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1.  Comparison of Longer-Term Safety and Effectiveness of Four Atypical Antipsychotics in Patients over Age 40: A Trial Using Equipoise-Stratified Randomization 
Objective
To compare longer-term safety and effectiveness of the four most commonly used atypical antipsychotics (AAPs: aripiprazole, olanzapine, quetiapine, and risperidone) in 332 patients, aged >40 years, having psychosis associated with schizophrenia, mood disorders, PTSD, or dementia, diagnosed using DSM-IV-TR criteria.
Methods
We used Equipoise-Stratified Randomization (a hybrid of Complete Randomization and Clinician’s Choice Methods) that allowed patients or their treating psychiatrists to exclude one or two of the study AAPs, because of past experience or anticipated risk. Patients were followed for up to two years, with assessments at baseline, 6 weeks, 12 weeks, and every 12 weeks thereafter. Medications were administered employing open-label design and flexible dosages, but with blind raters.
Outcome Measures
(1) Primary metabolic markers (body mass index or BMI, blood pressure, fasting blood glucose, LDL cholesterol, HDL cholesterol, and triglycerides), (2) % patients who stay on the randomly assigned AAP for at least 6 months, (3) Psychopathology, (4) % patients who develop Metabolic Syndrome, and (5) % patients who develop serious and non-serious adverse events.
Results
Because of high incidence of serious adverse events, quetiapine was discontinued midway through the trial. There were significant differences among patients willing to be randomized to different AAPs, suggesting that treating clinicians tended to exclude olanzapine and prefer aripiprazole as one of the possible choices in patients with metabolic problems. Yet, the AAP groups did not differ in longitudinal changes in metabolic parameters or on most other outcome measures. Overall results suggested a high discontinuation rate (median duration 26 weeks prior to discontinuation), lack of significant improvement in psychopathology, and high cumulative incidence of metabolic syndrome (36.5% in one year) and of serious (23.7%) and non-serious (50.8%) adverse events for all AAPs in the study.
Conclusions
Employing a study design that closely mimicked clinical practice, we found a lack of effectiveness and a high incidence of side effects with four commonly prescribed AAPs across diagnostic groups in patients over age 40, with relatively few differences among the drugs. Caution in the use of these drugs is warranted in middle-aged and older patients.
doi:10.4088/JCP.12m08001
PMCID: PMC3600635  PMID: 23218100
Antipsychotic; Metabolic Syndrome; Schizophrenia; Dementia; Mood disorder; Equipoise-Stratified Randomization
2.  DEVELOPMENT OF PARENTING SELF-EFFICACY IN MOTHERS OF INFANTS WITH HIGH NEGATIVE EMOTIONALITY 
Infant mental health journal  2012;33(1):10.1002/imhj.20332.
Maternal parenting self-efficacy (PSE) is a potential target for infant mental health interventions because it is associated with a number of positive outcomes for children and mothers. Understanding the development of maternal PSE under conditions of increased parenting stress, such as parenting an infant who is easily distressed and difficult to soothe, will contribute to providing more effective interventions. This study examines the development of maternal PSE in mothers of infants with high negative emotionality (NE). The Neonatal Behavioral Assessment Scale (NBAS; T. Brazelton, 1973) was administered twice to 111 infants to select a sample of irritable (n = 24) and nonirritable (n = 29) infants for a prospective study comparing the development of PSE in mothers of infants differing in neonatal NE. Consistent with our hypotheses and previous research, at 8 weeks’ postpartum, mothers of irritable infants have significantly lower domain-specific PSE than do mothers of nonirritable infants. Contrary to our predictions, mothers of irritable infants exhibit a significant increase in domain-specific and domain-general PSE from 8 to 16 weeks’ postpartum. The implications of these results for infant mental health screening, infant mental health interventions, and research on self-efficacy theory are discussed.
doi:10.1002/imhj.20332
PMCID: PMC3875133  PMID: 24382937
3.  Short-term practice effects in amnestic mild cognitive impairment: implications for diagnosis and treatment 
Background
Practice effects have been widely reported in healthy older adults, but these improvements due to repeat exposure to test materials have been more equivocal in individuals with mild cognitive impairment (MCI).
