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Zisook S, Moutier CY, Rush AJ, Johnson GR, Tal I, Chen PJ, Davis LL, Hicks PB, Wilcox J, Planeta B, Lauro KW, Scrymgeour AA, Kasckow J, Mohamed S. Effect of next-step antidepressant treatment on suicidal ideation: findings from the VAST-D trial. Psychol Med 2024; 54:1172-1183. [PMID: 37859623 DOI: 10.1017/s0033291723003008] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2023]
Abstract
BACKGROUND Major depressive disorder (MDD) contributes to suicide risk. Treating MDD effectively is considered a key suicide prevention intervention. Yet many patients with MDD do not respond to their initial medication and require a 'next-step'. The relationship between next-step treatments and suicidal thoughts and behaviors is uncharted. METHOD The VA Augmentation and Switching Treatments for Depression trial randomized 1522 participants to one of three next-step treatments: Switching to Bupropion, combining with Bupropion, and augmenting with Aripiprazole. In this secondary analysis, features associated with lifetime suicidal ideation (SI) and attempts (SA) at baseline and current SI during treatment were explored. RESULTS Compared to those with SI only, those with lifetime SI + SA were more likely to be female, divorced, or separated, unemployed; and to have experienced more childhood adversity. They had a more severe depressive episode and were more likely to respond to 'next-step' treatment. The prevalence of SI decreased from 46.5% (694/1492) at baseline to 21.1% (315/1492) at end-of-treatment. SI during treatment was associated with baseline SI; low positive mental health, more anxiety, greater severity and longer duration of current MDD episode; being male and White; and treatment with S-BUP or C-BUP as compared to A-ARI. CONCLUSION SI declines for most patients during next-step medication treatments. But about 1 in 5 experienced emergent or worsening SI during treatment, so vigilance for suicide risk through the entire 12-week acute treatment period is necessary. Treatment selection may affect the risk of SI.
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Affiliation(s)
- Sidney Zisook
- University of California San Diego, San Diego, CA, USA
- VA San Diego Healthcare System, San Diego, CA, USA
| | | | - A John Rush
- Duke Medical School, Durham, NC, USA
- Duke-National University of Singapore, Singapore
| | - Gary R Johnson
- Cooperative Studies Program Coordinating Center, VA Connecticut Healthcare System, West Haven, CT, USA
| | - Ilanit Tal
- VA San Diego Healthcare System, San Diego, CA, USA
| | - P J Chen
- Department of Psychiatry, VA Northeast Ohio Healthcare System, and Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Lori L Davis
- Tuscaloosa VA Medical Center, Tuscaloosa, AL, USA
| | - Paul B Hicks
- Department of Psychiatry, Texas A&M College of Medicine, Temple, TX, USA
| | - James Wilcox
- Department of Veterans Affairs, Phoenix, AZ, USA
| | - Beata Planeta
- Cooperative Studies Program Coordinating Center, VA Connecticut Healthcare System, West Haven, CT, USA
| | | | - Alexandra A Scrymgeour
- Cooperative Studies Program Clinical Research Pharmacy Coordinating Center, Albuquerque, NM, USA
| | - John Kasckow
- University of Pittsburgh Physicians, Pittsburgh, PA, USA
| | - Somaia Mohamed
- Veterans Affairs (VA) New England Mental Illness Research, Education, and Clinical Center, VA Connecticut Healthcare System, West Haven, CT, USA
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2
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Zisook S, Mohamad S, Johnson G, Tal I, Villarreal G, Wilcox JA, Shear KM. Clinical implications of co-occurring prolonged grief disorder in patients with treatment-resistant major depressive disorder. World Psychiatry 2021; 20:303-304. [PMID: 34002524 PMCID: PMC8129840 DOI: 10.1002/wps.20877] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Affiliation(s)
- Sidney Zisook
- Department of PsychiatryUniversity of California San DiegoLa JollaCAUSA,VA San Diego Healthcare SystemLa JollaCAUSA
| | - Somaia Mohamad
- Department of PsychiatryYale University School of MedicineNew HavenCTUSA
| | - Gary Johnson
- Cooperative Studies Program Coordinating CenterVA Connecticut Healthcare SystemWest HavenCTUSA
| | - Ilanit Tal
- VA San Diego Healthcare SystemLa JollaCAUSA
| | - Gerardo Villarreal
- VA New Mexico Healthcare SystemAlbuquerqueNMUSA,Department of PsychiatryUniversity of New MexicoAlbuquerqueNMUSA
| | | | - Katherine M. Shear
- Center for Complicated GriefNew YorkNYUSA,Columbia University School of Social WorkCollege of Physicians and SurgeonsNew YorkNYUSA
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3
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Oleinikov K, Uri I, Jacob H, Epshtein J, Benson A, Ben-Haim S, Atlan K, Tal I, Meirovitz A, Maimon O, Lev-Cohain N, Mazeh H, Glaser B, Gross DJ, Grozinsky-Glasberg S. Long-term outcomes in MEN-1 patients with pancreatic neuroendocrine neoplasms: an Israeli specialist center experience. Endocrine 2020; 68:222-229. [PMID: 32036501 DOI: 10.1007/s12020-020-02217-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Accepted: 01/29/2020] [Indexed: 12/16/2022]
Abstract
PURPOSE The decreased life expectancy of MEN-1 patients is mainly related to pancreatic neuroendocrine tumors (pNETs). At best, limited data is available on the natural history of MEN-1-associated pNETs, as these tumors are rare and have a wide range of biologic behavior. Our study aims to explore the clinical course of patients with MEN-1-associated pNETs and the long-term outcomes. METHODS This longitudinal study was conducted on the MEN-1 cohort treated at our referral center over a 22-year period (1996-2018). Relevant clinical data were retrospectively analysed. RESULTS Among the 33 MEN-1 patients included in our study, pNETs were identified in 21 subjects with a penetrance of 48% by the age of 50. Non-functioning and functioning pNETs were diagnosed in sixteen (76%) and five (24%) patients, respectively. Two-thirds of the patients had multifocal tumors. The median number of pancreatic macroscopic lesions per individual was 4.0 ± 3.9 (range 1-8) with a mean size of 1.3 ± 2.1 cm (range 0.5-10). The metastatic rate according to the dominant pNET lesion reached 100%, 62% and 6% for tumors sized > 4 cm, 2.1-4 cm, and 1-2 cm, respectively. Over the study period, one or more therapeutic interventions for pNETs were required in 20 out of the 21 patients. pNET-related metastatic complication was the main cause of death within this MEN-1 cohort. The overall survival rate for the pNETs patients was 86% during a mean follow-up period of 8.0 ± 4.6 years. CONCLUSIONS In our MEN-1 cohort, non-functioning pNETs were the most frequent type of pancreaticoduodenal tumor, and the tumor size correlated with the risks of metastasis and death. Increased awareness, early diagnosis, and a multidisciplinary approach may improve the associated morbidity and mortality in these patients.
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Affiliation(s)
- Kira Oleinikov
- Neuroendocrine Tumor Unit, Department of Endocrinology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
- ENETS Center of Excellence, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Inbal Uri
- Neuroendocrine Tumor Unit, Department of Endocrinology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
- ENETS Center of Excellence, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Harold Jacob
- ENETS Center of Excellence, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
- Advanced Endoscopy Unit, Department of Gastroenterology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Julia Epshtein
- ENETS Center of Excellence, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
- Advanced Endoscopy Unit, Department of Gastroenterology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Ariel Benson
- ENETS Center of Excellence, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
- Advanced Endoscopy Unit, Department of Gastroenterology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Simona Ben-Haim
- ENETS Center of Excellence, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
- Department of Nuclear Medicine, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
- Institute of Nuclear Medicine, University College Hospitals, NHS Trust, London, UK
| | - Karine Atlan
- ENETS Center of Excellence, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
- Department of Pathology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Ilanit Tal
- Neuroendocrine Tumor Unit, Department of Endocrinology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
- ENETS Center of Excellence, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Amichay Meirovitz
- ENETS Center of Excellence, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
- Sharett Institute of Oncology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Ofra Maimon
- ENETS Center of Excellence, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
- Sharett Institute of Oncology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Naama Lev-Cohain
- ENETS Center of Excellence, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
- Department of Radiology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Haggi Mazeh
- ENETS Center of Excellence, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
- Department of Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Benjamin Glaser
- Neuroendocrine Tumor Unit, Department of Endocrinology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
- ENETS Center of Excellence, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - David J Gross
- Neuroendocrine Tumor Unit, Department of Endocrinology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
- ENETS Center of Excellence, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Simona Grozinsky-Glasberg
- Neuroendocrine Tumor Unit, Department of Endocrinology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
- ENETS Center of Excellence, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
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4
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Gilboa M, Houri-Levi E, Cohen C, Tal I, Rubin C, Feld-Simon O, Brom A, Eden-Friedman Y, Segal S, Rahav G, Regev-Yochay G. Environmental shedding of toxigenic Clostridioides difficile by asymptomatic carriers: A prospective observational study. Clin Microbiol Infect 2020; 26:1052-1057. [PMID: 31904567 DOI: 10.1016/j.cmi.2019.12.011] [Citation(s) in RCA: 9] [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: 09/12/2019] [Revised: 12/17/2019] [Accepted: 12/19/2019] [Indexed: 01/23/2023]
Abstract
OBJECTIVES The aim was to compare the burden of environmental shedding of toxigenic Clostridioides difficile among asymptomatic carriers, C. difficile-infected (CDI) patients and non-carriers in an inpatient non-epidemic setting. METHODS C. difficile carriage was determined by positive toxin-B PCR from rectal swabs of asymptomatic patients. Active CDI was defined as a positive two-step enzyme immunoassay/polymerase chain reaction (EIA/PCR) test in patients with more than three unformed stools/24 hr. C. difficile environmental contamination was assessed by obtaining specimens from ten sites in the patients' rooms. Toxigenic strains were identified by PCR. We created a contamination scale to define the overall level of room contamination that ranged from clean to heavy contamination. RESULTS One hundred and seventeen rooms were screened: 70 rooms inhabited by C. difficile carriers, 30 rooms by active CDI patients and 17 rooms by non C. difficile -carriers (control). In the carrier rooms 29 (41%) had more than residual contamination, from which 17 (24%) were heavily contaminated. In the CDI rooms 12 (40%) had more than residual contamination from which three (10%) were heavily contaminated, while in the control rooms, one room (6%) had more than residual contamination and none were heavily contaminated. In a multivariate analysis, the contamination score of rooms inhabited by carriers did not differ from rooms of CDI patients, yet both were significantly more contaminated than those of non-carriers odd ratio 12.23 and 11.16 (95% confidence interval 1.5-99.96 p 0.0195, and 1.19-104.49 p 0.035), respectively. DISCUSSION Here we show that the rooms of C. difficile carriers are as contaminated as those of patients with active CDI and significantly more than those of non-carriers.
