Chronic hepatitis C virus(HCV) viral infection is the most common blood-borne viral infection and approximately 2%-3% of the world's population or 170-200 million people are infected. In the United States as many ...Chronic hepatitis C virus(HCV) viral infection is the most common blood-borne viral infection and approximately 2%-3% of the world's population or 170-200 million people are infected. In the United States as many as 3-5 million people may have HCV. Psychiatric and substance use disorders(SUDs) are common co-morbid conditions found in people with HCV and are factors in predisposing people to HCV infection. Also, these co-morbidities are reasons that clinicians exclude people from antiviral therapy in spite of evidence that people with HCV and co-morbid psychiatric and SUD can be safely and effectively treated. Furthermore, the neuropsychiatric side effects of interferon(IFN), until recently the mainstay of antiviral therapy, have necessitated an appreciation and assessment of psychiatric co-morbidities present in people with HCV. The availability of new medications and IFNfree antiviral therapy medication combinations will shorten the duration of treatment and exposure to IFN and thus decrease the risk of neuropsychiatric side effects. This will have the consequence of dramatically altering the clinical landscape of HCV care and will increase the number of eligible treatment candidates as treatment of people with HCV and co-morbid psychiatric and SUDs will become increasingly viable. While economically developed countries will rely on expensive IFN-free antiviral therapy, less developed countries will likely continue to use IFN-based therapies at least until such time as IFNfree antiviral medications become generic. The current manuscript discusses the efficacy and viability of treating HCV in people with psychiatric and SUDs comorbidities, the treatment of the neuropsychiatric side effects of IFN-based therapies and the impact of new medications and new treatment options for HCV that offer the promise of increasing the availability of antiviral therapy in this vulnerable population.展开更多
AIM: To compare adherence, response, and remission with light treatment in African-American and Caucasian patients with Seasonal Affective Disorder.METHODS: Seventy-eight study participants, agerange 18-64(51 African-...AIM: To compare adherence, response, and remission with light treatment in African-American and Caucasian patients with Seasonal Affective Disorder.METHODS: Seventy-eight study participants, agerange 18-64(51 African-Americans and 27 Caucasians)recruited from the Greater Baltimore Metropolitan area, with diagnoses of recurrent mood disorder with seasonal pattern, and confirmed by a Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders-Ⅳ, were enrolled in an open label study of daily bright light treatment. The trial lasted6 wk with flexible dosing of light starting with 10000 lux bright light for 60 min daily in the morning. At the end of six weeks there were 65 completers. Three patients had Bipolar Ⅱ disorder and the remainder had Major depressive disorder. Outcome measures were remission(score ≤ 8) and response(50% reduction)in symptoms on the Structured Interview Guide for the Hamilton Rating Scale for Depression(SIGH-SAD)as well as symptomatic improvement on SIGH-SAD and Beck Depression Inventory-Ⅱ. Adherence was measured using participant daily log. Participant groups were compared using t-tests, chi square, linear and logistic regressions. RESULTS: The study did not find any significant group difference between African-Americans and their Caucasian counterparts in adherence with light treatment as well as in symptomatic improvement.While symptomatic improvement and rate of treatment response were not different between the two groups,African-Americans, after adjustment for age, gender and adherence, achieved a significantly lower remission rate(African-Americans 46.3%; Caucasians 75%; P =0.02).CONCLUSION: This is the first study of light treatment in African-Americans, continuing our previous work reporting a similar frequency but a lower awareness of SAD and its treatment in African-Americans. Similar rates of adherence, symptomatic improvement and treatment response suggest that light treatment is a feasible, acceptable, and beneficial treatment for SAD in African-American patients. These results should lead to intensifying education initiatives to increase awareness of SAD and its treatment in African-American communities to increased SAD treatment engagement.In African-American vs Caucasian SAD patients a remission gap was identified, as reported before with antidepressant medications for non-seasonal depression, demanding sustained efforts to investigate and then address its causes.展开更多
