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Luckett PH, Park KY, Lee JJ, Lenze EJ, Wetherell JL, Eyler L, Snyder AZ, Ances BM, Shimony JS, Leuthardt EC. Data-efficient resting-state functional magnetic resonance imaging brain mapping with deep learning. J Neurosurg 2023; 139:1258-1269. [PMID: 37060318 PMCID: PMC10576012 DOI: 10.3171/2023.3.jns2314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 03/01/2023] [Indexed: 04/16/2023]
Abstract
OBJECTIVE Resting-state functional MRI (RS-fMRI) enables the mapping of function within the brain and is emerging as an efficient tool for the presurgical evaluation of eloquent cortex. Models capable of reliable and precise mapping of resting-state networks (RSNs) with a reduced scanning time would lead to improved patient comfort while reducing the cost per scan. The aims of the present study were to develop a deep 3D convolutional neural network (3DCNN) capable of voxel-wise mapping of language (LAN) and motor (MOT) RSNs with minimal quantities of RS-fMRI data. METHODS Imaging data were gathered from multiple ongoing studies at Washington University School of Medicine and other thoroughly characterized, publicly available data sets. All study participants (n = 2252 healthy adults) were cognitively screened and completed structural neuroimaging and RS-fMRI. Random permutations of RS-fMRI regions of interest were used to train a 3DCNN. After training, model inferences were compared using varying amounts of RS-fMRI data from the control data set as well as 5 patients with glioblastoma multiforme. RESULTS The trained model achieved 96% out-of-sample validation accuracy on data encompassing a large age range collected on multiple scanner types and varying sequence parameters. Testing on out-of-sample control data showed 97.9% similarity between results generated using either 50 or 200 RS-fMRI time points, corresponding to approximately 2.5 and 10 minutes, respectively (96.9% LAN, 96.3% MOT true-positive rate). In evaluating data from patients with brain tumors, the 3DCNN was able to accurately map LAN and MOT networks despite structural and functional alterations. CONCLUSIONS Functional maps produced by the 3DCNN can inform surgical planning in patients with brain tumors in a time-efficient manner. The authors present a highly efficient method for presurgical functional mapping and thus improved functional preservation in patients with brain tumors.
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Affiliation(s)
- Patrick H. Luckett
- Division of Neurotechnology, Department of Neurological Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Ki Yun Park
- Division of Neurotechnology, Department of Neurological Surgery, Washington University School of Medicine, St. Louis, Missouri
- Department of Neuroscience, Washington University School of Medicine, St. Louis, Missouri
| | - John J. Lee
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri
| | - Eric J Lenze
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri
| | - Julie L Wetherell
- Mental Health Impact Unit 3, VA San Diego Healthcare System, San Diego, California
- Department of Psychiatry, University of California, San Diego, California
| | - Lisa Eyler
- Department of Psychiatry, University of California, San Diego, California
| | - Abraham Z. Snyder
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri
- Department of Neurology, Washington University School of Medicine, St. Louis, Missouri
| | - Beau M. Ances
- Department of Neurology, Washington University School of Medicine, St. Louis, Missouri
| | - Joshua S. Shimony
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri
| | - Eric C. Leuthardt
- Division of Neurotechnology, Department of Neurological Surgery, Washington University School of Medicine, St. Louis, Missouri
- Department of Neuroscience, Washington University School of Medicine, St. Louis, Missouri
- Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, MO
- Department of Mechanical Engineering and Materials Science, Washington University in St. Louis, St. Louis, MO
- Center for Innovation in Neuroscience and Technology, Division of Neurotechnology, Washington University School of Medicine, St. Louis, MO
- Brain Laser Center, Washington University School of Medicine, St. Louis, Missouri
- National Center for Adaptive Neurotechnologies
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Mlinac ME, Smith RW, Siffert KJ, Richter LC, Steadman-Wood PL, Wetherell JL. Development of a Suicide Prevention Toolkit for VA Home-Based Primary Care Teams. Home Healthc Now 2021; 39:13-19. [PMID: 33417357 PMCID: PMC7927422 DOI: 10.1097/nhh.0000000000000922] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The U.S. Department of Veterans Affairs Home-Based Primary Care program (HBPC) serves Veterans with multiple comorbid physical and psychological conditions that can increase suicide risk. HBPC teams are uniquely able to implement suicide risk assessment and prevention practices, and the team's mental health provider often trains other team members. An online suicide prevention toolkit was developed for HBPC mental health providers and their teams as part of a quality improvement project. Toolkit development was guided by a needs assessment consisting of first focus group and then data from surveys of HBPC program directors (n = 53) and HBPC mental health providers (n = 56). Needs identified by both groups included training specific to the HBPC patient population and more resources if mental health needs could not be fully managed by the HBPC team. HBPC mental health providers within integrated care teams play a key role in clinical intervention, policy development, and interprofessional team education on suicide prevention. HBPC teams have specific learning and support needs around suicide prevention that can be addressed with a feasible, easily accessible clinical and training resource.
