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O'Connor S, Sherlock L, Moran K, Whyte E. Musculoskeletal Injury in Referees That Officiate Over Ladies Gaelic Football and Camogie. Ir Med J 2022; 115:537. [PMID: 35416471] [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: 05/23/2023]
Abstract
Aim Ladies Gaelic football and Camogie are leading female sports in Ireland. Referees are essential to the game, however, no research has examined injury in referees that officiate over female Gaelic games to date. Therefore, this study aims to retrospectively examine the musculoskeletal injury profile and injury prevention practices of referees that officiate over female Gaelic games. Methods A retrospective anonymous questionnaire examined injuries that occurred in the previous 12 months in currently active Ladies Gaelic football and Camogie referees (n=170). Incidence and repeat incidence proportions were calculated along with descriptive statistics. Results In 2019, 42.9% (n=73) of referees sampled sustained an injury with 27.4% (n=20) sustaining two or more. Injuries primarily occurred to the lower extremity (79.6%,n=78), particularly the lower leg (20.4%,n=20) and knee (18.4%,18). Muscle strains and cramps (55.1%,n=54) were most frequent and injuries predominantly occurred during games (71.4%,n=70). Referees largely completed a warm-up but just 30.6% (n=52) conducted a cool-down. Over half had undertaken injury prevention education but only 37.6% (n=64) incorporated injury prevention elements into their training. Conclusion Just over two in five referees that officiate female Gaelic games became injured in the previous year, however their utilisation of injury prevention strategies, beyond completing a warm-up, is lacking. Thus, a referee specific injury prevention programme should be developed and if found to be effective, incorporated into a comprehensive injury prevention strategy by the governing bodies.
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Affiliation(s)
- S O'Connor
- Centre for Injury Prevention and Performance, Athletic Therapy and Training, School of Health and Human Performance, Dublin City University, Ireland
| | - L Sherlock
- Centre for Injury Prevention and Performance, Athletic Therapy and Training, School of Health and Human Performance, Dublin City University, Ireland
| | - K Moran
- Centre for Injury Prevention and Performance, Athletic Therapy and Training, School of Health and Human Performance, Dublin City University, Ireland
- Insight SFI Research Centre for Data Analytics, Dublin City University, Ireland
| | - E Whyte
- Centre for Injury Prevention and Performance, Athletic Therapy and Training, School of Health and Human Performance, Dublin City University, Ireland
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Whyte E, Peni A, Marzolini S, Thomas S. MUSCLE OXYGENATION BETWEEN THE PARETIC AND NONPARETIC LEG MEASURED DURING ARTERIAL OCCLUSION AND EXERCISE IN CHRONIC STROKE. Can J Cardiol 2021. [DOI: 10.1016/j.cjca.2021.07.227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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3
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O’Connor S, McCaffrey N, Whyte E, Moran K. Can the Y balance test predict lower-extremity injury in collegiate Gaelic games? J Sci Med Sport 2017. [DOI: 10.1016/j.jsams.2017.09.229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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4
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Whyte E, Richter C, O’Connor S, Moran K. A preliminary investigation into the between-session reliability of the biomechanics of side cutting manoeuvres. J Sci Med Sport 2017. [DOI: 10.1016/j.jsams.2017.09.368] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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5
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Skidmore ER, Butters M, Whyte E, Grattan E, Shen J, Terhorst L. Guided Training Relative to Direct Skill Training for Individuals With Cognitive Impairments After Stroke: A Pilot Randomized Trial. Arch Phys Med Rehabil 2016; 98:673-680. [PMID: 27794487 DOI: 10.1016/j.apmr.2016.10.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 10/03/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To examine the effects of direct skill training and guided training for promoting independence after stroke. DESIGN Single-blind randomized pilot study. SETTING Inpatient rehabilitation facility. PARTICIPANTS Participants in inpatient rehabilitation with acute stroke and cognitive impairments (N=43). INTERVENTIONS Participants were randomized to receive direct skill training (n=22, 10 sessions as adjunct to usual inpatient rehabilitation) or guided training (n=21, same dose). MAIN OUTCOME MEASURE The FIM assessed independence at baseline, rehabilitation discharge, and months 3, 6, and 12. RESULTS Linear mixed models (random intercept, other effects fixed) revealed a significant intervention by time interaction (F4,150=5.11, P<.001), a significant main effect of time (F4,150=49.25, P<.001), and a significant effect of stroke severity (F1,150=34.46, P<.001). There was no main effect of intervention (F1,150=.07, P=.79). Change in FIM scores was greater for the direct group at rehabilitation discharge (effect size of between-group differences, d=.28) and greater for the guide group at months 3 (d=.16), 6 (d=.39), and 12 (d=.53). The difference between groups in mean 12-month change scores was 10.57 points. CONCLUSIONS Guided training, provided in addition to usual care, offered a small advantage in the recovery of independence, relative to direct skill training. Future studies examining guided training in combination with other potentially potent intervention elements may further advise best practices in rehabilitation for individuals with cognitive impairments after acute stroke.
