Using Experience Sampling Methodology Data to Characterize the Substance Use of Youth With or At-Risk of Psychosis

OBJECTIVES

Psychotic-spectrum disorders emerge during adolescence and early adulthood, which corresponds with the peak period for substance use initiation. Clinical and epidemiological data provide support that substance use is associated with psychotic symptom onset and severity. Experience-sampling methodology (ESM) data may provide additional insight into dynamic associations between substance use and psychotic symptoms. This is one of the first efforts to characterize substance use frequency and dynamic associations with psychotic symptoms and negative affect from ESM data in both clinical high risk (CHR) and early psychosis (EP) individuals.

METHODS

Using ESM, 33 individuals, including 17 with CHR and 16 EP (age range: 15-24), provided information on substance use, negative affect, and psychotic symptoms 6 times a day across a 21-day data collection window. Psychotic symptoms and negative affect included multi-item variables rated on a seven-point Likert Scale. Participants reported recent substance use for 4 drug classes (nicotine, cannabis, depressants, stimulants) via a yes/no item. Descriptive information included data on substance use frequency, and momentary negative affect and psychotic symptoms. Exploratory analyses included multi-level and person-level dynamic structural equation models, which assessed contemporaneous and lagged associations between substance use and symptoms.

RESULTS

Twenty-seven individuals (82%) reported recurrent substance use including stimulants (n = 12, 46%), nicotine (n = 9, 27%), cannabis (n = 6, 18%), and depressants (n = 4, 12%). Individuals with any recurrent substance use indicated usage at 47.7% of answered prompts; stimulants at 23.6%; nicotine at 74.2%; cannabis at 39.1%; and depressants at 20.1%. A multi-level dynamic structural equation model reflected that substance use (any class) was associated with lagged negative affect (β = -0.02, CI: -0.06, < -0.00) but no significant contemporaneous or lagged associations between substance use and psychotic symptoms. Person-level models suggest potentially meaningful inter-individual variability.

CONCLUSIONS

CHR and EP individuals use a range of substances that may both reflect and influence other experiences in daily life experiences. Data reflected moderate to high rates of recurrent substance use with more consistent use within nicotine and cannabis classes. ESM data have the potential to increase our understanding of the dynamic relationships between substance use and symptoms and to inform treatment for individuals in early course psychosis.

Identification of Zika Virus and Dengue Virus Dependency Factors using Functional Genomics

The flaviviruses dengue virus (DENV) and Zika virus (ZIKV) are severe health threats with rapidly expanding ranges. To identify the host cell dependencies of DENV and ZIKV, we completed orthologous functional genomic screens using RNAi and CRISPR/Cas9 approaches. The screens recovered the ZIKV entry factor AXL as well as multiple host factors involved in endocytosis (RAB5C and RABGEF), heparin sulfation (NDST1 and EXT1), and transmembrane protein processing and maturation, including the endoplasmic reticulum membrane complex (EMC). We find that both flaviviruses require the EMC for their early stages of infection. Together, these studies generate a high-confidence, systems-wide view of human-flavivirus interactions and provide insights into the role of the EMC in flavivirus replication.

The interface of child mental health and juvenile diabetes mellitus

Diabetes mellitus is a common childhood illness, and its management is often complicated by mental health challenges. Psychiatric comorbidities are common, including anxiety, depression, and eating disorders. The illness can profoundly affect the developing brain and family functioning and have lifelong consequences. The child mental health provider can provide valuable assistance to support the child and family and assessment and treatment of comorbid mental health problems and to promote positive family functioning and normal developmental progress.

The interface of child mental health and juvenile diabetes mellitus

Diabetes mellitus is a common childhood illness, and its management is often complicated by mental health challenges. Psychiatric comorbidities are common, including anxiety, depression, and eating disorders. The illness can profoundly affect the developing brain and family functioning and have lifelong consequences. The child mental health provider can provide valuable assistance to support the child and family and assessment and treatment of comorbid mental health problems and to promote positive family functioning and normal developmental progress.

The interface of child mental health and juvenile diabetes mellitus

Diabetes mellitus is a common childhood illness, and its management is often complicated by mental health challenges. Psychiatric comorbidities are common, including anxiety, depression, and eating disorders. The illness can profoundly affect the developing brain and family functioning and have lifelong consequences. The child mental health provider can provide valuable assistance to support the child and family and assessment and treatment of comorbid mental health problems and to promote positive family functioning and normal developmental progress.

