bluuebunny/crossref_metadata_2025_split huggingface dataset:
Quantitative DT-MRI Investigations of the Human Cingulum Bundle
Authors: Makris Nikos , Pandya Deepak N. , Normandin Joseph J. , Papadimitriou George M. , Rauch Scott L. , Caviness Verne S. , Kennedy David N. 
Published: August 2016

ABSTRACTWhite matter fiber pathways are key structural components of the brain and its functional organization. The limbic system carries a great deal of its anatomic connectivity via the cingulum bundle. By allowing the in vivo delineation of the stem of the major fiber pathway systems, diffusion tensor magnetic resonance imaging has opened a new window into the detailed structure of the white matter in health and disease. Topographic, biophysical, and volumetric information about fiber tracts will provide a more complete understanding of the brain. By appreciating its interconnections, the precise anatomical knowledge of the cingulum bundle will improve our understanding of the limbic system and may enable improvements in the assessment and treatment of neuropsychiatric disorders. In this study, the stem of the cingulum bundle was investigated and defined in terms of its trajectory, anisotropy, and volume, in four normal human subjects, using diffusion tensor imaging.
How Well Does Cognitive-Behavioral Therapy Treat Symptoms of Complex PTSD? An Examination of Child Sexual Abuse Survivors Within A Clinical Trial
Authors: Resick Patricia A. , Nishith Pallavi , Griffin Michael G. 
Published: August 2016

ABSTRACTAre brief cognitive-behavioral treatments for posttraumatic stress disorder (PTSD) also effective for the wider range of symptoms conceptualized as complex PTSD? Female rape victims, most of whom had extensive histories of trauma, were randomly assigned to cognitive-processing therapy, prolonged exposure, or a delayed-treatment waiting-list condition. After determining that both types of treatment were equally effective for treating complex PTSD symptoms, we divided the sample of 121 participants into two groups depending upon whether they had a history of child sexual abuse. Both groups improved significantly over the course of treatment with regard to PTSD, depression, and the symptoms of complex PTSD as measured by the Trauma Symptom Inventory. Improvements were maintained for at least 9 months. Although there were group main effects on the Self and Trauma factors, there were no differences between the two groups at posttreatment once pretreatment scores were covaried. These findings indicate that cognitive-behavioral therapies are effective for patients with complex trauma histories and symptoms patterns.
Cognitive-Behavioral Therapy for Panic Disorder: A Review of Treatment Elements, Strategies, and Outcomes
Authors: Rayburn Nadine Recker , Otto Michael W. 
Published: August 2016

ABSTRACTThis article provides an overview of cognitive-behavioral therapy (CBT) for panic disorder. CBT is currently considered a first-line treatment for panic disorder. It offers benefit after short-term intervention, typically consisting of 12–15 sessions conducted in either an individual or a group format. The treatment focuses on the elimination of the patterns that underlie and perpetuate the disorder. Through CBT, patients learn about the nature of the disorder and acquire a set of strategies that counter the fears of panic attacks themselves, and break the recurring cycle of anticipatory anxiety, panic, and agoraphobic avoidance. The collaborative format of treatment, and a focus on elimination of core fears may be factors in enhancing longer-term outcome. In this article, we review the efficacy of CBT as a first-line treatment, a strategy for medication nonresponders, a replacement strategy for patients who wish to discontinue pharmacotherapy, and a potential preventive strategy for at-risk individuals. We also discuss some of the complex issues involved with combination-treatment strategies.
Topiramate in the Preventive Treatment of Episodic Migraine: A Combined Analysis From Pilot, Double-Blind, Placebo-Controlled Trials
Authors: Edwards Keith R. , Potter Doreen L. , Wu Shu-Chen , Kamin Marc , Hulihan Joseph 
Published: August 2016

