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Mahr F, Billman Miller MG, Quaill MA, Ryan SA, Nadeem T. Serum zinc levels in youth with avoidant/restrictive food intake disorder and anorexia nervosa: Clinical correlation with weight and psychopathology. Nutr Health 2023:2601060231191658. [PMID: 37501551 DOI: 10.1177/02601060231191658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
BACKGROUND Avoidant/restrictive food intake disorder (ARFID) and anorexia nervosa (AN) are characterized by restrictive eating and micronutrient deficiencies. While zinc deficiency has been identified in AN, zinc level in ARFID has not been systematically assessed. AIM Examine serum zinc levels and their association with eating pathology, psychopathology, and executive functioning in youth with ARFID and AN. METHODS This study included 28 adolescents (Mage = 13, 75% female) receiving treatment for ARFID (n = 13) and AN (n = 15). Demographic data and intake mood metrics were obtained via chart review. Participants completed the Delis-Kaplan Executive Functioning Systems and their mothers completed the behavior rating inventory of executive function (BRIEF-2). Zinc level was collected via blood draw. Independent samples t-tests, Pearson's chi-square, and Pearson's correlations were used to evaluate between-group differences and the relationship between zinc level and clinical correlates. RESULTS No between-groups differences emerged in zinc levels, though half the sample demonstrated low levels for their ages. No significant correlations were found between zinc level and demographic data, mood measures, or executive functioning tasks. AN had relatively lower zinc levels, higher eating pathology, and anxiety, though ARFID had a longer duration of illness. Correlations between zinc and BRIEF-2 scores were mixed. CONCLUSION This is the first study to systematically assess zinc levels in ARFID. While there were no group differences for zinc levels, 50% of the sample had low zinc levels. Zinc level did not correlate with higher psychopathology. Monitoring zinc levels throughout treatment in the context of anabolic processes can inform treatment strategies.
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Affiliation(s)
- Fauzia Mahr
- Department of Psychiatry and Behavioural Health, Penn State College of Medicine, Hershey, PA, USA
- Department of Pediatrics, Penn State College of Medicine, Hershey, PA, USA
| | | | | | - Sheryl A Ryan
- Department of Pediatrics, Penn State College of Medicine, Hershey, PA, USA
| | - Tania Nadeem
- Department of Psychiatry, Aga Khan University, Karachi, Pakistan
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Mahr F, Waschbusch DA, Vgontzas A. A Pilot Study on the Effectiveness of Prazosin as a Treatment of Post-Traumatic Stress Disorder-Related Nightmares in Women with Bulimia Nervosa. Cureus 2023; 15:e42433. [PMID: 37637523 PMCID: PMC10448916 DOI: 10.7759/cureus.42433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2023] [Indexed: 08/29/2023] Open
Abstract
Objectives Post-traumatic stress disorder (PTSD) symptoms are reported in over 36% of individuals with bulimia nervosa. To date, none of the clinical trials have examined nightmare reduction in this population. We evaluated the effectiveness of prazosin in bulimic females experiencing PTSD-related nightmares. We hypothesized that prazosin will decrease nightmares, normalize cortisol levels and secretory patterns, and improve sleep. Methods Our seven-week prospective, randomized, double-blind, placebo-controlled crossover pilot trial recruited eight adult women. Each participant received three weeks of prazosin and a placebo, separated by a one-week washout period. The order of treatment was counterbalanced across participants. Self-reports, clinician-administered scales, and salivary cortisol was collected to measure outcomes. Results A significant treatment effect was seen in nightmare intensity on the Clinician-Administered PTSD Scale (CAPS-I) (p=0.026) and a marginally significant effect on nightmare frequency (p=0.069). The only significant main effect of treatment on self-reported sleep parameters was on nightmares. Cortisol secretory patterns did not change, but on average, study participants had significantly higher cortisol levels compared to normative values. ANOVA showed a significant main effect of time for cortisol (F(4, 28) = 6.15, p=.001) but no within or between groups significant effects (ps>.179). Follow-up tests showed the effect of time was linear (F(1, 7) = 10.77, p=.013). Conclusion Prazosin significantly reduced intensity and marginally reduced the frequency of PTSD-related nightmares in bulimia nervosa but did not affect subjective sleep efficiency, quality, cortisol levels, or diurnal cortisol secretory pattern. Larger trials using objective sleep measures are warranted to replicate these findings.
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Affiliation(s)
- Fauzia Mahr
- Pediatrics and Eating Disorders, Penn State College of Medicine, Hershey, USA
| | - Daniel A Waschbusch
- Psychiatry and Behavioral Health, Penn State College of Medicine, Hershey, USA
| | - Alexandros Vgontzas
- Psychiatry and Behavioral Health, Penn State College of Medicine, Hershey, USA
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Nadeem T, Gul B, Chhapra R, Mahr F, Pirani S, Asad N. Eating Disorders in Medical and Nursing Students of a Private University: Relationship with Depression, Anxiety, and Stress. J Coll Physicians Surg Pak 2023; 33:823-825. [PMID: 37401229 DOI: 10.29271/jcpsp.2023.07.823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 02/23/2023] [Indexed: 07/05/2023]
Abstract
The study aimed to identify the relationship between Avoidant/Restrictive Food Intake Disorder (ARFID), Anorexia and Bulimia nervosa with stress, depression, and anxiety, among undergraduate students at Aga Khan University (AKU) in Pakistan. The data collection was done online using Eating Attitude Test-26 (EAT-26), Nine Item ARFID Screen (NIAS), and Depression Anxiety Stress Scale (DASS-21). A total of 79 responses were received. Among them, 83.5% (n=66) were females and 16.5% (n=13) were males. On the NIAS screen, 16.5% participants tested positive and 15.2% indicated high risk of eating disorders on EAT-26. There were 26% participants who were underweight while 20% were overweight. Anxiety was significantly associated with all eating disorders while depression and stress were significantly associated with positive EAT-26 results too. Females and early- year students were at higher risk. We recommend regular monitoring for eating changes which may improve psychological and physical wellbeing of medical and nursing students. Key Words: Eating disorders, Stress, Dysfunctional eating behaviours, Students, Pakistan.
