Faculty Bibliography

This study examined the safety and efficacy of gamma vinyl-GABA (GVG, vigabatrin) for the treatment of methamphetamine and/or cocaine addiction. A total of 30 subjects, who met DSM-IV criteria for methamphetamine and/or cocaine dependence, were enrolled in an open label 9-week safety study. The protocol was specifically designed to include extensive visual field monitoring as well as outcome measures of therapeutic efficacy. Patients were screened twice weekly for the presence of urinary cocaine, methamphetamine, heroin, alcohol, and marijuana. In total, 18/30 subjects completed the study and 16/18 tested negative for methamphetamine and cocaine during the last 6 weeks of the trial. GVG did not produce any visual field defects or alterations in visual acuity. Furthermore, it did not produce changes in vital signs even with continued use of methamphetamine and cocaine. Thus, under conditions that appear to be appropriate for the successful treatment of methamphetamine and/or cocaine addiction, GVG is safe. Synapse 55:122-125, 2005. (c) 2004 Wiley-Liss, Inc

OBJECTIVES: We sought to estimate the extended mental health service capacity requirements of persons affected by the September 11, 2001, terrorist attacks. METHODS: We developed a formula to estimate the extended mental health service capacity requirements following disaster situations and assessed availability of the information required by the formula. RESULTS: Sparse data exist on current services and supports used by people with mental health problems outside of the formal mental health specialty sector. There also are few systematically collected data on mental health sequelae of disasters. CONCLUSIONS: We recommend research-based surveys to understand service usage in non-mental health settings and suggest that federal guidelines be established to promote uniform data collection of a core set of items in studies carried out after disasters

BACKGROUND: The September 11th disaster in New York City resulted in an increase in mental health service delivery as a vast network of providers responded to the urgent needs of those impacted by the tragedy. Estimates of current capacity, potential additional capacity to deliver services and of potential shortfall within the mental health sector are needed pieces of information for planning the responses to future disasters. AIMS OF THE STUDY: Using New York State data, to determine the distribution of clinical service delivery rates among programs and to examine an explanatory model of observed variation; to estimate potential additional capacity in the mental health sector; and to estimate shortfall based on this capacity and data from studies on the need and use of services post September 11th METHODS: Empirical distributions of weekly clinical service delivery rates in programs likely to be used by persons with post disaster mental health problems were obtained from available data. Three regression models were fit to explain rate variation in terms of unmodifiable program characteristics likely to impact the rates. We argue that rates could not be easily increased if any of the models had good explanatory power, and could be increased if it did not. All models had poor fit. We then assumed that the median and 75th percentile of the clinical service delivery rates were candidates for the minimum production capability of a clinician. The service rates of those clinicians whose rates fell below these quartiles were increased to the quartile value to yield estimates of potential additional capacity. These were used along with data on clinical need to estimate shortfall. RESULTS: There is substantial variation in clinical service delivery rates within impact regions and among programs serving different age populations. The estimate of the percent increase in services overall based on the median is 12% and based on the 75th percentile is 27%. Using an estimate of need of.03 suggested by available data, and a range of services (1-10) that might be required in a six month period, shortfall estimates based on the median ranged between 22-92% and for the 75th percentile from no shortfall to 86%. A less conservative estimate of need of.05 produces median shortfall ranging between 59-96% and for the 75th percentile between 10-91%. LIMITATIONS: While the program descriptor variables used in the explanatory model of rates were those most likely to impact rates, explanatory power of the model might have increased if other characteristics that are not modifiable had been included. In this case, the assumption that service production can be increased is called into question. IMPLICATIONS FOR HEALTH CARE PROVISION AND USE: In the first six months post September 11th, in New York State (NYS) 250,000 persons received crisis counseling through Project Liberty. In 1999, NYS served approximately that same number in mental health clinic programs during the entire year. The estimates of this study suggest that additional funding and personnel are needed to provide mental health services in the event of a major disaster. IMPLICATIONS FOR HEALTH POLICIES: A disaster plan is needed to coordinate the use of current and additional personnel including mental health resources from other sources and sectors

