Showing papers in "American Journal of Psychiatry in 2006"
TL;DR: The acute and longer-term treatment outcomes associated with each of four successive steps in the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) trial are described and compared.
Abstract: Objective: This report describes the participants and compares the acute and longer-term treatment outcomes associated with each of four successive steps in the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) trial. Method: A broadly representative adult outpatient sample with nonpsychotic major depressive disorder received one (N=3,671) to four (N=123) successive acute treatment steps. Those not achieving remission with or unable to tolerate a treatment step were encouraged to move to the next step. Those with an acceptable benefit, preferably symptom remission, from any particular step could enter a 12-month naturalistic follow-up phase. A score of ≤5 on the Quick Inventory of Depressive Symptomatology–Self-Report (QIDS-SR 16 ) (equivalent to ≤7 on the 17-item Hamilton Rating Scale for Depression [HRSD 17 ]) defined remission; a QIDS-SR 16 total score of ≥11 (HRSD 17 ≥14) defined relapse. Results: The QIDS-SR 16 remission rates were 36.8%, 30.6%, 13.7%, and 13.0% for the first, second, t...
3,768 citations
TL;DR: Efforts are needed to increase the detection and treatment of adult ADHD and research is needed to determine whether effective treatment would reduce the onset, persistence, and severity of disorders that co-occur with adult ADHD.
Abstract: Objective: Despite growing interest in adult attention deficit hyperactivity disorder (ADHD), little is known about its prevalence or correlates. Method: A screen for adult ADHD was included in a probability subsample (N=3,199) of 18–44-year-old respondents in the National Comorbidity Survey Replication, a nationally representative household survey that used a lay-administered diagnostic interview to assess a wide range of DSM-IV disorders. Blinded clinical follow-up interviews of adult ADHD were carried out with 154 respondents, oversampling those with positive screen results. Multiple imputation was used to estimate prevalence and correlates of clinician-assessed adult ADHD. Results: The estimated prevalence of current adult ADHD was 4.4%. Significant correlates included being male, previously married, unemployed, and non-Hispanic white. Adult ADHD was highly comorbid with many other DSM-IV disorders assessed in the survey and was associated with substantial role impairment. The majority of cases were u...
3,280 citations
TL;DR: The response and remission rates in this highly generalizable sample with substantial axis I and axis III comorbidity closely resemble those seen in 8-week efficacy trials.
Abstract: OBJECTIVE: Selective serotonin reuptake inhibitors (SSRIs) are widely used to treat depression, but the rates, timing, and baseline predictors of remission in “real world” patients are not established. The authors’ primary objectives in this study were to evaluate the effectiveness of citalopram, an SSRI, using measurement-based care in actual practice, and to identify predictors of symptom remission in outpatients with major depressive disorder. METHOD: This clinical study included outpatients with major depressive disorder who were treated in 23 psychiatric and 18 primary care “real world” settings. The patients received flexible doses of citalopram prescribed by clinicians for up to 14 weeks. The clinicians were assisted by a clinical research coordinator in the application of measurement-based care, which included the routine measurement of symptoms and side effects at each treatment visit and the use of a treatment manual that described when and how to modify medication doses based on these measures....
3,228 citations
TL;DR: For patients with schizophrenia who prospectively failed to improve with an atypical antipsychotic, clozapine was more effective than switching to another newer atypicals antipsychotics.
Abstract: Objective: When a schizophrenia patient has an inadequate response to treatment with an antipsychotic drug, it is unclear what other antipsychotic to switch to and when to use clozapine. In this study, the authors compared switching to clozapine with switching to another atypical antipsychotic in patients who had discontinued treatment with a newer atypical antipsychotic in the context of the Clinical Antipsychotic Trials for Interventions Effectiveness (CATIE) investigation. Method: Ninety-nine patients who discontinued treatment with olanzapine, quetiapine, risperidone, or ziprasidone in phase 1 or 1B of the trials, primarily because of inadequate efficacy, were randomly assigned to open-label treatment with clozapine (N=49) or blinded treatment with another newer atypical antipsychotic not previously received in the trial (olanzapine [N=19], quetiapine [N= 15], or risperidone [N=16]).