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Affiliation(s)
- Tania Nadeem
- Department of Psychiatry, The Aga Khan University, Karachi, Pakistan
- Department of Psychiatry, Penn State College of Medicine, Pennsylvania, United States of American
| | - Banafsha Gul
- Department of Psychiatry, Baluchistan Institute of Psychiatry and Behavioral Sciences, Quetta, Pakistan
| | - Rijah Chhapra
- Department of Psychiatry, The Aga Khan University, Karachi, Pakistan
- Department of Psychiatry, Penn State College of Medicine, Pennsylvania, United States of American
| | | | - Shahina Pirani
- Department of Psychiatry, The Aga Khan University, Karachi, Pakistan
- Department of Psychiatry, Penn State College of Medicine, Pennsylvania, United States of American
| | - Nargis Asad
- Department of Psychiatry, The Aga Khan University, Karachi, Pakistan
- Department of Psychiatry, Penn State College of Medicine, Pennsylvania, United States of American
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Roden RC, Billman M, Lane-Loney S, Essayli J, Mahr F, Vrana K, Ryan S. An experimental protocol for a double-blind placebo-controlled evaluation of the effectiveness of oral naltrexone in management of adolescent eating disorders. Contemp Clin Trials 2022; 122:106937. [PMID: 36167287 DOI: 10.1016/j.cct.2022.106937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 05/09/2022] [Revised: 09/13/2022] [Accepted: 09/20/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND This double-blind, placebo-controlled study evaluates the effectiveness of oral naltrexone in adolescents and young adults with eating disorders (EDs) characterized by purging with or without binge-eating behaviors. We hypothesize that participants receiving oral naltrexone will demonstrate greater improvements in body mass index in underweight participants and self-reported ED symptomatology compared to placebo. METHODS Thirty individuals receiving treatment in a partial hospitalization program for EDs with diagnoses of anorexia nervosa binge-eating/purging type, bulimia nervosa, or purging disorder will receive six weeks of either placebo or oral naltrexone. Participants will complete a battery of self-report measures and laboratory safety monitoring every three weeks in addition to standard of medical care for treatment environment. RESULTS Analysis will compare outcomes at weeks three and six, and follow-up at nine weeks and six-months across the oral naltrexone and placebo groups. Main effects for time will examine improvements over the course of treatment for all participants, while group × time interactions will examine differences in the rate of change over time between study arms. CONCLUSIONS We hypothesize that participants receiving oral naltrexone will experience more rapid improvements in symptom severity and weight restoration compared to placebo across study time points. There are very few medications with high-quality data demonstrating both safety and efficacy in the treatment of eating disorders. The authors theorize this study will demonstrate a clinically significant effect of oral naltrexone on impulsive-type EDs and support its use as an effective option for treatment augmentation.
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Affiliation(s)
- Rosemary Claire Roden
- Division of Adolescent Medicine, Department of Pediatrics, The Pennsylvania State University, Penn State College of Medicine, 700 HMC Crescent Road, Hershey, PA 17033, United States.
| | - Marley Billman
- Division of Adolescent Medicine, Department of Pediatrics, The Pennsylvania State University, Penn State College of Medicine, 700 HMC Crescent Road, Hershey, PA 17033, United States.
| | - Susan Lane-Loney
- Division of Adolescent Medicine, Department of Pediatrics, The Pennsylvania State University, Penn State College of Medicine, 700 HMC Crescent Road, Hershey, PA 17033, United States.
| | - Jamal Essayli
- Division of Adolescent Medicine, Department of Pediatrics, The Pennsylvania State University, Penn State College of Medicine, 700 HMC Crescent Road, Hershey, PA 17033, United States
| | - Fauzia Mahr
- Division of Adolescent Medicine, Department of Pediatrics, The Pennsylvania State University, Penn State College of Medicine, 700 HMC Crescent Road, Hershey, PA 17033, United States; Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Health, The Pennsylvania State University, Penn State College of Medicine, 700 HMC Crescent Road, Hershey, PA 17033, United States.
| | - Kent Vrana
- Department of Pharmacology, The Pennsylvania State University, Penn State College of Medicine, 700 HMC Crescent Road, Hershey, PA 17033, United States.
| | - Sheryl Ryan
- Division of Adolescent Medicine, Department of Pediatrics, The Pennsylvania State University, Penn State College of Medicine, 700 HMC Crescent Road, Hershey, PA 17033, United States.
