Depressive Symptoms and Clinical Status During the Treatment of Adolescent Suicide Attempters (TASA) Study

ObjectiveTo examine the course of depression during the treatment of adolescents with depression who had recently attempted suicide.MethodAdolescents (N = 124), ages 12 to 18 years, with a 90-day history of suicide attempt, a current diagnosis of depressive disorder (96.0% had major depressive disorder), and a Children's Depression Rating Scale-Revised (CDRS-R) score of 36 or higher, entered a 6-month treatment with antidepressant medication, cognitive-behavioral therapy focused on suicide prevention, or their combination (Comb), at five academic sites. Treatment assignment could be either random or chosen by study participants. Intent-to-treat, mixed effects regression models of depression and other relevant ratings were estimated. Improvement and remission rates were computed with the last observation carried forward.ResultsMost patients (n = 104 or 84%) chose treatment assignment, and overall, three fourths (n = 93) received Comb. In Comb, CDRS-R declined from a baseline adjusted mean of 49.6 (SD 12.3) to 38.3 (8.0) at week 12 and to 27.0 (10.1) at week 24 (p < .0001), with a Clinical Global Impression -defined improvement rate of 58.0% at week 12 and 72.2% at week 24 and a remission (CDRS-R ≤28) rate of 32.5% at week 12 and 50.0% at week 24. The CDRS-R and the Scale for Suicidal Ideation scores were correlated at baseline (r= 0.43, p < .0001) and declined in parallel.ConclusionsWhen vigorously treated with a combination of medication and psychotherapy, adolescents with depression who have recently attempted suicide show rates of improvement and remission of depression that seem comparable to those observed in nonsuicidal adolescents with depression.     

Retrosplenial cortex connectivity in schizophrenia

In this paper, we build on our previous analysis [Bluhm, R.L., Miller, J., Lanius, R.A., Osuch, E.A., Boksman, K., Neufeld, R.W.J., et al., 2007 Spontaneous low-frequency fluctuations in the BOLD signal in schizophrenic patients: anomalies in the default network. Schizophrenia Bulletin 33, 1004–1012] of resting state connectivity in schizophrenia by examining alterations in connectivity of the retrosplenial cortex. We have previously demonstrated altered connectivity of the posterior cingulate/precuneus, particularly with other regions of the “default network” (which includes the medial prefrontal cortex and bilateral lateral parietal cortex). It was hypothesized that the retrosplenial cortex would show aberrant patterns of connectivity with regions of the default network and regions associated with memory. Patients with schizophrenia (N = 17) and healthy controls (N = 17) underwent a 5.5-min resting functional magnetic resonance imaging scan. Lower correlations were observed in patients with schizophrenia than in healthy controls between the retrosplenial cortex and both the temporal lobe and regions of the default network. In patients with schizophrenia, activity in the retrosplenial cortex correlated negatively with activity in bilateral anterior cingulate gyrus/medial prefrontal cortex (BA 32/10), despite the fact that these regions, as part of the default network, were expected to show positive correlations in activity. Connectivity of the retrosplenial cortex was greater in patients with more positive symptoms with areas previously associated with hallucinations, particularly the left superior temporal gyrus. These results suggest that spontaneous activity in the retrosplenial cortex during rest is altered in patients with schizophrenia. These alterations may help to explain alterations in self-oriented processing in this patient population.     

Adaptation of the stroop color and word test for use with deaf adults

Abstract

The Stroop Color and Word Test was administered once to 20 deaf adults who responded with American Sign Language (ASL) responses, and twice to 29 hearing adults who were fluent in sign language - once using signed responses, and once using spoken responses. For the hearing subjects, signed responses were significantly slower than spoken responses in both the word and color conditions, but not in the color-word condition. No significant differences were found when comparing the rate of signing of the deaf subjects to that of the hearing subjects. These results demonstrate that Stroop responses cannot be signed as rapidly as they can be spoken; therefore, it would be inappropriate to apply standard adult norms to Stroop scores obtained from signed responses. This paper provides preliminary norms which are appropriate for use with deaf adults giving signed responses to the Stroop Color and Word Test.     

Youth Views on Communication About ADHD and Medication Adherence

The purpose of this study was to examine youth perceptions of attention deficit hyperactivity disorder (ADHD) communication with their pediatric providers, their reported adherence to their ADHD medications, and their desired location for an ADHD educational program. Youth ages 7 through 17 with an ADHD diagnosis were recruited. A research associate interviewed the youth. Parents completed demographic questionnaires. Seventy families participated. One-third of the youth wanted more discussion about ADHD with their providers during visits. The average youth had over eight questions about ADHD and its treatment. Most youth wanted to learn about ADHD at their provider’s office. Non-white and older youth were significantly more likely to be less adherent to their ADHD medications. Youth want their providers to engage them more during visits. Providers should take advantage of this interest to engage youth more in discussions regarding ADHD and its treatment during pediatric ADHD visits.     