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3
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Bower ES, Wetherell JL, Petkus AJ, Lenze EJ. Neuroticism predicts fear of falling after hip fracture. Int J Geriatr Psychiatry 2020; 35:498-506. [PMID: 31894600 DOI: 10.1002/gps.5261] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 12/21/2019] [Indexed: 01/01/2023]
Abstract
OBJECTIVES Fear of falling (FoF) is common and associated with poorer functional outcomes after hip fracture. We sought to differentiate patterns of FoF at 4 and 12 weeks after surgical repair for hip fracture and examine predictors of FoF. METHODS/DESIGN Secondary analysis of existing data from a 52-week prospective study examining recovery after hip fracture. Participants (N = 263) were aged 60 and older with recent hip fracture recruited from eight hospitals. FoF was measured 4 and 12 weeks postfracture with the Short Falls Efficacy Scale-International. Latent class mixed models were constructed to identify distinct patterns of FoF from 4 to 12 weeks postfracture and predictors of FoF. Predictors examined included age, gender, neuroticism, depression, negative affect, perceived social support, medical comorbidity, functional ability, cognition, and pain. RESULTS Three latent classes of FoF were identified: a group with minimal FoF at weeks 4 and 12 (72%), a group with high FoF that decreased (17%), and a group with high FoF that increased from week 4 to 12 (11%). In a multivariate model, higher neuroticism was associated with greater risk for high FoF (increasing or decreasing), whereas higher premorbid medical comorbidity was associated with increasing FoF, poorer premorbid functional ability was associated with decreasing FoF, and social support was not significantly associated. CONCLUSIONS Older adults with higher neuroticism are more likely to have FoF in the first 12 weeks after a hip fracture. Screening for neuroticism in health care settings might identify individuals who would benefit from interventions to improve outcomes during recovery.
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Affiliation(s)
- Emily S Bower
- SDSU/UCSD Joint Doctoral Program in Clinical Psychology, San Diego, California.,Psychiatry, University of California, San Diego, California
| | - Julie L Wetherell
- VA San Diego Healthcare System, University of California, San Diego, California.,Psychiatry, University of California, San Diego, California
| | - Andrew J Petkus
- Department of Neurology, University of Southern California, Los Angeles, California
| | - Eric J Lenze
- Healthy Mind Lab, Department of Psychiatry, Washington University School of Medicine, St Louis, Missouri
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Wetherell JL, Herbert M, Afari N. MECHANISM OF ACTION: AGE DIFFERENCES IN RESPONSE TO ACCEPTANCE AND COMMITMENT THERAPY FOR CHRONIC PAIN. Innov Aging 2019. [PMCID: PMC6846173 DOI: 10.1093/geroni/igz038.2979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
A recent randomized comparison of Acceptance and Commitment Therapy (ACT) vs. Cognitive-Behavioral Therapy for chronic pain found a clear age interaction effect, such that older adults benefitted more from ACT. In a subsequent study comparing ACT delivered in person to ACT delivered via telehealth to a sample of veterans (N=128, mean age 51.9, SD 13.3, range 25-89), we found no significant age by modality interactions, suggesting that older veterans responded as well as younger people did to telehealth delivery. Consistent with our previous findings, we found a trend for older adults to experience greater reduction in pain interference (p = .051) and significantly greater reduction in pain severity (p = .001) than younger adults following ACT. In younger veterans, change in pain acceptance from baseline to posttreatment was related to change in pain interference from baseline to 6-month follow-up (r = -.38), but change in pain interference from baseline to posttreatment was not related to change in pain acceptance from baseline to follow-up (r = .14), suggesting that, consistent with the ACT model, increased pain acceptance at posttreatment was related to reduced pain interference at follow-up. By contrast, in older veterans, both correlations were significant and of comparable magnitude (rs = -.43 and -.46, respectively), providing no support for the idea that change in pain acceptance drove change in pain interference. Overall, our findings suggest that ACT may work better in older adults with chronic pain than in younger adults, but via a different mechanism.
