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Doraiswamy PM, Goldberg TE, Qian M, Linares AR, Nwosu A, Nino I, D'Antonio J, Phillips J, Ndouli C, Hellegers C, Michael AM, Petrella JR, Andrews H, Sneed J, Devanand DP. Validity of the Web-Based, Self-Directed, NeuroCognitive Performance Test in Mild Cognitive Impairment. J Alzheimers Dis 2022; 86:1131-1136. [PMID: 35180109 DOI: 10.3233/jad-220015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Digital cognitive tests offer several potential advantages over established paper-pencil tests but have not yet been fully evaluated for the clinical evaluation of mild cognitive impairment. OBJECTIVE The NeuroCognitive Performance Test (NCPT) is a web-based, self-directed, modular battery intended for repeated assessments of multiple cognitive domains. Our objective was to examine its relationship with the Alzheimer's Disease Assessment Scale-Cognition Subscale (ADAS-Cog) and Mini-Mental State Examination (MMSE) as well as with established paper-pencil tests of cognition and daily functioning in mild cognitive impairment (MCI). METHODS We used Spearman correlations, regressions and principal components analysis followed by a factor analysis (varimax rotated) to examine our objectives. RESULTS In MCI subjects, the NCPT composite is significantly correlated with both a composite measure of established tests (r = 0.77, p < 0.0001) as well as with the ADAS-Cog (r = 0.55, p < 0.0001). Both NCPT and paper-pencil test batteries had a similar factor structure that included a large "g" component with a high eigenvalue. The correlation for the analogous tests (e.g., Trails A and B, learning memory tests) were significant (p < 0.0001). Further, both the NCPT and established tests significantly (p < 0.01) predicted the University of California San Diego Performance-Based Skills Assessment and Functional Activities Questionnaire, measures of daily functioning. CONCLUSION The NCPT, a web-based, self-directed, computerized test, shows high concurrent validity with established tests and hence offers promise for use as a research or clinical tool in MCI. Despite limitations such as a relatively small sample, absence of control group and cross-sectional nature, these findings are consistent with the growing literature on the promise of self-directed, web-based cognitive assessments for MCI.
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Affiliation(s)
- P Murali Doraiswamy
- Neurocognitive Disorders Program, Department of Psychiatry, Duke University School of Medicine, Durham, NC, USA.,Duke Institute for Brain Sciences, Durham, NC, USA
| | - Terry E Goldberg
- Department of Psychiatry, Columbia University Medical Center, and the New York State Psychiatry Institute, New York, NY, USA
| | - Min Qian
- Department of Biostatistics, Mailman School of Public Health, Columbia University Medical Center, New York, NY, USA
| | - Alexandra R Linares
- Neurocognitive Disorders Program, Department of Psychiatry, Duke University School of Medicine, Durham, NC, USA
| | - Adaora Nwosu
- Neurocognitive Disorders Program, Department of Psychiatry, Duke University School of Medicine, Durham, NC, USA
| | - Izael Nino
- Department of Psychiatry, Columbia University Medical Center, and the New York State Psychiatry Institute, New York, NY, USA
| | - Jessica D'Antonio
- Department of Psychiatry, Columbia University Medical Center, and the New York State Psychiatry Institute, New York, NY, USA
| | - Julia Phillips
- Department of Psychiatry, Columbia University Medical Center, and the New York State Psychiatry Institute, New York, NY, USA
| | - Charlie Ndouli
- Department of Psychiatry, Columbia University Medical Center, and the New York State Psychiatry Institute, New York, NY, USA
| | - Caroline Hellegers
- Neurocognitive Disorders Program, Department of Psychiatry, Duke University School of Medicine, Durham, NC, USA
| | | | - Jeffrey R Petrella
- Department of Radiology, Duke University Medical Center, Durham, NC, USA
| | - Howard Andrews
- Department of Biostatistics, Mailman School of Public Health, Columbia University Medical Center, New York, NY, USA
| | - Joel Sneed
- Department of Psychology, Queens College, City University of New York, Flushing, NY, USA.,Department of Psychology, The Graduate Center, City University of New York, New York, NY, USA
| | - Davangere P Devanand
- Department of Psychiatry, Columbia University Medical Center, and the New York State Psychiatry Institute, New York, NY, USA
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James OG, Linares AR, Hellegers C, Doraiswamy PM, Wong TZ. Evaluating Alzheimer Disease With Flortaucipir and Florbetapir PET: A Clinical Case Series. Clin Nucl Med 2021; 46:605-608. [PMID: 33443955 DOI: 10.1097/rlu.0000000000003493] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
ABSTRACT Early, accurate diagnosis of Alzheimer disease (AD) is essential but remains challenging. Neuropathological hallmarks of AD are β-amyloid neuritic plaques and tau protein neurofibrillary tangles. 18F-Florbetapir is one of several available PET tracers for imaging cortical fibrillary β-amyloid plaques. 18F-Flortaucipir PET was recently approved for evaluating the distribution and density of aggregated neurofibrillary tangles. We present cases of mild cognitive impairment or suspected AD to depict the nuances of flortaucipir distribution and scan interpretation as well as how combined information from amyloid and tau PET may help with differential diagnosis and prognosis.
