Research Interests:
Research Interests:
A cohort analysis was performed to predict the lifetime lung cancer risk to a US or Canadian nonwhite male steelworker exposed to coke oven emissions. The procedure employed required that the lung cancer mortality (used for risk... more
A cohort analysis was performed to predict the lifetime lung cancer risk to a US or Canadian nonwhite male steelworker exposed to coke oven emissions. The procedure employed required that the lung cancer mortality (used for risk assessment) be estimated by addition of the excess to the background rates. The age-specific excess rates were obtained following selection of the proper excess risk function as implied by the multistage theory of carcinogenesis. A quantitative approach based on model fitting was used for selection of the excess risk function. The results show no evidence that coke oven emissions have a late stage carcinogenic effect. The indication that the agent acts as an initiator is moderate to weak. The number of carcinogenic stages involved was estimated to be four. Based on the assumption that exposure was set at a high concentration for 40 years with a starting age of 20 years, it was estimated that the lifetime risk through age 85+ years for a hypothetical US or Canadian nonwhite male oven worker could be as high as 0.40. This represents a 15-fold increase of the baseline risk.
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Research Interests:
... A block t1ia.gra.in of the neural network based anti-skid brake system is sliown in Figure 2. The in-puts to the neural network adaptive controller are t ... ii~,ioii of t,lie veliicle--brake tlyiiamics is oiily rieces-sttry t,o... more
... A block t1ia.gra.in of the neural network based anti-skid brake system is sliown in Figure 2. The in-puts to the neural network adaptive controller are t ... ii~,ioii of t,lie veliicle--brake tlyiiamics is oiily rieces-sttry t,o oht,a.iii ail approxiriiat,e of tlie plaiit Jacobiaii wliicli is t,heri used to ...
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The Application of Neural Networks to Anti-skid Brake System Design ... obtained from a locked-wheel stop (Table 1). The braking distance is defined as the distance travelled by the vehicle once the brakes have been applied until the... more
The Application of Neural Networks to Anti-skid Brake System Design ... obtained from a locked-wheel stop (Table 1). The braking distance is defined as the distance travelled by the vehicle once the brakes have been applied until the vehicle stops. As can be seen from these ...
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Research Interests:
Abstract Two measures of reliability assessed inter-rater agreement regarding neonatal seizure scoring: coefficient of variation and intraclass correlation coefficient. Ten neonates with electrographic seizures recorded during each of 2 h... more
Abstract Two measures of reliability assessed inter-rater agreement regarding neonatal seizure scoring: coefficient of variation and intraclass correlation coefficient. Ten neonates with electrographic seizures recorded during each of 2 h of an EEG-sleep study were ...
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Research Interests:
A program package using FORTRAN and GLIM is presented to compute lifetime risks of dying from a particular cause of death for a worker subjected to specific risk exposures using death rates adjusted for selected covariates (risk factors).... more
A program package using FORTRAN and GLIM is presented to compute lifetime risks of dying from a particular cause of death for a worker subjected to specific risk exposures using death rates adjusted for selected covariates (risk factors). Calculations of the exposure index and adjusted rates depend on several commonly used procedures. Tests of homogeneity and trend for adjusted rates are provided. Lifetime risks are calculated in two different ways: adjusting or ignoring competing causes of death.
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Use of cognitive, psychiatric and behavioral domains to assess the effectiveness of a pharmacological or behavioral intervention in the treatment of neurodegenerative disorders (e.g., Alzheimer disease) aids the identification of specific... more
Use of cognitive, psychiatric and behavioral domains to assess the effectiveness of a pharmacological or behavioral intervention in the treatment of neurodegenerative disorders (e.g., Alzheimer disease) aids the identification of specific types of impairment or distress in behavioral status and quality-of-life issues in this population. With confirmatory approaches to subscale development readily available, we can obtain a more precise understanding of the sub-components of a scale, potentially providing the basis for selecting behavioral and/or quality-of-life outcome measures that may be more sensitive to the effects of pharmacological or behavioral interventions. The authors illustrate the use of a confirmatory factor-analytic approach to verify scale sub-domains of the Neurobehavioral Rating Scale (NBRS) in elderly patients with dementia. With data collected from two groups of patients being treated for significant psychiatric and behavioral symptoms, authors investigated the relationships among scale items in order to test several competing models, including a general one-factor model, a first-order multifactor model, and a second-order factor model. The first-order model, with seven factors, provided the best fit to the correlations among items in the NBRS, indicating the multidimensionality of problematic behaviors and symptoms exhibited by dementia patients. Authors advocate the use of a confirmatory factor-analytic approach to verify scale sub-domains in other, more widely used rating scales for patients with dementia.