876 citations
TL;DR: The risks for anxiety disorders, major depression, and substance dependence were approximately three times as high in the offspring of depressed parents as inThe offspring of nondepressed parents.
Abstract: Objective: This study was a 20-year follow-up of offspring of depressed and nondepressed parents to determine the magnitude and continuity of the risk of parental depression to the offspring. Method: The authors followed 151 offspring of moderately to severely depressed parents or nonpsychiatrically ill comparison subjects for about 20 years, to a mean age of 35 years. Four interviews and diagnostic assessments from childhood or adolescence to adulthood were conducted by assessors blind to the parents’ clinical status or the offspring’s previous history. Final best-estimate diagnoses were also made by blinded psychologists or psychiatrists. Results: The risks for anxiety disorders, major depression, and substance dependence were approximately three times as high in the offspring of depressed parents as in the offspring of nondepressed parents. Social impairment was also greater. The period of highest incidence for major depressive disorder remained between ages 15 and 20 years, largely in females. The ear...
826 citations
TL;DR: Employer interest in workplace costs of mood disorders should be broadened beyond major depressive disorder to include bipolar disorder, and effectiveness trials are needed to study the return on employer investment of coordinated programs for workplace screening and treatment of bipolar disorder and major depressive Disorder.
Abstract: Objective: Research on the workplace costs of mood disorders has focused largely on major depressive episodes. Bipolar disorder has been overlooked both because of the failure to distinguish between major depressive disorder and bipolar disorder and by the failure to evaluate the workplace costs of mania/hypomania. Method: The National Comorbidity Survey Replication assessed major depressive disorder and bipolar disorder with the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI) and work impairment with the WHO Health and Work Performance Questionnaire. A regression analysis of major depressive disorder and bipolar disorder predicting Health and Work Performance Questionnaire scores among 3,378 workers was used to estimate the workplace costs of mood disorders. Results: A total of 1.1% of the workers met CIDI criteria for 12-month bipolar disorder (I or II), and 6.4% meet criteria for 12-month major depressive disorder. Bipolar disorder was associated with 65.5 and major ...
784 citations
TL;DR: In the largest sample to date, lifetime major depression was moderately heritable, with estimates similar to those in prior studies, and it is suggested that the heritability of major depression is higher in women than in men and that some genetic risk factors for major depression are sex-specific in their effect.
Abstract: OBJECTIVE: Substantial evidence supports the heritability of lifetime major depression. Less clear is whether genetic influences in major depression are more important in women than in men and whether genetic risk factors are the same in the two sexes. It is not known whether genetic effects on major depression are constant across historical cohorts. METHOD: Lifetime major depression was assessed at personal interview by modified DSM-IV criteria in 42,161 twins, including 15,493 complete pairs, from the national Swedish Twin Registry. Twin models were evaluated by using the program Mx. RESULTS: Model fitting indicated that the heritability of liability to major depression was significantly higher in women (42%) than men (29%) and the genetic risk factors for major depression were moderately correlated in men and women. No significant differences were seen in the etiologic roles of genetic and environmental factors in major depression in three cohorts spanning birth years 1900–1958. CONCLUSIONS: In the lar...
707 citations
TL;DR: Trier Social Stress Test-induced increases in IL-6 and NF-κB DNA-binding were greater in major depression patients with increased early life stress and independently correlated with depression severity, but not early life Stress.
Abstract: Objective: The authors sought to determine innate immune system activation following psychosocial stress in patients with major depression and increased early life stress. Method: Plasma interleukin (IL)-6, lymphocyte subsets, and DNA binding of nuclear factor (NF)-kB in peripheral blood mononuclear cells were compared in medically healthy male subjects with current major depression and increased early life stress (N=14) versus nondepressed male comparison subjects (N=14) before and after completion of the Trier Social Stress Test. Results: Trier Social Stress Test-induced increases in IL-6 and NF-κB DNA-binding were greater in major depression patients with increased early life stress and independently correlated with depression severity, but not early life stress. Natural killer (NK) cell percentages also increased following stress. However, there were no differences between groups and no correlation between NK cell percentage and stress-induced NF-κB DNA-binding or IL-6. Conclusions: Male major depress...
