Faculty Bibliography

RATIONALE:As early as age 11 children begin to take responsibility for asthma self-management, yet very little is known about asthma management behaviors in early adolescents. In this study we characterize early adolescents' asthma prevention and management steps and their perceived responsibility; explore differences in asthma self-management and responsibility according to demographic characteristics; and investigate the role of perceived responsibility in prevention and management behaviors. METHODS:We utilized baseline data from a randomized controlled trial testing the efficacy of an asthma intervention. 317 African-American (41%) and Hispanic (59%) children (mean age=12.7) with persistent asthma answered 9 questions regarding prevention steps taken regularly (3-point Likert scale), 7 questions regarding steps taken to manage symptoms (yes/no), and the 10-item Asthma Responsibility Questionnaire (5-point Likert scale). Using generalized estimating equations, we modeled the total number of prevention and management steps taken and individual self-management items as a function of demographic characteristics, controlling for asthma severity. We then added responsibility to the model. Last we modeled asthma responsibility as a function of demographic characteristics controlling for severity. RESULTS:49% took 7-9 prevention steps; 31% took daily medication regularly; 34% did not take daily medication; only 24% saw a physician when asymptomatic. 61% took 6-7 management steps; 92% took medication, but only 26% asked for help. Older youth had lower odds of observing how they feel when asthma is likely to start (Odds ratio[OR]=0.82,p<0.05), observing symptoms to see if they improve or get worse (OR=0.71,p<0.05) and asking for help (OR=0.72,p<0.05). Boys had significantly higher odds of taking daily medication preventively (OR=1.52,p<0.05) and upon exposure to triggers (OR=1.62,p<0.05). Results were consistent when controlling for asthma severity and both asthma severity and responsibility. Controlling for age and asthma severity, early adolescents who reported taking more responsibility for managing their asthma were more likely to take fewer steps to manage their asthma once symptoms begin (Risk ratio=0.97,p<0.01), and had lower odds of seeking preventive care (OR=0.67,p<0.001), asking for help (OR=0.70, p<0.01), and going to a doctor or hospital to manage their asthma (OR=0.74,p<0.001); results were consistent when controlling for gender and race/ethnicity. CONCLUSIONS:Early adolescents' asthma self-management is suboptimal. Despite having persistent asthma, a minority took daily medication preventively or sought preventive medical care. With increasing age, children were less observant regarding their asthma and less likely to seek help. As early adolescents perceive themselves to have greater responsibility for managing their asthma, they have lower odds of taking certain self-management steps

BACKGROUND: The expanded suffocation false alarm theory (SFA) hypothesizes that dysfunction in endogenous opioidergic regulation increases sensitivity to CO2, separation distress and panic attacks. In panic disorder (PD) patients, both spontaneous clinical panics and lactate-induced panics markedly increase tidal volume (TV), whereas normals have a lesser effect, possibly due to their intact endogenous opioid system. We hypothesized that impairing the opioidergic system by naloxone could make normal controls parallel PD patients' response when lactate challenged. Whether actual separations and losses during childhood (childhood parental loss, CPL) affected naloxone-induced respiratory contrasts was explored. Subjective panic-like symptoms were analyzed although pilot work indicated that the subjective aspect of anxious panic was not well modeled by this specific protocol. METHOD: Randomized cross-over sequences of intravenous naloxone (2 mg/kg) followed by lactate (10 mg/kg), or saline followed by lactate, were given to 25 volunteers. Respiratory physiology was objectively recorded by the LifeShirt. Subjective symptomatology was also recorded. RESULTS: Impairment of the endogenous opioid system by naloxone accentuates TV and symptomatic response to lactate. This interaction is substantially lessened by CPL. CONCLUSIONS: Opioidergic dysregulation may underlie respiratory pathophysiology and suffocation sensitivity in PD. Comparing specific anti-panic medications with ineffective anti-panic agents (e.g. propranolol) can test the specificity of the naloxone+lactate model. A screen for putative anti-panic agents and a new pharmacotherapeutic approach are suggested. Heuristically, the experimental unveiling of the endogenous opioid system impairing effects of CPL and separation in normal adults opens a new experimental, investigatory area

This study examines the efficacy of ParentCorps among 4-year-old children (N = 171) enrolled in prekindergarten in schools in a large urban school district. ParentCorps includes a series of 13 group sessions for parents and children held at the school during early evening hours and facilitated by teachers and mental health professionals. ParentCorps resulted in significant benefits on effective parenting practices and teacher ratings of child behavior problems in school. Intervention effects were of similar magnitude for families at different levels of risk and for Black and Latino families. The number of sessions attended was related to improvements in parenting. Study findings support investment in and further study of school-based family interventions for children from underserved, urban communities

