1
|
Forster SE, Torres TM, Steinhauer SR, Forman SD. Telehealth-Based Contingency Management Targeting Stimulant Abstinence: A Case Series From the COVID-19 Pandemic. J Stud Alcohol Drugs 2024; 85:26-31. [PMID: 37796622 PMCID: PMC10846603 DOI: 10.15288/jsad.23-00016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 07/31/2023] [Indexed: 10/07/2023] Open
Abstract
OBJECTIVE Contingency management (CM) is the gold standard treatment for stimulant use disorder but typically requires twice- to thrice-weekly in-person treatment visits to objectively verify abstinence and deliver therapeutic incentives. There has been growing interest in telehealth-based delivery of CM to support broad access to this essential intervention--a need that has been emphatically underscored by the COVID-19 pandemic. Herein, we present observations from initial efforts to develop and test a protocol for telehealth-based delivery of prize-based CM treatment incentivizing stimulant abstinence. METHOD Four participants engaged in hybrid courses of CM, including one or more telehealth-based treatment sessions, involving self-administered oral fluid testing to confirm abstinence. Observations from initial participants informed iterative improvements to telehealth procedures, and a 12-week course of telehealth-based CM was subsequently offered to two additional participants to further evaluate preliminary feasibility and acceptability. RESULTS In most cases, participants were able to successfully join telehealth treatment sessions, self-administer oral fluid testing, and share oral fluid test results to verify stimulant abstinence. However, further improvements in telehealth-based toxicology testing may be necessary to interpret test results accurately and reliably, especially when colorimetric immunoassay results reflect substance concentrations near the cutoff for point-of-care testing devices. CONCLUSIONS Preliminary findings suggest that telehealth-based CM is sufficiently feasible and acceptable to support future development, in particular through improved methods for remote interpretation and verification of test results. This is especially important in CM, wherein accurate and reliable detection of both early and sustained abstinence is crucial for appropriate delivery of therapeutic incentives.
Collapse
Affiliation(s)
- Sarah E. Forster
- Veterans Affairs Pittsburgh Healthcare System, VISN 4 Mental Illness Research, Education, & Clinical Center (MIRECC), Pittsburgh, Pennsylvania
| | - Taylor M. Torres
- Veterans Affairs Pittsburgh Healthcare System, VISN 4 Mental Illness Research, Education, & Clinical Center (MIRECC), Pittsburgh, Pennsylvania
| | - Stuart R. Steinhauer
- Veterans Affairs Pittsburgh Healthcare System, VISN 4 Mental Illness Research, Education, & Clinical Center (MIRECC), Pittsburgh, Pennsylvania
- University of Pittsburgh, Department of Psychiatry, Pittsburgh, Pennsylvania
| | - Steven D. Forman
- Veterans Affairs Pittsburgh Healthcare System, VISN 4 Mental Illness Research, Education, & Clinical Center (MIRECC), Pittsburgh, Pennsylvania
- University of Pittsburgh, Department of Psychiatry, Pittsburgh, Pennsylvania
| |
Collapse
|
2
|
Torres TM, Steinhauer SR, Forman SD, Forster SE. Patients with cocaine use disorder exhibit reductions in delay discounting with episodic future thinking cues regardless of incarceration history. Addict Behav Rep 2023; 18:100518. [PMID: 37955039 PMCID: PMC10632774 DOI: 10.1016/j.abrep.2023.100518] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 10/25/2023] [Accepted: 10/27/2023] [Indexed: 11/14/2023] Open
Abstract
Research examining episodic future thinking (EFT; i.e., imagining oneself in future contexts) in community samples has demonstrated reduced discounting of delayed rewards when personalized event cues are included to prompt EFT related to reward latencies. While this EFT effect was recently demonstrated in individuals with substance use disorders, it is not yet known if it manifests similarly in individuals with and without a significant incarceration history-the latter being at elevated risk for negative outcomes including criminal recidivism. Individuals with cocaine use disorder (n = 35) identified personally-relevant future events and participated in a computerized delay discounting task, involving decisions between smaller immediate rewards or larger delayed rewards with and without EFT cues. Individuals with (n = 19) and without (n = 16) a significant history of incarceration were identified using the Addiction Severity Index-Lite. A significant reduction in discounting rates was observed when event cues were included to promote EFT (p = 0.02); however, there was no main effect of incarceration history on discounting behavior, or interaction between episodic future thinking condition and incarceration history. Results suggest personalized cues included to evoke EFT reduce discounting behavior in individuals with cocaine use disorder, regardless of incarceration history. EFT-based interventions may therefore have promise to reduce impulsive decision-making in individuals with cocaine use disorder with and without a significant history of incarceration, potentially supporting improved outcomes with respect to both substance use and future criminality.
Collapse
Affiliation(s)
- Taylor M. Torres
- VA Pittsburgh Healthcare System, VISN 4 Mental Illness Research, Education, & Clinical Center (MIRECC), USA
| | - Stuart R. Steinhauer
- VA Pittsburgh Healthcare System, VISN 4 Mental Illness Research, Education, & Clinical Center (MIRECC), USA
- University of Pittsburgh, Department of Psychiatry, USA
| | - Steven D. Forman
- VA Pittsburgh Healthcare System, VISN 4 Mental Illness Research, Education, & Clinical Center (MIRECC), USA
- University of Pittsburgh, Department of Psychiatry, USA
| | - Sarah E. Forster
- VA Pittsburgh Healthcare System, VISN 4 Mental Illness Research, Education, & Clinical Center (MIRECC), USA
| |
Collapse
|
3
|
Ehrlich TJ, Bhat J, Horwege AM, Mathalon DH, Glover GH, Roach BJ, Badran BW, Forman SD, George MS, Scott JC, Thase ME, Yesavage JA, Yurgelun-Todd DA, Rosen AC. Ruminative reflection is associated with anticorrelations between the orbitofrontal cortex and the default mode network in depression: implications for repetitive transcranial magnetic stimulation. Brain Imaging Behav 2022; 16:1186-1195. [PMID: 34860349 PMCID: PMC9107429 DOI: 10.1007/s11682-021-00596-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2021] [Indexed: 02/01/2023]
Abstract
Patients with depression who ruminate repeatedly focus on depressive thoughts; however, there are two cognitive subtypes of rumination, reflection and brooding, each associated with different prognoses. Reflection involves problem-solving and is associated with positive outcomes, whereas brooding involves passive, negative, comparison with other people and is associated with poor outcomes. Rumination has also been related to atypical functional hyperconnectivity between the default mode network and subgenual prefrontal cortex. Repetitive pulse transcranial magnetic stimulation of the prefrontal cortex has been shown to alter functional connectivity, suggesting that the abnormal connectivity associated with rumination could potentially be altered. This study examined potential repetitive pulse transcranial magnetic stimulation prefrontal cortical targets that could modulate one or both of these rumination subtypes. Forty-three patients who took part in a trial of repetitive pulse transcranial magnetic stimulation completed the Rumination Response Scale questionnaire and resting-state functional magnetic resonance imaging. Seed to voxel functional connectivity analyses identified an anticorrelation between the left lateral orbitofrontal cortex (-44, 26, -8; k = 172) with the default mode network-subgenual region in relation to higher levels of reflection. Parallel analyses were not significant for brooding or the RRS total score. These findings extend previous studies of rumination and identify a potential mechanistic model for symptom-based neuromodulation of rumination.
Collapse
Affiliation(s)
- Tobin J Ehrlich
- Veterans Affairs Palo Alto Health Care System, 3801 Miranda Ave (151Y), Palo Alto, CA, 94304, USA
- University of Michigan, Ann Arbor, MI, USA
| | - Jyoti Bhat
- Veterans Affairs Palo Alto Health Care System, 3801 Miranda Ave (151Y), Palo Alto, CA, 94304, USA
- Palo Alto Veterans Institute for Research, Palo Alto, CA, 94304, USA
| | - Andrea M Horwege
- Veterans Affairs Palo Alto Health Care System, 3801 Miranda Ave (151Y), Palo Alto, CA, 94304, USA
| | - Daniel H Mathalon
- Mental Health Service, San Francisco Veterans Affairs Health Care System, University of California, San Francisco, San Francisco, CA, USA
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA, USA
| | - Gary H Glover
- Department of Radiology, Stanford University, Stanford, CA, USA
| | - Brian J Roach
- Mental Health Service, San Francisco Veterans Affairs Health Care System, University of California, San Francisco, San Francisco, CA, USA
- Northern California Institute for Research and Education, San Francisco Veterans Affairs Medical Center, University of California, San Francisco, San Francisco, CA, USA
| | - Bashar W Badran
- Brain Stimulation Division, Department of Psychiatry, Medical University of South Carolina, Charleston, SC, USA
| | - Steven D Forman
- Department of Veterans Affairs, Veterans Affairs Medical Center, Pittsburgh, PA, USA
- Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Mark S George
- Brain Stimulation Division, Department of Psychiatry, Medical University of South Carolina, Charleston, SC, USA
- Ralph H. Johnson VA Medical Center, Charleston, SC, USA
| | - J Cobb Scott
- VISN4 Mental Illness Research, Education, and Clinical Center at the Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, 19104, USA
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Michael E Thase
- VISN4 Mental Illness Research, Education, and Clinical Center at the Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, 19104, USA
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Jerome A Yesavage
- Veterans Affairs Palo Alto Health Care System, 3801 Miranda Ave (151Y), Palo Alto, CA, 94304, USA
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Deborah A Yurgelun-Todd
- Rocky Mountain Network Mental Illness Research Education and Clinical Centers (VISN 19), VA Salt Lake City Health Care System, Salt Lake City, UT, USA
- Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Allyson C Rosen
- Veterans Affairs Palo Alto Health Care System, 3801 Miranda Ave (151Y), Palo Alto, CA, 94304, USA.
