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Jeff Allen

University of North Texas, Learning Technologies, Faculty Member

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Biography

Dr. Jeff M. Allen is a leading scholar in the area of learning and performance innovation for the knowledge economy. He serves as a Regents Professor of Information Science and Director of the Center for Knowledge Solutions in the College of Information at the University of North Texas.

At the national level, he has provided leadership as a Board member of the Academy of Human Resource Development, Past Editor-in-Chief of Performance Improvement Quarterly, and Past Editor of Career and Technical Education Research, and Founding-Editor of Learning and Performance Quarterly. Currently he serves as President of Knowledge & Information Professional Association (KIPA).

Outside of his scholarship, Dr. Allen is a triathlete, ultra-distance runner, martial artist, and boxer.

Research Passion

Workforce Innovation for a Knowledge-Economy

My scholarly passion is workforce innovation in our growing global knowledge economy. Specifically looking at the role of self-learning, personal learning networks, problem-based learning, and mass customization in knowledge acquisition and transfer within the broad context of performance innovation and information literacy.

Current Research

Chasing Wisdom: Fostering Workforce Wisdom in a Global Knowledge-Economy

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Papers by Jeff Allen

Cellular mechanisms of estradiol-mediated masculinization of the brain

Journal of Steroid Biochemistry and Molecular Biology, 2008

Learning and Performance Innovation

Encyclopedia of E-Leadership, Counseling and Training, 2012

ABSTRACT Great changes are occurring in learning and performance programs. Learner demographics a... more

Author’s Name Harris, Ellen L. Document Type Dissertation Title An analysis of sales people’s perceptions of performance appraisal criteria at a telecommunications corporation. Degree Doctor of Education Major Applied Technology, Training, and Development

Attention Deficit Hyperactivity Disorder in Men and Women Newly Committed to PrisonClinical Characteristics, Psychiatric Comorbidity, and Quality of Life

by Tracy Gunter and Jeff Allen

International Journal of Offender Therapy and Comparative Criminology, 2010

Attention deficit hyperactivity disorder (ADHD) is associated with comorbid psychiatric diagnoses... more Attention deficit hyperactivity disorder (ADHD) is associated with comorbid psychiatric diagnoses and antisocial behaviors that contribute to criminality, yet studies of ADHD in offenders are few. The authors evaluate a random sample of 319 offenders using a version of the Mini International Neuropsychiatric Interview and Medical Outcome Survey Health Survey. ADHD was present in 68 subjects (21.3%). Offenders with ADHD were more likely to report problems with emotional and social functioning and to have higher suicide risk scores (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;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .001). They also had higher rates of mood, anxiety, psychotic, and somatoform disorders. Antisocial and borderline personality disorders were also more common among offenders with ADHD. The authors conclude that ADHD is common in offenders and is associated with comorbid disorders, worse quality of life, and higher risk for suicidal behaviors. Its presence should alert prison staff that the offender is likely to require more intensive mental health services.

Antisocial personality disorder in incarcerated offenders: Psychiatric comorbidity and quality of life

Annals of Clinical Psychiatry

We determined the frequency of antisocial personality disorder (ASPD) in offenders. We examined d... more We determined the frequency of antisocial personality disorder (ASPD) in offenders. We examined demographic characteristics, psychiatric comorbidity, and quality of life in those with and without ASPD. We also looked at the subset with attention-deficit/hyperactivity disorder (ADHD). A random sample of 320 newly incarcerated offenders was assessed using the Mini International Neuropsychiatric Interview (MINI), the 36-item Short Form Health Survey (SF-36), and the Level of Service Inventory-Revised (LSI-R). ASPD was present in 113 subjects (35.3%). There was no gender-based prevalence difference. Offenders with ASPD were younger, had a higher suicide risk, and had higher rates of mood, anxiety, substance use, psychotic, somatoform disorders, borderline personality disorder, and ADHD. Quality of life was worse, and their LSI-R scores were higher, indicating a greater risk for recidivism. A subanalysis showed that offenders with ASPD who also had ADHD had a higher suicide risk, higher rates of comorbid disorders, and worse mental health functioning. ASPD is relatively common among both male and female inmates and is associated with comorbid disorders, high suicide risk, and impaired quality of life. Those with comorbid ADHD were more impaired than those without ADHD. ASPD occurs frequently in prison populations and is nearly as common in women as in men. These study findings should contribute to discussions of appropriate and innovative treatment of ASPD in correctional settings.