Research Interests: Psychology, Clinical Psychology, Dementia, Medicine, Distress, and 15 moreHumans, Female, Confirmatory factor analysis, Male, American, Mental Disorders, Clinical Sciences, Rating Scale, Aged, Public health systems and services research, Reproducibility of Results, Psychological Models, Cognition disorders, Psychiatric Status Rating Scales, and Elderly patient
The authors treated 115 elderly patients (ambulatory and without dementia) with recurrent major depression, by means of combined nortriptyline and interpersonal psychotherapy. They contrasted Cumulative Illness Rating Scale-Geriatric... more
The authors treated 115 elderly patients (ambulatory and without dementia) with recurrent major depression, by means of combined nortriptyline and interpersonal psychotherapy. They contrasted Cumulative Illness Rating Scale-Geriatric (CIRS-G) scores (for medical burden) in recovered and nonrecovered patients and generated a Cox proportional-hazards model of time-to-remission. The authors found no association between pretreatment chronic medical burden and acute treatment outcome in recovered (83 of 115) and nonrecovered patients and no relation of pretreatment CIRS-G scores with time-to-recovery. Findings support recent recommendations that practitioners be optimistic in treating elderly depressed, ambulatory patients whether or not significant medical burden coexists.
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Research Interests:
The authors' goal was to compare serum anticholinergicity of 61 elderly depressed patients randomly assigned to double-blind treatment with paroxetine (N=31) or nortriptyline (N=30). Both antidepressants were titrated in a... more
The authors' goal was to compare serum anticholinergicity of 61 elderly depressed patients randomly assigned to double-blind treatment with paroxetine (N=31) or nortriptyline (N=30). Both antidepressants were titrated in a standardized manner, and plasma was sampled weekly for measurement of paroxetine and nortriptyline and its hydroxy metabolite concentrations. Serum anticholinergicity was measured at baseline and after 1, 4, and 6 weeks of treatment. Side effects were assessed by using a validated scale. After correcting for pretreatment anticholinergicity, the authors found that mean serum anticholinergicity for the nortriptyline-treated patients was significantly greater than that for the paroxetine group at all weeks assessed. Serum anticholinergicity was significantly correlated with nortriptyline but not with paroxetine plasma levels. Complaints of dry mouth and tachycardia were significantly more frequent and severe in the nortriptyline group. These findings suggest that, at therapeutic plasma concentrations, paroxetine has approximately one-fifth the anticholinergic potential of nortriptyline in older patients.
Research Interests: Depression, Treatment, Medicine, Humans, American Journal of Psychiatry, and 15 moreAmerican, Depressive Disorder, Aged, Radioligand Assay, Xerostomia, Cholinergic Receptor, Biological activity, American J of Psychiatry, Anticholinergic, Tachycardia, Paroxetine, Psychology and Cognitive Sciences, Cholinergic antagonists, Medical and Health Sciences, and Nortriptyline
The authors examined weight change in 32 elderly patients treated for 12 weeks with either nortriptyline or paroxetine during acute-phase pharmacotherapy. Random assignment to treatment and double-blind assessment of weight change were... more
The authors examined weight change in 32 elderly patients treated for 12 weeks with either nortriptyline or paroxetine during acute-phase pharmacotherapy. Random assignment to treatment and double-blind assessment of weight change were performed, including ascertainment of premorbid (i.e., pre-depression) weight. Pretreatment severity of depression was correlated with weight loss during the depressive episode and depression-related weight loss, in turn, correlated with weight regained during antidepressant treatment. There was no differential weight change associated with nortriptyline vs. paroxetine. Rather, subjects in both groups approximated their premorbid weights by 12 weeks of acute-phase pharmacotherapy with either agent. However, additional investigation of weight change during continuation and maintenance pharmacotherapy is necessary and would be clinically useful for the long-term management of elderly patients with depression.
