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Who would like a monster like me to be alive? Obsessive compulsive disorder or pedophilia in a patient with high functioning autism spectrum disorder
- C. Pastor Jordá, A. Gu, A. Kelly, D. Mckessy, S. Shear
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- Journal:
- European Psychiatry / Volume 64 / Issue S1 / April 2021
- Published online by Cambridge University Press:
- 13 August 2021, p. S233
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Introduction
Case of a 17yo patient with high functioning ASD and OCD with obsessions about being a pedophile, with suicidal ideation and self-harming behaviors. He was followed in outpatient care for one year since his first contact with Mental Health, following an inpatient admission for suicidal ideation.
ObjectivesDifferential diagnosis between OCD, ASD and possible pedophilia. Learn about different levels of care involved, and other possibilities. Therapy resources used.
MethodsDescription of the case report: description of initial and final Mental Status Exam Differential Diagnosis: ASD vs OCD vs Pedophilia vs Depressive Disorder Children’s Yale-Brown Obsessive Compulsive Scale Therapy: family based therapy, and Exposure response prevention therapy.
ResultsIntrusive images, and reassurance seeking, helped with OCD diagnosis. ASD made symptoms harder to manage with SSRIs alone, which drove to add Aripiprazol at low doses in outpatient care. CY-BOCS showed obsessions other than doubts about being a pedophile. He participated in Exposure response prevention therapy with response, especially when antipsychotic medication was added. Family based therapy worked with his parents in not providing excessive reassurance, and with the patient in gaining insight about his OCD. Decreased anxiety, decreased self-deprecation and no new suicidal thoughts Functionality of the patient in the community improved, with possibility of going college next year.
ConclusionsRecommendation of good assessment of sexuality in ASD population Importance of individual and family therapy for OCD and specially when there is poor judgement and insight in the patient. Importance of combined treatment: pharmacology + therapy
Conflict of interestAlicia Koplowitz Foundation
Optimizing the clinical utility of four proposed criteria for a persistent and impairing grief disorder by emphasizing core, rather than associated symptoms
- Stephen J. Cozza, M. Katherine Shear, Charles F. Reynolds III, Joscelyn E. Fisher, Jing Zhou, Andreas Maercker, Naomi Simon, Christine Mauro, Natalia Skritskaya, Sidney Zisook, Barry Lebowitz, Colleen Gribbin Bloom, Carol S. Fullerton, Robert J. Ursano
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- Journal:
- Psychological Medicine / Volume 50 / Issue 3 / February 2020
- Published online by Cambridge University Press:
- 04 March 2019, pp. 438-445
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Background
Distinguishing a disorder of persistent and impairing grief from normative grief allows clinicians to identify this often undetected and disabling condition. As four diagnostic criteria sets for a grief disorder have been proposed, their similarities and differences need to be elucidated.
MethodsParticipants were family members bereaved by US military service death (N = 1732). We conducted analyses to assess the accuracy of each criteria set in identifying threshold cases (participants who endorsed baseline Inventory of Complicated Grief ⩾30 and Work and Social Adjustment Scale ⩾20) and excluding those below this threshold. We also calculated agreement among criteria sets by varying numbers of required associated symptoms.
ResultsAll four criteria sets accurately excluded participants below our identified clinical threshold (i.e. correctly excluding 86–96% of those subthreshold), but they varied in identification of threshold cases (i.e. correctly identifying 47–82%). When the number of associated symptoms was held constant, criteria sets performed similarly. Accurate case identification was optimized when one or two associated symptoms were required. When employing optimized symptom numbers, pairwise agreements among criteria became correspondingly ‘very good’ (κ = 0.86–0.96).
ConclusionsThe four proposed criteria sets describe a similar condition of persistent and impairing grief, but differ primarily in criteria restrictiveness. Diagnostic guidance for prolonged grief disorder in International Classification of Diseases, 11th Edition (ICD-11) functions well, whereas the criteria put forth in Section III of Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) are unnecessarily restrictive.