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Mahr F, Bunce SC, Meyer RE, Halmi KA. Affect Modulated Startle Response in Anorexia Nervosa, Restricting Type: Implications for Theory and Practice. Cureus 2022; 14:e27304. [PMID: 36039238 PMCID: PMC9403399 DOI: 10.7759/cureus.27304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/23/2022] [Indexed: 11/29/2022] Open
Abstract
Objective: Individuals with anorexia nervosa (AN), restricting type demonstrate unique emotional responses to hedonically positive stimuli beyond eating disorder (ED)-related stimuli. The goal of this study was to evaluate differences in responses to five types of emotionally positive stimuli among acutely ill anorexia nervosa (IAN), restricting type patients, weight-recovered anorexia patients (WRAN), and healthy controls (HCs) using affect modulated startle response (AMSR) as an objective measure. Method: A total of 28 participants were recruited (n=28). Fourteen participants were recruited as IAN using the Diagnostic and Statistical Manual of Mental Disorders-V (DSM-V) criteria, seven were WRAN, and seven were HC females. All participants were female and aged between 8 and 18 years. The participants viewed images depicting negative, neutral, standardized, and non-eating disorder (ED)-related positive stimuli. Additionally, four categories of ED-related stimuli (high-calorie food, body image, success, and parent-child relationships) were presented to all participants during a standard AMSR paradigm. Results: No significant between-group differences were found for any of the four ED stimulus categories; all groups showed an inhibited startle response to the four ED-related categories. In contrast, IAN and WRAN showed reduced hedonic responses to standardized positive stimuli relative to HC-replicating previous results. Reduced hedonic response to the standardized (non-ED) positive stimuli was highly correlated with self-reported social anxiety, low self-esteem, body dissatisfaction, asceticism, interpersonal problems, and ineffectiveness. Conclusion: AN patients had a reduced hedonic response to some non-ED-related positive stimuli, which correlated with several anxiety-related traits. In contrast, their early automatic responses to high-calorie food, normal weight models, images of success, and positive parent-child relationships did not differ from HC, suggesting these stimuli are either being evaluated as highly interesting or hedonically positive.
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Mahr F, Brennan G, Billman M, Lane-Loney S. Sleep and Avoidant Restrictive Food Intake Disorder (ARFID): Correlation With Psychopathology, Gender, and Academic Performance. Cureus 2022; 14:e25628. [PMID: 35795524 PMCID: PMC9250759 DOI: 10.7759/cureus.25628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2022] [Indexed: 12/01/2022] Open
Abstract
Objective No studies have investigated sleep disturbance in avoidant/restrictive food intake disorder (ARFID). We examined sleep disturbance in ARFID and its association with eating problems, body mass index (BMI), gender, internalizing and externalizing symptoms, cognitive performance, and academic difficulties. Methods Data from 71 ARFID patients from our partial hospitalization program (PHP) for children and adolescents were examined. Sleep data were extracted from measures administered at admission including Achenbach Child Behavior Checklist (CBCL), Children's Depression Inventory (CDI), and Revised Children's Manifest Anxiety Scale (RCMAS). Correlational analyses were conducted to evaluate the convergent validity of parent-reported and participant-reported sleep problems. Association with the severity of eating problems, BMI, percentage of median body weight (% MBW), age, gender, psychotropic medication, psychopathology, and academic difficulties was examined using analysis of variance (ANOVA) and Pearson’s correlation. Results Fifty-two percent of parents and 74% of participants reported two or more sleep symptoms. Trouble sleeping was reported by 46.48% and nightmares by 35.21% of parents. Parent-reported trouble sleeping highly correlated with internalizing disorders. Parent-reported trouble sleeping and participant-reported difficulty sleeping positively correlated with attention and attention-deficit/hyperactivity disorder (ADHD) problems. Parent-reported less sleep and feeling tired correlated with sluggish cognitive tempo, while walking/talking in sleep negatively correlated with school performance. Gender differences were noted in parent-reported sleep problems. Sleep disturbances were not associated with lower BMI or median body weight at intake. Parent-reported talking/walking in sleep and participant-reported bad dreams and bedtime worries positively correlated with Children's Eating Attitudes Test (ChEAT) scores at intake and discharge. Discussion Our results provide compelling evidence to screen for sleep disturbance in ARFID patients regardless of median body weight and BMI. Exploration of sleep disturbances in ARFID using objective measures is warranted.
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Mahr F, Billman M, Essayli JH, Lane Loney SE. Selective Serotonin Reuptake Inhibitors and Hydroxyzine in the Treatment of Avoidant/Restrictive Food Intake Disorder in Children and Adolescents: Rationale and Evidence. J Child Adolesc Psychopharmacol 2022; 32:117-121. [PMID: 34619050 DOI: 10.1089/cap.2021.0038] [Citation(s) in RCA: 0] [Impact Index Per Article: 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] [Indexed: 11/12/2022]
Abstract
Objective: Despite lack of evidence, various pharmacological agents are judiciously used to manage anxiety in avoidant restrictive food intake disorder (ARFID). We aimed to explore the effectiveness of selective serotonin reuptake inhibitors (SSRIs), either alone or in combination with hydroxyzine, in a well-defined cohort of children and adolescents with ARFID receiving treatment in a partial hospitalization program for eating disorders. Methods: We conducted a retrospective chart review of 53 patients with ARFID who were prescribed an SSRI (n = 39) or SSRI with hydroxyzine (n = 14). We investigated changes from admission to discharge in these two medication groups on various outcome measures assessing weight, eating behaviors, mood, anxiety, and fears about food. Results: Participants in the SSRI+hydroxyzine group were significantly older than those in the SSRI only group. The majority of participants in both groups exhibited the fear presentation of ARFID. Repeated-measures analysis of variance yielded a significant main effect for treatment for all outcome measures, indicating that patients in both groups experienced improvements in weight, eating behaviors, mood, anxiety, and fears of food. A significant main effect for medication group emerged on the Children's Depression Inventory, suggesting that the group receiving SSRI+hydroxyzine experienced greater depressive symptomatology than the SSRI-only group. We did not find any significant interactions, indicating that participants in both medication groups experienced similar improvements over the course of treatment. Conclusion: These results provide preliminary evidence that SSRIs and hydroxyzine may be helpful in the treatment of children and adolescents with ARFID. Given that hydroxyzine was prescribed to patients who experienced high pre- and/or postmeal anxiety, it possibly contributed to similar decreases in anxiety and fear of food in a more challenging subset of patients. Randomized, placebo-controlled studies for children and adolescents with ARFID are warranted to better evaluate and understand the efficacy of SSRIs and hydroxyzine in this clinical population.