Background: Selective serotonergic reuptake inhibitors(SSRIs) are first-line pharmacologic treatments for patients with posttraumatic stress disorder(PTSD), but must be given over extended period of time before the on...Background: Selective serotonergic reuptake inhibitors(SSRIs) are first-line pharmacologic treatments for patients with posttraumatic stress disorder(PTSD), but must be given over extended period of time before the onset of action. The use of SSRIs in PTSD patients with mild traumatic brain injury(m TBI) is problematic since SSRIs could exacerbate post-concussion syndrome(PCS) symptoms. VA/DOD guidelines identify trauma-focused psychotherapy as the best evidence-based treatment for PTSD, but overall effectiveness is limited by reduced levels of patient engagement and retention. A previous study from this research group suggested that quetiapine monotherapy, but not risperidone or valproate, could increase engagement in trauma-focused psychotherapy.Methods: We report the study protocol of a pilot study funded under the South-Central Mental Illness Research, Education, and Clinical Center pilot study program from the U.S. Department of Veterans Affairs. This randomized, open-label study was designed to evaluate the feasibility of completing a randomized trial of quetiapine vs. treatment as usual to promote patient engagement in PTSD patients with a history of m TBI.Discussion: We expect that the success of this ongoing study should provide us with the preliminary data necessary to design a full-scale randomized trial. Positive efficacy results in a full-scale trial should inform new VA guidelines for clinical practice by showing that quetiapine-related improvements in patient engagement and retention may be the most effective approach to assure that VA resources achieve the best possible outcome for veterans.Trial registration: NCT04280965.展开更多
Post-traumatic stress disorder(PTSD) is a disabling, potentially chronic disorder that is characterized by re-experience and hyperarousal symptoms as well as the avoidance of trauma-related stimuli. The distress exper...Post-traumatic stress disorder(PTSD) is a disabling, potentially chronic disorder that is characterized by re-experience and hyperarousal symptoms as well as the avoidance of trauma-related stimuli. The distress experienced by many veterans of the Vietnam War and their partners prompted a strong interest in developing conjoint interventions that could both alleviate the core symptoms of PTSD and strengthen family bonds. We review the evolution of and evidence base for conjoint PTSD treatments from the Vietnam era through the post-911 era. Our review is particularly focused on the use of treatment strategies that are designed to address the emotions that are generated by the core symptoms of the disorder to reduce their adverse impact on veterans, their partners and the relationship. We present a rationale and evidence to support the direct incorporation of emotion-regulation skills training into conjoint interventions for PTSD. We begin by reviewing emerging evidence suggesting that high levels of emotion dysregulation are characteristic of and predict the severity of both PTSD symptoms and the level of interpersonal/marital difficulties reported by veterans with PTSD and their family members. In doing so, we present a compelling rationale for the inclusion of formal skills training in emotional regulation in couple–/family-based PTSD treatments. We further argue that increased exposure to trauma-related memories and emotions in treatments based on learning theory requires veterans and their partners to learn to manage the uncomfortable emotions that they previously avoided. Conjoint treatments that were developed in the last 30 years all acknowledge the importance of emotions in PTSD but vary widely in their relative emphasis on helping participants to acquire strategies to modulate them compared to other therapeutic tasks such as learning about the disorder or disclosing the trauma to a loved one. We conclude our review by describing two recent innovative treatments for PTSD that incorporate a special emphasis on emotion-regulation skills training in the dyadic context: structured approach therapy(SAT) and multi-family group for military couples(MFG-MC). Although the incorporation of emotion-regulation skills into conjoint PTSD therapies appears promising, replication and comparison to cognitive-behavioral approaches is needed to refine our understanding of which symptoms and veterans might be more responsive to one approach versus others.展开更多
Major depressive disorder(MDD)and type 2 diabetes(T2D)are two common complex multifactorial disorders that share several genetic and environmental risk factors such as hypercortisolism and related genes'riskvarian...Major depressive disorder(MDD)and type 2 diabetes(T2D)are two common complex multifactorial disorders that share several genetic and environmental risk factors such as hypercortisolism and related genes'riskvariants within the stress response and the neuroendocrine hypothalamicpituitary axis.Under stress,the pituitary gland releases prolactin(PRL),whose effects are pleiotropic and include mood control and insulin secretion from the beta cells.1 Variations in the prolactin receptor(PRLR)gene are associated in rodent models with stress level,depressionlike behavior,2 and hepatic insulin sensitivity3 and in humans with maternal glucose homeostasis and gestational diabetes.展开更多
Melatonin is an endogenous monoamine hormone secreted by the pineal gland.Melatonergic signaling has been shown to play a role in circadian rhythm regulation,lipid and glucose metabolism,and obesity,and it has anti-in...Melatonin is an endogenous monoamine hormone secreted by the pineal gland.Melatonergic signaling has been shown to play a role in circadian rhythm regulation,lipid and glucose metabolism,and obesity,and it has anti-inflammatory and antioxidant properties.The melatonin receptor 1B gene(MTNR1B)is expressed in,among other tissues,the brain and pancreatic beta cells,and risk variants for T2D have been reported as impairing early insulin secretion and increasing fasting glucose levels.^(1) Variants in the MTNR1B gene also have been reported in patients with depression(MDD).展开更多