Performance characteristics and clinical utility of diagnostic criteria proposals in bereaved treatment-seeking patients
- C. Mauro, M. K. Shear, C. F. Reynolds III, N. M. Simon, S. Zisook, N. Skritskaya, Y. Wang, B. Lebowitz, N. Duan, M. B. First, A. Ghesquiere, C. Gribbin, K. Glickman
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- Journal:
- Psychological Medicine / Volume 47 / Issue 4 / March 2017
- Published online by Cambridge University Press:
- 08 November 2016, pp. 608-615
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Background
Persistent complex bereavement disorder (PCBD) is a protracted form of grief included in DSM Section 3 indicating a need for more research. Two other criteria sets [prolonged grief disorder (PGD) and complicated grief (CG) disorder] are also currently in use by researchers. This study evaluates rates of diagnosis of each proposed criteria set in a clinical sample of bereaved individuals participating in clinical research.
MethodTwo groups in which persistent grief was judged to be present or absent completed an assessment instrument that included items needed to diagnose PCBD as well as PGD and CG. One group included grief treatment-seeking participants in our multicenter National Institute of Mental Health (NIMH)-sponsored study who scored ⩾30 on the Inventory of Complicated Grief (ICG) and the other comprised bereaved adults enrolled in clinical research studies who scored <20 on the ICG. Rates of diagnosis were determined for proposed PCBD, PGD and CG criteria.
ResultsPCBD criteria diagnosed 70 [95% confidence interval (CI) 64.2–75.8] % of the grief treatment-seeking group, PGD criteria identified 59.6 (95% CI 53.4–65.8) % of these individuals and CG criteria identified 99.6 (95% CI 98.8–100.0) %. None of the three proposed criteria identified any cases in the bereaved comparison group.
ConclusionsBoth proposed DSM-5 criteria for PCBD and criteria for PGD appear to be too restrictive as they failed to identify substantial numbers of treatment-seeking individuals with clinically significant levels of grief-related distress and impairment. Use of CG criteria or a similar algorithm appears to be warranted.
Depression in the Elderly: The Unique Features Related to Diagnosis and Treatment
- Katherine Shear, David L. Ginsberg, Steven P. Roose, Eric J. Lenze, George S. Alexopoulos, Eric Hollander
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- Journal:
- CNS Spectrums / Volume 10 / Issue S8 / 2005
- Published online by Cambridge University Press:
- 07 November 2014, pp. 1-41
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Depression affects 6.5 million of the 35 million Americans ≥65 years of age. While depression usually begins earlier in life and recurs periodically, it can present for the first time in people 80–90 years of age as well. Depression throughout the lifespan has a genetic/biological component but is also very much affected by social environmental factors. As people age, demographic factors, social support, and negative life events remain important to overall mental health, while physical illness and disability begin to take on a much more prominent role. Depression in the elderly is associated with impairment, dependency, disability, and significant distress for the individual and their family. This population is likely to present with concomitant cognitive dysfunction and medical illness, which can complicate the identification and treatment of psychiatric conditions. Bereavement is almost universal in late life and is sometimes a deterrent to appropriate diagnosis and treatment of depression. Physical frailty and diminishing social resources further complicate the treatment of depression in the elderly. Elderly individuals respond well to standard pharmacotherapy and psychotherapy treatments for depression. However, due to the high rate of relapse of depression in this population, continuous treatment is often warranted. This monograph will review depression in the elderly in the context of social disruptions, such as bereavement, caregiver strain, interpersonal conflict, role transitions, and social isolation; late-onset vascular depression and cognitive impairment; and physical illness including disability.
