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Duman B, Herdi O, Sayar-Akaslan D, Onur Kırımker E, Çolak B, Ağtaş-Ertan E, Çakar G, Hasanlı J, Kocaay AF, Tüzüner A, Koloğlu M, Karayalçın K, Doğanay-Erdoğan B, Balcı D, Kumbasar H, Iacoviello BM. Live Donor Assessment Tool (LDAT): A Turkish validity and reliability study. Turk J Gastroenterol 2021; 31:917-922. [PMID: 33626005 DOI: 10.5152/tjg.2020.19980] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND/AIMS Psychosocial and psychiatric evaluations are crucial components of the assessment of a live donor candidate. The Live Donor Assessment Tool (LDAT) was developed for this purpose. This study aims to evaluate the validity and reliability of the Turkish version of LDAT. MATERIALS AND METHODS 132 live kidney or liver donor were referred to assess their psychosocial/psychiatric appropriateness for donation and were randomized for clinical evaluation as usual or with LDAT. The internal consistency of LDAT was measured by Chronbach's alpha coefficient. Inter-rater reliability was measured by using Spearman's correlation coefficient. The potential validity of LDAT was assessed by comparing LDAT scores to clinical decisions. The Mann-Whitney U test was used to compare LDAT scores across two clinically classified groups (acceptable/declined). Logistic regression was performed using LDAT scores to predict the clinical decision. RESULTS The Turkish version of LDAT items demonstrate good internal consistency (α=0.773). Inter-rater reliability of LDAT demonstrated strong correlation (ICC=0.72). LDAT scores differentiated the accepted/declined groups, and strongly predicted the clinical decision. With a cut-off score of 60.5, LDAT was found to have high sensitivity and specificity. CONCLUSION The Turkish version of LDAT was found to be a valid and reliable tool. LDAT could be an appropriate tool to assess live donor candidates.
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Affiliation(s)
- Berker Duman
- Division of Consultation-Liaison Psychiatry, Department of Psychiatry, Ankara University School of Medicine, Ankara, Turkey
| | - Oğuzhan Herdi
- Department of Psychiatry, Ankara University School of Medicine, Ankara, Turkey
| | - Damla Sayar-Akaslan
- Department of Psychiatry, Ankara University School of Medicine, Ankara, Turkey
| | | | - Burçin Çolak
- Department of Psychiatry, Ankara University School of Medicine, Ankara, Turkey
| | - Ece Ağtaş-Ertan
- Department of Psychiatry, Ankara University School of Medicine, Ankara, Turkey
| | - Gülsüm Çakar
- Department of Psychiatry, Ankara University School of Medicine, Ankara, Turkey
| | - Jamal Hasanlı
- Department of Psychiatry, Ankara University School of Medicine, Ankara, Turkey
| | - Akın Fırat Kocaay
- Department of Surgery, Ankara University School of Medicine, Ankara, Turkey
| | - Acar Tüzüner
- Department of Surgery, Ankara University School of Medicine, Ankara, Turkey
| | - Meltem Koloğlu
- Department of Pediatric Surgery, Ankara University School of Medicine, Ankara, Turkey
| | - Kaan Karayalçın
- Department of Surgery, Ankara University School of Medicine, Ankara, Turkey
| | | | - Deniz Balcı
- Department of Surgery, Ankara University School of Medicine, Ankara, Turkey
| | - Hakan Kumbasar
- Division of Consultation-Liaison Psychiatry, Department of Psychiatry, Ankara University School of Medicine, Ankara, Turkey
| | - Brian M Iacoviello
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, USA
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2
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Hoch MM, Doucet GE, Moser DA, Hee Lee W, Collins KA, Huryk KM, DeWilde KE, Fleysher L, Iosifescu DV, Murrough JW, Charney DS, Frangou S, Iacoviello BM. Initial Evidence for Brain Plasticity Following a Digital Therapeutic Intervention for Depression. Chronic Stress (Thousand Oaks) 2020; 3:2470547019877880. [PMID: 32440602 PMCID: PMC7219906 DOI: 10.1177/2470547019877880] [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] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 09/03/2019] [Indexed: 11/16/2022]
Abstract
Background Digital therapeutics such as cognitive-emotional training have begun to show promise for the treatment of major depressive disorder. Available clinical trial data suggest that monotherapy with cognitive-emotional training using the Emotional Faces Memory Task is beneficial in reducing depressive symptoms in patients with major depressive disorder. The aim of this study was to investigate whether Emotional Faces Memory Task training for major depressive disorder is associated with changes in brain connectivity and whether changes in connectivity parameters are related to symptomatic improvement. Methods Fourteen major depressive disorder patients received Emotional Faces Memory Task training as monotherapy over a six-week period. Patients were scanned at baseline and posttreatment to identify changes in resting-state functional connectivity and effective connectivity during emotional working memory processing. Results Compared to baseline, patients showed posttreatment reduced connectivity within resting-state networks involved in self-referential and salience processing and greater integration across the functional connectome at rest. Moreover, we observed a posttreatment increase in the Emotional Faces Memory Task-induced modulation of connectivity between cortical control and limbic brain regions, which was associated with clinical improvement. Discussion These findings provide initial evidence that cognitive-emotional training may be associated with changes in short-term plasticity of brain networks implicated in major depressive disorder. Conclusion Our findings pave the way for the principled design of large clinical and neuroimaging studies.
