riverside Dr., New York, NY 10032, United States
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27
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Marino L, Scodes J, Ngo H, Nossel I, Bello I, Wall M, Dixon L. Determinants of pathways to care among young adults with early psychosis entering a coordinated specialty care program. Early Interv Psychiatry 2020; 14:544-552. [PMID: 31502409 DOI: 10.1111/eip.12877] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 08/05/2019] [Accepted: 08/25/2019] [Indexed: 02/03/2023]
Abstract
AIM To describe the characteristics of the pathway to coordinated specialty care for young adults with early psychosis in the United States, to examine how various factors correlate with the duration of untreated psychosis (DUP), and to explore factors associated with time from onset of symptoms to first mental health service contact (help-seeking DUP). METHODS The sample included 779 individuals ages 16 to 30 with recent-onset non-affective psychosis enrolled in OnTrackNY. Domains assessed included demographics, clinical characteristics, mental health service utilization and characteristics of the pathway to care. Primary outcomes included the time from onset of psychotic symptoms to admission to OnTrackNY (DUP) and time from onset of psychotic symptoms to first mental health service contact (help-seeking DUP). RESULTS The mean DUP was 231.2 days (SD = 87.7, median = 169) and mean help-seeking DUP was 73.7 days (SD = 110.8, median = 27). Being in school, better social functioning, and greater number of ER visits or hospitalizations were associated with shorter DUP. Violent ideation or behaviour and having an outpatient mental health visit as the first service contact or hallucinations as the reason for first service contact were significantly associated with longer DUP. Only the type of first service contact (outpatient mental health treatment or other non-mental health service provider) and having hallucinations as the clinical reason for the first service contact were associated with help-seeking DUP. CONCLUSIONS Referral delays were longer than help-seeking delays. Strategies to reduce treatment referral delays through systems-level interventions may be most likely to reduce the overall DUP in this population.
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Affiliation(s)
- Leslie Marino
- New York State Psychiatric Institute, New York, New York
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York
| | - Jennifer Scodes
- New York State Psychiatric Institute, New York, New York
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York
| | - Hong Ngo
- New York State Psychiatric Institute, New York, New York
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York
| | - Ilana Nossel
- New York State Psychiatric Institute, New York, New York
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York
| | - Iruma Bello
- New York State Psychiatric Institute, New York, New York
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York
| | - Melanie Wall
- New York State Psychiatric Institute, New York, New York
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York
| | - Lisa Dixon
- New York State Psychiatric Institute, New York, New York
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York
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28
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Randesi M, Rotrosen J, Nunes EV, Lee JD, Novo P, Levran O, Ott J, Pavlicova M, Scodes J, Kreek MJ. Variants of opioid genes and response to treatment of opioid use disorder with buprenorphine-naloxone versus extended-release naltrexone in Caucasians. Am J Drug Alcohol Abuse 2020; 46:761-768. [PMID: 32851876 DOI: 10.1080/00952990.2020.1797064] [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] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Background: Sublingual buprenorphine-naloxone (BUP-NX), an FDA-approved treatment for opioid use disorder (OUD), combines buprenorphine (a partial mu/kappa agonist) with naloxone (a mu/ kappa antagonist). Extended-release injection naltrexone (XR-NTX; a mu receptor antagonist and kappa receptor partial agonist) is also an FDA-approved treatment for OUD. However, while some patients respond well to these medications, many others leave treatment and relapse. Objectives: Determine whether gene variants in the opioid gene system are associated with better or worse treatment response. Methods: In a 24-week, multisite, randomized, comparative effectiveness trial of daily, sublingual self-administration of BUP-NX versus monthly injection of XR-NTX conducted in the National Drug Abuse Clinical Trials Network, DNA was collected and four opioid gene variants were evaluated: (1) mu opioid receptor 118A>G; (2) 68-bp repeat in prodynorphin; (3) prodynorphin SNP rs910080; and (4) kappa opioid receptor SNP rs6473797. In non-Hispanic Caucasians (N = 334), two outcomes measures were assessed: received first dose (yes/no) and received last dose (yes/no). Separate logistic regressions were used to model each outcome measure as a function of treatment (XR-NTX vs BUP-NX), each gene variant, and their interaction. Results: There were no significant main effects of gene variant on receiving first dose or last dose. There were also no significant gene variant by treatment interactions. Conclusions: The outcome of treatment of OUD with medications is likely a complex function of multiple factors, including environmental, psychosocial, and possibly genetic, such that major effects of genetic variants may be unlikely.
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Affiliation(s)
- Matthew Randesi
- Laboratory of the Biology of Addictive Diseases, the Rockefeller University , New York, NY, USA
| | - John Rotrosen
- Department of Psychiatry, NYU Grossman School of Medicine , New York, NY, USA
| | - Edward V Nunes
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University Medical Center , New York, NY, USA
| | - Joshua D Lee
- Department of Population Health, NYU Grossman School of Medicine , New York, NY, USA
| | - Patricia Novo
- Department of Psychiatry, NYU Grossman School of Medicine , New York, NY, USA
| | - Orna Levran
- Laboratory of the Biology of Addictive Diseases, the Rockefeller University , New York, NY, USA
| | - Jurg Ott
- Laboratory of Statistical Genetics, the Rockefeller University , New York, NY, USA
| | - Martina Pavlicova
- Department of Biostatistics, Columbia University Mailman School of Public Health , New York, NY, USA
| | - Jennifer Scodes
- Division of Mental Health Data Science, New York State Psychiatric Institute , New York, NY, USA
| | - Mary Jeanne Kreek
- Laboratory of the Biology of Addictive Diseases, the Rockefeller University , New York, NY, USA
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29
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van der Ven E, Scodes J, Basaraba C, Pauselli L, Mascayano F, Nossel I, Bello I, Humensky J, Susser E, Wall M, Dixon L. Trajectories of occupational and social functioning in people with recent-onset non-affective psychosis enrolled in specialized early intervention services across New York state. Schizophr Res 2020; 222:218-226. [PMID: 32513547 PMCID: PMC8273912 DOI: 10.1016/j.schres.2020.05.051] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 04/03/2020] [Accepted: 05/19/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Despite the benefits of early intervention services for the initial stages of psychosis ongoing impairments in functioning are common. AIMS To identify 1-year trajectories of occupational and social functioning in individuals enrolled in OnTrackNY, a statewide program offering early intervention services for recent-onset psychosis in community settings. METHOD We included 937 persons with recent-onset psychosis enrolled at 19 programs across New York State. Demographic, social and clinical data was collected at program entry and at 3, 6, 9 and 12 months. We used growth mixture models to identify occupational and social functioning trajectories and examined the association between trajectory class, baseline factors and symptoms during 1-year follow-up. RESULTS Four distinct trajectory classes of occupational and social functioning were identified. The converging (58.0%) class had disparate levels of functioning at baseline (low occupational, higher social) which eventually converged. The other classes had high-stable (14.8%), moderate-stable (17.8%) and low-improving (9.4%) trajectories. Female gender, educational attainment and private insurance status were significantly associated with the trajectory characterized by higher functioning, while living alone, homelessness, a longer period from psychosis onset to program enrollment, a schizophrenia diagnosis and cannabis use at enrollment were associated with the poorest trajectory. The differences in severity of symptoms by trajectory class diminished over time. CONCLUSIONS Trajectories of occupational and social functioning showed substantial variation, but overall, remained stable or improved during 1-year follow-up. The relationship between symptoms and occupational and social functioning attenuated after the acute treatment phase.