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Affiliation(s)
- M Gilboa
- Internal Medicine D, Sheba Medical Centre, Ramat Gan, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Infectious Disease Unit, Sheba Medical Centre, Ramat Gan, Israel.
| | - E Houri-Levi
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Internal Medicine B, Sheba Medical Centre, Ramat Gan, Israel
| | - C Cohen
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Infection Control & Prevention Unit, Sheba Medical Centre, Ramat Gan, Israel
| | - I Tal
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Infection Control & Prevention Unit, Sheba Medical Centre, Ramat Gan, Israel
| | - C Rubin
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Biostatistics Unit, Gertner Institute, Ramat Gan, Israel
| | - O Feld-Simon
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Infectious Disease Unit, Sheba Medical Centre, Ramat Gan, Israel; Internal Medicine F, Sheba Medical Centre, Ramat Gan, Israel
| | - A Brom
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Infection Control & Prevention Unit, Sheba Medical Centre, Ramat Gan, Israel; Internal Medicine T, Sheba Medical Centre, Ramat Gan, Israel
| | - Y Eden-Friedman
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Internal Medicine E, Sheba Medical Centre, Ramat Gan, Israel
| | - S Segal
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Infection Control & Prevention Unit, Sheba Medical Centre, Ramat Gan, Israel
| | - G Rahav
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Infectious Disease Unit, Sheba Medical Centre, Ramat Gan, Israel
| | - G Regev-Yochay
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Infectious Disease Unit, Sheba Medical Centre, Ramat Gan, Israel; Infection Control & Prevention Unit, Sheba Medical Centre, Ramat Gan, Israel
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5
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Hicks PB, Sevilimedu V, Johnson GR, Tal I, Chen P, Davis LL, Vertrees JE, Mohamed S, Zisook S. Predictability of Nonremitting Depression After First 2 Weeks of Antidepressant Treatment: A VAST‐D Trial Report. Psychiatr res clin pract 2019; 1:58-67. [PMID: 36101874 PMCID: PMC9176018 DOI: 10.1176/appi.prcp.20190003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 05/12/2019] [Accepted: 06/18/2019] [Indexed: 11/30/2022] Open
Abstract
Objective: In this secondary analysis of data from the Veterans Affairs Augmentation and Switching Treatments for Improving Depression Outcomes (VAST‐D) study, the authors sought to determine the effectiveness of early improvement (or lack thereof) for predicting remission from depression with antidepressant therapy. Methods: This study used data from the VAST‐D study, a multisite, randomized, single‐blind trial with parallel assignment to one of three medication interventions for 1,522 veterans whose major depressive disorder was unresponsive to at least one course of antidepressant treatment meeting minimal standards for dosage and duration. The authors calculated the positive predictive value (PPV) and negative predictive value (NPV) of early improvement on remission, response, or greater than minimal improvement from depression for various degrees of improvement (10%–50%) on the Quick Inventory of Depressive Symptomatology–Clinician Rated (QIDS‐C) at 1, 2, 4, and 6 weeks. Results: The end of week 2 of treatment was identified as the best time to evaluate early improvement. The presence of a ≥20% drop from the baseline QIDS‐C score by the end of week 2 resulted in a PPV for remission of 38% and an NPV of 93% by week 12. Extending the observational window to week 6 minimally improved NPV (97%). This association did not differ across treatment groups. Conclusions: A lack of early improvement at the end of week 2 of antidepressant therapy can be used to inform clinical decisions on the likelihood of nonremission of depression during the subsequent 10 weeks, even when dosage optimization is incomplete.
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Affiliation(s)
- Paul B. Hicks
- Department of PsychiatryBaylor Scott & White Health
- Texas A&M College of MedicineTempleTexas
| | - Varadan Sevilimedu
- Yale University School of Public HealthNew HavenConnecticut
- Cooperative Studies Program Coordinating CenterVeterans Affairs (VA) Connecticut Healthcare SystemWest Haven
| | - Gary R. Johnson
- Cooperative Studies Program Coordinating CenterVeterans Affairs (VA) Connecticut Healthcare SystemWest Haven
| | | | - Peijun Chen
- Louis Stokes Cleveland VA Medical CenterClevelend
| | - Lori L. Davis
- Tuscaloosa VA Medical CenterTuscaloosaAlabama
- University of Alabama School of MedicineBirmingham
| | - Julia E. Vertrees
- Cooperative Studies Program Clinical Research Pharmacy Coordinating CenterAlbuquerqueNew Mexico
| | - Somaia Mohamed
- VA New England Mental Illness Research, Education, and Clinical CenterVA Connecticut Healthcare SystemWest Haven
| | - Sidney Zisook
- VA San Diego Healthcare SystemSan Diego
- Department of PsychiatryUniversity of CaliforniaSan Diego
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6
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Pospos S, Tal I, Iglewicz A, Newton IG, Tai-Seale M, Downs N, Jong P, Lee D, Davidson JE, Lee SY, Rubanovich CK, Ho EV, Sanchez C, Zisook S. Gender differences among medical students, house staff, and faculty physicians at high risk for suicide: A HEAR report. Depress Anxiety 2019; 36:902-920. [PMID: 31102314 DOI: 10.1002/da.22909] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [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: 06/29/2018] [Revised: 03/30/2019] [Accepted: 04/13/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In comparison with the general population, physicians, and physicians-in-training are at greater risk for suicide. Although key gender differences in suicide risk factors and behaviors have been identified in the general population, the extent to which these differences apply to physicians and physicians-in-training is unclear. Here, we aimed to identify gender differences in risk factors, clinical presentation, and help-seeking behaviors of medical students, house staff, and physician faculty at high risk for suicide. METHODS We explored gender differences among 450 physicians and trainees meeting criteria for high suicide risk on anonymous online questionnaires completed between 2009 and 2017. RESULTS High-risk female trainees and physicians had higher mean Patient Health Questionnaire-9 (PHQ-9) scores compared with the males (11.1, standard deviation [SD] 5.1 vs. 9.8, SD 4.7) and were more likely to endorse feeling worried (73.8% vs. 61.2%), irritable (60.4% vs. 49.4%), and stressed (79.6% vs. 70%). High-risk male trainees and physicians were more likely than females to endorse suicidal thoughts (31.2% vs. 22.1%), intense anger (24.3% vs. 16.1%), drinking too much (31.2% vs. 22.3%), and recreational drug or prescription medication use without clinically appropriate follow-up (9.4% vs. 4.3%). There were no gender differences in help-seeking behaviors. CONCLUSIONS This is the first study to report gender differences among risk factors, presentation, and help-seeking behaviors of physicians, and trainees at high risk for suicide. Our findings are mostly consistent with those of the general population and show that only a minority of at-risk men and women in healthcare sought treatment, highlighting the importance of intervention and suicide prevention in this population.