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Affiliation(s)
- Julie L Wetherell
- VA San Diego Healthcare System, San Diego, California, United States
| | - Matthew Herbert
- VA San Diego Healthcare System, San Diego, California, United States
| | - Niloofar Afari
- VA San Diego Healthcare System, San Diego, California, United States
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Groessl EJ, Liu L, Chang DG, Wetherell JL, Bormann JE, Atkinson JH, Baxi S, Schmalzl L. Yoga for Military Veterans with Chronic Low Back Pain: A Randomized Clinical Trial. Am J Prev Med 2017; 53:599-608. [PMID: 28735778 PMCID: PMC6399016 DOI: 10.1016/j.amepre.2017.05.019] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [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: 11/19/2016] [Revised: 05/02/2017] [Accepted: 05/22/2017] [Indexed: 01/24/2023]
Abstract
INTRODUCTION Chronic low back pain (cLBP) is prevalent, especially among military veterans. Many cLBP treatment options have limited benefits and are accompanied by side effects. Major efforts to reduce opioid use and embrace nonpharmacological pain treatments have resulted. Research with community cLBP patients indicates that yoga can improve health outcomes and has few side effects. The benefits of yoga among military veterans were examined. DESIGN Participants were randomized to either yoga or delayed yoga treatment in 2013-2015. Outcomes were assessed at baseline, 6 weeks, 12 weeks, and 6 months. Intention-to-treat analyses occurred in 2016. SETTING/PARTICIPANTS One hundred and fifty military veterans with cLBP were recruited from a major Veterans Affairs Medical Center in California. INTERVENTION Yoga classes (with home practice) were led by a certified instructor twice weekly for 12 weeks, and consisted primarily of physical postures, movement, and breathing techniques. MAIN OUTCOME MEASURES The primary outcome was Roland-Morris Disability Questionnaire scores after 12 weeks. Pain intensity was identified as an important secondary outcome. RESULTS Participant characteristics were mean age 53 years, 26% were female, 35% were unemployed or disabled, and mean back pain duration was 15 years. Improvements in Roland-Morris Disability Questionnaire scores did not differ between the two groups at 12 weeks, but yoga participants had greater reductions in Roland-Morris Disability Questionnaire scores than delayed treatment participants at 6 months -2.48 (95% CI= -4.08, -0.87). Yoga participants improved more on pain intensity at 12 weeks and at 6 months. Opioid medication use declined among all participants, but group differences were not found. CONCLUSIONS Yoga improved health outcomes among veterans despite evidence they had fewer resources, worse health, and more challenges attending yoga sessions than community samples studied previously. The magnitude of pain intensity decline was small, but occurred in the context of reduced opioid use. The findings support wider implementation of yoga programs for veterans. TRIAL REGISTRATION This study is registered at www.clinicaltrials.gov NCT02524158.
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Affiliation(s)
- Erik J Groessl
- VA San Diego Healthcare System, San Diego, California; Department of Family Medicine and Public Health, University of California San Diego, San Diego, California.
| | - Lin Liu
- VA San Diego Healthcare System, San Diego, California; Department of Family Medicine and Public Health, University of California San Diego, San Diego, California
| | - Douglas G Chang
- VA San Diego Healthcare System, San Diego, California; Department of Orthopaedic Surgery, University of California San Diego, San Diego, California
| | - Julie L Wetherell
- VA San Diego Healthcare System, San Diego, California; Department of Psychiatry, University of California San Diego, San Diego, California
| | - Jill E Bormann
- VA San Diego Healthcare System, San Diego, California; Hahn School of Nursing and Health Sciences, University of San Diego, San Diego, California; VA Center of Excellence in Stress and Mental Health, San Diego, California
| | - J Hamp Atkinson
- VA San Diego Healthcare System, San Diego, California; Department of Psychiatry, University of California San Diego, San Diego, California
| | - Sunita Baxi
- VA San Diego Healthcare System, San Diego, California; Department of Medicine, University of California San Diego, San Diego, California
| | - Laura Schmalzl
- Department of Family Medicine and Public Health, University of California San Diego, San Diego, California; College of Science and Integrative Health, Southern California University of Health Sciences, Whittier, California
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Dozier ME, Wetherell JL, Twamley EW, Schiehser DM, Ayers CR. The relationship between age and neurocognitive and daily functioning in adults with hoarding disorder. Int J Geriatr Psychiatry 2016; 31:1329-1336. [PMID: 26876803 PMCID: PMC5612662 DOI: 10.1002/gps.4438] [Citation(s) in RCA: 20] [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: 07/27/2015] [Accepted: 01/05/2016] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Given the increase in hoarding symptoms with age, there is a pressing need for understanding the clinical features as they relate to potential interventions for older adults with hoarding disorder (HD). The aim of the current investigation was to explore age-related differences in the level of functional and cognitive impairment in individuals with HD. METHODS The current study utilized the baseline assessments of 122 adults with HD. Age-related differences in the raw scores of psychiatric, cognitive, and daily functioning were analyzed using a series of multiple regression models controlling for the possible age-related differences in premorbid IQ. RESULTS Our results suggested that older adults with HD may experience increased levels of impairment in skills related to executive functioning and everyday functioning when compared with younger adults with HD. CONCLUSIONS Given these difficulties with neurocognitive functioning, older HD patients may require interventions that focus more on behavioral and functional skills, rather than focusing on changing thought processes. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Mary E. Dozier
- San Diego State University/University of California, Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA,VA San Diego Healthcare System, San Diego, CA, USA
| | - Julie L. Wetherell