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Affiliation(s)
- Els van der Ven
- Mailman School of Public Health, Columbia University, New York, NY, USA; School for Mental Health and Neuroscience (MHeNS), Maastricht University, Maastricht, the Netherlands.
| | - Jennifer Scodes
- Mental Health Data Science, Columbia University, New York, NY, USA,New York State Psychiatric Institute, New York, NY, USA
| | - Cale Basaraba
- Mental Health Data Science, Columbia University, New York, NY, USA,New York State Psychiatric Institute, New York, NY, USA
| | - Luca Pauselli
- New York State Psychiatric Institute, New York, NY, USA,Division of Behavioral Health Services and Policy Research, Columbia University, New York, NY, USA
| | - Franco Mascayano
- Mailman School of Public Health, Columbia University, New York, NY, USA,New York State Psychiatric Institute, New York, NY, USA
| | - Ilana Nossel
- New York State Psychiatric Institute, New York, NY, USA,Division of Behavioral Health Services and Policy Research, Columbia University, New York, NY, USA
| | - Iruma Bello
- New York State Psychiatric Institute, New York, NY, USA,Division of Behavioral Health Services and Policy Research, Columbia University, New York, NY, USA
| | | | - Ezra Susser
- Mailman School of Public Health, Columbia University, New York, NY, USA,New York State Psychiatric Institute, New York, NY, USA
| | - Melanie Wall
- Mailman School of Public Health, Columbia University, New York, NY, USA,New York State Psychiatric Institute, New York, NY, USA
| | - Lisa Dixon
- New York State Psychiatric Institute, New York, NY, USA,Division of Behavioral Health Services and Policy Research & Center for Practice Innovations, Columbia University, New York, NY, USA
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Marino L, Scodes J, Richkin T, Alves-Bradford JM, Nossel I, Wall M, Dixon L. Persistent cannabis use among young adults with early psychosis receiving coordinated specialty care in the United States. Schizophr Res 2020; 222:274-282. [PMID: 32473930 PMCID: PMC8237378 DOI: 10.1016/j.schres.2020.05.035] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 04/27/2020] [Accepted: 05/15/2020] [Indexed: 11/19/2022]
Abstract
Persistent cannabis use among young adults with first episode psychosis (FEP), even those receiving early intervention services, has been associated with poor outcomes. In the United States (US), Coordinated Specialty Care (CSC) has been shown to be more effective at reducing symptoms, improving quality of life and increasing involvement in work or school, compared to typical care for FEP. However, little is known about the prevalence, course and outcomes for cannabis use in this real-world, clinical setting. This study examined the prevalence, course and outcomes of cannabis use categorized into three groups: no use, reduced use, and persistent use, among a sample of 938 CSC participants enrolled for at least 1 year. Prevalence of cannabis use was 38.8% at admission and 32.8% of the sample had persistent cannabis use at 1 year. At baseline, persistent cannabis users were more likely to be male (p < .001), white, non-Hispanic and black non-Hispanic (p = .001), have worse symptoms as measured by the GAF (p < .001), increased suicidality (p = .024), violent ideation (p = .008), and legal trouble (p = .006) compared with non-users. At 1 year, persistent users maintained worse symptoms compared with non-users (p = .021) while those who reduced use had significant improvement in symptoms compared with persistent users (p = .008). This study suggests that cannabis use is common among young adults enrolled in a CSC program in the US and that persistent cannabis users may have worse outcomes while reducing cannabis use may improve outcomes. These findings highlight the potential impact of secondary prevention in this population through reduction in cannabis use.
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Affiliation(s)
- Leslie Marino
- New York State Psychiatric Institute, 1051 Riverside Drive, New York 10032, NY, USA; Department of Psychiatry, Columbia University Irving Medical Center, 1051 Riverside Drive, New York, NY, USA 10032.
| | - Jennifer Scodes
- New York State Psychiatric Institute, 1051 Riverside Drive, New York 10032, NY, USA; Department of Psychiatry, Columbia University Irving Medical Center, 1051 Riverside Drive, New York, NY, USA 10032
| | - Talia Richkin
- New York State Psychiatric Institute, 1051 Riverside Drive, New York 10032, NY, USA
| | - Jean-Marie Alves-Bradford
- New York State Psychiatric Institute, 1051 Riverside Drive, New York 10032, NY, USA; Department of Psychiatry, Columbia University Irving Medical Center, 1051 Riverside Drive, New York, NY, USA 10032
| | - Ilana Nossel
- New York State Psychiatric Institute, 1051 Riverside Drive, New York 10032, NY, USA; Department of Psychiatry, Columbia University Irving Medical Center, 1051 Riverside Drive, New York, NY, USA 10032
| | - Melanie Wall
- New York State Psychiatric Institute, 1051 Riverside Drive, New York 10032, NY, USA; Department of Psychiatry, Columbia University Irving Medical Center, 1051 Riverside Drive, New York, NY, USA 10032
| | - Lisa Dixon
- New York State Psychiatric Institute, 1051 Riverside Drive, New York 10032, NY, USA; Department of Psychiatry, Columbia University Irving Medical Center, 1051 Riverside Drive, New York, NY, USA 10032
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31
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Knox J, Scodes J, Witkiewitz K, Kranzler HR, Mann K, O'Malley SS, Wall M, Anton R, Hasin DS. Reduction in World Health Organization Risk Drinking Levels and Cardiovascular Disease. Alcohol Clin Exp Res 2020; 44:1625-1635. [PMID: 32619058 DOI: 10.1111/acer.14386] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [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: 01/15/2020] [Accepted: 05/17/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Reductions in World Health Organization (WHO) risk drinking levels have recently been shown to lower the risk of multiple adverse health outcomes, but prior work has not examined reductions in WHO risk drinking levels in relation to cardiovascular disease (CVD), the leading cause of death for men and women in the United States and of global mortality. This study examined associations between reductions in WHO risk drinking levels and subsequent risk for CVD. METHODS In a US national survey, 1,058 very-high-risk and high-risk drinkers participated in Wave 1 interviews (2001 to 2002) and Wave 2 follow-ups (2004 to 2005). Self-reported CVD history that was communicated to the participant by a doctor or other healthcare professionals included arteriosclerosis, hypertension, angina, tachycardia, or myocardial infarction. We used logistic regression to estimate adjusted odds ratios (aOR) evaluating relationships between ≥2-level reductions in WHO risk drinking levels from Wave 1 to Wave 2 and the risk of Wave 2 CVD, controlling for baseline characteristics. RESULTS Reductions of ≥2 WHO risk drinking levels were associated with significantly lower odds of CVD in individuals who at Wave 1 were very-high-risk (aOR = 0.58 [0.41 to 0.80]) or high-risk drinkers (aOR = 0.81 [0.70 to 0.94]). Interaction terms showed that this relationship varied by age. Among individuals >40 years old at Wave 1, reductions of ≥2 WHO risk drinking levels were associated with significantly lower odds of CVD among very-high-risk drinkers (aOR = 0.42 [0.28 to 0.63]) but not high-risk drinkers (p = 0.50). Among individuals ≤40 years old at Wave 1, reductions of ≥2 WHO risk drinking levels were associated with significantly lower odds of CVD among high-risk drinkers (aOR = 0.50 [0.37 to 0.69]) but not very-high-risk drinkers (p = 0.27). CONCLUSIONS These results show that reductions in WHO risk drinking levels are associated with reduced CVD risk among very-high-risk and high-risk drinkers in the US general population, and provide further evidence that reducing high levels of drinking provides important benefit across multiple clinical domains.