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Affiliation(s)
- Megan M Hoch
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Gaelle E Doucet
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Dominik A Moser
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Won Hee Lee
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Katherine A Collins
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Kathryn M Huryk
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Psychology, Fairleigh Dickinson University, Teaneck, NJ, USA
| | - Kaitlin E DeWilde
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Albert Einstein College of Medicine, Bronx, NY, USA
| | - Lazar Fleysher
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Dan V Iosifescu
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Psychiatry, NYU School of Medicine, New York, NY, USA.,Nathan Kline Institute for Psychiatric Research, Orangeburg, NY, USA
| | - James W Murrough
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Dennis S Charney
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sophia Frangou
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Brian M Iacoviello
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Click Therapeutics, Inc., New York, NY, USA
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3
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Nikolin S, Martin D, Loo CK, Iacoviello BM, Boonstra TW. Assessing neurophysiological changes associated with combined transcranial direct current stimulation and cognitive-emotional training for treatment-resistant depression. Eur J Neurosci 2020; 51:2119-2133. [PMID: 31859397 DOI: 10.1111/ejn.14656] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 11/20/2019] [Accepted: 12/11/2019] [Indexed: 12/15/2022]
Abstract
Transcranial direct current stimulation (tDCS), a form of non-invasive brain stimulation, is a promising treatment for depression. Recent research suggests that tDCS efficacy can be augmented using concurrent cognitive-emotional training (CET). However, the neurophysiological changes associated with this combined intervention remain to be elucidated. We therefore examined the effects of tDCS combined with CET using electroencephalography (EEG). A total of 20 participants with treatment-resistant depression took part in this open-label study and received 18 sessions over 6 weeks of tDCS and concurrent CET. Resting-state and task-related EEG during a 3-back working memory task were acquired at baseline and immediately following the treatment course. Results showed an improvement in mood and working memory accuracy, but not response time, following the intervention. We did not find significant effects of the intervention on resting-state power spectral density (frontal theta and alpha asymmetry), time-frequency power (alpha event-related desynchronisation and theta event-related synchronisation) or event-related potentials (P2 and P3 components). We therefore identified little evidence of neurophysiological changes associated with treatment using tDCS and concurrent CET, despite significant improvements in mood and near-transfer effects of cognitive training to working memory accuracy. Further research incorporating a sham-controlled group may be necessary to identify the neurophysiological effects of the intervention.
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Affiliation(s)
- Stevan Nikolin
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia.,Black Dog Institute, Sydney, NSW, Australia
| | - Donel Martin
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia.,Black Dog Institute, Sydney, NSW, Australia
| | - Colleen K Loo
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia.,Black Dog Institute, Sydney, NSW, Australia.,St. George Hospital, Sydney, NSW, Australia
| | - Brian M Iacoviello
- Click Therapeutics, Inc., New York, NY, USA.,Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Tjeerd W Boonstra
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia.,Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
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4
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Iacoviello BM, Murrough JW, Hoch MM, Huryk KM, Collins KA, Cutter GR, Iosifescu DV, Charney DS. A randomized, controlled pilot trial of the Emotional Faces Memory Task: a digital therapeutic for depression. NPJ Digit Med 2018; 1. [PMID: 30854473 PMCID: PMC6404739 DOI: 10.1038/s41746-018-0025-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [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] [Indexed: 12/28/2022] Open
Abstract
There is an urgent need for more effective treatments for major depressive disorder (MDD). Digital therapeutics, such as computerized cognitive-emotional training interventions, represent a promising new strategy for treating MDD. Here we report a replication of efficacy of a digital cognitive-emotional training intervention designed to enhance cognitive control for emotional information-processing. In a randomized, double-blind, controlled study design, fifty-one participants with MDD in a current major depressive episode were randomly assigned to participate in a digital cognitive-emotional training regimen (Emotional Faces Memory Task (EFMT); n= 28) involving 18 sessions over 6 weeks, or an active control condition (CT; n= 23) involving computerized working memory training. MDD symptoms were assessed weekly using a clinician-rated measure (Hamilton Depression Rating Scale; Ham-D); and neurocognition (working memory), at baseline and study outcome. Mixed-effects model for repeated measures (MMRM) analysis of all participants randomized revealed a significantly greater reduction in MDD symptom severity (Ham-D) from baseline to outcome in the EFMT group (8.65 points) compared to the CT group (4.77 points) (F(6,205)= 3.23, p= .005, d= .46). Ten of 28 EFMT participants achieved clinical response (≥ 50% reduction in symptoms) compared to 4 of 23 in CT. Both groups exhibited similar, small improvements in working memory. This replicated the preliminary efficacy of a digital cognitive-emotional training approach for the treatment of MDD. EFMT may be a feasible and effective intervention strategy for MDD, but future studies to elucidate its mechanism of action are warranted. This study is registered with Clinicaltrials.gov (NCT: 01934491).
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Affiliation(s)
- Brian M Iacoviello
- Click Therapeutics, Inc., New York, NY, USA.,Department of Psychiatry, Mood and Anxiety Disorders Program, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - James W Murrough
- Department of Psychiatry, Mood and Anxiety Disorders Program, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Fishberg Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Megan M Hoch
- Department of Psychiatry, Mood and Anxiety Disorders Program, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Kathryn M Huryk
- Department of Psychiatry, Mood and Anxiety Disorders Program, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Katherine A Collins
- Department of Psychiatry, Mood and Anxiety Disorders Program, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Gary R Cutter
- Department of Biostatistics, University of Alabama at Birmingham School of Public Health, Birmingham, AL, USA
| | - Dan V Iosifescu
- Department of Psychiatry, Mood and Anxiety Disorders Program, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Psychiatry, NYU School of Medicine, New York, NY, USA.,Nathan Kline Institute for Psychiatric Research, Orangeburg, NY, USA
| | - Dennis S Charney
- Department of Psychiatry, Mood and Anxiety Disorders Program, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Fishberg Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Pharmacology and Systems Therapeutics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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5
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Martin DM, Teng JZ, Lo TY, Alonzo A, Goh T, Iacoviello BM, Hoch MM, Loo CK. Clinical pilot study of transcranial direct current stimulation combined with Cognitive Emotional Training for medication resistant depression. J Affect Disord 2018; 232:89-95. [PMID: 29477590 DOI: 10.1016/j.jad.2018.02.021] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 01/19/2018] [Accepted: 02/15/2018] [Indexed: 01/23/2023]
Abstract
BACKGROUND While the clinical results from transcranial direct current stimulation (tDCS) for the treatment of depression have been promising, antidepressant effects in patients with medication resistance have been suboptimal. There is therefore a need to further optimise tDCS for medication resistant patients. In this clinical pilot study we examined the feasibility, safety, and clinical efficacy of combining tDCS with a psychological intervention which targets dysfunctional circuitry related to emotion regulation in depression, Cognitive Emotional Training (CET). METHODS tDCS was administered during CET three times a week for a total of 18 sessions over 6 weeks. Mood, cognition and emotion processing outcomes were examined at baseline and after 3 and 6 weeks of treatment. RESULTS Twenty patients with medication resistant depression participated, of whom 17 were study completers. tDCS combined with CET was found to be feasible, safe, and associated with significant antidepressant efficacy at 6 weeks, with 41% of study completers showing treatment response (≥ 50% improvement in depression score). There were no significant cognitive enhancing effects with the exception of improved emotion recognition. Responders demonstrated superior recognition for the emotions fear and surprise at pre-treatment compared to non-responders, suggesting that better pre-treatment emotion recognition may be associated with antidepressant efficacy. LIMITATIONS This was an open label study. CONCLUSIONS tDCS combined with CET has potential as a novel method for optimising the antidepressant efficacy of tDCS in medication resistant patients. Future controlled studies are required to determine whether tDCS combined with CET has greater antidepressant efficacy compared to either intervention alone.