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Affiliation(s)
- Sarah Pospos
- Psychiatry, University of California San Diego, La Jolla, California, USA
| | - Ilanit Tal
- Psychiatry, Veterans Affairs San Diego Healthcare System, La Jolla, California, USA
| | - Alana Iglewicz
- Psychiatry, University of California San Diego, La Jolla, California, USA.,Psychiatry, Veterans Affairs San Diego Healthcare System, La Jolla, California, USA
| | - Isabel G Newton
- Radiology, Veterans Affairs San Diego Healthcare System, La Jolla, California, San Diego.,Radiology, University of California San Diego, La Jolla, California, San Diego
| | - Ming Tai-Seale
- Family and Preventive Medicine, University of California San Diego, La Jolla, California, San Diego
| | - Nancy Downs
- Psychiatry, University of California San Diego, La Jolla, California, USA
| | - Pamela Jong
- Internal Medicine, Veterans Affairs San Diego Healthcare System, La Jolla, California, San Diego.,Internal Medicine, University of California San Diego, La Jolla, California, USA
| | - Daniel Lee
- Anesthesiology, University of California San Diego, La Jolla, California, USA
| | - Judy E Davidson
- Psychiatry, University of California San Diego, La Jolla, California, USA
| | - Soo Y Lee
- Undergraduate Student, University of California San Diego, La Jolla, California, USA
| | - Caryn Kseniya Rubanovich
- Joint Doctoral Program in Clinical Psychology, University of California San Diego and San Diego State University, La Jolla, California, USA
| | - Emily V Ho
- Medical Student, University od California San Diego, La Jolla, California, USA
| | - Courtney Sanchez
- Psychiatry, University of California San Diego, La Jolla, California, USA
| | - Sidney Zisook
- Psychiatry, University of California San Diego, La Jolla, California, USA.,Psychiatry, Veterans Affairs San Diego Healthcare System, La Jolla, California, USA
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7
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Zisook S, Shear MK, Reynolds CF, Simon NM, Mauro C, Skritskaya NA, Lebowitz B, Wang Y, Tal I, Glorioso D, Wetherell JL, Iglewicz A, Robinaugh D, Qiu X. Treatment of Complicated Grief in Survivors of Suicide Loss: A HEAL Report. J Clin Psychiatry 2019; 79. [PMID: 29617064 DOI: 10.4088/jcp.17m11592] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [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] [Received: 03/20/2017] [Accepted: 08/17/2017] [Indexed: 10/17/2022]
Abstract
OBJECTIVE Suffering associated with complicated grief (CG) is profound. Because suicide loss survivors are susceptible to developing CG, identifying effective treatments for suicide loss survivors with CG is a high priority. This report provides data on the acceptability and effectiveness of antidepressant medication and complicated grief therapy (CGT), a CG-targeted psychotherapy, for suicide loss survivors with CG identified by an Inventory of Complicated Grief score ≥ 30. METHODS This is a secondary analysis of data collected from March 2010 to September 2014 for a 4-site, double-blind, placebo-controlled randomized trial comparing the effectiveness of antidepressant medication alone or in combination with CGT for participants with CG (score ≥ 30 on the Inventory of Complicated Grief) who were bereaved by suicide (SB; n = 58), accident/homicide (A/H; n = 74), or natural causes (NC; n = 263). Using mode of death as a grouping factor, we evaluated acceptability of treatments by comparing 12-week medication and 16-session CGT completion; we evaluated effectiveness by comparing response at week 20, defined by a score of 1 or 2 on the Complicated Grief Clinical Global Impressions-Improvement scale (CG-CGI-I), and additional secondary response measures. RESULTS Among participants receiving medication alone, SB medication completion rates (36%) were lower than rates for A/H (54%) and NC (68%; χ² = 11.76, P < .01). SB medication completion rates were much higher for SB individuals receiving CGT (82%; χ² = 12.45, P < .001) than for SB individuals receiving medication alone. CGT completion rates were similar in the 3 groups (SB = 74%, A/H = 64%, NC = 77%; χ² = 2.48, P = .29). For SB participants receiving CGT, CG-CGI-I response rates were substantial (64%), but lower compared to the other groups (A/H = 93%, NC = 84%; χ² = 8.00, P < .05). However, on all other outcomes, changes from baseline for SB participants were comparable to those for A/H and NC participants, including number and severity of grief symptoms, suicidal ideation, and grief-related impairment, avoidance, and maladaptive beliefs. CONCLUSIONS These results raise concern about the acceptability of medication alone as a treatment for complicated grief in treatment-seeking suicide-bereaved adults. In contrast, CGT is an acceptable and promising treatment for suicide-bereaved individuals with complicated grief. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT01179568.
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Affiliation(s)
- Sidney Zisook
- Department of Psychiatry, UC San Diego, 9500 Gilman Dr, La Jolla, CA 92093. .,Department of Psychiatry, University of California San Diego, La Jolla, California, USA.,Veterans Affairs San Diego Healthcare System and Veterans Medical Research Foundation, La Jolla, California, USA.,Drs Zisook, Shear, Reynolds, and Simon are co-first authors of this article
| | - M Katherine Shear
- Columbia University School of Social Work, New York, New York, USA.,Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, New York, USA.,Drs Zisook, Shear, Reynolds, and Simon are co-first authors of this article
| | - Charles F Reynolds
- Department of Psychiatry, University of Pittsburgh School of Medicine, and Department of Community and Behavioral Health Science, University of Pittsburgh Graduate School of Public Health, Western Psychiatric Institute and Clinic, Pittsburgh, Pennsylvania, USA.,Drs Zisook, Shear, Reynolds, and Simon are co-first authors of this article
| | - Naomi M Simon
- Center for Anxiety and Traumatic Stress Disorders, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA.,Drs Zisook, Shear, Reynolds, and Simon are co-first authors of this article
| | - Christine Mauro
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York, USA
| | | | - Barry Lebowitz
- Department of Psychiatry, University of California San Diego, La Jolla, California, USA
| | - Yuanjia Wang
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Ilanit Tal
- Veterans Affairs San Diego Healthcare System and Veterans Medical Research Foundation, La Jolla, California, USA
| | - Danielle Glorioso
- Department of Psychiatry, University of California San Diego, La Jolla, California, USA
| | - Julie Loebach Wetherell
- Department of Psychiatry, University of California San Diego, La Jolla, California, USA.,Veterans Affairs San Diego Healthcare System and Veterans Medical Research Foundation, La Jolla, California, USA
| | - Alana Iglewicz
- Department of Psychiatry, University of California San Diego, La Jolla, California, USA.,Veterans Affairs San Diego Healthcare System and Veterans Medical Research Foundation, La Jolla, California, USA
| | - Donald Robinaugh
- Center for Anxiety and Traumatic Stress Disorders, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Xin Qiu
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York, USA
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8
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Oleinikov K, Dancour A, Epshtein J, Benson A, Mazeh H, Tal I, Matalon S, Benbassat CA, Livovsky DM, Goldin E, Gross DJ, Jacob H, Grozinsky-Glasberg S. Endoscopic Ultrasound-Guided Radiofrequency Ablation: A New Therapeutic Approach for Pancreatic Neuroendocrine Tumors. J Clin Endocrinol Metab 2019; 104:2637-2647. [PMID: 31102458 DOI: 10.1210/jc.2019-00282] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [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] [Received: 02/03/2019] [Accepted: 04/03/2019] [Indexed: 02/07/2023]
Abstract
CONTEXT Endoscopic ultrasound-guided radiofrequency ablation (EUS-RFA) is rapidly emerging as feasible therapy for patients with pancreatic neuroendocrine tumors (pNETs) in selected cases, as a result of its favorable safety profile. OBJECTIVE To assess the feasibility, safety, and efficacy of EUS-RFA in a cohort of patients with functional and nonfunctional pNETs (NF-pNETs). DESIGN Data on pNET patients treated with EUS-RFA between March 2017 and October 2018 at two tertiary centers was retrospectively analyzed. RESULTS The cohort included 18 adults (eight women, 10 men), aged 60.4 ± 14.4 years (mean ± SD), seven insulinoma patients, and 11 patients with NF-pNETs. Twenty-seven lesions with a mean diameter of 14.3 ± 7.3 mm (range 4.5 to 30) were treated. Technical success defined as typical postablative changes on a surveillance imaging was achieved in 26 out of 27 lesions. Clinical response with normalization of glucose levels was observed in all (seven of seven) insulinoma cases within 24 hours of treatment. Overall, there were no major complications 48 hours postprocedure. No clinically significant recurrences were observed during mean follow-up of 8.7 ± 4.6 months (range 2 to 21 months). CONCLUSIONS EUS-guided RFA of pNETs is a minimally invasive, safe, and technically feasible procedure for selected patients.