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Affiliation(s)
- Justin Knox
- Columbia University Mailman School of Public Health, New York, New York.,New York State Psychiatric Institute, New York, New York
| | | | - Katie Witkiewitz
- Department of Psychology, University of New Mexico, Albuquerque, New Mexico
| | - Henry R Kranzler
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.,Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania
| | - Karl Mann
- Department of Addictive Behavior and Addiction Medicine, Medical Faculty Mannheim, Central Institute of Mental Health, Heidelberg University, Mannheim, Germany
| | | | - Melanie Wall
- Columbia University Mailman School of Public Health, New York, New York.,New York State Psychiatric Institute, New York, New York
| | - Raymond Anton
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - Deborah S Hasin
- Columbia University Mailman School of Public Health, New York, New York.,New York State Psychiatric Institute, New York, New York
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32
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Barbosa-Leiker C, Campbell ANC, Pavlicova M, Scodes J, Burlew AK, Hatch-Maillette M, Mennenga SE, Mitchell SG, Novo P, Nunes EV, Rotrosen J, Greenfield SF. Substance Use and Mental Health in Emerging Adult Vs Older Adult Men and Women With Opioid Use Disorder. Am J Addict 2020; 29:536-542. [PMID: 32438502 DOI: 10.1111/ajad.13059] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 03/20/2020] [Accepted: 05/02/2020] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND AND OBJECTIVES We examined age differences across genders in clinical characteristics in emerging adult (≤25 years) vs older adult patients (26+ years) with opioid use disorder (OUD). METHODS Participants (N = 570; 30% female) entering a comparative effectiveness medication trial of buprenorphine vs extended-release naltrexone. RESULTS Differences in clinical characteristics in emerging adult vs older participants were similar across genders. However, women 26+ years reported more mental health problems compared with women ≤25, while men ≤25 years reported more mental health problems compared with men 26+ years. DISCUSSION AND CONCLUSION Different strategies for emerging adult and older patients seeking OUD treatment may be necessary to address psychiatric comorbidities that differ across genders in this population. SCIENTIFIC SIGNIFICANCE Comprehensive psychiatric assessment should be systematically included in OUD treatment for all genders. Treatment should focus on the emerging adult developmental phase when appropriate, with psychiatric treatment tailored for women and men, separately, across the lifespan. (Am J Addict 2020;29:536-542).
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Affiliation(s)
- Celestina Barbosa-Leiker
- College of Nursing, Washington State University, Spokane, Washington.,Program of Excellence in Addictions Research, Washington State University, Spokane, Washington
| | - Aimee N C Campbell
- Department of Psychiatry, Columbia University Irving Medical Center and New York State Psychiatric Institute, New York, New York
| | - Martina Pavlicova
- Department of Biostatistics, Columbia University Mailman School of Public Health, New York, New York
| | - Jennifer Scodes
- Division of Mental Health Data Science, New York State Psychiatric Institute, New York, New York
| | | | - Mary Hatch-Maillette
- Department of Psychiatry and Behavioral Sciences, Alcohol and Drug Abuse Institute, University of Washington, Seattle, Washington
| | - Sarah E Mennenga
- Department of Psychiatry, New York University Grossman School of Medicine, New York, New York
| | | | - Patricia Novo
- Department of Psychiatry, New York University Grossman School of Medicine, New York, New York
| | - Edward V Nunes
- Department of Psychiatry, Columbia University Irving Medical Center and New York State Psychiatric Institute, New York, New York
| | - John Rotrosen
- Department of Psychiatry, New York University Grossman School of Medicine, New York, New York
| | - Shelly F Greenfield
- Department of Psychiatry, Harvard Medical School, McLean Hospital, Belmont, Massachusetts
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33
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Humensky JL, Bello I, Malinovsky I, Nossel I, Patel S, Jones G, Cabassa LJ, Radigan M, Sobeih T, Tobey C, Basaraba C, Scodes J, Smith T, Wall M, Labouliere C, Stanley B, Dixon LB. OnTrackNY's learning healthcare system. J Clin Transl Sci 2020; 4:301-306. [PMID: 33244410 PMCID: PMC7681143 DOI: 10.1017/cts.2020.35] [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] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Revised: 03/13/2020] [Accepted: 03/28/2020] [Indexed: 11/09/2022] Open
Abstract
Worldwide, early intervention services for young people with recent-onset psychosis have been associated with improvements in outcomes, including reductions in hospitalization, symptoms, and improvements in treatment engagement and work/school participation. States have received federal mental health block grant funding to implement team-based, multi-element, evidence-based early intervention services, now called coordinated specialty care (CSC) in the USA. New York State's CSC program, OnTrackNY, has grown into a 23-site, statewide network, serving over 1800 individuals since its 2013 inception. A state-supported intermediary organization, OnTrackCentral, has overseen the growth of OnTrackNY. OnTrackNY has been committed to quality improvement since its inception. In 2019, OnTrackNY was awarded a regional hub within the National Institute of Mental Health-sponsored Early Psychosis Intervention Network (EPINET). The participation in the national EPINET initiative reframes and expands OnTrackNY's quality improvement activities. The national EPINET initiative aims to develop a learning healthcare system (LHS); OnTrackNY's participation will facilitate the development of infrastructure, including a systematic approach to facilitating stakeholder input and enhancing the data and informatics infrastructure to promote quality improvement. Additionally, this infrastructure will support practice-based research to improve care. The investment of the EPINET network to build regional and national LHSs will accelerate innovations to improve quality of care.
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Affiliation(s)
- Jennifer L. Humensky
- Division of Behavioral Health Services and Policy Research, New York State Psychiatric Institute, New York, NY, USA
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
| | - Iruma Bello
- Division of Behavioral Health Services and Policy Research, New York State Psychiatric Institute, New York, NY, USA
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
| | - Igor Malinovsky
- Division of Behavioral Health Services and Policy Research, New York State Psychiatric Institute, New York, NY, USA
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
| | - Ilana Nossel
- Division of Behavioral Health Services and Policy Research, New York State Psychiatric Institute, New York, NY, USA
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
| | - Sapana Patel
- Division of Behavioral Health Services and Policy Research, New York State Psychiatric Institute, New York, NY, USA
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
| | - Genevra Jones
- Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa, FL, USA
| | | | - Marleen Radigan
- Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany, NY, USA
| | - Tarek Sobeih
- Innovative Clinical Research Solutions, Nathan Kline Institute, Orangeburg, NY, USA
| | - Caroline Tobey
- Innovative Clinical Research Solutions, Nathan Kline Institute, Orangeburg, NY, USA
| | - Cale Basaraba
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
- Mental Health Data Science, New York State Psychiatric Institute, New York, NY, USA
| | - Jennifer Scodes
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
- Mental Health Data Science, New York State Psychiatric Institute, New York, NY, USA
| | - Thomas Smith
- Division of Behavioral Health Services and Policy Research, New York State Psychiatric Institute, New York, NY, USA
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
- Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany, NY, USA
| | - Melanie Wall
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
- Mental Health Data Science, New York State Psychiatric Institute, New York, NY, USA
| | - Christa Labouliere
- Division of Behavioral Health Services and Policy Research, New York State Psychiatric Institute, New York, NY, USA
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
| | - Barbara Stanley
- Division of Behavioral Health Services and Policy Research, New York State Psychiatric Institute, New York, NY, USA
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
| | - Lisa B. Dixon
- Division of Behavioral Health Services and Policy Research, New York State Psychiatric Institute, New York, NY, USA
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
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Ruglass LM, Scodes J, Pavlicova M, Campbell ANC, Fitzpatrick S, Barbosa-Leiker C, Burlew K, Greenfield SF, Rotrosen J, Nunes EV. Trajectory classes of opioid use among individuals in a randomized controlled trial comparing extended-release naltrexone and buprenorphine-naloxone. Drug Alcohol Depend 2019; 205:107649. [PMID: 31704382 PMCID: PMC6990451 DOI: 10.1016/j.drugalcdep.2019.107649] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Revised: 09/01/2019] [Accepted: 09/10/2019] [Indexed: 01/03/2023]
Abstract
OBJECTIVES To advance our understanding of medication treatments for opioid use disorders (OUDs), identification of distinct subgroups and factors associated with differential treatment response is critical. We examined trajectories of opioid use for patients with OUD who were randomized to (but not in all cases inducted onto) buprenorphine-naloxone (BUP-NX) or extended-release naltrexone (XR-NTX), and identified characteristics associated with each trajectory. METHODS Growth mixture models (GMMs) were run to identify distinct trajectories of days of opioid use among a subsample of 535 individuals with OUD who participated in a 24-week randomized controlled trial (RCT; 2014-2016) of BUP-NX (n = 281) or XR-NTX (n = 254). RESULTS Four distinct opioid use trajectory classes were identified for BUP-NX (near abstinent/no use (59%); low use (13.2%); low use, increasing over time (15%); and moderate use, increasing over time (12.8%)). Three distinct opioid use trajectory classes were found for XR-NTX (near abstinent/no use (59.1%); low use (14.6%); and moderate use, increasing over time (26.4%)). Across both BUP-NX and XR-NTX, the near abstinent/no use class had the highest number of medical management visits. Within BUP-NX, the low use class had a greater proportion of individuals with a previous successful treatment history compared with other classes. Within XR-NTX, the moderate use, increasing over time class had the highest proportion of Hispanic participants compared with other classes. CONCLUSIONS Findings highlight the significant heterogeneity of opioid use during a RCT of BUP-NX and XR-NTX and factors associated with opioid use patterns including medical management visits and history of treatment success.