The capture-recapture approach to estimating the size of a population is a well-studied area of statistics. The number of distinct individuals, N(A) and N(B), on each of two lists, A and B, and the number common to both lists, N(AB), are used to form an estimate of the binomial probability of being on one of the lists, which then allows an estimate to be made of the size of the population. Critical to the method is an accurate count of N(AB). We consider situations in which this count is not available. Such problems arise in a variety of behavioural health contexts in which the need for protection of privacy may prevent sharing identifying information, so it is not possible to specifically match an individual who appears on one list with an individual on the other. Suppose that the birth dates and/or other demographics of individuals on each list are known. We introduce two methods for estimating the duplication rates and the size of the population. Conditioning on the set beta of birth dates of those on list B, N(A) and N(B), the maximum likelihood estimators (MLEs) and their variance are derived. The MLEs are based on the proportion of individuals on list A whose birth dates fall in beta. This approach is particularly useful if list B itself contains duplicates. The second model utilizes the full sample distribution of the birth dates. We generalize this approach to accommodate multiple demographic characteristics. The approaches are applied to the problem of estimating duplication rates and the population size of veterans who have mental illness in Kings County, NY. The data are lists of those receiving service from the Veterans Administration system and from providers funded or certified by the New York State Office of Mental Health

STUDY OBJECTIVES: To determine the long-term efficacy of eszopiclone in patients with chronic insomnia. DESIGN: Randomized, double-blind, multicenter, placebo-controlled. SETTING: Out-patient, with monthly visits. PATIENTS: Aged 21 to 69 years meeting DSM IV criteria for primary insomnia and reporting less than 6.5 hours of sleep per night, and/or a sleep latency of more than 30 minutes each night for at least 1 month before screening. INTERVENTIONS: Eszopiclone 3 mg (n = 593) or placebo (n = 195), nightly for 6 months MEASUREMENTS AND RESULTS: Efficacy was evaluated weekly using an interactive voice-response system. Endpoints included sleep latency; total sleep time; number of awakenings; wake time after sleep onset; quality of sleep; and next-day ratings of ability to function, daytime alertness, and sense of physical well-being. At the first week and each month for the study duration, eszopiclone produced significant and sustained improvements in sleep latency, wake time after sleep onset, number of awakenings, number of nights awakened per week, total sleep time, and quality of sleep compared with placebo (P < or = 0.003). Monthly ratings of next-day function, alertness, and sense of physical well-being were also significantly better with the use of eszopiclone than with placebo (P < or = 0.002). There was no evidence of tolerance, and the most common adverse events were unpleasant taste and headache. CONCLUSIONS: Throughout 6 months, eszopiclone improved all of the components of insomnia as defined by DSM-IV, including patient ratings of daytime function. This placebo-controlled study of eszopiclone provides compelling evidence that long-term pharmacologic treatment of insomnia is efficacious

Statistical methods are given for producing a cost-effectiveness frontier for an arbitrary number of programs. In the deterministic case, the net health benefit (NHB) decision rule is optimal; the rule funds the program with the largest positive NHB at each lambda, the amount a decision-maker is willing to pay for an additional unit of effectiveness. For bivariate normally distributed cost and effectiveness variables and a specified lambda, a statistical procedure is presented, based on the method of constrained multiple comparisons with the best (CMCB), for determining the program with the largest NHB. A one-tailed t test is used to determine if the NHB is positive. To obtain a statistical frontier in the lambda-NHB plane, we develop a method to produce the region in which each program has the largest NHB, by pivoting a CMCB confidence interval. A one-sided version of Fieller's theorem is used to determine the region where the NHB of each program is positive. At each lambda, the pointwise error rate is bounded by a prespecified alpha. Upper bounds on the familywise error rate, the probability of an error at any value of lambda, are given. The methods are applied to a hypothetical clinical trial of antipsychotic agents