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Affiliation(s)
- Olga G James
- From the Division of Nuclear Medicine and PET Center, Department of Radiology
| | | | | | | | - Terence Z Wong
- From the Division of Nuclear Medicine and PET Center, Department of Radiology
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Tolbert S, Liu Y, Hellegers C, Petrella JR, Weiner MW, Wong TZ, Murali Doraiswamy P. Financial Management Skills in Aging, MCI and Dementia: Cross Sectional Relationship to 18F-Florbetapir PET Cortical β-amyloid Deposition. J Prev Alzheimers Dis 2019; 6:274-282. [PMID: 31686100 DOI: 10.14283/jpad.2019.26] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND There is a need to more fully characterize financial capacity losses in the preclinical and prodromal stages of Alzheimer's disease (AD) and their pathological substrates. OBJECTIVES To test the association between financial skills and cortical β-amyloid deposition in aging and subjects at risk for AD. DESIGN Cross-sectional analyses of data from the Alzheimer's Disease Neuroimaging Initiative (ADNI-3) study conducted across 50 plus sites in the US and Canada. SETTING Multicenter biomarker study. PARTICIPANTS 243 subjects (144 cognitively normal, 79 mild cognitive impairment [MCI], 20 mild AD). MEASUREMENTS 18F-Florbetapir brain PET scans to measure global cortical β-amyloid deposition (SUVr) and the Financial Capacity Instrument Short Form (FCI-SF) to evaluate an individual's financial skills in monetary calculation, financial concepts, checkbook/register usage, and bank statement usage. There are five sub scores and a total score (range of 0-74) with higher scores indicating better financial skill. RESULTS FCI-SF total score was significantly worse in MCI [Cohen's d= 0.9 (95%CI: 0.6-1.2)] and AD subjects [Cohen's d=3.1(CI: 2.5-3.7)] compared to normals. Domain scores and completion times also showed significant difference. Across all subjects, higher cortical β-amyloid SUVr was significantly associated with worse FCI-SF total score after co-varying for age, education, and cognitive score [Cohen's f2=0.751(CI: 0.5-1.1)]. In cognitively normal subjects, after covarying for age, gender, and education, higher β -amyloid PET SUVr was associated with longer task completion time [Cohen's f2=0.198(CI: 0.06-0.37)]. CONCLUSION Using a multicenter study sample, we document that financial capacity is impaired in the prodromal and mild stages of AD and that such impairments are, in part, associated with the extent of cortical β-amyloid deposition. In normal aging, β-amyloid deposition is associated with slowing of financial tasks. These data confirm and extend prior research highlighting the utility of financial capacity assessments in at risk samples.