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Affiliation(s)
- Elizabeth R Skidmore
- Department of Occupational Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA; Department of Physical Medicine and Rehabilitation, School of Medicine, University of Pittsburgh, Pittsburgh, PA.
| | - Meryl Butters
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Ellen Whyte
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Emily Grattan
- Department of Health Science and Research, Medical University of South Carolina, Charleston, SC
| | - Jennifer Shen
- Department of Physical Medicine and Rehabilitation, School of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Lauren Terhorst
- Department of Occupational Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA
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Whyte E, Morse J, Leibold M, Chisholm D, Raina K. Effectiveness of a Behavioral Intervention to Help Individuals Manage Posttraumatic Brain Injury Fatigue. Am J Occup Ther 2015. [DOI: 10.5014/ajot.2015.69s1-rp103a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Abstract
Date Presented 4/16/2015
A significant proportion of individuals with traumatic brain injury (TBI) experience persistent and significant fatigue that affects their daily life. The Maximizing Energy (MAX) intervention is a promising behavioral intervention that has been shown to decrease the impact of post-TBI fatigue on everyday life.
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Kasckow JW, Karp JF, Whyte E, Butters M, Brown C, Begley A, Bensasi S, Reynolds CF. Subsyndromal depression and anxiety in older adults: health related, functional, cognitive and diagnostic implications. J Psychiatr Res 2013; 47:599-603. [PMID: 23414701 PMCID: PMC3594429 DOI: 10.1016/j.jpsychires.2013.01.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2012] [Revised: 11/30/2012] [Accepted: 01/18/2013] [Indexed: 10/27/2022]
Abstract
Subsyndromal depression in later life is common in primary care. Comorbid anxiety disorders could exacerbate the negative effect of subsyndromal depression on functioning, health-related quality of life, comorbidity and/or cognition. We examined anxiety disorders co-existing with subsyndromal depression in participants ≥ age 50 in an NIH trial of Problem Solving Therapy for Primary Care for indicated prevention of major depression. There were 247 participants, with Centers for Epidemiologic Studies - Depression scores ≥ 11. Participants could have multiple psychiatric diagnoses: 22% of the sample had no DSM IV diagnosis; 39% of the sample had only 1 DSM IV diagnosis; 28% had 2 diagnoses; 6% had 3 DSM IV diagnoses; 4% had 4 DSM IV diagnoses; and 1% had 5 diagnoses. Furthermore, 34% of participants had a current comorbid DSM IV diagnosis of a syndromal anxiety disorder. We hypothesized that those with subsyndromal depression, alone relative to those with co-existing anxiety disorders, would report better health-related quality of life, less disability, less medical comorbidity and less cognitive impairment. However, there were no differences in quality of life based on the SF 12 nor in disability based on Late Life Function and Disability Instrument scores. There were no differences in medical comorbidity based on the Cumulative Illness Scale-Geriatrics scale scores nor in cognitive function based on the Executive Interview (EXIT), Hopkins Verbal Learning Test-Revised and Mini-Mental Status Exam. Our findings suggest that about one third of participants 50 years and older with subsyndromal depression have comorbid anxiety disorders; however, this does not appear to be associated with worse quality of life, functioning, disability, cognitive function or medical comorbidity.