666 citations
TL;DR: In this paper, the authors examined cross-sectional data from a study of the course of neuropsychological and adaptive life skills of older (age 50-85) schizophrenia patients (N=78).
Abstract: OBJECTIVE: Impairments in adaptive life skills are a major source of disability in patients with schizophrenia. The relationship between adaptive life skills in real-world settings and performance on neuropsychological tests may be complicated by other factors that interfere with deployment of skills. Assessment of the ability to perform life skills under optimal conditions (i.e., assessment of functional capacity) has been proposed as a means to clarify these relationships. METHOD: The authors examined cross-sectional data from a study of the course of neuropsychological and adaptive life skills of older (age 50–85) schizophrenia patients (N=78). Functional capacity was examined with a performance-based measure (UCSD Performance-Based Skills Assessment), and case managers rated real-world adaptive functions (i.e., interpersonal skills, work skills, and community activities). Neuropsychological performance was assessed with a comprehensive battery, while symptoms were assessed with patient self-report and...
653 citations
Journal Article•
TL;DR: Freud: a life for our time (review) as mentioned in this paper is a life-for-our-time book about the psychoanalytic theories of the freud family.
Abstract: freud: a life for our time (review) project muse freud a life for our time hipart freud a life for our time cafebr freud a life for our time excons (size 42,52mb) book freud a life for our time freud a life for our time ojaa epub freud a life for our time rbforums freud a life for our time mjro freud a life for our time peter gay lxnews read online freud a life for our time freud a life for our time user manuals by ogata mugito freud a life for our time epub book newyorkcitywraps freud a life for our time peter gay zyggis freud a life for our time cvpi freud a life for our time hostal-azul historicizing psychoanalysis: freud in his time and for sigmund freud the psychopathology of everyday life (1901) lucian freud: “a life of uncertainty and loneliness” ... and link download freud a life for our time freud a life for our time peter gay imseoadvertising dr freud a life biografie van freud engelstalig met fotos p-739: freud, jung and religion freud a life for our time user manuals by sachi kitahara freud: darkness in the midst of vision--an analytical sigmund freud, sublimation, and the russian silver age william james and sigmund freud: pioneers of modern psychology the life and work of sigmund freud vol 1 erpd the analytic freud the divine conspiracy trends in psychology why freud isn’t dead the influence of sigmund freud’s jewishness on his “an oedipus for our time” nietzsche's presence in freud's life and thought on the philosophy 421: topics in european and continental times literary supplement stephen frosh on the freud family a psychoanalytic reading list freud – the development of psychoanalytical theories i the life and work of sigmund freud nylahs freud’s wife guilford journals freud vs. adler life and work
633 citations
TL;DR: Recurrence was frequent and associated with the presence of residual mood symptoms at initial recovery and Targeting residual symptoms in maintenance treatment may represent an opportunity to reduce risk of recurrence.
Abstract: OBJECTIVE: Little is known about clinical features associated with the risk of recurrence in patients with bipolar disorder receiving treatment according to contemporary practice guidelines. The authors looked for the features associated with risk of recurrence. METHOD: The authors examined prospective data from a cohort of patients with bipolar disorder participating in the multicenter Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) study for up to 24 months. For those who were symptomatic at study entry but subsequently achieved recovery, time to recurrence of mania, hypomania, mixed state, or a depressive episode was examined with Cox regression. RESULTS: Of 1,469 participants symptomatic at study entry, 858 (58.4%) subsequently achieved recovery. During up to 2 years of follow-up, 416 (48.5%) of these individuals experienced recurrences, with more than twice as many developing depressive episodes (298, 34.7%) as those who developed manic, hypomanic, or mixed episodes (118, 13.8...
TL;DR: There is substantial, but not complete, overlap between the genetic factors that influence individual variation in neuroticism and those that increase liability across the internalizing disorders, helping to explain the high rates of comorbidity among the latter.