Methods
The current study examined short-term practice effects in MCI by repeating a brief battery of cognitive tests across one week in 59 older adults with amnestic MCI and 62 intact older adults.
Results
Participants with amnestic MCI showed significantly greater improvements on two delayed recall measures (p < 0.01) compared to intact peers. All other practice effects were comparable between these two groups. Practice effects significantly improved scores in the MCI group so that 49% of them were reclassified as “intact” after one week, whereas the other 51% remained “stable” as MCI. Secondary analyses indicated the MCI-Intact group demonstrated larger practice effects on two memory measures than their peers (p < 0.01).
Conclusions
These results continue to inform us about the nature of memory deficits in MCI, and could have implications for the diagnosis and possible treatment of this amnestic condition.
doi:10.1017/S1041610208007254
PMCID: PMC3789513  PMID: 18405398
mild cognitive impairment; practice effects; repeat testing
4.  Anxious symptoms and cognitive function in non-demented elderly adults: an inverse relationship 
Objective
The goals of this study were to determine the relationship between anxious symptoms and cognitive functioning in a non-demented, community-dwelling elderly sample (N = 48), and to determine the effect of depressive symptoms upon this relationship.
Methods
Anxious and depressive symptoms were assessed using Symptom Checklist 90-Revised. Cognitive functioning was assessed with the Repeatable Battery for the Assessment of Neuropsychological Status.
Results
Results indicated that while both cognitive functioning and anxious symptoms were within normal limits in this sample, anxious symptoms showed a significant, inverse relationship with global cognitive function [r(47) = −.400, p = .005]. In addition, specific relationships were noted between severity of anxious symptoms and visuospatial/constructional ability as well as immediate and delayed memory. With regard to the secondary objective, both anxiety and depressive symptoms together accounted for the highest level of variance [R2 = .175, F(2, 45) = 4.786, p = .013] compared to anxiety [R2(47) = .160, p = .005] and depression [R2(47) = .106, p = .024] alone. Nevertheless, neither anxious nor depressive symptoms emerged as a unique correlate with cognitive ability [r(47)= −.278, p = .058; r(48)= −.136, p = .363, respectively].
Conclusion
This study demonstrates that subthreshold anxiety symptoms and cognitive functioning are significantly related even among generally healthy older adults whose cognitive ability and severity of anxious symptoms are within broad normal limits. These findings have implications both for clinical care of elderly patients, as well as for cognitive research studies utilizing this population.
doi:10.1002/gps.2785
PMCID: PMC3391343  PMID: 21919061
anxiety; cognitive function; elderly
5.  Association between the serotonin transporter promoter polymorphism (5-HTTLPR) and adult unresolved attachment 
Developmental psychology  2009;45(1):64-76.
Research on antecedents of organized attachment has focused on the quality of caregiving received during childhood. In recent years, research has begun to examine the influence of genetic factors on quality of infant attachment. However, no published studies report on the association between specific genetic factors and adult attachment. This study examined the link between the 5-HTTLPR promoter polymorphism of the serotonin transporter gene and adult unresolved attachment assessed with the Adult Attachment Interview. Genetic material and information on attachment-related loss or trauma were available for 86 participants. Multivariate regression analyses showed an association between the short 5-HTTLPR allele and increased risk for unresolved attachment. Temperament traits and psychological symptoms did not affect the association between 5-HTTLPR and unresolved attachment. The authors hypothesize that the increased susceptibility to unresolved attachment among carriers of the short allele of 5-HTTLPR is consistent with the role of serotonin in modulation of frontal–amygdala circuitry. The findings challenge current thinking by demonstrating significant genetic influences on a phenomenon previously thought to be largely environmentally driven.