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Affiliation(s)
- D M Martin
- School of Psychiatry, University of New South Wales, Sydney, Australia; The Black Dog Institute, Sydney, Australia.
| | - J Z Teng
- School of Psychiatry, University of New South Wales, Sydney, Australia; The Black Dog Institute, Sydney, Australia
| | - T Y Lo
- School of Psychiatry, University of New South Wales, Sydney, Australia; The Black Dog Institute, Sydney, Australia
| | - A Alonzo
- School of Psychiatry, University of New South Wales, Sydney, Australia; The Black Dog Institute, Sydney, Australia
| | - T Goh
- School of Psychiatry, University of New South Wales, Sydney, Australia; The Black Dog Institute, Sydney, Australia
| | - B M Iacoviello
- Click Therapeutics, Inc., New York, United States; Icahn School of Medicine at Mount Sinai, New York, United States
| | - M M Hoch
- Icahn School of Medicine at Mount Sinai, New York, United States
| | - C K Loo
- School of Psychiatry, University of New South Wales, Sydney, Australia; The Black Dog Institute, Sydney, Australia
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6
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Iacoviello BM, Steinerman JR, Klein DB, Silver TL, Berger AG, Luo SX, Schork NJ. Clickotine, A Personalized Smartphone App for Smoking Cessation: Initial Evaluation. JMIR Mhealth Uhealth 2017; 5:e56. [PMID: 28442453 PMCID: PMC5424127 DOI: 10.2196/mhealth.7226] [Citation(s) in RCA: 89] [Impact Index Per Article: 12.7] [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: 12/23/2016] [Revised: 03/01/2017] [Accepted: 03/27/2017] [Indexed: 11/24/2022] Open
Abstract
Background Tobacco smoking is the leading cause of preventable death in the United States, and the annual economic burden attributable to smoking exceeds US $300 billion. Obstacles to smoking cessation include limited access and adherence to effective cessation interventions. Technology can help overcome these obstacles; many smartphone apps have been developed to aid smoking cessation, but few that conform to the US clinical practice guideline (USCPG) have been rigorously tested and reported in the literature. Clickotine is a novel smartphone app for smoking cessation, designed to deliver the essential features of the USCPG and engineered to engage smokers by personalizing intervention components. Objective Our objective was to assess the engagement, efficacy, and safety of Clickotine in an initial, single-arm study. Outcomes measured were indicators of engagement with the smartphone app (number of app opens, number of interactions with the Clickotine program, and weeks active with Clickotine), cessation outcomes of 7- and 30-day self-reported abstinence from smoking, and negative health events. Methods We recruited US residents between 18 and 65 years of age who owned an iPhone and smoked 5 or more cigarettes daily for the study via online advertising. Respondents were prescreened for eligibility by telephone and, if appropriate, directed to a Web portal to provide informed consent, confirm eligibility, and download the Clickotine app. Participants completed study assessments via the online portal at baseline and after 8 weeks. Data were collected in Amazon S3 with no manual data entry, and access to all data was maximally restrictive, logged, and auditable. Results A total of 416 participants downloaded the app and constituted the intention-to-treat (ITT) sample. On average, participants opened the Clickotine app 100.6 times during the 8-week study (median 69), logged 214.4 interactions with the Clickotine program (median 178), and remained engaged with Clickotine for 5.3 weeks (median 5). Among the ITT sample, 45.2% (188/416) reported 7-day abstinence and 26.2% (109/416) reported 30-day abstinence from smoking after 8 weeks. Completer analysis focused on 365 (87.7%) of the 416 enrolled participants who completed the 8-week questionnaire revealed that 51.5% (188/365) of completers reported 7-day abstinence and 29.9% (109/365) reported 30-day abstinence. Few adverse events, mostly consistent with nicotine withdrawal symptoms, were reported and overall no safety signal was detected. Conclusions In this initial single-arm trial, Clickotine users appeared to demonstrate encouraging indicators of engagement in terms of the number of app opens, number of program interactions, and continued engagement over time. Clickotine users reported encouraging quit rates while reporting few adverse events. Future research is warranted to assess Clickotine’s efficacy in a randomized controlled trial. Trial Registration Clinicaltrials.gov NCT02656745; https://clinicaltrials.gov/ct2/show/NCT02656745 (Archived by WebCite at http://www.webcitation.org/6peTT4x60)
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Affiliation(s)
- Brian M Iacoviello
- Click Therapeutics, Inc., New York, NY, United States.,Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | | | - David B Klein
- Click Therapeutics, Inc., New York, NY, United States
| | | | - Adam G Berger
- Click Therapeutics, Inc., New York, NY, United States
| | - Sean X Luo
- Click Therapeutics, Inc., New York, NY, United States
| | - Nicholas J Schork
- Click Therapeutics, Inc., New York, NY, United States.,The Translational Genomics Research Institute, Phoenix, AZ, United States
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7
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Iacoviello BM, Shenoy A, Hunt J, Filipovic-Jewell Z, Haydel B, LaPointe Rudow D. A Prospective Study of the Reliability and Validity of the Live Donor Assessment Tool. Psychosomatics 2017; 58:519-526. [PMID: 28526401 DOI: 10.1016/j.psym.2017.03.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 03/13/2017] [Accepted: 03/14/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND The psychosocial evaluation is an important part of the live organ donor evaluation process, yet this is not standardized across institutions. OBJECTIVE This study was designed to prospectively test the reliability and validity of a semistructured psychosocial evaluation tool that was recently developed and reported in the literature (the Live Donor Assessment Tool [LDAT]). METHODS A total of 248 live donor candidates who presented for evaluation were invited to participate in a study that involved the LDAT being scored as part of the standard psychosocial evaluation process; 222 provided informed consent. Evaluations were conducted by staff experienced with psychosocial evaluation of living donors and trained in the use of the LDAT. Furthermore, 123 donor candidates were evaluated twice, as per routine standard of care, and had 2 LDATs administered. Reliability of the LDAT was assessed by calculating the internal consistency of the LDAT items and inter-rater reliability. Validity was assessed by comparing LDAT scores across the risk-group categories (the traditional outcome designation of the psychosocial evaluation) and in 86 eventual donors, associations between LDAT scores, and indicators of psychosocial outcomes post-donation. RESULTS The LDAT was found to have good internal consistency, strong inter-rater reliability, and showed signs of validity: LDAT scores differentiated the traditional risk-group categories, and a significant association between LDAT score and treatment adherence post-donation was revealed. CONCLUSIONS The LDAT demonstrated good reliability and validity, but future research on the LDAT and the ability to implement the LDAT across institutions is warranted.