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Affiliation(s)
- JW Kasckow
- VA Pittsburgh MIRECC and Behavioral Health, 7180 Highland Dr (116a), Pittsburgh, PA 15206,Department of Psychiatry, University of Pittsburgh School of Medicine, 3811 O’Hara St, Pittsburgh, PA 15213,Corresponding Author John Kasckow, MD, PhD, VA Pittsburgh Health Care System Behavioral Health, 7180 Highland Dr (116a), Pittburgh, PA 15206, Ph: (412) 954-4344,
| | - JF Karp
- Department of Psychiatry, University of Pittsburgh School of Medicine, 3811 O’Hara St, Pittsburgh, PA 15213
| | - E Whyte
- Department of Psychiatry, University of Pittsburgh School of Medicine, 3811 O’Hara St, Pittsburgh, PA 15213
| | - M Butters
- Department of Psychiatry, University of Pittsburgh School of Medicine, 3811 O’Hara St, Pittsburgh, PA 15213
| | - C Brown
- Department of Psychiatry, University of Pittsburgh School of Medicine, 3811 O’Hara St, Pittsburgh, PA 15213
| | - A Begley
- Department of Psychiatry, University of Pittsburgh School of Medicine, 3811 O’Hara St, Pittsburgh, PA 15213
| | - S Bensasi
- Department of Psychiatry, University of Pittsburgh School of Medicine, 3811 O’Hara St, Pittsburgh, PA 15213
| | - CF Reynolds
- Department of Psychiatry, University of Pittsburgh School of Medicine, 3811 O’Hara St, Pittsburgh, PA 15213
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8
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Weissman J, Flint A, Meyers B, Ghosh S, Mulsant B, Rothschild A, Whyte E. Factors associated with non-completion in a double-blind randomized controlled trial of olanzapine plus sertraline versus olanzapine plus placebo for psychotic depression. Psychiatry Res 2012; 197:221-6. [PMID: 22464991 PMCID: PMC3418413 DOI: 10.1016/j.psychres.2012.02.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2011] [Accepted: 02/13/2012] [Indexed: 10/28/2022]
Abstract
High rates of attrition have been reported in randomized controlled trials of patients with severe psychiatric illness, including psychotic depression (MDpsy). The purpose of this study is to examine factors associated with overall attrition and with subtypes of attrition in the Study of the Pharmacotherapy of Psychotic Depression (STOP-PD). Secondary analysis of data collected in a multi-site, randomized, placebo-controlled trial. Clinical services of academic hospitals. Participants comprised 259 persons with MDpsy, aged 18-93 years. The intervention consisted of the random allocation to 12 weeks of treatment of either olanzapine plus sertraline or olanzapine plus placebo. Demographic and clinical variables associated with overall non-completion and sub-types of non-completion of randomized treatment. One hundred and seventeen (45.2%) subjects did not complete 12 weeks of randomized treatment. In a logistic regression analysis, inpatient entry status, olanzapine monotherapy, and higher cumulative medical burden were statistically significant independent predictors of overall non-completion. In a multinomial logistic regression model that examined predictors of subtypes of non-completion, subjects who entered the study as an inpatient were less likely to complete because of inadequate efficacy as determined by the investigator, and older subjects were less likely to complete because of poorer tolerability. Subjects who were assigned to olanzapine monotherapy, younger subjects, and subjects who entered the study as inpatients were less likely to complete because of reasons other than efficacy or tolerability. Understanding factors that contribute to premature discontinuation in studies of MDpsy, and to the specific reasons for attrition, has the potential to improve the management of this disorder, as well as improve the design of future clinical trials of MDpsy.
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Affiliation(s)
- Judith Weissman
- Department of Psychiatry Weill Medical College of Cornell University and New York Presbyterian Hospital–Westchester Division
| | - Alastair Flint
- Department of Psychiatry, University of Toronto,Department of Psychiatry, University Health Network, Toronto,Toronto General and Toronto Rehab Research Institutes, Toronto
| | - Barnett Meyers
- Department of Psychiatry Weill Medical College of Cornell University and New York Presbyterian Hospital–Westchester Division
| | - Samiran Ghosh
- Department of Psychiatry Weill Medical College of Cornell University and New York Presbyterian Hospital–Westchester Division
| | - Benoit Mulsant
- Department of Psychiatry, University of Toronto,Centre for Addiction and Mental Health, Toronto,Western Psychiatric Institute and Clinic, Department of Psychiatry, University of Pittsburgh School of Medicine
| | - Anthony Rothschild
- University of Massachusetts Medical School and UMass Memorial Health Care
| | - Ellen Whyte
- Western Psychiatric Institute and Clinic, Department of Psychiatry, University of Pittsburgh School of Medicine
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9
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Blumberger DM, Mulsant BH, Emeremni C, Houck P, Andreescu C, Mazumdar S, Whyte E, Rothschild AJ, Flint AJ, Meyers BS. Impact of prior pharmacotherapy on remission of psychotic depression in a randomized controlled trial. J Psychiatr Res 2011; 45:896-901. [PMID: 21300377 PMCID: PMC3419434 DOI: 10.1016/j.jpsychires.2011.01.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2010] [Revised: 12/20/2010] [Accepted: 01/06/2011] [Indexed: 11/26/2022]
Abstract
Having failed to respond to an adequate antidepressant treatment course predicts poorer treatment outcomes in patients with major depression. However, little is known about the impact of prior treatment on the outcome of major depression with psychotic features (MDpsy). We examined the effect of prior treatment history on the outcome of pharmacotherapy of MDpsy in patients who participated in the STOPD-PD study, a randomized, double-blind, clinical trial comparing a combination of olanzapine plus sertraline vs. olanzapine plus placebo. The strength of treatment courses received prior to randomization was classified using a validated method. A hierarchy of outcomes was hypothesized based on treatments received prior to randomization and randomized treatment. A high remission rate was observed in subjects with a history of no prior treatment or inadequate treatment who were treated with a combination of olanzapine and sertraline. A low remission rate was observed in subjects who had previously failed to respond to an antidepressant alone and who were treated with olanzapine monotherapy. A low remission rate was also observed in subjects who had previously failed to respond to a combination of an antipsychotic and an antidepressant. Similar to patients with major depression, these results emphasize the impact of prior pharmacotherapy on treatment outcomes in patients with MDpsy.