Research Interests: Psychology, Treatment Outcome, Medicine, Humans, Antidepressant, and 15 moreMajor Depressive Disorder, Female, Male, American, Randomized Trial, Clinical Sciences, Pharmacotherapy, Aged, Middle Aged, Public health systems and services research, Body Weight, Serotonin Uptake Inhibitors, Severity of Illness Index, Paroxetine, and Nortriptyline
To our knowledge, no prospective randomized study has compared the efficacy of an antidepressant alone vs. an antidepressant plus a neuroleptic in the treatment of psychotic major depression in late life. The efficacy of nortriptyline vs.... more
To our knowledge, no prospective randomized study has compared the efficacy of an antidepressant alone vs. an antidepressant plus a neuroleptic in the treatment of psychotic major depression in late life. The efficacy of nortriptyline vs. nortriptyline plus perphenazine was compared ...
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The aim of this study is to compare the Empirical Behavioral Rating Scale (E-BEHAVE-AD), Neurobehavioral Rating Scale (NBRS), and Neuropsychiatric Interview (NPI) in detecting behavioral disturbance and psychotic symptoms in dementia and... more
The aim of this study is to compare the Empirical Behavioral Rating Scale (E-BEHAVE-AD), Neurobehavioral Rating Scale (NBRS), and Neuropsychiatric Interview (NPI) in detecting behavioral disturbance and psychotic symptoms in dementia and characterizing changes in response to treatment. Eighty-seven subjects in the randomized controlled trial "Continuation Pharmacotherapy for Agitation of Dementia" were included in this analysis. We compared the detection in, and changes of, both agitation and psychosis, using these three instruments. A receiver operating characteristic analysis was performed to compare the performance of the three instruments in detecting global improvement. The instruments were equally likely to detect agitation. The NBRS was most likely to detect psychosis. Although the NPI best detected improvement in agitation, the instruments were equal for detecting improvement in psychosis. In the receiver operating characteristic analysis for overall clinical impro...
Research Interests: Psychology, Psychosis, Dementia, Medicine, Humans, and 13 moreFemale, Male, ROC Curve, Clinical Sciences, Rating Scale, Rating Scales, Public health systems and services research, RISPERIDONE, Psychotic Disorders, Citalopram, Receiver Operating Characteristic, Psychiatric Status Rating Scales, and Symptom assessment
Deficits in executive functions may play an important role in late-life suicide; however the association is understudied. This study examined cognitive function in general and executive functioning specifically in depressed elderly with... more
Deficits in executive functions may play an important role in late-life suicide; however the association is understudied. This study examined cognitive function in general and executive functioning specifically in depressed elderly with and without suicidal ideation and attempts. Case-control study. University-affiliated psychiatric hospital. We compared 32 suicidal depressed participants aged 60 and older with 32 non-suicidal depressed participants equated for age, education, and gender. We assessed global cognitive function and executive function with the Dementia Rating Scale (DRS) and the Executive Interview (EXIT25), respectively. Suicidal and non-suicidal depressed groups were comparable in terms of severity of depression and burden of physical illness. Suicidal participants performed worse on the EXIT25, and on the DRS total scale, as well as on Memory and Attention subscales. The differences were not explained by the presence of dementia, substance use, medication exposure, ...
Research Interests: Clinical Psychology, Dementia, Cognition, Adaptation, Medicine, and 15 moreComorbidity, Humans, Major Depressive Disorder, Hospitalization, Female, Male, Cognitive Performance, Clinical Sciences, Aged, Middle Aged, Cost of Illness, Frontal Lobe, Attempted Suicide, Cognition disorders, and Case Control Studies
An intent-to-treat (IT) analysis includes all observed data, even those obtained after the primary treatment assignment is changed or rescue treatment is substituted. The so-called "pragmatic" approach accounts for this type of... more
An intent-to-treat (IT) analysis includes all observed data, even those obtained after the primary treatment assignment is changed or rescue treatment is substituted. The so-called "pragmatic" approach accounts for this type of treatment change or rescue treatment. The advantage of the pragmatic approach to IT analysis is that the timing and duration of the rescue treatment can be included in the analysis with mixed-effect modeling, which estimates the difference between the randomized treatment arms while adjusting for the use (timing and duration) of the subsequent treatment. We illustrate the inclusion of information on rescue treatment timing and duration in the analysis of a two-arm randomized clinical trial comparing antidepressant medications in an elderly depressed population. In this study, the randomized treatments are found to be similar. This enhanced analysis, where information about rescue treatment is implicitly added in the model, corroborates our previous ...