Mass data massage: an automated data processing system used for NHEXAS, Arizona. National Human Exposure Assessment Survey

Data entry and management are critical components of all large survey projects; data quality objectives must be met and data must be quickly and readily accessible. We developed a comprehensive system for data entry and management utilizing scannable forms with bubble fields and handwriting recognition. This 'Mass Data Massage' (MDM) system had three components: (1) form creation and database definition; (2) programming of data dictionaries for documentation and preliminary logic and range checks; and (3) data entry, management and documentation using the 'Mass Data Cleaning Program' (MDCP). Scannable forms were written in Teleform, where the data field definition, variable names and ranges were defined as the form was created. Completed forms were returned from the field, subjected to final field quality control (QC) checks, and transferred to the data management section. They were batched and coded as necessary. Once a batch of data was scanned and visually verified, the operator called up the menu for the MDCP. The MDCP had 31 program modules with 500-1200 lines of code each. The operator could select and run the appropriate dictionary on each data batch 'correcting' apparent errors in responses. This process was iterative until the data batch passed all dictionary checks. Proposed 'changes' were forwarded to the data coordinator (DC) for acceptance or rejection. After all errors had been resolved, each data batch was subjected to a 10% quality assurance (QA) check. The original data batch and associated file of applied changes were archived. Time expenditure using the scanning approach varied with the number of questions and the types of responses (handwritten or bubble fields). One-page forms took 42-60% of the time needed for hand entry; forms longer than 10 pages took 35-38% of the time. Use of faster machines will further speed the process. The main advantage of the system was the reduction of systematic errors. Scanning alone reduced errors found on 995 NHEXAS Baseline Questionnaires. Overall, the dictionary identified 0.55% errors on the scanned forms. Ten percent QC checks, performed on corrected batches ready for appendage to the master database, revealed an overall error rate of 0.02%. Similar checks on a laboratory form scanned from numeric handwriting detected 0.3% errors following dictionary application and 0.2% errors during the 10% QA check. This system was faster, more accurate, and more cost-effective than hand entry of data. A batch of data that took >1 week to process using the hand entry method was processed within 1 day using MDM. Human coding of specific answers and the final verification were the most time-consuming processes.

Lung function development in young adults: is there a plateau phase?

Numerous population studies have reported that pulmonary function following the adolescent growth phase appears to be in a steady-state, where there is little or no growth occurring up to 40 yrs of age. We examined longitudinal forced expiratory volume in one second (FEV1), changes using three different statistical approaches to determine which subjects actually have significant trends during this period. Participants, who were employees at a metal processing plant, underwent quarterly spirometry for up to 10 yrs. Test results up to 33 yrs of age were included in the analysis. Each subject's FEV1 data was first analysed using simple linear regression (SLR) to test for a statistically significant linear slope. Next, each subject's data were fitted using bootstrap sampling (BSS) of their original data, to yield reduced estimates of the slope variances and increase the power of detecting a significant trend. And thirdly, we fitted a regression breakpoint (BKPT) model to the data to find those subjects who may have piecewise linear growth or decline in function. All analyses were stratified, based on smoking status. Subjects included 111 nonsmokers and 110 smokers. Among the nonsmokers, 34 subjects had significant slopes using SLR, an additional three using BSS, and only two with BKPT. Among the smokers, 36 had a significant trend using SLR, 7 were added using BSS, and no additional subjects with BKPT. We conclude that in young adult males lung function is not in a steady-state and that as many as 40% have a significant slope, either positive or negative.(ABSTRACT TRUNCATED AT 250 WORDS)

Lung function development in young adults: is there a plateau phase?