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Affiliation(s)
- Brian M Iacoviello
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY.
| | - Akhil Shenoy
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY; Recanati-Miller Transplantation Institute at Mount Sinai, The Zweig Family Center for Living Donation, New York, NY
| | - Julia Hunt
- Recanati-Miller Transplantation Institute at Mount Sinai, The Zweig Family Center for Living Donation, New York, NY
| | - Zorica Filipovic-Jewell
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY; Recanati-Miller Transplantation Institute at Mount Sinai, The Zweig Family Center for Living Donation, New York, NY
| | - Brandy Haydel
- Recanati-Miller Transplantation Institute at Mount Sinai, The Zweig Family Center for Living Donation, New York, NY
| | - Dianne LaPointe Rudow
- Recanati-Miller Transplantation Institute at Mount Sinai, The Zweig Family Center for Living Donation, New York, NY
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8
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Murrough JW, Soleimani L, DeWilde KE, Collins KA, Lapidus KA, Iacoviello BM, Lener M, Kautz M, Kim J, Stern JB, Price RB, Perez AM, Brallier JW, Rodriguez GJ, Goodman WK, Iosifescu DV, Charney DS. Ketamine for rapid reduction of suicidal ideation: a randomized controlled trial. Psychol Med 2015; 45:3571-3580. [PMID: 26266877 DOI: 10.1017/s0033291715001506] [Citation(s) in RCA: 204] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Suicide is a devastating public health problem and very few biological treatments have been found to be effective for quickly reducing the intensity of suicidal ideation (SI). We have previously shown that a single dose of ketamine, a glutamate N-methyl-d-aspartate (NMDA) receptor antagonist, is associated with a rapid reduction in depressive symptom severity and SI in patients with treatment-resistant depression. METHOD We conducted a randomized, controlled trial of ketamine in patients with mood and anxiety spectrum disorders who presented with clinically significant SI (n = 24). Patients received a single infusion of ketamine or midazolam (as an active placebo) in addition to standard of care. SI measured using the Beck Scale for Suicidal Ideation (BSI) 24 h post-treatment represented the primary outcome. Secondary outcomes included the Montgomery-Asberg Depression Rating Scale--Suicidal Ideation (MADRS-SI) score at 24 h and additional measures beyond the 24-h time-point. RESULTS The intervention was well tolerated and no dropouts occurred during the primary 7-day assessment period. BSI score was not different between the treatment groups at 24 h (p = 0.32); however, a significant difference emerged at 48 h (p = 0.047). MADRS-SI score was lower in the ketamine group compared to midazolam group at 24 h (p = 0.05). The treatment effect was no longer significant at the end of the 7-day assessment period. CONCLUSIONS The current findings provide initial support for the safety and tolerability of ketamine as an intervention for SI in patients who are at elevated risk for suicidal behavior. Larger, well-powered studies are warranted.