Characterization of Three Protein Components Required for Functional Reconstitution of the Epoxide Carboxylase Multienzyme Complex from Xanthobacter Strain Py2

Epoxide carboxylase from Xanthobacter strain Py2 catalyzes the reductant- and NAD+-dependent carb... more Epoxide carboxylase from Xanthobacter strain Py2 catalyzes the reductant- and NAD+-dependent carboxylation of aliphatic epoxides to beta-keto acids. Epoxide carboxylase from Xanthobacter strain Py2 has been resolved from cell extracts by anion-exchange chromatography into three protein components, designated I, II, and III, that are obligately required for functional reconstitution of epoxide carboxylase activity. Component II has been purified to homogeneity on the basis of its ability to complement components I and III in restoring epoxide carboxylase activity. Purified component II had a specific activity for epoxide carboxylation of 41.8 mU x min(-1) x mg(-1) when components I and III were present at saturating levels. The biochemical properties of component II reveal that it is the flavin-containing NADPH:disulfide oxidoreductase that was recently shown by other means to be associated with epoxide degradation activity in Xanthobacter strain Py2 (J. Swaving, J. A. M. de Bont, A. Westphal, and A. Dekok, J. Bacteriol. 178:6644-6646, 1996). The rate of epoxide carboxylation was dependent on the relative concentrations of the three carboxylase components. At fixed concentrations of two of the components, epoxide carboxylation rates were saturated in a hyperbolic fashion by increasing the concentration of the third variable component. Methylepoxypropane has been characterized as a time-dependent, irreversible inactivator of epoxide carboxylase activity that is proposed to be a mechanism-based inactivator of the enzyme. The addition of component I, but not that of component II or III, to methylepoxypropane-inactivated cell extracts restored epoxide carboxylase activity, suggesting that component I contains the epoxide binding and activation sites.

Identification and Characterization of Epoxide Carboxylase Activity in Cell Extracts of Nocardia corallina B276

that was dependent on the addition of CO2, NAD 1 , and a reductant (NADPH or dithiothreitol). In ... more that was dependent on the addition of CO2, NAD 1 , and a reductant (NADPH or dithiothreitol). In the absence of CO2, epoxypropane was isomerized by cell extracts to form acetone at a rate approximately 10-fold lower than the rate of epoxypropane carboxylation. Methylepoxypropane was found to be a time-dependent, irre- versible inactivator of epoxyalkane-degrading activity. These properties demonstrate that

STEPPS: Systems Training for Emotional Predictability and Problem Solving in women offenders with borderline personality disorder in prison--a pilot study

CNS spectrums

An uncontrolled pilot study of Systems Training for Emotional Predictability and Problem Solving ... more An uncontrolled pilot study of Systems Training for Emotional Predictability and Problem Solving (STEPPS) was conducted with incarcerated women offenders. STEPPS is a promising new cognitive-behavioral group treatment for persons with borderline personality disorder (BPD). Twelve women offenders with Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition BPD were enrolled in the 20-week program at an Iowa prison. Efficacy assessments included the Borderline Evaluation of Severity over Time, the Positive and Negative Affectivity Scale, and the Beck Depression Inventory. Data were collected at baseline, and weeks 4, 8, 12, 16, and 20. A prison therapist was trained to deliver the STEPPS program. The 12 volunteers had a mean age of 34.8+/-8.5 years. Two women discontinued early because they were released from prison; the others attended all sessions. The analysis showed significant improvements in BPD-related symptoms, negative affectivity, and depression. The Borderline...

Borderline personality disorder in male and female offenders newly committed to prison

Comprehensive Psychiatry

The objective of the study was to estimate the rate of borderline personality disorder (BPD) in m... more The objective of the study was to estimate the rate of borderline personality disorder (BPD) in male and female offenders newly committed to the Iowa Department of Corrections. We also compared clinical and demographic characteristics of offenders with and without BPD. A random sample of 220 offenders entering Iowa's prison system were evaluated by using a version of the Mini International Neuropsychiatric Interview, the BPD module of the Structured Interview for DSM-IV Personality Disorders, the Medical Outcome Survey Short Form-36 Health Survey, and the Level of Service Inventory-Revised. Borderline personality disorder was present in 65 (29.5%) subjects, although 93.2% had at least one Diagnostic and Statistical Manual of Mental Disorders-IV BPD trait. The percentage of women meeting criteria for BPD was more than twice that for men. Subjects with BPD were more likely than those without to be married, employed, and to have a high suicide risk score. Offenders with BPD were mo...