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The goal of this study was to test the efficacy of paroxetine for primary insomnia in older adults. Adults over age 55 with primary insomnia were randomly assigned to six weeks of double-blind treatment with paroxetine (N = 14) or placebo... more
The goal of this study was to test the efficacy of paroxetine for primary insomnia in older adults. Adults over age 55 with primary insomnia were randomly assigned to six weeks of double-blind treatment with paroxetine (N = 14) or placebo (N = 13). Outcome measures included persistence or resolution of insomnia; weekly diary measures of sleep quality, daytime alertness, and mood; and pre-/postpolysomnographic measures of sleep latency, wake time after sleep onset, and sleep efficiency. Although weekly diary-based measures showed improved subjective sleep quality, daytime alertness, and mood with paroxetine, the authors observed no effect on sleep efficiency or categorical response rates. Paroxetine appears to be ineffective for treating primary insomnia in old age.
Research Interests: Psychology, Medicine, Insomnia, Mood, Humans, and 15 moreChronic Disease, Female, Male, Clinical Sciences, Polysomnography, Aged, Middle Aged, Sleep Onset, Public health systems and services research, Time Factors, Alertness, Serotonin Uptake Inhibitors, Paroxetine, Primary insomnia, and Sleep initiation and maintenance disorders
To identify actionable predictors of remission to antidepressant pharmacotherapy in depressed older adults and to use signal detection theory to develop decision trees to guide clinical decision making. We treated 277 participants with... more
To identify actionable predictors of remission to antidepressant pharmacotherapy in depressed older adults and to use signal detection theory to develop decision trees to guide clinical decision making. We treated 277 participants with current major depression using open-label venlafaxine XR (up to 300 mg/day) for 12 weeks, in an NIMH-sponsored randomized, placebo-controlled augmentation trial of adjunctive aripiprazole. Multiple logistic regression and signal detection approaches identified predictors of remission in both completer and intent-to-treat samples. Higher baseline depressive symptom severity (odds ratio [OR]: 0.86, 95% confidence interval [CI]: 0.80-0.93; p <0.001), smaller symptom improvement during the first two weeks of treatment (OR: 0.96, 95% CI: 0.94-0.97; p <0.001), male sex (OR: 0.41 95% CI: 0.18-0.93; p = 0.03), duration of current episode ≥2 years (OR: 0.26, 95% CI: 0.12-0.57; p <0.001) and adequate past depression treatment (ATHF ≥3) (OR: 0.34, 95% C...
Research Interests: Psychology, Medicine, Humans, Internal Medicine, Placebo, and 15 moreMajor Depressive Disorder, Female, Male, Quinolones, Clinical Sciences, Aged, Middle Aged, Public health systems and services research, Odds ratio, Combination drug therapy, Logistic Models, Predictive value of tests, Age of Onset, Confidence Interval, and Psychiatric Status Rating Scales
Research Interests: Clinical Trial, Neuropsychopharmacology, Drug interactions, Medicine, Brain, and 15 moreHumans, Internal Medicine, Major Depressive Disorder, Carbon Isotopes, Female, Male, Aged, Middle Aged, Major Depression, Geriatric Assessment, Late Life Depression, Case Control Studies, Paroxetine, Medical and Health Sciences, and Compartmental Model
Research Interests: Depression, Clinical Trial, Medicine, Humans, Major Depressive Disorder, and 15 moreMaximum Likelihood, Female, Male, Missing Data, Data Collection, Aged, Middle Aged, Longitudinal data, Multiple Imputation, Missing Values, Cognition disorders, Neuropsychological Tests, missing at random, Medical and Health Sciences, and Nortriptyline
Research Interests: Pain, Aging, Medicine, Comorbidity, Cognitive Flexibility, and 15 moreHumans, Chronic Disease, Female, Male, Depressive Disorder, Pain Medicine, Aged, Educational Status, Older Adult, Memory Disorders, Pain Measurement, Cognition disorders, Neuropsychological Tests, Disability Evaluation, and McGill pain questionnaire
Mental health education for the staffs of nursing homes is difficult to provide and often inadequate. The objectives of this study were to design and assess a curriculum of staff training on depression and dementia that is accessible,... more