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Affiliation(s)
- Daniel M. Blumberger
- Centre for Addiction and Mental Health, Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Benoit H. Mulsant
- Centre for Addiction and Mental Health, Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada,Western Psychiatric Institute and Clinic, Department of Psychiatry, University of Pittsburgh School of Medicine
| | - Chetachi Emeremni
- Western Psychiatric Institute and Clinic, Department of Psychiatry, University of Pittsburgh School of Medicine
| | - Patricia Houck
- Western Psychiatric Institute and Clinic, Department of Psychiatry, University of Pittsburgh School of Medicine
| | - Carmen Andreescu
- Western Psychiatric Institute and Clinic, Department of Psychiatry, University of Pittsburgh School of Medicine
| | - Sati Mazumdar
- Western Psychiatric Institute and Clinic, Department of Psychiatry, University of Pittsburgh School of Medicine
| | - Ellen Whyte
- Western Psychiatric Institute and Clinic, Department of Psychiatry, University of Pittsburgh School of Medicine
| | - Anthony J. Rothschild
- University of Massachusetts Medical School and University of Massachusetts Memorial Health Care
| | - Alastair J. Flint
- University Health Network Department of Psychiatry, the Geriatric Program and Research Institute, Toronto Rehabilitation Institute, Department of Psychiatry University of Toronto
| | - Barnett S. Meyers
- Department of Psychiatry, Weill Medical College of Cornell University and New York Presbyterian Hospital - Westchester Division
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10
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Whyte E, Skidmore E, Aizenstein H, Ricker J, Butters M. Cognitive impairment in acquired brain injury: a predictor of rehabilitation outcomes and an opportunity for novel interventions. PM R 2011; 3:S45-51. [PMID: 21703580 PMCID: PMC4492523 DOI: 10.1016/j.pmrj.2011.05.007] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2011] [Accepted: 05/09/2011] [Indexed: 11/16/2022]
Abstract
Cognitive impairment is a common sequela in acquired brain injury and one that predicts rehabilitation outcomes. There is emerging evidence that impairments in cognitive functions can be manipulated by both pharmacologic and nonpharmacologic interventions to improve rehabilitation outcomes. By using stroke as a model for acquired brain injury, we review the evidence that links cognitive impairment to poor rehabilitation outcomes and discuss possible mechanisms to explain this association. Furthermore, we examine nascent promising research that suggests that interventions that target cognitive impairments can lead to better rehabilitation outcomes.
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Affiliation(s)
- Ellen Whyte
- Department of Psychiatry, School of Medicine, WPIC-BT 764, 3811 O'Hara St, Pittsburgh PA 15213, USA
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11
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Skidmore E, Whyte E, Holm M, Becker J, Butters M, Dew MA, Lenze E. Poster 18: Cognitive Impairment and Rehabilitation Participation After Stroke. Arch Phys Med Rehabil 2009. [DOI: 10.1016/j.apmr.2009.08.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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12
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Mehta M, Whyte E, Lenze E, Hardy S, Roumani Y, Subashan P, Huang W, Studenski S. Depressive symptoms in late life: associations with apathy, resilience and disability vary between young-old and old-old. Int J Geriatr Psychiatry 2008; 23:238-43. [PMID: 17676651 DOI: 10.1002/gps.1868] [Citation(s) in RCA: 101] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Prior research has found that disability and apathy are associated with late-life depression. However, the effect of age on these associations in "late-life," an ambiguous term encompassing all individuals typically older than 60 years, has not been examined. We investigated the association of depression with disability, apathy and resilience across the age range of late-life. METHODS One hundred and five community-dwelling elderly with moderate levels of disability were assessed using the Geriatric Depression Scale (GDS), Hardy-Gill Resilience Scale, Starkstein Apathy Scale and IADL/ADL questionnaire. Multiple regression analysis was used to assess relationships between depression, disability, apathy and resilience, stratified by age (<80 vs. >80). RESULTS In the <80 year old subject group, resilience, apathy and disability scores (partial type III R(2) = 11.1%, 10.4% and 12.8%, respectively) equally contributed to the variability of GDS score. In contrast, in the >80 year old subject group, apathy (partial type III R(2) = 18.7%) had the greatest contribution to GDS score. CONCLUSIONS In elderly persons under age 80, resilience, apathy and disability all have relatively equal contributions to depression scores, whereas in those over age 80, depression is most highly correlated with apathy. These data suggest that depressive symptoms in elderly persons have different clinical features along the age spectrum from young-old to old-old.