Contributors
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- By Michael H. Allen, Leora Amira, Victoria Arango, David W. Ayer, Helene Bach, Christopher R. Bailey, Ross J. Baldessarini, Kelsey Ball, Alan L. Berman, Marian E. Betz, Emily A. Biggs, R. Warwick Blood, Kathleen T. Brady, David A. Brent, Jeffrey A. Bridge, Gregory K. Brown, Anat Brunstein Klomek, A. Jacqueline Buchanan, Michelle J. Chandley, Tim Coffey, Jessica Coker, Yeates Conwell, Scott J. Crow, Collin L. Davidson, Yogesh Dwivedi, Stacey Espaillat, Jan Fawcett, Steven J. Garlow, Robert D. Gibbons, Catherine R. Glenn, Deborah Goebert, Erica Goldstein, Tina R. Goldstein, Madelyn S. Gould, Kelly L. Green, Alison M. Greene, Philip D. Harvey, Robert M. A. Hirschfeld, Donna Holland Barnes, Andres M. Kanner, Gary J. Kennedy, Stephen H. Koslow, Benoit Labonté, Alison M. Lake, William B. Lawson, Steve Leifman, Adam Lesser, Timothy W. Lineberry, Amanda L. McMillan, Herbert Y. Meltzer, Michael Craig Miller, Michael J. Miller, James A. Naifeh, Katharine J. Nelson, Charles B. Nemeroff, Alexander Neumeister, Matthew K. Nock, Jennifer H. Olson-Madden, Gregory A. Ordway, Michael W. Otto, Ghanshyam N. Pandey, Giampaolo Perna, Jane Pirkis, Kelly Posner, Anne Rohs, Pedro Ruiz, Molly Ryan, Alan F. Schatzberg, S. Charles Schulz, M. Katherine Shear, Morton M. Silverman, April R. Smith, Marcus Sokolowski, Barbara Stanley, Zachary N. Stowe, Sarah A. Struthers, Leonardo Tondo, Gustavo Turecki, Robert J. Ursano, Kimberly Van Orden, Anne C. Ward, Danuta Wasserman, Jerzy Wasserman, Melinda K. Westlund, Tracy K. Witte, Kseniya Yershova, Alexandra Zagoloff, Sidney Zisook
- Edited by Stephen H. Koslow, University of Miami, Pedro Ruiz, University of Miami, Charles B. Nemeroff, University of Miami
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- Book:
- A Concise Guide to Understanding Suicide
- Published online:
- 05 October 2014
- Print publication:
- 18 September 2014, pp vii-x
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Iowa Gambling Task Performance in Overweight Children and Adolescents at Risk for Obstructive Sleep Apnea
- Kelly A. McNally, Paula K. Shear, Sarah Tlustos, Raouf. S. Amin, Dean W. Beebe
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- Journal:
- Journal of the International Neuropsychological Society / Volume 18 / Issue 3 / May 2012
- Published online by Cambridge University Press:
- 03 February 2012, pp. 481-489
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Obstructive sleep apnea (OSA) is a nocturnal respiratory disorder associated with cognitive and behavioral sequelae, including impairments in executive functioning (EF). Previous literature has focused on “cool” EF, meaning abilities such as working memory and planning that do not involve affective control requirements. Little is known about the impact OSA may have on “hot” EF that involves regulation of affect and risk-related decision-making, and that may be particularly salient during adolescence, when these skills are rapidly developing. This study examined performance on the Iowa Gambling Task (IGT), a task believed to assess aspects of “hot” EF, in overweight adolescents at risk for OSA. Consistent with hypotheses, individuals without OSA made more beneficial decisions on the IGT over time, but participants with OSA did not benefit from feedback and continued to make choices associated with higher initial rewards, but greater long-term losses. The relationship between developmental level and IGT performance was moderated by OSA status. Individuals with OSA did not demonstrate the expected developmental gains in performance during the IGT. This finding suggests that OSA may impact the development of critical aspects of EF, or at least the expression of these skills during the developmentally important period of adolescence. (JINS, 2012, 18, 481–489)
36 - When institutional, professional, and public health obligations conflict: the controversial case of youth boxing
- from Section 5 - Children, public health, and justice
- Edited by Douglas S. Diekema, Mark R. Mercurio, Mary B. Adam
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- Book:
- Clinical Ethics in Pediatrics
- Published online:
- 07 October 2011
- Print publication:
- 08 September 2011, pp 211-214
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Summary
Case narrative
A city police league asked a children’s hospital pediatrician to provide ringside medical supervision at a community amateur youth boxing event for at-risk urban boys. Amateur youth boxing is a legal sport performed in a controlled fashion with protective headgear. A licensed provider is required at the ringside in order for all boxing events to occur. The ringside physician provides pre-match assessments of the participants, monitors the boxing bouts, and has the authority to stop matches if they decide that doing so is in the participants’ best interests. The ringside physician may also prevent an individual from participating in future matches because of injury, illegal hits, or poor sportsmanship if deemed necessary. Neither professional boxing nor amateur martial arts events give such wide discretion to the ringside physician. Unlike professional boxing, the goal in amateur boxing is to score points rather than to “knock someone out.” The police league’s at-risk youth program upholds values such as diversity, equal opportunity, and self-confidence.