Mental health education for the staffs of nursing homes is difficult to provide and often inadequate. The objectives of this study were to design and assess a curriculum of staff training on depression and dementia that is accessible, educational, and relevant. A core curriculum of 12 computer-based interactive video training modules was created in a television news-documentary format to educate nursing home staffs. A randomized trial of the first six modules, which are dedicated to mental health and aging, was conducted at a computer site (CS), a &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;lecture site&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; (LS), and control site (CON). Three not-for-profit nursing facilities in Western Pennsylvania. The certified nursing assistants, and other nursing staff participated in the study as part of their required training. Nursing staffs at the two intervention sites (CS and LS) were mandated to participate in monthly educational sessions. At the CS, the computer program scheduled staff members each month for 45 minutes of individual, self-paced training using the interactive video modules. At the LS, staff members were scheduled to attend a 45-minute monthly lecture with identical learning objectives delivered by an advanced degree nurse educator. A videotape of the lectures was shown at two additionally scheduled times during the month to accommodate all shifts. Compliance and satisfaction with training were monitored at both intervention sites. Knowledge was assessed at the CS, LS, and CON, before each monthly training session, and with a cumulative post-training exam, administered at the end of the 6-month study. Over the 6-month period, training compliance was 66% and 22% at CS and LS, respectively (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). Satisfaction with training and the relevance of training were rated significantly higher at the CS (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.0001). Before the study, assessed knowledge was similar at the CS, LS, and CON. After 6 months, the CS scored significantly higher than the LS and CON in terms of knowledge (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.005). Individual, self-paced, interactive video education for nursing home staff resulted in greater compliance and satisfaction with training compared to staff receiving lectures. Knowledge of core concepts was greater for staff of the computer site compared to the staffs of either the lecture or control sites at the end of this 6-month study.
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Research Interests: Psychology, Research Design, Clinical Trial, Medicine, Humans, and 14 moreStatistical Inference, Data Collection, Medical Care, Major Depression, Mixture models, Mixture Model, Statistical models, Psychiatric, Drug treatment, Conditional Model, Weighted Averaging, Clinical Trials as Topic, Psychology and Cognitive Sciences, and Medical and Health Sciences
Speed of response is an important clinical issue in the treatment of depressed elderly patients. Our objective was to compare rapid response rates in a study combining therapeutic sleep deprivation (TSD) with paroxetine with two earlier... more
Speed of response is an important clinical issue in the treatment of depressed elderly patients. Our objective was to compare rapid response rates in a study combining therapeutic sleep deprivation (TSD) with paroxetine with two earlier randomized, double-blind studies in late-life depression, one of paroxetine versus nortriptyline and another of nortriptyline versus placebo. We measured depressive symptoms with the 17-item Hamilton Rating Scale of Depression (HRSD), defining rapid response as an HRSD ≤ 10 by 2 weeks. With combination therapy (TSD + paroxetine), 9 of 13 patients (69%) experienced a rapid response. In the nortriptyline versus paroxetine study, nor triptyline brought about rapid response in 12 of 37 (32%) and paroxetine in 11 of 43 patients (26%). In the third study, rapid response to nortriptyline occurred in 10 of 41 patients (24%) and to placebo in 6 of 39 patients (15%). The overall chi square, including the rate of rapid response to placebo, was 14.87 (P = .005)....