- San Diego State University/University of California, Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA,VA San Diego Healthcare System, San Diego, CA, USA,University of California, San Diego School of Medicine, CA, USA
| | - Elizabeth W. Twamley
- San Diego State University/University of California, Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA,VA San Diego Healthcare System, San Diego, CA, USA,University of California, San Diego School of Medicine, CA, USA
| | - Dawn M. Schiehser
- San Diego State University/University of California, Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA,VA San Diego Healthcare System, San Diego, CA, USA,University of California, San Diego School of Medicine, CA, USA
| | - Catherine R. Ayers
- San Diego State University/University of California, Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA,VA San Diego Healthcare System, San Diego, CA, USA,University of California, San Diego School of Medicine, CA, USA
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Atkinson JH, Slater MA, Capparelli EV, Patel SM, Wolfson T, Gamst A, Abramson IS, Wallace MS, Funk SD, Rutledge TR, Wetherell JL, Matthews SC, Zisook S, Garfin SR. A randomized controlled trial of gabapentin for chronic low back pain with and without a radiating component. Pain 2016; 157:1499-1507. [PMID: 26963844 PMCID: PMC5001843 DOI: 10.1097/j.pain.0000000000000554] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Gabapentin is prescribed for analgesia in chronic low back pain, yet there are no controlled trials supporting this practice. This randomized, 2-arm, 12-week, parallel group study compared gabapentin (forced titration up to 3600 mg daily) with inert placebo. The primary efficacy measure was change in pain intensity from baseline to the last week on treatment measured by the Descriptor Differential Scale; the secondary outcome was disability (Oswestry Disability Index). The intention-to-treat analysis comprised 108 randomized patients with chronic back pain (daily pain for ≥6 months) whose pain did (43%) or did not radiate into the lower extremity. Random effects regression models which did not impute missing scores were used to analyze outcome data. Pain intensity decreased significantly over time (P < 0.0001) with subjects on gabapentin or placebo, reporting reductions of about 30% from baseline, but did not differ significantly between groups (P = 0.423). The same results pertained for disability scores. In responder analyses of those who completed 12 weeks (N = 72), the proportion reporting at least 30% or 50% reduction in pain intensity, or at least "Minimal Improvement" on the Physician Clinical Global Impression of Change did not differ significantly between groups. There were no significant differences in analgesia between participants with radiating (n = 46) and nonradiating (n = 62) pain either within or between treatment arms. There was no significant correlation between gabapentin plasma concentration and pain intensity. Gabapentin appears to be ineffective for analgesia in chronic low back pain with or without a radiating component.
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Affiliation(s)
- J Hampton Atkinson
- VA San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| | - Mark A Slater
- VA San Diego Healthcare System, San Diego, CA, USA
- Scottsdale Healthcare Research Institute, Scottsdale, AZ, USA
| | - Edmund V Capparelli
- VA San Diego Healthcare System, San Diego, CA, USA
- Department of Pediatrics, University of California, San Diego, La Jolla, CA, USA
| | | | - Tanya Wolfson
- Computational and Applied Statistics Laboratory, University of California, San Diego, La Jolla, CA, USA
| | - Anthony Gamst
- Computational and Applied Statistics Laboratory, University of California, San Diego, La Jolla, CA, USA
| | | | - Mark S Wallace
- VA San Diego Healthcare System, San Diego, CA, USA
- Anesthesiology, and
| | | | - Thomas R Rutledge
- VA San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| | - Julie L Wetherell
- VA San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| | - Scott C Matthews
- VA San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| | - Sidney Zisook
- VA San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| | - Steven R Garfin
- VA San Diego Healthcare System, San Diego, CA, USA
- Orthopaedic Surgery, University of California, San Diego, La Jolla, CA, USA
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Rosnick CB, Wetherell JL, White KS, Andreescu C, Dixon D, Lenze EJ. Cognitive-behavioral therapy augmentation of SSRI reduces cortisol levels in older adults with generalized anxiety disorder: A randomized clinical trial. J Consult Clin Psychol 2016; 84:345-52. [PMID: 26881447 DOI: 10.1037/a0040113] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVES Elevated cortisol in stress and aging, such as has been seen in late-life anxiety disorders, is postulated to accelerate cognitive and physiological decline in this large and increasing population. Selective serotonin-reuptake inhibitors (SSRIs) and cognitive-behavioral therapy (CBT) are both effective treatments for generalized anxiety disorder (GAD) in older adults. On the other hand, there is very little research examining the effect of combining these therapies on peak cortisol levels. For the current analyses, we examined the effectiveness of CBT augmentation on peak cortisol levels in older adults diagnosed with GAD. METHODS The sample consisted of 42 individuals with late-life GAD who received an acute course of the SSRI escitalopram and then entered a 16-week randomized phase. Twenty-one participants were randomized to receive 16 sessions of CBT in addition to continuing escitalopram and the remaining 21 participants continued on escitalopram without CBT. Generalized estimating equations were performed to assess the effectiveness of CBT augmentation on peak cortisol levels (30 min after waking). RESULTS Older adults with GAD who received both escitalopram and CBT demonstrated a significant reduction in peak cortisol levels at posttreatment compared to the group who received escitalopram without CBT augmentation. CONCLUSIONS CBT augmentation of SSRI treatment reduced peak cortisol levels for older adults with GAD. Since persistently high cortisol levels in aging are thought to increase age-related cognitive and medical problems, our findings suggest that there may be a benefit to health and cognition of CBT augmentation for late-life anxiety disorders.