In the past, this pediatrician has provided assistance at other youth events sponsored by the police league, including football and soccer games. While checking her malpractice coverage to participate, she found herself mired in a larger controversy when several staff in her department expressed vehement opposition to her participation. The pediatrician’s colleagues cited the American Academy of Pediatrics (AAP) policy statement “vigorously opposing” youth boxing (Committee on Sports Medicine and Fitness, 1997). The AAP policy does not directly mention ringside assistance; however, the physician’s colleagues felt that participating in this program was inconsistent with the hospital’s commitment to injury prevention and programs designed to reduce concussions. Some individuals opined that boxing was nothing more than a “brutal sport” masquerading as “legalized violence,” and that the sport did not promote a healthy lifestyle.
Contributors
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- By Aakash Agarwala, Linda S. Aglio, Rae M. Allain, Paul D. Allen, Houman Amirfarzan, Yasodananda Kumar Areti, Amit Asopa, Edwin G. Avery, Patricia R. Bachiller, Angela M. Bader, Rana Badr, Sibinka Bajic, David J. Baker, Sheila R. Barnett, Rena Beckerly, Lorenzo Berra, Walter Bethune, Sascha S. Beutler, Tarun Bhalla, Edward A. Bittner, Jonathan D. Bloom, Alina V. Bodas, Lina M. Bolanos-Diaz, Ruma R. Bose, Jan Boublik, John P. Broadnax, Jason C. Brookman, Meredith R. Brooks, Roland Brusseau, Ethan O. Bryson, Linda A. Bulich, Kenji Butterfield, William R. Camann, Denise M. Chan, Theresa S. Chang, Jonathan E. Charnin, Mark Chrostowski, Fred Cobey, Adam B. Collins, Mercedes A. Concepcion, Christopher W. Connor, Bronwyn Cooper, Jeffrey B. Cooper, Martha Cordoba-Amorocho, Stephen B. Corn, Darin J. Correll, Gregory J. Crosby, Lisa J. Crossley, Deborah J. Culley, Tomas Cvrk, Michael N. D'Ambra, Michael Decker, Daniel F. Dedrick, Mark Dershwitz, Francis X. Dillon, Pradeep Dinakar, Alimorad G. Djalali, D. John Doyle, Lambertus Drop, Ian F. Dunn, Theodore E. Dushane, Sunil Eappen, Thomas Edrich, Jesse M. Ehrenfeld, Jason M. Erlich, Lucinda L. Everett, Elliott S. Farber, Khaldoun Faris, Eddy M. Feliz, Massimo Ferrigno, Richard S. Field, Michael G. Fitzsimons, Hugh L. Flanagan Jr., Vladimir Formanek, Amanda A. Fox, John A. Fox, Gyorgy Frendl, Tanja S. Frey, Samuel M. Galvagno Jr., Edward R. Garcia, Jonathan D. Gates, Cosmin Gauran, Brian J. Gelfand, Simon Gelman, Alexander C. Gerhart, Peter Gerner, Omid Ghalambor, Christopher J. Gilligan, Christian D. Gonzalez, Noah E. Gordon, William B. Gormley, Thomas J. Graetz, Wendy L. Gross, Amit Gupta, James P. Hardy, Seetharaman Hariharan, Miriam Harnett, Philip M. Hartigan, Joaquim M. Havens, Bishr Haydar, Stephen O. Heard, James L. Helstrom, David L. Hepner, McCallum R. Hoyt, Robert N. Jamison, Karinne Jervis, Stephanie B. Jones, Swaminathan Karthik, Richard M. Kaufman, Shubjeet Kaur, Lee A. Kearse Jr., John C. Keel, Scott D. Kelley, Albert H. Kim, Amy L. Kim, Grace Y. Kim, Robert J. Klickovich, Robert M. Knapp, Bhavani S. Kodali, Rahul Koka, Alina Lazar, Laura H. Leduc, Stanley Leeson, Lisa R. Leffert, Scott A. LeGrand, Patricio Leyton, J. Lance Lichtor, John Lin, Alvaro A. Macias, Karan Madan, Sohail