Research Interests: Psychology, Medicine, Humans, Placebo, Sleep Deprivation, and 15 moreAntidepressant, Female, Male, Depressive Disorder, Clinical Sciences, Rating Scale, Geriatric Psychiatry, Aged, Middle Aged, Combination drug therapy, Neurosciences, Serotonin Uptake Inhibitors, Combined Modality Therapy, Paroxetine, and Nortriptyline
Research Interests:
Research Interests: Geriatrics, Research Design, Depression, Medicine, Humans, and 15 moreAntidepressant, Major Depressive Disorder, Female, Clinical, Male, Duration, Rating Scale, Aged, Clinical Psychopharmacology, Health services for the aged, Clinical Trials as Topic, Psychiatric Status Rating Scales, Psychology and Cognitive Sciences, Medical and Health Sciences, and Antidepressive agents
Research Interests: Depression, Comparative Study, Medicine, Humans, Hospitalization, and 15 moreFemale, Clinical, Male, Depressive Disorder, Aged, Middle Aged, Clinical Psychiatry, Age Factors, Combination drug therapy, Ambulatory Care, Age of Onset, Multicenter Studies as Topic, Antipsychotic agents, Medical and Health Sciences, and Nortriptyline
Research Interests: Cognitive Science, Medicine, Anxiety, Multivariate Analysis, Humans, and 15 moreMajor Depressive Disorder, Female, Male, Clinical Sciences, Pharmacotherapy, Geriatric Psychiatry, Geriatric, Aged, Middle Aged, Prognosis, Geriatric Assessment, ANXIETY, Citalopram, Escitalopram, and Partial hospitalization
Research Interests: Cognitive Science, Geriatrics, Gerontology, Depression, Evaluation, and 15 moreComparative Study, Humans, Internal Medicine, Antidepressant, Female, Care, Depressive Disorder, Clinical Sciences, Geriatric Psychiatry, Geriatric, Aged, Citalopram, Disease Management, Escitalopram, and Combined Modality Therapy
Research Interests: Psychology, Depression, Medicine, Humans, Antidepressant, and 14 moreMajor Depressive Disorder, Female, Male, Follow-up studies, Recurrence, Clinical Sciences, Anxiety and Depression, Aged, Time Factors, Serotonin Uptake Inhibitors, Severity of Illness Index, Psychiatric Status Rating Scales, Paroxetine, and Nortriptyline
Research Interests: Psychology, Psychiatry, Nonparametric Statistics, Electroencephalography, Medicine, and 15 moreHumans, Sleep Deprivation, Antidepressant, Major Depressive Disorder, Female, Male, Sleep, Clinical Sciences, Anxiety and Depression, Aged, Pilot study, Time Factors, Pilot Projects, Combined Modality Therapy, and Paroxetine
Research Interests: Psychology, Behavior, Treatment, Medicine, Biological Sciences, and 14 moreBiological Psychiatry, Dopamine, Humans, Internal Medicine, Female, Male, Biological, Aged, Alzheimer Disease, Preliminary Report, Elderly patient, Antipsychotic agents, Psychology and Cognitive Sciences, and Medical and Health Sciences
Depression has been associated with increased platelet activation. Variations in the serotonin-transporter-linked promoter region (5-HTTLPR) polymorphism may influence the degree of activation. The authors examined the association among... more
Depression has been associated with increased platelet activation. Variations in the serotonin-transporter-linked promoter region (5-HTTLPR) polymorphism may influence the degree of activation. The authors examined the association among depression, platelet activation, and 5-HTTLPR genotype. Elderly subjects with (N=61) and without (N=12) major depression were assessed for cognitive impairment, cardiovascular disease, and two indices of platelet activation. The depressed subjects were genotyped for the 5-HTTLPR polymorphism. The depressed subjects were older, were more cognitively impaired, and had higher platelet factor 4 and beta-thromboglobulin levels; cardiovascular disease was minimal in both groups. In the depressed group, subjects with the 5-HTTLPR l/l genotype had significantly higher platelet factor 4 and beta-thromboglobulin levels. Platelet activation is increased in elderly depressed patients, especially those with the 5-HTTLPR l/l genotype. This finding suggests how genetic differences may influence cardiovascular mortality in depressed patients with ischemic heart disease.