Abstract: Objective: The anxiety and depressive disorders exhibit high levels of lifetime comorbidity with one another. The authors examined how genetic and environmental factors shared by the personality trait neuroticism and seven internalizing disorders may help explain this comorbidity. Method: Lifetime major depression, generalized anxiety disorder, panic disorder, agoraphobia, social phobia, animal phobia, situational phobia, and neuroticism were assessed in over 9,000 twins from male-male, female-female, and oppositesex pairs through structured diagnostic interviews. Multivariate structural equation models were used to decompose the correlations between these phenotypes into genetic and environmental components, allowing for sex-specific factors. Results: Genetic factors shared with neuroticism accounted for between one-third and one-half of the genetic risk across the internalizing disorders. When nonsignificant gender differences were removed from the models, the genetic correlations between neuroticism and each disorder were high, while individual-specific environmental correlations were substantially lower. In addition, the authors could identify a neuroticism-independent genetic factor that significantly increased risk for major depression, generalized anxiety disorder, and panic disorder. Conclusions: There is substantial, but not complete, overlap between the genetic factors that influence individual variation in neuroticism and those that increase liability across the internalizing disorders, helping to explain the high rates of comorbidity among the latter. This may have important implications for identifying the susceptibility genes for these conditions.
TL;DR: Combined exposure to verbal abuse and witnessing domestic violence had a greater negative effect on some measures than exposure to familial sexual abuse, and parental verbal aggression was a potent form of maltreatment.
Abstract: Objective: Childhood maltreatment is an important psychiatric risk factor. Research has focused primarily on the effects of physical abuse, sexual abuse, or witnessing domestic violence. Parental verbal aggression has received little attention as a specific form of abuse. This study was designed to delineate the impact of parental verbal aggression, witnessing domestic violence, physical abuse, and sexual abuse, by themselves and in combination, on psychiatric symptoms. Method: Symptoms and exposure ratings were collected from 554 subjects 18–22 years of age (68% female) who responded to advertisement s. The Verbal Abuse Questionnaire was used to assess exposure to parental verbal aggression. Outcome measures included dissociation and symptoms of “limbic irritability,” depression, anxiety, and anger-hostility. Comparisons were made by using effect sizes. Results: Verbal aggression was associated with moderate to large effects, comparable to those associated with witnessing domestic violence or nonfamilial sexual abuse and larger than those associated with familial physical abuse. Exposure to multiple forms of maltreatment had an effect size that was often greater than the component sum. Combined exposure to verbal abuse and witnessing domestic violence had a greater negative effect on some measures than exposure to familial sexual abuse. Conclusions: Parental verbal aggression was a potent form of maltreatment. Exposure to multiple forms of abuse was associated with very large effect sizes. Most maltreated children had been exposed to multiple types of abuse, and the number of different types is a critically important factor.
TL;DR: Impaired inhibition of motor responses (impulsivity) was found in OCD and trichotillomania, whereas cognitive inflexibility (thought to contribute to compulsivity), was limited to OCD.
Abstract: Objective: Problems with inhibiting certain pathological behaviors are integral to obsessive-compulsive disorder (OCD), trichotillomania, and other putative obsessive-compulsive spectrum disorders. The authors assessed and compared motor inhibition and cognitive flexibility in OCD and trichotillomania for the first time, to their knowledge. Method: The Stop-Signal Task and the Intradimensiona/Extradimensional Shift Task were administered to 20 patients with OCD, 17 patients with trichotillomania, and 20 healthy comparison subjects. Results: Both OCD and trichotillomania showed impaired inhibition of motor responses. For trichotillomania, the deficit was worse than for OCD, and the degree of the deficit correlated significantly with symptom severity. Only patients with OCD showed deficits in cognitive flexibility. Conclusions: Impaired inhibition of motor responses (impulsivity) was found in OCD and trichotillomania, whereas cognitive inflexibility (thought to contribute to compulsivity) was limited to OCD...
TL;DR: The nearly significant differences suggest that olanzapine might reduce the conversion rate and delay onset of psychosis, and was efficacious for positive prodromal symptoms but induced weight gain.