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA.
| |
Collapse
|
4
|
Forster SE, Forman SD, Gancz NN, Siegle GJ, Dickey MW, Steinhauer SR. Electrophysiological predictors and indicators of contingency management treatment response: Rationale and design for the ways of rewarding abstinence project (WRAP). Contemp Clin Trials Commun 2021; 23:100796. [PMID: 34278041 PMCID: PMC8264114 DOI: 10.1016/j.conctc.2021.100796] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 05/18/2021] [Accepted: 06/03/2021] [Indexed: 10/25/2022] Open
Abstract
Background Electrophysiological measures can predict and reflect substance use treatment response. Veterans are disproportionately affected by disorders of addiction; cocaine use disorder (CUD) being particularly problematic due to high relapse rates and the absence of approved pharmacotherapies. Prize-based Contingency Management (PBCM) is an evidence-based behavioral intervention for CUD, involving incentives for cocaine abstinence but treatment response is variable. Measurement-based adaptation of PBCM has promise to improve effectiveness but remains to be usefully developed. Methods This trial aims to determine if individuals with distinct neurocognitive profiles differentially benefit from one of two existing versions of PBCM. CUD patients will be randomized into treatment-as-usual or 12-weeks of PBCM using either monetary or tangible prize incentives. Prior to randomization, EEG will be used to assess response to monetary versus tangible reward; EEG and cognitive-behavioral measures of working memory, cognitive control, and episodic future thinking will also be acquired. Substance use and treatment engagement will be monitored throughout the treatment interval and assessments will be repeated at post-treatment. Discussion Results of this trial may elucidate individual differences contributing to PBCM treatment response and reveal predictors of differential benefits from existing treatment variants. The design also affords the opportunity to evaluate treatment-related changes in neurocognitive functioning over the course of PBCM. Our model posits that PBCM scaffolds future-oriented goal representation and self-control to support abstinence. Individuals with poorer functioning may be less responsive to abstract monetary reward and will therefore achieve better outcomes with respect to abstinence and treatment engagement when tangible incentives are utilized.
Collapse
Affiliation(s)
- Sarah E Forster
- VISN 4 Mental Illness Research, Education, and Clinical Center, VA Pittsburgh Healthcare System, United States
| | - Steven D Forman
- VISN 4 Mental Illness Research, Education, and Clinical Center, VA Pittsburgh Healthcare System, United States.,University of Pittsburgh, Department of Psychiatry, United States
| | - Naomi N Gancz
- VISN 4 Mental Illness Research, Education, and Clinical Center, VA Pittsburgh Healthcare System, United States
| | - Greg J Siegle
- University of Pittsburgh, Department of Psychiatry, United States.,University of Pittsburgh, Department of Psychology, United States
| | - Michael Walsh Dickey
- VISN 4 Mental Illness Research, Education, and Clinical Center, VA Pittsburgh Healthcare System, United States.,University of Pittsburgh, Department of Psychology, United States.,University of Pittsburgh, Department of Communication Science and Disorders, United States
| | - Stuart R Steinhauer
- VISN 4 Mental Illness Research, Education, and Clinical Center, VA Pittsburgh Healthcare System, United States.,University of Pittsburgh, Department of Psychiatry, United States
| |
Collapse
|
5
|
Rosen AC, Bhat JV, Cardenas VA, Ehrlich TJ, Horwege AM, Mathalon DH, Roach BJ, Glover GH, Badran BW, Forman SD, George MS, Thase ME, Yurgelun-Todd D, Sughrue ME, Doyen SP, Nicholas PJ, Scott JC, Tian L, Yesavage JA. Targeting location relates to treatment response in active but not sham rTMS stimulation. Brain Stimul 2021; 14:703-709. [PMID: 33866020 PMCID: PMC8884259 DOI: 10.1016/j.brs.2021.04.010] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 03/25/2021] [Accepted: 04/01/2021] [Indexed: 11/28/2022] Open
Abstract
Background: Precise targeting of brain functional networks is believed critical for treatment efficacy of rTMS (repetitive pulse transcranial magnetic stimulation) in treatment resistant major depression. Objective: To use imaging data from a “failed” clinical trial of rTMS in Veterans to test whether treatment response was associated with rTMS coil location in active but not sham stimulation, and compare fMRI functional connectivity between those stimulation locations. Methods: An imaging substudy of 49 Veterans (mean age, 56 years; range, 27e78 years; 39 male) from a randomized, sham-controlled, double-blinded clinical trial of rTMS treatment, grouping participants by clinical response, followed by group comparisons of treatment locations identified by individualized fiducial markers on structural MRI and resting state fMRI derived networks. Results: The average stimulation location for responders versus nonresponders differed in the active but not in the sham condition (P = .02). The average responder location derived from the active condition showed significant negative functional connectivity with the subgenual cingulate (P < .001) while the nonresponder location did not (P = .17), a finding replicated in independent cohorts of 84 depressed and 35 neurotypical participants. The responder and nonresponder stimulation locations evoked different seed based networks (FDR corrected clusters, all P < .03), revealing additional brain regions related to rTMS treatment outcome. Conclusion: These results provide evidence from a randomized controlled trial that clinical response to rTMS is related to accuracy in targeting the region within DLPFC that is negatively correlated with subgenual cingulate. These results support the validity of a neuro-functionally informed rTMS therapy target in Veterans.
Collapse
Affiliation(s)
- A C Rosen
- Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA; Department of Psychiatry, Stanford University, Stanford, CA, 94305, USA.
| | - J V Bhat
- Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA; Palo Alto Veterans Institute for Research, Palo Alto, CA, 94304, USA
| | - V A Cardenas
- Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - T J Ehrlich
- Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA; University of Michigan, Ann Arbor, USA
| | - A M Horwege
- Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - D H Mathalon
- Mental Health Service, San Francisco Veterans Affairs Health Care System, University of California, San Francisco, CA, USA; Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, USA
| | - B J Roach
- Mental Health Service, San Francisco Veterans Affairs Health Care System, University of California, San Francisco, CA, USA; Northern California Institute for Research and Education, San Francisco Veterans Affairs Medical Center, University of California, San Francisco, CA, USA
| | - G H Glover
- Department of Radiology, Stanford University, Stanford, CA, USA
| | - B W Badran
- Brain Stimulation Division, Department of Psychiatry, Medical University of South Carolina, Charleston, SC, USA
| | - S D Forman
- Department of Veterans Affairs, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA; Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - M S George
- Brain Stimulation Division, Department of Psychiatry, Medical University of South Carolina, Charleston, SC, USA; Ralph H. Johnson VA Medical Center, Charleston, SC, USA
| | - M E Thase
- VISN4 Mental Illness Research, Education, and Clinical Center at the Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, 19104, USA; Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - D Yurgelun-Todd
- Rocky Mountain Network Mental Illness Research Education and Clinical Centers (VISN 19), VA Salt Lake City Health Care System, Salt Lake City, UT, USA; Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - M E Sughrue
- Omniscient Neurotechnologies, Sydney, Australia; Prince of Wales Hospital, Randwick, NSW, Australia
| | - S P Doyen
- Omniscient Neurotechnologies, Sydney, Australia
| | | | - J C Scott
- VISN4 Mental Illness Research, Education, and Clinical Center at the Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, 19104, USA; Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - L Tian
- Department of Biomedical Data Science, Stanford University School of Medicine, Stanford, CA, USA
| | - J A Yesavage
- Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA; Department of Psychiatry, Stanford University, Stanford, CA, 94305, USA
| |
Collapse
|
6
|
Forster SE, Steinhauer SR, Ortiz A, Forman SD. Evaluating effects of episodic future thinking on valuation of delayed reward in cocaine use disorder: a pilot study. Am J Drug Alcohol Abuse 2021; 47:199-208. [PMID: 33539190 DOI: 10.1080/00952990.2020.1865997] [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] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Background: Episodic future thinking (EFT; i.e., envisioning oneself in future contexts) has been demonstrated to reduce discounting of future reward in healthy adults. While this approach has the potential to support future-oriented decision-making in substance use recovery, the impact of EFT on discounting behavior in illicit stimulant users has not yet been evaluated.Objectives: This pilot study aimed to (1) assess the feasibility of utilizing EFT methods in individuals with cocaine use disorder (CUD) and (2) conduct preliminary measurement of the EFT effect on discounting behavior in this population.Methods: Eighteen treatment-seeking individuals with CUD (17 males) were interviewed about positive and neutral events expected to occur at a range of future latencies. Future event information identified by participants was subsequently included on a subset of trials in an intertemporal choice task to promote EFT; within-subject differences in discounting between standard and EFT conditions were evaluated.Results: Participants identified relevant events and demonstrated decreased discounting of future reward when event descriptors were included (relative to discounting without event descriptors; p = .039). It was further noted that most events identified by participants were goals, rather than plans or significant dates.Conclusion: While methods previously used to study the effect of EFT on discounting behavior in healthy individuals are also effective in individuals with CUD, methodological factors - including types of events identified - should be carefully considered in future work. These preliminary findings suggest that EFT can reduce impulsive decision-making in cocaine use disorder and may therefore have therapeutic value.