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Affiliation(s)
| | | | - Kamila S White
- Department of Psychology, University of Missouri-St. Louis
| | - Carmen Andreescu
- Department of Psychiatry, University of Pittsburgh School of Medicine
| | - David Dixon
- Department of Psychiatry, Washington University School of Medicine
| | - Eric J Lenze
- Department of Psychiatry, Washington University School of Medicine
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Bormann JE, Thorp SR, Wetherell JL, Golshan S, Lang AJ. Meditation-based mantram intervention for veterans with posttraumatic stress disorder: A randomized trial. ACTA ACUST UNITED AC 2013. [DOI: 10.1037/a0027522] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Mittal D, Fortney JC, Pyne JM, Wetherell JL. Predictors of persistence of comorbid generalized anxiety disorder among veterans with major depressive disorder. J Clin Psychiatry 2011; 72:1445-51. [PMID: 21208594 DOI: 10.4088/jcp.10m05981blu] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2010] [Accepted: 04/05/2010] [Indexed: 10/18/2022]
Abstract
OBJECTIVE A limited number of randomized clinical trials show that efficacious pharmacologic treatments exist for comorbid major depressive disorder (MDD) and generalized anxiety disorder (GAD). The aims of this effectiveness study were to describe the impact of a depression care management intervention on the persistence of comorbid GAD symptoms in a sample of primary care patients with MDD and to identify risk factors for persistent GAD. METHOD Data were collected from April 2003 to September 2005 for the Telemedicine-Enhanced Antidepressant Management (TEAM) study, a multisite, randomized effectiveness trial targeting US Department of Veterans Affairs (VA) primary care patients with depression. Veterans aged 26.59-88.36 years received either the TEAM intervention or usual care in small VA community-based outpatient clinics. The TEAM care management intervention focused on optimizing antidepressant therapy through patient education and activation, symptom monitoring, adherence promotion, and side-effect management. Veterans who screened positive for MDD using the Patient Health Questionnaire-9 (based on DSM-IV criteria) and who met the Mini-International Neuropsychiatric Interview criteria (maintaining consistency with DSM-IV-TR) for comorbid GAD at baseline were selected for the present study (N = 168). The primary outcome was persistence of GAD at 6 months and 12 months. All predictors available in the TEAM study data that were described in the literature to be associated with influencing GAD outcomes were examined. RESULTS Persistence of depression was the strongest predictor of persistence of comorbid GAD at both 6 months (OR = 5.75; 95% CI, 2.38-13.86; P < .05) and 12 months (OR = 15.56; 95% CI, 6.10-39.68; P < .05). Although the TEAM intervention significantly reduced depression symptom severity, it was not significantly associated with GAD persistence. Insomnia was a significant protective factor for persistence of GAD at 6 months (OR = 0.66; 95% CI, 0.44-0.99; P < .05). CONCLUSIONS Early screening for presence of comorbid GAD among those with MDD may be valuable both for further research and for enhancing clinical management of GAD and MDD comorbidity.
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Affiliation(s)
- Dinesh Mittal
- Department of Veterans Affairs (VA) Health Services Research and Development, Center for Mental Health and Outcomes Research, North Little Rock, AR, USA.