Attitudes Toward Borderline Personality Disorder: A Survey of 706 Mental Health Clinicians

CNS spectrums

Objective: We sought to determine attitudes toward patients with borderline personality disorder ... more Objective: We sought to determine attitudes toward patients with borderline personality disorder (BPD) among mental health clinicians at nine academic centers in the United States. Methods: A self-report questionnaire was distributed to 706 mental health clinicians, including psychiatrists, psychiatry residents, social workers, nurses, and psychologists. Results: The study showed that most clinicians consider BPD a valid diagnosis, although nearly half reported that they preferred to avoid these patients. The clinician's occupational subgroup was significantly related to attitude. Staff nurses had the lowest self-ratings on overall caring attitudes, while social workers had the highest. Social workers and psychiatrists had the highest ratings on treatment optimism. Social workers and psychologists were most optimistic about psychotherapy effectiveness, while psychiatrists were most optimistic about medication effectiveness. Staff nurses had the lowest self-ratings on empathy tow...

Ms. Blum and colleagues reply

American Journal of Psychiatry

A blind re-analysis of the Iowa family study of obsessive-compulsive disorder

We present results from a re-analysis of the Iowa family study of obsessive-compulsive disorder (... more We present results from a re-analysis of the Iowa family study of obsessive-compulsive disorder (OCD) that previously concluded the disorder was not familial. These conclusions were based on Diagnostic Interview Schedule results of first-degree relatives (FDRs) and not a best estimate diagnosis (BED). For the re-analysis we reviewed raw data on OCD and control probands and their FDRs. Relatives had been assessed through structured interviews, validated questionnaires, family history, and medical records in some cases. BEDs were assigned through a blind consensus procedure employing DSM-IV criteria. The data were analyzed using logistic regression with generalized estimating equations to account for within family correlations. BEDs were assigned to 32 OCD probands, 31 control probands, and 352 FDRs, including 249 FDRs who were interviewed directly and 103 FDRs who were unavailable or deceased. Lifetime prevalence of definite/probable OCD was significantly higher in the FDRs of OCD pr...

Treatment received by persons with BPD participating in a randomized clinical trial of the Systems Training for Emotional Predictability and Problem Solving programme

Personality and Mental Health

We report the treatment experience of 164 subjects with BPD who participated in a randomized clin... more We report the treatment experience of 164 subjects with BPD who participated in a randomized clinical trial testing the Systems Training for Emotional Predictability and Problem Solving group treatment programme. Participation in psychotherapy, use of psychotropic medication, use of emergency services and hospitalization were carefully tracked. Nearly all (96%) subjects were prescribed psychotropic medication; 74% took antidepressants at baseline; the figures were 41% for anxiolytics, 39% for mood stabilizers and 32% for antipsychotics. Sixty-four percent reported taking ≥2 medications, and 39% took ≥3 medications. Most subjects (73%) participated in individual psychotherapy; 24% had been hospitalized at least once in the month prior to study entry. Importantly, medication usage at baseline was not associated with clinical severity. Medication usage declined during the 20-week clinical trial and 1-year follow-up. Few patients (6%) had ever received electroconvulsive therapy. In conc...

Use of complementary and alternative medicine in patients with liver disease

American Journal of Gastroenterology, 2002

OBJECTIVES:Complementary and alternative medicine (CAM) is used by 42% of the U.S. population. It... more OBJECTIVES:Complementary and alternative medicine (CAM) is used by 42% of the U.S. population. Its use among patients with chronic liver disease has not been well defined. Toward that end, we surveyed patients in six geographically diverse liver disease clinics in the United States for use of CAM.METHODS:Patients attending six liver disease clinics were polled via a common questionnaire regarding their

Age at onset of DSM-IV pathological gambling in a non-treatment sample: Early- versus later-onset

Comprehensive psychiatry, Jan 20, 2015

Pathological gambling (PG) is a prevalent and impairing public health problem. In this study we a... more Pathological gambling (PG) is a prevalent and impairing public health problem. In this study we assessed age at onset in men and women with PG and compared the demographic and clinical picture of early- vs. later-onset individuals. We also compared age at onset in PG subjects and their first-degree relatives with PG. Subjects with DSM-IV PG were recruited during the conduct of two non-treatment clinical studies. Subjects were evaluated with structured interviews and validated questionnaires. Early-onset was defined as PG starting prior to age 33years. Age at onset of PG in the 255 subjects ranged from 8 to 80years with a mean (SD) of 34.0 (15.3) years. Men had an earlier onset than women. 84% of all subjects with PG had developed the disorder by age 50years. Early-onset subjects were more likely to be male, to prefer action games, and to have substance use disorders, antisocial personality disorder, attention deficit/hyperactivity disorder, trait impulsiveness, and social anxiety di...