Research Interests: Endocrinology, Genetics, Depression, Polymorphism, Comparative Study, and 15 moreMedicine, Platelet, Humans, Internal Medicine, Major Depressive Disorder, Female, Male, American, Genetic determinism, Platelet activation mechanism, Membrane transport proteins, Aged, Genotype, Alzheimer Disease, and Medical and Health Sciences
Research Interests: Psychology, Psychometrics, Clinical Trial, Treatment Outcome, Peer Review, and 14 moreMedicine, Humans, American Journal of Psychiatry, American, Depressive Disorder, Observer Variation, Inter-rater reliability, Reproducibility of Results, Professional Competence, Statistics as Topic, Multicenter Studies as Topic, Randomized Controlled Trials as Topic, Psychology and Cognitive Sciences, and Medical and Health Sciences
Research Interests: Psychology, Cognitive Science, Treatment Outcome, Medicine, Humans, and 15 moreFemale, Male, Clinical Sciences, Randomized Controlled Trial, RISPERIDONE, Psychotic Disorders, Citalopram, Alzheimer Disease, Neurosciences, Dementia With Lewy Bodies, Psychiatric Status Rating Scales, Neuropsychological Tests, Tolerability, Antipsychotic agents, and discontinuation
Research Interests: Psychiatry, Psychotherapy, Risk, Medicine, Comorbidity, and 15 moreEngland, Humans, Placebo, Major Depressive Disorder, Old Age, Female, Male, Aged, Major Depression, New England Journalof Medicine, SECONDARY PREVENTION, Interpersonal Psychotherapy, Combined Modality Therapy, Paroxetine, and Medical and Health Sciences
Research Interests: Depression, Cognition, Aging, Evaluation, Medicine, and 15 moreActivities of Daily Living, Humans, Major Depressive Disorder, Female, Male, Cholinesterase inhibitors, Donepezil, Aged, Activity, Combination drug therapy, New England Journalof Medicine, Archives General Psychiatry, Indans, Medical and Health Sciences, and Antidepressive agents
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ECGs of 50 patients who completed a long-term nortriptyline (NT) study are presented at baseline, after 7 weeks on NT, and after 1 year. The ECGs of patients with preexisting cardiac disease were compared with non-cardiac patients.... more
ECGs of 50 patients who completed a long-term nortriptyline (NT) study are presented at baseline, after 7 weeks on NT, and after 1 year. The ECGs of patients with preexisting cardiac disease were compared with non-cardiac patients. Significant ECG changes and increases in heart rate were observed by Week 7 and persisted at a mean of 55 weeks (range: 24-111) in patients who were continued on NT. No significant difference was found in long-term ECG effects in patients with preexisting cardiac disease; ECG changes reverted to baseline when placebo was substituted. Patients with known cardiac disease did not show significantly worse ECG changes on NT than non-cardiac patients.
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The Generalized Anxiety Disorder Severity Scale (GADSS) is a validated measure of Generalized Anxiety Disorder (GAD) symptom severity. Given the high prevalence of GAD in the elderly and the need for a validated scale to assess GAD... more
The Generalized Anxiety Disorder Severity Scale (GADSS) is a validated measure of Generalized Anxiety Disorder (GAD) symptom severity. Given the high prevalence of GAD in the elderly and the need for a validated scale to assess GAD severity in this age group, the authors examined the psychometric properties of the GADSS in the elderly. The authors examined a sample of 134 elderly subjects (age 60 and above) who met diagnostic criteria for current GAD, 33 healthy elderly comparison subjects (age 60 and above) and 186 younger subjects (age 18-60) diagnosed with GAD. The GADSS had a high internal consistency in the elderly subjects (raw Cronbach's alpha = 0.76). Pearson correlations showed a significant positive correlation between GADSS, Hamilton Rating Scale for Anxiety and Penn State Worry Questionnaire. Pearson correlations showed an inverse significant correlation between GADSS and the Medical Outcome Study SF-36. There was no correlation between GADSS and Mini Mental State Ex...
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Selective serotonin reuptake inhibitors may be less efficacious than tricyclic antidepressants in the treatment of severe depression in older patients. The authors compared the 12-week clinical outcome of older depressed patients treated... more
Selective serotonin reuptake inhibitors may be less efficacious than tricyclic antidepressants in the treatment of severe depression in older patients. The authors compared the 12-week clinical outcome of older depressed patients treated with nortriptyline or paroxetine in a double-blind randomized comparison in 116 psychiatric inpatients and outpatients (mean age: 72+/-8 years) who presented with a major depressive episode or melancholic depression. Discontinuation and response rates were compared in patients who began or who completed treatment. The discontinuation rate due to side effects was significantly higher with nortriptyline than with paroxetine (33% vs. 16%). There were no significant differences between the rates of response in the Intent-to-Treat analysis (nortriptyline: 57% vs. paroxetine: 55% ), or the Completer analysis (nortriptyline: 78% vs. paroxetine: 84%). Although paroxetine appears to be better tolerated than nortriptyline, the efficacy of these two drugs does...
