bluuebunny/crossref_metadata_2025_split huggingface dataset:
The National Institutes of Health Attention-Deficit/Hyperactivity Disorder Consensus Statement: Implications for Practitioners and Scientists
Authors: Jensen Peter S. 
Published: August 2016

AbstractAlthough the concept of pharmacotherapyfor attention-deficit/hyperactivity disorder (ADHD) was first introduced more than 60 years ago, treatment of this disorder remains more controversial than ever. It is hoped, however, that the recent Consensus Development Conference (CDC) Statement on the diagnosis and treatment of ADHD will not only help answer some of the questions surrounding management of this disorder, but also lend needed scientific weight to debate in this area. While more research in ADHD is needed, the CDC partic ipants pointed to a solid body of evidence showing that careful medication management can result in noticeable improvement in several measures, with little risk of adverse events.
Psychosocial Function and Economic Costs of Obsessive-Compulsive Disorder
Authors: Hollander Eric , Stein Dan J. , Kwon Jee H. , Rowland Clayton , Wong Cheryl M. , Broatch James , Himelein Carol 
Published: August 2016

AbstractThe study presented was conducted to analyze the effects of obsessive-compulsive symptoms on patients' quality of life and the costs incurred by patients and society for the treatment of obsessive-compulsive disorder (OCD). To accomplish this, a detailed 410-item questionnaire of psychosocial function and economic cost was sent to every fourth member of the Obsessive Compulsive Foundation. Of the 2,670 members who received the survey, 701 (26.9%) returned it.Outcome measures included symptomatology, course of illness, impact of illness on psychosocial and other functioning, effects of diagnosis and treatment, and economic consequences. The demographics of this group were similar to those in smaller treatment-seeking clinical samples, but not necessarily to OCD sufferers within the US population as a whole. More than half of the patients reported moderate to severe interference in family relationships, socializing, and ability to study or work, secondary to OCD symptoms. A 10.2-year gap was observed between the onset of symptoms and the first attempt to seek professional help, and a 17.2-year gap was observed between the onset of symptoms and receipt of effective treatment. Specific treatments, such as serotonin reuptake inhibitors and behavior therapy, showed greater symptom improvement, and significantly reduced the total annual fees incurred by OCD patients when compared with nonspecific treatments.Our study results indicate that OCD has a profound effect on psychosocial functioning and quality of life. Large direct costs for OCD and even larger indirect costs due to lost wages and underemployment were found. Greater awareness of OCD among practitioners may result in earlier diagnosis and more appropriate and cost-effective treatments.
Third International Obsessive-Compulsive Disorder Conference: Childhood and OCD
Authors: Riddle Mark A. 
Published: August 2016

AbstractWorkshop 2, “Childhood and OCD,” focused on six areas of research of special relevance to children: phenomenology, age of onset, subtypes, infectious and immune etiologies, psychosocial treatments, and medication treatments. Overarching themes in this session were the relative paucity of research in children and adolescents with obsessive-compulsive disorder (OCD) in comparison to adults and the unique potential for research in children to provide answers to important questions about the etiology, subtypes, pathophysiology, and treatment of OCD.
The Continuing Evolution of Psychiatric Neurosurgery
Authors: Kopell Brian Harris , Rezai Ali R. 
Published: August 2016

AbstractIn this article, the authors examine the growth of the discipline of psychiatric surgery from the earliest lesioning procedures to the neuroaugmentative strategies used today. Special attention is paid to the neural circuitry that underlies psychiatric disorders and how surgical manipulation of these circuits might result in the amelioration of the disease state. Also examined is the effect that the technology curve has had on psychiatric surgery with regard to functional imaging and neurosurgical equipment. Finally, the authors use the current state of psychiatric surgery to speculate on some of the future directions that psychiatric neurosurgical procedures might take.
Is Seasonal Affective Disorder a Disorder of Circadian Rhythms?
Authors: Desan Paul H. , Oren Dan A. 
Published: August 2016