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11
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Saxena S, Ayers CR, Maidment KM, Vapnik T, Wetherell JL, Bystritsky A. Quality of life and functional impairment in compulsive hoarding. J Psychiatr Res 2011; 45:475-80. [PMID: 20822778 PMCID: PMC3009837 DOI: 10.1016/j.jpsychires.2010.08.007] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.6] [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: 05/29/2010] [Revised: 08/03/2010] [Accepted: 08/10/2010] [Indexed: 11/21/2022]
Abstract
Compulsive hoarding patients have been found in previous studies to have substantial disability and functional impairment. However, no prior study has examined subjective and objective quality of life (QOL) in patients with compulsive hoarding. This present study compared compulsive hoarders and non-hoarding OCD patients across a variety of QOL domains. Subjects were 171 consecutive adult patients (34 compulsive hoarders, 137 non-hoarding patients with DSM-IV OCD) treated openly between 1998 and 2004 in the UCLA OCD Partial Hospitalization Program (OCD PHP), a specialized, intensive, multi-modal treatment program for treatment-refractory patients. Scores on the Quality of Life Scale and other symptom severity measures on admission were compared between compulsive hoarders and non-hoarding OCD patients. Compulsive hoarders were older and had lower global functioning than non-hoarding OCD patients. Both groups had low overall QOL scores across multiple domains. Compulsive hoarders had significantly lower levels of satisfaction with their safety than non-hoarding OCD patients, were more often the victims of both violent and non-violent crime, felt less safe in their neighborhoods, and felt less protected against attack. Compulsive hoarders were also much less satisfied with their living arrangements than non-hoarding OCD patients. No differences were found on financial variables, but the vast majority of patients in both groups were unemployed. Compulsive hoarders have lower QOL than non-hoarding OCD patients in the domains of safety and living situation. Psychosocial rehabilitation that focuses on problems with victimization, safety, employment, and financial areas may be a beneficial augmentation to treatment for compulsive hoarding.
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Affiliation(s)
- Sanjaya Saxena
- Department of Psychiatry, University of California at San Diego, 140 Arbor Drive, San Diego, CA 92103, United States.
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Bormann JE, Aschbacher K, Wetherell JL, Roesch S, Redwine L. Effects of faith/assurance on cortisol levels are enhanced by a spiritual mantram intervention in adults with HIV: a randomized trial. J Psychosom Res 2009; 66:161-71. [PMID: 19154859 PMCID: PMC2760973 DOI: 10.1016/j.jpsychores.2008.09.017] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2007] [Revised: 09/16/2008] [Accepted: 09/25/2008] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Previous research among HIV-infected individuals suggests that spiritual well-being is inversely related to psychological distress and rates of disease progression. Use of a mantram, a spiritual word or phrase repeated frequently and silently throughout the day, has been associated with decreased psychological distress and increased spiritual well-being. This study compared the effects of 2 interventions-a spiritually-based mantram intervention versus an attention-matched control group-on faith/assurance and average salivary cortisol levels among HIV-infected individuals. METHODS Using a randomized design, HIV-infected adults were assigned to the intervention (n = 36) or control condition (n = 35). Faith scores and saliva (collected at 7 a.m., 11 a.m., 4 p.m., and 9 p.m.) were assessed at preintervention, postintervention, and 5-week follow-up. Path analyses tested competing models that specify both concurrent and sequential relationships between faith and average daily cortisol levels while comparing groups. RESULTS Faith levels increased among mantram participants from pre- to postintervention. Greater faith at preintervention was significantly associated with lower average cortisol at postintervention in the mantram group but not in the controls. The associations between faith at postintervention and cortisol levels at 5-week follow-up were significant among both groups but weaker than the pre- to postintervention association identified in the mantram group. CONCLUSIONS These results suggest the presence of lagged or antecedent consequent relationships between faith and cortisol, which may be enhanced by mantram use. Decreased cortisol could potentially benefit immune functioning among HIV-infected individuals.
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Affiliation(s)
- Jill E Bormann
- Veterans Affairs San Diego Healthcare System, San Diego, CA 92161, USA.
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13
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Bormann JE, Thorp S, Wetherell JL, Golshan S. A spiritually based group intervention for combat veterans with posttraumatic stress disorder: feasibility study. J Holist Nurs 2008; 26:109-16. [PMID: 18356284 DOI: 10.1177/0898010107311276] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
PURPOSE To assess the feasibility, effect sizes, and satisfaction of mantram repetition -- the spiritual practice of repeating a sacred word/phrase throughout the day -- for managing symptoms of posttraumatic stress disorder (PTSD) in veterans. DESIGN A two group (intervention vs. control) by two time (pre- and postintervention) experimental design was used. METHODS Veterans were randomly assigned to intervention (n = 14) or delayed-treatment control (n = 15). Measures were PTSD symptoms, psychological distress, quality of life, and patient satisfaction. Effect sizes were calculated using Cohen's d. FINDINGS Thirty-three male veterans were enrolled, and 29 (88%) completed the study. Large effect sizes were found for reducing PTSD symptom severity (d = -.72), psychological distress (d = -.73) and increasing quality of life (d = -.70). CONCLUSIONS A spiritual program was found to be feasible for veterans with PTSD. They reported moderate to high satisfaction. Effect sizes show promise for symptom improvement but more research is needed.
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Affiliation(s)
- Jill E Bormann
- VA San Diego Healthcare System and San Diego State University, San Diego, CA 92161, USA.