doi:10.1037/a0014026
PMCID: PMC3676880  PMID: 19209991
6.  IQ estimate smackdown: Comparing IQ proxy measures to the WAIS-III 
Brief assessments of general cognitive ability are frequently needed by neuropsychologists, and many methods of estimating intelligence quotient (IQ) have been published. While these measures typically present overall correlations with the Wechsler Adult Intelligence Scale (WAIS) Full Scale IQ, it is tacitly acknowledged that these estimates are most accurate within 1 standard deviation of the mean and that accuracy diminishes moving toward the tails of the IQ distribution. However, little work has been done to systematically characterize proxy measures at the tails of the IQ distribution. Additionally, while these measures are all correlated with the WAIS, multiple proxy measures are rarely presented in one manuscript. The current article has two goals: (1) Examine various IQ proxies against Wechsler Adult Intelligence Scale (Third Version) scores, showing the overall accuracy of each measure against the gold standard IQ measure. This comparison will assist in selecting the best proxy measure for particular clinical constraints. (2) The sample is then divided into three groups (below, average, and above-average ability), and each group is analyzed separately to characterize proxy performance at the tails of the IQ distribution. Repeated measures multivariate analysis of variance compares the different proxy measures across ability levels. All IQ estimates are represented in tables so that they can be examined side by side.
doi:10.1017/S1355617709090766
PMCID: PMC3666826  PMID: 19573277
7.  Barriers to Care for Antenatal Depression 
Objective
This study examined the individual-level factors impacting pregnant women’s access to mental health treatment for depression.
Methods
A total of 1,416 pregnant women receiving prenatal care completed measures of depressive symptomatology, willingness to seek treatment for depression or anxiety, and perceived barriers to seeking such care.
Results
Women with Beck Depression Inventory scores {greater than or equal to; ≥}16 (indicating possible depression) (N=183) were more likely than women with lower scores (N=1,233) to identify the following barriers: cost, lack of insurance, lack of transportation, long waits for treatment, previous bad experience with mental health care, and not knowing where to go for treatment. Lower income was correlated with increased endorsement of cost and transportation as barriers.
Conclusions
Results suggest that addressing financial and logistical barriers through changes in mental health services and policy will improve access to care for antenatal depression. However, attending to these issues alone will not address additional important barriers to care such as lack of trust.
doi:10.1176/appi.ps.59.4.429
PMCID: PMC3652590  PMID: 18378843
8.  Implementation of an Evidence-Based Depression Treatment Into Social Service Settings: The Relative Importance of Acceptability and Contextual Factors 
Listening Visits (LV), an empirically supported depression treatment delivered by non mental health specialists, were implemented into two distinctly structured programs. The relative importance of providers’ views and organizational context on implementation were examined. Thirty-seven home visitors completed pre- and post-LV training surveys assessing their views toward implementing LV. Implementation rates markedly differed in the two organizations (73.9% vs. 35.7%). Logistic regression results showed that when predicting the implementation rate, the impact of the organizational setting outweighed home visitors’ personal views. These results underscore the importance of organizational context in the implementation of empirically supported treatments.
doi:10.1007/s10488-011-0345-0
PMCID: PMC3166422  PMID: 21461974
Depression treatment; Implementation; Views; Organizational context
9.  Systems Training for Emotional Predictability and Problem Solving (STEPPS) for Outpatients With Borderline Personality Disorder: A Randomized Controlled Trial and 1-Year Follow-Up 
The American journal of psychiatry  2008;165(4):468-478.
Objective
Systems Training for Emotional Predictability and Problem Solving (STEPPS) is a 20-week manual-based group treatment program for outpatients with borderline personality disorder that combines cognitive behavioral elements and skills training with a systems component. The authors compared STEPPS plus treatment as usual with treatment as usual alone in a randomized controlled trial.
Method
Subjects with borderline personality disorder were randomly assigned to STEPPS plus treatment as usual or treatment as usual alone. Total score on the Zanarini Rating Scale for Borderline Personality Disorder was the primary outcome measure. Secondary outcomes included measures of global functioning, depression, impulsivity, and social functioning; suicide attempts and self-harm acts; and crisis utilization. Subjects were followed 1 year posttreatment. A linear mixed-effects model was used in the analysis.