AbstractSeasonal affective disorder (SAD) is a form of depression that starts in the fall and ends in the spring. This article reviews existing theories about the relationship between circadian rhythms and the disorder. Recent research indicates that as with pharmacologic antidepressants, at least 2–4 weeks are needed to demonstrate the effectiveness of bright-light therapy compared to placebo. The response to such treatment is strongest with precisely timed light exposure: treatment is optimal during the morning hours when the circadian systemt is susceptible to phase advance. Such clinical improvement is correlated with the magnitude of the phase shift induced. These observations suggest a model of circadian function in SAD and provide important guidelines for its treatment.
Subject Selection and Characterization in Clinical Trials in Children with Autism
Authors: Scahill Lawrence , Lord Catherine 
Published: August 2016

ABSTRACTThe goal of psychopharmacohgic research in autism is to provide guidance to clinicians and families on the risks and benefits of specific interventions. Careful subject selection and subject characterization in clinical trials are necessary for replication, to inform clinicians about the sample, and to elucidate the type of patients who might benefit from, the treatment. At minimum, subject characterization includes demographic information, diagnosis (autism, Åsperger's syndrome, or pervasive developmental disorder-not otherwise specified), intellectual functioning, adaptive functioning, symptom severity, general behavioral profile, health status, pertinent clinical laboratory measures, height, weight, current treatments, and educational placements. Subject selection, sample size, and choice of the primary outcome measure are closely interrelated and linked to the study hypothesis. The magnitude of expected improvement on the primary outcome measure, which can be expressed by effect size, has direct implications for sample size. Large sample sizes are required to detect small effect sizes. To facilitate interpretation of study results, research reports should provide descriptive characteristics of the sample as well as the mean change and standard deviation on the primary outcome measure data to permit calculation of the effect size.
Barriers to the Management of Patients with Surgically Remediable Intractable Epilepsy
Authors: Swarztrauber Kari 
Published: August 2016

AbstractIt is estimated that only a small proportion of patients with surgically remediable intractable epilepsy receive surgical treatment. There are multiple reasons why this is the case. Patients with intractable epilepsy are sometimes severely disabled and disability can create barriers to getting recommended care. Patients with epilepsy are not well informed about their condition and the available treatments. The incidence of epilepsy is similar in minority populations, and surgically remediable epilepsy frequently presents in adolescence. Nevertheless, these vulnerable populations have specific barriers to receiving epilepsy care, which are often not addressed. In addition, despite scientific evidence for the benefits of the surgical treatment of epilepsy, many healthcare providers do not recommend or adequately discuss surgery with patients. Solutions to these barriers will require interventions that result in informed and capable patients who actively participate in their care and healthcare providers who practice culturally sensitive, recommended care.
A Magnetic Resonance Imaging Study of Regional Cortical Volumes Following Stereotactic Anterior Cingulotomy
Authors: Rauch Scott L. , Makris Nikos , Cosgrove G. Rees , Kim Hackjin , Cassem Edwin H. , Price Bruce H. , Baer Lee , Savage Cary R. , Caviness Verne S. , Jenike Michael A. , Kennedy David N. 
Published: August 2016

AbstractThe purpose of this study was to test the hypothesis that orbitofrontal cortical volume would be reduced following anterior cingulotomy for obsessive-compulsive disorder (OCD). Whole brain cortical parcellation was performed on magnetic resonance imaging (MRI) data from nine patients, before and 9(±6) months following anterior cingulotomy. No significant volumetric reductions were found in the orbitofrontal cortex. Exploratory findings of reduced volume in ventral temporo-fusiform and posterior cingulate regions were consistent with chance differences, in the face of multiple comparisons. Therefore, though the circumscribed lesions of anterior cingulotomy have recently been associated with corresponding volumetric reductions in the caudate nucleus, no comparable volumetric reductions are evident in cortical territories. Taken together, these results are most consistent with a model of cingulo-striatal perturbation as a putative mechanism for the efficacy of this procedure. While limitations in sensitivity may have also contributed to these negative findings, the methods employed have previously proven sufficient to detect cortical volumetric abnormalities in OCD. The current results may reflect a relatively diffuse pattern of cortico-cortical connections involving the neurons at the site of cingulotomy lesions. Future functional neuroimaging studies are warranted to assess possible cortical or subcortical metabolic changes associated with anterior cingulotomy, as well as predictors of treatment response.
The Timing of Neurodevelopmental Abnormality in Schizophrenia: An Integrative Review of the Neuroimaging Literature
Authors: Lencz Todd , Bilder Robert M. , Cornblatt Barbara 
Published: August 2016