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Affiliation(s)
- Fauzia Mahr
- Department of Psychiatry and Behavioural Health, Penn State College of Medicine, Hershey, Pennsylvania, USA.,Department of Pediatrics, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Marley Billman
- Department of Pediatrics, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Jamal H Essayli
- Department of Psychiatry and Behavioural Health, Penn State College of Medicine, Hershey, Pennsylvania, USA.,Department of Pediatrics, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Susan E Lane Loney
- Department of Psychiatry and Behavioural Health, Penn State College of Medicine, Hershey, Pennsylvania, USA.,Department of Pediatrics, Penn State College of Medicine, Hershey, Pennsylvania, USA
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Nadeem T, Asad N, Hamid SN, Mahr F, Baig K, Pirani S. A need for trauma informed care curriculum: Experiences from Pakistan. Asian J Psychiatr 2021; 63:102791. [PMID: 34325251 DOI: 10.1016/j.ajp.2021.102791] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 07/18/2021] [Accepted: 07/19/2021] [Indexed: 10/20/2022]
Abstract
Trauma is a major global health problem. Currently a trauma curriculum, from a psychological perspective, has not been uniformly incorporated in medical education. Nonetheless, professionals from various medical disciplines have an integral role in providing trauma care to survivors. The current COVID-19 pandemic only underscores the relevance and urgent need of this training, as studies show an uptick in mental health disorders due to this trauma. This article will present a discussion on the need for trauma curriculum for health care professionals, using information gained through trauma informed care workshops for healthcare personnel at Aga Khan University Hospital Pakistan.
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Affiliation(s)
- Tania Nadeem
- Department of Psychiatry, Aga Khan University, Stadium Road, PO Box 3500, Karachi, 74800, Pakistan.
| | - Nargis Asad
- Department of Psychiatry, Aga Khan University, Stadium Road, PO Box 3500, Karachi, 74800, Pakistan.
| | | | - Fauzia Mahr
- Psychiatry Department, Penn State University, Hershey, PA, USA.
| | - Kanza Baig
- Jinnah Sindh Medical University, Karachi, Pakistan.
| | - Shahina Pirani
- Department of Psychiatry, Aga Khan University, Stadium Road, PO Box 3500, Karachi, 74800, Pakistan.
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Mahr F, Dalke K, Roden RC, Keisling AK, Petrovic-Dovat L. Gender competence in medical education. Clin Teach 2021; 18:490-493. [PMID: 34101347 DOI: 10.1111/tct.13366] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 04/09/2021] [Accepted: 04/12/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Fauzia Mahr
- Department of Psychiatry and Behavioural Health, Penn State University College of Medicine, Hershey, USA
| | - Katharine Dalke
- Department of Psychiatry and Behavioural Health, Penn State University College of Medicine, Hershey, USA
| | | | - Amy K Keisling
- Department of Pediatrics, Penn State University College of Medicine, Hershey, USA
| | - Lidija Petrovic-Dovat
- Department of Psychiatry and Behavioural Health, Penn State University College of Medicine, Hershey, USA
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Lane-Loney SE, Zickgraf HF, Ornstein RM, Mahr F, Essayli JH. A Cognitive-Behavioral Family-Based Protocol for the Primary Presentations of Avoidant/Restrictive Food Intake Disorder (ARFID): Case Examples and Clinical Research Findings. Cognitive and Behavioral Practice 2020. [DOI: 10.1016/j.cbpra.2020.06.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Pierre JM, Mahr F, Carter A, Madaan V. Underrepresented in Medicine Recruitment: Rationale, Challenges, and Strategies for Increasing Diversity in Psychiatry Residency Programs. Acad Psychiatry 2017; 41:226-232. [PMID: 27052504 DOI: 10.1007/s40596-016-0499-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Accepted: 01/27/2016] [Indexed: 06/05/2023]
Affiliation(s)
- Joseph M Pierre
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
| | - Fauzia Mahr
- Penn State College Of Medicine, Hershey, PA, USA
| | - Andrea Carter
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Vishal Madaan
- University of Virginia Health System, Charlottesville, VA, USA
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Pheister M, Stagno S, Cotes R, Prabhakar D, Mahr F, Crowell A, Schwartz A. Simulated Patients and Scenarios to Assess and Teach Psychiatry Residents. Acad Psychiatry 2017; 41:114-117. [PMID: 26763534 DOI: 10.1007/s40596-015-0477-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Accepted: 12/08/2015] [Indexed: 06/05/2023]
Affiliation(s)
| | - Susan Stagno
- University Hospitals Case Medical Center, Cleveland, OH, USA
| | - Robert Cotes
- Emory University School of Medicine, Atlanta, GA, USA
| | | | - Fauzia Mahr
- Penn State Milton S Hershey Medical Center, Hershey, PA, USA
| | | | - Ann Schwartz
- Emory University School of Medicine, Atlanta, GA, USA