Numerous population studies have reported that pulmonary function following the adolescent growth phase appears to be in a steady-state, where there is little or no growth occurring up to 40 yrs of age. We examined longitudinal forced expiratory volume in one second (FEV1), changes using three different statistical approaches to determine which subjects actually have significant trends during this period. Participants, who were employees at a metal processing plant, underwent quarterly spirometry for up to 10 yrs. Test results up to 33 yrs of age were included in the analysis. Each subject's FEV1 data was first analysed using simple linear regression (SLR) to test for a statistically significant linear slope. Next, each subject's data were fitted using bootstrap sampling (BSS) of their original data, to yield reduced estimates of the slope variances and increase the power of detecting a significant trend. And thirdly, we fitted a regression breakpoint (BKPT) model to the data to find those subjects who may have piecewise linear growth or decline in function. All analyses were stratified, based on smoking status. Subjects included 111 nonsmokers and 110 smokers. Among the nonsmokers, 34 subjects had significant slopes using SLR, an additional three using BSS, and only two with BKPT. Among the smokers, 36 had a significant trend using SLR, 7 were added using BSS, and no additional subjects with BKPT. We conclude that in young adult males lung function is not in a steady-state and that as many as 40% have a significant slope, either positive or negative.(ABSTRACT TRUNCATED AT 250 WORDS)

Smoking cessation and changes in respiratory symptoms in two populations followed for 13 years

To investigate the relationship between persistence and incidence rates of respiratory symptoms, and the cessation of cigarette smoking, the data from longitudinal studies conducted in Cracow, Poland and Tucson, USA were analysed jointly. Among 1722 subjects smoking at the beginning of the study, 468 had given up smoking at the 13-year follow-up. The persistence and incidence rates of chronic cough, chronic phlegm, wheeze and attacks of breathlessness were reduced by 50% in ex-smokers compared to the subjects continuing to smoke. The beneficial effects of smoking cessation were decreased in subjects smoking more cigarettes per day in the past and starting to smoke at a younger age. The symptoms were less likely if smoking ceased before the onset of any respiratory disease. These results were similar in the Cracow and Tucson populations, confirming the universal nature of the observations.

Panic disorder in children and adolescents

Undiagnosed panic disorder may be a significant health problem in children and adolescents. Some of the adolescents and children who have presented for years with school refusal or psychogenic somatic complaints may suffer from this disorder and may benefit significantly from appropriate treatment.

Death certificate reporting of confirmed airways obstructive disease

Death certificate reporting of chronic airways disease was examined during 13 years of follow-up in the Tucson Epidemiologic Study of Airways Obstructive Disease. The Tucson study population is a geographically clustered stratified random sample of white, non-Mexican-American households in Tucson, Arizona. The initial survey was performed in 1972-1973. Using clinical and physiologic criteria from nine surveys to define airways obstructive disease in the population, the authors compared death certificate reporting with these criteria as the underlying cause and as reported anywhere on the death certificate. Reporting was related to the degree of antemortem airways obstruction. Sex differences in reporting were also noted. Females showed greater rates of reporting at low levels of impairment while males showed greater reporting at high levels of impairment. When airways obstructive disease was not the underlying cause of death, the type of underlying cause was found to affect reporting of airways obstructive disease on the death certificate.

Panic disorder in children and adolescents

Panic disorder is a common and well-known psychiatric disorder which commonly has its onset during adolescence. However, the disorder has only recently been described in children and adolescents. The clinical literature describing panic disorder in children and adolescents is reviewed, and six cases are presented. Future directions for research are suggested.

Treatment of adolescents with major depression: implications of the DST and the melancholic clinical subtype

Of 38 adolescents hospitalized with major depression, 47% of those receiving psychosocial treatment alone responded. Of the non-responders then treated with combined tricyclic antidepressants and psychosocial treatment, 92% responded. The melancholic subtype and dexamethasone suppression test non-suppression were associated with failure to respond to psychosocial treatment alone. Implications for controlled studies are discussed.

Insulin misuse: a review of an overlooked psychiatric problem

A number of forms of insulin misuse, other than the usual noncompliance, have been reported in the literature on the treatment of diabetes mellitus. These include attempted and completed suicide, factitious hypoglycemia, Munchausen syndrome by proxy, and the use of insulin by substance abusers. Such misuse has involved diabetic patients, their family members and medical staff, as well as others. The reports of suicide attempts reveal an equal distribution of misuse between the sexes (rather than the expected preponderance of females), underrepresentation of adolescents, and a high rate of recurrence. Recommendations for treatment are discussed for clinicians and investigators regarding this overlooked problem.

Attempted suicide by insulin overdose in insulin-dependent diabetic adolescents

Two cases of attempted suicide by insulin overdose in adolescent girls with insulin-dependent diabetes mellitus were observed. It is possible that suicidal insulin overdose in adolescents is more common than reports suggest and that it may often be unrecognized.