K. Mahboobi, Devi Mahendran, Christine Mai, Sayeed Malek, S. Rao Mallampati, Thomas J. Mancuso, Ramon Martin, Matthew C. Martinez, J. A. Jeevendra Martyn, Kai Matthes, Tommaso Mauri, Mary Ellen McCann, Shannon S. McKenna, Dennis J. McNicholl, Abdel-Kader Mehio, Thor C. Milland, Tonya L. K. Miller, John D. Mitchell, K. Annette Mizuguchi, Naila Moghul, David R. Moss, Ross J. Musumeci, Naveen Nathan, Ju-Mei Ng, Liem C. Nguyen, Ervant Nishanian, Martina Nowak, Ala Nozari, Michael Nurok, Arti Ori, Rafael A. Ortega, Amy J. Ortman, David Oxman, Arvind Palanisamy, Carlo Pancaro, Lisbeth Lopez Pappas, Benjamin Parish, Samuel Park, Deborah S. Pederson, Beverly K. Philip, James H. Philip, Silvia Pivi, Stephen D. Pratt, Douglas E. Raines, Stephen L. Ratcliff, James P. Rathmell, J. Taylor Reed, Elizabeth M. Rickerson, Selwyn O. Rogers Jr., Thomas M. Romanelli, William H. Rosenblatt, Carl E. Rosow, Edgar L. Ross, J. Victor Ryckman, Mônica M. Sá Rêgo, Nicholas Sadovnikoff, Warren S. Sandberg, Annette Y. Schure, B. Scott Segal, Navil F. Sethna, Swapneel K. Shah, Shaheen F. Shaikh, Fred E. Shapiro, Torin D. Shear, Prem S. Shekar, Stanton K. Shernan, Naomi Shimizu, Douglas C. Shook, Kamal K. Sikka, Pankaj K. Sikka, David A. Silver, Jeffrey H. Silverstein, Emily A. Singer, Ken Solt, Spiro G. Spanakis, Wolfgang Steudel, Matthias Stopfkuchen-Evans, Michael P. Storey, Gary R. Strichartz, Balachundhar Subramaniam, Wariya Sukhupragarn, John Summers, Shine Sun, Eswar Sundar, Sugantha Sundar, Neelakantan Sunder, Faraz Syed, Usha B. Tedrow, Nelson L. Thaemert, George P. Topulos, Lawrence C. Tsen, Richard D. Urman, Charles A. Vacanti, Francis X. Vacanti, Joshua C. Vacanti, Assia Valovska, Ivan T. Valovski, Mary Ann Vann, Susan Vassallo, Anasuya Vasudevan, Kamen V. Vlassakov, Gian Paolo Volpato, Essi M. Vulli, J. Matthias Walz, Jingping Wang, James F. Watkins, Maxwell Weinmann, Sharon L. Wetherall, Mallory Williams, Sarah H. Wiser, Zhiling Xiong, Warren M. Zapol, Jie Zhou
- Edited by Charles Vacanti, Scott Segal, Pankaj Sikka, Richard Urman
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- Book:
- Essential Clinical Anesthesia
- Published online:
- 05 January 2012
- Print publication:
- 11 July 2011, pp xv-xxviii
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Contributors
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- By Avishek Adhikari, Susanne E. Ahmari, Anne Marie Albano, Carlos Blanco, Desiree K. Caban, Jonathan S. Comer, Jeremy D. Coplan, Ana Alicia De La Cruz, Emily R. Doherty, Bruce Dohrenwend, Amit Etkin, Brian A. Fallon, Michael B. First, Abby J. Fyer, Angela Ghesquiere, Jay A. Gingrich, Robert A. Glick, Joshua A. Gordon, Ethan E. Gorenstein, Marco A. Grados, James P. Hambrick, James Hanks, Kelli Jane K. Harding, Richard G. Heimberg, Rene Hen, Devon E. Hinton, Myron A. Hofer, Matthew J. Kaplowitz, Sharaf S. Khan, Donald F. Klein, Karestan C. Koenen, E. David Leonardo, Roberto Lewis-Fernández, Jeffrey A. Lieberman, Michael R. Liebowitz, Sarah H. Lisanby, Antonio Mantovani, John C. Markowitz, Patrick J. McGrath, Caitlin McOmish, Jeffrey M. Miller, Jan Mohlman, Elizabeth Sagurton Mulhare, Philip R. Muskin, Navin Arun Natarajan, Yuval Neria, Nicole R. Nugent, Mayumi Okuda, Mark Olfson, Laszlo A. Papp, Sapana R. Patel, Anthony Pinto, Kristin Pontoski, Jesse W. Richardson-Jones, Carolyn I. Rodriguez, Steven P. Roose, Moira A. Rynn, Franklin Schneier, M. Katherine Shear, Ranjeeb Shrestha, Helen Blair Simpson, Smit S. Sinha, Natalia Skritskaya, Jami Socha, Eun Jung Suh, Gregory M. Sullivan, Anthony J. Tranguch, Hilary B. Vidair, Tor D. Wager, Myrna M Weissman, Noelia V. Weisstaub