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Affiliation(s)
- Kira Oleinikov
- Neuroendocrine Tumor Unit, Endocrinology Department, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
- European Neuroendocrine Tumor Society (ENETS) Centre of Excellence, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Alain Dancour
- Gastroenterology Institute, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Julia Epshtein
- European Neuroendocrine Tumor Society (ENETS) Centre of Excellence, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
- Department of Gastroenterology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Ariel Benson
- European Neuroendocrine Tumor Society (ENETS) Centre of Excellence, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
- Department of Gastroenterology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Haggi Mazeh
- European Neuroendocrine Tumor Society (ENETS) Centre of Excellence, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
- Department of Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Ilanit Tal
- Neuroendocrine Tumor Unit, Endocrinology Department, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
- European Neuroendocrine Tumor Society (ENETS) Centre of Excellence, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Shay Matalon
- Institute of Gastroenterology, Assaf Harofeh Medical Center, Zrifin, Israel
| | - Carlos A Benbassat
- Institute of Endocrinology, Assaf Harofeh Medical Center, Zrifin, Israel
| | - Dan M Livovsky
- Gastroenterology Institute, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Eran Goldin
- Gastroenterology Institute, Shaare Zedek Medical Center, Jerusalem, Israel
| | - David J Gross
- Neuroendocrine Tumor Unit, Endocrinology Department, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
- European Neuroendocrine Tumor Society (ENETS) Centre of Excellence, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Harold Jacob
- European Neuroendocrine Tumor Society (ENETS) Centre of Excellence, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
- Department of Gastroenterology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Simona Grozinsky-Glasberg
- Neuroendocrine Tumor Unit, Endocrinology Department, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
- European Neuroendocrine Tumor Society (ENETS) Centre of Excellence, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
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Zisook S, Johnson GR, Tal I, Hicks P, Chen P, Davis L, Thase M, Zhao Y, Vertrees J, Mohamed S. General Predictors and Moderators of Depression Remission: A VAST-D Report. Am J Psychiatry 2019; 176:348-357. [PMID: 30947531 DOI: 10.1176/appi.ajp.2018.18091079] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [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: 11/30/2022]
Abstract
OBJECTIVE Almost two-thirds of patients with major depressive disorder do not achieve remission with initial treatments. Thus, identifying and providing effective, feasible, and safe "next-step" treatments are clinical imperatives. This study explores patient baseline features that might help clinicians select between commonly used next-step treatments. METHODS The authors used data from the U.S. Department of Veterans Affairs (VA) Augmentation and Switching Treatments for Improving Depression Outcomes (VAST-D) study, a multisite, randomized, single-blind trial of 1,522 Veterans Health Administration patients who did not have an adequate response to at least one course of antidepressant treatment meeting minimal standards for dosage and duration. For 12 weeks, participants received one of three possible next-step treatments: switch to another antidepressant-sustained-release bupropion; combination with another antidepressant-sustained-release bupropion; or augmentation with an antipsychotic-aripiprazole. Life table regression models were used to identify baseline characteristics associated with remission overall (general predictors) and their interaction with remission among the three treatment groups (moderators). RESULTS Remission was more likely for individuals who were employed, less severely and chronically depressed, less anxious, not experiencing complicated grief symptoms, did not experience childhood adversity, and had better quality of life and positive mental health. Two features suggested specific next-step treatment selections: age ≥65 years (for whom augmentation with aripiprazole was more effective than switch to bupropion) and severe mixed hypomanic symptoms (for which augmentation with aripiprazole and combination with bupropion were more effective than switch to bupropion). CONCLUSIONS If replicated, these preliminary findings could help clinicians determine which patients with depression requiring next-step treatment will benefit most from a specific augmentation, combination, or switching strategy.
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Affiliation(s)
- Sidney Zisook
- VA San Diego Healthcare System (Zisook, Tal); the Department of Psychiatry, University of California San Diego (Zisook); Cooperative Studies Program Coordinating Center, VA Connecticut Healthcare System, West Haven (Johnson, Zhao); the Department of Psychiatry, Texas A&M College of Medicine, Temple (Hicks); Louis Stokes VA Medical Center and the Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland (Chen); Tuscaloosa VA Medical Center, Tuscaloosa, Ala. (Davis); University of Alabama School of Medicine, Birmingham (Davis); Philadelphia VA Medical Center (Thase); Cooperative Studies Program Clinical Research Pharmacy Coordinating Center, Albuquerque, N.Mex. (Vertrees); and the VA New England Mental Illness Research, Education, and Clinical Center, VA Connecticut Healthcare System, West Haven (Mohamed)
| | - Gary R Johnson
- VA San Diego Healthcare System (Zisook, Tal); the Department of Psychiatry, University of California San Diego (Zisook); Cooperative Studies Program Coordinating Center, VA Connecticut Healthcare System, West Haven (Johnson, Zhao); the Department of Psychiatry, Texas A&M College of Medicine, Temple (Hicks); Louis Stokes VA Medical Center and the Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland (Chen); Tuscaloosa VA Medical Center, Tuscaloosa, Ala. (Davis); University of Alabama School of Medicine, Birmingham (Davis); Philadelphia VA Medical Center (Thase); Cooperative Studies Program Clinical Research Pharmacy Coordinating Center, Albuquerque, N.Mex. (Vertrees); and the VA New England Mental Illness Research, Education, and Clinical Center, VA Connecticut Healthcare System, West Haven (Mohamed)
| | - Ilanit Tal
- VA San Diego Healthcare System (Zisook, Tal); the Department of Psychiatry, University of California San Diego (Zisook); Cooperative Studies Program Coordinating Center, VA Connecticut Healthcare System, West Haven (Johnson, Zhao); the Department of Psychiatry, Texas A&M College of Medicine, Temple (Hicks); Louis Stokes VA Medical Center and the Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland (Chen); Tuscaloosa VA Medical Center, Tuscaloosa, Ala. (Davis); University of Alabama School of Medicine, Birmingham (Davis); Philadelphia VA Medical Center (Thase); Cooperative Studies Program Clinical Research Pharmacy Coordinating Center, Albuquerque, N.Mex. (Vertrees); and the VA New England Mental Illness Research, Education, and Clinical Center, VA Connecticut Healthcare System, West Haven (Mohamed)
| | - Paul Hicks
- VA San Diego Healthcare System (Zisook, Tal); the Department of Psychiatry, University of California San Diego (Zisook); Cooperative Studies Program Coordinating Center, VA Connecticut Healthcare System, West Haven (Johnson, Zhao); the Department of Psychiatry, Texas A&M College of Medicine, Temple (Hicks); Louis Stokes VA Medical Center and the Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland (Chen); Tuscaloosa VA Medical Center, Tuscaloosa, Ala. (Davis); University of Alabama School of Medicine, Birmingham (Davis); Philadelphia VA Medical Center (Thase); Cooperative Studies Program Clinical Research Pharmacy Coordinating Center, Albuquerque, N.Mex. (Vertrees); and the VA New England Mental Illness Research, Education, and Clinical Center, VA Connecticut Healthcare System, West Haven (Mohamed)
| | - Peijun Chen
- VA San Diego Healthcare System (Zisook, Tal); the Department of Psychiatry, University of California San Diego (Zisook); Cooperative Studies Program Coordinating Center, VA Connecticut Healthcare System, West Haven (Johnson, Zhao); the Department of Psychiatry, Texas A&M College of Medicine, Temple (Hicks); Louis Stokes VA Medical Center and the Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland (Chen); Tuscaloosa VA Medical Center, Tuscaloosa, Ala. (Davis); University of Alabama School of Medicine, Birmingham (Davis); Philadelphia VA Medical Center (Thase); Cooperative Studies Program Clinical Research Pharmacy Coordinating Center, Albuquerque, N.Mex. (Vertrees); and the VA New England Mental Illness Research, Education, and Clinical Center, VA Connecticut Healthcare System, West Haven (Mohamed)
| | - Lori Davis
- VA San Diego Healthcare System (Zisook, Tal); the Department of Psychiatry, University of California San Diego (Zisook); Cooperative Studies Program Coordinating Center, VA Connecticut Healthcare System, West Haven (Johnson, Zhao); the Department of Psychiatry, Texas A&M College of Medicine, Temple (Hicks); Louis Stokes VA Medical Center and the Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland (Chen); Tuscaloosa VA Medical Center, Tuscaloosa, Ala. (Davis); University of Alabama School of Medicine, Birmingham (Davis); Philadelphia VA Medical Center (Thase); Cooperative Studies Program Clinical Research Pharmacy Coordinating Center, Albuquerque, N.Mex. (Vertrees); and the VA New England Mental Illness Research, Education, and Clinical Center, VA Connecticut Healthcare System, West Haven (Mohamed)
| | - Michael Thase
- VA San Diego Healthcare System (Zisook, Tal); the Department of Psychiatry, University of California San Diego (Zisook); Cooperative Studies Program Coordinating Center, VA Connecticut Healthcare System, West Haven (Johnson, Zhao); the Department of Psychiatry, Texas A&M College of Medicine, Temple (Hicks); Louis Stokes VA Medical Center and the Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland (Chen); Tuscaloosa VA Medical Center, Tuscaloosa, Ala. (Davis); University of Alabama School of Medicine, Birmingham (Davis); Philadelphia VA Medical Center (Thase); Cooperative Studies Program Clinical Research Pharmacy Coordinating Center, Albuquerque, N.Mex. (Vertrees); and the VA New England Mental Illness Research, Education, and Clinical Center, VA Connecticut Healthcare System, West Haven (Mohamed)
| | - Yinjun Zhao