Collapse
Affiliation(s)
- Sarah E Forster
- VISN 4 Mental Illness Research, Education, and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA.,Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Stuart R Steinhauer
- VISN 4 Mental Illness Research, Education, and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA.,Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Andrea Ortiz
- VISN 4 Mental Illness Research, Education, and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - Steven D Forman
- VISN 4 Mental Illness Research, Education, and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA.,Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| |
Collapse
|
7
|
Forster SE, DePhilippis D, Forman SD. "I's" on the prize: A systematic review of individual differences in Contingency Management treatment response. J Subst Abuse Treat 2019; 100:64-83. [PMID: 30898330 DOI: 10.1016/j.jsat.2019.03.001] [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] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 01/30/2019] [Accepted: 03/06/2019] [Indexed: 01/02/2023]
Abstract
Contingency Management is an evidence-based treatment for substance use disorders with strong potential for measurement-based customization. Previous work has examined individual difference factors in Contingency Management treatment response of potential relevance to treatment targeting and adaptive implementation; however, a systematic review of such factors has not yet been conducted. Here, we summarize and evaluate the existing literature on patient-level predictors, mediators, and moderators of Contingency Management treatment response in stimulant and/or opioid using outpatients - clinical populations most frequently targeted in Contingency Management research and clinical practice. Our search strategy identified 648 unique, peer-reviewed publications, of which 39 met full inclusion criteria for the current review. These publications considered a variety of individual difference factors, including (1) motivation to change and substance use before and during treatment (8/39 publications), (2) substance use comorbidity and chronicity (8/39 publications), (3) psychiatric comorbidity and severity (8/39 publications), (4) medical, legal, and sociodemographic considerations (15/39 publications), and (5) cognitive-behavioral variables (1/39 publications). Contingency Management was generally associated with improved treatment outcomes (e.g., longer periods of continuous abstinence, better retention), regardless of individual difference factors; however, specific patient-level characteristics were associated with either an enhanced (e.g., more previous treatment attempts, history of sexual abuse, diagnosis of antisocial personality disorder) or diminished (e.g., complex post-traumatic stress symptoms, pretreatment benzodiazepine use) response to Contingency Management. Overall, the current literature is limited but existing evidence generally supports greater benefits of Contingency Management in patients who would otherwise have a poorer prognosis in standard outpatient care. It was also identified that the majority of previous work represents a posteriori analysis of pre-existing clinical samples and has therefore rarely considered pre-specified, hypothesis-driven individual difference factors. We therefore additionally highlight patient-level factors that are currently understudied, as well as promising future directions for measurement-based treatment adaptations that may directly respond to patient traits and states to improve Contingency Management effectiveness across individuals and over time.
Collapse
Affiliation(s)
- Sarah E Forster
- VISN 4 Mental Illness Research, Education, and Clinical Center, VA Pittsburgh Healthcare System, United States of America; University of Pittsburgh, Department of Psychiatry, United States of America.
| | - Dominick DePhilippis
- Center of Excellence in Substance Addiction Treatment and Education, Corporal Michael J. Crescenz VA Medical Center, United States of America; Perelman School of Medicine, University of Pennsylvania, United States of America
| | - Steven D Forman
- VISN 4 Mental Illness Research, Education, and Clinical Center, VA Pittsburgh Healthcare System, United States of America; University of Pittsburgh, Department of Psychiatry, United States of America
| |
Collapse
|
8
|
Yesavage JA, Fairchild JK, Mi Z, Biswas K, Davis-Karim A, Phibbs CS, Forman SD, Thase M, Williams LM, Etkin A, O’Hara R, Georgette G, Beale T, Huang GD, Noda A, George MS. Effect of Repetitive Transcranial Magnetic Stimulation on Treatment-Resistant Major Depression in US Veterans: A Randomized Clinical Trial. JAMA Psychiatry 2018; 75:884-893. [PMID: 29955803 PMCID: PMC6142912 DOI: 10.1001/jamapsychiatry.2018.1483] [Citation(s) in RCA: 103] [Impact Index Per Article: 17.2] [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] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Treatment-resistant major depression (TRMD) in veterans is a major clinical challenge given the high risk for suicidality in these patients. Repetitive transcranial magnetic stimulation (rTMS) offers the potential for a novel treatment modality for these veterans. OBJECTIVE To determine the efficacy of rTMS in the treatment of TRMD in veterans. DESIGN, SETTING, AND PARTICIPANTS A double-blind, sham-controlled randomized clinical trial was conducted from September 1, 2012, to December 31, 2016, in 9 Veterans Affairs medical centers. A total of 164 veterans with TRD participated. INTERVENTIONS Participants were randomized to either left prefrontal rTMS treatment (10 Hz, 120% motor threshold, 4000 pulses/session) or to sham (control) rTMS treatment for up to 30 treatment sessions. MAIN OUTCOMES AND MEASURES The primary dependent measure of the intention-to-treat analysis was remission rate (Hamilton Rating Scale for Depression score ≤10, indicating that depression is in remission and not a clinically significant burden), and secondary analyses were conducted on other indices of posttraumatic stress disorder, depression, hopelessness, suicidality, and quality of life. RESULTS The 164 participants had a mean (SD) age of 55.2 (12.4) years, 132 (80.5%) were men, and 126 (76.8%) were of white race. Of these, 81 were randomized to receive active rTMS and 83 to receive sham. For the primary analysis of remission, there was no significant effect of treatment (odds ratio, 1.16; 95% CI, 0.59-2.26; P = .67). At the end of the acute treatment phase, 33 of 81 (40.7%) of those in the active treatment group achieved remission of depressive symptoms compared with 31 of 83 (37.4%) of those in the sham treatment group. Overall, 64 of 164 (39.0%) of the participants achieved remission. CONCLUSIONS AND RELEVANCE A total of 39.0% of the veterans who participated in this trial experienced clinically significant improvement resulting in remission of depressive symptoms; however, there was no evidence of difference in remission rates between the active and sham treatments. These findings may reflect the importance of close clinical surveillance, rigorous monitoring of concomitant medication, and regular interaction with clinic staff in bringing about significant improvement in this treatment-resistant population. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01191333.
Collapse
Affiliation(s)
- Jerome A. Yesavage
- Department of Veterans Affairs, Sierra-Pacific Mental Illness Research Educational and Clinical Center, Palo Alto, California,Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
| | - J. Kaci Fairchild
- Department of Veterans Affairs, Sierra-Pacific Mental Illness Research Educational and Clinical Center, Palo Alto, California,Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
| | - Zhibao Mi
- Department of Veterans Affairs, Cooperative Studies Program Coordinating Center, Perry Point, Maryland
| | - Kousick Biswas
- Department of Veterans Affairs, Cooperative Studies Program Coordinating Center, Perry Point, Maryland
| | - Anne Davis-Karim
- Department of Veterans Affairs, Cooperative Studies Program Pharmacy Coordinating Center, Albuquerque, New Mexico
| | - Ciaran S. Phibbs
- Department of Veterans Affairs, Health Economics Resource Center and Center for Implementation to Innovation, Palo Alto, California,Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Steven D. Forman
- Department of Veterans Affairs, Veterans Affairs Medical Center, Pittsburgh, Pennsylvania,Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Michael Thase
- Department of Veterans Affairs, Veterans Affairs Medical Center, Philadelphia, Pennsylvania
| | - Leanne M. Williams
- Department of Veterans Affairs, Sierra-Pacific Mental Illness Research Educational and Clinical Center, Palo Alto, California,Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
| | - Amit Etkin
- Department of Veterans Affairs, Sierra-Pacific Mental Illness Research Educational and Clinical Center, Palo Alto, California,Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California,Stanford Neurosciences Institute, Stanford University, Stanford, California
| | - Ruth O’Hara
- Department of Veterans Affairs, Sierra-Pacific Mental Illness Research Educational and Clinical Center, Palo Alto, California,Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
| | - Gerald Georgette
- Department of Veterans Affairs, Sierra-Pacific Mental Illness Research Educational and Clinical Center, Palo Alto, California
| | - Tamara Beale
- Department of Veterans Affairs, Sierra-Pacific Mental Illness Research Educational and Clinical Center, Palo Alto, California
| | - Grant D. Huang
- Department of Veterans Affairs, Cooperative Studies Program Central Office, Washington, DC
| | - Art Noda
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
| | - Mark S. George
- Department of Veterans Affairs, Ralph H. Johnson Veterans Affairs Medical Center, Charleston, South Carolina,Brain Stimulation Laboratory, Psychiatry Department, Medical University of South Carolina, Charleston
| | | |
Collapse
|
9
|
Forster SE, Dickey MW, Forman SD. Regional cerebral blood flow predictors of relapse and resilience in substance use recovery: A coordinate-based meta-analysis of human neuroimaging studies. Drug Alcohol Depend 2018; 185:93-105. [PMID: 29428325 DOI: 10.1016/j.drugalcdep.2017.12.009] [Citation(s) in RCA: 14] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 11/29/2017] [Accepted: 12/01/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND Predicting relapse vulnerability can inform level-of-care and personalized substance use treatment. Few reliable predictors of relapse risk have been identified from traditional clinical, psychosocial, and demographic variables. However, recent neuroimaging findings highlight the potential prognostic import of brain-based signals, indexing the degree to which neural systems have been perturbed by addiction. These proposed "neuromarkers" forecast the likelihood, severity, and timing of relapse but the reliability and generalizability of such effects remains to be established. METHODS Activation likelihood estimation was used to conduct a preliminary quantitative, coordinate-based meta-analysis of the addiction neuroprediction literature; specifically, studies wherein baseline measures of regional cerebral blood flow were prospectively associated with substance use treatment outcomes. Consensus patterns of activation associated with relapse vulnerability (greater activation predicts poorer outcomes) versus resilience (greater activation predicts improved outcomes) were specifically investigated. RESULTS Twenty-four eligible studies yielded 134 foci, representing 923 subjects. Consensus activation was identified in right putamen and claustrum (p < .05, cluster-corrected) in relation to positive and negative treatment outcomes - likely reflecting variability in measurement context (e.g., task, sample characteristics) across datasets. A single cluster in rostral-ventral anterior cingulate cortex (rACC) was associated with relapse resilience, specifically (p < .05, cluster-corrected); no significant vulnerability-related clusters were identified. CONCLUSIONS Right putamen activation has been associated with relapse vulnerability and resilience, while increased baseline rACC activation has been consistently associated with improved treatment outcomes. Methodological heterogeneity within the existing literature, however, limits firm conclusions and future work will be necessary to confirm and clarify these results.