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Affiliation(s)
- S Tolbert
- Sierra Tolbert, DUMC Box #3018, Durham, NC 27710, USA, , 919-684-5929/919-681-7668 (fax)
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D'Antonio J, Simon-Pearson L, Goldberg T, Sneed JR, Rushia S, Kerner N, Andrews H, Hellegers C, Tolbert S, Perea E, Petrella J, Doraiswamy PM, Devanand D. Cognitive training and neuroplasticity in mild cognitive impairment (COG-IT): protocol for a two-site, blinded, randomised, controlled treatment trial. BMJ Open 2019; 9:e028536. [PMID: 31471436 PMCID: PMC6720324 DOI: 10.1136/bmjopen-2018-028536] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 06/17/2019] [Accepted: 07/10/2019] [Indexed: 01/22/2023] Open
Abstract
INTRODUCTION Mild cognitive impairment (MCI) is common in older adults and represents a high-risk group for progression to Alzheimer's disease (AD). Medication trials in MCI have generally failed, but new discoveries with brain plasticity in ageing have led to the study of cognitive training as a potential treatment to improve cognitive abilities. Computerised cognitive training (CCT) involves computerised cognitive exercises that target specific cognitive abilities and neural networks to potentially improve cognitive functioning through neuroplasticity. METHODS AND ANALYSIS In a two-site study (New York State Psychiatric Institute/Columbia University Medical Center and Duke University Medical Center), we will randomise 100 patients with MCI (Wechsler Memory Scale-III Logical Memory II score 0-11; Folstein Mini Mental State Examination ≥23) to home-based CCT (suite of exercises: memory, matching, spatial recognition, processing speed) or a home-based active control condition (computerised crossword puzzle training (CPT)) with 12 weeks of intensive training followed by regular booster sessions up to 78 weeks. All patients will receive standard neuropsychological and functional assessments in clinic as well as structural/functional brain MRI scans at study entry and endpoint. We will test if CCT, versus CPT, leads to improved cognitive functioning, transfers to functional ability and tasks of everyday life and impacts hippocampal volume changes and changes in the default mode network of the brain measured by resting-state functional MRI. ETHICS AND DISSEMINATION The study will be conducted following ethics approval and written informed consent will be obtained from all subjects. Study results will be disseminated via publication, clinicaltrials.gov, media and conference presentations. This will be the first controlled long-term trial to evaluate the effects of home-based CCT versus computerised CPT on cognitive abilities and functional measures and neural outcomes as determined by MRI indices in patients with MCI. Positive results from trial may support further development of home-based CCT. TRIAL REGISTRATION NUMBER ClinicalTrials.gov identifier (NCT03205709).
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Affiliation(s)
- Jessica D'Antonio
- Division of Geriatric Psychiatry, New York State Psychiatric Institute, New York, New York, USA
| | - Laura Simon-Pearson
- Division of Geriatric Psychiatry, New York State Psychiatric Institute, New York, New York, USA
| | - Terry Goldberg
- Division of Geriatric Psychiatry, New York State Psychiatric Institute, New York, New York, USA
- Department of Psychiatry, Columbia University Medical Center, New York, New York, USA
| | - Joel R Sneed
- Division of Geriatric Psychiatry, New York State Psychiatric Institute, New York, New York, USA
- Department of Psychology, Queens College, City University of New York, Flushing, New York, USA
| | - Sara Rushia
- Department of Psychology, Queens College, City University of New York, Flushing, New York, USA
- Department of Psychology, The Graduate Center, City University of New York, New York, New York, USA
| | - Nancy Kerner
- Department of Psychiatry, Columbia University Medical Center, New York, New York, USA
| | - Howard Andrews
- Department of Biostatistics, Mailman School of Public Health, Columbia University Medical Center, New York, New York, USA
| | - Caroline Hellegers
- Department of Psychiatry, Duke University Medical Center, Durham, North Carolina, USA
| | - Sierra Tolbert
- Department of Psychiatry, Duke University Medical Center, Durham, North Carolina, USA
| | - Elena Perea
- Department of Psychiatry, Duke University Medical Center, Durham, North Carolina, USA
| | - Jeffrey Petrella
- Department of Radiology, Duke University Medical Center, Durham, North Carolina, USA
| | - P Murali Doraiswamy
- Department of Psychiatry, Duke University Medical Center, Durham, North Carolina, USA
| | - Davangere Devanand
- Division of Geriatric Psychiatry, New York State Psychiatric Institute, New York, New York, USA
- Department of Psychiatry, Columbia University Medical Center, New York, New York, USA