Abstract: Objective: This study assessed the efficacy of olanzapine in delaying or preventing conversion to psychosis and reducing symptoms in people with prodromal symptoms of schizophrenia. Method: This randomized trial occurred at four North American clinics in the Prevention Through Risk Identification, Management, and Education project. Outpatients received olanzapine (5–15 mg/day, N=31) or placebo (N=29) during a 1-year double-blind treatment period and no treatment during a 1-year follow-up period. Efficacy measures included the conversion-to-psychosis rate and Scale of Prodromal Symptoms scores. Results: During the treatment year, 16.1% of olanzapine patients and 37.9% of placebo patients experienced a conversion to psychosis, a nearly significant difference. The hazard of conversion among placebo patients was about 2.5 times that among olanzapine-treated patients, which also approached significance. In the follow-up year, the conversion rate did not differ significantly between groups. During treatment, th...
TL;DR: A component of the syndrome of depression—the cognitive element of negative expectations—is identified as a stronger indicator of suicidal intent than depression itself, suggesting that approaches specifically designated to alleviate hopelessness may be successful in preventing suicide.
Abstract: The authors have identified a component of the syndrome of depression—the cognitive element of negative expectations—as a stronger indicator of suicidal intent than depression itself. This not only suggests a solution to the puzzling question of why there is a relationship between depression and suicide, but also indicates that approaches specifically designated to alleviate hopelessness may be successful in preventing suicide.
TL;DR: In this article, the authors document the rates of recovery, treatment-seeking, and natural recovery among individuals with DSM-IV pathological gambling disorder in two large and representative U.S. national surveys.
Abstract: OBJECTIVE: Pathological gambling is described in DSM-IV as a chronic and persisting disorder, but recent community-based longitudinal studies that have highlighted the transitory nature of gambling-related problems have called into question whether this is an accurate characterization. This emerging evidence of high rates of recovery coupled with low rates of treatment-seeking for pathological gambling suggests that natural recovery might be common. The purpose of the present study was to document the rates of recovery, treatment-seeking, and natural recovery among individuals with DSM-IV pathological gambling disorder in two large and representative U.S. national surveys. METHOD: Prevalences of recovery, treatment-seeking, and natural recovery were estimated among individuals from the Gambling Impact and Behavior Study (N=2,417) and the National Epidemiologic Survey on Alcohol and Related Conditions (N=43,093) who reported a lifetime history of DSM-IV pathological gambling disorder (N=21 and N=185, respe...
TL;DR: Schizophrenia is associated with a larger range of autoimmune diseases than heretofore suspected and future research on comorbidity has the potential to advance understanding of pathogenesis of both psychiatric and autoimmune disorders.
Abstract: OBJECTIVE: Individuals with schizophrenia and their relatives tend to have either higher or lower than expected prevalences of autoimmune disorders, especially rheumatoid arthritis, celiac disease, autoimmune thyroid diseases, and type 1 diabetes. The purpose of the study was to estimate the association of schizophrenia with these disorders as well as a range of other autoimmune diseases in a single large epidemiologic study. METHOD: The Danish Psychiatric Register, the National Patient Register, and a register with socioeconomic information were linked to form a data file that included all 7,704 persons in Denmark diagnosed with schizophrenia from 1981 to 1998 and their parents along with a sample of matched comparison subjects and their parents. The data linkage required that the autoimmune disease occur before the diagnosis of schizophrenia. RESULTS: A history of any autoimmune disease was associated with a 45% increase in risk for schizophrenia. Nine autoimmune disorders had higher prevalence rates am...
TL;DR: Multiple dimensions of job performance are impaired by depression, and this impact persisted after symptoms have improved, so efforts to reduce work-impairment secondary to depression are needed.
Abstract: Objective: This study assessed the relationship between depression severity and job performance among employed primary care patients. Method: In a 2001–2004 longitudinal observational study of depression’s affect on work productivity, 286 patients with DSM-IV major depressive disorder and/or dysthymia were compared to 93 individuals with rheumatoid arthritis, a condition associated with work disability, and 193 depression-free healthy control subjects. Participants were employed at least 15 hours per week, did not plan to stop working, and had no major medical comorbidities. Measures at baseline, six, 12, and 18 months included the Work Limitations Questionnaire for work outcomes, and the Patient Health Questionnaire-9 for depression. Results: At baseline and each follow-up, the depression group had significantly greater deficits in managing mental-interpersonal, time, and output tasks, as measured by the Work Limitations Questionnaire: The rheumatoid arthritis group’s deficits in managing physical job de...