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Affiliation(s)
| | | | | | - Aimee N. C. Campbell
- Columbia University Irving Medical Center and New York State Psychiatric Institute
| | | | | | | | | | | | - Edward V. Nunes
- Columbia University Irving Medical Center and New York State Psychiatric Institute
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Knox J, Wall M, Witkiewitz K, Kranzler HR, Falk DE, Litten R, Mann K, O’Malley SS, Scodes J, Anton R, Hasin DS. Reduction in non-abstinent World Health Organization (WHO) drinking risk levels and drug use disorders: 3-year follow-up results in the US general population. Drug Alcohol Depend 2019; 201:16-22. [PMID: 31174140 PMCID: PMC6662197 DOI: 10.1016/j.drugalcdep.2019.03.020] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 03/18/2019] [Accepted: 03/19/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND To provide information on the clinical relevance of a reduction in the World Health Organization (WHO) drinking risk categories, we examined their relationship to an important indicator of how individuals feel and function: drug use disorders (DUDs), i.e., those involving substances other than alcohol. METHOD Current drinkers in a U.S. national survey (n = 22,005) were interviewed in 2001-02 and re-interviewed 3 years later. WHO drinking risk levels and DSM-IV-defined DUD were assessed at both waves. The relationship of changes in WHO drinking risk levels to the presence of DUD were examined using adjusted odds ratios (aOR). RESULTS At Wave 1, 2.5% of respondents were WHO very-high-risk drinkers, and 2.5%, 4.8%, and 90.2% were high-risk, moderate-risk, and low-risk drinkers, respectively. Among Wave 1 very-high-risk drinkers, significantly lower odds of DUD at Wave 2 were predicted by reductions in WHO risk levels of one, two or three levels (aOR = 0.15, 0.01, 0.24, respectively; all p-values <.0001). Among participants who initially were drinking at lower risk levels, reductions in drinking or abstinence were generally associated with significantly lower odds of DUD, although the results were less consistent. CONCLUSIONS Among very-high-risk drinkers, reduction in the WHO drinking risk categories were associated with lower risk of a DUD. These results add to findings indicating that reductions in WHO drinking risk levels are a meaningful indicator of how individuals feel and function and could therefore serve as informative outcomes in alcohol clinical trials. WHO risk levels can also guide treatment goals and clinical recommendations on drinking reduction.
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Affiliation(s)
- Justin Knox
- Columbia University Mailman School of Public Health, 722 West 168th Street, New York, NY 10032, USA,New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, USA
| | - Melanie Wall
- Columbia University Mailman School of Public Health, 722 West 168th Street, New York, NY 10032, USA,New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, USA
| | - Katie Witkiewitz
- Department of Psychology, University of New Mexico, 1 University of New Mexico, Albuquerque, NM 87131, USA
| | - Henry R. Kranzler
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, Philadelphia, PA 19104, USA,Crescenz Veterans Affairs Medical Center, 3900 Woodland Avenue, Philadelphia, PA 19104, USA
| | - Daniel E. Falk
- National Institute on Alcohol Abuse and Alcoholism, 6700B Rockledge Drive, Bethesda, MD 20892, USA
| | - Raye Litten
- National Institute on Alcohol Abuse and Alcoholism, 6700B Rockledge Drive, Bethesda, MD 20892, USA
| | - Karl Mann
- Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, J 5, 68159 Mannheim, Germany
| | - Stephanie S. O’Malley
- Department of Psychiatry, Yale School of Medicine, 300 George Street, New Haven, CT 06511, USA
| | - Jennifer Scodes
- New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, USA
| | - Raymond Anton
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 171 Ashley Avenue, Charleston, SC 29425, USA
| | - Deborah S. Hasin
- Columbia University Mailman School of Public Health, 722 West 168th Street, New York, NY 10032, USA,New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, USA
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36
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Knox J, Scodes J, Wall M, Witkiewitz K, Kranzler HR, Falk D, Litten R, Mann K, O’Malley SS, Anton R, Hasin DS. Reduction in non-abstinent WHO drinking risk levels and depression/anxiety disorders: 3-year follow-up results in the US general population. Drug Alcohol Depend 2019; 197:228-235. [PMID: 30852375 PMCID: PMC6440807 DOI: 10.1016/j.drugalcdep.2019.01.009] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 12/28/2018] [Accepted: 01/03/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Non-abstinent drinking reductions that predict improvement in how individuals feel or function, such as the World Health Organization (WHO) drinking risk levels, may be useful outcomes in clinical trials for alcohol use disorders (AUD). METHODS Current drinkers in a U.S. national survey (n = 22,005) were interviewed in 2001-02 (Wave 1) and re-interviewed 3 years later (Wave 2). WHO drinking risk levels, a 4- level categorization system (very-high-risk, high-risk, moderate-risk, and low-risk drinkers) defined using estimated mean ethanol consumption (grams) per day in the prior 12 months, and DSM-IV depressive and anxiety disorders were assessed at both waves. Logistic regression was used to produce adjusted odds ratios (aOR) testing the associations of changes between Wave 1 and Wave 2 WHO risk levels to the presence or persistence of depression and/or anxiety disorder by each initial Wave 1 risk level. RESULTS Among Wave 1 very-high-risk drinkers, lower odds of depression and/or anxiety disorders at Wave 2 were predicted by reductions in WHO risk levels of one-, two- or three-levels (aOR = 0.42, 0.37, 0.67, p-values 0.04-<.0001), as was the persistence of depression and/or anxiety disorders among those with such disorders at Wave 1 (aOR = 0.37, 0.29, 0.51, p-values .03-<.0001). Results were less consistent for participants initially drinking at lower risk levels. CONCLUSIONS Among very-high-risk drinkers, reductions in the WHO drinking risk categories were associated with lower risk of depression and/or anxiety disorders. These results add to findings indicating reductions in WHO risk levels are a meaningful indicator of how individuals feel and function.