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Affiliation(s)
- Mona Mehta
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
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13
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Saghafi R, Brown C, Butters MA, Cyranowski J, Dew MA, Frank E, Gildengers A, Karp JF, Lenze EJ, Lotrich F, Martire L, Mazumdar S, Miller MD, Mulsant BH, Weber E, Whyte E, Morse J, Stack J, Houck PR, Bensasi S, Reynolds CF. Predicting 6-week treatment response to escitalopram pharmacotherapy in late-life major depressive disorder. Int J Geriatr Psychiatry 2007; 22:1141-6. [PMID: 17486678 PMCID: PMC3579589 DOI: 10.1002/gps.1804] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Approximately half of older patients treated for major depressive disorder (MDD) do not achieve symptomatic remission and functional recovery with first-line pharmacotherapy. This study aims to characterize sociodemographic, clinical, and neuropsychologic correlates of full, partial, and non-response to escitalopram monotherapy of unipolar MDD in later life. METHODS One hundred and seventy-five patients aged 60 and older were assessed at baseline on demographic variables, depression severity, hopelessness, anxiety, cognitive functioning, co-existing medical illness burden, social support, and quality of life (disability). Subjects received 10 mg/d of open-label escitalopram and were divided into full (n = 55; 31%), partial (n = 75; 42.9%), and non-responder (n = 45; 25.7%) groups based on Hamilton depression scores at week 6. Univariate followed by multivariate analyses tested for differences between the three groups. RESULTS Non-responders to treatment were found to be more severely depressed and anxious at baseline than both full and partial responders, more disabled, and with lower self-esteem than full responders. In general partial responders resembled full responders more than they resembled non-responders. In multivariate models, more severe anxiety symptoms (both psychological and somatic) and lower self-esteem predicted worse response status at 6 weeks. CONCLUSION Among treatment-seeking elderly persons with MDD, higher anxiety symptoms and lower self-esteem predict poorer response after six weeks of escitalopram treatment.
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Affiliation(s)
- Ramin Saghafi
- Western Psychiatric Institute and Clinic, Department of Psychiatry, University of Pittsburgh School of Medicine, the Advanced Center for Interventions and Services Research in Late-Life Mood Disorders; the John A. Hartford Center of Excellence in Geriatric Psychiatry, University of Pittsburgh School of Medicine; Project EXPORT at the Center for Minority Health, NIH/NCMHD P60 MD-000-207, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, USA
| | - Charlotte Brown
- Western Psychiatric Institute and Clinic, Department of Psychiatry, University of Pittsburgh School of Medicine, the Advanced Center for Interventions and Services Research in Late-Life Mood Disorders; the John A. Hartford Center of Excellence in Geriatric Psychiatry, University of Pittsburgh School of Medicine; Project EXPORT at the Center for Minority Health, NIH/NCMHD P60 MD-000-207, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, USA
| | - Meryl A. Butters
- Western Psychiatric Institute and Clinic, Department of Psychiatry, University of Pittsburgh School of Medicine, the Advanced Center for Interventions and Services Research in Late-Life Mood Disorders; the John A. Hartford Center of Excellence in Geriatric Psychiatry, University of Pittsburgh School of Medicine; Project EXPORT at the Center for Minority Health, NIH/NCMHD P60 MD-000-207, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, USA
| | - Jill Cyranowski
- Western Psychiatric Institute and Clinic, Department of Psychiatry, University of Pittsburgh School of Medicine, the Advanced Center for Interventions and Services Research in Late-Life Mood Disorders; the John A. Hartford Center of Excellence in Geriatric Psychiatry, University of Pittsburgh School of Medicine; Project EXPORT at the Center for Minority Health, NIH/NCMHD P60 MD-000-207, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, USA
| | - Mary Amanda Dew
- Western Psychiatric Institute and Clinic, Department of Psychiatry, University of Pittsburgh School of Medicine, the Advanced Center for Interventions and Services Research in Late-Life Mood Disorders; the John A. Hartford Center of Excellence in Geriatric Psychiatry, University of Pittsburgh School of Medicine; Project EXPORT at the Center for Minority Health, NIH/NCMHD P60 MD-000-207, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, USA
| | - Ellen Frank
- Western Psychiatric Institute and Clinic, Department of Psychiatry, University of Pittsburgh School of Medicine, the Advanced Center for Interventions and Services Research in Late-Life Mood Disorders; the John A. Hartford Center of Excellence in Geriatric Psychiatry, University of Pittsburgh School of Medicine; Project EXPORT at the Center for Minority Health, NIH/NCMHD P60 MD-000-207, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, USA