TL;DR: Overall employment of persons with schizophrenia seems to be impeded by clinical problems, including symptoms of schizophrenia and poorer neurocognitive and intrapsychic functioning, however, participation in competitive employment may be specifically impeding by the potentially adverse incentives of disability payments and by race and may be promoted by the availability of rehabilitation services.
Abstract: OBJECTIVE: There is growing interest in identifying and surmounting barriers to employment for people with schizophrenia. The authors examined factors associated with participation in competitive employment or other vocational activities in a large group of patients with schizophrenia who participated in the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) study, a multisite clinical trial comparing the effects of first- and second-generation antipsychotics. METHOD: Baseline data on more than 1,400 patients with a diagnosis of schizophrenia were collected before their entry into the CATIE study. Multinomial logistic regression was used to examine the relationship between participation in either competitive employment or other vocational activities and sociodemographic characteristics, schizophrenia symptoms, neurocognitive functioning, intrapsychic functioning, availability of psychosocial rehabilitation services, and local unemployment rates. RESULTS: Altogether, 14.5% of the patients ...
TL;DR: The emotional and functional toll of compulsive buying and the frequency of comorbid psychiatric disorders suggests that studies of treatments and social interventions are warranted.
Abstract: Objective: Compulsive buying (uncontrolled urges to buy, with resulting significant adverse consequences) has been estimated to affect from 1.8% to 16% of the adult U.S. population. To the authors’ knowledge, no study has used a large general population sample to estimate its prevalence. Method: The authors conducted a random sample, national household telephone survey in the spring and summer of 2004 and interviewed 2,513 adults. The interviews addressed buying attitudes and behaviors, their consequences, and the respondents’ financial and demographic data. The authors used a clinically validated screening instrument, the Compulsive Buying Scale, to classify respondents as either compulsive buyers or not. Results: The rate of response was 56.3%, which compares favorably with rates in federal national health surveys. The cooperation rate was 97.6%. Respondents included a higher percentage of women and people ages 55 and older than the U.S. adult population. The estimated point prevalence of compulsive buying among respondents was 5.8% (by gender: 6.0% for women, 5.5% for men). The gender-adjusted prevalence rate was 5.8%. Compared with other respondents, compulsive buyers were younger, and a greater proportion reported incomes under $50,000. They exhibited more maladaptive responses on most consumer behavior measures and were more than four times less likely to pay off credit card balances in full. Conclusions: A study using clinically valid interviews is needed to evaluate these results. The emotional and functional toll of compulsive buying and the frequency of comorbid psychiatric disorders suggests that studies of treatments and social interventions are warranted.
TL;DR: The presence of emotion regulation disruptions, which are targeted in CBT, may be the key to recovery with this intervention.
Abstract: Cognitive behavior therapy (CBT) is a common empirically supported intervention (1) that is effective in 40%–60% of patients with unipolar depression (2). Knowing which patients are likely to benefit from CBT could increase the response rate and, through targeted referrals, decrease costs. CBT involves, among other skills, learning to interrupt automatic sustained emotional processing (e.g., elaboration, rumination) with controlled processing. As a preliminary step toward prediction, this study examined the association of the neural substrates of sustained emotional processes pretreatment with posttreatment recovery. Sustained emotional reactivity was examined because it is specifically addressed in CBT and because depressed individuals display increased and sustained reactivity in brain regions that subserve emotional processing, particularly the amygdala (3–5). Unmedicated patients with unipolar depression underwent functional magnetic resonance imaging during an emotional information processing task before initiating CBT. Analyses identified brain regions in which sustained reactivity to emotional information was associated with symptom change. Activity in these regions was then compared with that of healthy subjects.
TL;DR: Adolescents with generalized anxiety disorder show greater right ventrolateral prefrontal cortex activation and attentional bias away from angry faces than healthy adolescents, suggesting that this activation may serve as a compensatory response.