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Han X, Rozen S, Boyle SH, Hellegers C, Cheng H, Burke JR, Welsh-Bohmer KA, Doraiswamy PM, Kaddurah-Daouk R. Metabolomics in early Alzheimer's disease: identification of altered plasma sphingolipidome using shotgun lipidomics. PLoS One 2011; 6:e21643. [PMID: 21779331 PMCID: PMC3136924 DOI: 10.1371/journal.pone.0021643] [Citation(s) in RCA: 302] [Impact Index Per Article: 23.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2011] [Accepted: 06/04/2011] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The development of plasma biomarkers could facilitate early detection, risk assessment and therapeutic monitoring in Alzheimer's disease (AD). Alterations in ceramides and sphingomyelins have been postulated to play a role in amyloidogensis and inflammatory stress related neuronal apoptosis; however few studies have conducted a comprehensive analysis of the sphingolipidome in AD plasma using analytical platforms with accuracy, sensitivity and reproducibility. METHODS AND FINDINGS We prospectively analyzed plasma from 26 AD patients (mean MMSE 21) and 26 cognitively normal controls in a non-targeted approach using multi-dimensional mass spectrometry-based shotgun lipidomics to determine the levels of over 800 molecular species of lipids. These data were then correlated with diagnosis, apolipoprotein E4 genotype and cognitive performance. Plasma levels of species of sphingolipids were significantly altered in AD. Of the 33 sphingomyelin species tested, 8 molecular species, particularly those containing long aliphatic chains such as 22 and 24 carbon atoms, were significantly lower (p<0.05) in AD compared to controls. Levels of 2 ceramide species (N16:0 and N21:0) were significantly higher in AD (p<0.05) with a similar, but weaker, trend for 5 other species. Ratios of ceramide to sphingomyelin species containing identical fatty acyl chains differed significantly between AD patients and controls. MMSE scores were correlated with altered mass levels of both N20:2 SM and OH-N25:0 ceramides (p<0.004) though lipid abnormalities were observed in mild and moderate AD. Within AD subjects, there were also genotype specific differences. CONCLUSIONS In this prospective study, we used a sensitive multimodality platform to identify and characterize an essentially uniform but opposite pattern of disruption in sphingomyelin and ceramide mass levels in AD plasma. Given the role of brain sphingolipids in neuronal function, our findings provide new insights into the AD sphingolipidome and the potential use of metabolomic signatures as peripheral biomarkers.
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Affiliation(s)
- Xianlin Han
- Sanford-Burnham Medical Research Institute, Orlando, Florida, United States of America
| | - Steve Rozen
- Department of Medicine, Duke-NUS Graduate Medical School, Singapore, Singapore
| | - Stephen H. Boyle
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Caroline Hellegers
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Hua Cheng
- Sanford-Burnham Medical Research Institute, Orlando, Florida, United States of America
| | - James R. Burke
- Bryan Alzheimer Disease Research Center, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Kathleen A. Welsh-Bohmer
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina, United States of America
- Bryan Alzheimer Disease Research Center, Duke University Medical Center, Durham, North Carolina, United States of America
| | - P. Murali Doraiswamy
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina, United States of America
- Duke Institute of Brain Sciences, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Rima Kaddurah-Daouk
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina, United States of America
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Petrella JR, Prince SE, Wang L, Hellegers C, Doraiswamy PM. Prognostic value of posteromedial cortex deactivation in mild cognitive impairment. PLoS One 2007; 2:e1104. [PMID: 17971867 PMCID: PMC2040216 DOI: 10.1371/journal.pone.0001104] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2007] [Accepted: 09/27/2007] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Normal subjects deactivate specific brain regions, notably the posteromedial cortex (PMC), during many tasks. Recent cross-sectional functional magnetic resonance imaging (fMRI) data suggests that deactivation during memory tasks is impaired in Alzheimer's disease (AD). The goal of this study was to prospectively determine the prognostic significance of PMC deactivation in mild cognitive impairment (MCI). METHODOLOGY/PRINCIPAL FINDINGS 75 subjects (34 MCI, 13 AD subjects and 28 controls) underwent baseline fMRI scanning during encoding of novel and familiar face-name pairs. MCI subjects were followed longitudinally to determine conversion to AD. Regression and analysis of covariance models were used to assess the effect of PMC activation/deactivation on conversion to dementia as well as in the longitudinal change in dementia measures. At longitudinal follow up of up to 3.5 years (mean 2.5+/-0.79 years), 11 MCI subjects converted to AD. The proportion of deactivators was significantly different across all groups: controls (79%), MCI-Nonconverters (73%), MCI-converters (45%), and AD (23%) (p<0.05). Mean PMC activation magnitude parameter estimates, at baseline, were negative in the control (-0.57+/-0.12) and MCI-Nonconverter (-0.33+/-0.14) groups, and positive in the MCI-Converter (0.37+/-0.40) and AD (0.92+/-0.30) groups. The effect of diagnosis on PMC deactivation remained significant after adjusting for age, education and baseline Mini-Mental State Exam (p<0.05). Baseline PMC activation magnitude was correlated with change in dementia ratings from baseline. CONCLUSION Loss of physiological functional deactivation in the PMC may have prognostic value in preclinical AD, and could aid in profiling subgroups of MCI subjects at greatest risk for progressive cognitive decline.