Collapse
Affiliation(s)
- Sarah E Forster
- VA Pittsburgh Healthcare System, United States; University of Pittsburgh, Department of Psychiatry, United States.
| | - Michael Walsh Dickey
- VA Pittsburgh Healthcare System, United States; University of Pittsburgh, Department of Psychology, United States; University of Pittsburgh, Department of Communication Science and Disorders, United States
| | - Steven D Forman
- VA Pittsburgh Healthcare System, United States; University of Pittsburgh, Department of Psychiatry, United States
| |
Collapse
|
10
|
Mi Z, Biswas K, Fairchild JK, Davis-Karim A, Phibbs CS, Forman SD, Thase M, Georgette G, Beale T, Pittman D, McNerney MW, Rosen A, Huang GD, George M, Noda A, Yesavage JA. Repetitive transcranial magnetic stimulation (rTMS) for treatment-resistant major depression (TRMD) Veteran patients: study protocol for a randomized controlled trial. Trials 2017; 18:409. [PMID: 28865495 PMCID: PMC5581925 DOI: 10.1186/s13063-017-2125-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 08/02/2017] [Indexed: 01/29/2023] Open
Abstract
Background Evaluation of repetitive transcranial magnetic stimulation (rTMS) for treatment-resistant major depression (TRMD) in Veterans offers unique clinical trial challenges. Here we describe a randomized, double-blinded, intent-to-treat, two-arm, superiority parallel design, a multicenter study funded by the Cooperative Studies Program (CSP No. 556) of the US Department of Veterans Affairs. Methods We recruited medical providers with clinical expertise in treating TRMD at nine Veterans Affairs (VA) medical centers as the trial local investigators. We plan to enroll 360 Veterans diagnosed with TRMD at the nine VA medical centers over a 3-year period. We will randomize participants into a double-blinded clinical trial to left prefrontal rTMS treatment or to sham (control) rTMS treatment (180 participants each group) for up to 30 treatment sessions. All participants will meet Diagnostic and statistical manual of mental disorders, 4thedition (DSM-IV) criteria for major depression and will have failed at least two prior pharmacological interventions. In contrast with other rTMS clinical trials, we will not exclude Veterans with posttraumatic stress disorder (PTSD) or history of substance abuse and we will obtain detailed history regarding these disorders. Furthermore, we will maintain participants on stable anti-depressant medication throughout the trial. We will evaluate all participants on a wide variety of potential predictors of treatment response including cognitive, psychological and functional parameters. Discussion The primary dependent measure will be remission rate (Hamilton Rating Scale for Depression (HRSD24) ≤ 10), and secondary analyses will be conducted on other indices. Comparisons between the rTMS and the sham groups will be made at the end of the acute treatment phase to test the primary hypothesis. The unique challenges to performing such a large technically challenging clinical trial with Veterans and potential avenues for improvement of the design in future trials will be described. Trial registration ClinicalTrials.gov, NCT01191333. Registered on 26 August 2010. This report is based on the protocol version 4.6 amended in February 2016. All items from the World Health Organization Trial Registration Data Set are listed in Appendix A. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-2125-y) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Zhibao Mi
- Department of Veterans Affairs, Cooperative Studies Program Coordinating Center, Perry Point, MD, USA
| | - Kousick Biswas
- Department of Veterans Affairs, Cooperative Studies Program Coordinating Center, Perry Point, MD, USA
| | - J Kaci Fairchild
- Department of Veterans Affairs, Sierra-Pacific MIRECC, and WRIISC, Palo Alto, CA, USA.,Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Anne Davis-Karim
- Department of Veterans Affairs, Cooperative Studies Program Pharmacy Coordinating Center, Albuquerque, NM, USA
| | - Ciaran S Phibbs
- Department of Veterans Affairs, Sierra-Pacific MIRECC, and WRIISC, Palo Alto, CA, USA.,Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Steven D Forman
- Department of Veterans Affairs, VA Medical Center, Pittsburgh, PA, USA.,Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Michael Thase
- Department of Veterans Affairs, VA Medical Center, Philadelphia, PA, USA
| | - Gerald Georgette
- Department of Veterans Affairs, Sierra-Pacific MIRECC, and WRIISC, Palo Alto, CA, USA
| | - Tamara Beale
- Department of Veterans Affairs, Sierra-Pacific MIRECC, and WRIISC, Palo Alto, CA, USA
| | - David Pittman
- Department of Veterans Affairs, Cooperative Studies Program Pharmacy Coordinating Center, Albuquerque, NM, USA
| | - Margaret Windy McNerney
- Department of Veterans Affairs, Sierra-Pacific MIRECC, and WRIISC, Palo Alto, CA, USA.,Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Allyson Rosen
- Department of Veterans Affairs, Sierra-Pacific MIRECC, and WRIISC, Palo Alto, CA, USA.,Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Grant D Huang
- Department of Veterans Affairs, Cooperative Studies Program Central Office, Washington DC, USA
| | - Mark George
- Department of Veterans Affairs, Ralph H. Johnson VA Medical Center, Charleston, SC, USA.,Brain Stimulation Laboratory (BSL), Psychiatry Department, Medical University of South Carolina (MUSC), Charleston, SC, USA
| | - Art Noda
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Jerome A Yesavage
- Department of Veterans Affairs, Sierra-Pacific MIRECC, and WRIISC, Palo Alto, CA, USA. .,Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA. .,VISN21 MIRECC, Department of Veterans Affairs, Department of Psychiatry, Stanford University School of Medicine, 3801 Miranda Avenue, Palo Alto, CA, 94304, USA.
| |
Collapse
|
11
|
Vanyukov PM, Szanto K, Hallquist MN, Siegle GJ, Reynolds CF, Forman SD, Aizenstein HJ, Dombrovski AY. Paralimbic and lateral prefrontal encoding of reward value during intertemporal choice in attempted suicide. Psychol Med 2016; 46:381-391. [PMID: 26446615 PMCID: PMC4797639 DOI: 10.1017/s0033291715001890] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [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] [Indexed: 02/06/2023]
Abstract
BACKGROUND Alongside impulsive suicide attempts, clinicians encounter highly premeditated suicidal acts, particularly in older adults. We have previously found that in contrast to the more impulsive suicide attempters' inability to delay gratification, serious and highly planned suicide attempts were associated with greater willingness to wait for larger rewards. This study examined neural underpinnings of intertemporal preference in suicide attempters. We expected that impulsivity and suicide attempts, particularly poorly planned ones, would predict altered paralimbic subjective value representations. We also examined lateral prefrontal and paralimbic correlates of premeditation in suicidal behavior. METHOD A total of 48 participants aged 46-90 years underwent extensive clinical and cognitive characterization and completed the delay discounting task in the scanner: 26 individuals with major depression (13 with and 13 without history of suicide attempts) and 22 healthy controls. RESULTS More impulsive individuals displayed greater activation in the precuneus/posterior cingulate cortex (PCC) to value difference favoring the delayed option. Suicide attempts, particularly better-planned ones, were associated with deactivation of the lateral prefrontal cortex (lPFC) in response to value difference favoring the immediate option. Findings were robust to medication exposure, depression severity and possible brain damage from suicide attempts, among other confounders. Finally, in suicide attempters longer reward delays were associated with diminished parahippocampal responses. CONCLUSIONS Impulsivity was associated with an altered paralimbic (precuneus/PCC) encoding of value difference during intertemporal choice. By contrast, better-planned suicidal acts were associated with altered lPFC representations of value difference. The study provides preliminary evidence of impaired decision processes in both impulsive and premeditated suicidal behavior.