Suicide Ideations, Suicide Attempts, and Completed Suicide in Persons with Pathological Gambling and Their First-Degree Relatives

Suicide & life-threatening behavior, Jan 6, 2015

We examined the relationship between suicidal ideations and attempts in 95 probands with patholog... more We examined the relationship between suicidal ideations and attempts in 95 probands with pathological gambling (PG), 91 controls, and 1075 first-degree relatives. The results were analyzed using logistic regression with generalized estimating equations. Thirty-four PG probands (35.8%) and 4 controls (4.4%) had attempted suicide (OR = 12.12, p < .001); in 13 probands, the attempt occurred before PG onset. Lifetime suicidal ideations occurred in 60 PG probands (63.2%) and 12 controls (13.2%) (OR = 11.29, p < .001). Suicidality in PG probands is a marker of PG severity and is associated with greater psychiatric comorbidity. Offspring of PG probands had significantly higher rates of suicide attempts than control offspring.

An open-label trial of escitalopram in the treatment of pathological gambling

Clinical neuropharmacology

The effectiveness and tolerability of escitalopram was tested in the treatment of pathological ga... more The effectiveness and tolerability of escitalopram was tested in the treatment of pathological gambling (PG). Nondepressed outpatients with Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition PG received flexibly dosed escitalopram in a prospective, 10-week, open-label trial after a 2-week observation period. Subjects were evaluated at baseline and at 2-week intervals for assessment of gambling behavior, mood symptoms, and adverse experiences. The primary efficacy measure was the Yale-Brown Obsessive-Compulsive Scale modified for PG. Secondary efficacy measures included the Clinical Global Impression (CGI) Improvement and Severity Scales, a patient self-rated global rating, the Sheehan Disability Scale, and the Timeline Follow Back. Nineteen subjects (12 men and 7 women) had at least 1 postbaseline visit and were included in the analysis; 16 subjects (84%) completed the protocol. Significant improvement was found in all measures, including the Yale-Brown Obsessive-...

Frequency of mental and addictive disorders among 320 men and women entering the Iowa prison system: use of the MINI-Plus

The journal of the American Academy of Psychiatry and the Law, 2008

The Mini-International Neuropsychiatric Interview-Plus (MINI-Plus) was used to assess the frequen... more The Mini-International Neuropsychiatric Interview-Plus (MINI-Plus) was used to assess the frequency of mental and addictive disorders among 320 randomly selected men and women newly committed to the general population of the Iowa prison system. More than 90 percent of offenders met criteria for a current or lifetime psychiatric disorder. The most frequent were substance use disorders (90%), mood disorders (54%), psychotic disorders (35%), antisocial personality disorder (35%), and attention deficit hyperactivity disorder (22%). Offenders had a mean of 4.2 MINI-Plus disorders, and two-thirds had 3 or more disorders. Contrary to expectation, there were few gender-based differences. Thirty percent of the offenders were rated at risk for suicide. We conclude that mental and addictive disorders are common among incarcerated offenders and that these individuals are at risk for suicidal behavior.

An open-label trial of acamprosate in the treatment of pathological gambling

Annals of clinical psychiatry : official journal of the American Academy of Clinical Psychiatrists, 2011

The efficacy and tolerability of acamprosate has been tested in the treatment of pathological gam... more The efficacy and tolerability of acamprosate has been tested in the treatment of pathological gambling (PG). Acamprosate is known to reduce alcohol craving and use in persons with alcohol dependence, and it has been hypothesized that the drug would have a similar effect in individuals with PG. Participants with DSM-IV criteria for PG received acamprosate in an 8-week, open-label trial following a 2-week observation. The primary efficacy measure was the Yale-Brown Obsessive Compulsive Scale modified for PG (Y-BOCS-PG). Secondary efficacy measures included the Gambling Severity Assessment Scale (GSAS), the Clinical Global Impression (CGI) Improvement and Severity Scales, a patient self-rated global rating, the Hamilton Depression Rating Scale (HDRS), the Sheehan Disability Scale (SDS), and the Timeline Follow Back (TLFB). The study was conducted at 2 sites. Twenty-six participants (11 men, 15 women) had at least 1 post-baseline visit and were included in the analysis. Twenty participa...

Comparison of Low and Moderate Dosages of Extended-Release Quetiapine in Borderline Personality Disorder: A Randomized, Double-Blind, Placebo-Controlled Trial

The American journal of psychiatry, Jan 27, 2014

The authors compared the efficacy and tolerability of low and moderate dosages of extended-releas... more The authors compared the efficacy and tolerability of low and moderate dosages of extended-release quetiapine in adults with borderline personality disorder. Ninety-five participants with DSM-IV borderline personality disorder were randomly assigned to receive 150 mg/day of quetiapine (the low-dosage group; N=33), 300 mg/day of quetiapine (the moderate-dosage group; N=33), or placebo (N=29). Total score over time on the clinician-rated Zanarini Rating Scale for Borderline Personality Disorder ("Zanarini scale") was analyzed in a mixed-effects model accounting for informative dropout. Participants in the low-dosage quetiapine group had significant improvement on the Zanarini scale compared with those in the placebo group. Time to response (defined as a reduction of 50% or more on the Zanarini scale total score) was significantly shorter for both the low-dosage quetiapine group (hazard ratio=2.54, p=0.007) and the moderate-dosage quetiapine group (hazard ratio=2.37, p=0.011)...

