33 results
Validation of hierarchical taxonomy in a clinical sample
- Holly Frances Levin-Aspenson, Mark Zimmerman
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- Journal:
- Psychological Medicine / Volume 53 / Issue 13 / October 2023
- Published online by Cambridge University Press:
- 29 November 2022, pp. 6142-6149
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Background
Quantitatively derived dimensional models of psychopathology enjoy overwhelming empirical support, and a large and active community of psychopathology researchers has been establishing an empirically based dimensional hierarchical taxonomy of psychopathology (or HiTOP) as a strong candidate replacement for the current categorical classification system. The hierarchical nature of this taxonomy implies that different levels of resolution are likely to be optimal for different purposes. Our aim was to identify which level of detail is likely to provide optimal validity and explanatory power with regard to relevant clinical variables.
MethodsIn the present report from the Rhode Island Methods to Improve Diagnostic Assessment and Services project, we used data from a sample of 2900 psychiatric outpatients to compare different levels from a bass-ackwards model of psychopathology in relation to psychosocial impairment across different domains (global functioning, inability to work, social functioning, suicidal ideation, history of suicide attempts, history of psychiatric hospitalization).
ResultsAll functioning indices were significantly associated with general psychopathology, but more complex levels provided significant incremental validity. The optimal level of complexity varied across functioning indices, suggesting that there is no single ‘best’ level for understanding relations between psychopathology and functioning.
ConclusionsResults support the hierarchical organization of psychopathology dimensions with regard to validity considerations and downstream implications for applied assessment. It would be fruitful to develop and implement measurement of these dimensions at the appropriate level for the purpose at hand. These findings can be used to guide HiTOP-consistent assessment in other research and clinical settings.
The hidden borderline patient: patients with borderline personality disorder who do not engage in recurrent suicidal or self-injurious behavior
- Mark Zimmerman, Lena Becker
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- Journal:
- Psychological Medicine / Volume 53 / Issue 11 / August 2023
- Published online by Cambridge University Press:
- 29 July 2022, pp. 5177-5184
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Background
Despite the significant psychosocial morbidity associated with borderline personality disorder (BPD), its underrecognition is a significant clinical problem. BPD is likely underdiagnosed, in part, because patients with BPD usually present with chief complaints associated with mood, anxiety, and substance use disorders. When patients with BPD do not exhibit self-harm behavior, we suspect that BPD is less likely to recognized. An important question is whether the absence of this criterion, which might attenuate the likelihood of recognizing and diagnosing the disorder, identifies a subgroup of patients with BPD who are ‘less borderline’ than patients with BPD who do not manifest this criterion.
MethodsPsychiatric outpatients were evaluated with a semi-structured diagnostic interview for DSM-IV BPD, 390 of whom were diagnosed with BPD. We compared the demographic and clinical characteristics of patients with BPD who do and do not engage in repeated suicidal and self-harm behavior.
ResultsApproximately half of the patients with BPD did not meet the suicidality/self-injury diagnostic criterion for the disorder. There were no differences between the patients who did and did not meet this criterion in occupational impairment, likelihood of receiving disability payments, impairment in social functioning, level of educational achievement, comorbid psychiatric disorders, history of childhood trauma, or severity of depression, anxiety, or anger upon presentation for treatment.
ConclusionsRepeated self-injurious and suicidal behavior is not synonymous with BPD. It is critical for clinicians to be aware that the absence of repeated self-injury and suicide threats/gestures or attempts does not rule out the diagnosis of BPD.
Borderline personality disorder symptom networks across adolescent and adult clinical samples: examining symptom centrality and replicability
- Jessica R. Peters, Michael L. Crowe, Theresa Morgan, Mark Zimmerman, Carla Sharp, Carlos M. Grilo, Charles A. Sanislow, M. Tracie Shea, Mary C. Zanarini, Thomas H. McGlashan, Leslie C. Morey, Andrew E. Skodol, Shirley Yen
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- Journal:
- Psychological Medicine / Volume 53 / Issue 7 / May 2023
- Published online by Cambridge University Press:
- 31 January 2022, pp. 2946-2953
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Background
Numerous theories posit different core features to borderline personality disorder (BPD). Recent advances in network analysis provide a method of examining the relative centrality of BPD symptoms, as well as examine the replicability of findings across samples. Additionally, despite the increase in research supporting the validity of BPD in adolescents, clinicians are reluctant to diagnose BPD in adolescents. Establishing the replicability of the syndrome across adolescents and adults informs clinical practice and research. This study examined the stability of BPD symptom networks and centrality of symptoms across samples varying in age and clinical characteristics.
MethodsCross-sectional analyses of BPD symptoms from semi-structured diagnostic interviews from the Collaborative Longitudinal Study of Personality Disorders (CLPS), the Methods to Improve Diagnostic Assessment and Service (MIDAS) study, and an adolescent clinical sample. Network attributes, including edge (partial association) strength and node (symptom) expected influence, were compared.