Results
Data pertaining to 124 subjects (STEPPS plus treatment as usual [N=65]; treatment as usual alone [N=59]) were analyzed. Subjects assigned to STEPPS plus treatment as usual experienced greater improvement in the Zanarini Rating Scale for Borderline Personality Disorder total score and subscales assessing affective, cognitive, interpersonal, and impulsive domains. STEPPS plus treatment as usual also led to greater improvements in impulsivity, negative affectivity, mood, and global functioning. These differences yielded moderate to large effect sizes. There were no differences between groups for suicide attempts, self-harm acts, or hospitalizations. Most gains attributed to STEPPS were maintained during follow-up. Fewer STEPPS plus treatment as usual subjects had emergency department visits during treatment and follow-up. The discontinuation rate was high in both groups.
Conclusions
STEPPS, an adjunctive group treatment, can deliver clinically meaningful improvements in borderline personality disorder-related symptoms and behaviors, enhance global functioning, and relieve depression.
doi:10.1176/appi.ajp.2007.07071079
PMCID: PMC3608469  PMID: 18281407
10.  Vascular smooth muscle function is associated with initiation and processing speed in patients with atherosclerotic vascular disease 
We previously reported a relationship between forearm resistance vessel function and global neuropsychological performance in patients with atherosclerotic vascular disease (AVD). This study was conducted to determine the relationships among vascular smooth muscle function, endothelial function, and initiation and processing speed in this sample. Participants were 80 individuals with AVD. Resistance vessel function was measured before and after infusion of vasoactive agents. Neuropsychological assessment included measures of estimated premorbid cognitive function, current global cognitive function, initiation, and processing speed. Vascular smooth muscle function was significantly associated with the initiation/processing speed composite score [R-Square Change = .152; F Change (1,71) = 16.61; p < .001], above and beyond the variance accounted for by age, education, premorbid cognitive function, and endothelium-dependent vascular function. This relationship remained significant when controlling for current level of global cognitive functioning and 10 vascular risk factors. Endothelium-dependent vascular function was not significantly associated with test performance. Decreased vascular smooth muscle function in forearm resistance vessels was significantly associated with relatively poor initiation and processing speed in individuals with AVD. With additional research, measures of vascular function might become useful in the early identification of those individuals at greatest risk for vascular-related cognitive dysfunction.
doi:10.1017/S1355617708080697
PMCID: PMC3597121  PMID: 18577282
Vascular dementia; Subcortical vascular dementia; Neuropsychology; Atherosclerosis; Aging; Vascular endothelium-dependent relaxation
11.  Gender differences in neuropsychological performance in individuals with atherosclerosis: Impact of vascular function 
This study was conducted to assess gender differences in cognition in elderly individuals (N = 88; 38 women, 50 men) with atherosclerotic vascular disease (AVD) and to determine whether these were attributable to differences in vascular health. Assessments included neuropsychological testing and measurement of forearm vascular function using venous occlusion plethysmography. There was a significant female advantage on multiple neuropsychological tests. This gender effect was reduced somewhat but remained significant when controlling for education and vascular function. Our study suggests that gender differences in cognition persist into older age and are not primarily due to gender differences in vascular health.
doi:10.1080/13803391003757841
PMCID: PMC3592378  PMID: 20512721
Gender; Cognition; Vascular disease; Neuropsychology; Vascular function
12.  Cerebral Blood Flow and Neuropsychological Functioning in Elderly Vascular Disease Patients 
This study was designed to determine the relationships between PET-based quantitative measures of cerebral blood flow and cerebrovascular reserve and neuropsychological functioning in elderly individuals with atherosclerotic vascular disease. It was hypothesized that cerebrovascular function would be significantly associated with neuropsychological functioning. Results showed that both baseline global cerebral blood flow and cerebrovascular reserve were significantly associated with global neuropsychological functioning, when controlling for age and sex. Cerebrovascular reserve was additionally associated with performance on measures of memory and attention. Additional research is needed to determine whether measures of cerebral blood flow can be used to predict cognitive decline.
doi:10.1080/13803395.2011.630653
PMCID: PMC3582376  PMID: 22149630
13.  Impulsive and Callous Traits Are More Strongly Associated With Delinquent Behavior in Higher Risk Neighborhoods Among Boys and Girls 
Journal of abnormal psychology  2008;117(2):377-385.