AbstractIn this paper we will review recent neuroimaging research in schizophrenia, with an aim to critically evaluate several recent proposals concerning the nature and the timing of the neuroanatomic abnormalities underlying the disorder. Specifically, enlargement of cerebrospinal fluid spaces, deficits in cortical gray matter, and reduced volume of mesiotemporal structures have all been reported in patients in the first episode of schizophrenia, their first-degree relatives, and individuals with schizotypal personality disorder, supporting the possibility that these abnormalities reflect a genetically mediated neurodevelopmental disorder. These findings from the empirical literature will be synthesized from the perspective of dual cytoarchitectonic trends theory of neurodevelopment, as well as in relation to current conceptions of the schizophrenia prodrome. We believe that the evidence shows that sufficient groundwork has been laid to begin longitudinal neuroimaging studies of adolescents at clinical risk for schizophrenia, in order to more definitively determine the pathophysiology of the disorder. Such information could have significant implications in terms of understanding the prediction, treatment, and ultimately the prevention of schizophrenia.
Medical Burden, Cerebrovascular Disease, and Cognitive Impairment in Geriatric Depression: Modeling the Relationships With the CART Analysis
Authors: Lavretsky Helen , Kitchen Christina , Mintz Jim , Kim Moon-Doo , Estanol Laverne , Kumar Anand 
Published: August 2016

ABSTRACTHerein, the background information reflecting roles of medical burden, cerebrovascular disease and risk factors, and cognitive impairment in geriatric depression are reviewed. The authors then propose a nonparametric statistical approach to the data analysis of multiple putative causal variables for late-life depression, the Classification and Regression Tree Analysis. This analysis presents a useful approach to modeling nonlinear relationships and interactions among variables measuring physical and mental health, as well as magnetic resonance imaging and cognitive measures in depressed elderly. This method uncovers the existing interactions among multiple predictor variables, and provide thresholds for each variable, at which its predictive power becomes statistically significant. It presents a “hierarchy” of the predictors in a form of a decision tree by finding the best combination of predictors of an outcome.The authors present two models based on demographic variables, measures of vascular and nonvascular medical burden, neuroimaging indices, the Mini-Mental State Examination score, and neuropsychological test scores of 81 elderly depressed subjects.Cognitive tests of verbal fluency and executive function are identified as the best predictors of depression, followed by the frontal lobe volume and Mini-Mental State Examination. The authors observed that an interaction between frontal lobe volume, total lesion volume, and medical burden was predictive of depression.
The Neuroendocrinology of Posttraumatic Stress Disorder: New Directions
Authors: Rasmusson Ann M. , Vythilingam Meena , Morgan Charles A. 
Published: August 2016

ABSTRACTStudies of the hypothalamic-pituitary-adrenal (HPA ) axis in persons with posttraumatic stress disorder (PTSD) have produced variable findings. This review focuses on the factors likely to have affected the outcome of these studies, including population characteristics and experimental design. Also discussed is a possible role for the adrenal neurosteroid dehydroepiandrosterone (DHEA) as a mediator of HPA axis adaptation to extreme stress and the psychiatric symptoms associated with PTSD. The antiglucocorticoid properties of DHEA may contribute to an upregulation of HPA axis responses as well as mitigate possible deleterious effects of high cortisol levels on the brain in some PTSD subpopulations. The neuromodulatory effects of DHEA and its metabolite DHEAS at γ-arninobutyric acid and N-methyl-D-aspartate receptors in the brain may contribute to psychiatric symptoms associated with PTSD. The possible importance of other neurohormone systems in modulating HPA axis and symptom responses to traumatic stress is also discussed. Understanding the complex interactions of these stress-responsive neurosteroid and peptide systems may help explain the variability in patterns of HPA axis adaptation, brain changes, and psychiatric symptoms observed in PTSD and lead to better targeting of preventive and therapeutic interventions.
Methylphenidate Treatment of Attention-Defit/Hyperactivity Disorder Secondary to Traumatic Brain Injury: A Critical Appraisal of Treatment Studies
Authors: Jin Charles , Schachar Russell 
Published: August 2016