文摘Chronic hepatitis C virus(HCV) viral infection is the most common blood-borne viral infection and approximately 2%-3% of the world's population or 170-200 million people are infected. In the United States as many as 3-5 million people may have HCV. Psychiatric and substance use disorders(SUDs) are common co-morbid conditions found in people with HCV and are factors in predisposing people to HCV infection. Also, these co-morbidities are reasons that clinicians exclude people from antiviral therapy in spite of evidence that people with HCV and co-morbid psychiatric and SUD can be safely and effectively treated. Furthermore, the neuropsychiatric side effects of interferon(IFN), until recently the mainstay of antiviral therapy, have necessitated an appreciation and assessment of psychiatric co-morbidities present in people with HCV. The availability of new medications and IFNfree antiviral therapy medication combinations will shorten the duration of treatment and exposure to IFN and thus decrease the risk of neuropsychiatric side effects. This will have the consequence of dramatically altering the clinical landscape of HCV care and will increase the number of eligible treatment candidates as treatment of people with HCV and co-morbid psychiatric and SUDs will become increasingly viable. While economically developed countries will rely on expensive IFN-free antiviral therapy, less developed countries will likely continue to use IFN-based therapies at least until such time as IFNfree antiviral medications become generic. The current manuscript discusses the efficacy and viability of treating HCV in people with psychiatric and SUDs comorbidities, the treatment of the neuropsychiatric side effects of IFN-based therapies and the impact of new medications and new treatment options for HCV that offer the promise of increasing the availability of antiviral therapy in this vulnerable population.
基金supported in part by funding from the Mental Hygiene Administration of the Maryland Department of Health and Mental Hygiene to the Center for Excellence on Early Intervention for Serious Mental Illness(OPASS#14-13717G/M00B4400241)
基金Supported by The National Institute of Mental Health of the National Institutes of Health under award No.1R34MH073797-01A2(PI Postolache TT)in part by the National Institutes of Health award No.K12RR023250-01(PI Reeves GM)by the National Center for Research Resources of the National Institutes of Health award No.M01 RR 16500(General Clinical Research Program)
文摘AIM: To compare adherence, response, and remission with light treatment in African-American and Caucasian patients with Seasonal Affective Disorder.METHODS: Seventy-eight study participants, agerange 18-64(51 African-Americans and 27 Caucasians)recruited from the Greater Baltimore Metropolitan area, with diagnoses of recurrent mood disorder with seasonal pattern, and confirmed by a Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders-Ⅳ, were enrolled in an open label study of daily bright light treatment. The trial lasted6 wk with flexible dosing of light starting with 10000 lux bright light for 60 min daily in the morning. At the end of six weeks there were 65 completers. Three patients had Bipolar Ⅱ disorder and the remainder had Major depressive disorder. Outcome measures were remission(score ≤ 8) and response(50% reduction)in symptoms on the Structured Interview Guide for the Hamilton Rating Scale for Depression(SIGH-SAD)as well as symptomatic improvement on SIGH-SAD and Beck Depression Inventory-Ⅱ. Adherence was measured using participant daily log. Participant groups were compared using t-tests, chi square, linear and logistic regressions. RESULTS: The study did not find any significant group difference between African-Americans and their Caucasian counterparts in adherence with light treatment as well as in symptomatic improvement.While symptomatic improvement and rate of treatment response were not different between the two groups,African-Americans, after adjustment for age, gender and adherence, achieved a significantly lower remission rate(African-Americans 46.3%; Caucasians 75%; P =0.02).CONCLUSION: This is the first study of light treatment in African-Americans, continuing our previous work reporting a similar frequency but a lower awareness of SAD and its treatment in African-Americans. Similar rates of adherence, symptomatic improvement and treatment response suggest that light treatment is a feasible, acceptable, and beneficial treatment for SAD in African-American patients. These results should lead to intensifying education initiatives to increase awareness of SAD and its treatment in African-American communities to increased SAD treatment engagement.In African-American vs Caucasian SAD patients a remission gap was identified, as reported before with antidepressant medications for non-seasonal depression, demanding sustained efforts to investigate and then address its causes.