Panic and depressive disorders among psychiatrically hospitalized adolescents

Sixty-one adolescents hospitalized on an inpatient psychiatric unit were evaluated to determine whether they met criteria for panic and affective disorders according to Research Diagnostic Criteria. Ten (16%) and 15 (24%) met criteria for definite or possible panic disorder. Fifteen (24.5%) had major depressive disorder (MDD) endogenous subtype, 10 (16%) had MDD nonendogenous subtype, 8 (13%) had minor depressive disorder (mDD), and 27 (44%) had no diagnosable mood disorder. Four adolescents with definite panic disorders were diagnosed as having MDD endogenous subtype, three MDD, two mDD, and one had no diagnosable depressive disorder. The mean total score on the Hamilton Rating Scale for Depression (HRSD) was significantly higher among those subjects with definite panic attacks compared with those with either possible or no panic. Patients with definite panic disorder showed significant increases on the HRSD items of guilt, decreased work and interest, psychological and somatic anxiety, and weight loss compared to these samples.

Depressive symptoms and suicidal behavior in adolescents

Depressive symptoms and suicidal behavior in 64 adolescent psychiatric patients were assessed by a structured interview and the Schedule for Affective Disorders and Schizophrenia. The medical seriousness of suicidal behavior was associated with conscious intent to die and with the number of previous nonlethal suicide attempts. Suicidal behavior was associated with depressed mood, negative self-evaluation, anhedonia, insomnia, poor concentration, indecisiveness, lack of reactivity of mood, psychomotor disturbance, and alcohol and drug abuse. The results suggest that adolescents can be reliable reporters of their suicide potential and that clinicians need to be sensitive to symptoms of major depressive disorder in assessing potentially suicidal adolescents.

Use of the Hamilton Rating Scale for Depression and the Carroll Self-Rating Scale in adolescents

The relationship of clinicians' ratings of depression in adolescents to self-rating is important to clinical research. The Hamilton Rating Scale for Depression (HRSD) and the Carroll Self-Rating Scale (CSRS) were compared in a study of 81 psychiatrically hospitalized adolescents. The correlation of CSRS and HRSD total scores in adolescents with melancholic major depression was 0.46, lower than the correlation reported in adults (0.80). Higher correlations were seen in females and in nonmelancholic and nondepressed subgroups. While the comparison of the two rating methods suggests some characteristics of depressed adolescents' presentation of their illness, it does not appear that the self-rating instrument can be used as an alternative to clinicians' ratings.

Symptoms and subtypes of depression among adolescents distinguished by the dexamethasone suppression test: a preliminary report

Twenty-three adolescents hospitalized on an inpatient psychiatric unit underwent a dexamethasone suppression test (DST) and were diagnosed as having major depressive disorder by interviewers blind to the DST results. These patients were divided into four categories according to whether they had major depressive disorders, endogenous ( MDDe ) or nonendogenous (MDD), and whether they were nonsuppressors (+) or suppressors (-) in response to the DST, i.e., MDDe (+), MDDe (-), MDD (+), or MDD (-). Psychomotor features significantly differentiated the MDDe group from the MDD group. Among symptoms this further differentiated the MDDe (+) from the MDD (-) group. The primary subtype of depression occurred significantly more frequently among the MDDe group than the MDD group. The primary subtype also occurred more frequently among the MDDe (+) group than the MDD (-) group, whereas the MDD (-) group had a greater frequency of secondary depression.

The assessment of depression in normal adolescents--a comparison study

This pilot study addressed two questions. The first was whether the combination of an observer scale (Hamilton Rating Scale) and a self-rating scale (Carroll Self-Rating Scale, modelled after the Hamilton) can make a valid distinction between the frequency and severity of depressive symptomatology in adolescents not referred for treatment, and psychiatric inpatients. The second was whether Major Depressive Disorder (MDD) could be recognized and diagnosed in "non-patient" adolescents using this interview and rating scale approach. The median Hamilton and Carroll scores of the school students differed significantly from those of the inpatients, though the scores alone did not correspond with the presence or absence of MDD. Only 1 of the 26 (3.8%) tenth grade students interviewed appeared to have MDD, compared with 9 of 33 (27%) adolescent inpatients studied previously with the same methodology. The strength and limitations of this interview and assessment approach are discussed.