ResultsThe three networks were largely similar and strongly correlated. Affective instability and identity disturbance emerged as relatively central symptoms across the three samples, and relationship difficulties across adult networks. Differences in network attributes were more evident between networks varying both in age and in BPD symptom severity level.
ConclusionsFindings highlight the relative importance of affective, identity, and relationship symptoms, consistent with several leading theories of BPD. The network structure of BPD symptoms appears generally replicable across multiple large samples including adolescents and adults, providing further support for the validity of the diagnosis across these developmental phases.
Patients with borderline personality disorder and bipolar disorder: a descriptive and comparative study
- Mark Zimmerman, Caroline Balling, Iwona Chelminski, Kristy Dalrymple
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- Journal:
- Psychological Medicine / Volume 51 / Issue 9 / July 2021
- Published online by Cambridge University Press:
- 17 March 2020, pp. 1479-1490
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Background
Bipolar disorder and borderline personality disorder (BPD) are each significant public health problems. It has been frequently noted that distinguishing BPD from bipolar disorder is challenging. Consequently, reviews and commentaries have focused on differential diagnosis and identifying clinical features to distinguish the two disorders. While there is a burgeoning literature comparing patients with BPD and bipolar disorder, much less research has characterized patients with both disorders. In the current report from the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project, we compare psychiatric outpatients with both BPD and bipolar disorder to patients with BPD without bipolar disorder and patients with bipolar disorder without BPD.
MethodsPsychiatric outpatients presenting for treatment were evaluated with semi-structured interviews. The focus of the current study is the 517 patients with both BPD and bipolar disorder (n = 59), BPD without bipolar disorder (n = 330), and bipolar disorder without BPD (n = 128).
ResultsCompared to patients with bipolar disorder, the patients with bipolar disorder and BPD had more comorbid disorders, psychopathology in their first-degree relatives, childhood trauma, suicidality, hospitalizations, time unemployed, and likelihood of receiving disability payments. The added presence of bipolar disorder in patients with BPD was associated with more posttraumatic stress disorder in the patients as well as their family, more bipolar disorder and substance use disorders in their relatives, more childhood trauma, unemployment, disability, suicide attempts, and hospitalizations.
ConclusionsPatients with both bipolar disorder and BPD have more severe psychosocial morbidity than patients with only one of these disorders.
The Impact of Sleep on the Relationship between Soccer Heading Exposure and Neuropsychological Function in College-Age Soccer Players
- Cara F. Levitch, Eric McConathey, Maral Aghvinian, Mark Himmelstein, Michael L. Lipton, Molly E. Zimmerman
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- Journal:
- Journal of the International Neuropsychological Society / Volume 26 / Issue 7 / August 2020
- Published online by Cambridge University Press:
- 26 February 2020, pp. 633-644
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Objective:
Soccer is the most popular sport worldwide and is the only sport where athletes purposely use their head to deflect the ball during play, termed “heading” the ball. These repetitive head impacts (RHI) are associated with worse neuropsychological function; however, factors that can increase risk of injury following exposure to such head impacts have been largely unexamined. The present study provided a novel examination of the modifying role of sleep on the relationship between RHI exposure and neuropsychological function in college-age soccer players.
Methods:Fifty varsity and intramural college soccer players completed questionnaires assessing recent and long-term heading exposure, a self-report measure of sleep function, and a battery of neuropsychological tests.
Results:A high level of recent heading exposure was significantly associated with poorer processing speed, independent of concussion history. With reduced sleep duration, a high level of recent heading exposure was related to worse sustained attention. However, with greater hours of sleep duration, heading exposure was related to preserved neuropsychological outcome in sustained attention.
Conclusions:We replicated our earlier finding of an association between recent head impact exposure and worse processing speed in an independent sample. In addition, we found that sleep may serve as a risk or protective factor for soccer players following extensive exposure to head impacts. Ultimately, this study furthers the understanding of factors impacting neuropsychological function in soccer players and provides empirical support for sleep interventions to help ensure safer soccer play and recovery from injury.
Understanding the severity of depression: do nondepressive symptoms influence global ratings of depression severity?
- Mark Zimmerman, Caroline Balling, Iwona Chelminski, Kristy Dalrymple
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- Journal:
- CNS Spectrums / Volume 25 / Issue 4 / August 2020
- Published online by Cambridge University Press:
- 12 November 2019, pp. 557-560
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Objective.
Almost all depression measures have been developed without discussing how to best conceptualize and assess the severity of depression. It is therefore not surprising that measures differ in both how items are rated and item content. The question that we address in the present report from the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project is whether a measure of depression severity should include symptoms that are frequent in depressed patients but are defining features of other disorders (eg, anxiety, irritability)
Methods.Patients were evaluated with a semi-structured interview and severity ratings were made of each symptom of major depressive disorder (MDD) as well as anxiety, irritability, and somatization. Patients were also rated on the Clinical Global Index of severity (CGI).