Abstract: Objective: While adolescent anxiety disorders represent prevalent, debilitating conditions, few studies have explored their brain physiology. Using event-related functional magnetic resonance imaging (fMRI) and a behavioral measure of attention to angry faces, the authors evaluated differences in response between healthy adolescents and adolescents with generalized anxiety disorder. Method: In the primary trials of interest, 18 adolescents with generalized anxiety disorder and 15 comparison subjects of equivalent age/gender/IQ viewed angry/neutral face pairs during fMRI acquisition. Following the presentation of each face pair, subjects pressed a button to indicate whether a subsequent asterisk appeared on the same (congruent) or opposite (incongruent) side as the angry face. Reaction time differences between congruent and incongruent face trials provided a measure of attention bias to angry faces. Results: Relative to the comparison subjects, patients with generalized anxiety disorder manifested greater ...
TL;DR: This finding supports a pathophysiological model of depression that includes reward/motivational pathway dysfunction, suggests a contributing neural substrate of the inability to experience pleasure or engage in rewarding activities, and provides greater specification of abnormalities of basal ganglia function in depression, and may help guide treatment approaches.
Abstract: Objective: Most of the functional neuroimaging studies of depression have focused primarily on the resting state or responses to negatively valenced stimuli. However, depression consists not only of an accentuation of negative affective processing but of an inability to experience pleasure or positive motivation. The authors tested the hypothesis that depressed subjects would show less activation than healthy comparison subjects, in response to positive stimuli, in ventral striatal regions associated with processing of reward and positive stimuli. Method: Positive, negative, and neutral words were presented to 10 unmedicated depressed patients and 12 healthy comparison subjects in the context of a 3T functional magnetic resonance imaging (MRI) paradigm. Image processing and analysis were performed using statistical parametric mapping with a mixed-effects model. Significant differences in neural responses were assessed, examining group, condition, and interaction effects of interest within the context of a general linear model.
TL;DR: Rates of major depression rose markedly over the past decade in the United States, and increases were noted for most sociodemographic subgroups of the population and for black men 18-29 years of age.
Abstract: Objective: The authors examined changes in the prevalence of major depression in the United States between 1991–1992 and 2001–2002 and sought to determine whether changes in depression rates were associated with changes in rates of comorbid substance use disorder. Method: Data were drawn from two large (Ns exceeding 42,000) cross-sectional surveys of representative samples of the U.S. population conducted 10 years apart. Both surveys used face-to-face interviews, the same diagnostic criteria, and consistent assessment instruments. Rates of past-year major depressive episode in the total samples and among subjects with and without co-occurring substance use disorders in major demographic groups were compared. Results: From 1991–1992 to 2001–2002, the prevalence of major depression among U.S. adults increased from 3.33% to 7.06%. Increases were statistically significant for whites, blacks, and Hispanics and for all age groups. For Hispanic men overall and Hispanic women 18–29 years of age, rates increased but not significantly. The hypothesis that increases in the rates of depression could be explained by concomitant increases in cooccurring substance use disorders was supported only for black men 18–29 years of age. Conclusions: Rates of major depression rose markedly over the past decade in the United States, and increases were noted for most sociodemographic subgroups of the population. If the prevalence continues to increase at the rate it did during the past decade, the demand for services will increase dramatically in the coming years.
TL;DR: It is important that individuals entering treatment for substance use disorder or PTSD be assessed for this comorbidity, and the addition of either disorder may present complications that need to be considered for the provision of appropriate treatment.
Abstract: Objective: The aim of the present study was to examine the association between trauma and posttraumatic stress disorder (PTSD) and substance use disorders and to examine the correlates of substance use disorder plus PTSD comorbidity in the Australian general population. Method: Data were collected from a stratified sample of 10,641 participants as part of the Australian National Survey of Mental Health and Well-Being. A modified version of the Composite International Diagnostic Interview was used to determine the presence of DSM-IV anxiety, affective, and substance use disorders and ICD-10 personality disorders. Results: Substance use disorder plus PTSD was experienced by a significant minority of the Australian general population (0.5%). Among those with PTSD, the most common substance use disorder was an alcohol use disorder (24.1%), whereas among those with a substance use disorder, PTSD was most common among individuals with an opioid use disorder (33.2%). Consistent with U.S. clinical literature, ind...
TL;DR: The population impact of patients with severe mental illness on violent crime, estimated by calculating the population-attributable risk, varies by gender and age.