ABSTRACTThe safety and efficacy of medications for preventive treatment of migraine is the subject of current concern and investigation in health care. Two single-center, double-blind, placebo-controlled studies were conducted to evaluate the efficacy and safety of topiramate for migraine prophylaxis. Seventy patients with a diagnosis of migraine were randomly assigned to topiramate-treated and placebo groups. The studies consisted of a 4-week baseline phase, a 6—8 week titration, and 8–12 weeks of maintenance. Topiramate was titrated from an initial dose of 25 mg/day to a target dose of 100 mg BID. The primary efficacy measure, the mean 28-day migraine frequency, was lower in topiramate-treated patients than in the placebo group (3.2 versus 3.8, P=.001). Similarly, topiramate treatment resulted in a significantly greater mean reduction in migraine frequency than did placebo (1.55 versus 0.47, P=.001) and a significantly higher responder rate (35.3% versus 8.3%, P=.008). Paresthesia was the most common side effect reported with topiramate treatment. Other topiramate-associated adverse events included altered taste, memory impairment, diarrhea, and appetite suppression/weight loss. The rates of discontinuation were similar for the topiramate group (n=10) and the placebo group (n=8). These results suggest that topiramate is effective and well tolerated in the preventive treatment of migraine headaches.
Restless Legs Syndrome and Drug-Induced Akathisia in Headache Patients
Authors: Young William B. , Piovesan Elcio J. , Biglan Kevin M. 
Published: August 2016

ABSTRACTThe purpose of the research presented in this article was to characterize restless legs syndrome (RLS) in a headache population and correlate treatment induced risks with dopamine blockers. Fifty patients with severe headache who were admitted to an outpatient infusion center were enrolled. The diagnosis of RLS was established using the International Restless Legs Syndrome Study Group criteria. Patients were screened for baseline akathisia using an akathisia scale and reexamined for akathisia after receiving intravenous infusion with one of four dopamine receptor blocking agents as treatment for their headaches. A change from baseline to post-infusion assessment of two points on a global assessment of akathisia was considered positive for drug-induced akathisia. Our results indicated that 41 (82%) of patients had episodic or chronic migraine. The rest had new daily persistent headache, cluster, or posttraumatic headache. Seventeen subjects (34%) met the criteria for RLS. Nineteen (38%) of the subjects developed drug-induced akathisia. Thirteen (76.5%) of the subjects with RLS developed akathisia compared with only 6 of the 33 (18.2%) without RLS (P<.0001). Finally, we concluded that headache patients with RLS are at a greatly increased risk of developing drug-induced akathisia when treated with intravenous dopamine receptor blocking agents.
Putative Common Pathways in Therapeutic Brain Stimulation for Affective Disorders
Authors: Bolwig Tom G. 
Published: August 2016

ABSTRACTBrain stimulation methods in the treatment of affective disorder are electroconvulsive therapy (ECT), transcranial magnetic stimulation (TMS), vagus nerve stimulation (VNS), and deep brain stimulation (DBS). Clinically, ECT is considered the strongest remedy in the treatment of severe depression, especially depression with psychotic features, and in the elderly. TMS, despite positive reports, is somewhat more controversial. VNS has, so far, only been used in treatment-resistant depression with limited results. DBS may be of potential use in rare cases of treatment-resistant cases of affective disorder. This article highlights the similarities and differences between the four stimulation methods. The main difference is the seizures necessary in ECT. A stronger involvement of the hippocampus following experimental seizures compared with effects in that region induced by TMS and VNS might explain the consistent findings of the superiority of ECT in the most severe cases of affective disorder.
Norepinephrine Function in Personality Disorder: Plasma Free MHPG Correlates Inversely With Life History of Aggression
Authors: Coccaro Emil F. , Lee Royce , McCloskey Michael 
Published: August 2016

ABSTRACTObjective:Clinical and pre-clinical data suggest the possibility of a facilitory role for norepinephrine (NE) in impulsive-aggressive behavior. While clinical studies have focused on putative central measures of NE activity, few studies have been published using peripheral measures. In this study, the relationship between plasma free NE metabolite, plasma free 3-methoxy-4-hydroxyphenylglycol (pMHPG), and impulsive aggression was explored in subjects with personality disorder.Methods:Subjects were 30 male subjects with personality disorder in whom basal plasma free MHPG concentrations were obtained. Aggression was assessed using the Life History of Aggression (LHA) assessment and the Buss-Durkee Aggression scales; impulsivity was assessed using the Barratt Impulsiveness and the Eysenck Personality Questionnaire Impulsivity scales.Results:A significant inverse correlation was found between LHA-Aggression and pMHPG in these subjects. Correlations with other behavioral measures were not statistically significant. pMHPG was significantly lower among subjects with borderline personality disorder but not significantly lower after controlling for LHA-Aggression scores.Conclusion:These data suggest that pMHPG is inversely correlated with life history of aggression in subjects with personality disorder and that central and/or peripheral NE may play a role in modulating aggressive behavior in these subjects.
The Role of Childhood Trauma in Differences in Affective Instability in Those With Personality Disorders
Authors: Goodman Marianne , Weiss Daniel S. , Koenigsberg Harold , Kotlyarevsky Vladimir , New Antonia S. , Mitropoulou Vivian , Silverman Jeremy M. , O'Flynn Karen , Siever Larry J. 
Published: August 2016