ABSTRACTObjective:Are stimulants effective in treating attention-deficit/hyperactivity disorder secondary to traumatic brain injury (ADHD/TBI)? The authors reviewed and examined the current knowledge on efficacy of stimulant treatment ADHD/TBI.Method:A systematic review of the literature using a quality assessment scale to assess the quality of randomized clinical trials was undertaken. We identified all studies in which stimulants had been administered to individuals with ADHD/TBI. Information was extracted on study characteristics, interventions, and outcomes. A meta-analysis was not performed because of the limited number of studies with strict research design and the heterogeneity of outcome measures. Seven studies involving 118 subjects, 41 of whom were children and adolescents, were identified.Results:Of the seven identified studies, one was a chart review, one used a single-blind, placebo-controlled crossover design, and five were double-blind, placebo-controlled crossovers. These studies used >50 subjective and objective tests to measure behavioral and cognitive outcomes. Methylphenidate (MPH) effects on behavior (hyperactivity, impulsivity) were evident but were not as robust as those typically observed with MPH in primary ADHD. The effect of MPH on cognition was less apparent. More favorable outcome was associated with initiation of treatment soon after head injury, although this factor was not systematically studied, and trials with relativly long durations. Studies with negative MPH response reported neither improvement in behavioral nor cognitive symptoms.Conclusion:There is only modest evidence to support the efficacy of MPH in the treatment of ADHD/TBI. While MPH might still be a promising treatment for ADHD/TBI, there is need for rigorous treatment outcome research among representative samples of ADHD/TBI individuals.
Posttraumatic Stress Disorder, Supported Employment, and Outcomes in People with Severe Mental Illness
Authors: Mueser Kim T. , Essock Susan M. , Haines Michael , Wolfe Rosemarie , Xie Haiyi 
Published: August 2016

AbstractObjective: To evaluate whether posttraumatic stress disorder (PTSD) is related to outcomes in persons with severe mental illness (SMI) participating in a study of vocatinal rehabilitation programsBackground: PTSD is a common comorbid disorder in people with SMI, but it is unknown whether PTSD interferes with the ability to benefit from rehabilitation programs such as supported employment.Methods: The relationships between PTSD and symptoms, health, quality of life, and work outcomes was examined in 176 clients with SMI participating in a 2-year randomized controlled trial of three vocational rehabilitation programs: supported employment based on the Individual Placement and Support model, a psychosocial rehabilitation program based on transitional employment, and standard services.Results: The overall rate of current PTSD in the sample was 16%. Compared with clients without PTSD, clients with PTSD had more severe psychiatric symptoms, worse reported health, lower self-esteem, and lower subjective quality of life. Clients with PTSD who participated in the Individual Placement and Support model (the most effective vocational model of the three studied) also had worse employment outcomes over the 2-year study period than clients without PTSD, with lower rates of compeitive work, fewer hours worked, and fewer wages earned. Employment outcomes did not differ between clients with PTSD versus without PTSD in the other two vocational rehabilitation approaches.Conclusion: The findings suggest that PTSD may contribute to worse work outcomes in clients participating in supported employment programs. Effective treatment of these clients with PTSD may improve their ability to benefit from supported employment.
Prediction of Outcome from the Dartmouth Assertive Community Treatment Fidelity Scale
Authors: Bond Gary R. , Salyers Michelle P. 
Published: August 2016