Cellular mechanisms of estradiol-mediated masculinization of the brain

Journal of Steroid Biochemistry and Molecular Biology, 2008

Learning and Performance Innovation

Encyclopedia of E-Leadership, Counseling and Training, 2012

ABSTRACT Great changes are occurring in learning and performance programs. Learner demographics a... more

Author’s Name Harris, Ellen L. Document Type Dissertation Title An analysis of sales people’s perceptions of performance appraisal criteria at a telecommunications corporation. Degree Doctor of Education Major Applied Technology, Training, and Development

Attention Deficit Hyperactivity Disorder in Men and Women Newly Committed to PrisonClinical Characteristics, Psychiatric Comorbidity, and Quality of Life

by Tracy Gunter and Jeff Allen

International Journal of Offender Therapy and Comparative Criminology, 2010

Attention deficit hyperactivity disorder (ADHD) is associated with comorbid psychiatric diagnoses... more Attention deficit hyperactivity disorder (ADHD) is associated with comorbid psychiatric diagnoses and antisocial behaviors that contribute to criminality, yet studies of ADHD in offenders are few. The authors evaluate a random sample of 319 offenders using a version of the Mini International Neuropsychiatric Interview and Medical Outcome Survey Health Survey. ADHD was present in 68 subjects (21.3%). Offenders with ADHD were more likely to report problems with emotional and social functioning and to have higher suicide risk scores (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;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .001). They also had higher rates of mood, anxiety, psychotic, and somatoform disorders. Antisocial and borderline personality disorders were also more common among offenders with ADHD. The authors conclude that ADHD is common in offenders and is associated with comorbid disorders, worse quality of life, and higher risk for suicidal behaviors. Its presence should alert prison staff that the offender is likely to require more intensive mental health services.

Antisocial personality disorder in incarcerated offenders: Psychiatric comorbidity and quality of life

Annals of Clinical Psychiatry

We determined the frequency of antisocial personality disorder (ASPD) in offenders. We examined d... more We determined the frequency of antisocial personality disorder (ASPD) in offenders. We examined demographic characteristics, psychiatric comorbidity, and quality of life in those with and without ASPD. We also looked at the subset with attention-deficit/hyperactivity disorder (ADHD). A random sample of 320 newly incarcerated offenders was assessed using the Mini International Neuropsychiatric Interview (MINI), the 36-item Short Form Health Survey (SF-36), and the Level of Service Inventory-Revised (LSI-R). ASPD was present in 113 subjects (35.3%). There was no gender-based prevalence difference. Offenders with ASPD were younger, had a higher suicide risk, and had higher rates of mood, anxiety, substance use, psychotic, somatoform disorders, borderline personality disorder, and ADHD. Quality of life was worse, and their LSI-R scores were higher, indicating a greater risk for recidivism. A subanalysis showed that offenders with ASPD who also had ADHD had a higher suicide risk, higher rates of comorbid disorders, and worse mental health functioning. ASPD is relatively common among both male and female inmates and is associated with comorbid disorders, high suicide risk, and impaired quality of life. Those with comorbid ADHD were more impaired than those without ADHD. ASPD occurs frequently in prison populations and is nearly as common in women as in men. These study findings should contribute to discussions of appropriate and innovative treatment of ASPD in correctional settings.

Characterization of Three Protein Components Required for Functional Reconstitution of the Epoxide Carboxylase Multienzyme Complex from Xanthobacter Strain Py2