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Affiliation(s)
- J W Murrough
- Mood and Anxiety Disorders Program,Department of Psychiatry,Icahn School of Medicine at Mount Sinai,New York,NY,USA
| | - L Soleimani
- Mood and Anxiety Disorders Program,Department of Psychiatry,Icahn School of Medicine at Mount Sinai,New York,NY,USA
| | - K E DeWilde
- Mood and Anxiety Disorders Program,Department of Psychiatry,Icahn School of Medicine at Mount Sinai,New York,NY,USA
| | - K A Collins
- Mood and Anxiety Disorders Program,Department of Psychiatry,Icahn School of Medicine at Mount Sinai,New York,NY,USA
| | - K A Lapidus
- Departments of Psychiatry and Neurobiology,Stony Brook University,Stony Brook,NY,USA
| | - B M Iacoviello
- Mood and Anxiety Disorders Program,Department of Psychiatry,Icahn School of Medicine at Mount Sinai,New York,NY,USA
| | - M Lener
- Mood and Anxiety Disorders Program,Department of Psychiatry,Icahn School of Medicine at Mount Sinai,New York,NY,USA
| | - M Kautz
- Mood and Anxiety Disorders Program,Department of Psychiatry,Icahn School of Medicine at Mount Sinai,New York,NY,USA
| | - J Kim
- Deparment of Psychology,UCLA,Los Angeles,CA,USA
| | - J B Stern
- Department of Psychology,Drexel University,Philadelphia,PA,USA
| | - R B Price
- Department of Psychiatry,University of Pittsburgh School of Medicine,Pittsburgh,PA,USA
| | - A M Perez
- Department of Anesthesiology,Icahn School of Medicine at Mount Sinai,New York,NY,USA
| | - J W Brallier
- Department of Anesthesiology,Icahn School of Medicine at Mount Sinai,New York,NY,USA
| | - G J Rodriguez
- Department of Psychiatry,Icahn School of Medicine at Mount Sinai,New York,NY,USA
| | - W K Goodman
- Department of Psychiatry,Icahn School of Medicine at Mount Sinai,New York,NY,USA
| | - D V Iosifescu
- Mood and Anxiety Disorders Program,Department of Psychiatry,Icahn School of Medicine at Mount Sinai,New York,NY,USA
| | - D S Charney
- Mood and Anxiety Disorders Program,Department of Psychiatry,Icahn School of Medicine at Mount Sinai,New York,NY,USA
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9
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Affiliation(s)
- Sehrish Sayed
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, One Gustave L Levy Pl, Box 1230, New York, NY, 10029, USA,
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10
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Iacoviello BM, Charney DS. Developing cognitive-emotional training exercises as interventions for mood and anxiety disorders. Eur Psychiatry 2014; 30:75-81. [PMID: 25451246 DOI: 10.1016/j.eurpsy.2014.09.415] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Revised: 09/29/2014] [Accepted: 09/29/2014] [Indexed: 12/28/2022] Open
Abstract
There is an urgent need for more effective treatments for mood and anxiety disorders. As our understanding of the cognitive and affective neuroscience underlying psychiatric disorders expands, so do opportunities to develop novel interventions that capitalize on the capacity for brain plasticity. Cognitive training is one such strategy. This paper provides the background and rationale for developing cognitive-emotional training exercises as an intervention strategy, and proposes guidelines for the development and evaluation of cognitive training interventions with a specific focus on major depressive disorder as an example.
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Affiliation(s)
- B M Iacoviello
- Department of Psychiatry, Icahn School of Medicine, Mount Sinai, NY, USA.
| | - D S Charney
- Department of Psychiatry, Icahn School of Medicine, Mount Sinai, NY, USA
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Iacoviello BM, Wu G, Alvarez E, Huryk K, Collins KA, Murrough JW, Iosifescu DV, Charney DS. Cognitive-emotional training as an intervention for major depressive disorder. Depress Anxiety 2014; 31:699-706. [PMID: 24753225 DOI: 10.1002/da.22266] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Revised: 02/26/2014] [Accepted: 03/01/2014] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND There is an urgent need for more effective treatments for major depressive disorder (MDD). As understanding of the cognitive and affective neuroscience underlying psychiatric disorders expands, so do opportunities to develop interventions that capitalize on the capacity for brain plasticity. Cognitive training is one such strategy. In this article, we report a proof-of-concept study of a novel cognitive-emotional training exercise designed to enhance cognitive control for emotional information processing and targeting components of the neural networks that have been implicated in MDD. METHODS Twenty-one participants with MDD in a current episode were randomly assigned to one of the two treatment conditions: 11 participating in a cognitive-emotional training paradigm (emotional faces memory task (EFMT)) involving eight sessions over 4 weeks, and 10 participating in an active control condition (control training, CT). Assessments of MDD symptoms, negative affective bias in cognitive processing, and neurocognition (attention and working memory) were administered at baseline and after 4 weeks. RESULTS Participants in the EFMT group exhibited a greater reduction in MDD symptoms compared to the CT group, and 6 of the 11 EFMT participants achieved clinical response (≥ 50% reduction in symptoms). EFMT participants also exhibited changes in negative affective bias in the hypothesized direction whereas the CT participants did not. Both groups exhibited similar, small improvements in attention and working memory. CONCLUSIONS Cognitive-emotional training may represent a feasible and effective intervention strategy for MDD. This proof-of-concept study highlights the need for future studies to fully understand the effectiveness, and mechanisms of effect, of these training strategies.
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Abstract
OBJECTIVE To explore the psychosocial characteristics of living liver and kidney donors to identify common traits including personality traits, purpose in life, resilience, and post donation growth. METHODS Questionnaires were mailed to 835 living donors. Included were a survey of demographic characteristics and donation experiences, the NEO Five-Factor Inventory, the Purpose in Life Scale, the Posttraumatic Growth Inventory, and the Connor-Davidson Resilience Scale. Analyses compared the donor groups with the scale norms (where available) and compared differences between donor groups. RESULTS Eighteen percent of donors (n=151) responded anonymously. The sample was as resilient as the general population and significantly more resilient than the population of primary care patients. Kidney donors were significantly more resilient than liver donors. Live donors demonstrated scores on the NEO Five-Factor Inventory in the "high" range for agreeableness and conscientiousness and "low" for neuroticism. Kidney donors scored significantly lower on the neuroticism scale than liver donors scored. Purpose in Life scores and Post Donation Growth scores were skewed and were overwhelmingly high in this sample. Additional differences in psychosocial variables are also described. CONCLUSION Live donors are resilient and show adaptive personality traits. It is difficult to conclude whether these traits were inspired by the act of donation or if they make one more apt to choose donation. Moreover, the study methods introduce the possibility of selection bias: those with certain characteristics may have been more likely to respond. Prospective studies before and after donation are warranted.