Results.Three of the 5 nondepressive symptoms (psychic anxiety, somatic anxiety, and subjective anger) were significantly correlated with the CGI. The correlation between the sum of all 5 nondepressive symptoms and the CGI was significantly lower than the correlation between the sum of the depressive symptom severity ratings (0.12 vs 0.52, z = 11.0, p < .001). The partial correlation between the CGI and the nondepressive symptom severity ratings (after controlling for the total depressive symptom ratings) was nonsignificant.
Discussion.After accounting for the severity of depressive symptoms, the severity of the nondepressive symptoms was not associated with global ratings of depressive severity. These findings raise questions regarding the appropriateness of including ratings of anxiety, irritability, and somatization on a measure that purportedly assesses the severity of depression.
Chapter 21 - Classification of Nonepileptic Seizures
- from Section 4 - Psychiatric and Neuropsychological Considerations in Adults with Psychogenic Nonepileptic Seizures
- Edited by W. Curt LaFrance, Jr, Steven C. Schachter
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- Book:
- Gates and Rowan's Nonepileptic Seizures
- Published online:
- 18 May 2018
- Print publication:
- 03 May 2018, pp 217-230
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Guidelines for the recognition and management of mixed depression
- Stephen M. Stahl, Debbi A. Morrissette, Gianni Faedda, Maurizio Fava, Joseph F. Goldberg, Paul E. Keck, Yena Lee, Gin Malhi, Ciro Marangoni, Susan L. McElroy, Michael Ostacher, Joshua D. Rosenblat, Eva Solé, Trisha Suppes, Minoru Takeshima, Michael E. Thase, Eduard Vieta, Allan Young, Mark Zimmerman, Roger S. McIntyre
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- Journal:
- CNS Spectrums / Volume 22 / Issue 2 / April 2017
- Published online by Cambridge University Press:
- 28 February 2017, pp. 203-219
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A significant minority of people presenting with a major depressive episode (MDE) experience co-occurring subsyndromal hypo/manic symptoms. As this presentation may have important prognostic and treatment implications, the DSM–5 codified a new nosological entity, the “mixed features specifier,” referring to individuals meeting threshold criteria for an MDE and subthreshold symptoms of (hypo)mania or to individuals with syndromal mania and subthreshold depressive symptoms. The mixed features specifier adds to a growing list of monikers that have been put forward to describe phenotypes characterized by the admixture of depressive and hypomanic symptoms (e.g., mixed depression, depression with mixed features, or depressive mixed states [DMX]). Current treatment guidelines, regulatory approvals, as well the current evidentiary base provide insufficient decision support to practitioners who provide care to individuals presenting with an MDE with mixed features. In addition, all existing psychotropic agents evaluated in mixed patients have largely been confined to patient populations meeting the DSM–IV definition of “mixed states” wherein the co-occurrence of threshold-level mania and threshold-level MDE was required. Toward the aim of assisting clinicians providing care to adults with MDE and mixed features, we have assembled a panel of experts on mood disorders to develop these guidelines on the recognition and treatment of mixed depression, based on the few studies that have focused specifically on DMX as well as decades of cumulated clinical experience.
Clinically useful screen for borderline personality disorder in psychiatric out-patients
- Mark Zimmerman, Matthew D. Multach, Kristy Dalrymple, Iwona Chelminski
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- Journal:
- The British Journal of Psychiatry / Volume 210 / Issue 2 / February 2017
- Published online by Cambridge University Press:
- 02 January 2018, pp. 165-166
- Print publication:
- February 2017
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A total of 3674 psychiatric out-patients were evaluated with a semi-structured diagnostic interview for DSM-IV borderline personality disorder (BPD). The affective instability criterion had a sensitivity of 92.8%, higher than the sensitivities of the other eight BPD criteria. The negative predictive value of the affective instability criterion was 99%. We recommend that clinicians screen for BPD in the same way that they screen for other psychiatric disorders: by enquiring about a single feature of the disorder (i.e. affective instability), the presence of which identifies most patients with the disorder and the absence of which rules out the disorder.
Dynamic Benefit–Cost Analysis for Controlling Perennial Pepperweed (Lepidium latifolium): A Case Study
- Mark E. Eiswerth, Loretta Singletary, John R. Zimmerman, Wayne S. Johnson
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- Journal:
- Weed Technology / Volume 19 / Issue 2 / June 2005
- Published online by Cambridge University Press:
- 20 January 2017, pp. 237-243
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Perennial pepperweed, found throughout the western United States, reduces biodiversity and causes economic losses in the form of control costs as well as decreased quantity and quality of agricultural yields. The future stream of net benefits of weed management and the future point in time at which they will have accumulated enough to equal total management costs were estimated under different land-use and expansion rate scenarios. Benefits and costs were calculated in present value terms by applying a rate of discount to future values. On land used solely for grazing, the total economic returns from management did not equal total costs until 15 yr after initial treatment. However, on land used for grazing plus hay harvest, cumulative benefits equaled and began to exceed cumulative costs after 4 to 5 yr. The costs and benefits of management efforts were also estimated for a landowner, who controls an adjacent infestation before it spreads. This landowner benefited economically from weed management in as little as 5 to 6 yr, highlighting the importance of cooperative efforts to control nearby weed infestations.