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Mayes SD, Baweja R, Calhoun SL, Syed E, Mahr F, Siddiqui F. Suicide ideation and attempts and bullying in children and adolescents: psychiatric and general population samples. Crisis 2016; 36:55-60. [PMID: 25115491 DOI: 10.1027/0227-5910/a000284] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Studies of the relationship between bullying and suicide behavior yield mixed results. AIMS This is the first study comparing frequencies of suicide behavior in four bullying groups (bully, victim, bully/victim, and neither) in two large psychiatric and community samples of young children and adolescents. METHOD Maternal ratings of bullying and suicide ideation and attempts were analyzed for 1,291 children with psychiatric disorders and 658 children in the general population 6-18 years old. RESULTS For both the psychiatric and community samples, suicide ideation and attempt scores for bully/victims were significantly higher than for victims only and for neither bullies nor victims. Differences between victims only and neither victims nor bullies were nonsignificant. Controlling for sadness and conduct problems, suicide behavior did not differ between the four bullying groups. All children with suicide attempts had a comorbid psychiatric disorder, as did all but two children with suicide ideation. CONCLUSION Although the contribution of bullying per se to suicide behavior independent of sadness and conduct problems is small, bullying has obvious negative psychological consequences that make intervention imperative. Interventions need to focus on the psychopathology associated with being a victim and/or perpetrator of bullying in order to reduce suicide behavior.
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Affiliation(s)
| | - Raman Baweja
- Department of Psychiatry, Penn State College of Medicine, Hershey, PA, USA
| | - Susan L Calhoun
- Department of Psychiatry, Penn State College of Medicine, Hershey, PA, USA
| | - Ehsan Syed
- Department of Psychiatry, Penn State College of Medicine, Hershey, PA, USA
| | - Fauzia Mahr
- Department of Psychiatry, Penn State College of Medicine, Hershey, PA, USA
| | - Farhat Siddiqui
- Department of Psychiatry, Penn State College of Medicine, Hershey, PA, USA
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Mayes SD, Calhoun SL, Baweja R, Mahr F. MATERNAL RATINGS OF BULLYING AND VICTIMIZATION: DIFFERENCES IN FREQUENCIES BETWEEN PSYCHIATRIC DIAGNOSES IN A LARGE SAMPLE OF CHILDREN (.). Psychol Rep 2015; 116:710-22. [PMID: 26030206 DOI: 10.2466/16.pr0.116k30w8] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Little is known about psychiatric diagnoses that place children at risk for bullying and victimization. Mothers of 1,707 children 6-18 yr. rated their child as a bully and a victim (not at all, to very often a problem) on the Pediatric Behavior Scale. Children with psychiatric diagnoses were evaluated in an outpatient psychiatry clinic (M age = 9.2 yr., 68.4% male). Control children were community children not on psychotropic medication and with no neurodevelopmental disorder (M age = 8.7 yr., 43.5% male). Children with autism, intellectual disability, and ADHD-Combined type had higher victim and bully maternal ratings than children in the ADHD-Inattentive, depression, anxiety, eating disorder, and control groups. Eating disorder and controls were the only groups in which most children were not rated a victim or a bully. Comorbid oppositional defiant disorder accounted for the higher bully ratings for ADHD-Combined, autism, and intellectual disability. Victimization ratings did not differ between psychiatric groups. Except for eating disorders, victimization ratings were greater in all groups than in control children, suggesting that most psychiatric disorders place children at risk for victimization, as perceived by their mothers.
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Affiliation(s)
- Susan D Mayes
- 1 Department of Psychiatry, Penn State College of Medicine, Hershey, Pennsylvania
| | - Susan L Calhoun
- 1 Department of Psychiatry, Penn State College of Medicine, Hershey, Pennsylvania
| | - Raman Baweja
- 1 Department of Psychiatry, Penn State College of Medicine, Hershey, Pennsylvania
| | - Fauzia Mahr
- 1 Department of Psychiatry, Penn State College of Medicine, Hershey, Pennsylvania
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Mahr F, Farahmand P, Bixler EO, Domen RE, Moser EM, Nadeem T, Levine RL, Halmi KA. A national survey of eating disorder training. Int J Eat Disord 2015; 48:443-5. [PMID: 25047025 DOI: 10.1002/eat.22335] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [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: 07/23/2013] [Revised: 06/14/2014] [Accepted: 07/06/2014] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Eating disorders (EDs) result in the highest mortality rate of all psychiatric disorders, and in the United States, approximately one in twenty females suffers from an eating disorder. However, training provided within residency programs to address the needs of these patients is sparse. The objective of this study was to conduct a national survey that assesses the amount of EDs training for trainees across five ACGME accredited specialties: internal medicine, pediatrics, family medicine, psychiatry, and child and adolescent psychiatry. The results of the survey will be used to develop strategies to improve eating disorder education among residents. METHOD Eight hundred eighty training coordinators were contacted using information available on the ACGME website and asked to complete the survey. RESULTS Of the 637 responding programs, 514 did not offer any scheduled or elective rotations for EDs. Of the 123 programs offering rotations, only 42 offered a formal, scheduled rotation. Child and adolescent psychiatry offered the most clinical experiences, and pediatric programs offered the greatest number of didactic hours on EDs. DISCUSSION Training in EDs is limited. Simulated patient encounters, massive open online courses, web-based curricula, dedicated rotations and clinical experiences, didactic curricula, and brief-training programs may help to improve eating disorder diagnostic and treatment skills among trainees.