The purpose of the present study was to determine whether the effect of impulsive and callous personality traits on delinquent behavior varied across neighborhood context in a population-based, statewide sample of 85,000 Iowa schoolchildren ages 10–19. Two previous studies examining the association between impulsivity and delinquency across disadvantaged and affluent neighborhoods have yielded contrasting findings. Results of the present study suggested a robust moderating effect of neighborhood context on personality risk for delinquency. The relation between impulsivity and delinquency was greater in neighborhoods low in collective efficacy compared to neighborhoods high in collective efficacy. A similar interaction was found for callous personality traits, indicating the consistency of the moderating effect of neighborhood context on personality risk for delinquency. Gender differences were also examined, and results were replicated in a holdout sample.
doi:10.1037/0021-843X.117.2.377
PMCID: PMC3553854  PMID: 18489213
delinquency; neighborhood context; impulsivity; callousness; gender differences
14.  Practice effects predict cognitive outcome in amnestic Mild Cognitive Impairment 
Objective
Practice effects on cognitive tests have been shown to further characterize patients with amnestic Mild Cognitive Impairment (aMCI), and may provide predictive information about cognitive change across time. We tested the hypothesis that a loss of practice effects would portend a worse prognosis in aMCI.
Design
Longitudinal, observational design following participants across one year.
Setting
Community-based cohort.
Participants
Three groups of older adults: 1. cognitively intact (n=57), 2. aMCI with large practice effects across one week (MCI+PE, n=25), and 3. aMCI with minimal practice effects across one week (MCI−PE, n=26).
Measurements
Neuropsychological tests.
Results
After controlling for age and baseline cognitive differences, the MCI−PE group performed significantly worse than the other groups after one year on measures of immediate memory, delayed memory, language, and overall cognition.
Conclusions
Although these results need to be replicated in larger samples, the loss of short-term practice effects portends a worse prognosis in patients with aMCI.
doi:10.1097/JGP.0b013e318209dd3a
PMCID: PMC3202689  PMID: 22024617
Mild Cognitive Impairment; practice effects; dementia
15.  Increased frequency of first episode poststroke depression following discontinuation of escitalopram 
Background and Purpose
To compare escitalopram, problem-solving therapy (PST), and placebo, to prevent poststroke depression during 6 months after discontinuation of treatment.
Methods
We examined for depression, 33 patients assigned to placebo, 34 to escitalopram, and 41 to PST.
Results
After controlling for age, gender, prior mood disorder, and severity of stroke, new onset major depression and Hamilton Depression scores were significantly higher 6 months after escitalopram was discontinued, compared to the PST or placebo groups.
Conclusions
Discontinuation of escitalopram may increase poststroke depressive symptoms.
doi:10.1161/STROKEAHA.111.626507
PMCID: PMC3223021  PMID: 21868736
stroke; depression
16.  Listening Visits: An Evaluation of the Effectiveness and Acceptability of a Home-based Depression Treatment 
Purpose
Maternal depression affects approximately one in five women, is under-treated, and compromises infant development. In the UK, public health nurses provide an empirically supported intervention (Listening Visits or LV), to depressed postpartum women. This study evaluates the effectiveness of LV when delivered by US home visitors.
Method
Nineteen women with depressive symptoms received LV. Pre, post, and follow-up assessments evaluated depression status, life satisfaction, and treatment acceptability.
Results
Listening Visits were associated with a statistically and clinically significant reduction in depression, improvement in life satisfaction, and were acceptable to women.