Epoxide carboxylase from Xanthobacter strain Py2 catalyzes the reductant- and NAD+-dependent carb... more Epoxide carboxylase from Xanthobacter strain Py2 catalyzes the reductant- and NAD+-dependent carboxylation of aliphatic epoxides to beta-keto acids. Epoxide carboxylase from Xanthobacter strain Py2 has been resolved from cell extracts by anion-exchange chromatography into three protein components, designated I, II, and III, that are obligately required for functional reconstitution of epoxide carboxylase activity. Component II has been purified to homogeneity on the basis of its ability to complement components I and III in restoring epoxide carboxylase activity. Purified component II had a specific activity for epoxide carboxylation of 41.8 mU x min(-1) x mg(-1) when components I and III were present at saturating levels. The biochemical properties of component II reveal that it is the flavin-containing NADPH:disulfide oxidoreductase that was recently shown by other means to be associated with epoxide degradation activity in Xanthobacter strain Py2 (J. Swaving, J. A. M. de Bont, A. Westphal, and A. Dekok, J. Bacteriol. 178:6644-6646, 1996). The rate of epoxide carboxylation was dependent on the relative concentrations of the three carboxylase components. At fixed concentrations of two of the components, epoxide carboxylation rates were saturated in a hyperbolic fashion by increasing the concentration of the third variable component. Methylepoxypropane has been characterized as a time-dependent, irreversible inactivator of epoxide carboxylase activity that is proposed to be a mechanism-based inactivator of the enzyme. The addition of component I, but not that of component II or III, to methylepoxypropane-inactivated cell extracts restored epoxide carboxylase activity, suggesting that component I contains the epoxide binding and activation sites.

Identification and Characterization of Epoxide Carboxylase Activity in Cell Extracts of Nocardia corallina B276

that was dependent on the addition of CO2, NAD 1 , and a reductant (NADPH or dithiothreitol). In ... more that was dependent on the addition of CO2, NAD 1 , and a reductant (NADPH or dithiothreitol). In the absence of CO2, epoxypropane was isomerized by cell extracts to form acetone at a rate approximately 10-fold lower than the rate of epoxypropane carboxylation. Methylepoxypropane was found to be a time-dependent, irre- versible inactivator of epoxyalkane-degrading activity. These properties demonstrate that

STEPPS: Systems Training for Emotional Predictability and Problem Solving in women offenders with borderline personality disorder in prison--a pilot study

CNS spectrums

An uncontrolled pilot study of Systems Training for Emotional Predictability and Problem Solving ... more An uncontrolled pilot study of Systems Training for Emotional Predictability and Problem Solving (STEPPS) was conducted with incarcerated women offenders. STEPPS is a promising new cognitive-behavioral group treatment for persons with borderline personality disorder (BPD). Twelve women offenders with Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition BPD were enrolled in the 20-week program at an Iowa prison. Efficacy assessments included the Borderline Evaluation of Severity over Time, the Positive and Negative Affectivity Scale, and the Beck Depression Inventory. Data were collected at baseline, and weeks 4, 8, 12, 16, and 20. A prison therapist was trained to deliver the STEPPS program. The 12 volunteers had a mean age of 34.8+/-8.5 years. Two women discontinued early because they were released from prison; the others attended all sessions. The analysis showed significant improvements in BPD-related symptoms, negative affectivity, and depression. The Borderline...

Borderline personality disorder in male and female offenders newly committed to prison

Comprehensive Psychiatry

The objective of the study was to estimate the rate of borderline personality disorder (BPD) in m... more The objective of the study was to estimate the rate of borderline personality disorder (BPD) in male and female offenders newly committed to the Iowa Department of Corrections. We also compared clinical and demographic characteristics of offenders with and without BPD. A random sample of 220 offenders entering Iowa's prison system were evaluated by using a version of the Mini International Neuropsychiatric Interview, the BPD module of the Structured Interview for DSM-IV Personality Disorders, the Medical Outcome Survey Short Form-36 Health Survey, and the Level of Service Inventory-Revised. Borderline personality disorder was present in 65 (29.5%) subjects, although 93.2% had at least one Diagnostic and Statistical Manual of Mental Disorders-IV BPD trait. The percentage of women meeting criteria for BPD was more than twice that for men. Subjects with BPD were more likely than those without to be married, employed, and to have a high suicide risk score. Offenders with BPD were mo...

Attitudes Toward Borderline Personality Disorder: A Survey of 706 Mental Health Clinicians

CNS spectrums

Objective: We sought to determine attitudes toward patients with borderline personality disorder ... more Objective: We sought to determine attitudes toward patients with borderline personality disorder (BPD) among mental health clinicians at nine academic centers in the United States. Methods: A self-report questionnaire was distributed to 706 mental health clinicians, including psychiatrists, psychiatry residents, social workers, nurses, and psychologists. Results: The study showed that most clinicians consider BPD a valid diagnosis, although nearly half reported that they preferred to avoid these patients. The clinician's occupational subgroup was significantly related to attitude. Staff nurses had the lowest self-ratings on overall caring attitudes, while social workers had the highest. Social workers and psychiatrists had the highest ratings on treatment optimism. Social workers and psychologists were most optimistic about psychotherapy effectiveness, while psychiatrists were most optimistic about medication effectiveness. Staff nurses had the lowest self-ratings on empathy tow...