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Affiliation(s)
- Jeffrey R Petrella
- Alzheimer Imaging Research Laboratory and Brain Imaging and Analysis Center, Department of Radiology, Duke University Medical Center, Durham, North Carolina, United States of America.
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Petrella JR, Prince SE, Wang L, Hellegers C, Doraiswamy M. O2–02–06: Functional MRI as a prognostic marker of cognitive decline in mild cognitive impairment. Alzheimers Dement 2007. [DOI: 10.1016/j.jalz.2007.04.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Varia I, Venkataraman S, Hellegers C, Gersing K, Doraiswamy PM. Effect of mirtazapine orally disintegrating tablets on health-related quality of life in elderly depressed patients with comorbid medical disorders: a pilot study. Psychopharmacol Bull 2007; 40:47-56. [PMID: 17285095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
BACKGROUND There is a need for additional studies on the quality of life (QOL) of elderly depressed subjects with medical comorbidity. METHOD We conducted a 10-week, open trial of mirtazapine orally disintegrating tablets in 16 elderly subjects with major depressive disorder and one or more serious medical illnesses. Quality of life was measured by the Medical Outcomes Study Short Form-36 Health Status Survey (SF- 36). RESULTS Treatment with mirtazapine was associated with significant reductions in clinical global impressions-severity of illness scale (CGI-S) score, the Hamilton rating scale for anxiety (HAM-A) total score, the 17-item Hamilton rating scale for depression (HAM-D) total score and the Beck depression inventory (BDI) total scores. The SF-36 "physical functioning", "role limitation physical", "vitality", "social functioning", "role limitation emotional", and "mental health" domains improved significantly. The mean mirtazapine dose at endpoint was 35 mg per day. The drug was relatively well tolerated except for three subjects who dropped out because of side effects. No drug-drug interactions or significant changes in blood pressure or heart rate occurred. CONCLUSION Mirtazapine orally disintegrating tablets may improve depression, insomnia, anxiety, somatic symptoms, and certain quality-of-life measures in elderly depressed subjects with medical disorders. A randomized, placebo-controlled study is warranted to confirm these promising findings.
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Affiliation(s)
- Indira Varia
- Department of Psychiatry, Duke University Medical Center, Durham, NC 27710, USA
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Doraiswamy PM, Varia I, Hellegers C, Wagner HR, Clary GL, Beyer JL, Newby LK, O'Connor JF, Beebe KL, O'Connor C, Krishnan KR. A randomized controlled trial of paroxetine for noncardiac chest pain. Psychopharmacol Bull 2006; 39:15-24. [PMID: 17065971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Noncardiac chest pain occurs frequently in medical practice and is often difficult to treat. We conducted a randomized double-blind, placebo-controlled, 8-week trial of paroxetine in 50 patients with noncardiac chest pain. None of the patients met criteria for panic disorder or major depression. Paroxetine-treated patients showed greater (P < .05) improvements than placebo-treated patients on the Clinical Global Impressions (CGI) scale. Both paroxetine and placebo-treated patients improved to a similar extent on selfrated pain measures, although baseline differences limited the interpretation of this outcome variable. There were no differences on other outcome ratings. Treatment was well tolerated. These preliminary findings extend other data on the potential of selective serotonin reuptake inhibitors for the acute treatment of noncardiac chest pain. Some recommendations for future studies to definitively test this potential are presented.
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Affiliation(s)
- P Murali Doraiswamy
- Department of Psychiatry, Duke University Medical Center, Durham, NC 27710, USA
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