Measures of the DSM–5 mixed-features specifier of major depressive disorder
- Mark Zimmerman
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- Journal:
- CNS Spectrums / Volume 22 / Issue 2 / April 2017
- Published online by Cambridge University Press:
- 12 January 2017, pp. 196-202
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During the past two decades, a number of studies have found that depressed patients frequently have manic symptoms intermixed with depressive symptoms. While the frequency of mixed syndromes are more common in bipolar than in unipolar depressives, mixed states are also common in patients with major depressive disorder. The admixture of symptoms may be evident when depressed patients present for treatment, or they may emerge during ongoing treatment. In some patients, treatment with antidepressant medication might precipitate the emergence of mixed states. It would therefore be useful to systematically inquire into the presence of manic/hypomanic symptoms in depressed patients. We can anticipate that increased attention will likely be given to mixed depression because of changes in the DSM–5. In the present article, I review instruments that have been utilized to assess the presence and severity of manic symptoms and therefore could be potentially used to identify the DSM–5 mixed-features specifier in depressed patients and to evaluate the course and outcome of treatment. In choosing which measure to use, clinicians and researchers should consider whether the measure assesses both depression and mania/hypomania, assesses all or only some of the DSM–5 criteria for the mixed-features specifier, or assesses manic/hypomanic symptoms that are not part of the DSM–5 definition. Feasibility, more so than reliability and validity, will likely determine whether these measures are incorporated into routine clinical practice.
The FDA's failure to address the lack of generalisability of antidepressant efficacy trials in product labelling
- Mark Zimmerman
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- Journal:
- The British Journal of Psychiatry / Volume 208 / Issue 6 / June 2016
- Published online by Cambridge University Press:
- 02 January 2018, pp. 512-514
- Print publication:
- June 2016
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According to the US Food and Drug Administration's (FDA's) regulations, the criteria used to select patients into registration studies should be addressed in a product's label. The FDA's labelling guidelines, which specifically indicate that the routine exclusion of patients of a certain level of severity should be noted in the label, has been uniformly ignored.
Psychosocial morbidity associated with bipolar disorder and borderline personality disorder in psychiatric out-patients: Comparative study
- Mark Zimmerman, William Ellison, Theresa A. Morgan, Diane Young, Iwona Chelminski, Kristy Dalrymple
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- Journal:
- The British Journal of Psychiatry / Volume 207 / Issue 4 / October 2015
- Published online by Cambridge University Press:
- 02 January 2018, pp. 334-338
- Print publication:
- October 2015
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Background
The morbidity associated with bipolar disorder is, in part, responsible for repeated calls for improved detection and recognition. No such commentary exists for the improved detection of borderline personality disorder. Clinical experience suggests that it is as disabling as bipolar disorder, but no study has directly compared the two disorders.
AimsTo compare the levels of psychosocial morbidity in patients with bipolar disorder and borderline personality disorder.
MethodPatients were assessed with semi-structured interviews. We compared 307 patients with DSM-IV borderline personality disorder but without bipolar disorder and 236 patients with bipolar disorder but without borderline personality disorder.
ResultsThe patients with borderline personality disorder less frequently were college graduates, were diagnosed with more comorbid disorders, more frequently had a history of substance use disorder, reported more suicidal ideation at the time of the evaluation, more frequently had attempted suicide, reported poorer social functioning and were rated lower on the Global Assessment of Functioning. There was no difference between the two patient groups in history of admission to psychiatric hospital or time missed from work during the past 5 years.
ConclusionsThe level of psychosocial morbidity associated with borderline personality disorder was as great as (or greater than) that experienced by patients with bipolar disorder. From a public health perspective, efforts to improve the detection and treatment of borderline personality disorder might be as important as efforts to improve the recognition and treatment of bipolar disorder.
Case 38 - Giant coronary artery aneurysms
- from Section 4 - Coronary arteries
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- By Mark Stellingworth, University of South Carolina Medical School, Saurabh Jha, Hospital of the University of Pennsylvania, Koteswara Pothineni, Louisiana State University School of Medicine, Stefan L. Zimmerman, Johns Hopkins University School of Medicine
- Edited by Stefan L. Zimmerman, Elliot K. Fishman
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- Book:
- Pearls and Pitfalls in Cardiovascular Imaging
- Published online:
- 05 June 2015
- Print publication:
- 21 May 2015, pp 120-123
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Summary
Imaging description
Coronary artery aneurysms are defined as localized vessel dilatation exceeding 50% of the adjacent normal coronary artery diameter. A precise definition of the threshold between aneurysm and “giant” aneurysm is not well established, but some authors have suggested that aneurysms > 20 mm meet this criteria. Giant coronary artery aneurysms are identified by the presence of a round or ovoid structure on the epicardial surface of the heart in the typical location for coronary arteries. Often discovered incidentally on echocardiogram, they will appear as a paracardiac mass with varying degrees of flow on Doppler interrogation depending on presence of thrombus. On non-contrast CT, they are low- attenuation, rounded masses that may have peripheral calcifications related to atherosclerosis. After contrast administration, lesions will enhance similar to blood pool, although varying degrees of thrombosis may be present (Figure 38.1). Large aneurysms can erroneously appear thrombosed on cardiac CT due to incomplete filling at the time of arterial phase acquisition (Figure 38.2). Delayed venous images will demon- strate further fill-in of the aneurysm. Cardiovascular magnetic resonance (CMR) imaging will typically show low signal on dark blood images due to flow (Figure 38.1). Steady-state free precession (SSFP) and contrast injections with gadolinium will confirm high signal in the structure due to blood and may show evidence of thrombus (Figures 38.1 and 38.2).