Collapse
Affiliation(s)
- P M Vanyukov
- Department of Psychiatry,University of Pittsburgh School of Medicine,Pittsburgh,PA 5213,USA
| | - K Szanto
- Department of Psychiatry,University of Pittsburgh School of Medicine,Pittsburgh,PA 5213,USA
| | - M N Hallquist
- Department of Psychiatry,University of Pittsburgh School of Medicine,Pittsburgh,PA 5213,USA
| | - G J Siegle
- Department of Psychiatry,University of Pittsburgh School of Medicine,Pittsburgh,PA 5213,USA
| | - C F Reynolds
- Department of Psychiatry,University of Pittsburgh School of Medicine,Pittsburgh,PA 5213,USA
| | - S D Forman
- Department of Psychiatry,University of Pittsburgh School of Medicine,Pittsburgh,PA 5213,USA
| | - H J Aizenstein
- Department of Psychiatry,University of Pittsburgh School of Medicine,Pittsburgh,PA 5213,USA
| | - A Y Dombrovski
- Department of Psychiatry,University of Pittsburgh School of Medicine,Pittsburgh,PA 5213,USA
| |
Collapse
|
12
|
Shad MU, Prasad K, Forman SD, Haas GL, Walker JD, Pisarov LA, Goldstein G. Insight and neurocognitive functioning in bipolar subjects. Compr Psychiatry 2015; 56:112-20. [PMID: 25439524 DOI: 10.1016/j.comppsych.2014.04.016] [Citation(s) in RCA: 7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Revised: 04/24/2014] [Accepted: 04/24/2014] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Insight concerning having a mental illness has been found to influence outcome and effectiveness of treatment. It has been studied mainly in the area of schizophrenia with few studies addressing other disorders. This study evaluates insight in individuals with bipolar disorder using the Scale to Assess Unawareness of Mental Disorder (SUMD), a comprehensive interview for evaluation of awareness of illness and attribution of symptoms. The hypothesis was that in bipolar disorder level of awareness may be associated with numerous factors including neurocognitive function, structural changes in the frontal lobes and hippocampus evaluated by MRI, neurocognitive status, severity of mania and other psychiatric symptoms and comorbid alcoholism. METHOD In order to evaluate this hypothesis 33 individuals with DSM-IV diagnosed bipolar disorder, some with and some without comorbid alcoholism, were administered the SUMD and a number of other procedures including a quantitative MRI measuring volume of the frontal lobes and hippocampus, a brief battery of neurocognitive tests, the Brief Psychiatric Rating Scale, and the Young Mania Rating Scale. The data were analyzed by comparing participants with and without alcoholism on these procedures using t tests and by linear multiple regression, with SUMD ratings of awareness and attribution as the dependent variables and variable sets from the other procedures administered as multivariate independent variables. RESULTS The median score obtained from the SUMD for current awareness was in a range between full awareness and uncertainty concerning presence of a mental disorder. For attribution, the median score indicated that attribution was usually made to the illness itself. None of the differences between participants with and without comorbid alcoholism were significant for the SUMD awareness and attribution scores, neurocognitive or MRI variables. The multiple regression analyses only showed a significant degree of association between the SUMD awareness score and the Young Mania Rating Scale (r(2)=.632, p<.05). A stepwise analysis indicated that items assessing degree of insight, irritability, and sleep disturbance met criteria for entry into the regression equation. None of the regression analyses for the SUMD attribution item were significant. CONCLUSIONS Apparently unlike the case for schizophrenia, most of the participants, all of whom had bipolar disorder, were aware of their symptoms and correctly related them to a mental disorder. Hypotheses concerning the relationships between degree of unawareness and possible contributors to its development including comorbid alcoholism, cognitive dysfunction and structural reduction of gray matter in the frontal region and hippocampus, were not associated with degree of unawareness but symptoms of mania were significantly associated. The apparent reason for this result is that the sample obtained a SUMD modal awareness score of 1 or 2, reflecting the area between full awareness and uncertainty about having a mental disorder. None of the participants were rated as having a 5 response reflecting the belief that s/he does not have a mental disorder.
Collapse
Affiliation(s)
- Mujeeb U Shad
- Mental Illness, Research, Educational and Clinical Center VA Pittsburgh Healthcare System, Pittsburgh, PA
| | - Konasale Prasad
- Department of Psychiatry, University of Pittsburgh School of Medicine, Educational and Clinical Center VA Pittsburgh Healthcare System, Pittsburgh, PA
| | - Steven D Forman
- Department of Psychiatry, University of Pittsburgh School of Medicine, Educational and Clinical Center VA Pittsburgh Healthcare System, Pittsburgh, PA; VISN-IV Mental Illness Research, Educational and Clinical Center VA Pittsburgh Healthcare System, Pittsburgh, PA
| | - Gretchen L Haas
- Department of Psychiatry, University of Pittsburgh School of Medicine, Educational and Clinical Center VA Pittsburgh Healthcare System, Pittsburgh, PA; VISN-IV Mental Illness Research, Educational and Clinical Center VA Pittsburgh Healthcare System, Pittsburgh, PA
| | - Jon D Walker
- VISN-IV Mental Illness Research, Educational and Clinical Center VA Pittsburgh Healthcare System, Pittsburgh, PA
| | - Liubomir A Pisarov
- VISN-IV Mental Illness Research, Educational and Clinical Center VA Pittsburgh Healthcare System, Pittsburgh, PA
| | - Gerald Goldstein
- Department of Psychiatry, University of Pittsburgh School of Medicine, Educational and Clinical Center VA Pittsburgh Healthcare System, Pittsburgh, PA; VISN-IV Mental Illness Research, Educational and Clinical Center VA Pittsburgh Healthcare System, Pittsburgh, PA.
| |
Collapse
|
13
|
Abstract
BACKGROUND Both solar and non-solar exposures associated with occupation and work tasks have been reported as skin carcinogens. In the UK, there are well-established surveillance schemes providing relevant information, including when exposures took place, occupation, location of work and dates of symptom onset and diagnosis. AIMS To add to the evidence on work-related skin neoplasia, including causal agents, geographical exposure and time lag between exposure and diagnosis. METHODS This study investigated incident case reports of occupational skin disease originating from clinical specialists in dermatology reporting to a UK-wide surveillance scheme (EPIDERM) by analysing case reports of skin neoplasia from 1996 to 2012 in terms of diagnosis, employment, suspected causal agent and symptom onset. RESULTS The suspected causal agent was 'sun/sunlight/ultraviolet light' in 99% of the reported work-related skin neoplasia cases. Most cases reported (91%) were in males, and the majority (62%) were aged over 65 at the time of reporting. More detailed information on exposure was available for 42% of the cases, with the median time from exposure to symptom onset ranging from 44 (melanoma) to 57 (squamous cell carcinoma) years. Irrespective of diagnostic category, the median duration of exposure to 'sun/sunlight/ultraviolet light' appeared longer where exposures occurred in the UK (range 39-51 years) rather than outside the UK (range 2.5-6.5 years). CONCLUSIONS It is important to provide effective information about skin protection to workers exposed to solar radiation, especially to outdoor workers based outside the UK.
Collapse
Affiliation(s)
- S Turner
- Centre for Occupational and Environmental Health, University of Manchester, Manchester M13 9PL, UK,
| | - S D Forman
- Centre for Occupational and Environmental Health, University of Manchester, Manchester M13 9PL, UK
| | - R McNamee
- Centre for Biostatistics, University of Manchester, Manchester M13 9PL, UK
| | - S M Wilkinson
- Department of Dermatology, Leeds General Infirmary, Leeds LS1 3EX, UK
| | - R Agius
- Centre for Occupational and Environmental Health, University of Manchester, Manchester M13 9PL, UK
| |
Collapse
|
14
|
Cohen JD, Forman SD, Braver TS, Casey BJ, Servan-Schreiber D, Noll DC. Activation of the prefrontal cortex in a nonspatial working memory task with functional MRI. Hum Brain Mapp 2014; 1:293-304. [PMID: 24591198 DOI: 10.1002/hbm.460010407] [Citation(s) in RCA: 386] [Impact Index Per Article: 38.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/1994] [Accepted: 06/27/1994] [Indexed: 11/08/2022] Open
Abstract
Functional magnetic resonance imaging (fMRI) was used to examine the pattern of activity of the prefrontal cortex during performance of subjects in a nonspatial working memory task. Subjects observed sequences of letters and responded whenever a letter repeated with exactly one nonidentical letter intervening. In a comparison task, subjects monitored similar sequences of letters for any occurrence of a single, prespecified target letter. Functional scanning was performed using a newly developed spiral scan image acquisition technique that provides high-resolution, multislice scanning at approximately five times the rate usually possible on conventional equipment (an average of one image per second). Using these methods, activation of the middle and inferior frontal gyri was reliably observed within individual subjects during performance of the working memory task relative to the comparison task. Effect sizes (2-4%) closely approximated those that have been observed within primary sensory and motor cortices using similar fMRI techniques. Furthermore, activation increased and decreased with a time course that was highly consistent with the task manipulations. These findings corroborate the results of positron emission tomography studies, which suggest that the prefrontal cortex is engaged by tasks that rely on working memory. Furthermore, they demonstrate the applicability of newly developed fMRI techniques using conventional scanners to study the associative cortex in individual subjects. © 1994 Wiley-Liss, Inc.
Collapse
Affiliation(s)
- J D Cohen
- Department of Psychiatry, University of Pittsburgh, Bethesda, Maryland; Department of Psychology, Bethesda, Maryland
| | | | | | | | | | | |
Collapse
|
15
|
Dombrovski AY, Szanto K, Siegle GJ, Wallace ML, Forman SD, Sahakian B, Reynolds CF, Clark L. Lethal forethought: delayed reward discounting differentiates high- and low-lethality suicide attempts in old age. Biol Psychiatry 2011; 70:138-44. [PMID: 21329911 PMCID: PMC3125431 DOI: 10.1016/j.biopsych.2010.12.025] [Citation(s) in RCA: 126] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2010] [Revised: 12/17/2010] [Accepted: 12/20/2010] [Indexed: 10/18/2022]
Abstract
BACKGROUND The decision to commit suicide may be impulsive, but lethal suicidal acts often involve planning and forethought. People who attempt suicide make disadvantageous decisions in other contexts, but nothing is known about the way they decide about the future. Can the willingness to postpone future gratification differentiate between individuals prone to serious, premeditated and less serious, unplanned suicidal acts? METHODS Four groups of depressed participants aged 60 and older made choices between smaller immediate and larger delayed monetary rewards: 15 who had made high-lethality suicide attempts, 14 who had made low-lethality suicide attempts, 12 who seriously contemplated suicide, and 42 people with depression, but no history of suicidal thoughts. The reference group was 31 psychiatrically healthy elders. RESULTS Individuals who had made low-lethality attempts displayed an exaggerated preference for immediate rewards compared with nonsuicidal depressed and healthy control subjects. Those who had carried out high-lethality suicide attempts were more willing to delay future rewards, compared with low-lethality attempters. Better planned suicide attempts were also associated with willingness to wait for larger rewards. These effects were unchanged after accounting for education, global cognitive function, substance use disorders, psychotropic medications, and possible brain injury from attempts. Discount rates were correlated with having debt, but were not significantly associated with income, hopelessness, depressive severity, premorbid IQ, age at first attempt, or choice of violent means. CONCLUSIONS Although clinicians often focus on impulsivity in patients at risk for suicide, these data suggest that identifying biological characteristics and treatments for nonimpulsive suicidal older people may be even more important.