Ms. Blum and colleagues reply

American Journal of Psychiatry

A blind re-analysis of the Iowa family study of obsessive-compulsive disorder

We present results from a re-analysis of the Iowa family study of obsessive-compulsive disorder (... more We present results from a re-analysis of the Iowa family study of obsessive-compulsive disorder (OCD) that previously concluded the disorder was not familial. These conclusions were based on Diagnostic Interview Schedule results of first-degree relatives (FDRs) and not a best estimate diagnosis (BED). For the re-analysis we reviewed raw data on OCD and control probands and their FDRs. Relatives had been assessed through structured interviews, validated questionnaires, family history, and medical records in some cases. BEDs were assigned through a blind consensus procedure employing DSM-IV criteria. The data were analyzed using logistic regression with generalized estimating equations to account for within family correlations. BEDs were assigned to 32 OCD probands, 31 control probands, and 352 FDRs, including 249 FDRs who were interviewed directly and 103 FDRs who were unavailable or deceased. Lifetime prevalence of definite/probable OCD was significantly higher in the FDRs of OCD pr...

Treatment received by persons with BPD participating in a randomized clinical trial of the Systems Training for Emotional Predictability and Problem Solving programme

Personality and Mental Health

We report the treatment experience of 164 subjects with BPD who participated in a randomized clin... more We report the treatment experience of 164 subjects with BPD who participated in a randomized clinical trial testing the Systems Training for Emotional Predictability and Problem Solving group treatment programme. Participation in psychotherapy, use of psychotropic medication, use of emergency services and hospitalization were carefully tracked. Nearly all (96%) subjects were prescribed psychotropic medication; 74% took antidepressants at baseline; the figures were 41% for anxiolytics, 39% for mood stabilizers and 32% for antipsychotics. Sixty-four percent reported taking ≥2 medications, and 39% took ≥3 medications. Most subjects (73%) participated in individual psychotherapy; 24% had been hospitalized at least once in the month prior to study entry. Importantly, medication usage at baseline was not associated with clinical severity. Medication usage declined during the 20-week clinical trial and 1-year follow-up. Few patients (6%) had ever received electroconvulsive therapy. In conc...

Use of complementary and alternative medicine in patients with liver disease

American Journal of Gastroenterology, 2002

OBJECTIVES:Complementary and alternative medicine (CAM) is used by 42% of the U.S. population. It... more OBJECTIVES:Complementary and alternative medicine (CAM) is used by 42% of the U.S. population. Its use among patients with chronic liver disease has not been well defined. Toward that end, we surveyed patients in six geographically diverse liver disease clinics in the United States for use of CAM.METHODS:Patients attending six liver disease clinics were polled via a common questionnaire regarding their

Age at onset of DSM-IV pathological gambling in a non-treatment sample: Early- versus later-onset

Comprehensive psychiatry, Jan 20, 2015

Pathological gambling (PG) is a prevalent and impairing public health problem. In this study we a... more Pathological gambling (PG) is a prevalent and impairing public health problem. In this study we assessed age at onset in men and women with PG and compared the demographic and clinical picture of early- vs. later-onset individuals. We also compared age at onset in PG subjects and their first-degree relatives with PG. Subjects with DSM-IV PG were recruited during the conduct of two non-treatment clinical studies. Subjects were evaluated with structured interviews and validated questionnaires. Early-onset was defined as PG starting prior to age 33years. Age at onset of PG in the 255 subjects ranged from 8 to 80years with a mean (SD) of 34.0 (15.3) years. Men had an earlier onset than women. 84% of all subjects with PG had developed the disorder by age 50years. Early-onset subjects were more likely to be male, to prefer action games, and to have substance use disorders, antisocial personality disorder, attention deficit/hyperactivity disorder, trait impulsiveness, and social anxiety di...

Suicide Ideations, Suicide Attempts, and Completed Suicide in Persons with Pathological Gambling and Their First-Degree Relatives

Suicide & life-threatening behavior, Jan 6, 2015

We examined the relationship between suicidal ideations and attempts in 95 probands with patholog... more We examined the relationship between suicidal ideations and attempts in 95 probands with pathological gambling (PG), 91 controls, and 1075 first-degree relatives. The results were analyzed using logistic regression with generalized estimating equations. Thirty-four PG probands (35.8%) and 4 controls (4.4%) had attempted suicide (OR = 12.12, p < .001); in 13 probands, the attempt occurred before PG onset. Lifetime suicidal ideations occurred in 60 PG probands (63.2%) and 12 controls (13.2%) (OR = 11.29, p < .001). Suicidality in PG probands is a marker of PG severity and is associated with greater psychiatric comorbidity. Offspring of PG probands had significantly higher rates of suicide attempts than control offspring.