Importance
Patients with giant coronary aneurysms may present with life-threatening tamponade due to rupture. Thrombosis, fistulization to cardiac chambers, and embolization have also been noted in the literature. Giant coronary artery aneurysms can be misinterpreted as cardiac tumors, particularly if only limited imaging is available. The distinction between tumor and aneurysm could have significant impact on treatment.
Typical clinical scenario
Coronary artery aneurysms more commonly affect males and have an incidence between 0.3% and 5%. Coronary aneurysms greater than 20 mm are extremely rare and in one series represented only 0.02% of patients undergoing cardiac surgery. They are more likely to involve the right coronary artery.
Case 24 - Unroofed coronary sinus
- from Section 3 - Anatomic variants and congenital lesions
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- By Mark Stellingworth, University of South Carolina, Stefan L. Zimmerman, Johns Hopkins University
- Edited by Stefan L. Zimmerman, Elliot K. Fishman
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- Book:
- Pearls and Pitfalls in Cardiovascular Imaging
- Published online:
- 05 June 2015
- Print publication:
- 21 May 2015, pp 78-80
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Summary
Imaging description
Unroofed coronary sinus is a communication between the coronary sinus and left atrium. The result is a left-to-right shunt that allows flow of oxygenated blood from the left atrium into the coronary sinus. In the normal situation, the coronary sinus courses inferior to the undersurface of the left atrium in the left atrioventricular groove, emptying into the right atrium. In unroofed coronary sinus there is a variably sized communication between the two structures (Figure 24.1). In partial unroofing, a single or several small orifices are seen. In complete unroofing, there is total absence of the tissue separating the left atrium and coronary sinus. At crosssectional imaging, defects are optimally visualized in a shortaxis plane parallel to the atrioventricular groove (Figure 24.2). Associated signs include enlargement of the right atrium and right ventricle due to shunting, which can be quantified using phase-contrast MRI. In the case of small restrictive defects, turbulent flow jets may be visualized in the left atrium on cardiac MRI.
Importance
Unroofed coronary sinus is a rare cause for left-to-right shunt. It may be challenging to make the diagnosis on transthoracic echocardiography due to limited imaging windows, resulting in referral of patients to cardiac CT or MRI to evaluate for occult shunt. Diagnosis is important due to potential for transient right-to-left shunting that can result in systemic emboli or brain abscess.
Typical clinical scenario
Unroofed coronary sinus is a rare disorder that is the least common type of atrial septal defect, representing less than 1% of these anomalies. There is a frequent association with left-sided superior vena cava, which is seen in approximately 63–75% of cases. Many patients will have additional congenital cardiac defects.
Differential diagnosis
Unroofed coronary sinus should be distinguished from other types of potentially difficult to diagnose left-to-right shunts, such as sinus venosus atrial septal defects and partial anomalous pulmonary venous return.