Collapse
Affiliation(s)
- Alexandre Y. Dombrovski
- Western Psychiatric Institute and Clinic, Department of Psychiatry, University of Pittsburgh School of Medicine
| | - Katalin Szanto
- Western Psychiatric Institute and Clinic, Department of Psychiatry, University of Pittsburgh School of Medicine
| | - Greg J. Siegle
- Western Psychiatric Institute and Clinic, Department of Psychiatry, University of Pittsburgh School of Medicine
| | - Meredith L. Wallace
- Western Psychiatric Institute and Clinic, Department of Psychiatry, University of Pittsburgh School of Medicine
| | - Steven D. Forman
- Western Psychiatric Institute and Clinic, Department of Psychiatry, University of Pittsburgh School of Medicine,Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
| | - Barbara Sahakian
- Behavioural and Clinical Neuroscience Institute, Department of Experimental Psychology, University of Cambridge (UK)
| | - Charles F. Reynolds
- Western Psychiatric Institute and Clinic, Department of Psychiatry, University of Pittsburgh School of Medicine
| | - Luke Clark
- Behavioural and Clinical Neuroscience Institute, Department of Experimental Psychology, University of Cambridge (UK)
| |
Collapse
|
16
|
Yücel M, Lubman DI, Harrison BJ, Fornito A, Allen NB, Wellard RM, Roffel K, Clarke K, Wood SJ, Forman SD, Pantelis C. A combined spectroscopic and functional MRI investigation of the dorsal anterior cingulate region in opiate addiction. Mol Psychiatry 2007; 12:611, 691-702. [PMID: 17245325 DOI: 10.1038/sj.mp.4001955] [Citation(s) in RCA: 105] [Impact Index Per Article: 6.2] [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: 11/09/2022]
Abstract
Converging neuropsychological and functional neuroimaging evidence indicates that the dorsal anterior cingulate cortex (dACC) is dysfunctional in drug-addicted populations. Few studies, however, have investigated the biochemical and physiological properties of the dACC in such populations. We used proton magnetic resonance spectroscopy ((1)H-MRS) together with functional magnetic resonance imaging (fMRI) to probe dACC biochemistry and physiological activity during performance of a behavioural control task in 24 opiate-dependent individuals (maintained on a stable dose of methadone or buprenorphine at the time of study) and 24 age, gender, intelligence and performance-matched healthy subjects. While both groups activated the dACC to comparable levels, the opiate-using group displayed relatively increased task-related activation of frontal, parietal and cerebellar regions, as well as reduced concentrations of dACC N-acetylaspartate and glutamate/glutamine. In addition, the opiate-using group failed to show the expected correlations between dACC activation and behavioural measures of cognitive control. These findings suggest that the dACC is biochemically and physiologically abnormal in long-term opiate-dependent individuals. Furthermore, opiate addicts required increased, perhaps compensatory, involvement of the fronto-parietal and cerebellar behavioural regulation network to achieve normal levels of task performance/behavioural control. These neurobiological findings may partly underpin key addiction-related phenomena, such as poor inhibitory control of drug-related behaviour in the face of adverse consequences, and may be of relevance to the design of future treatment studies.
Collapse
Affiliation(s)
- M Yücel
- ORYGEN Research Centre, Melbourne, VIC, Australia.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
17
|
Abstract
PURPOSE This study describes and compares the characteristics of patients within a VA Opiate Substitution Therapy Program (OSTP) who report arrests for non-violent and violent crimes and describes patients' attitudes and preferences of criminal treatment within an OSTP. METHODS An anonymous survey was distributed to all veterans at one VA-OSTP. Analyses were conducted to describe the sample characteristics and their associations with prior violent and non-violent criminal behavior. RESULTS A majority of participants were Caucasian, male, middle-aged, unemployed, and had a history of injection drug use. Participants reported arrests for violent (44%), non-violent (47%), and unspecified crimes (16%). There were few significant differences on demographic and drug use characteristics between participants who reported arrests for any violent and only non-violent crimes, and no arrests. Slightly fewer than half the subjects were satisfied with their ability to access treatment for past criminal behavior within or outside of the VA treatment settings. More veterans reporting violent arrests were satisfied with services addressing criminal behavior within the VA-OSTP than were veterans reporting only nonviolent arrests. Nearly equal proportions of veterans reporting violent (45%) and non-violent (44%) arrests reported dissatisfaction with such services received outside of the VA-OSTP. CONCLUSIONS Prior violent criminal behavior is common among participants of a VA-OSTP. Many individuals with criminal histories seek treatment for criminality within VA-OSTP.
Collapse
|
18
|
Goldstein G, Sanders RD, Forman SD, Tarpey T, Gurklis JA, Van Kammen DP, Keshavan MS. The effects of antipsychotic medication on factor and cluster structure of neurologic examination abnormalities in schizophrenia. Schizophr Res 2005; 75:55-64. [PMID: 15820324 DOI: 10.1016/j.schres.2004.08.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2004] [Revised: 08/16/2004] [Accepted: 08/25/2004] [Indexed: 11/27/2022]
Abstract
This study extends a previous study of the factor structure of the neurologic examination in unmedicated schizophrenia, utilizing cluster analysis and adding a medicated condition. We administered a modified version of the Neurologic Evaluation Scale (NES) on two occasions to 80 patients with schizophrenia or schizoaffective disorder, once while on antipsychotic medications and once while off medication. Data were distilled by combining right- and left-side scores, and by excluding rarely abnormal and unreliable items from the analysis. Principal components analysis yielded an intuitive four-factor solution in the unmedicated condition, but an inscrutable five-factor solution during medication. Cluster analysis revealed three groups: normal, cognitively impaired, and diffusely impaired. These results were also less interpretable with data from the medicated condition. Neurologic performance was better in the medicated than in the unmedicated condition. As is the case with other domains of symptoms and performance in schizophrenia, relationships among neurologic exam variables are altered by the presence of antipsychotic medication.
Collapse
Affiliation(s)
- Gerald Goldstein
- VA Pittsburgh HCS, 7180 Highland Drive, Pittsburgh, PA 15206, USA.
| | | | | | | | | | | | | |
Collapse
|
19
|
Sanders RD, Allen DN, D Forman S, Tarpey T, Keshavan MS, Goldstein G. Confirmatory factor analysis of the Neurological Evaluation Scale in unmedicated schizophrenia. Psychiatry Res 2005; 133:65-71. [PMID: 15698678 DOI: 10.1016/j.psychres.2004.10.005] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2004] [Revised: 09/28/2004] [Accepted: 10/18/2004] [Indexed: 11/21/2022]
Abstract
Factor structure of the Neurological Evaluation Scale (NES) was evaluated in 95 unmedicated patients with schizophrenia using confirmatory factor analysis (CFA). CFA was used to test four competing models that were based on prior empirical work examining the factor structure of the NES, as well as on theoretical considerations. A three-factor solution composed of "repetitive motor," "cognitive-perceptual," and "balance-tandem" factors best accounted for the data. These findings are consistent with prior exploratory studies that have suggested the NES is a multidimensional procedure that assesses diverse neurological domains. The current results contribute to the development of empirical subscales for neurological assessment procedures to be used in psychiatric conditions.
Collapse
|
20
|
Forman SD, Dougherty GG, Casey BJ, Siegle GJ, Braver TS, Barch DM, Stenger VA, Wick-Hull C, Pisarov LA, Lorensen E. Opiate addicts lack error-dependent activation of rostral anterior cingulate. Biol Psychiatry 2004; 55:531-7. [PMID: 15023582 DOI: 10.1016/j.biopsych.2003.09.011] [Citation(s) in RCA: 188] [Impact Index Per Article: 9.4] [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: 12/13/2002] [Revised: 09/23/2003] [Accepted: 09/24/2003] [Indexed: 11/21/2022]
Abstract
BACKGROUND Healthy individuals performing response suppression tasks activate anterior cingulate cortex with occurrence of false alarm error responses to nontargets. Fundamental questions include whether this error-related activation provides a signal contributing to behavioral control and, given generally poorer performance on such tasks by addicts, whether this signal is disrupted in addiction. METHODS We used rapid, event-related functional magnetic resonance imaging to study 13 individuals with opiate dependence and 26 healthy control individuals performing a Go/NoGo task. RESULTS Compared with controls, opiate addicts exhibited an attenuated anterior cingulate cortex error signal and significantly poorer task performance. In controls, the individual level of event-related anterior cingulate cortex activation accompanying false alarm error positively predicted task performance, particularly sensitivity in discriminating targets from nontargets. CONCLUSIONS The attenuation of this error signal in anterior cingulate cortex may play a role in loss of control in addiction and other forms of impulsive behavior.