基金supported by the South Central Mental Illness Research,Education,and Clinical Center (SC MIRECC),which is a MIRECC for Veterans Integrated Service Network (VISN) 16&17。
文摘Background: Selective serotonergic reuptake inhibitors(SSRIs) are first-line pharmacologic treatments for patients with posttraumatic stress disorder(PTSD), but must be given over extended period of time before the onset of action. The use of SSRIs in PTSD patients with mild traumatic brain injury(m TBI) is problematic since SSRIs could exacerbate post-concussion syndrome(PCS) symptoms. VA/DOD guidelines identify trauma-focused psychotherapy as the best evidence-based treatment for PTSD, but overall effectiveness is limited by reduced levels of patient engagement and retention. A previous study from this research group suggested that quetiapine monotherapy, but not risperidone or valproate, could increase engagement in trauma-focused psychotherapy.Methods: We report the study protocol of a pilot study funded under the South-Central Mental Illness Research, Education, and Clinical Center pilot study program from the U.S. Department of Veterans Affairs. This randomized, open-label study was designed to evaluate the feasibility of completing a randomized trial of quetiapine vs. treatment as usual to promote patient engagement in PTSD patients with a history of m TBI.Discussion: We expect that the success of this ongoing study should provide us with the preliminary data necessary to design a full-scale randomized trial. Positive efficacy results in a full-scale trial should inform new VA guidelines for clinical practice by showing that quetiapine-related improvements in patient engagement and retention may be the most effective approach to assure that VA resources achieve the best possible outcome for veterans.Trial registration: NCT04280965.
文摘Post-traumatic stress disorder(PTSD) is a disabling, potentially chronic disorder that is characterized by re-experience and hyperarousal symptoms as well as the avoidance of trauma-related stimuli. The distress experienced by many veterans of the Vietnam War and their partners prompted a strong interest in developing conjoint interventions that could both alleviate the core symptoms of PTSD and strengthen family bonds. We review the evolution of and evidence base for conjoint PTSD treatments from the Vietnam era through the post-911 era. Our review is particularly focused on the use of treatment strategies that are designed to address the emotions that are generated by the core symptoms of the disorder to reduce their adverse impact on veterans, their partners and the relationship. We present a rationale and evidence to support the direct incorporation of emotion-regulation skills training into conjoint interventions for PTSD. We begin by reviewing emerging evidence suggesting that high levels of emotion dysregulation are characteristic of and predict the severity of both PTSD symptoms and the level of interpersonal/marital difficulties reported by veterans with PTSD and their family members. In doing so, we present a compelling rationale for the inclusion of formal skills training in emotional regulation in couple–/family-based PTSD treatments. We further argue that increased exposure to trauma-related memories and emotions in treatments based on learning theory requires veterans and their partners to learn to manage the uncomfortable emotions that they previously avoided. Conjoint treatments that were developed in the last 30 years all acknowledge the importance of emotions in PTSD but vary widely in their relative emphasis on helping participants to acquire strategies to modulate them compared to other therapeutic tasks such as learning about the disorder or disclosing the trauma to a loved one. We conclude our review by describing two recent innovative treatments for PTSD that incorporate a special emphasis on emotion-regulation skills training in the dyadic context: structured approach therapy(SAT) and multi-family group for military couples(MFG-MC). Although the incorporation of emotion-regulation skills into conjoint PTSD therapies appears promising, replication and comparison to cognitive-behavioral approaches is needed to refine our understanding of which symptoms and veterans might be more responsive to one approach versus others.
文摘Major depressive disorder(MDD)and type 2 diabetes(T2D)are two common complex multifactorial disorders that share several genetic and environmental risk factors such as hypercortisolism and related genes'riskvariants within the stress response and the neuroendocrine hypothalamicpituitary axis.Under stress,the pituitary gland releases prolactin(PRL),whose effects are pleiotropic and include mood control and insulin secretion from the beta cells.1 Variations in the prolactin receptor(PRLR)gene are associated in rodent models with stress level,depressionlike behavior,2 and hepatic insulin sensitivity3 and in humans with maternal glucose homeostasis and gestational diabetes.
基金supported in part with the funds received under Nebraska Laws2021,LB380,Section 109 awarded to C.G.(Pl)Creighton University School of Medicine,through the Nebraska Department of Health&Human Services(DHHS).
文摘Melatonin is an endogenous monoamine hormone secreted by the pineal gland.Melatonergic signaling has been shown to play a role in circadian rhythm regulation,lipid and glucose metabolism,and obesity,and it has anti-inflammatory and antioxidant properties.The melatonin receptor 1B gene(MTNR1B)is expressed in,among other tissues,the brain and pancreatic beta cells,and risk variants for T2D have been reported as impairing early insulin secretion and increasing fasting glucose levels.^(1) Variants in the MTNR1B gene also have been reported in patients with depression(MDD).