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14
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Meeks TW, Wetherell JL, Irwin MR, Redwine LS, Jeste DV. Complementary and alternative treatments for late-life depression, anxiety, and sleep disturbance: a review of randomized controlled trials. J Clin Psychiatry 2007; 68:1461-71. [PMID: 17960959 DOI: 10.4088/jcp.v68n1001] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [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: 10/20/2022]
Abstract
OBJECTIVE We reviewed randomized controlled trials of complementary and alternative medicine (CAM) treatments for depression, anxiety, and sleep disturbance in nondemented older adults. DATA SOURCES We searched PubMed (1966-September 2006) and PsycINFO (1984-September 2006) databases using combinations of terms including depression, anxiety, and sleep; older adult/elderly; randomized controlled trial; and a list of 56 terms related to CAM. STUDY SELECTION Of the 855 studies identified by database searches, 29 met our inclusion criteria: sample size >or= 30, treatment duration >or= 2 weeks, and publication in English. Four additional articles from manual bibliography searches met inclusion criteria, totaling 33 studies. DATA EXTRACTION We reviewed identified articles for methodological quality using a modified Scale for Assessing Scientific Quality of Investigations (SASQI). We categorized a study as positive if the CAM therapy proved significantly more effective than an inactive control (or as effective as active control) on at least 1 primary psychological outcome. Positive and negative studies were compared on the following characteristics: CAM treatment category, symptom(s) assessed, country where the study was conducted, sample size, treatment duration, and mean sample age. DATA SYNTHESIS 67% of the 33 studies reviewed were positive. Positive studies had lower SASQI scores for methodology than negative studies. Mind-body and body-based therapies had somewhat higher rates of positive results than energy- or biologically-based therapies. CONCLUSIONS Most studies had substantial methodological limitations. A few well-conducted studies suggested therapeutic potential for certain CAM interventions in older adults (e.g., mind-body interventions for sleep disturbances and acupressure for sleep and anxiety). More rigorous research is needed, and suggestions for future research are summarized.
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Affiliation(s)
- Thomas W Meeks
- Division of Geriatric Psychiatry, Department of Psychiatry, University of California, San Diego, USA.
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15
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Mittal D, Fortney JC, Pyne JM, Edlund MJ, Wetherell JL. Impact of comorbid anxiety disorders on health-related quality of life among patients with major depressive disorder. Psychiatr Serv 2006; 57:1731-7. [PMID: 17158487 DOI: 10.1176/ps.2006.57.12.1731] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study examined the impact of comorbid anxiety disorders-posttraumatic stress disorder (PTSD), generalized anxiety disorder, and panic disorder-on health-related quality of life among primary care patients enrolled in a collaborative care depression intervention study for the Department of Veterans Affairs (VA). METHODS Baseline data were used from 324 participants in the Telemedicine Enhanced Antidepressant Management (TEAM) Study, a multisite randomized effectiveness trial targeting VA primary care patients with depression. Health-related quality of life was measured by using the Quality of Well-Being Scale, self-administered version (QWB-SA) and the mental component summary (MCS-12V) and physical component summary (PCS-12V) of the 12-item Short Form Health Survey for Veterans (SF-12V). RESULTS A majority of participants (69 percent) had at least one anxiety disorder. Generalized anxiety disorder and PTSD predicted scores on the QWB-SA. PTSD predicted scores on the PCS-12V, but none of the comorbid anxiety disorders predicted scores on the MCS-12V. In addition, social support, depression severity, and the number of chronic medical conditions significantly predicted QWB-SA scores; the number of self-reported chronic physical health conditions and the number of depression episodes significantly predicted PCS-12V scores; and social support and depression severity significantly predicted MCS-12V scores. CONCLUSIONS According to scores on the QWB-SA, generalized anxiety disorder and PTSD comorbid with major depressive disorder impair health-related quality of life above and beyond major depressive disorder alone.
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Affiliation(s)
- Dinesh Mittal
- Health Services Research and Development Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, 2200 Fort Roots Drive, Building 58 (152/NLR), Little Rock, AR 72114, USA.
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16
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Halpain MC, Jeste DV, Trinidad GI, Wetherell JL, Lebowitz BD. Intensive short-term research training for undergraduate, graduate, and medical students: early experience with a new national-level approach in geriatric mental health. Acad Psychiatry 2005; 29:58-65. [PMID: 15772406 DOI: 10.1176/appi.ap.29.1.58] [Citation(s) in RCA: 13] [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] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
OBJECTIVE There is an urgent need for research training in psychiatry at early career stages, especially in geriatric psychiatry. The authors describe their first-year experience with the Summer Training in Aging Research Topics-in Mental Health (START-MH), a new federally funded national-level training program intended to offer intensive short-term research training for undergraduate, graduate, and medical students. METHODS The funding was used primarily to pay stipends for trainees who spent 10 weeks during the Summer working on research projects under established research mentors. At the end, a workshop brought together all the trainees who presented research posters. RESULTS Thirty trainees were selected from among 85 applicants. They worked on projects including basic, translational, clinical, or services research. Evaluations from trainees and mentors were uniformly positive. All the trainees reported that the START-MH program enhanced their interest in pursuing a career in geriatric mental health research. Several trainees later submitted their work for presentation or publication. CONCLUSIONS The initial data suggest that the START-MH program can be a potentially useful model for attracting talented early-career trainees into mental health research.