Conclusions
Listening Visits show considerable promise as an effective and acceptable depression treatment.
doi:10.1080/10503307.2010.518636
PMCID: PMC3226338  PMID: 21154029
17.  Remission from Substance Dependence in U.S. Whites, African-Americans, and Latinos 
We investigated remission from any type of substance dependence in Latinos, African Americans, and whites using the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions, a national sample of community adults. Analyses focused on the 4,520 participants who indicated prior-to-last-year dependence on either alcohol or drugs. Outcome was categorized as current substance dependence or abuse, current use, or abstinence. Whites reported greater likelihood of substance dependence and African Americans and Latinos are just as likely to remit as Whites, once social support and age are controlled. The outcome variable “time to remission” produced a similar pattern of results.
doi:10.1080/15332640.2010.522889
PMCID: PMC3207634  PMID: 21161807
Recovery; Remission; Race; Ethnicity
18.  Clinical Variables Impacting Prescribing of Olanzapine, Quetiapine, and Risperidone 
Pharmacotherapy  2011;31(8):806-812.
Objective
To identify determinants of new use of the first-line SGAs associated with weight gain.
Design
Retrospective chart review.
Setting
Outpatient and inpatient psychiatry services at a tertiary, academic medical center.
Patients
Sample of 340 consecutive patients over two time periods with major depression with psychotic features, bipolar I, bipolar II, bipolar not otherwise specified, and schizoaffective disorder.
Interventions
None.
Measurements and Main Results
Clinical and sociodemographic variables associated with new use of olanzapine, risperidone, and quetiapine were identified using univariate and multivariate logistic regression. Several clinical factors were individually associated with initiation of these SGAs: mania (OR 3.6, 95% CI 1.2–10.8), psychosis (OR 3.3, 95% CI 1.5–6.9), and inpatient treatment (OR 3.8, 95% CI 1.8–7.9). Prevalent use of lithium (OR 0.3, 95% CI 0.1–0.9) and being married (OR 0.3, 95% CI 0.1–0.8) were inversely associated. Mania, psychosis, married status, and lithium use remained independently associated on multivariate analysis. Factors related to metabolic or vascular risk were not associated with SGA initiation.
Conclusions
Psychiatric clinicians weigh clinical features related to mental status and acuity heavily in determining whether to initiate SGAs. However, factors related to vascular risk were not associated. Future observational studies should consider current clinical status as an important factor in determining propensity to receive antipsychotics or other acute treatments for bipolar disorder.
doi:10.1592/phco.31.8.806
PMCID: PMC3192400  PMID: 21923607
Antipsychotic agents; Bipolar disorder; Inpatients; Logistic models; Major Depressive Disorder; Outpatients; Propensity Score; Psychotic Disorders
19.  Screening and Counseling for Postpartum Depression by Nurses: The Women’s Views 
Purpose
In this Part 2 article of research examining a model of care in which nurses screen and counsel postpartum women for postpartum depression, acceptability of such a model to postpartum patients was evaluated with a diverse sample of American women.
Study Design and Methods
Descriptive survey of two groups: 691 predominately white postpartum women with relatively high annual incomes (Sample 1) and 132 low-income women, some of whom were ethnic minorities (Sample 2). The surveys were distributed and needed to be mailed back to the investigators. The response rate was 72% in Sample 1 and 30% in Sample 2.
Results
The overwhelming majority in both groups (>90%) felt that it was acceptable for nurses to perform screening for postpartum depression and for nurses to do the necessary counseling. More than one-half in each sample were “definitely willing” to see a nurse for counseling. Although women in both samples had positive views, when compared with each other, women with higher incomes (Sample 1) had more positive views of nurse delivered mental health care. More than one-half in each sample were “definitely willing” to see a nurse for counseling. For Sample 1, 15% reported having taken medications for postpartum depression; in Sample 2 this number was 22.3%.
Clinical Implications
Nurses have frequent contact with postpartum women; as such, they are well positioned to provide depression screening and counseling. Nurse-delivered mental health care has the potential to obviate many barriers that prevent the detection and treatment of depression, and ultimately improve outcomes for infant and children.
doi:10.1097/NMC.0b013e3181e62679
PMCID: PMC3106984  PMID: 20706098
Postpartum Depression; Nurses’ Role; Counseling; Patient Acceptance of Health Care
20.  Nursing Care for Postpartum Depression, Part 1: Do Nurses Think they should offer both Screening and Counseling? 
Purpose
To assess nurses' views of a nursing model in which nurses screen and also treat new mothers who exhibit symptoms of depression.