Introduction: An important goal of ongoing Alzheimer's disease (AD) research is to identify markers that allow one to predict risk for the development of this type of dementia in cognitively intact elderly. Known cognitive changes associated with AD, possibly reflecting hippocampal pathology, include a worse recall of primacy items and better immediate recall of items learned at the end of a list compared to the middle (recency effect). Aims: The aim of our study was to examine whether learning and recall of primacy and recency words predicted future decline in intact elderly subjects. Methods: Individuals with MMSE of 28 or over at baseline were included in the study. Of these, 211 had at least two successive cognitive evaluations; mean age at baseline was 69.5 (SD=8.0). We regressed MMSE decline on baseline Auditory-Verbal Learning Test (AVLT) memory measures, focusing especially on learning and recall of primacy and recency words, and controlling for baseline age, time since baseline and other variables. Results: Worse learning/delayed recall of primacy words on AVLT trials consistently predicted greater subsequent cognitive decline. Additionally, this effect was stronger among older subjects than among younger ones. APOE e4, a well established genetic risk factor for late-onset AD, was not a significant predictor of MMSE decline in this sample. Conclusions: Decreased learning and poorer recall of primacy words in the AVLT is a predictor of decline in healthy elderly individuals, and future studies should examine if decreased learning and recall can predict conversion to AD

OBJECTIVE: Posttraumatic stress disorder (PTSD) related to childhood abuse is associated with features of affect regulation and interpersonal disturbances that substantially contribute to impairment. Existing treatments do not address these problems or the difficulties they may pose in the exploration of trauma memories, an efficacious and frequently recommended approach to resolving PTSD. The authors evaluated the benefits and risks of a treatment combining an initial preparatory phase of skills training in affect and interpersonal regulation (STAIR) followed by exposure by comparing it against two control conditions: Supportive Counseling followed by Exposure (Support/Exposure) and skills training followed by Supportive Counseling (STAIR/Support). METHOD: Participants were women with PTSD related to childhood abuse (N=104) who were randomly assigned to the STAIR/Exposure condition, Support/Exposure condition (exposure comparator), or STAIR/Support condition (skills comparator) and assessed at posttreatment, 3 months, and 6 months. RESULTS: The STAIR/Exposure group was more likely to achieve sustained and full PTSD remission relative to the exposure comparator, while the skills comparator condition fell in the middle (27% versus 13% versus 0%). STAIR/Exposure produced greater improvements in emotion regulation than the exposure comparator and greater improvements in interpersonal problems than both conditions. The STAIR/Exposure dropout rate was lower than the rate for the exposure comparator and similar to the rate for the skills comparator. There were significantly lower session-to-session PTSD symptoms during the exposure phase in the STAIR/Exposure condition than in the Support/Exposure condition. STAIR/Exposure was associated with fewer cases of PTSD worsening relative to both of the other two conditions. CONCLUSIONS: For a PTSD population with chronic and early-life trauma, a phase-based skills-to-exposure treatment was associated with greater benefits and fewer adverse effects than treatments that excluded either skills training or exposure

To provide effective treatments for childhood posttraumatic stress disorder (PTSD) children with PTSD must first be identified. The authors implemented a 'screen and treat' program following a widely witnessed school suicide. Three months after the suicide, exposed students received the Child Trauma Symptom Questionnaire at school. Parents received the questionnaire to rate their children's PTSD symptoms. Children with scores > or =5 received follow-up interviews and those diagnosed with PTSD were referred for treatment. Ninety-six percent of exposed students were screened, 14% screened positive, and 6% had PTSD. Child and parent agreement was generally poor. All children with PTSD were successfully referred to treatment. Screen and treat programs using existing clinical instruments are efficient and acceptable for use in school settings following trauma

OBJECTIVE: The goal of our study was to investigate the impact of dysthymic disorder (DD), a form of chronic depression, on naturalistic outcome in individuals with personality disorders (PDs). METHOD: The Collaborative Longitudinal Personality Disorders Study is a cohort initially including 573 subjects with 4 targeted PDs (borderline, avoidant, schizotypal, and obsessive-compulsive) and 95 subjects with major depression but no PD. At baseline, 115 subjects were diagnosed with coexisting DD, of whom 109 (94.8%) were PD subjects. Regression analyses were performed to predict 3 classes of broad clinical outcome after 2 years of prospective follow-up. We hypothesized that DD diagnosis at baseline would be associated with worse outcome on (1) persistence of a PD diagnosis, (2) impairment in psychosocial functioning (as measured by the Longitudinal Interval Follow-up Evaluation), and (3) crisis-related treatment utilization. RESULTS: Baseline DD diagnosis was associated with persistence of PD diagnosis at 2 years, particularly for borderline and avoidant PDs. It was associated with worse outcome on global social adjustment, life satisfaction, recreation, and friendships, but not employment or relationship with spouse. Contrary to expectation, DD did not increase suicide attempts, emergency room visits, or psychiatric hospitalizations. CONCLUSIONS: Comorbidity of DD is associated with persistence of PD diagnosis and with worse outcome on many, but not all, measures of psychosocial functioning