Contributors
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- By Mitchell Aboulafia, Frederick Adams, Marilyn McCord Adams, Robert M. Adams, Laird Addis, James W. Allard, David Allison, William P. Alston, Karl Ameriks, C. Anthony Anderson, David Leech Anderson, Lanier Anderson, Roger Ariew, David Armstrong, Denis G. Arnold, E. J. Ashworth, Margaret Atherton, Robin Attfield, Bruce Aune, Edward Wilson Averill, Jody Azzouni, Kent Bach, Andrew Bailey, Lynne Rudder Baker, Thomas R. Baldwin, Jon Barwise, George Bealer, William Bechtel, Lawrence C. Becker, Mark A. Bedau, Ernst Behler, José A. Benardete, Ermanno Bencivenga, Jan Berg, Michael Bergmann, Robert L. Bernasconi, Sven Bernecker, Bernard Berofsky, Rod Bertolet, Charles J. Beyer, Christian Beyer, Joseph Bien, Joseph Bien, Peg Birmingham, Ivan Boh, James Bohman, Daniel Bonevac, Laurence BonJour, William J. Bouwsma, Raymond D. Bradley, Myles Brand, Richard B. Brandt, Michael E. Bratman, Stephen E. Braude, Daniel Breazeale, Angela Breitenbach, Jason Bridges, David O. Brink, Gordon G. Brittan, Justin Broackes, Dan W. Brock, Aaron Bronfman, Jeffrey E. Brower, Bartosz Brozek, Anthony Brueckner, Jeffrey Bub, Lara Buchak, Otavio Bueno, Ann E. Bumpus, Robert W. Burch, John Burgess, Arthur W. Burks, Panayot Butchvarov, Robert E. Butts, Marina Bykova, Patrick Byrne, David Carr, Noël Carroll, Edward S. Casey, Victor Caston, Victor Caston, Albert Casullo, Robert L. Causey, Alan K. L. Chan, Ruth Chang, Deen K. Chatterjee, Andrew Chignell, Roderick M. Chisholm, Kelly J. Clark, E. J. Coffman, Robin Collins, Brian P. Copenhaver, John Corcoran, John Cottingham, Roger Crisp, Frederick J. Crosson, Antonio S. Cua, Phillip D. Cummins, Martin Curd, Adam Cureton, Andrew Cutrofello, Stephen Darwall, Paul Sheldon Davies, Wayne A. Davis, Timothy Joseph Day, Claudio de Almeida, Mario De Caro, Mario De Caro, John Deigh, C. F. Delaney, Daniel C. Dennett, Michael R. DePaul, Michael Detlefsen, Daniel Trent Devereux, Philip E. Devine, John M. Dillon, Martin C. Dillon, Robert DiSalle, Mary Domski, Alan Donagan, Paul Draper, Fred Dretske, Mircea Dumitru, Wilhelm Dupré, Gerald Dworkin, John Earman, Ellery Eells, Catherine Z. Elgin, Berent Enç, Ronald P. Endicott, Edward Erwin, John Etchemendy, C. Stephen Evans, Susan L. Feagin, Solomon Feferman, Richard Feldman, Arthur Fine, Maurice A. Finocchiaro, William FitzPatrick, Richard E. Flathman, Gvozden Flego, Richard Foley, Graeme Forbes, Rainer Forst, Malcolm R. Forster, Daniel Fouke, Patrick Francken, Samuel Freeman, Elizabeth Fricker, Miranda Fricker, Michael Friedman, Michael Fuerstein, Richard A. Fumerton, Alan Gabbey, Pieranna Garavaso, Daniel Garber, Jorge L. A. Garcia, Robert K. Garcia, Don Garrett, Philip Gasper, Gerald Gaus, Berys Gaut, Bernard Gert, Roger F. Gibson, Cody Gilmore, Carl Ginet, Alan H. Goldman, Alvin I. Goldman, Alfonso Gömez-Lobo, Lenn E. Goodman, Robert M. Gordon, Stefan Gosepath, Jorge J. E. Gracia, Daniel W. Graham, George A. Graham, Peter J. Graham, Richard E. Grandy, I. Grattan-Guinness, John Greco, Philip T. Grier, Nicholas Griffin, Nicholas Griffin, David A. Griffiths, Paul J. Griffiths, Stephen R. Grimm, Charles L. Griswold, Charles B. Guignon, Pete A. Y. Gunter, Dimitri Gutas, Gary Gutting, Paul Guyer, Kwame Gyekye, Oscar A. Haac, Raul Hakli, Raul Hakli, Michael Hallett, Edward C. Halper, Jean Hampton, R. James Hankinson, K. R. Hanley, Russell Hardin, Robert M. Harnish, William Harper, David Harrah, Kevin Hart, Ali Hasan, William Hasker, John Haugeland, Roger Hausheer, William Heald, Peter Heath, Richard Heck, John F. Heil, Vincent F. Hendricks, Stephen Hetherington, Francis Heylighen, Kathleen Marie Higgins, Risto Hilpinen, Harold T. Hodes, Joshua Hoffman, Alan Holland, Robert L. Holmes, Richard Holton, Brad W. Hooker, Terence E. Horgan, Tamara Horowitz, Paul Horwich, Vittorio Hösle, Paul Hoβfeld, Daniel Howard-Snyder, Frances Howard-Snyder, Anne Hudson, Deal W. Hudson, Carl A. Huffman, David L. Hull, Patricia Huntington, Thomas Hurka, Paul Hurley, Rosalind Hursthouse, Guillermo Hurtado, Ronald E. Hustwit, Sarah Hutton, Jonathan Jenkins Ichikawa, Harry A. Ide, David Ingram, Philip J. Ivanhoe, Alfred L. Ivry, Frank Jackson, Dale Jacquette, Joseph Jedwab, Richard Jeffrey, David Alan Johnson, Edward Johnson, Mark D. Jordan, Richard Joyce, Hwa Yol Jung, Robert Hillary Kane, Tomis Kapitan, Jacquelyn Ann K. Kegley, James A. Keller, Ralph Kennedy, Sergei Khoruzhii, Jaegwon Kim, Yersu Kim, Nathan L. King, Patricia Kitcher, Peter