ABSTRACTBackground:This study examined the relationship of self-reported histories of childhood trauma to measures of affective instability in a sample of unmedicated outpatients with various personality disorders (n=174).Methods:Childhood trauma was measured by the Childhood Trauma Questionnaire. Affective instability comprises at least two dimensions: affective lability, assessed using the Affective Lability Scale, and affective intensity, assessed using the Affective Intensity Measure.Results:A history of emotional abuse was the only trauma variable that significantly correlated with the affect measures in the total sample (r=.21–.30). More fine-grained analyses revealed that the relationship of emotional abuse and affective instability measures varied as a function of both gender and personality disorder type. In subjects with borderline personality disorder, the correlation for emotional abuse was greatly attenuated for both Affective Lability Scale (r=.10) and Affective Intensity Measure (r=.15) total scores.Conclusion:This suggests that nontrauma-related factors may be more predominant in affective dyscontrol in individuals with borderline personality disorder.
The Impact of Comorbidity on the Management of Pathological Gambling
Authors: Dell'Osso Bernardo , Hollander Eric 
Published: August 2016

AbstractA 30-year-old woman with severe pathological gambling and cyclothymia presented to our program with no previous history of pharmacologic or psychotherapeutic treatment. Pathological gambling is an impulse-control disorder not otherwise specified (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) in which comorbidity is common, particularly with substance abuse, obsessive-compulsive disorder and mood disorders. As described in this case, pathological gamblers with bipolar comorbidity may be effectively treated with mood stabilizers such as lithium. After receiving 10 weeks of lithium treatment, the patient showed improvement in both gambling behavior and affective instability. The identification of specific subtypes among patients with pathological gambling may be relevant to the choice of pharmacologic treatment.
Anxiety and Schizophrenia: The Interaction of Subtypes of Anxiety and Psychotic Symptoms
Authors: Huppert Jonathan D. , Smith Thomas E. 
Published: August 2016

AbstractObjectiveTo examine the interaction of specific anxiety subtypes and psychosis.IntroductionAccumulating evidence suggests that anxiety and its disorders play a significant role in patients with schizophrenia, but few studies have examined multiple types of anxiety and how they interact with different symptoms of schizophrenia.MethodsThirty-two patients diagnosed with schizophrenia or schizoaffective disorder were assessed through self-report measures and interviewer rating scales to examine symptoms of psychosis and anxiety.ResultsA majority of patients (62%) were diagnosed with at least one comorbid anxiety disorder. Obsessive-compulsive symptoms and social anxiety symptoms were related to positive symptoms, bizarre behavior, and quality of life (QOL). Furthermore, panic and social anxiety were related to suspiciousness/paranoia. No consistent relationship was found with negative symptoms. Finally, severity of anxiety disorders was negatively correlated with the severity of formal thought disorder.DiscussionThis is one of the first studies to simultaneously examine the interrelationships of different types of anxiety symptoms and psychotic symptoms. The present findings are consistent with the studies that have suggested relationships between panic and paranoia and comorbid anxiety disorders and impaired QOL. These data suggest that further research into anxiety in schizophrenia, including the cognitive and neurobiological correlates, may help elucidate the mechanisms involved in the manifestation of these psychopathologiesConclusionAnxiety disorders are common in patients with schizophrenia. The presence of such symptoms may influence the presence of core psychotic symptoms and QOL. More information is needed in terms of the relationship between treatment of these symptoms and changes in psychotic symptoms and/or relapse prevention.
Pain Perception in Irritable Bowel Syndrome
Authors: Tillisch Kirsten , Mayer Emeran A. 
Published: August 2016

ABSTRACTIrritable bowel syndrome (IBS) is a functional gastrointestinal disorder characterized by chronic abdominal discomfort or pain in the absence of detectable organic disease. IBS is common and is associated with a significant impairment in health-related quality of life. Enhanced perception of visceral stimuli (“visceral hypersensitivity”) appears to be an important patho-physiological mechanism. Early IBS studies using functional brain imaging techniques suggest an alteration in central pain modulation circuits, rather than an increased sensitivity of peripheral visceral pain pathways. The frequent comorbidity with psychiatric disorders suggests the possibility of shared pathophysiological mechanisms and etiologic factors.
An Integrated Analysis of the Efficacy of Desvenlafaxine Compared with Placebo in Patients with Major Depressive Disorder
Authors: Thase Michael E. , Kornstein Susan G. , Germain Jean-Michel , Jiang Qin , Guico-Pabia Christine , Ninan Philip T. 
Published: August 2016