- VA San Diego Healthcare System (Zisook, Tal); the Department of Psychiatry, University of California San Diego (Zisook); Cooperative Studies Program Coordinating Center, VA Connecticut Healthcare System, West Haven (Johnson, Zhao); the Department of Psychiatry, Texas A&M College of Medicine, Temple (Hicks); Louis Stokes VA Medical Center and the Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland (Chen); Tuscaloosa VA Medical Center, Tuscaloosa, Ala. (Davis); University of Alabama School of Medicine, Birmingham (Davis); Philadelphia VA Medical Center (Thase); Cooperative Studies Program Clinical Research Pharmacy Coordinating Center, Albuquerque, N.Mex. (Vertrees); and the VA New England Mental Illness Research, Education, and Clinical Center, VA Connecticut Healthcare System, West Haven (Mohamed)
| | - Julia Vertrees
- VA San Diego Healthcare System (Zisook, Tal); the Department of Psychiatry, University of California San Diego (Zisook); Cooperative Studies Program Coordinating Center, VA Connecticut Healthcare System, West Haven (Johnson, Zhao); the Department of Psychiatry, Texas A&M College of Medicine, Temple (Hicks); Louis Stokes VA Medical Center and the Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland (Chen); Tuscaloosa VA Medical Center, Tuscaloosa, Ala. (Davis); University of Alabama School of Medicine, Birmingham (Davis); Philadelphia VA Medical Center (Thase); Cooperative Studies Program Clinical Research Pharmacy Coordinating Center, Albuquerque, N.Mex. (Vertrees); and the VA New England Mental Illness Research, Education, and Clinical Center, VA Connecticut Healthcare System, West Haven (Mohamed)
| | - Somaia Mohamed
- VA San Diego Healthcare System (Zisook, Tal); the Department of Psychiatry, University of California San Diego (Zisook); Cooperative Studies Program Coordinating Center, VA Connecticut Healthcare System, West Haven (Johnson, Zhao); the Department of Psychiatry, Texas A&M College of Medicine, Temple (Hicks); Louis Stokes VA Medical Center and the Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland (Chen); Tuscaloosa VA Medical Center, Tuscaloosa, Ala. (Davis); University of Alabama School of Medicine, Birmingham (Davis); Philadelphia VA Medical Center (Thase); Cooperative Studies Program Clinical Research Pharmacy Coordinating Center, Albuquerque, N.Mex. (Vertrees); and the VA New England Mental Illness Research, Education, and Clinical Center, VA Connecticut Healthcare System, West Haven (Mohamed)
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McClure JR, Tal I, Macera CA, Ji M, Nievergelt CM, Lee SY, Kayman J, Zisook S. Agreement between self and psychiatrist reporting of suicidal ideation at a Veterans Administration psychiatric emergency clinic. Depress Anxiety 2018; 35:1114-1121. [PMID: 30102445 DOI: 10.1002/da.22813] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 05/25/2018] [Accepted: 05/29/2018] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND With suicide rising in the United States, identifying and preventing suicides is increasingly important. To provide a valuable step toward achieving effective suicide risk assessment, this study examines the agreement between self-report measures and psychiatrist documentation of suicidal ideation and behaviors (SI) at a Veterans Administration (VA) psychiatric emergency clinic. METHODS A total of 377 veterans presenting at a VA psychiatric emergency clinic completed a self-report survey on SI and other acute risk factors for suicidal behavior. We examined agreement between veterans' self-reported SI and psychiatrists' clinical notes regarding SI. RESULTS A total of 199 veterans (53%) self-reported SI; 80 psychiatrist notes (21%) indicated SI. Psychiatrists and veterans differed in 44% (164/377) of cases. Among the discordant cases, the veterans' self-report was more severe than the psychiatrists' in 97% of cases. Of the 120 veterans with SI and documented as having no SI by psychiatrists, 31 (26%) reported having a suicide plan and 18 (15%) plan preparations. Findings were similar when controlling for presenting problem, current depression, presence of a standardized suicide risk assessment, psychiatrist training level, past suicide attempt, homelessness, diagnosis of personality, or substance use disorder. CONCLUSIONS Agreement between veterans' self-reports and psychiatrists' documentation of SI was generally low, with veterans self-reporting SI significantly more often than psychiatrists documented SI in their clinical notes. This suggests that inclusion of a self-report questionnaire provides an additional source of data to complement information gleaned from the clinical interview for a more comprehensive risk assessment, but only if actually examined by the clinician.
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Affiliation(s)
- Janet R McClure
- Department of Research, VA San Diego Healthcare System, San Diego, California
| | - Ilanit Tal
- Department of Research, VA San Diego Healthcare System, San Diego, California
| | - Caroline A Macera
- School of Public Health, San Diego State University, San Diego, California.,Department of Medicine, University of California, San Diego, California
| | - Ming Ji
- College of Nursing, University of South Florida, Tampa, Florida
| | - Caroline M Nievergelt
- Department of Research, VA San Diego Healthcare System, San Diego, California.,Department of Psychiatry, University of California, San Diego, California
| | - Soo Yong Lee
- Department of Psychiatry, University of California, San Diego, California
| | | | - Sidney Zisook
- Department of Research, VA San Diego Healthcare System, San Diego, California.,Department of Medicine, University of California, San Diego, California.,Department of Psychiatry, University of California, San Diego, California.,Department of Psychiatry, VA San Diego Healthcare System, San Diego, California
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11
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Abstract
This letter presents a noninvasive imaging technique that captures the exact timing and locations of cortical activity sequences that are specific to a cognitive process. These precise spatiotemporal sequences can be detected in the human brain as specific time-position pattern associated with a cognitive task. They are consistent with direct measurements of population activity recorded in nonhuman primates, thus suggesting that specific time-position patterns associated with a cognitive task can be identified. This imaging technique is based on estimating the amplitude of cortical current dipoles from MEG recordings. Although the spatial resolution of these estimations is poor (approximately 2 cm), the temporal resolution is high (milliseconds). We show that within these cortical current dipoles, time points of cortical activation can be identified as brief amplitude undulations and that sequences of these transients repeat with millisecond accuracy, hence making it possible to treat the timing of these transients as point processes. We illustrate the feasibility of finding spatiotemporal templates specific to the cognitive processes associated with following the rhythm of drumbeats that involve the activation at multiple cortical and cerebellar loci. These templates evolve at an accuracy of a few milliseconds. This approach can thus pave the way for new perspectives on the relationships between brain dynamics and cognition.
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Affiliation(s)
- I Tal
- Gonda Multidisciplinary Brain Research Center, Bar-Ilan University, Ramat-Gan 52902, Israel
| | - M Abeles
- Gonda Multidisciplinary Brain Research Center, Bar-Ilan University, Ramat-Gan 52902, Israel, and Hebrew University of Jerusalem, Jerusalem 91950, Israel
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12
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Mohamed S, Johnson GR, Chen P, Hicks PB, Davis LL, Yoon J, Gleason TC, Vertrees JE, Weingart K, Tal I, Scrymgeour A, Lawrence DD, Planeta B, Thase ME, Huang GD, Zisook S. Effect of Antidepressant Switching vs Augmentation on Remission Among Patients With Major Depressive Disorder Unresponsive to Antidepressant Treatment: The VAST-D Randomized Clinical Trial. JAMA 2017; 318:132-145. [PMID: 28697253 PMCID: PMC5817471 DOI: 10.1001/jama.2017.8036] [Citation(s) in RCA: 87] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
IMPORTANCE Less than one-third of patients with major depressive disorder (MDD) achieve remission with their first antidepressant. OBJECTIVE To determine the relative effectiveness and safety of 3 common alternate treatments for MDD. DESIGN, SETTING, AND PARTICIPANTS From December 2012 to May 2015, 1522 patients at 35 US Veterans Health Administration medical centers who were diagnosed with nonpsychotic MDD, unresponsive to at least 1 antidepressant course meeting minimal standards for treatment dose and duration, participated in the study. Patients were randomly assigned (1:1:1) to 1 of 3 treatments and evaluated for up to 36 weeks. INTERVENTIONS Switch to a different antidepressant, bupropion (switch group, n = 511); augment current treatment with bupropion (augment-bupropion group, n = 506); or augment with an atypical antipsychotic, aripiprazole (augment-aripiprazole group, n = 505) for 12 weeks (acute treatment phase) and up to 36 weeks for longer-term follow-up (continuation phase). MAIN OUTCOMES AND MEASURES The primary outcome was remission during the acute treatment phase (16-item Quick Inventory of Depressive Symptomatology-Clinician Rated [QIDS-C16] score ≤5 at 2 consecutive visits). Secondary outcomes included response (≥50% reduction in QIDS-C16 score or improvement on the Clinical Global Impression Improvement scale), relapse, and adverse effects. RESULTS Among 1522 randomized patients (mean age, 54.4 years; men, 1296 [85.2%]), 1137 (74.7%) completed the acute treatment phase. Remission rates at 12 weeks were 22.3% (n = 114) for the switch group, 26.9% (n = 136)for the augment-bupropion group, and 28.9% (n = 146) for the augment-aripiprazole group. The augment-aripiprazole group exceeded the switch group in remission (relative risk [RR], 1.30 [95% CI, 1.05-1.60]; P = .02), but other remission comparisons were not significant. Response was greater for the augment-aripiprazole group (74.3%) than for either the switch group (62.4%; RR, 1.19 [95% CI, 1.09-1.29]) or the augment-bupropion group (65.6%; RR, 1.13 [95% CI, 1.04-1.23]). No significant treatment differences were observed for relapse. Anxiety was more frequent in the 2 bupropion groups (24.3% in the switch group [n = 124] vs 16.6% in the augment-aripiprazole group [n = 84]; and 22.5% in augment-bupropion group [n = 114]). Adverse effects more frequent in the augment-aripiprazole group included somnolence, akathisia, and weight gain. CONCLUSIONS AND RELEVANCE Among a predominantly male population with major depressive disorder unresponsive to antidepressant treatment, augmentation with aripiprazole resulted in a statistically significant but only modestly increased likelihood of remission during 12 weeks of treatment compared with switching to bupropion monotherapy. Given the small effect size and adverse effects associated with aripiprazole, further analysis including cost-effectiveness is needed to understand the net utility of this approach. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01421342.