| | - Ariel Gildengers
- Western Psychiatric Institute and Clinic, Department of Psychiatry, University of Pittsburgh School of Medicine, the Advanced Center for Interventions and Services Research in Late-Life Mood Disorders; the John A. Hartford Center of Excellence in Geriatric Psychiatry, University of Pittsburgh School of Medicine; Project EXPORT at the Center for Minority Health, NIH/NCMHD P60 MD-000-207, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, USA
| | - Jordan F. Karp
- Western Psychiatric Institute and Clinic, Department of Psychiatry, University of Pittsburgh School of Medicine, the Advanced Center for Interventions and Services Research in Late-Life Mood Disorders; the John A. Hartford Center of Excellence in Geriatric Psychiatry, University of Pittsburgh School of Medicine; Project EXPORT at the Center for Minority Health, NIH/NCMHD P60 MD-000-207, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, USA
| | - Eric J. Lenze
- Western Psychiatric Institute and Clinic, Department of Psychiatry, University of Pittsburgh School of Medicine, the Advanced Center for Interventions and Services Research in Late-Life Mood Disorders; the John A. Hartford Center of Excellence in Geriatric Psychiatry, University of Pittsburgh School of Medicine; Project EXPORT at the Center for Minority Health, NIH/NCMHD P60 MD-000-207, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, USA
| | - Francis Lotrich
- Western Psychiatric Institute and Clinic, Department of Psychiatry, University of Pittsburgh School of Medicine, the Advanced Center for Interventions and Services Research in Late-Life Mood Disorders; the John A. Hartford Center of Excellence in Geriatric Psychiatry, University of Pittsburgh School of Medicine; Project EXPORT at the Center for Minority Health, NIH/NCMHD P60 MD-000-207, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, USA
| | - Lynn Martire
- Western Psychiatric Institute and Clinic, Department of Psychiatry, University of Pittsburgh School of Medicine, the Advanced Center for Interventions and Services Research in Late-Life Mood Disorders; the John A. Hartford Center of Excellence in Geriatric Psychiatry, University of Pittsburgh School of Medicine; Project EXPORT at the Center for Minority Health, NIH/NCMHD P60 MD-000-207, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, USA
| | - Sati Mazumdar
- Western Psychiatric Institute and Clinic, Department of Psychiatry, University of Pittsburgh School of Medicine, the Advanced Center for Interventions and Services Research in Late-Life Mood Disorders; the John A. Hartford Center of Excellence in Geriatric Psychiatry, University of Pittsburgh School of Medicine; Project EXPORT at the Center for Minority Health, NIH/NCMHD P60 MD-000-207, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, USA
| | - Mark D. Miller
- Western Psychiatric Institute and Clinic, Department of Psychiatry, University of Pittsburgh School of Medicine, the Advanced Center for Interventions and Services Research in Late-Life Mood Disorders; the John A. Hartford Center of Excellence in Geriatric Psychiatry, University of Pittsburgh School of Medicine; Project EXPORT at the Center for Minority Health, NIH/NCMHD P60 MD-000-207, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, USA
| | - Benoit H. Mulsant
- Western Psychiatric Institute and Clinic, Department of Psychiatry, University of Pittsburgh School of Medicine, the Advanced Center for Interventions and Services Research in Late-Life Mood Disorders; the John A. Hartford Center of Excellence in Geriatric Psychiatry, University of Pittsburgh School of Medicine; Project EXPORT at the Center for Minority Health, NIH/NCMHD P60 MD-000-207, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, USA
- Centre for Addiction and Mental Health, University of Toronto, Canada
| | - Elizabeth Weber
- Western Psychiatric Institute and Clinic, Department of Psychiatry, University of Pittsburgh School of Medicine, the Advanced Center for Interventions and Services Research in Late-Life Mood Disorders; the John A. Hartford Center of Excellence in Geriatric Psychiatry, University of Pittsburgh School of Medicine; Project EXPORT at the Center for Minority Health, NIH/NCMHD P60 MD-000-207, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, USA
| | - Ellen Whyte
- Western Psychiatric Institute and Clinic, Department of Psychiatry, University of Pittsburgh School of Medicine, the Advanced Center for Interventions and Services Research in Late-Life Mood Disorders; the John A. Hartford Center of Excellence in Geriatric Psychiatry, University of Pittsburgh School of Medicine; Project EXPORT at the Center for Minority Health, NIH/NCMHD P60 MD-000-207, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, USA
| | - Jennifer Morse