Study Design and Methods
This is Part 1 of this descriptive survey (Part 2 in MCN 35(4)), in which nurses (n=520) completed a statewide survey assessing nurses' views of a model of nursing care which both screens and treats postpartum depression.
Results
The majority “strongly agreed” or “agreed” with the statement “having nurses screen for depression using a brief screening tool is a good idea”. Most (67.1%) chose the Ob-Gyn Clinic as the appropriate site for such screening. Regarding treatment by nurses, the vast majority of nurses (93.7%) “agreed” or “strongly agreed” with the statement “nurse-delivered counseling with mildly depressed women is a good idea.” Almost one-half of the nurses already regularly provided some form of counseling and approximately three quarters were willing to participate in a counseling skills training program. Less than 1.0% (n=3) indicated that nurse-delivered counseling should not be implemented. The most frequently chosen setting for a nurse-delivered counseling program was home visits (70.6%, n=367).
Clinical Implications
Our results indicate nurse-delivered screening and treatment of postpartum women is overwhelmingly supported by this segment of US nursing professionals, and indeed, is already occurring in many instances. Nurses who have frequent contact with women during the perinatal period are well positioned to provide screening and treatment for PPD. To implement the 2 part UK model (both screening and treatment), it is necessary to develop educational programs for staff and patients, and establish screening and treatment protocols as well as referral resources for those with such a need.
doi:10.1097/NMC.0b013e3181dd9d81
PMCID: PMC2898158  PMID: 20585212
Postpartum Depression; Nurses' Role; Counseling
21.  Birth Outcomes, Lifetime Alcohol Dependence and Cognition in Middle Adulthood 
Prenatal exposure to alcohol is associated with cognitive abnormalities that persist throughout the lifespan and are also often a focus of studies examining cognitive outcomes associated with excessive alcohol use by an individual. This study examined the effect of birth outcomes consistent with fetal alcohol exposure on associations between lifetime alcohol dependence and cognition in middle adulthood. The sample was comprised of 315 adult adoptees ranging in age from 31 to 64 years (SD = 7.20). Facial morphology, pre-morbid cognition, and current cognition were assessed. Birth parent behaviors and birth outcomes (e.g., birthweight, gestational age) were obtained from adoption agency records. Lifetime alcohol dependence was determined from the Semi-Structured Assessment of the Genetics of Alcoholism – II. Univariate associations showed significantly poorer pre-morbid and current cognition when birth parent problems, short palpebral fissures, and thin upper lips were present. Lifetime alcohol dependence was associated with lower perceptional organization, processing speed and working memory. Multivariate analyses demonstrated continued significance suggesting unique contributions of each to cognition. Evaluating the possible role of fetal alcohol exposure within studies on alcoholism can only further improve the treatment and prevention of alcohol-related problems by isolating those cognitive outcomes uniquely attributable to an individual’s consumption of alcohol.
doi:10.4172/2155-6105.1000102
PMCID: PMC3105241  PMID: 21643430
Fetal alcohol exposure; Alcohol dependence; Cognition; Facial morphology
22.  Predicting Cognitive Change in Older Adults: The Relative Contribution of Practice Effects 
Assessing cognitive change in older adults is a common use of neuropsychological services, and neuropsychologists have utilized several strategies to determine if a change is “real,” “reliable,” and “meaningful.” Although standardized regression-based (SRB) prediction formulas may be useful in determining change, SRBs have not been widely applied to older adults. The current study sought to develop SRB formulas on a group of 127 community-dwelling older adults for several widely used neuropsychological measures. In addition to baseline test scores and demographic information, the current study also examined the role of short-term practice effects in predicting test scores after 1 year. Consistent with prior research on younger adults, baseline test performances were the strongest predictors of future test performances, accounting for 25%–58% of the variance. Short-term practice effects significantly added to the predictability of all nine of the cognitive tests examined (3%–22%). Future studies should continue extending SRB methodology for older adults, and the inclusion of practice effects appears to add to the prediction of future cognition.
doi:10.1093/arclin/acp105
PMCID: PMC2819829  PMID: 20064816
Predicting cognition; Practice effects
23.  Assessing community variation and randomness in public health indicators 
Background
Evidence-based health indicators are vital to needs-based programming and epidemiological planning. Agencies frequently make programming funds available to local jurisdictions based on need. The use of objective indicators to determine need is attractive but assumes that selection of communities with the highest indicators reflects something other than random variability from sampling error.