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Iacoviello BM, Wu G, Abend R, Murrough JW, Feder A, Fruchter E, Levinstein Y, Wald I, Bailey CR, Pine DS, Neumeister A, Bar-Haim Y, Charney DS. Attention bias variability and symptoms of posttraumatic stress disorder. J Trauma Stress 2014; 27:232-239. [PMID: 24604631 PMCID: PMC4617532 DOI: 10.1002/jts.21899] [Citation(s) in RCA: 116] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Cognitive theories implicate information-processing biases in the etiology of anxiety disorders. Results of attention-bias studies in posttraumatic stress disorder (PTSD) have been inconsistent, suggesting biases towards and away from threat. Within-subject variability of attention biases in posttraumatic patients may be a useful marker for attentional control impairment and the development of posttrauma symptoms. This study reports 2 experiments investigating threat-related attention biases, mood and anxiety symptoms, and attention-bias variability following trauma. Experiment 1 included 3 groups in a cross-sectional design: (a) PTSD, (b) trauma-exposed without PTSD, and (c) healthy controls with no trauma or Axis I diagnoses. Greater attention-bias variability was found in the PTSD group compared to the other 2 groups (η(p)2=.23); attention-bias variability was significantly and positively correlated (r = .37) with PTSD symptoms. Experiment 2 evaluated combat-exposed and nonexposed soldiers before and during deployment. Attention-bias variability did not differentiate groups before deployment, but did differentiate groups during deployment (ηp2=.16); increased variability was observed in groups with acute posttraumatic stress symptoms and acute depression symptoms only. Attention-bias variability could be a useful marker for attentional impairment related to threat cues associated with mood and anxiety symptoms after trauma exposure.
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Affiliation(s)
- Brian M. Iacoviello
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Gang Wu
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Rany Abend
- School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel
| | - James W. Murrough
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Adriana Feder
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Eyal Fruchter
- Department of Mental Health, Medical Corps, Israel Defense Force, Tel Hashomer, Israel
| | - Yoav Levinstein
- Department of Mental Health, Medical Corps, Israel Defense Force, Tel Hashomer, Israel
| | - Ilan Wald
- School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Christopher R. Bailey
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Daniel S. Pine
- National Institute of Mental Health Intramural Research Program, Bethesda, Maryland, USA
| | - Alexander Neumeister
- Department of Psychiatry, New York University School of Medicine, New York, New York, USA
| | - Yair Bar-Haim
- School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel,Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Dennis S. Charney
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Iacoviello BM, Charney DS. Psychosocial facets of resilience: implications for preventing posttrauma psychopathology, treating trauma survivors, and enhancing community resilience. Eur J Psychotraumatol 2014; 5:23970. [PMID: 25317258 PMCID: PMC4185137 DOI: 10.3402/ejpt.v5.23970] [Citation(s) in RCA: 111] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Revised: 03/30/2014] [Accepted: 04/25/2014] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND There is a range of potential responses to stress and trauma. Whereas, on one extreme, some respond to stress and trauma by developing psychiatric disorders (e.g., posttraumatic stress disorder, PTSD), on the other extreme are the ones who exhibit resilience. Resilience is broadly defined as adaptive characteristics of an individual to cope with and recover from adversity. OBJECTIVE Understanding of the factors that promote resilience is warranted and can be obtained by interviewing and learning from particularly resilient individuals as well as empirical research. In this paper, we discuss a constellation of factors comprising cognitive, behavioral, and existential elements that have been identified as contributing to resilience in response to stress or trauma. RESULTS The psychosocial factors associated with resilience include optimism, cognitive flexibility, active coping skills, maintaining a supportive social network, attending to one's physical well-being, and embracing a personal moral compass. CONCLUSIONS These factors can be cultivated even before exposure to traumatic events, or they can be targeted in interventions for individuals recovering from trauma exposure. Currently available interventions for PTSD could be expanded to further address these psychosocial factors in an effort to promote resilience. The cognitive, behavioral, and existential components of psychosocial factors that promote individual resilience can also inform efforts to promote resilience to disaster at the community level.
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Affiliation(s)
- Brian M Iacoviello
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Dennis S Charney
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Iacoviello BM, Alloy LB, Abramson LY, Choi JY, Morgan JE. Patterns of symptom onset and remission in episodes of hopelessness depression. Depress Anxiety 2013; 30:564-73. [PMID: 23495016 PMCID: PMC4079009 DOI: 10.1002/da.22085] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2012] [Revised: 01/25/2013] [Accepted: 02/07/2013] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Hopelessness depression (HD) is a subtype of depression postulated by the Hopelessness Theory of Depression to present as a constellation of symptoms occurring when an individual with a specific cognitive vulnerability (negative inferential style) experiences negative life events. In the current study, the course of HD episodes was evaluated prospectively and analyzed to explore patterns of symptom onset and remission. METHODS In 169 HD episodes reported by 65 participants, survival analyses were conducted on the time to onset or remission for 29 individual symptoms. Survival analyses yielded probability density graphs for risk of onset and risk of offset that indicated whether the symptom tended to appear or remit early, late, or unpredictably during the episode. RESULTS The symptom of hopelessness often appeared earliest in HD episodes, followed by self-blame, brooding/worry, decreased self-esteem, dependency, and decreased appetite. Hopelessness, decreased self-esteem, self-blame, brooding/worry, dependency, and increased appetite were typically the latest symptoms to remit. CONCLUSIONS The current study provided evidence for patterns of symptom onset and remission in HD episodes. Hopelessness and other symptoms predicted to appear according to the Hopelessness Theory were generally the earliest to appear, latest to remit, and appeared to form the core syndrome of these HD episodes. Identifying patterns of symptom onset and remission may provide a tool for subtyping depression episodes. Clinically, these results point to the utility of attending to patterns of symptom onset and remission in patients presenting with HD episodes, particularly for treatment planning and monitoring.
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Affiliation(s)
- Brian M Iacoviello
- Psychiatry Department, Mount Sinai School of Medicine, New York, New York 10029, USA.