- Edited by Helen Blair Simpson, Columbia University, New York, Yuval Neria, Columbia University, New York, Roberto Lewis-Fernández, Columbia University, New York, Franklin Schneier, Columbia University, New York
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- Book:
- Anxiety Disorders
- Published online:
- 10 November 2010
- Print publication:
- 26 August 2010, pp vii-xii
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Predictors and moderators of time to remission of major depression with interpersonal psychotherapy and SSRI pharmacotherapy
- E. Frank, G. B. Cassano, P. Rucci, W. K. Thompson, H. C. Kraemer, A. Fagiolini, L. Maggi, D. J. Kupfer, M. K. Shear, P. R. Houck, S. Calugi, V. J. Grochocinski, P. Scocco, J. Buttenfield, R. N. Forgione
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- Journal:
- Psychological Medicine / Volume 41 / Issue 1 / January 2011
- Published online by Cambridge University Press:
- 12 April 2010, pp. 151-162
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Background
Although many studies suggest that, on average, depression-specific psychotherapy and antidepressant pharmacotherapy are efficacious, we know relatively little about which patients are more likely to respond to one versus the other. We sought to determine whether measures of spectrum psychopathology are useful in deciding which patients with unipolar depression should receive pharmacotherapy versus depression-specific psychotherapy.
MethodA total of 318 adult out-patients with major depression were randomly assigned to escitalopram pharmacotherapy or interpersonal psychotherapy (IPT) at academic medical centers at Pittsburgh, Pennsylvania and Pisa, Italy. Our main focus was on predictors and moderators of time to remission on monotherapy at 12 weeks.
ResultsParticipants with higher scores on the need for medical reassurance factor of the Panic–Agoraphobic Spectrum Self-Report (PAS-SR) had more rapid remission with IPT and those with lower scores on the psychomotor activation factor of the Mood Spectrum Self-Report (MOODS-SR) experienced more rapid remission with selective serotonin reuptake inhibitor (SSRI) pharmacotherapy. Non-specific predictors of longer time to remission with monotherapy included several panic spectrum and mood spectrum factors and the Social Phobia Spectrum (SHY) total score. Higher baseline scores on the 17- and 25-item Hamilton Depression Rating Scales (HAMD-17 and HAMD-25) and the Work and Social Adjustment Scale (WSAS) also predicted a longer time to remission, whereas being married predicted a shorter time to remission.
ConclusionsThis exploratory study identified several non-specific predictors but few moderators of psychotherapy versus pharmacotherapy outcome. It offers useful indicators of the characteristics of patients that are generally difficult to treat, but only limited guidance as to who benefits from IPT versus SSRI pharmacotherapy.