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Affiliation(s)
- Fauzia Mahr
- Penn State Milton S. Hershey Medical Center 500 university drive Hershey PA, PO BOX 850 H073, 17033, USA
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Pejovic S, Natelson BH, Basta M, Fernandez-Mendoza J, Mahr F, Vgontzas AN. Chronic fatigue syndrome and fibromyalgia in diagnosed sleep disorders: a further test of the 'unitary' hypothesis. BMC Neurol 2015; 15:53. [PMID: 25884538 PMCID: PMC4405866 DOI: 10.1186/s12883-015-0308-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Accepted: 02/18/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Since chronic fatigue syndrome (CFS) and fibromyalgia (FM) often co-exist, some believe they reflect the same process, somatization. Against that hypothesis are data suggesting FM but not CFS was common in patients with sleep-disordered breathing (SDB). The presence of discrete case definitions for CFS and FM allowed us to explore rates of CFS alone, CFS with FM, and FM alone in SDB patients compared to those with sleep complaints that fulfilled criteria for insomnia. METHODS Participants were 175 sequential patients with sleep-related symptoms (122 had SDB and 21 had insomnia) and 39 healthy controls. Diagnoses were made by questionnaires, tender point count, and rule out labs; sleepiness was assessed with Epworth Sleepiness Scale and mood with Beck Depression Inventory. RESULTS Rates of CFS, FM or CFS + FM were high: 13% in SDB and 48% in insomnia. CFS occurred frequently in SDB and insomnia, but FM occurred frequently only in insomnia. SDB patients with CFS and/or FM had higher daytime sleepiness than those without these disorders. CONCLUSION CFS patients should complete Epworth scales, and sleep evaluation should be considered for those with scores ≥ 16 before receiving the diagnosis of CFS; the coexistence of depressed mood in these patients suggests some may be helped by treatment of their depression. That FM was underrepresented in SDB suggests FM and CFS may have different underlying pathophysiological causes.
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Affiliation(s)
- Slobodanka Pejovic
- Department of Psychiatry, Sleep Research and Treatment Center, Penn State College of Medicine, Hershey, PA, 17033, USA.
| | - Benjamin H Natelson
- Department of Neurology, Pain and Fatigue Study Center, Mount Sinai Beth Israel, Icahn School of Medicine at Mount Sinai, New York, NY, 10003, USA.
| | - Maria Basta
- Department of Psychiatry, School of Medicine, University of Crete, Iraklion, Greece.
| | - Julio Fernandez-Mendoza
- Department of Psychiatry, Sleep Research and Treatment Center, Penn State College of Medicine, Hershey, PA, 17033, USA.
| | - Fauzia Mahr
- Department of Psychiatry, Sleep Research and Treatment Center, Penn State College of Medicine, Hershey, PA, 17033, USA.
| | - Alexandros N Vgontzas
- Department of Psychiatry, Sleep Research and Treatment Center, Penn State College of Medicine, Hershey, PA, 17033, USA.
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Mahr F, McLachlan N, Friedberg RD, Mahr S, Pearl AM. Cognitive-behavioral treatment of a second-generation child of Pakistani descent: ethnocultural and clinical considerations. Clin Child Psychol Psychiatry 2015; 20:134-47. [PMID: 23982991 DOI: 10.1177/1359104513499766] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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] [Indexed: 11/15/2022]
Abstract
Ethnocultural variables in cognitive behavioral therapy (CBT) are gaining an increasing amount of attention. This is a welcome development since cultural responsiveness is a core element in ethical and effective CBT practice. However, the literature is sparse and generally silent regarding CBT with children of Pakistani descent. Accordingly, this case based article attempts to close the knowledge gap by reviewing the extant literature pertaining to the role of religion, help seeking behavior, and emotional expression in Pakistani families. The literature review is followed by a case discussion of an 11 year old second generation Pakistani male living in the United Kingdom who is struggling with posttraumatic stress disorder (PTSD). The case presentation highlights the importance of culturally informed case conceptualization and individually tailored interventions. The case illustrates the way cognitive behavioral psychotherapy balanced empirically based procedures with a sensitive appreciation of cultural context.