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Deficits in executive functions may play an important role in late-life suicide; however the association is understudied. This study examined cognitive function in general and executive functioning specifically in depressed elderly with... more
Deficits in executive functions may play an important role in late-life suicide; however the association is understudied. This study examined cognitive function in general and executive functioning specifically in depressed elderly with and without suicidal ideation and attempts. Case-control study. University-affiliated psychiatric hospital. We compared 32 suicidal depressed participants aged 60 and older with 32 non-suicidal depressed participants equated for age, education, and gender. We assessed global cognitive function and executive function with the Dementia Rating Scale (DRS) and the Executive Interview (EXIT25), respectively. Suicidal and non-suicidal depressed groups were comparable in terms of severity of depression and burden of physical illness. Suicidal participants performed worse on the EXIT25, and on the DRS total scale, as well as on Memory and Attention subscales. The differences were not explained by the presence of dementia, substance use, medication exposure, ...
Research Interests: Suicide, Comorbidity, Humans, Major Depressive Disorder, Hospitalization, and 13 moreFemale, Male, Cognitive Performance, Clinical Sciences, Aged, Middle Aged, Public health systems and services research, Cost of Illness, Frontal Lobe, Substance-Related Disorders, Cognition disorders, Case Control Studies, and The American
Age-associated alterations in hypothalamic-pituitary-adrenal (HPA) axis functioning may make individuals more susceptible to HPA dysregulation in the context of mood and anxiety disorders. Little to no research has been done to examine... more
Age-associated alterations in hypothalamic-pituitary-adrenal (HPA) axis functioning may make individuals more susceptible to HPA dysregulation in the context of mood and anxiety disorders. Little to no research has been done to examine HPA axis function in generalized anxiety disorder (GAD), particularly in late-life GAD, the most prevalent anxiety disorder in the elderly. The study sample consisted of 71 GAD subjects and 40 nonanxious comparison subjects over 60 years of age. We examined the hypotheses that elderly individuals with GAD will have elevated salivary cortisol levels compared to nonanxious subjects, and that elevated cortisol levels in GAD will be associated with measures of symptom severity. We report that late-life GAD is characterized by elevated basal salivary cortisol levels, with higher peak cortisol levels and larger areas under the curve, compared to nonanxious subjects. Additionally, severity of GAD as measured by the GAD Severity Scale and the Penn State Worry...
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’s model for the modeling of time-varying effects of covariates.
The objective of this study was to examine the relative speed of improvement in sleep disturbance and anxiety symptoms compared with core mood symptoms in acute treatment of late-life major depression. The authors conducted secondary... more
The objective of this study was to examine the relative speed of improvement in sleep disturbance and anxiety symptoms compared with core mood symptoms in acute treatment of late-life major depression. The authors conducted secondary analysis of acute treatment data in 470 older patients treated in three federally funded studies. The authors compared rates of improvement in three Hamilton Rating Scale for Depression symptom clusters after stratification by study. Anxiety symptoms improved more slowly with antidepressant monotherapy and with combined pharmacotherapy/psychotherapy, whereas sleep symptoms improved at a similar rate as core mood symptoms. Anxiety symptoms tend to persist in patients with late-life depression.
Research Interests:
To describe an electronic, telephone-delivered, suicide risk management protocol (SRMP) that is designed to guide research staff and safely triage study participants who are at risk for self-harm. We tested the SRMP in the context of the... more
To describe an electronic, telephone-delivered, suicide risk management protocol (SRMP) that is designed to guide research staff and safely triage study participants who are at risk for self-harm. We tested the SRMP in the context of the NIH-funded randomized clinical trial "Bypassing the Blues" in which 302 patients who had undergone coronary artery bypass graft surgery (CABG) were screened for depression and assessed by telephone 2-weeks following hospital discharge and at 2-, 4-, and 8-month follow-up. We programmed the SRMP to assign different risk levels based on patients' answers from none to imminent with action items for research staff keyed to each of them. We describe frequency of suicidal thinking, SRMP use, and completion of specific steps in the SRMP management process over the 8-month follow-up period. Suicidal ideation was expressed by 74 (25%) of the 302 study participants in 139 (13%) of the 1069 blinded telephone assessments performed by research staf...
Research Interests:
using randomized, double-blind, placebo-controlled, parallel or crossover designs with benzodiazepines or zolpidem in adults younger than 65 years with chronic insomnia (modified Diagnostic and Statistical Manual of Mental Disorders,... more
using randomized, double-blind, placebo-controlled, parallel or crossover designs with benzodiazepines or zolpidem in adults younger than 65 years with chronic insomnia (modified Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria for primary insomnia) were selected for review. Self-report and polysomnographic measures of sleep-onset latency, total sleep time, number of awakenings, and sleep quality were selected as outcomes. Data