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Affiliation(s)
- Justin Knox
- Columbia University Mailman School of Public Health, 722 West 168th Street, New York, NY 10032, USA,New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, USA
| | - Jennifer Scodes
- New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, USA
| | - Melanie Wall
- Columbia University Mailman School of Public Health, 722 West 168th Street, New York, NY 10032, USA,New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, USA
| | - Katie Witkiewitz
- Department of Psychology, University of New Mexico, 1 University of New Mexico, Albuquerque, NM 87131, USA
| | - Henry R. Kranzler
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, Philadelphia, PA 19104, USA,Crescenz Veterans Affairs Medical Center, 3900 Woodland Avenue, Philadelphia, PA 19104, USA
| | - Daniel Falk
- National Institute on Alcohol Abuse and Alcoholism, 6700B Rockledge Drive, Bethesda, MD 20892, USA
| | - Raye Litten
- National Institute on Alcohol Abuse and Alcoholism, 6700B Rockledge Drive, Bethesda, MD 20892, USA
| | - Karl Mann
- Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, J 5, 68159 Mannheim, Germany
| | - Stephanie S. O’Malley
- Department of Psychiatry, Yale School of Medicine, 300 George Street, New Haven, CT 06511, USA
| | - Raymond Anton
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 171 Ashley Avenue, Charleston, SC 29425, USA
| | - Deborah S. Hasin
- Columbia University Mailman School of Public Health, 722 West 168th Street, New York, NY 10032, USA,New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, USA
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Knox J, Wall M, Witkiewitz K, Kranzler HR, Falk D, Litten R, Mann K, O'Malley SS, Scodes J, Anton R, Hasin DS. Reduction in Nonabstinent WHO Drinking Risk Levels and Change in Risk for Liver Disease and Positive AUDIT-C Scores: Prospective 3-Year Follow-Up Results in the U.S. General Population. Alcohol Clin Exp Res 2018; 42:2256-2265. [PMID: 30204248 PMCID: PMC6263142 DOI: 10.1111/acer.13884] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 09/04/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND Abstinence is often the treatment aim for alcohol use disorders (AUD), but this may deter individuals who prefer drinking reduction goals from entering treatment, and be an overly restrictive end point in alcohol clinical trials. Nonabstinent drinking reductions that predict improvement in how individuals feel or function may be useful clinical trial outcomes, for example, reductions in the 4-category World Health Organization (WHO) drinking risk levels. To investigate the clinical relevance of these reductions, we examined their relationship with 2 outcomes of interest to medical providers: liver disease, and positive scores on an alcohol screening measure. METHODS Current drinkers in a U.S. national survey (n = 21,925) were interviewed in 2001 to 2002 (Wave 1) and re-interviewed 3 years later (Wave 2). WHO drinking risk levels, liver disease, and the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) were assessed at both waves. Adjusted odds ratios (aORs) were used to indicate the association of change in WHO drinking risk levels with Wave 2 liver disease and AUDIT-C scores. RESULTS Wave 1 very-high-risk drinkers who reduced 1, 2, or 3 WHO drinking risk levels had significantly lower odds of Wave 2 liver disease (aORs = 0.34, 0.23, 0.17) and positive AUDIT-C scores (aORs = 0.27, 0.09, 0.03). Wave 1 high-risk drinkers who reduced 1 or 2 WHO risk levels had significantly lower odds of positive AUDIT-C scores (aORs = 0.61, 0.25). Adjusting for alcohol dependence or AUDIT-C scoring variations did not affect results. CONCLUSIONS In the highest-risk drinkers, reductions in WHO drinking risk levels predicted lower likelihood of liver disease and positive AUDIT-C scores. Results add to findings that reductions in the 4-category WHO drinking risk levels are a meaningful indicator of how individuals feel and function, and could serve as nonabstinent end points in clinical trials. Results also connect the WHO risk drinking levels to commonly used alcohol screening questions, which may be more familiar to healthcare providers.
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Affiliation(s)
- Justin Knox
- Department of Epidemiology, Columbia University Medical Center, New York, New York
- New York State Psychiatric Institute, New York, New York
| | - Melanie Wall
- Department of Epidemiology, Columbia University Medical Center, New York, New York
- New York State Psychiatric Institute, New York, New York
- Department of Biostatistics, Columbia University Medical Center, New York, New York
| | - Katie Witkiewitz
- Department of Psychology, University of New Mexico, Albuquerque, New Mexico
| | - Henry R Kranzler
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
- Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania
| | - Daniel Falk
- National Institute on Alcohol Abuse and Alcoholism, Bethesda, Maryland
| | - Raye Litten
- National Institute on Alcohol Abuse and Alcoholism, Bethesda, Maryland
| | - Karl Mann
- Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | | | | | - Raymond Anton
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - Deborah S Hasin
- Department of Epidemiology, Columbia University Medical Center, New York, New York
- New York State Psychiatric Institute, New York, New York
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Devanand DP, Pelton GH, D’Antonio K, Ciarleglio A, Scodes J, Andrews H, Lunsford J, Beyer JL, Petrella JR, Sneed J, Ciovacco M, Doraiswamy PM. Donepezil Treatment in Patients With Depression and Cognitive Impairment on Stable Antidepressant Treatment: A Randomized Controlled Trial. Am J Geriatr Psychiatry 2018; 26:1050-1060. [PMID: 30037778 PMCID: PMC6396676 DOI: 10.1016/j.jagp.2018.05.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 05/15/2018] [Accepted: 05/16/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE Depression and cognitive impairment are often comorbid in older adults, but optimal treatment strategies remain unclear. In a two-site study, the efficacy and safety of add-on donepezil versus placebo were compared in depressed patients with cognitive impairment receiving stable antidepressant treatment. METHODS A randomized, double-blind, placebo-controlled trial was conducted in older adults with depression and cognitive impairment (https://clinicaltrials.gov/ct2/show/NCT01658228; NCT01658228). Patients received open-label antidepressant treatment for 16 weeks, initially with citalopram and then with venlafaxine, if needed, followed by random assignment to add-on donepezil 5-10 mg daily or placebo for another 62 weeks. Outcome measures were neuropsychological test performance (Alzheimer's Disease Assessment Scale-Cognitive subscale [ADAS-Cog] and Selective Reminding Test [SRT] total immediate recall) and instrumental activities of daily living (Functional Activities Questionnaire). RESULTS Of 81 patients who signed informed consent, 79 patients completed the baseline evaluation. Open antidepressant treatment was associated with improvement in depression in 63.93% responders by week 16. In the randomized trial, there were no treatment group differences between donepezil and placebo on dementia conversion rates, ADAS-Cog, SRT total immediate recall, or FAQ. Neither baseline cognitive impairment severity nor apolipoprotein E e4 genotype influenced donepezil efficacy. Donepezil was associated with more adverse effects than placebo. CONCLUSION The results do not support adjunctive off-label cholinesterase inhibitor treatment in patients with depression and cognitive impairment. The findings highlight the need to prioritize discovery of novel treatments for this highly prevalent population with comorbid illnesses.