- Western Psychiatric Institute and Clinic, Department of Psychiatry, University of Pittsburgh School of Medicine, the Advanced Center for Interventions and Services Research in Late-Life Mood Disorders; the John A. Hartford Center of Excellence in Geriatric Psychiatry, University of Pittsburgh School of Medicine; Project EXPORT at the Center for Minority Health, NIH/NCMHD P60 MD-000-207, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, USA
| | - Jacqueline Stack
- Western Psychiatric Institute and Clinic, Department of Psychiatry, University of Pittsburgh School of Medicine, the Advanced Center for Interventions and Services Research in Late-Life Mood Disorders; the John A. Hartford Center of Excellence in Geriatric Psychiatry, University of Pittsburgh School of Medicine; Project EXPORT at the Center for Minority Health, NIH/NCMHD P60 MD-000-207, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, USA
| | - Patricia R. Houck
- Western Psychiatric Institute and Clinic, Department of Psychiatry, University of Pittsburgh School of Medicine, the Advanced Center for Interventions and Services Research in Late-Life Mood Disorders; the John A. Hartford Center of Excellence in Geriatric Psychiatry, University of Pittsburgh School of Medicine; Project EXPORT at the Center for Minority Health, NIH/NCMHD P60 MD-000-207, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, USA
| | - Salem Bensasi
- Western Psychiatric Institute and Clinic, Department of Psychiatry, University of Pittsburgh School of Medicine, the Advanced Center for Interventions and Services Research in Late-Life Mood Disorders; the John A. Hartford Center of Excellence in Geriatric Psychiatry, University of Pittsburgh School of Medicine; Project EXPORT at the Center for Minority Health, NIH/NCMHD P60 MD-000-207, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, USA
| | - Charles F. Reynolds
- Western Psychiatric Institute and Clinic, Department of Psychiatry, University of Pittsburgh School of Medicine, the Advanced Center for Interventions and Services Research in Late-Life Mood Disorders; the John A. Hartford Center of Excellence in Geriatric Psychiatry, University of Pittsburgh School of Medicine; Project EXPORT at the Center for Minority Health, NIH/NCMHD P60 MD-000-207, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, USA
- Correspondence to: Dr C. F. Reynolds, III, 3811 O’Hara Street, Pittsburgh, PA 15213, USA.
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Wu M, Rosano C, Butters M, Whyte E, Nable M, Crooks R, Meltzer CC, Reynolds CF, Aizenstein3 HJ. A fully automated method for quantifying and localizing white matter hyperintensities on MR images. Psychiatry Res 2006; 148:133-42. [PMID: 17097277 PMCID: PMC1761950 DOI: 10.1016/j.pscychresns.2006.09.003] [Citation(s) in RCA: 152] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2005] [Revised: 06/16/2006] [Accepted: 09/11/2006] [Indexed: 12/25/2022]
Abstract
White matter hyperintensities (WMH), commonly found on T2-weighted FLAIR brain MR images in the elderly, are associated with a number of neuropsychiatric disorders, including vascular dementia, Alzheimer's disease, and late-life depression. Previous MRI studies of WMHs have primarily relied on the subjective and global (i.e., full-brain) ratings of WMH grade. In the current study we implement and validate an automated method for quantifying and localizing WMHs. We adapt a fuzzy-connected algorithm to automate the segmentation of WMHs and use a demons-based image registration to automate the anatomic localization of the WMHs using the Johns Hopkins University White Matter Atlas. The method is validated using the brain MR images acquired from eleven elderly subjects with late-onset late-life depression (LLD) and eight elderly controls. This dataset was chosen because LLD subjects are known to have significant WMH burden. The volumes of WMH identified in our automated method are compared with the accepted gold standard (manual ratings). A significant correlation of the automated method and the manual ratings is found (P<0.0001), thus demonstrating similar WMH quantifications of both methods. As has been shown in other studies (e.g. [Taylor, W.D., MacFall, J.R., Steffens, D.C., Payne, M.E., Provenzale, J.M., Krishnan, K.R., 2003. Localization of age-associated white matter hyperintensities in late-life depression. Progress in Neuro-Psychopharmacology and Biological Psychiatry. 27 (3), 539-544.]), we found there was a significantly greater WMH burden in the LLD subjects versus the controls for both the manual and automated method. The effect size was greater for the automated method, suggesting that it is a more specific measure. Additionally, we describe the anatomic localization of the WMHs in LLD subjects as well as in the control subjects, and detect the regions of interest (ROIs) specific for the WMH burden of LLD patients. Given the emergence of large NeuroImage databases, techniques, such as that described here, will allow for a better understanding of the relationship between WMHs and neuropsychiatric disorders.