D. Klein, E. D. Klemke, Virginia Klenk, George L. Kline, Christian Klotz, Simo Knuuttila, Joseph J. Kockelmans, Konstantin Kolenda, Sebastian Tomasz Kołodziejczyk, Isaac Kramnick, Richard Kraut, Fred Kroon, Manfred Kuehn, Steven T. Kuhn, Henry E. Kyburg, John Lachs, Jennifer Lackey, Stephen E. Lahey, Andrea Lavazza, Thomas H. Leahey, Joo Heung Lee, Keith Lehrer, Dorothy Leland, Noah M. Lemos, Ernest LePore, Sarah-Jane Leslie, Isaac Levi, Andrew Levine, Alan E. Lewis, Daniel E. Little, Shu-hsien Liu, Shu-hsien Liu, Alan K. L. Chan, Brian Loar, Lawrence B. Lombard, John Longeway, Dominic McIver Lopes, Michael J. Loux, E. J. Lowe, Steven Luper, Eugene C. Luschei, William G. Lycan, David Lyons, David Macarthur, Danielle Macbeth, Scott MacDonald, Jacob L. Mackey, Louis H. Mackey, Penelope Mackie, Edward H. Madden, Penelope Maddy, G. B. Madison, Bernd Magnus, Pekka Mäkelä, Rudolf A. Makkreel, David Manley, William E. Mann (W.E.M.), Vladimir Marchenkov, Peter Markie, Jean-Pierre Marquis, Ausonio Marras, Mike W. Martin, A. P. Martinich, William L. McBride, David McCabe, Storrs McCall, Hugh J. McCann, Robert N. McCauley, John J. McDermott, Sarah McGrath, Ralph McInerny, Daniel J. McKaughan, Thomas McKay, Michael McKinsey, Brian P. McLaughlin, Ernan McMullin, Anthonie Meijers, Jack W. Meiland, William Jason Melanson, Alfred R. Mele, Joseph R. 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Wolterstorff, Rega Wood, W. Jay Wood, Paul Woodruff, Alison Wylie, Gideon Yaffe, Takashi Yagisawa, Yutaka Yamamoto, Keith E. Yandell, Xiaomei Yang, Dean Zimmerman, Günter Zoller, Catherine Zuckert, Michael Zuckert, Jack A. Zupko (J.A.Z.)
- Edited by Robert Audi, University of Notre Dame, Indiana
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- Book:
- The Cambridge Dictionary of Philosophy
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- 05 August 2015
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- 27 April 2015, pp ix-xxx
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Introduction: Selecting an Antidepressant
- Mark Zimmerman
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- Journal:
- CNS Spectrums / Volume 14 / Issue S12 / 2009
- Published online by Cambridge University Press:
- 07 November 2014, pp. 4-7
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Four years ago, my colleagues and I published an article titled “Why isn't bupropion the most frequently prescribed antidepressant?” The goal of that article was not to advocate bupropion as the preferred agent for treating depression, but rather to stimulate discussion about how psychiatrists choose an antidepressant as well as to highlight the gap between results of efficacy studies and clinical decision making in real-world practice.
The argument in support of bupropion being the preferred antidepressant was based on three premises: all antidepressants are equally effective; adverse effects (AEs) of greatest concern to patients who take antidepressants are weight gain and sexual dysfunction; and bupropion does not cause either of these AEs. Acceptance of these three premises suggested the title of that article.
Although many reviews of the antidepressant literature, including the revised American Psychiatric Association Practice Guideline for the Treatment of Major Depressive Disorder, conclude that antidepressants are equally effective in general, several experts in the treatment of depression have suggested that medications with >1 mechanism of action may be more effective than agents that have more selective neurotransmitter effects. In a meta-analysis of eight studies comparing the remission rates in patients treated with the serotonin-norepinephrine reuptake inhibitor (SNRI) venlafaxine or selective serotonin reuptake inhibitors (SSRIs), Thase and colleagues demonstrated that venlafaxine was more effective than SSRIs in achieving remission in depressed patients. However, these conclusions were tentative as most of the included studies were comparisons of venlafaxine and fluoxetine; only one study included sertraline, and there were no studies of citalopram included in the review. In addition, patients who had previously failed treatment with an SSRI were not excluded, and, although patients who fail with one SSRI may respond to subsequent treatment with another SSRI, the inclusion of SSRI failures may favor venlafaxine in comparisons with SSRIs. Lastly, all of the studies included in the meta-analysis were funded by the manufacturer of venlafaxine.