Methods
The authors compare the statistical performance of two heterogeneity measures applied to community differences that provide tests for randomness and measures of the percentage of true community variation, as well as estimates of the true variation. One measure comes from the meta-analysis literature and the other from the simple Pearson chi-square statistic. Simulations of populations and an example using real data are provided.
Results
The measure based on the simple chi-square statistic seems superior, offering better protection against Type I errors and providing more accurate estimates of the true community variance.
Conclusions
The heterogeneity measure based on Pearson's χ2 should be used to assess indices. Methods for improving poor indices are discussed.
doi:10.1186/1478-7954-9-3
PMCID: PMC3045330  PMID: 21288354
24.  Lifetime Substance Misuse and 5-Year Incidence Rates of Emergent Health Problems among Middle-Aged Adults 
Journal of addictive diseases  2009;28(4):320-331.
Understanding the impact of prior substance misuse on emergent health problems is important to the implementation of effective preventive care. This study examined 5-year incidence rates using a sample of middle-aged adult adoptees (N = 309, Mage = 44.32, SDage = 7.28). Subjects reported on health problems at two waves of study. DSM-IV diagnoses of substance misuse were obtained using a semi-structured diagnostic interview. Finally, health services utilization and perceived health status were collected. Lifetime diagnoses of marijuana and other non-marijuana substance misuse significantly predicted new occurrences of cardiovascular and metabolic disease. Alcohol misuse predicted earlier onset of cardiovascular disease among men. Marijuana and other non-marijuana drugs predicted earlier onset of CVD for men and women. Finally, marijuana and other non-marijuana drugs predicted earlier onset of metabolic disease among men. Substance misuse did not predict health services utilization despite higher rates of disease. These findings emphasize the need to assess lifetime substance misuse when evaluating health risks associated with use.
doi:10.1080/10550880903182796
PMCID: PMC2824908  PMID: 20155602
25.  Impulsivity across the course of bipolar disorder 
Bipolar disorders  2010;12(3):285-297.
Objective
To determine whether abnormalities of impulse control persist across the course of bipolar disorder, thereby representing potential state markers and endophenotypes.
Methods
Impulse control of 108 bipolar I manic or mixed patients was measured on three tasks designed to study response inhibition, ability to delay gratification, and attention; namely a stop signal task, a delayed reward task, and a continuous performance task, respectively. Barrett Impulsivity Scale (BIS-11) scores were also obtained. Patients were then followed for up to one year and re-assessed with the same measures if they developed depression or euthymia. Healthy comparison subjects were also assessed with the same instruments on two occasions to assess measurement stability.
Results
At baseline, bipolar subjects demonstrated significant deficits on all three tasks as compared to healthy subjects, consistent with more impulsive responding in the bipolar manic/mixed group. In general, performance on the three behavioral tasks normalized upon switching to depression or developing euthymia. In contrast, BIS-11 scores were elevated during mania and remained elevated as bipolar subjects developed depression or achieved euthymia.
Conclusions
Bipolar I disorder patients demonstrate deficits on laboratory tests of various aspects of impulsivity when manic, as compared to healthy subjects, that largely normalize with recovery and switching into depression. However, elevated BIS scores persist across phases of illness. These findings suggest that impulsivity has both affective-state dependent and trait components in bipolar disorder.
doi:10.1111/j.1399-5618.2010.00806.x
PMCID: PMC2923549  PMID: 20565435
Bipolar disorder; BIS; impulsivity; delayed reward; inattention; response inhibition

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