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Affiliation(s)
- Minjie Wu
- Department of Electrical and Computer Engineering
| | | | | | | | | | | | | | | | - Howard J. Aizenstein3
- * Correspondence should be addressed to: Howard J. Aizenstein, M.D., Ph.D., Western Psychiatric Institute and Clinic, 3811 O’Hara Street, Pittsburgh, PA 15213, USA, Tel: (412) 624-4997, Fax: (412) 624-0223,
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Johnson EM, Whyte E, Mulsant BH, Pollock BG, Weber E, Begley AE, Reynolds CF. Cardiovascular changes associated with venlafaxine in the treatment of late-life depression. Am J Geriatr Psychiatry 2006; 14:796-802. [PMID: 16943176 DOI: 10.1097/01.jgp.0000204328.50105.b3] [Citation(s) in RCA: 91] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Potential cardiovascular side effects from venlafaxine-XR must be considered when prescribing this medication, especially in geriatric patients, who often present with comorbid medical conditions. METHODS Participants age 60 and older with a Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition diagnosis of a major depressive episode without psychotic features were treated openly with venlafaxine-XR for 12 weeks during which venlafaxine-XR was titrated based on tolerability and response according to predefined guidelines. Sitting and standing blood pressures and heart rates were measured. A 12-lead electrocardiogram was obtained at baseline and at week 12. RESULTS Sixty-two participants started treatment; 59 completed at least two weeks of the 12-week study. The mean final dose of venlafaxine-XR was 195.5 mg/day (standard deviation: 72.2). Twenty-four percent (95% confidence interval [CI]: 7.3%-40.7%) of initially normotensive participants and 54% (95% CI: 34.3%-74%) of those with preexisting hypertension experienced an increase in blood pressure. Twenty-nine percent (95% CI: 14.6%-43.4%) of participants developed orthostatic hypotension. Two participants experienced a clinically significant increase in QTc interval. One participant reported new-onset mild dizziness, whereas four participants reported new-onset tachycardia or palpitation. Overall, 17 unique participants (28.8%; 95% CI: 17.3%-40.4%) experienced a new-onset cardiovascular problem, potentially related to the study medication. CONCLUSION Overall, venlafaxine-XR was well tolerated. However, similar to previous reports, venlafaxine-XR was associated with some undesirable cardiovascular effects in some of the participants. Systematic monitoring of cardiovascular parameters during treatment with venlafaxine-XR should be strongly recommended, especially in the elderly.
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Affiliation(s)
- Ellyn M Johnson
- Western Psychiatric Institute and Clinic, Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Toro JARD, Penrod LE, Whyte E. Poster 141. Arch Phys Med Rehabil 2005. [DOI: 10.1016/j.apmr.2005.07.166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Whyte E, Ball DR. A response to 'Patients ideas of surgical risk', Palmer J, Anaesthesia 2003; 58: 1239. Anaesthesia 2004; 59:518; author reply 518. [PMID: 15096261 DOI: 10.1111/j.1365-2044.2004.03781.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
Depression and anxiety disorders are very common in the elderly. Data accumulated over the past 2 decades have shown that most older patients can tolerate and respond to acute treatment with serotonergic antidepressants, other psychotropic agents, or manual-based psychotherapy. However, outcomes under usual-care conditions remain poor. This review proposes that clinicians may significantly improve the long-term outcomes of their older patients with depression and anxiety by focusing on four key factors: (1) identification and treatment of comorbid conditions; (2) full remission of acute symptoms; (3) education of patients, families, and professional colleagues about the need for long-term treatment; and (4) prevention and management of medication side-effects.
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Affiliation(s)
- Benoit H Mulsant
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
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Miller MD, Lenze EJ, Dew MA, Whyte E, Weber E, Begley AE, Reynolds CF. Effect of cerebrovascular risk factors on depression treatment outcome in later life. Am J Geriatr Psychiatry 2002; 10:592-8. [PMID: 12213694] [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] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
OBJECTIVE The vascular depression hypothesis posits that depression can arise in late life from cerebrovascular damage and that depression arising this way has a different clinical presentation and is more chronic and treatment-resistant than early-onset depression. This study tested the relationship of cerebrovascular risk factors (CVRF) to clinical presentation and treatment outcome in 156 subjects enrolled in a long-term maintenance treatment study of late-life recurrent major depression. METHODS CVRF scores were generated with the Probability of Stroke Risk Profile. Subjects with the highest one-third of scores were designated High CVRF, and their baseline clinical presentation and treatment outcomes were compared with the remaining subjects. RESULTS In the High-CVRF group, a greater proportion of subjects had first-onset depression after age 60. However, high CVRF score, late onset of depression, and their interaction had no effect on time-to-remission, need for adjunctive medication, or increased risk for recurrence during 3-year follow-up. Furthermore, high CVRF score and late onset of depression did not predict the associated clinical features of vascular depression, such as psychomotor retardation and lack of insight, previously described in the literature. CONCLUSION Optimism about the outcome of late-life depression treatment should not be diminished by the presence of high cerebrovascular risk.
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Affiliation(s)
- Mark D Miller
- Intervention Research Center in Late-Life Mood Disorders, Department of Psychiatry, University of Pittsburgh School of Medicine, 3811 O'Hara Street, Pittsburgh, PA 15213, USA.
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Whyte E. Health begins at school. Nurs Times 1984; 80:40-42. [PMID: 6569479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
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