Recognition and Treatment of Depression with or Without Comorbid Anxiety Disorders
- Mark Zimmerman, Iwona Chelminski, Sidney Zisook, David L. Ginsberg
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- Journal:
- CNS Spectrums / Volume 11 / Issue 1 / January 2006
- Published online by Cambridge University Press:
- 07 November 2014, pp. 1-2
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Anxiety disorders are common in depressed patients. Several studies of the full range of Diagnostic and Statistical Manual of Mental Disorders-defined anxiety disorders in depressed psychiatric outpatients each found that when diagnoses are based on semi-structured diagnostic interviews >40% of the patients had a comorbid anxiety disorder. The recognition of comorbidity is not simply of academic interest, but it has important clinical significance. Epidemiological studies, such as the National Comorbidity Study, have demonstrated that depressed individuals with a history of anxiety disorders are at increased risk for hospitalization, suicide attempt, and greater impairment from the depression. The co-occurrence of anxiety disorders in depressed patients has been associated with a more chronic course of depression in psychiatric patients, primary care patients, and epidemiological samples. Recent research has suggested that clinicians underrecognize anxiety disorder comorbidity in depressed patients. The clinical significance of this underrecognition is highlighted by the finding that patients often want treatment to address their anxiety disorder comorbidity. When anxiety disorders are detected they often influence clinicians' selection of antidepressant medication, though some of clinicians' prescribing biases are not supported by empirical data.
In this monograph, Iwona Chelminski, PhD, reviews the significance of anxiety in patients with depression as well as diagnostic instruments for recognizing this comorbidity. Next, Mark Zimmerman, MD, addresses the factors that affect the clinician's choice of antidepressant, focusing on the influence of comorbid anxiety. Finally, Sidney Zisook, MD, discusses the differential efficacy of antidepressants as well as the role of psychotherapy in patients with comorbid anxiety and depression.
The Influence of Comorbid Anxiety Disorders on the Selection of Antidepressant Medication in Depressed Patients
- Mark Zimmerman
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- Journal:
- CNS Spectrums / Volume 11 / Issue S1 / January 2006
- Published online by Cambridge University Press:
- 07 November 2014, pp. 4-6
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Although there is a wide array of choices of antidepressants, there is little empirical evidence to guide clinicians in their selection. Most reviews of the antidepressant literature, including the American Psychiatric Association's (APA) Practice Guideline for the Treatment of Major Depressive Disorder, conclude that these medications are generally equally effective. Consistent with this, a recent metaanalysis of studies comparing two or more new-generation antidepressants found little evidence that any medication was superior to the others. Although the APA guideline suggests that the choice of antidepressant be based principally on side effects, tolerability, patient preference, and cost, it also reviewed evidence of differential treatment response related to patients' clinical profiles. For patients with nonpsychotic, nonbipolar major depressive disorder (MDD), the guideline indicated that the presence of anxiety symptoms, atypical features, melancholic subtype, symptom severity, and borderline personality disorder may be associated with differential response to antidepressants. Selective serotonin reuptake inhibitors (SSRIs) are recommended for high anxiety, SSRIs and clomipramine for obsessive-compulsive disorder (OCD) symptoms, tricyclic antidepressants (TCAs) for severe depression and melancholia, and SSRIs and monoamine oxidase inhibitors (MAOIs) for atypical depression.
What is most striking in the guideline's review is how limited in scope and utility are the data to guide the outpatient psychiatrist in selecting an antidepressant. Melancholia and severe depression are relatively infrequently encountered in the outpatient setting. The most common comorbidities in depressed outpatients are anxiety disorders, but the guideline simply says that bupropion may be anxiogenic and should be avoided, and that although MAOIs may work well in depressed patients with anxiety, other medications are preferred. It does not discuss the possible influence of specific comorbidities on antidepressant selection.
Recognition and Treatment of Depression With or Without Comorbid Anxiety Disorders
- Mark Zimmerman, Iwona Chelminski, Sidney Zisook, David L. Ginsberg
-
- Journal:
- CNS Spectrums / Volume 11 / Issue S1 / January 2006
- Published online by Cambridge University Press:
- 07 November 2014, pp. 1-2
-
- Article
- Export citation
-
Anxiety disorders are common in depressed patients. Several studies of the full range of Diagnostic and Statistical Manual of Mental
Disorders-defined anxiety disorders in depressed psychiatric outpatients each found that when diagnoses are based on semi-structured diagnostic interviews >40% of the patients had a comorbid anxiety disorder. The recognition of comorbidity is not simply of academic interest, but it has important clinical significance. Epidemiological studies, such as the National Comorbidity Study, have demonstrated that depressed individuals with a history of anxiety disorders are at increased risk for hospitalization, suicide attempt, and greater impairment from the depression. The co-occurrence of anxiety disorders in depressed patients has been associated with a more chronic course of depression in psychiatric patients, primary care patients, and epidemiological samples. Recent research has suggested that clinicians underrecognize anxiety disorder comorbidity in depressed patients. The clinical significance of this underrecognition is highlighted by the finding that patients often want treatment to address their anxiety disorder comorbidity. When anxiety disorders are detected they often influence clinicians' selection of antidepressant medication, though some of clinicians' prescribing biases are not supported by empirical data.
In this monograph, Iwona Chelminski, PhD, reviews the significance of anxiety in patients with depression as well as diagnostic instruments for recognizing this comorbidity. Next, Mark Zimmerman, MD, addresses the factors that affect the clinician's choice of antidepressant, focusing on the influence of comorbid anxiety. Finally, Sidney Zisook, MD, discusses the differential efficacy of antidepressants as well as the role of psychotherapy in patients with comorbid anxiety and depression.