Serum BLyS levels increase after rituximab as initial therapy in patients with follicular grade 1 non‐Hodgkin lymphoma

Serum B‐lymphocyte stimulator (BLyS) levels are elevated in a subset of non‐Hodgkin lymphoma (NHL) patients, particularly those with a family history of B‐cell malignancies or a polymorphism in the BLyS gene. BLyS promotes growth of malignant B‐cells and increased serum BLyS levels are associated with a poor clinical outcome. In this study, BLyS levels were measured before and after 4 weekly doses of rituximab in 30 patients with previously untreated follicular Grade 1 NHL. A significant increase was seen in the serum levels of BLyS (P = 0.0001) after rituximab therapy. The increase was independent of genetic variability in the BLyS gene. Am. J. Hematol., 2009. © 2008 Wiley‐Liss, Inc.     

Initial evaluation of a cultural approach to implementation of evidence‐based parenting interventions in American Indian communities

The current investigation puts forth the authors' conceptualization of a cultural approach to implementing evidence‐based practices with American Indian (AI) families. Their approach involves two phases, the motivational phase, which sets an historical context for current difficulties; and the intervention phase, which links evidence‐based skills with cultural traditions, beliefs, and values. Herein, they present preliminary evidence for the efficacy of the intervention phase, overlaid onto the Incredible Years parenting program (Webster‐Stratton, 1992). Forty‐nine families with American Indian children, ages 3–11 (26 boys), participated in the study; all families participated in the motivational phase and were subsequently randomized to the culturally linked intervention or a control condition. Significant pre‐ and postimprovements in parenting and child behavior were observed in the intervention group. Moreover, a majority of participants reported high levels of satisfaction with the intervention. Results are discussed in relation to approaches to respectful implementation of mainstream, evidence‐based interventions in Indian Country. © 2009 Wiley Periodicals, Inc.     

Self-reported prevalence and factors associated with nonadherence with glaucoma medications in veteran outpatients

Objective: The purpose of the current study was to determine the self-reported prevalence of and factors associated with nonadherence with glaucoma medications in veteran outpatients.Methods: This survey study was conducted at a Veterans Affairs (VA) clinic. A survey was administered to patients with glaucoma. We calculated the percentage of self-reported adherence with glaucoma medications in each patient. Logistic regression was used to assess whether patient characteristics and difficulties with using glaucoma medications were related to patients' reporting that they were <100% adherent with their glaucoma medications in the previous week.Results: The survey was completed by 141 patients (men, 91.5%; mean [SD] age, 70.22 [11.60] years [range, 37–93 years]; black race, 45.4%; white race, 44.0%; “other” or data unavailable, 10.6%). Nonwhite patients were significantly less adherent in the previous week than were white patients (27.0% vs 11.3%; P < 0.05). A total of 67.4% patients reported ≥1 difficulty in using their glaucoma medications. The 3 most commonly reported difficulties were “drops fall on cheek” (29.1%), “too many drops come out” (20.6%), and “hard to read print” (17.0%). A total of 19.1% of patients self-reported using <100% of their glaucoma medications in the previous week. The number of difficulties reported was significantly associated with reporting being <100% adherent in the previous week (P<0.05).Conclusion: In this small sample of VA patients with glaucoma, adherence to glaucoma medications could be improved, especially among those who reported difficulties using their medications and those who were nonwhite.     

Assessment of 54 biomarkers for biopsy-detectable prostate cancer.

OBJECTIVE: We analyzed the association of 54 biomarkers from seven classes including adipokines, immune response metalloproteinases, adhesion molecules, and growth factors with prostate cancer risk adjusting for the Prostate Cancer Prevention Trial (PCPT) risk score. METHODS: A total of 123 incident prostate cancer cases and 127 age-matched controls were selected from subjects in the San Antonio Center for Biomarkers of Risk of Prostate Cancer cohort study. Prediagnostic serum concentrations were measured in the sample collected at baseline using LabMAP technology. The odds ratios (OR) of prostate cancer risk associated with serum concentrations of 54 markers were estimated using univariate conditional logistic regression before and after adjustment for the PCPT risk score. Two-way hierarchical unsupervised clustering techniques were used to evaluate whether the 54-marker panel distinguished cases from controls. RESULTS: Vascular endothelial growth factor, resistin, interleukin 1Ra (IL-1Ra), granulocyte colony-stimulating factor, matrix metalloproteinase-3, plasminogen activator inhibitor, and kallikrein-8 were statistically significantly (P < 0.05) underexpressed in prostate cancer cases, and alpha-fetoprotein was statistically significantly overexpressed in prostate cancer cases, but all had area underneath the receiver-operating characteristic curve <60%; none were statistically significant adjusting for multiple comparisons (P < 0.0008) or after adjustment for the PCPT risk score. Statistical clustering of patients by the marker panel did not distinguish a separate group of cases from controls. CONCLUSIONS: This age-matched case-control study did not support findings of increased diagnostic potential from a 54-marker panel when compared with the conventional risk factors incorporated in the PCPT risk calculator. Future discovery of new biomarkers should always be tested and compared against conventional risk factors before applying them in clinical practice.