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Affiliation(s)
- Somaia Mohamed
- Veterans Affairs (VA) New England Mental Illness Research, Education, and Clinical Center, VA Connecticut Healthcare System, West Haven
- Yale University School of Medicine, West Haven, Connecticut
| | - Gary R. Johnson
- Cooperative Studies Program Coordinating Center, VA Connecticut Healthcare System, West Haven
| | - Peijun Chen
- Louis Stokes VA Medical Center and Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Paul B. Hicks
- Central Texas Veterans Healthcare System and Department of Psychiatry and Behavioral Science, Texas A&M Health Science Center College of Medicine, Temple
- Central Texas Veterans Healthcare System, Temple
| | - Lori L. Davis
- Tuscaloosa VA Medical Center, Tuscaloosa, Alabama
- University of Alabama School of Medicine, Birmingham
| | - Jean Yoon
- Health Economics Resource Center, VA Palo Alto, Menlo Park, California
| | - Theresa C. Gleason
- Department of Veterans Affairs, Office of Research and Development, Washington, DC
| | - Julia E. Vertrees
- Cooperative Studies Program Clinical Research Pharmacy Coordinating Center, Albuquerque, New Mexico
| | - Kimberly Weingart
- VA San Diego Healthcare System, San Diego, California
- University of California, San Diego
| | - Ilanit Tal
- VA San Diego Healthcare System, San Diego, California
| | - Alexandra Scrymgeour
- Cooperative Studies Program Clinical Research Pharmacy Coordinating Center, Albuquerque, New Mexico
| | - David D. Lawrence
- Cooperative Studies Program Coordinating Center, VA Connecticut Healthcare System, West Haven
| | - Beata Planeta
- Cooperative Studies Program Coordinating Center, VA Connecticut Healthcare System, West Haven
| | | | - Grant D. Huang
- Cooperative Studies Program Central Office, Department of Veterans Affairs Office of Research and Development, Washington, DC
| | - Sidney Zisook
- VA San Diego Healthcare System, San Diego, California
- University of California, San Diego
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Tal I, Mauro C, Reynolds CF, Shear MK, Simon N, Lebowitz B, Skritskaya N, Wang Y, Qiu X, Iglewicz A, Glorioso D, Avanzino J, Wetherell JL, Karp JF, Robinaugh D, Zisook S. Complicated grief after suicide bereavement and other causes of death. Death Stud 2017; 41:267-275. [PMID: 27892842 DOI: 10.1080/07481187.2016.1265028] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
The authors compared baseline demographic characteristics, clinical features, and grief-related thoughts, feelings, and behaviors of individuals bereaved by suicide, accident/homicide and natural causes participating in a complicated grief (CG) treatment clinical trial. Severity of CG and depression and current depression diagnosis did not vary by loss type. After adjusting for baseline demographic features, time since death and relationship to the deceased, those with CG after suicide had the highest rates of lifetime depression, preloss passive suicidal ideation, self-blaming thoughts, and impaired work and social adjustment. Even among this treatment-seeking sample of research participants with CG, suicide survivors may face unique challenges.
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Affiliation(s)
- Ilanit Tal
- a Veterans Affairs San Diego Healthcare System , Veterans Medical Research Foundation , San Diego , California , USA
| | - Christine Mauro
- b Department of Biostatistics, Mailman School of Public Health , Columbia University , New York , New York , USA
| | - Charles F Reynolds
- c Department of Psychiatry, Western Psychiatric Institute and Clinic , University of Pittsburgh School of Medicine , Pittsburgh , Pennsylvania , USA
| | - M Katherine Shear
- d Center for Complicated Grief , Columbia School of Social Work , New York , New York , USA
- e Department of Psychiatry , Columbia University College of Physicians and Surgeons , New York , New York , USA
| | - Naomi Simon
- f Center for Anxiety and Traumatic Stress Disorders , Massachusetts General Hospital , Boston , Massachusetts , USA
- g Harvard Medical School , Boston , Massachusetts , USA
| | - Barry Lebowitz
- h Department of Psychiatry , University of California San Diego , La Jolla , California , USA
| | - Natalia Skritskaya
- d Center for Complicated Grief , Columbia School of Social Work , New York , New York , USA
| | - Yuanjia Wang
- b Department of Biostatistics, Mailman School of Public Health , Columbia University , New York , New York , USA
| | - Xin Qiu
- b Department of Biostatistics, Mailman School of Public Health , Columbia University , New York , New York , USA
| | - Alana Iglewicz
- a Veterans Affairs San Diego Healthcare System , Veterans Medical Research Foundation , San Diego , California , USA
- h Department of Psychiatry , University of California San Diego , La Jolla , California , USA
| | - Danielle Glorioso
- a Veterans Affairs San Diego Healthcare System , Veterans Medical Research Foundation , San Diego , California , USA
- h Department of Psychiatry , University of California San Diego , La Jolla , California , USA
| | - Julie Avanzino
- a Veterans Affairs San Diego Healthcare System , Veterans Medical Research Foundation , San Diego , California , USA
- h Department of Psychiatry , University of California San Diego , La Jolla , California , USA
| | - Julie Loebach Wetherell
- a Veterans Affairs San Diego Healthcare System , Veterans Medical Research Foundation , San Diego , California , USA
- h Department of Psychiatry , University of California San Diego , La Jolla , California , USA
| | - Jordan F Karp
- c Department of Psychiatry, Western Psychiatric Institute and Clinic , University of Pittsburgh School of Medicine , Pittsburgh , Pennsylvania , USA
| | - Don Robinaugh
- f Center for Anxiety and Traumatic Stress Disorders , Massachusetts General Hospital , Boston , Massachusetts , USA
- g Harvard Medical School , Boston , Massachusetts , USA
| | - Sidney Zisook
- a Veterans Affairs San Diego Healthcare System , Veterans Medical Research Foundation , San Diego , California , USA
- h Department of Psychiatry , University of California San Diego , La Jolla , California , USA
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Zisook S, Tal I, Weingart K, Hicks P, Davis LL, Chen P, Yoon J, Johnson GR, Vertrees JE, Rao S, Pilkinton PD, Wilcox JA, Sapra M, Iranmanesh A, Huang GD, Mohamed S. Characteristics of U.S. Veteran Patients with Major Depressive Disorder who require "next-step" treatments: A VAST-D report. J Affect Disord 2016; 206:232-240. [PMID: 27479536 DOI: 10.1016/j.jad.2016.07.023] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [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: 04/21/2016] [Revised: 07/09/2016] [Accepted: 07/16/2016] [Indexed: 02/09/2023]
Abstract
OBJECTIVE Finding effective and lasting treatments for patients with Major Depressive Disorder (MDD) that fail to respond optimally to initial standard treatment is a critical public health imperative. Understanding the nature and characteristics of patients prior to initiating "next-step" treatment is an important component of identifying which specific treatments are best suited for individual patients. We describe clinical features and demographic characteristics of a sample of Veterans who enrolled in a "next-step" clinical trial after failing to achieve an optimal outcome from at least one well-delivered antidepressant trial. METHODS 1522 Veteran outpatients with nonpsychotic MDD completed assessments prior to being randomized to study treatment. Data is summarized and presented in terms of demographic, social, historical and clinical features and compared to a similar, non-Veteran sample. RESULTS Participants were largely male and white, with about half unmarried and half unemployed. They were moderately severely depressed, with about one-third reporting recent suicidal ideation. More than half had chronic and/or recurrent depression. General medical and psychiatric comorbidities were highly prevalent, particularly PTSD. Many had histories of childhood adversity and bereavement. Participants were impaired in multiple domains of their lives and had negative self-worth. LIMITATIONS These results may not be generalizable to females, and some characteristics may be specific to Veterans of US military service. There was insufficient data on age of clinical onset and depression subtypes, and three novel measures were not psychometrically validated. CONCLUSIONS Characterizing VAST-D participants provides important information to help clinicians understand features that may optimize "next-step" MDD treatments.