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Campbell ANC, Barbosa-Leiker C, Hatch-Maillette M, Mennenga SE, Pavlicova M, Scodes J, Saraiya T, Mitchell SG, Rotrosen J, Novo P, Nunes EV, Greenfield SF. Gender differences in demographic and clinical characteristics of patients with opioid use disorder entering a comparative effectiveness medication trial. Am J Addict 2018; 27:465-470. [PMID: 30106494 DOI: 10.1111/ajad.12784] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 06/19/2018] [Accepted: 07/22/2018] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND & OBJECTIVES We investigated gender differences in individuals with opioid use disorder (OUD) receiving inpatient services and entering a randomized controlled trial comparing extended-release naltrexone to buprenorphine. METHODS Participants (N = 570) provided demographic, substance use, and psychiatric information. RESULTS Women were significantly younger, more likely to identify as bisexual, live with a sexual partner, be financially dependent, and less likely employed. Women reported significantly greater psychiatric comorbidity and risk behaviors, shorter duration but similar age of onset of opioid use. DISCUSSION/CONCLUSIONS Findings underscore economic, psychiatric, and infection vulnerability among women with OUD. SCIENTIFIC SIGNIFICANCE Interventions targeting these disparities should be explored, as women may face complicated treatment initiation, retention, and recovery. (Am J Addict 2018;27:465-470).
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Affiliation(s)
- Aimee N C Campbell
- Department of Psychiatry and New York State Psychiatric Institute, Columbia University Medical Center, New York, New York
| | | | - Mary Hatch-Maillette
- Department of Psychiatry & Behavioral Sciences, Alcohol and Drug Abuse Institute, University of Washington, Seattle, Washington
| | - Sarah E Mennenga
- Department of Psychiatry, New York University School of Medicine, New York, New York
| | - Martina Pavlicova
- Department of Biostatistics, Columbia University Mailman School of Public Health, New York, New York
| | - Jennifer Scodes
- Department of Psychiatry and New York State Psychiatric Institute, Columbia University Medical Center, New York, New York
| | - Tanya Saraiya
- Derner School of Psychology, Adelphi University, Garden City, New York
| | | | - John Rotrosen
- Department of Psychiatry, New York University School of Medicine, New York, New York
| | - Patricia Novo
- Department of Psychiatry, New York University School of Medicine, New York, New York
| | - Edward V Nunes
- Department of Psychiatry and New York State Psychiatric Institute, Columbia University Medical Center, New York, New York
| | - Shelly F Greenfield
- Harvard Medical School Department of Psychiatry and McLean Hospital, Boston, Massachusetts
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Nossel I, Wall MM, Scodes J, Marino LA, Zilkha S, Bello I, Malinovsky I, Lee R, Radigan M, Smith TE, Sederer L, Gu G, Dixon L. Results of a Coordinated Specialty Care Program for Early Psychosis and Predictors of Outcomes. Psychiatr Serv 2018; 69:863-870. [PMID: 29759055 DOI: 10.1176/appi.ps.201700436] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study prospectively evaluated outcomes of OnTrackNY, a statewide coordinated specialty care (CSC) program for treatment of early psychosis in community settings, as well as predictors of outcomes. METHODS The sample included 325 individuals ages 16-30 with recent-onset nonaffective psychosis who were enrolled in OnTrackNY and who had at least one three-month follow-up. Clinicians provided data at baseline and quarterly up to one year. Domains assessed included demographic and clinical characteristics, social and occupational functioning, medications, suicidality and violence, hospitalization, and time to intervention. Primary outcomes included the symptoms, occupational functioning, and social functioning scales of the Global Assessment of Functioning (GAF), as adapted by the U.S. Department of Veterans Affairs Mental Illness Research, Education and Clinical Center; education and employment status; and psychiatric hospitalization rate. RESULTS Education and employment rates increased from 40% to 80% by six months, hospitalization rates decreased from 70% to 10% by three months, and improvement in GAF scores continued for 12 months. Female gender, non-Hispanic white race-ethnicity, and more education at baseline predicted better education and employment status at follow-up. CONCLUSIONS Individuals with early psychosis receiving CSC achieved significant improvements in education and employment and experienced a decrease in hospitalization rate. Demographic variables and baseline education predicted education and employment outcomes. CSC teams should make particular effort to support the occupational goals of individuals at increased risk of not engaging in work or school, including male participants and participants from racial and ethnic minority groups.
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Affiliation(s)
- Ilana Nossel
- Dr. Nossel, Dr. Wall, Ms. Scodes, Dr. Marino, Dr. Zilkha, Dr. Bello, Dr. Malinovsky, and Dr. Dixon are with the New York State Psychiatric Institute, New York. Dr. Nossel, Dr. Wall, Ms. Scodes, Dr. Bello, Dr. Malinovsky, Dr. Smith, and Dr. Dixon are also with the Department of Psychiatry, Columbia University Medical Center, New York. Dr. Smith is also with the New York State Office of Mental Health, Albany, where Dr. Radigan, Dr. Sederer, and Mr. Gu are affiliated. Dr. Lee is with the Silberman School of Social Work, Hunter College, New York
| | - Melanie M Wall
- Dr. Nossel, Dr. Wall, Ms. Scodes, Dr. Marino, Dr. Zilkha, Dr. Bello, Dr. Malinovsky, and Dr. Dixon are with the New York State Psychiatric Institute, New York. Dr. Nossel, Dr. Wall, Ms. Scodes, Dr. Bello, Dr. Malinovsky, Dr. Smith, and Dr. Dixon are also with the Department of Psychiatry, Columbia University Medical Center, New York. Dr. Smith is also with the New York State Office of Mental Health, Albany, where Dr. Radigan, Dr. Sederer, and Mr. Gu are affiliated. Dr. Lee is with the Silberman School of Social Work, Hunter College, New York
| | - Jennifer Scodes
- Dr. Nossel, Dr. Wall, Ms. Scodes, Dr. Marino, Dr. Zilkha, Dr. Bello, Dr. Malinovsky, and Dr. Dixon are with the New York State Psychiatric Institute, New York. Dr. Nossel, Dr. Wall, Ms. Scodes, Dr. Bello, Dr. Malinovsky, Dr. Smith, and Dr. Dixon are also with the Department of Psychiatry, Columbia University Medical Center, New York. Dr. Smith is also with the New York State Office of Mental Health, Albany, where Dr. Radigan, Dr. Sederer, and Mr. Gu are affiliated. Dr. Lee is with the Silberman School of Social Work, Hunter College, New York
| | - Leslie A Marino
- Dr. Nossel, Dr. Wall, Ms. Scodes, Dr. Marino, Dr. Zilkha, Dr. Bello, Dr. Malinovsky, and Dr. Dixon are with the New York State Psychiatric Institute, New York. Dr. Nossel, Dr. Wall, Ms. Scodes, Dr. Bello, Dr. Malinovsky, Dr. Smith, and Dr. Dixon are also with the Department of Psychiatry, Columbia University Medical Center, New York. Dr. Smith is also with the New York State Office of Mental Health, Albany, where Dr. Radigan, Dr. Sederer, and Mr. Gu are affiliated. Dr. Lee is with the Silberman School of Social Work, Hunter College, New York
| | - Sacha Zilkha