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Affiliation(s)
- Fauzia Mahr
- Penn State Milton S Hershey Medical Center, USA
| | - Niel McLachlan
- Cambridgeshire and Peterborough NHS Foundation Trust, USA
| | - Robert D Friedberg
- Center for the Study and Treatment of Anxious Youth at Palo Alto University, USA
| | - Safia Mahr
- Université Paris Ouest Nanterre La Défense/Laboratoire Evaclipsy, France
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Dickerson Mayes S, Baweja R, Calhoun SL, Syed E, Mahr F, Siddiqui F. Suicide Ideation and Attempts and Bullying in Children and Adolescents. Crisis 2014; 35:301-9. [DOI: 10.1027/0227-5910/a000264] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background: Studies of the relationship between bullying and suicide behavior yield mixed results. Aims: This is the first study comparing frequencies of suicide behavior in four bullying groups (bully, victim, bully/victim, and neither) in two large psychiatric and community samples of young children and adolescents. Method: Maternal ratings of bullying and suicide ideation and attempts were analyzed for 1,291 children with psychiatric disorders and 658 children in the general population 6–18 years old. Results: For both the psychiatric and community samples, suicide ideation and attempt scores for bully/victims were significantly higher than for victims only and for neither bullies nor victims. Differences between victims only and neither victims nor bullies were nonsignificant. Controlling for sadness and conduct problems, suicide behavior did not differ between the four bullying groups. All children with suicide attempts had a comorbid psychiatric disorder, as did all but two children with suicide ideation. Conclusion: Although the contribution of bullying per se to suicide behavior independent of sadness and conduct problems is small, bullying has obvious negative psychological consequences that make intervention imperative. Interventions need to focus on the psychopathology associated with being a victim and/or perpetrator of bullying in order to reduce suicide behavior.
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Affiliation(s)
| | - Raman Baweja
- Department of Psychiatry, Penn State College of Medicine, Hershey, PA, USA
| | - Susan L. Calhoun
- Department of Psychiatry, Penn State College of Medicine, Hershey, PA, USA
| | - Ehsan Syed
- Department of Psychiatry, Penn State College of Medicine, Hershey, PA, USA
| | - Fauzia Mahr
- Department of Psychiatry, Penn State College of Medicine, Hershey, PA, USA
| | - Farhat Siddiqui
- Department of Psychiatry, Penn State College of Medicine, Hershey, PA, USA
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Mayes SD, Fernandez-Mendoza J, Baweja R, Calhoun S, Mahr F, Aggarwal R, Arnold M. Correlates of suicide ideation and attempts in children and adolescents with eating disorders. Eat Disord 2014; 22:352-66. [PMID: 24842006 DOI: 10.1080/10640266.2014.915694] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
This is the first study determining correlates of suicide behavior in children with eating disorders using multiple sleep, psychological, and demographic variables. Mothers rated suicide ideation and attempts in 90 children ages 7-18 with bulimia nervosa or anorexia nervosa. Suicide ideation was more prevalent in children with bulimia nervosa (43%) than children with anorexia nervosa (20%). All children with bulimia nervosa who experienced ideation attempted suicide, whereas only 3% of children with anorexia nervosa attempted suicide. Correlates of ideation were externalizing behavior problems and sleep disturbances. Correlates of attempts were bulimia nervosa, self-induced vomiting, nightmares, and physical or sexual abuse. These problems should be assessed and targeted for intervention because of their association with suicide behavior.
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Affiliation(s)
- Susan Dickerson Mayes
- a Department of Psychiatry , Hershey Medical Center, Penn State College of Medicine , Hershey , Pennsylvania , USA
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Pearl AM, Mahr F, Friedberg RD. Supervising Child Psychiatry Fellows in Cognitive Behavioral Therapy: Crucibles and Choices. J Cogn Psychother 2013; 27:61-70. [DOI: 10.1891/0889-8391.27.1.61] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Child psychiatric fellows enter cognitive behavioral therapy (CBT) training experiences with a wide variety of backgrounds and experiences in this area of treatment. Although some child fellows have fundamental knowledge of cognitive-behavioral theory, most struggle with the CBT model and even more so, subsequently using this model to guide treatment. Unlike supervising early career mental health professionals, child residents often possess a skill set apt for CBT including using a problem-oriented focus, a tendency to use structured methods in treatment, the use of psychoeducation, and basic clinical skills including genuineness, understanding, and empathy. On the other hand, child psychiatric fellows find several areas of CBT challenging because it is often vastly different from previous experience, including more frequent and longer sessions, the use of collaborative empiricism, developing case conceptualizations, and tolerating negative affective arousal. Moreover, training climates in psychiatry departments may shape the supervision experiences. Various specific recommendations are offered to manage these crucibles. Overall, although there are significant challenges when supervising child residents in CBT rotations, having knowledge of these crucibles and access to choices for addressing these supervisory tests enhances both supervisor and supervisee competence.
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Calhoun SL, Vgontzas AN, Mayes SD, Tsaoussoglou M, Sauder K, Mahr F, Karippot A, Wisner K, Bixler EO. Prenatal and perinatal complications: is it the link between race and SES and childhood sleep disordered breathing? J Clin Sleep Med 2010; 6:264-269. [PMID: 20572420 PMCID: PMC2883038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
STUDY OBJECTIVES Recent evidence has suggested that low socioeconomic status (SES), race, prematurity, and maternal smoking during pregnancy are associated with childhood sleep disordered breathing (SDB). We investigated (1) the association of SDB with a wide range of risk factors, including prenatal and perinatal complications; (2) the association of these complications with SES and race; and (3) the association of SDB with developmental milestones. METHODS Six hundred thirteen school-aged children (105 clinically referred and 508 community control subjects) underwent overnight polysomnography and had a complete history and physical examination. A comprehensive child development questionnaire was completed by a parent. We compared clinically referred children with SDB to population-based control children without SDB from The Penn State Children's Cohort. RESULTS Maternal smoking during pregnancy; maternal age and weight gain during pregnancy; prenatal complications, such as maternal high blood pressure and gestational diabetes; perinatal complications related to prematurity; delayed motor milestones; race and SES were significantly associated with the presence of childhood SDB. Most of the risk factors became nonsignificant when analyses controlled for race and SES. Delayed motor milestones remained significantly associated with SDB after controlling for race and SES. CONCLUSION These data suggest that there is a significant association between children who experience prenatal or perinatal distress and the development of moderate to severe childhood SDB. SES and race may be mediating the impact on SDB through increased prenatal and perinatal risks. The significant delay in motor milestones suggests that prenatal and perinatal distress may result in neurologic insult, which could influence the development of SDB in later childhood.