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Affiliation(s)
- Sidney Zisook
- VA San Diego Healthcare System and University of California, San Diego, USA.
| | - Ilanit Tal
- VA San Diego Healthcare System and University of California, San Diego, USA
| | - Kimberly Weingart
- VA San Diego Healthcare System and University of California, San Diego, USA
| | - Paul Hicks
- Central Texas Veterans Healthcare System and Department of Psychiatry and Behavioral Sciences Texas A&M Health Science Center College of Medicine, Temple, TX, USA
| | - Lori L Davis
- Tuscaloosa VA Medical Center, Tuscaloosa, AL, USA; University of Alabama School of Medicine, USA
| | - Peijun Chen
- Louis Stokes VA Medical Center and Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Jean Yoon
- Health Economics Resource Center (HERC), VA Palo Alto, Menlo Park, CA, USA
| | - Gary R Johnson
- VA Cooperative Studies Program Coordinating Center, VA Connecticut Healthcare System, West Haven, CT, USA
| | - Julia E Vertrees
- VA Cooperative Studies Program Clinical Research Pharmacy Coordinating Center, New Mexico VA Healthcare System, Albuquerque, NM, USA
| | - Sanjai Rao
- VA San Diego Healthcare System and University of California, San Diego, USA
| | - Patricia D Pilkinton
- Tuscaloosa VA Medical Center, Tuscaloosa, AL, USA; Capstone College of Community Health Sciences, Tuscaloosa, AL, USA
| | - James A Wilcox
- Tucson VA Medical Center and Department of Psychiatry, University of Arizona, Tucson, AZ, USA
| | - Mamta Sapra
- Salem VA Medical Center, Salem, VA, USA; Virginia Tech Carilion School of Medicine, Roanoke, VA, USA
| | - Ali Iranmanesh
- Salem VA Medical Center, Salem, VA, USA; Virginia Tech Carilion School of Medicine, Roanoke, VA, USA
| | - Grant D Huang
- Cooperative Studies Program Central Office, VA Office of Research & Development, Washington DC, USA
| | - Somaia Mohamed
- VA VISN1 New England Mental Illness Research, Education and Clinical Center (MIRECC), Veterans Health Administration, West Haven, CT, USA; Yale University School of Medicine, USA
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Martinez S, Tal I, Norcross W, Newton IG, Downs N, Seay K, McGuire T, Kirby B, Chidley B, Tiamson-Kassab M, Lee D, Hadley A, Doran N, Jong P, Lee K, Moutier C, Norman M, Zisook S. Alcohol use in an academic medical school environment: A UC San Diego Healer Education Assessment and Referral (HEAR) Report. Ann Clin Psychiatry 2016; 28:85-94. [PMID: 27285389] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
BACKGROUND Medical students and physicians in training and in practice are at risk for excessive alcohol use and abuse, potentially impacting the affected individuals as well as their family members, trainees, and patients. However, several roadblocks to care, including stigma, often keep them from seeking treatment. METHODS We analyzed data from anonymous questionnaires completed by medical students, house staff, and faculty from 2009 to 2014 as part of a depression awareness and suicide prevention program at a state-supported medical school in the United States. The authors explored associations between self-reported "drinking too much" and depression, suicidal ideation, substance use, intense affective states, and mental health treatment. RESULTS Approximately one-fifth of the respondents reported "drinking too much." "Drinking too much" was associated with more severe depression and impairment, past suicide attempts and current suicidal ideation, intense affective states, and other substance use. Those who were "drinking too much" were more likely than others to accept referrals for mental health treatment through the anonymous interactive screening program, suggesting that this program may be effective in skirting the stigma barrier for accessing mental health care for this at-risk population. CONCLUSIONS The self-reported prevalence of "drinking too much" among medical students, house staff, and faculty is high and associated with negative mental health outcomes. Targeted, anonymous screenings may identify at-risk individuals and provide mental health care referrals to those in need.
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Gavrieli E, Drach-Zahavy A, Tal I, Rahav G, Ben-David D. The effects of immediate and delayed feedback on hand hygiene compliance. Antimicrob Resist Infect Control 2015. [PMCID: PMC4475220 DOI: 10.1186/2047-2994-4-s1-p287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Abstract
Using EEG, ECoG, MEG, and microelectrodes to record brain activity is prone to multiple artifacts. The main power line (mains line), video equipment, mechanical vibrations and activities outside the brain are the most common sources of artifacts. MEG amplitudes are low, and even small artifacts distort recordings. In this study, we show how these artifacts can be efficiently removed by recording external cues during MEG recordings. These external cues are subsequently used to register the precise times or spectra of the artifacts. The results indicate that these procedures preserve both the spectra and the time domain wave-shapes of the neuromagnetic signal, while successfully reducing the contribution of the artifacts to the target signals without reducing the rank of the data.
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Affiliation(s)
- I Tal
- Gonda Multidisciplinary Brain Research Center, Bar-Ilan University, Israel
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Ben-David D, Kordevani R, Keller N, Tal I, Marzel A, Gal-Mor O, Maor Y, Rahav G. Outcome of carbapenem resistant Klebsiella pneumoniae bloodstream infections. Clin Microbiol Infect 2011; 18:54-60. [PMID: 21722257 DOI: 10.1111/j.1469-0691.2011.03478.x] [Citation(s) in RCA: 233] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The aim of this study was to evaluate the impact of carbapenem-resistant K. pneumoniae bloodstream infections on mortality. During the study period 42, 68 and 120 patients were identified with carbapenem-resistant, extended-spectrum β-lactamase producers (ESBL) and susceptible K. pneumoniae bloodstream infections, respectively. Patients with carbapenem-resistant K. pneumoniae had higher rates of prior antimicrobial exposure, other nosocomial infections, and use of invasive devices. Infection-related mortality was 48% for carbapenem-resistant, 22% for ESBL producers and 17% for susceptible K. pneumoniae. Independent risk factors for infection-related mortality were Pitt bacteraemia score, Charlson score and carbapenem resistance.
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Affiliation(s)
- D Ben-David
- Infectious Diseases Unit, Sheba Medical Center, Tel Hashomer, Israel.
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19
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Figueredo AJ, Kirsner BR, Tal I. Amigos y amantes: los valores relativos de trueque de diferentes tipos de compañeros en el intercambio social. AP 2011. [DOI: 10.15517/ap.v18i105.46] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Se utilizó el Inventario de Valor como Pareja (IVP) en talleres paralelos titulados “La Racionalidad del romance” con muestras independientes recolectadas en cuatro sitios distintos: (1) Tucson, Arizona, Estados Unidos (n = 71), (2) Hermosillo, Sonora, México (n = 56), (3). Ciudad de México, Distrito Federal, México (n = 39), y (4) San José, Costa Rica (n = 77). Cada participante contestó un cuestionario anónimo y confidencial que incluía preguntas sobre su percepción de su propio “Valor como pareja” (VP), el VP de sus parejas románticas presentes o pasadas, y el VP de sus mejores amistades masculinas y femeninas. Cada participante dio informes sobre relaciones con sus parejas presentes o pasadas, incluyendo su grado de fidelidad a esa pareja, la seriedad de esa relación, y su satisfacción con esa relación. Se especificaron y analizaron varias relaciones entre los datos obtenidos por medio de un modelo económico de intercambio social.
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20
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Kolodny GM, Raptopolous V, Simon M, Mendel J, Barbaras LG, Tal I, Kressel HY. A low-cost, full-function picture archiving and communication system using standard PC hardware and the traditional 4-over-4 display format. AJR Am J Roentgenol 1999; 172:591-4. [PMID: 10063841 DOI: 10.2214/ajr.172.3.10063841] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [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] [Indexed: 11/18/2022]
Abstract
OBJECTIVE With a 12-year background of our completely digital nuclear medicine picture archiving and communication system (PACS), we have recently implemented a novel PACS, OpenPACS, which can be used for interpretation and display of CT, MR imaging, sonography, nuclear medicine, and computed and digital radiography studies. OpenPACS uses low-cost standard PC hardware and software that is widely available and is readily serviced and maintained. The OpenPACS application program is available over the Internet. CT or MR imaging slices from one or multiple studies can be presented simultaneously or in cine mode on a wall-sized multimonitor display. The assembly, with a total resolution of 6400 x 4800 pixels, resembles a traditional array of eight standard X-ray viewboxes. A wireless mouse is used to vary attenuation and other display parameters. Multiple backup and redundancy are provided. Currently, six CT and six MR imaging scanners of different vendors are networked to OpenPACS, which is also networked to our nuclear medicine PACS. CONCLUSION After only a brief introduction, radiologists rapidly become familiar with the system because it is based on the use of standard Windows icons and procedures and offers a display that resembles a standard X-ray film presentation.