- Dr. Nossel, Dr. Wall, Ms. Scodes, Dr. Marino, Dr. Zilkha, Dr. Bello, Dr. Malinovsky, and Dr. Dixon are with the New York State Psychiatric Institute, New York. Dr. Nossel, Dr. Wall, Ms. Scodes, Dr. Bello, Dr. Malinovsky, Dr. Smith, and Dr. Dixon are also with the Department of Psychiatry, Columbia University Medical Center, New York. Dr. Smith is also with the New York State Office of Mental Health, Albany, where Dr. Radigan, Dr. Sederer, and Mr. Gu are affiliated. Dr. Lee is with the Silberman School of Social Work, Hunter College, New York
| | - Iruma Bello
- Dr. Nossel, Dr. Wall, Ms. Scodes, Dr. Marino, Dr. Zilkha, Dr. Bello, Dr. Malinovsky, and Dr. Dixon are with the New York State Psychiatric Institute, New York. Dr. Nossel, Dr. Wall, Ms. Scodes, Dr. Bello, Dr. Malinovsky, Dr. Smith, and Dr. Dixon are also with the Department of Psychiatry, Columbia University Medical Center, New York. Dr. Smith is also with the New York State Office of Mental Health, Albany, where Dr. Radigan, Dr. Sederer, and Mr. Gu are affiliated. Dr. Lee is with the Silberman School of Social Work, Hunter College, New York
| | - Igor Malinovsky
- Dr. Nossel, Dr. Wall, Ms. Scodes, Dr. Marino, Dr. Zilkha, Dr. Bello, Dr. Malinovsky, and Dr. Dixon are with the New York State Psychiatric Institute, New York. Dr. Nossel, Dr. Wall, Ms. Scodes, Dr. Bello, Dr. Malinovsky, Dr. Smith, and Dr. Dixon are also with the Department of Psychiatry, Columbia University Medical Center, New York. Dr. Smith is also with the New York State Office of Mental Health, Albany, where Dr. Radigan, Dr. Sederer, and Mr. Gu are affiliated. Dr. Lee is with the Silberman School of Social Work, Hunter College, New York
| | - Rufina Lee
- Dr. Nossel, Dr. Wall, Ms. Scodes, Dr. Marino, Dr. Zilkha, Dr. Bello, Dr. Malinovsky, and Dr. Dixon are with the New York State Psychiatric Institute, New York. Dr. Nossel, Dr. Wall, Ms. Scodes, Dr. Bello, Dr. Malinovsky, Dr. Smith, and Dr. Dixon are also with the Department of Psychiatry, Columbia University Medical Center, New York. Dr. Smith is also with the New York State Office of Mental Health, Albany, where Dr. Radigan, Dr. Sederer, and Mr. Gu are affiliated. Dr. Lee is with the Silberman School of Social Work, Hunter College, New York
| | - Marleen Radigan
- Dr. Nossel, Dr. Wall, Ms. Scodes, Dr. Marino, Dr. Zilkha, Dr. Bello, Dr. Malinovsky, and Dr. Dixon are with the New York State Psychiatric Institute, New York. Dr. Nossel, Dr. Wall, Ms. Scodes, Dr. Bello, Dr. Malinovsky, Dr. Smith, and Dr. Dixon are also with the Department of Psychiatry, Columbia University Medical Center, New York. Dr. Smith is also with the New York State Office of Mental Health, Albany, where Dr. Radigan, Dr. Sederer, and Mr. Gu are affiliated. Dr. Lee is with the Silberman School of Social Work, Hunter College, New York
| | - Thomas E Smith
- Dr. Nossel, Dr. Wall, Ms. Scodes, Dr. Marino, Dr. Zilkha, Dr. Bello, Dr. Malinovsky, and Dr. Dixon are with the New York State Psychiatric Institute, New York. Dr. Nossel, Dr. Wall, Ms. Scodes, Dr. Bello, Dr. Malinovsky, Dr. Smith, and Dr. Dixon are also with the Department of Psychiatry, Columbia University Medical Center, New York. Dr. Smith is also with the New York State Office of Mental Health, Albany, where Dr. Radigan, Dr. Sederer, and Mr. Gu are affiliated. Dr. Lee is with the Silberman School of Social Work, Hunter College, New York
| | - Lloyd Sederer
- Dr. Nossel, Dr. Wall, Ms. Scodes, Dr. Marino, Dr. Zilkha, Dr. Bello, Dr. Malinovsky, and Dr. Dixon are with the New York State Psychiatric Institute, New York. Dr. Nossel, Dr. Wall, Ms. Scodes, Dr. Bello, Dr. Malinovsky, Dr. Smith, and Dr. Dixon are also with the Department of Psychiatry, Columbia University Medical Center, New York. Dr. Smith is also with the New York State Office of Mental Health, Albany, where Dr. Radigan, Dr. Sederer, and Mr. Gu are affiliated. Dr. Lee is with the Silberman School of Social Work, Hunter College, New York
| | - Gyojeong Gu
- Dr. Nossel, Dr. Wall, Ms. Scodes, Dr. Marino, Dr. Zilkha, Dr. Bello, Dr. Malinovsky, and Dr. Dixon are with the New York State Psychiatric Institute, New York. Dr. Nossel, Dr. Wall, Ms. Scodes, Dr. Bello, Dr. Malinovsky, Dr. Smith, and Dr. Dixon are also with the Department of Psychiatry, Columbia University Medical Center, New York. Dr. Smith is also with the New York State Office of Mental Health, Albany, where Dr. Radigan, Dr. Sederer, and Mr. Gu are affiliated. Dr. Lee is with the Silberman School of Social Work, Hunter College, New York
| | - Lisa Dixon
- Dr. Nossel, Dr. Wall, Ms. Scodes, Dr. Marino, Dr. Zilkha, Dr. Bello, Dr. Malinovsky, and Dr. Dixon are with the New York State Psychiatric Institute, New York. Dr. Nossel, Dr. Wall, Ms. Scodes, Dr. Bello, Dr. Malinovsky, Dr. Smith, and Dr. Dixon are also with the Department of Psychiatry, Columbia University Medical Center, New York. Dr. Smith is also with the New York State Office of Mental Health, Albany, where Dr. Radigan, Dr. Sederer, and Mr. Gu are affiliated. Dr. Lee is with the Silberman School of Social Work, Hunter College, New York
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Humensky J, Scodes J, Wall M, Malinovsky I, Marino L, Smith T, Sederer L, Nossel I, Bello I, Dixon L. Disability Enrollment in a Community-Based Coordinated Specialty Care Program. Am J Psychiatry 2017; 174:1224-1225. [PMID: 29191038 PMCID: PMC5839472 DOI: 10.1176/appi.ajp.2017.17070752] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Jennifer Humensky
- New York State Psychiatric Institute,Columbia University College of Physicians and Surgeons
| | | | - Melanie Wall
- New York State Psychiatric Institute,Columbia/Mailman School of Public Health
| | - Igor Malinovsky
- New York State Psychiatric Institute,Columbia University College of Physicians and Surgeons
| | | | - Thomas Smith
- Columbia University College of Physicians and Surgeons,New York State Office of Mental Health
| | - Lloyd Sederer
- Columbia/Mailman School of Public Health,New York State Office of Mental Health
| | - Ilana Nossel
- New York State Psychiatric Institute,Columbia University College of Physicians and Surgeons
| | - Iruma Bello
- New York State Psychiatric Institute,Columbia University College of Physicians and Surgeons
| | - Lisa Dixon
- New York State Psychiatric Institute,Columbia University College of Physicians and Surgeons
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Hasin DS, Wall M, Witkiewitz K, Kranzler HR, Falk D, Litten R, Mann K, O'Malley SS, Scodes J, Robinson RL, Anton R. Change in non-abstinent WHO drinking risk levels and alcohol dependence: a 3 year follow-up study in the US general population. Lancet Psychiatry 2017; 4:469-476. [PMID: 28456501 PMCID: PMC5536861 DOI: 10.1016/s2215-0366(17)30130-x] [Citation(s) in RCA: 97] [Impact Index Per Article: 13.9] [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] [Received: 06/21/2016] [Revised: 02/02/2017] [Accepted: 02/28/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND Alcohol dependence is often untreated. Although abstinence is often the aim of treatment, many drinkers prefer drinking reduction goals. Therefore, if supported by evidence of benefit, drinking reduction goals could broaden the appeal of treatment. Regulatory agencies are considering non-abstinent outcomes as efficacy indicators in clinical trials, including reduction in WHO drinking risk levels-very high, high, moderate, and low-defined in terms of mean ethanol consumption (in grams) per day. We aimed to study the relationship between reductions in WHO drinking risk levels and subsequent reduction in the risk of alcohol dependence. METHODS In this population-based cohort study, we