Abstract: Objective: This study aimed to determine the population impact of patients with severe mental illness on violent crime. Method: Sweden possesses high-quality national registers for all hospital admissions and criminal convictions. All individuals discharged from the hospital with ICD diagnoses of schizophrenia and other psychoses (N=98,082) were linked to the crime register to determine the population-attributable risk of patients with severe mental illness to violent crime. The attributable risk was calculated by gender, three age bands (15–24, 25–39, and 40 years and over), and offense type. Results: Over a 13-year period, there were 45 violent crimes committed per 1,000 inhabitants. Of these, 2.4 were attributable to patients with severe mental illness. This corresponds to a populationattributable risk fraction of 5.2%. This attributable risk fraction was higher in women than men across all age bands. In women ages 25–39, it was 14.0%, and in women over 40, it was 19.0%. The attributable risk fractions were lowest in those ages 15–24 (2.3% for male patients and 2.9% for female patients). Conclusions: The population impact of patients with severe mental illness on violent crime, estimated by calculating the population-attributable risk, varies by gender and age. Overall, the populationattributable risk fraction of patients was 5%, suggesting that patients with severe mental illness commit one in 20 violent crimes.
TL;DR: In this article, the authors characterize the rate and pattern of antidepressant discontinuation among adults initiating antidepressant treatment for depression and find that a majority of the patients discontinued antidepressant therapy during the first 30 days (42.4%) and only 27.6% of patients continued antidepressant therapy for more than 90 days.
Abstract: OBJECTIVE: Continuation of antidepressant treatment for depression beyond the first months helps to consolidate treatment response and to reduce the risk of early relapse. The authors sought to characterize the rate and pattern of antidepressant discontinuation among adults initiating antidepressant treatment for depression. METHOD: Data were drawn from the household component of the Medical Expenditure Panel Survey for 1996–2001. Analysis was limited to data for adults age 18 years and older (N=829) who initiated antidepressant treatment for depression and who 1) discontinued treatment during the first 30 days of treatment, 2) completed the first 30 days of treatment and then discontinued treatment during the following 60 days, or 3) continued treatment for more than 90 days after treatment initiation. RESULTS: A majority of the patients discontinued antidepressant therapy during the first 30 days (42.4%). Only 27.6% of the patients continued antidepressant therapy for more than 90 days. Antidepressant d...
TL;DR: Some sources of bias may limit the validity of head-to-head comparison studies of second-generation antipsychotics, and minor modifications may benefit from minor modifications to help avoid bias.
Abstract: OBJECTIVE: In many parts of the world, second-generation antipsychotics have largely replaced typical antipsychotics as the treatment of choice for schizophrenia. Consequently, trials comparing two drugs of this class—so-called head-to-head studies—are gaining in relevance. The authors reviewed results of head-to-head studies of second-generation antipsychotics funded by pharmaceutical companies to determine if a relationship existed between the sponsor of the trial and the drug favored in the study’s overall outcome. METHOD: The authors identified head-to-head comparison studies of second-generation antipsychotics through a MEDLINE search for the period from 1966 to September 2003 and identified additional head-to-head studies from selected conference proceedings for the period from 1999 to February 2004. The abstracts of all studies fully or partly funded by pharmaceutical companies were modified to mask the names and doses of the drugs used in the trial, and two physicians blinded to the study sponsor ...
TL;DR: Of the instruments reviewed, the MacArthur Competence Assessment Tools for Clinical Research and for Treatment have the most empirical support, although other instruments may be equally or better suited to certain situations.
Abstract: Objective: The need to evaluate decisional capacity among patients in treatment settings as well as subjects in clinical research settings has increasingly gained attention. Decisional capacity is generally conceptualized to include not only an understanding of disclosed information but also an appreciation of its significance, the ability to use the information in reasoning, and the ability to express a clear choice. The authors critically reviewed existing measures of decisional capacity for research and treatment. Method: Electronic medical and legal databases were searched for articles published from 1980 to 2004 describing structured assessments of adults’ capacity to consent to clinical treatment or research protocols. The authors identified 23 decisional capacity assessment instruments and evaluated each in terms of format, content, administration features, and psychometric properties. Results: Six instruments focused solely on understanding of disclosed information, and 11 tested for understanding...