An open-label trial of escitalopram in the treatment of pathological gambling

Clinical neuropharmacology

The effectiveness and tolerability of escitalopram was tested in the treatment of pathological ga... more The effectiveness and tolerability of escitalopram was tested in the treatment of pathological gambling (PG). Nondepressed outpatients with Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition PG received flexibly dosed escitalopram in a prospective, 10-week, open-label trial after a 2-week observation period. Subjects were evaluated at baseline and at 2-week intervals for assessment of gambling behavior, mood symptoms, and adverse experiences. The primary efficacy measure was the Yale-Brown Obsessive-Compulsive Scale modified for PG. Secondary efficacy measures included the Clinical Global Impression (CGI) Improvement and Severity Scales, a patient self-rated global rating, the Sheehan Disability Scale, and the Timeline Follow Back. Nineteen subjects (12 men and 7 women) had at least 1 postbaseline visit and were included in the analysis; 16 subjects (84%) completed the protocol. Significant improvement was found in all measures, including the Yale-Brown Obsessive-...

Frequency of mental and addictive disorders among 320 men and women entering the Iowa prison system: use of the MINI-Plus

The journal of the American Academy of Psychiatry and the Law, 2008

The Mini-International Neuropsychiatric Interview-Plus (MINI-Plus) was used to assess the frequen... more The Mini-International Neuropsychiatric Interview-Plus (MINI-Plus) was used to assess the frequency of mental and addictive disorders among 320 randomly selected men and women newly committed to the general population of the Iowa prison system. More than 90 percent of offenders met criteria for a current or lifetime psychiatric disorder. The most frequent were substance use disorders (90%), mood disorders (54%), psychotic disorders (35%), antisocial personality disorder (35%), and attention deficit hyperactivity disorder (22%). Offenders had a mean of 4.2 MINI-Plus disorders, and two-thirds had 3 or more disorders. Contrary to expectation, there were few gender-based differences. Thirty percent of the offenders were rated at risk for suicide. We conclude that mental and addictive disorders are common among incarcerated offenders and that these individuals are at risk for suicidal behavior.

An open-label trial of acamprosate in the treatment of pathological gambling

Annals of clinical psychiatry : official journal of the American Academy of Clinical Psychiatrists, 2011

The efficacy and tolerability of acamprosate has been tested in the treatment of pathological gam... more The efficacy and tolerability of acamprosate has been tested in the treatment of pathological gambling (PG). Acamprosate is known to reduce alcohol craving and use in persons with alcohol dependence, and it has been hypothesized that the drug would have a similar effect in individuals with PG. Participants with DSM-IV criteria for PG received acamprosate in an 8-week, open-label trial following a 2-week observation. The primary efficacy measure was the Yale-Brown Obsessive Compulsive Scale modified for PG (Y-BOCS-PG). Secondary efficacy measures included the Gambling Severity Assessment Scale (GSAS), the Clinical Global Impression (CGI) Improvement and Severity Scales, a patient self-rated global rating, the Hamilton Depression Rating Scale (HDRS), the Sheehan Disability Scale (SDS), and the Timeline Follow Back (TLFB). The study was conducted at 2 sites. Twenty-six participants (11 men, 15 women) had at least 1 post-baseline visit and were included in the analysis. Twenty participa...

Comparison of Low and Moderate Dosages of Extended-Release Quetiapine in Borderline Personality Disorder: A Randomized, Double-Blind, Placebo-Controlled Trial

The American journal of psychiatry, Jan 27, 2014

The authors compared the efficacy and tolerability of low and moderate dosages of extended-releas... more The authors compared the efficacy and tolerability of low and moderate dosages of extended-release quetiapine in adults with borderline personality disorder. Ninety-five participants with DSM-IV borderline personality disorder were randomly assigned to receive 150 mg/day of quetiapine (the low-dosage group; N=33), 300 mg/day of quetiapine (the moderate-dosage group; N=33), or placebo (N=29). Total score over time on the clinician-rated Zanarini Rating Scale for Borderline Personality Disorder ("Zanarini scale") was analyzed in a mixed-effects model accounting for informative dropout. Participants in the low-dosage quetiapine group had significant improvement on the Zanarini scale compared with those in the placebo group. Time to response (defined as a reduction of 50% or more on the Zanarini scale total score) was significantly shorter for both the low-dosage quetiapine group (hazard ratio=2.54, p=0.007) and the moderate-dosage quetiapine group (hazard ratio=2.37, p=0.011)...