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Affiliation(s)
- Susan L Calhoun
- Sleep Research and Treatment Center, Penn State University, College of Medicine, Hershey, PA, USA.
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Calhoun SL, Vgontzas AN, Mayes SD, Tsaoussoglou M, Sauder K, Mahr F, Karippot A, Wisner K, Bixler EO. Prenatal and Perinatal Complications: Is It the Link Between Race and SES and Childhood Sleep Disordered Breathing? J Clin Sleep Med 2010. [DOI: 10.5664/jcsm.27824] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Susan L. Calhoun
- Sleep Research and Treatment Center, Penn State University, College of Medicine, Hershey, PA
| | - Alexandros N. Vgontzas
- Sleep Research and Treatment Center, Penn State University, College of Medicine, Hershey, PA
| | - Susan D. Mayes
- Sleep Research and Treatment Center, Penn State University, College of Medicine, Hershey, PA
| | - Marina Tsaoussoglou
- Sleep Research and Treatment Center, Penn State University, College of Medicine, Hershey, PA
| | - Katherine Sauder
- Sleep Research and Treatment Center, Penn State University, College of Medicine, Hershey, PA
| | - Fauzia Mahr
- Sleep Research and Treatment Center, Penn State University, College of Medicine, Hershey, PA
| | - Anoop Karippot
- Sleep Research and Treatment Center, Penn State University, College of Medicine, Hershey, PA
| | - Krista Wisner
- Sleep Research and Treatment Center, Penn State University, College of Medicine, Hershey, PA
| | - Edward O. Bixler
- Sleep Research and Treatment Center, Penn State University, College of Medicine, Hershey, PA
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Mayes SD, Calhoun SL, Murray MJ, Morrow JD, Yurich KKL, Mahr F, Cothren S, Purichia H, Bouder JN, Petersen C. Comparison of scores on the Checklist for Autism Spectrum Disorder, Childhood Autism Rating Scale, and Gilliam Asperger's Disorder Scale for children with low functioning autism, high functioning autism, Asperger's disorder, ADHD, and typical development. J Autism Dev Disord 2009; 39:1682-93. [PMID: 19609662 DOI: 10.1007/s10803-009-0812-6] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Reliability and validity for three autism instruments were compared for 190 children with low functioning autism (LFA), 190 children with high functioning autism or Asperger's disorder (HFA), 76 children with attention deficit hyperactivity disorder (ADHD), and 64 typical children. The instruments were the Checklist for Autism Spectrum Disorder (designed for children with LFA and HFA), Childhood Autism Rating Scale (CARS) for children with LFA, and Gilliam Asperger's Disorder Scale (GADS). For children with LFA or ADHD, classification accuracy was 100% for the Checklist and 98% for the CARS clinician scores. For children with HFA or ADHD, classification accuracy was 99% for the Checklist and 93% for the GADS clinician scores. Clinician-parent diagnostic agreement was high (90% Checklist, 90% CARS, and 84% GADS).
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Affiliation(s)
- Susan Dickerson Mayes
- Department of Psychiatry H073, Milton S. Hershey Medical Center, Penn State College of Medicine, 500 University Drive, Hershey, PA 17033, USA.
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Mayes SD, Calhoun SL, Bixler EO, Vgontzas AN, Mahr F, Hillwig-Garcia J, Elamir B, Edhere-Ekezie L, Parvin M. ADHD subtypes and comorbid anxiety, depression, and oppositional-defiant disorder: differences in sleep problems. J Pediatr Psychol 2008; 34:328-37. [PMID: 18676503 DOI: 10.1093/jpepsy/jsn083] [Citation(s) in RCA: 136] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE Sleep problems were analyzed in children with ADHD (Attention-deficit hyperactivity disorder). METHODS Scales were completed by parents of 135 control children and 681 children with ADHD combined type (ADHD-C) or inattentive type (ADHD-I) with or without comorbid oppositional defiant disorder (ODD), anxiety, or depression. RESULTS Children with ADHD-I alone had the fewest sleep problems and did not differ from controls. Children with ADHD-C had more sleep problems than controls and children with ADHD-I. Comorbid anxiety/depression increased sleep problems, whereas ODD did not. Daytime sleepiness was greatest in ADHD-I and was associated with sleeping more (not less) than normal. Medicated children had greater difficulty falling asleep than unmedicated children. CONCLUSIONS Differences in sleep problems were found as a function of ADHD subtype, comorbidity, and medication.
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Affiliation(s)
- Susan Dickerson Mayes
- Department of Psychiatry, Milton S. Hershey Medical Center, PO Box 850, Hershey, PA 17033, USA.
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