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Iacoviello BM, Alloy LB, Abramson LY, Choi JY. The early course of depression: a longitudinal investigation of prodromal symptoms and their relation to the symptomatic course of depressive episodes. J Abnorm Psychol 2010; 119:459-67. [PMID: 20677835 DOI: 10.1037/a0020114] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The present study explored longitudinal evidence for prodromal symptoms of depression episodes. A model based on previous findings of the relations between prodromal and residual symptoms was described and used to generate hypotheses tested in this study. Data were analyzed from 160 participants from the Cognitive Vulnerability to Depression (CVD) project (L. Alloy & L. Abramson, 1999) who experienced an episode of depression during the prospective follow-up period and 60 CVD participants who did not. Congruent with the hypothesis, individuals who subsequently developed an episode of depression experienced significantly greater numbers of depression symptoms in the period of time leading up to the acute episode compared with those who did not develop a depressive episode. Seven depression symptoms were particularly likely to appear before the onset of an acute episode. Furthermore, all 3 predictions from the model were supported: the durations of prodromal and residual phases were correlated, the prodromal and residual symptom profiles were quite similar, and the order of symptom onset was significantly and highly negatively correlated with the order of symptom remission. Additionally, residual symptom profiles were similar to subsequent prodromal symptom profiles in individuals who experienced more than 1 depressive episode. These findings are discussed in terms of the importance of understanding the earliest prodromal symptoms to appear and their relation to the symptomatic course of depression episodes. Implications for early intervention are also discussed.
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Liu RT, Alloy LB, Abramson LY, Iacoviello BM, Whitehouse WG. Emotional maltreatment and depression: prospective prediction of depressive episodes. Depress Anxiety 2009; 26:174-81. [PMID: 19152341 PMCID: PMC2832855 DOI: 10.1002/da.20545] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Most research to date on the role of maltreatment experiences in depression has focused on physical and sexual maltreatment. However, several researchers have theorized that emotional maltreatment may be more strongly linked to depression. Furthermore, prospective studies in this area are lacking. This study addressed these issues by examining whether experiences of current emotional maltreatment predicted the development of new prospective episodes of major (MD) or minor depression (MiD), and the subtype of hopelessness depression (HD) in young adults. It also assessed whether current emotional maltreatment from peers and from authority figures separately predicted the occurrence of depressive episodes. METHOD One hundred and sixty-five participants from the Cognitive Vulnerability to Depression Project were followed prospectively for 2.5 years. Current emotional maltreatment and new depressive episodes were assessed with life event and diagnostic interviews administered every 6 weeks. RESULTS Greater overall emotional maltreatment predicted shorter time to onset of new MD, MiD, and HD episodes. Peer- and authority-perpetrated emotional maltreatment separately predicted shorter time to development of new HD episodes. CONCLUSIONS Greater emotional maltreatment in young adults prospectively predicts onset of depression, particularly HD. These findings highlight the importance of adult emotional maltreatment experiences in determining targets for prevention and treatment.
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Iacoviello BM, Grant DA, Alloy LB, Abramson LY. Cognitive Personality Characteristics Impact the Course of Depression: A Prospective Test of Sociotropy, Autonomy and Domain-Specific Life Events. Cognit Ther Res 2008; 33:187-198. [PMID: 20216915 DOI: 10.1007/s10608-008-9197-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Prospective tests of the impact of sociotropy and autonomy on the course of depression are lacking. In a sample of 97 cognitive high-risk and 62 cognitive low-risk undergraduates who experienced at least one prospective depressive episode, the interactions of sociotropy and interpersonal life events and autonomy and achievement-related life events were examined as predictors of four indicators of the course of depression. Initial analyses failed to support the hypothesis that global scores for sociotropy and autonomy interact with domain-congruent life events to predict the course indicators. The autonomy-achievement events interaction predicted less severe episodes, contrary to hypothesis. Then, factors hypothesized to underlie Sociotropy (Fear of Criticism and Rejection; Preference for Affiliation) and Autonomy were also analyzed. The puzzling autonomy-achievement life event interaction was explained by the underlying Independent Goal Attainment factor. Interactions between Fear of Criticism and Rejection and achievement events, and between Sensitivity to Others' Control and interpersonal events, significantly predicted chronicity, number and severity of episodes. The findings are discussed in terms of the event-congruency hypothesis.
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Affiliation(s)
- Brian M Iacoviello
- Department of Psychology, Temple University, 1701 N. 13th Street, Philadelphia, PA 19122, USA
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Alloy LB, Abramson LY, Walshaw PD, Cogswell A, Grandin LD, Hughes ME, Iacoviello BM, Whitehouse WG, Urosevic S, Nusslock R, Hogan ME. Behavioral Approach System and Behavioral Inhibition System sensitivities and bipolar spectrum disorders: prospective prediction of bipolar mood episodes. Bipolar Disord 2008; 10:310-22. [PMID: 18271911 DOI: 10.1111/j.1399-5618.2007.00547.x] [Citation(s) in RCA: 182] [Impact Index Per Article: 11.4] [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: 12/21/2022]
Abstract
OBJECTIVES Research has found that bipolar spectrum disorders are associated with Behavioral Approach System (BAS) hypersensitivity and both unipolar and bipolar depression are associated with high Behavioral Inhibition System (BIS) sensitivity, but prospective studies of these relationships are lacking. We tested whether BAS and BIS sensitivities prospectively predicted the time to new onsets of major depressive and hypomanic and manic episodes in bipolar spectrum individuals. METHODS We followed 136 bipolar II or cyclothymic and 157 demographically matched normal control individuals prospectively for an average of 33 months. Participants completed the BIS/BAS scales and symptom measures at Time 1 and semi-structured diagnostic interviews every four months of follow-up. RESULTS The bipolar spectrum group exhibited higher Time 1 BAS, but not BIS, scores than the normal controls, controlling for Time 1 symptoms. Among bipolar spectrum participants, high BAS sensitivity prospectively predicted a shorter time to onset of hypomanic and manic episodes, whereas high BIS sensitivity predicted less survival time to major depressive episodes, controlling for initial symptoms. CONCLUSIONS Consistent with the BAS hypersensitivity model of bipolar disorder, a highly responsive BAS provides vulnerability to onsets of (hypo)manic episodes. In addition, a highly sensitive BIS increases risk for major depressive episodes.
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Affiliation(s)
- Lauren B Alloy
- Psychology Department, Temple University, Philadelphia, PA 19122, USA.