Contributors
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- By Nicholas B. Allen, Stephanie Assuras, Robert M. Bilder, Joan C. Borod, John L. Bradshaw, Warrick J. Brewer, Ariel Brown, Nik Brown, Tyrone Cannon, Audrey Carstensen, Cameron S. Carter, Luke Clark, Phyllis Chua, Thilo Deckersbach, Richard A. Depue, Tali Ditman, Aleksey Dumer, David E. Fleck, Lara Foland-Ross, Judith M. Ford, Nelson Freimer, Paolo Fusar-Poli, Nathan A. Gates, Terry E. Goldberg, George Graham, Igor Grant, Melissa J. Green, Michelle M. Halfacre, Wendy Heller, John D. Herrington, Garry D. Honey, Jennifer E. Iudicello, Henry J. Jackson, J. David Jentsch, Donald Kalar, Paul Keedwell, Ester Klimkeit, Nancy S. Koven, Donna A. Kreher, Gina R. Kuperberg, Edythe London, Dan I. Lubman, Daniel H. Mathalon, Patrick D. McGorry, Philip McGuire, George R. Mangun, Gregory A. Miller, Albert Newen, Jack B. Nitschke, Jaak Panksepp, Christos Pantelis, Mary Philips, Russell A. Poldrack, Scott L. Rauch, Susan M. Ravizza, Steven Paul Reise, Nicole Rinehart, Angela Rizk-Jackson, Trevor W. Robbins, Tamara A. Russell, Fred W. Sabb, Cary R. Savage, Kimberley R. Savage, J. Cobb Scott, Marc L. Seal, Larry J. Seidman, Paula K. Shear, Marisa M. Silveri, Nadia Solowij, Laura Southgate, G. Lynn Stephens, D. Stott Parker, Stephen M. Strakowski, Simon A. Surguladze, Kate Tchanturia, René Testa, Janet Treasure, Eve M. Valera, Kai Vogeley, Anthony P. Weiss, Sarah Whittle, Stephen J. Wood, Steven Paul Woods, Murat Yücel, Deborah A. Yurgelun-Todd
- Edited by Stephen J. Wood, University of Melbourne, Nicholas B. Allen, University of Melbourne, Christos Pantelis, University of Melbourne
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- Book:
- The Neuropsychology of Mental Illness
- Published online:
- 10 May 2010
- Print publication:
- 01 October 2009, pp xv-xx
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Morbidity of Homebound Versus Inpatient Elderly Psychiatric Patients
- Rona Pasternak, Andrew Rosenweig, Bridget Booth, Andrea Fox, Richard Morycz, Benoit Mulsant, Robert Sweet, George S. Zubenko, Charles F. Reynolds, M. Katherine Shear
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- Journal:
- International Psychogeriatrics / Volume 10 / Issue 2 / June 1998
- Published online by Cambridge University Press:
- 10 January 2005, pp. 117-125
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This study compares the demographic and clinical characteristics of homebound (HB) elders referred for psychiatric services (N = 251) with those of inpatients (IP) admitted to a geriatric psychiatry unit (N = 594). Demographically, HB patients were older (78.8 vs. 74.7 years), were more likely to be women (83% vs. 68%), were widowed (54% vs. 44%), and had fewer years of education (10.3 vs. 11.1), but were similar in race, income, and proportion living alone. Clinically, HB patients had less functional disability, less severe depression, less cognitive impairment, and fewer medical problems. However, they were similar in the distribution of most psychiatric diagnoses except dementia (higher in the IP group) and dementia with depression (higher in the HB group). Outcome data for the HB group over 15 (range, 1 to 38) months revealed medical hospitalization in 20.7%, psychiatric hospitalization in 16.3%, nursing home placement in 9.2%, and mortality in 8.4%. These preliminary data show that the HB group had psychiatric problems that were comparable to those of the IP group but were not as severely impaired.
Quality of life impairments associated with diagnostic criteria for traumatic grief
- G. K. SILVERMAN, S. C. JACOBS, S. V. KASL, M. K. SHEAR, P. K. MACIEJEWSKI, F. S. NOAGHIUL, H. G. PRIGERSON
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- Journal:
- Psychological Medicine / Volume 30 / Issue 4 / July 2000
- Published online by Cambridge University Press:
- 01 July 2000, pp. 857-862
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Background. This study examined the association between a diagnosis of traumatic grief and quality of life outcomes.
Method. Sixty-seven widowed persons were interviewed at a median of 4 months after their loss. The multiple regression procedure was used to estimate the effects of a traumatic grief diagnosis on eight quality of life domains, controlling for age, sex, time from loss and diagnoses of major depressive episode and post-traumatic stress disorder.
Results. A positive traumatic grief diagnosis was significantly associated with lower social functioning scores, worse mental health scores, and lower energy levels than a negative traumatic grief diagnosis. In each of these domains, traumatic grief was found to be a better predictor of lower scores than either major depressive episode or post-traumatic stress disorder.
Conclusions. The results suggest that a traumatic grief diagnosis is significantly associated with quality of life impairments. These findings provide evidence supporting the criterion validity of the proposed consensus criteria and the newly developed diagnostic interview for traumatic grief – the Traumatic Grief Evaluation of Response to Loss (TRGR2L).