ABSTRACTIntroduction: To assess the efficacy of desvenlafaxine (administered as desvenlafaxine succinate) in outpatients with major depressive disorder.Methods: A meta-analysis of individual patient data was performed on the complete set of registration trials (nine randomized, double-blind, placebo-controlled 8-week studies) of desvenlafaxine. Patients received fixed (50, 100, 200, or 400 mg/day; n = 1,342) or flexible doses (100–400 mg/day; n = 463) of desvenlafaxine or placebo (n = 1,108). The primary efficacy variable was the 17-item Hamilton Rating Scale for Depression (HAM-D17); the primary intent to treat analyses used the last-observation-carried-forward method.Results: Significantly greater improvement with desvenlafaxine versus placebo on the HAM-D17 total score was observed for the full data set (difference in adjusted means: −1.9; P<.001), each fixed-dose group (all P<.001), and the flexible-dose group (P=.024). Overall rates of HAM-D17 response (≥50% decrease from baseline score: 53% vs 41%) and remission (HAM-D17 ≤7: 32% vs 23%) were significantly greater for desvenlafaxine versus placebo (all P<.001). Discontinuation rates due to adverse events increased with dose (4% to 18%; placebo: 3%).Conclusion: Desvenlafaxine demonstrated short-term efficacy for treating major depressive disorder across the range of doses studied. No evidence of greater efficacy was observed with doses >50 mg/day; a strong dose-response effect on tolerability was observed.
Extended Release Quetiapine Fumarate Monotherapy for Major Depressive Disorder: Results of a Double-Blind, Randomized, Placebo-Controlled Study
Authors: Weisler Richard , Joyce J. Mark , McGill Lora , Lazarus Arthur , Szamosi Johan , Eriksson Hans ,   Moonstone Study Group
Published: August 2016

AbstractIntroduction: Once-daily extended release quetiapine fumarate (quetiapine XR) monotherapy was evaluated in major depressive disorder (MDD).Method: This was an 8-week (6-week randomized-phase; 2-week drug-discontinuation/tapering phase), double-blind, parallel-group, placebo-controlled study. The primary outcome measure was Montgomery-Åsberg Depression Rating Scale (MADRS) total score randomization-to-Week 6 change. Other assessments included the Hamilton Rating Scale for Depression, the Hamilton Rating Scale for Anxiety, and adverse events (AEs).Results: 723 patients were randomized: 182, 178, 179, and 184 to quetiapine XR 50, 150, 300 mg/day, and placebo, respectively. At Week 6, significant reductions occurred in MADRS score with quetiapine XR 50 mg/day (−13.56; P<.05), 150 mg/day (−14.50; P<.01) and 300 mg/day (−14.18; P<.01) versus placebo (−11.07); at Day 4, reductions for quetiapine XR (titrated to 50 or 150 mg/day according to dose group) versus placebo (−2.9) were: −4.7 (P<.01), −5.2 (P<.001), and −5.1 (P<.001), respectively. At endpoint, MADRS response (≥50% reduction in score) was 42.7% (P<.01), 51.2% (P<.001), and 44.9% (P≤.001) for quetiapine XR 50, 150, and 300 mg/day, respectively; 30.3% for placebo. Overall, quetiapine XR 150 mg/day provided consistently more positive secondary efficacy results than 50 mg/day and 300 mg/day versus placebo. The most common AEs in quetiapine XR-treated patients were dry mouth, sedation, somnolence, headache, and dizziness.Conclusion: In patients with MDD, quetiapine XR monotherapy (50/150/300 mg/day) is effective in reducing depressive symptoms, with improvement from Day 4 onwards. Safety and tolerability were consistent with the known profile of quetiapine.
Effects of a Tyramine-Enriched Meal on Blood Pressure Response in Healthy Male Volunteers Treated with Selegiline Transdermal System 6 mg/24 Hour
Authors: Blob Lawrence F. , Sharoky Melvin , Campbell Bryan J. , Kemper Eva M. , Gilmor Michelle , VanDenBerg Chad M. , Azzaro Albert J. 
Published: August 2016