Collapse
Affiliation(s)
- Steven D Forman
- Department of Psychology (TSB, DMB), Washington University, St. Louis, Missouri, USA
| | | | | | | | | | | | | | | | | | | |
Collapse
|
21
|
Casey BJ, Forman SD, Franzen P, Berkowitz A, Braver TS, Nystrom LE, Thomas KM, Noll DC. Sensitivity of prefrontal cortex to changes in target probability: a functional MRI study. Hum Brain Mapp 2001; 13:26-33. [PMID: 11284044 PMCID: PMC6871821 DOI: 10.1002/hbm.1022] [Citation(s) in RCA: 124] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Electrophysiological studies suggest sensitivity of the prefrontal cortex to changes in the probability of an event. The purpose of this study was to determine if subregions of the prefrontal cortex respond differentially to changes in target probabilities using functional magnetic resonance imaging (fMRI). Ten right-handed adults were scanned using a gradient-echo, echo planar imaging sequence during performance of an oddball paradigm. Subjects were instructed to respond to any letter but "X". The frequency of targets (i.e., any letter but X) varied across trials. The results showed that dorsal prefrontal regions were active during infrequent events and ventral prefrontal regions were active during frequent events. Further, we observed an inverse relation between the dorsal and ventral prefrontal regions such that when activity in dorsal prefrontal regions increased, activity in ventral prefrontal regions decreased, and vice versa. This finding may index competing cognitive processes or capacity limitations. Most importantly, these findings taken as a whole suggest that any simple theory of prefrontal cortex function must take into account the sensitivity of this region to changes in target probability.
Collapse
Affiliation(s)
- B J Casey
- Sackler Institute for Developmental Psychobiology, Weill Medical College of Cornell University, New York, New York 10021, USA.
| | | | | | | | | | | | | | | |
Collapse
|
22
|
Sanders RD, Keshavan MS, Forman SD, Pieri JN, McLaughlin N, Allen DN, van Kammen DP, Goldstein G. Factor structure of neurologic examination abnormalities in unmedicated schizophrenia. Psychiatry Res 2000; 95:237-43. [PMID: 10974362 DOI: 10.1016/s0165-1781(00)00176-1] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The heterogeneity and uncertain significance of neurologic exam abnormalities in schizophrenia prompted us to evaluate their factor structure. We administered a modified version of the Neurological Evaluation Scale (NES) to 103 unmedicated patients with schizophrenia. Data were distilled by combining right- and left-side scores, and by eliminating superfluous, rarely abnormal and unreliable items from the analysis. Exploratory principal components analysis yielded four factors: repetitive motor tasks (fist-ring, fist-edge-palm, alternating fist-palm, dysdiadochokinesis); cognitive-perceptual tasks (memory, audiovisual integration, right-left orientation, face-hand test, rhythm tapping reproduction); balancing tasks (Romberg, tandem gait); and the palmomental reflex. Evaluation of the relationship between these factors and clinical and demographic variables revealed a robust correlation between the cognitive-perceptual factor and full-scale IQ score. This analysis is a step toward developing empirical subscales of a modified NES, which may provide insights into the nature of neurologic impairment in schizophrenia and may prove clinically useful.
Collapse
Affiliation(s)
- R D Sanders
- VA Pittsburgh Healthcare System, 151 R, 7180 Highland Drive Division, Pittsburgh, PA 15206-1297, USA
| | | | | | | | | | | | | | | |
Collapse
|
23
|
Allen DN, Goldstein G, Forman SD, Keshavan MS, van Kammen DP, Sanders RD. Neurologic examination abnormalities in schizophrenia with and without a history of alcoholism. Neuropsychiatry Neuropsychol Behav Neurol 2000; 13:184-7. [PMID: 10910089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
OBJECTIVE The current investigation examines the impact of a past history of alcoholism on neurologic examination abnormalities in schizophrenia (SZ). BACKGROUND Individuals with SZ have a high rate of comorbid alcohol use disorders (AUDs), but relatively little is known about the potential adverse consequences of alcoholism for neuropsychological and neurologic functioning in SZ. Recent evidence suggests consistent but subtle neurocognitive differences between groups, with more prominent differences in neurologic examination abnormalities. METHOD Thirty-three male patients with SZ or SZ/AUDs were evaluated using a modified Neurologic Evaluation Scale (NES) and ratings for positive and negative symptoms. RESULTS The SZ/AUD group exhibited a greater impairment in the Cognitive-Perceptual factor of the Neurologic Evaluation Scale. Greater impairment in the tandem-Romberg factor or in motor items was not found, nor were groups different based on positive or negative symptoms. CONCLUSIONS A history of alcoholism in SZ is associated with greater overall neurologic impairment, particularly in the area of cognitive-perceptual dysfunction, an area often found to be impaired in patients with schizophrenia without alcoholism.
Collapse
Affiliation(s)
- D N Allen
- Department of Psychology, University of Nevada, Las Vegas, USA
| | | | | | | | | | | |
Collapse
|
24
|
Abstract
Functional magnetic resonance imaging (fMRI) rests on the assumption that regional brain activity is closely coupled to regional cerebral blood flow (rCBF) in vivo. To test the degree of coupling, cortical brain activity was locally stimulated in rats by reversed microdialysis infusion of picrotoxinin, alphagamma-aminobutyric acid-A antagonist. Before and during the first 30 minutes of infusion, simultaneous fMRI (rCBF) and neurochemical (interstitial glutamate concentration) measures of brain activity were highly correlated (r = 0.83). After 30 minutes of picrotoxinin-induced stimulation, glutamate levels decreased but rCBF remained elevated, suggesting that additional factors modulate the relationship between neuronal neurotransmitters and hemodynamics at these later stages.
Collapse
Affiliation(s)
- S D Forman
- Pittsburgh Veterans Affairs Healthcare System, Department of Psychiatry, University of Pittsburgh, Pennsylvania, USA
| | | | | | | | | | | |
Collapse
|
25
|
Casey B, Thomas KM, Welsh TF, Berkowitz A, Forman SD, Eccard CH, Livnat R, Noll DC. A Developmental fMRI Study of Prefrontal Organization. Neuroimage 1998. [DOI: 10.1016/s1053-8119(18)31345-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
|
26
|
Abstract
Neurological Examination Abnormalities (NEA) are prevalent in schizophrenia, but the significance of this is obscured by methodological problems. The Neurological Evaluation Scale (NES), the most widely used structured neurological examination in schizophrenia research, has had limited study of its inter-rater reliability (IRR). An augmented version of the NES was jointly administered (one examiner-rater and one observer-rater) by three pairs of psychiatrists to two populations of patients with idiopathic psychotic disorders. In addition to the ordinal and categorical data yielded by the original NES, continuous data were recorded in one of the series. Reliability analyses of our populations and a previously published study, reveal consistently adequate IRR in 12 of the 26 items assessed, and inconsistently adequate IRR in an additional 11. Consistent with studies using other NEA schedules, IRR was unacceptably low for some items that rely on subjective severity ratings. Certain rare abnormalities, which posed difficulties for the estimation of IRR, are probably not generally useful in the study of schizophrenia. Reliability estimates of continuous, ordinal and dichotomous data were comparable in most cases. We recommend that certain items from the NES be deleted, and that other studies of NEA in psychiatry follow similar procedures before undertaking further analyses.
Collapse
Affiliation(s)
- R D Sanders
- Wright State University School of Medicine, Department of Psychiatry, Dayton, OH 45420, USA
| | | | | | | | | | | | | |
Collapse
|
27
|
Casey BJ, Trainor RJ, Orendi JL, Schubert AB, Nystrom LE, Giedd JN, Castellanos FX, Haxby JV, Noll DC, Cohen JD, Forman SD, Dahl RE, Rapoport JL. A Developmental Functional MRI Study of Prefrontal Activation during Performance of a Go-No-Go Task. J Cogn Neurosci 1997; 9:835-47. [PMID: 23964603 DOI: 10.1162/jocn.1997.9.6.835] [Citation(s) in RCA: 687] [Impact Index Per Article: 25.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Abstract
This study examines important developmental differences in patterns of activation in the prefrontal cortex during performance of a Go-No-Go paradigm using functional magnetic resonance imaging (fMRI). Eighteen subjects (9 children and 9 adults) were scanned using gradient echo, echo planar imaging during performance of a response inhibition task. The results suggest four general findings. First, the location of activation in the prefrontal cortex was not different between children and adults, which is similar to our earlier pediatric fMRI results of prefrontal activation during a working memory task (Casey et al., 1995). Second, the volume of activation was significantly greater for children relative to adults. These differences in volume of activation were observed predominantly in the dorsal and lateral prefrontal cortices. Third, although inhibitory processes have typically been associated with more ventral or orbital frontal regions, the current study revealed activation that was distributed across both dorsolateral and orbitofrontal cortices. Finally, consistent with animal and human lesion studies, activity in orbital frontal and anterior cingulate cortices correlated with behavioral performance (i.e., number of false alarms). These results further demonstrate the utility of this methodology in studying pediatric populations.
Collapse
Affiliation(s)
| | | | | | | | - Leigh E. Nystrom
- University of Pittsburgh Medical Center and Carnegie Mellon University
| | | | | | | | - Douglas C. Noll
- University of Pittsburgh Medical Center and Carnegie Mellon University
| | - Jonathan D. Cohen
- University of Pittsburgh Medical Center and Carnegie Mellon University
| | | | | | | |
Collapse
|
28
|
Abstract
A functional magnetic resonance imaging (fMRI) study was conducted to determine whether prefrontal cortex (PFC) increases activity in working memory (WM) tasks as a specific result of the demands placed on WM, or to other processes affected by the greater difficulty of such tasks. Increased activity in dorsolateral PFC (DLPFC) was observed during task conditions that placed demands on active maintenance (long retention interval) relative to control conditions matched for difficulty. Furthermore, the activity was sustained over the entire retention interval and did not increase when task difficulty was manipulated independently of WM requirements. This contrasted with the transient increases in activity observed in the anterior cingulate, and other regions of frontal cortex, in response to increased task difficulty but not WM demands. Thus, this study established a double-dissociation between regions responsive to WM versus task difficulty, indicating a specific involvement of DLPFC and related structures in WM function.