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Affiliation(s)
- G M Kolodny
- Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA
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21
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Schwartz M, Rochas M, Weller B, Sheinkman A, Tal I, Golan D, Toubi N, Eldar I, Sharf B, Attias D. High association of anticardiolipin antibodies with psychosis. J Clin Psychiatry 1998; 59:20-3. [PMID: 9491061 DOI: 10.4088/jcp.v59n0105] [Citation(s) in RCA: 102] [Impact Index Per Article: 3.9] [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: 02/06/2023]
Abstract
BACKGROUND Lupus anticoagulant (LA) and anticardiolipin antibodies (aCL) are autoantibodies that can be detected in plasma or serum of patients with autoimmune-related diseases. The presence of these autoantibodies has been associated with recurrent arterial and/or venous thromboembolism as well as with recurrent fetal loss and thrombocytopenia. In recent years, other medical conditions such as dementia, chorea, psychosis, migraine, and peripheral neuropathy have been associated with these autoantibodies. An adverse response to neuroleptic treatment was reported to be associated with the presence of autoantibodies, but these patients rarely developed clinical vascular manifestations. METHOD We conducted a study of 34 unmedicated patients admitted to the hospital with acute psychosis in whom aCL and LA were examined before and after neuroleptic treatment to determine the presence of antibodies relative to the treatment condition. RESULTS 32% (11/34) of the unmedicated psychotic patients had antiphospholipid antibodies: we detected elevated titers of IgG-aCL isotype in 24% (8/34) of unmedicated patients (p < .02 compared with 20 normal controls, none of whom tested positive), and 9% (3/34) had LA. Twenty-two patients were followed up after medication; 31.8% (7/22) of these patients showed moderate titers of IgG-aCL (p < .28), and 18.2% (4/22) were LA positive. Altogether, antiphospholipid antibodies were detected in 40.9% (9/22) of the medicated patients. CONCLUSION This study shows the increased incidence of LA and aCL antibodies in neuroleptic-treated psychotic patients and the possible association between psychosis and antiphospholipid antibodies.
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Affiliation(s)
- M Schwartz
- Department of Neurology, Bnai Zion Medical Center, Haifa, Israel
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Tal I, Shiber A. [Electro-convulsive therapy--review of law and literature]. Harefuah 1996; 130:470-4. [PMID: 8707218] [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: 02/01/2023]
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Abstract
Tardive dyskinesia (TD) is an iatrogenic syndrome caused by long-term treatment with neuroleptics and is characterized by abnormal involuntary movements in the orofacial region, lingual dyskinesia and in some cases dyskinesia also in the extremities, head and trunk. In the present study we found 20% TD in chronic-neuroleptic-treated patients with a significantly greater prevalence in females (27% of the total population), and a higher frequency in older patients. In males, patients who received electroconvulsive therapy had a significantly lower prevalence of TD. 23 patients had seizures; 7 of these suffered from TD, all of them female.
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Affiliation(s)
- M Schwartz
- Department of Neurology, Faculty of Medicine, Bnai Zion Medical Center, Acre, Israel
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Elpeleg ON, Meiron D, Barash V, Hurwitz Y, Tal I, Amir N. 3-Methylglutaconic aciduria with persistent metabolic acidosis and 'uncoupling episodes'. J Inherit Metab Dis 1990; 13:235-6. [PMID: 2116558 DOI: 10.1007/bf01799695] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- O N Elpeleg
- Department of Pediatrics and Neuropediatrics, Bikur-Cholim Hospital, Jerusalem, Israel
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Rakover Y, Adar H, Tal I, Lang Y, Kedar A. Behcet disease: long-term follow-up of three children and review of the literature. Pediatrics 1989; 83:986-92. [PMID: 2657628] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Behcet disease is rare in children. There are only two reports of Behcet disease in childhood, describing seven patients. Three pediatric patients are described, in whom the age of onset ranged from 6 to 11 years. Aphthous stomatitis and arthritis were present in all of the patients; genital ulcers, iridocylitis, erythema nodosum, and CNS involvement were present in two patients. Other manifestations included Stevens-Johnson-like eruption, fever of unknown origin, and testicular involvement. All of the patients responded to glucocorticoids; two were also treated with colchicine and one was treated with chlorambucil. In two patients, follow-up of more than 10 years was done, with complete cure in one patient and benign course of illness in the other. Because of the rarity of the disease in childhood and the difficulty in making the diagnosis, there is not enough awareness by pediatricians concerning this disease.
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Affiliation(s)
- Y Rakover
- Department of Pediatrics A, Central Emek Hospital, Afula, Israel
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Abstract
Rapid and reliable transmission of nuclear medicine studies using conventional telephone lines and commercially available modems and computer systems has been accomplished through use of software developed within the authors' hospital. Original digital images of all-night and weekend studies, acquired on any of the acquisition computers from different manufacturers, are now routinely sent for remote reading at the physician's home. Data, software, and letters are routinely exchanged using modems and standard telephone lines with a sister institution in Haifa, Israel. The software has been designed to achieve no loss data compression and minimal turnaround time loss. Thus, an average lung perfusion image or gallbladder study requires about 1-3 minutes of transmission time. Full analysis and display software is available on the remote computer.
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Affiliation(s)
- J A Orlin
- Division of Nuclear Medicine, Beth Israel Hospital, Boston, Massachusetts 02215
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Abstract
Two brothers and one sister had three variants of thrombotic thrombocytopenic purpura and haemolytic uraemic syndrome (the 'TTP-HUS' complex). The sister had a chronic fatal variant of thrombotic thrombocytopenic purpura with severe neurological manifestation. One brother had a chronic relapsing disease but the kidneys were not affected, and the other brother had haemolytic uraemic syndrome. This occurrence in one family supports the hypothesis that haemolytic uraemic syndrome and thrombotic thrombocytopenic purpura are actually two variants of the same disease.
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Affiliation(s)
- M Elias
- Department of Internal Medicine B, Central Emek Hospital, Afula, Israel
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Abstract
A case of a 12-year-old boy with sacroiliitis documented by positive Tc-99m MDP and Ga-67 scans is described. Isolation of brucella melitensis from the blood and bone marrow established the diagnosis. He responded promptly to docycycline therapy. Throughout the course of his disease this boy had neither fever nor other signs of brucellosis, and x-ray was normal.
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Abstract
Thirty four infants were studied; 21 with acute gastroenteritis, dehydration, and metabolic acidosis and 13 who served as controls. All infants with metabolic acidosis and without neurological signs had a normal to near normal cerebrospinal fluid acid base balance, but five with metabolic acidosis and severe neurological signs had cerebrospinal fluid acid base disequilibrium. Acute metabolic acidosis in infants may lead to cerebrospinal fluid acid base imbalance causing cerebral dysfunction.
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Jakob KM, Ben Yosef S, Tal I. Reduced repeat length of nascent nucleosomal DNA is generated by replicating chromatin in vivo. Nucleic Acids Res 1984; 12:5015-24. [PMID: 6739296 PMCID: PMC318896 DOI: 10.1093/nar/12.12.5015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Micrococcal nuclease digestion of nuclei from sea urchin embryos revealed transient changes in chromatin structure which resulted in a reduction in the repeat length of nascent chromatin DNA as compared with bulk DNA. This was considered to be entirely the consequence of in vivo events at the replication fork (Cell 14, 259, 1978). However, a micrococcal nuclease-generated sliding of nucleosome cores relative to nascent DNA, which might account for the smaller DNA fragments, was not excluded. In vivo [3H]thymidine pulse-labeled nuclei were fixed with a formaldehyde prior to micrococcal nuclease digestion. This linked chromatin proteins to DNA and thus prevented any in vitro sliding of histone cores. All the nascent DNAs exhibiting shorter repeat lengths after micrococcal nuclease digestion, were resolved at identical mobilities in polyacrylamide gels of DNA from fixed and unfixed nuclei. We conclude that these differences in repeat lengths between nascent and bulk DNA was generated in vivo by changes in chromatin structure during replication, rather than by micrococcal nuclease-induced sliding of histone cores in vitro.
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Abstract
Intensive lung accumulation of colloid (Tc-99m phytate) was demonstrated in a child suffering from acquired toxoplasmosis with a rare manifestation of severe liver damage. The possible mechanism and clinical importance of colloid lung concentration in this case is briefly discussed, including a review of the literature on this subject.
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Jakob KM, Tal I. Methylmethionine labeling of a higher plant tissue: the incorporation into RNA and pectinic acid on nucleic acid extracts. Biochim Biophys Acta 1973; 308:296-309. [PMID: 4706004 DOI: 10.1016/0005-2787(73)90159-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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