included data from 22 005 drinkers who were interviewed in 2001-02 (Wave 1) and re-interviewed 3 years later (2004-05; Wave 2) in the US National Epidemiologic Survey on Alcohol and Related Conditions. Alcohol consumption (WHO drinking risk levels) and alcohol dependence (at least three of seven DSM-IV criteria in the previous 12 months) were assessed at both waves. We used logistic regression to test the relationship between change in WHO drinking risk levels between Waves 1 and 2, and alcohol dependence at Wave 2. FINDINGS At Wave 1, 2·5% (weighted proportion) of the respondents were very-high-risk drinkers, 2·5% were high-risk drinkers, 4·8% were moderate-risk drinkers, and most (90·2%) were low-risk drinkers. Reduction in WHO drinking risk level predicted significantly lower odds of alcohol dependence at Wave 2, particularly among very-high-risk drinkers (adjusted odds ratios 0·27 [95% CI 0·18-0·41] for reduction by one level, 0·17 [0·10-0·27] for two levels, and 0·07 [0·05-0·10] for three levels) and high-risk drinkers (0·64 [0·54-0·75] for one level and 0·12 [0·09-0·15] for two levels), and among those with alcohol dependence at Wave 1 (0·29 [0·15-0·57] for one level, 0·06 [0·04-0·10] for two levels, and 0·04 [0·03-0·06] for three levels in very-high-risk drinkers). INTERPRETATION Our results support the use of reductions in WHO drinking risk levels as an efficacy outcome in clinical trials. Because these risk levels can be readily translated into standard drink equivalents per day of different countries, the WHO risk levels could also be used internationally to guide treatment goals and clinical recommendations on drinking reduction. FUNDING US National Institute on Alcohol Abuse and Alcoholism, New York State Psychiatric Institute, the Alcohol Clinical Trials Initiative.
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Affiliation(s)
- Deborah S Hasin
- Columbia University, New York, NY, USA; New York State Psychiatric Institute, New York, NY, USA.
| | - Melanie Wall
- Columbia University, New York, NY, USA; New York State Psychiatric Institute, New York, NY, USA
| | - Katie Witkiewitz
- Department of Psychology, University of New Mexico, Albuquerque, NM, USA
| | - Henry R Kranzler
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA; Crescenz Veterans Affairs Medical Center, Philadelphia, PA, USA
| | - Daniel Falk
- National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, USA
| | - Raye Litten
- National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, USA
| | - Karl Mann
- Central Institute of Mental Health, Mannheim, Germany
| | | | | | | | - Raymond Anton
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
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Kerner NA, Roose SP, Pelton GH, Ciarleglio A, Scodes J, Lentz C, Sneed JR, Devanand DP. Association of Obstructive Sleep Apnea with Episodic Memory and Cerebral Microvascular Pathology: A Preliminary Study. Am J Geriatr Psychiatry 2017; 25:316-325. [PMID: 28040430 PMCID: PMC5316492 DOI: 10.1016/j.jagp.2016.11.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [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: 06/30/2016] [Revised: 11/15/2016] [Accepted: 11/16/2016] [Indexed: 12/27/2022]
Abstract
OBJECTIVES To evaluate the impact of obstructive sleep apnea (OSA) on neurocognitive function and brain morphology in older adults with depression and cognitive impairment. METHODS We prospectively screened OSA with the STOP-Bang questionnaire in the last 25 patients enrolled into the Donepezil Treatment of Cognitive Impairment and Depression (DOTCODE) trial. High and low probability of OSA were defined as a STOP-Bang score of ≥5 (h-OSA) and of <5 (l-OSA), respectively. Baseline magnetic resonance imaging (MRI) was used to evaluate brain morphology. The initial 16 weeks of antidepressant treatment were part of the DOTCODE trial. RESULTS After 16 weeks of antidepressant treatment, the h-OSA group performed significantly worse on the Selective Reminding Test delayed recall task than the l-OSA group, controlling for baseline performance (F = 19.1, df = 1,22, p < 0.001). In 19 of 25 participants who underwent brain MRI, the h-OSA group had significantly greater volumes of MRI hyperintensities in deep white matter, periventricular white matter, and subcortical gray matter compared with the l-OSA group. There was no significant association between OSA and hippocampal or entorhinal cortex volumes in our sample, even after controlling for intracranial volume. CONCLUSIONS OSA is associated with impaired verbal episodic memory and microvascular damage in older adults with depression and cognitive impairment. One possibility is that by contributing to cerebral microvascular damage, OSA may exacerbate progressive memory decline.
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Affiliation(s)
- Nancy A. Kerner
- Department of Psychiatry, College of Physicians and Surgeons of Columbia University / Columbia University Medical Center, New York, NY, 10032,The Late-life Depression Clinic, the Memory Disorders Clinic, and the Division of Geriatric Psychiatry, New York State Psychiatric Institute, New York, NY 10032
| | - Steven P. Roose
- Department of Psychiatry, College of Physicians and Surgeons of Columbia University / Columbia University Medical Center, New York, NY, 10032,The Late-life Depression Clinic, the Memory Disorders Clinic, and the Division of Geriatric Psychiatry, New York State Psychiatric Institute, New York, NY 10032
| | - Gregory H. Pelton
- Department of Psychiatry, College of Physicians and Surgeons of Columbia University / Columbia University Medical Center, New York, NY, 10032,The Late-life Depression Clinic, the Memory Disorders Clinic, and the Division of Geriatric Psychiatry, New York State Psychiatric Institute, New York, NY 10032,Department of Neurology, Taub Institute for Research in Alzheimer's Disease and the Aging Brain, Gertrude H. Sergievsky Center, Columbia University College of Physicians and Surgeons, New York, NY, 10032
| | - Adam Ciarleglio
- Division of Biostatistics, Department of Psychiatry, College of Physicians and Surgeons of Columbia University / Columbia University Medical Center, New York, NY, 10032
| | - Jennifer Scodes
- Division of Biostatistics, Department of Psychiatry, College of Physicians and Surgeons of Columbia University / Columbia University Medical Center, New York, NY, 10032
| | - Cody Lentz
- Department of Psychiatry, College of Physicians and Surgeons of Columbia University / Columbia University Medical Center, New York, NY, 10032
| | - Joel R. Sneed
- Department of Psychiatry, College of Physicians and Surgeons of Columbia University / Columbia University Medical Center, New York, NY, 10032,The Late-life Depression Clinic, the Memory Disorders Clinic, and the Division of Geriatric Psychiatry, New York State Psychiatric Institute, New York, NY 10032,Queens College, City University of New York, New York
| | - D. P. Devanand
- Department of Psychiatry, College of Physicians and Surgeons of Columbia University / Columbia University Medical Center, New York, NY, 10032,The Late-life Depression Clinic, the Memory Disorders Clinic, and the Division of Geriatric Psychiatry, New York State Psychiatric Institute, New York, NY 10032,Department of Neurology, Taub Institute for Research in Alzheimer's Disease and the Aging Brain, Gertrude H. Sergievsky Center, Columbia University College of Physicians and Surgeons, New York, NY, 10032
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