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Abstract
The association between personality disturbance and depression has been noted consistently. Prospective tests of personality's impact on the course of depression, however, are lacking. In a sample of 159 undergraduates who experienced at least one prospective depressive episode, dimensional scores for clusters B and C personality disturbance were examined as prospective predictors of four indicators of the course of depression: severity, episode duration, symptomatic chronicity and number of episodes. Cluster C personality disturbance, characterized by anxious and fearful features, predicted depression chronicity. Cluster B, characterized by dramatic, emotional and/or erratic features, predicted severity and duration of depression. The findings are discussed in terms of the possible mechanisms underlying the effects of clusters B and C, as well as implications for future research.
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Affiliation(s)
- Brian M Iacoviello
- Department of Psychology,Temple University, Philadelphia, PA 19122, USA.
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Iacoviello BM, McCarthy KS, Barrett MS, Rynn M, Gallop R, Barber JP. Treatment preferences affect the therapeutic alliance: Implications for randomized controlled trials. J Consult Clin Psychol 2007; 75:194-8. [PMID: 17295580 DOI: 10.1037/0022-006x.75.1.194] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The influence of treatment preferences on the development of the therapeutic alliance was investigated. Seventy-five patients were followed while participating in a randomized controlled trial comparing supportive-expressive psychotherapy with sertraline or pill placebo in the treatment of major depressive disorder. Therapeutic alliance was assessed before treatment and at the 3rd, 5th, and 9th weeks of treatment. Among patients initially preferring psychotherapy, those receiving psychotherapy experienced increases in their alliance over time, whereas those receiving active medication or placebo experienced decreases. Among patients preferring pharmacotherapy, there were no differences in alliance development whether they received psychotherapy, active medication, or placebo. These relations were observed even when controlling for symptom severity. Thus, the congruence of patients' treatment preference and the treatment that they ultimately received influenced the development of the therapeutic alliance. Because alliance is a robust predictor of outcome, treatment preferences may need to be carefully considered in randomized controlled trial settings.
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Affiliation(s)
- Brian M Iacoviello
- Department of Psychiatry, Center for Psychotherapy Research, University of Pennsylvania School of Medicine, Philadelphia, PA 19104-3309, USA
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Alloy LB, Abramson LY, Walshaw PD, Cogswell A, Smith JM, Neeren AM, Hughes ME, Iacoviello BM, Gerstein RK, Keyser J, Urosevic S, Nusslock R. Behavioral Approach System (BAS) Sensitivity and Bipolar Spectrum Disorders: A Retrospective and Concurrent Behavioral High-Risk Design. Motiv Emot 2006. [DOI: 10.1007/s11031-006-9003-3] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Iacoviello BM, Alloy LB, Abramson LY, Whitehouse WG, Hogan ME. The course of depression in individuals at high and low cognitive risk for depression: a prospective study. J Affect Disord 2006; 93:61-9. [PMID: 16545464 DOI: 10.1016/j.jad.2006.02.012] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2005] [Revised: 02/01/2006] [Accepted: 02/08/2006] [Indexed: 11/25/2022]
Abstract
BACKGROUND Negative cognitive styles have been shown to prospectively predict depression onset and recurrence. Research has also begun to suggest that cognitive styles may be associated with the course of depression as well. This study examined whether cognitive risk for depression onset also predicts the course of depression in a prospective design. METHODS One hundred fifty-nine initially nondepressed participants from the Temple-Wisconsin Cognitive Vulnerability to Depression Project who experienced a depressive episode while in the study were followed prospectively for 2.5 years. Four indicators of the course of depression were assessed from diagnostic interviews and questionnaires administered every 6 weeks: the number, severity and duration of episodes and the chronicity of the depression experienced. RESULTS Cognitive high-risk participants experienced more episodes of depression, more severe episodes, and more chronic courses than low-risk participants. There were no risk group differences observed for the duration of episodes. LIMITATIONS This study's sample was chosen to include individuals with high and low cognitive vulnerability to depression, potentially limiting the generalizability of the findings to other individuals. Also, the study included some participants with a past history of depression. CONCLUSIONS Negative cognitive styles predict a worse course of depression as well as rendering an individual prone to depression onset. This highlights that the cognitive factors impacting depression's course overlap, at least partly, with those that initiate depression. Thus, knowledge of a depressed individual's cognitive styles could aid in prognosis and treatment planning.
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Affiliation(s)
- Brian M Iacoviello
- Department of Psychology, Temple University, Philadelphia, PA 19122, United States.
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Nierenberg AA, Papakostas GI, Petersen T, Kelly KE, Iacoviello BM, Worthington JJ, Tedlow J, Alpert JE, Fava M. Nortriptyline for treatment-resistant depression. J Clin Psychiatry 2003; 64:35-9. [PMID: 12590621 DOI: 10.4088/jcp.v64n0108] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Up to 30% of patients with major depression fail to respond to an antidepressant trial, with most taking a selective serotonin reuptake inhibitor (SSRI) as initial treatment. While the tricyclic antidepressants might be effective for SSRI nonresponders, they have been relegated to third- and fourth-line treatment. This study assesses the efficacy of nortriptyline for patients with treatment-resistant major depression. METHOD 92 patients with treatment-resistant DSM-III-R major depression, with resistance defined by at least 1, but no more than 5, well-documented adequate trials of antidepressants during the current episode, were treated openly with nortriptyline for 6 weeks. Patients were titrated up to full target doses of nortriptyline within 1 week, with target blood levels of 100 ng/mL. Response was defined as a 50% or greater decrease of baseline 17-item Hamilton Rating Scale for Depression score. We performed an intent-to-treat analysis with the last observation carried forward. RESULTS Approximately 40% of patients were responders (N = 39) and 12% were remitters (N = 11) after 6 weeks of nortriptyline. Over a third of patients were unable to complete the trial. CONCLUSION Nortriptyline was effective for over a third of patients with treatment-resistant depression, and nortriptyline should be considered as potential treatment if patients fail to respond to other antidepressants.
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Affiliation(s)
- Andrew A Nierenberg
- Depression Clinical and Research Program, Massachusetts General Hospital, Harvard Medical School, Boston, 02114, USA.
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