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Affiliation(s)
- Maureen C Halpain
- Department of Psychiatry, VA San Diego Healthcare System, 3350 La Jolla Village Dr., San Diego, CA 92161, USA
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17
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Abstract
The authors modeled depressive and anxiety symptom data from 1,391 participants in a longitudinal study of middle-aged and older Swedish twins (M age = 60.9 years, SD = 13.3). Although anxiety and depression were highly correlated, a model with distinct Anxiety and Depression factors fit the data better than models with Positive and Negative Affect factors or a single Mental Health factor. Lack of well-being was associated with anxiety rather than depression. Over two 3-year intervals, anxiety symptoms led to depressive symptoms, but the relationship was not reciprocal. Anxiety symptoms were more stable than depression. These findings provide additional support for the idea that anxiety symptoms may reflect a personality trait such as neuroticism more than do depressive symptoms and suggest that low positive affect may not be as specific to depression among older adults as in younger people.
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Affiliation(s)
- J L Wetherell
- Department of Psychology, University of Southern California, Los Angeles 90089-1061, USA.
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18
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Abstract
The authors modeled depressive and anxiety symptom data from 1,391 participants in a longitudinal study of middle-aged and older Swedish twins (M age = 60.9 years, SD = 13.3). Although anxiety and depression were highly correlated, a model with distinct Anxiety and Depression factors fit the data better than models with Positive and Negative Affect factors or a single Mental Health factor. Lack of well-being was associated with anxiety rather than depression. Over two 3-year intervals, anxiety symptoms led to depressive symptoms, but the relationship was not reciprocal. Anxiety symptoms were more stable than depression. These findings provide additional support for the idea that anxiety symptoms may reflect a personality trait such as neuroticism more than do depressive symptoms and suggest that low positive affect may not be as specific to depression among older adults as in younger people.
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Affiliation(s)
- J L Wetherell
- Department of Psychology, University of Southern California, Los Angeles 90089-1061, USA.
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19
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Pedersen NL, Miller BL, Wetherell JL, Vallo J, Toga AW, Knutson N, Mehringer CM, Small GW, Gatz M. Neuroimaging findings in twins discordant for Alzheimer's disease. Dement Geriatr Cogn Disord 1999; 10:51-8. [PMID: 9844037 DOI: 10.1159/000017097] [Citation(s) in RCA: 88] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Data from computed tomography (CT) scans of 12 twin pairs in which one partner had Azheimer's disease (AD) and the other partner is cognitively intact were analyzed to study structural brain features associated with AD while controlling for familial factors. Visual ratings and analysis of quantified areas and volumes indicated that AD twins showed more dilation of temporal horns, lateral ventricles and third ventricle, and more atrophy of temporal lobes, particularly in the anterior temporal/perisylvian area, than their healthy cotwins. Demented twins did not have smaller intracranial areas or overall brain volumes than their intact partners. The apolipoprotein sigma-4 allele was associated with greater dilation of lateral ventricles and ventricular volume. Significant intrapair correlations were found for total intracranial area and volume, cerebellar area and white matter lesions.
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Affiliation(s)
- N L Pedersen
- Department of Psychology, University of Southern California, Los Angeles, Calif., USA
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Wetherell JL, Gatz M, Johansson B, Pedersen NL. History of depression and other psychiatric illness as risk factors for Alzheimer disease in a twin sample. Alzheimer Dis Assoc Disord 1999; 13:47-52. [PMID: 10192642 DOI: 10.1097/00002093-199903000-00007] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Although case-control studies have found elevated risk for Alzheimer disease (AD) associated with a prior psychiatric history, most of the previous research had inadequate controls for familial risk factors. Putative psychiatric risk factors were evaluated for a registry-based sample of 65 twin pairs discordant for AD. Risk ratios were calculated for psychiatric illness at any time and for episodes more than 10 years before dementia onset. Prior psychiatric illness was significantly associated with elevated risk. Most of these cases represented depressive episodes. When analyses were restricted to individuals whose mental illness commenced more than 10 years before dementia onset, the magnitude of the odds ratio decreased markedly. These findings suggest that a history of psychiatric illness, especially depression, may be associated with an elevated risk for AD. In particular, these results are consistent with an interpretation that symptoms of depression and similar complaints represent prodromal phases of dementia.
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Affiliation(s)
- J L Wetherell
- Department of Psychology, University of Southern California, Los Angeles 90089-1061, USA
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