AbstractBackground: Assertive community treatment (ACT) is an intensive and comprehensive treatment for clients with severe mental illness (SMI) who do not readily benefit from clinic-based services. Monitoring the implementation of such programs is critical, because better-implemented programs have been found to be effective in improving client outcomes.Objective: We tested the hypothesis that fidelity to the ACT model would be positively correlated with improved client outcomes, as measured by reduction in psychiatric hospital use.Methods: A scale measuring fidelity of program implementation, the Dartmouth ACT Scale, was examined in 10 newly formed ACT teams. Using the team as the unit of measure, the mean reduction in state hospital days for a 1-year period before and after program admission was calculated. Mean effect size in reduction in hospital days was used as the outcome measure in a correlational design.Results: Pre/post comparisons showed a 43% reduction in hospital days for 317 clients (t=8.61, P<.001). The Pearson correlation between DACTS fidelity and reduction of state hospitaldays was .49, P=.08, one-tailed.Conclusion: Several possible reasons are offered for why the study hypothesis was not confirmed. However, even if predictive validity of the Dartmouth ACT Scale is limited, it continues to be a useful tool for program monitoring and for providing corrective feedback.
Development of Subtype Selective GABAAModulators
Authors: Dawson Gerard R. , Collinson Neil , Atack John R. 
Published: August 2016

AbstractDrugs modulating γ-aminobutyric acid (GABA) transmission via the benzodiazepine (BZ) site on the γ-aminobutyric acid type A (GABAA) receptor have been in widespread use for more than 40 years to treat anxiety, epilepsy, and sleep disorders. These drugs have been shown to be safe, well tolerated, and effective although the mechanism by they produce a myriad of pharmacologic effects remains elusive. In recent years it has been discovered that, although the GABAAreceptor is widely distributed in the brain, the substructure and composition of the receptor differs from between brain regions. Termed “GABAAreceptor subtypes” their discovery leads to speculation that different subtypes may mediate specific effects of BZs such as anxiety or sedation. The phenotypic analysis of transgenic knock-in and knock-out mice in which particular GABAAreceptors were rendered insensitive to the effects of BZ while others were unaffected confirmed this speculation. Subsequently, subtype-specific GABAAligands were developed that, for example, retained the anxiolytic effects of BZs but were devoid of their sedative effects. Therefore, it may be possible to develop effective anxiolytic compounds that have a much reduced side-effect profile compared with existing drugs.
Issues in the Psychopharmacologic Assessment and Treatment of the Orthodox Jewish Patient
Authors: Feinberg S. Shalom 
Published: August 2016

AbstractAs with members of other cultural and religious groups, patients within the Orthodox Jewish community present with their own distinct clinical psychiatric issues related to their unique beliefs and practices. This article reviews the existing literature and anecdotal experience on the psychopharmacologic assessment and treatment of Orthodox Jewish patients. Specific aspects examined include this group's perceived intense stigma in receiving treatment, the priority this community places on cognitive functioning, and how the influence of Jewish laws on marriage and sexual practices impacts one's treatment decisions. The relevance of Jewish dietary laws, the Sabbath, and the community's interest in alternative treatments are also discussed. The limited ethno-psychopharmacology research related to Orthodox Jewish psychiatric patients is reviewed. We conclude that understanding issues such as these is critical if one is going to work within this cultural system in order to successfully address their mental health issues. However, the dearth of controlled research in this community needs to be addressed to provide more effective treatment.
Gabapentin and Lamotrigine: Novel Treatments for Mood and Anxiety Disorders
Authors: Pollack Mark H. , Scott Erin L. 
Published: August 2016

AbstractClinical experience and systematic inquiry demonstrate that many patients with mood and anxiety disorders remain symptomatic despite standard interventions. These observations have prompted the search for alternative pharmacotherapeutic treatment options. Anticonvulsants, including valproic acid and carbamazepine, have demonstrated benefit for a number of psychiatric conditions. Recently, clinical and research attention has focused on the use of the new anticonvulsants gabapentin and lamotrigine as alternatives to standard pharmacotherapies for the treatment of mood and anxiety disorders. This paper reviews the experience to date with these agents in the treatment of psychiatric conditions. Gabapentin demonstrates promise for the treatment of panic and generalized anxiety, while both gabapentin and lamotrigine appear useful as mood stabilizers in the treatment of bipolar disorder.