ABSTRACTBackground:Monoamine oxidase inhibitors are well recognized as effective antidepressant agents but are rarely used due, in part, to the risk of hypertensive crisis following the ingestion of foods high in tyramine (“cheese reaction”). A selegiline transdermal system (STS) was developed to provide antidepressant concentrations of selegiline in the brain, while preserving the gastrointestinal monoamine oxidase A (MAO-A) barrier. The present study was conducted to determine the effect of the STS 6 mg/24 hour on cardiovascular safety following the ingestion of ∼400 mg of tyramine consumed as a component of aged cheeses.Methods:In this open-label, single-center phase I study, cardiovascular vital signs were recorded following tyramine challenges during placebo and STS 6 mg/24 hr treatment. Subjects were observed for clinical signs and symptoms of a pressor response and/or potential hypertensive crisis during and following the challenges.Results:Ingestion of tyramine-enriched meals following 13 consecutive days of treatment with the STS 6 mg/24 hr (pharmacokinetic steady-state) produced no clinically significant changes in cardiovascular vital signs in 12 healthy adult male subjects. No evidence of a tyramine pressor effect on systolic blood pressure or evidence of hypertensive crisis occurred during the STS treatment.Conclusion:These results suggest that STS 6 mg/24 hr may be administered without concern for dietary tyramine consumption.
Hyperperfusion Syndromes: Insight into the Pathophysiology and Treatment of Hypertensive Encephalopathy
Authors: Gardner Craig J. , Lee Kiwon 
Published: August 2016

ABSTRACTHypertensive encephalopathy is one of the manifestations of a hypertensive crisis. It is not the absolute value of the blood pressure that causes the encephalopathy, rather the presence of an abrupt rise in pressure. In terms of clinical and radiographic findings, there are many similarities among a group of entities, including hypertensive encephalopathy, eclampsia, and immunosuppressant neurotoxicity. Hyperperfusion syndromes may represent these clinical disease states that may share the same pathophysiology. Magnetic resonance imaging fluid attenuated inversion recovery sequences have recognized the prominent cortical involvement of the disease that had been previously missed on computed tomography. Studies have found cortical involvement in 94% of their patients, particularly in mild cases. Animal models demonstrate endothelial damage and enhanced pinocytosis in the cortex as reasons why edema may begin in that region of the brain. Patients diagnosed with hypertensive encephalopathy should be diagnosed and treated promptly in order to avoid further neurological complications. The mean arterial pressure should be lowered by 20% to 25% within the first hour of patient presentation, followed by further gradual reduction in blood pressure over the following 24 hours. Hypertensive emergency in acute ischemic stroke should be managed with more caution. According to the 2003 American Stroke Association treatment guidelines, for patients with ischemic stroke not eligible for thrombolytic therapy, target blood pressures are a diastolic blood pressure <120 mmHg and systolic blood pressure <220 mmHg. The systolic pressure must be <185 mmHg and diastolic pressure <110 mmHg at all times if eligible for thrombolytic therapy.
Alzheimer's Disease:Progress in the Development of Anti-amyloid Disease-Modifying Therapies
Authors: Christensen Daniel D. 
Published: August 2016

ABSTRACTThe amyloid hypothesis—the leading mechanistic theory of Alzheimer's disease—states that an imbalance in production or clearance of amyloid β (Aβ) results in accumulation of Aβ and triggers a cascade of events leading to neurodegeneration and dementia. The number of persons with Alzheimer's disease is expected to triple by mid-century. If steps are not taken to delay the onset or slow the progression of Alzheimer's disease, the economic and personal tolls will be immense. Different classes of potentially disease-modifying treatments that interrupt early pathological events (ie, decreasing production or aggregation of Aβ or increasing its clearance) and potentially prevent downstream events are in phase II or III clinical studies. These include immunotherapies; secretase inhibitors; selective Aβ42-lowering agents; statins; anti-Aβ aggregation agents; peroxisome proliferator-activated receptor-gamma agonists; and others. Safety and serious adverse events have been a concern with immunotherapy and γ-secretase inhibitors, though both continue in clinical trials. Anti-amyloid disease-modifying drugs that seem promising and have reached phase III clinical trials include those that selectively target Aβ42production (eg, tarenflurbil), enhance the activity of α-secretase (eg, statins), and block Aβ aggregation (eg, transiposate).