Collapse
Affiliation(s)
- D M Barch
- Department of Psychiatry, University of Pittsburgh, PA 15213, USA.
| | | | | | | | | | | |
Collapse
|
29
|
Noll DC, Genovese CR, Nystrom LE, Vazquez AL, Forman SD, Eddy WF, Cohen JD. Estimating test-retest reliability in functional MR imaging. II: Application to motor and cognitive activation studies. Magn Reson Med 1997; 38:508-17. [PMID: 9339453 DOI: 10.1002/mrm.1910380320] [Citation(s) in RCA: 87] [Impact Index Per Article: 3.2] [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: 02/05/2023]
Abstract
Functional magnetic resonance imaging (fMRI) using blood oxygenation contrast has rapidly spread into many application areas. In this paper, a new statistical model is used to evaluate the reliability of fMRI activation in a finger opposition motor paradigm for both within-session and between-session data and in a working memory paradigm for between-session data. A slice prescription procedure for between-session reproducibility is introduced. Estimates are made for the probabilities of correctly and falsely classifying voxels as active or inactive and receiver operator characteristic curves are generated. In the motor paradigm, estimated between-session reliability was found to be somewhat reduced relative to within-session reliability; however, this includes additional sources of variation and may not reflect intrinsically lower reliability. After matching false-positive classification probabilities, between-session reliability was found to be nearly identical for both motor and cognitive activation paradigms.
Collapse
Affiliation(s)
- D C Noll
- Department of Radiology, University of Pittsburgh Medical Center, PA 15213, USA
| | | | | | | | | | | | | |
Collapse
|
30
|
Paradise JE, Bass J, Forman SD, Berkowitz J, Greenberg DB, Mehta K. Minimum criteria for reporting child abuse from health care settings. Del Med J 1997; 69:357-63. [PMID: 9260386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
We evaluated how consistently clinicians of two hospitals reported child abuse and neglect, and the utility of specific, operational criteria for assessing hospital clinicians' compliance with the child abuse reporting laws. To evaluate clinicians' compliance, we audited the medical records of 85 children who had been reported to a child protective service (CPS) agency by clinicians at either of two hospitals and who had been seen at that hospital at least once before the index report of abuse. The time elapsed from first hospital visit to index abuse report among the 85 children averaged 4.3 years. In the children's records, we identified 28 earlier reports to the CPS agency and four episodes that met criteria we developed but that had not been reported. Thus, application of specific criteria resulted in the finding that 28 (88 percent) of 32 suspected abuse episodes were actually reported to the CPS agency (95 percent confidence interval: 76 to 99 percent). In a second phase of the study, we compared the content of 45 reported episodes of child abuse (4) index reports and four earlier reports) to the criteria in order to evaluate their utility. Thirty-five episodes (78 percent) met one of the criteria. Review of the remaining 10 episodes led to the development of one new criterion. We conclude that, although it has been estimated that hospital personnel nationwide report to CPS agencies only 69 percent of the child abuse cases they identify, clinicians at the hospitals we studied reported 88 percent of documented episodes of suspected abuse. We also conclude that specific, operational criteria can help in the assessment of hospital clinicians' compliance with their obligation to report child abuse and neglect.
Collapse
Affiliation(s)
- J E Paradise
- Department of Pediatrics, Boston City Hospital, Boston University School of Medicine, Massachusetts, USA
| | | | | | | | | | | |
Collapse
|
31
|
Forman SD, Cohen JD, Fitzgerald M, Eddy WF, Mintun MA, Noll DC. Improved assessment of significant activation in functional magnetic resonance imaging (fMRI): use of a cluster-size threshold. Magn Reson Med 1995; 33:636-47. [PMID: 7596267 DOI: 10.1002/mrm.1910330508] [Citation(s) in RCA: 2665] [Impact Index Per Article: 91.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The typical functional magnetic resonance (fMRI) study presents a formidable problem of multiple statistical comparisons (i.e., > 10,000 in a 128 x 128 image). To protect against false positives, investigators have typically relied on decreasing the per pixel false positive probability. This approach incurs an inevitable loss of power to detect statistically significant activity. An alternative approach, which relies on the assumption that areas of true neural activity will tend to stimulate signal changes over contiguous pixels, is presented. If one knows the probability distribution of such cluster sizes as a function of per pixel false positive probability, one can use cluster-size thresholds independently to reject false positives. Both Monte Carlo simulations and fMRI studies of human subjects have been used to verify that this approach can improve statistical power by as much as fivefold over techniques that rely solely on adjusting per pixel false positive probabilities.
Collapse
Affiliation(s)
- S D Forman
- Department of Psychiatry, University of Pittsburgh, PA 15213, USA
| | | | | | | | | | | |
Collapse
|
32
|
Forman SD, Bissette G, Yao J, Nemeroff CB, van Kammen DP. Cerebrospinal fluid corticotropin-releasing factor increases following haloperidol withdrawal in chronic schizophrenia. Schizophr Res 1994; 12:43-51. [PMID: 8018584 DOI: 10.1016/0920-9964(94)90083-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Corticotropin-releasing factor (CRF), an endogenous neuropeptide, has been shown to coordinate endocrine, behavioral and autonomic responses to stress. However, while previous studies of cerebrospinal fluid (CSF) CRF in schizophrenia have not demonstrated significant differences compared to control groups, these studies have not examined the effects of symptom severity or antipsychotic medication. CSF CRF concentrations increased in 18 of 21 male schizophrenic (DSM-III-R) patients after maintenance haloperidol was replaced by placebo (P < 0.0001); there was also a trend for relatively greater increases in relapsers. CRF concentrations were not significantly related to severity of psychosis, depression, anxiety or negative symptoms. During haloperidol treatment, but not after medication withdrawal, worse childhood premorbid adjustment was associated with higher CSF CRF levels. Finally, in contrast to the positive correlation between CSF CRF and norepinephrine concentrations reported in depression, a negative trend was seen in this schizophrenic sample.
Collapse
Affiliation(s)
- S D Forman
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, PA 15213
| | | | | | | | | |
Collapse
|
33
|
Sullivan PF, Bulik CM, Forman SD, Mezzich JE. Characteristics of repeat users of a psychiatric emergency service. Hosp Community Psychiatry 1993; 44:376-80. [PMID: 8462947 DOI: 10.1176/ps.44.4.376] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
OBJECTIVE Patients who visited a psychiatric emergency service were studied to determine whether repeat visitors, who consume a disproportionate share of services, could be identified by demographic and diagnostic characteristics. METHODS Data were obtained from a semistructured diagnostic interview given to all 16,257 persons who made 29,214 visits to an urban psychiatric emergency service in Pittsburgh, Pennsylvania, from 1985 to 1989. Patients were categorized into four groups based on the number of visits in the five-year period. Patients in group 1 made a single visit, while those in group 2 averaged less than one visit per year; those in group 3 made one or two visits per year, and those in group 4, more than two visits per year. RESULTS Groups 3 and 4 constituted 5.1 percent of the sample but made 27.1 percent of the total visits. Repeat users were significantly more likely to be male, younger, unmarried, unemployed, and nonwhite and to have diagnoses of schizophrenia, other psychotic disorders, and personality disorders. CONCLUSIONS Repeat users of psychiatric emergency services appear to have demographic and diagnostic characteristics that may permit their early identification. For such patients, implementation of alternative management strategies, such as intensive case management, may reduce their use of services.
Collapse
Affiliation(s)
- P F Sullivan
- University Department of Psychological Medicine, Christchurch School of Medicine, Princess Margaret Hospital, New Zealand
| | | | | | | |
Collapse
|
34
|
Forman SD, Nemerson Y. Membrane-dependent coagulation reaction is independent of the concentration of phospholipid-bound substrate: fluid phase factor X regulates the extrinsic system. Proc Natl Acad Sci U S A 1986; 83:4675-9. [PMID: 3487782 PMCID: PMC323804 DOI: 10.1073/pnas.83.13.4675] [Citation(s) in RCA: 29] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Negatively charged phospholipids accelerate blood coagulation; one suggestion is that the binding of the gamma-carboxyglutamic acid-containing zymogens to these lipid surfaces increases their effective concentration as substrates. Alternatively, the charged phospholipids could enhance the direct interaction of substrate with the catalytic complex, which is localized at the membrane surface. We distinguished the alternatives by using prothrombin fragment 1 to compete with the substrate for membrane binding sites without interfering with the direct enzyme-substrate interaction. In a tissue factor-factor VIIa system containing neutral phospholipids (to which the substrate does not bind), prothrombin fragment 1 had no significant effect on factor X activation (Km, 877 +/- 111 nM and 791 +/- 103 nM, with and without prothrombin fragment 1, respectively). In contrast, in a system containing 30% phosphatidylserine, prothrombin fragment 1 displaced phospholipid-bound factor X, increasing the free factor X concentration and the reaction velocity in all 22 determinations. As the velocity increases correlated only with the free factor X concentration, we conclude that the free factor X concentration controls this reaction velocity. The Km in the 30% phosphatidylserine system, calculated using free factor X concentration, was 41 +/- 5 nM and 63 +/- 9 nM, with and without prothrombin fragment 1, respectively. Thus, the negatively charged lipids decreased the intrinsic Km by over 90%. The methodology employed should be applicable to ligand-receptor systems in which ligand binds nonspecifically to the membrane surface.
Collapse
|