Faculty Bibliography

Non-specific treatment response, also known as placebo response, is ubiquitous in the treatment of mental illness, particularly in treating depression. The study of placebo effect is complicated because the factors that constitute non-specific treatment effects are latent and not directly observed. A flexible infinite mixture model is introduced to model these nonspecific treatment effects. The infinite mixture model stipulates that the non-specific treatment effects are continuous and this is contrasted with a finite mixture model that is based on the assumption that the non-specific treatment effects are discrete. Data from a depression clinical trial is used to illustrate the model and to study the evolution of the placebo effect over the course of treatment.

BACKGROUND. When the 2009 H1N1 influenza A virus emerged in the United States, epidemiologic and clinical information about severe and fatal cases was limited. We report the first 47 fatal cases of 2009 H1N1 influenza in New York City. METHODS. The New York City Department of Health and Mental Hygiene conducted enhanced surveillance for hospitalizations and deaths associated with 2009 H1N1 influenza A virus. We collected basic demographic and clinical information for all patients who died and compared abstracted data from medical records for a sample of hospitalized patients who died and hospitalized patients who survived. RESULTS. From 24 April through 1 July 2009, 47 confirmed fatal cases of 2009 H1N1 influenza were reported to the New York City Department of Health and Mental Hygiene. Most decedents (60%) were ages 18-49 years, and only 4% were aged 65 years. Many (79%) had underlying risk conditions for severe seasonal influenza, and 58% were obese according to their body mass index. Thirteen (28%) had evidence of invasive bacterial coinfection. Approximately 50% of the decedents had developed acute respiratory distress syndrome. Among all hospitalized patients, decedents had presented for hospitalization later (median, 3 vs 2 days after illness onset; P < .05) and received oseltamivir later (median, 6.5 vs 3 days; P < .01) than surviving patients. Hospitalized patients who died were less likely to have received oseltamivir within 2 days of hospitalization than hospitalized patients who survived (61% vs 96%; P < .01). CONCLUSIONS. With community-wide transmission of 2009 H1N1 influenza A virus, timely medical care and antiviral therapy should be considered for patients with severe influenza-like illness or with underlying risk conditions for complications from influenza.

It is well-established that youth with attention-deficit/hyperactivity disorder (ADHD) are often peer-rejected and rated by parents, teachers, and observers to have poor social skills, when compared to typically developing peers. Significantly less research, however, has been devoted to the experiences youth with ADHD have in their close friendships. The aim of this article is to draw attention to friendship as a distinct construct from peer rejection and social skills and to summarize what is known about youth with ADHD in their friendships. The potential for stable, high-quality friendships to buffer the negative outcomes typically conferred by peer rejection in this population is discussed. This article concludes with recommendations for interventions that specifically target improving the close friendships of youth with ADHD as a treatment strategy.

Functional connectivity has become one of the important approaches to understanding the functional organization of the human brain. Recently, functional near-infrared spectroscopy (fNIRS) was demonstrated as a feasible method to study resting-state functional connectivity (RSFC) in the sensory and motor systems. However, whether such fNIRS-based RSFC can be revealed in high-level and complex functional systems remains unknown. In the present study, the feasibility of such an approach is tested on the language system, of which the neural substrates have been well documented in the literature. After determination of a seed channel by a language localizer task, the correlation strength between the low frequency fluctuations of the fNIRS signal at the seed channel and those at all other channels is used to evaluate the language system RSFC. Our results show a significant RSFC between the left inferior frontal cortex and superior temporal cortex, components both associated with dominant language regions. Moreover, the RSFC map demonstrates left lateralization of the language system. In conclusion, the present study successfully utilized fNIRS-based RSFC to study a complex and high-level neural system, and provides further evidence for the validity of the fNIRS-based RSFC approach.

OBJECTIVES: It has been suggested that bipolar disorder (BD) with comorbid ADHD represents a distinct clinical phenotype of BD. There are no data regarding potential heterogeneity between BD subjects with a diagnosis of ADHD in childhood whose ADHD remitted in adulthood (cADHD-BD) vs. BD patients with persistent ADHD diagnosis in adulthood (aADHD-BD). This heterogeneity may constitute a confounder in investigations of the nature of the co-occurrence between BD and ADHD. The aim of this paper is to compare BD patients without ADHD, to those with aADHD-BD, and those with cADHD-BD on clinical and temperamental characteristics, hypothesizing that maladaptive temperament will be increased in BD subjects with a stable diagnosis of ADHD in adulthood compared to those whose ADHD remitted. We further hypothesize that maladaptive temperament will be associated with the severity of both illnesses. METHODS: A total of 100 outpatients (aged 18-30 years) with BD in remission were included. The assessment of ADHD was made according to a procedure aimed to reduce potential recall biases. Subjects had to have a parent available and had never been treated with stimulants. Temperamental traits were assessed with the California Child Q-sort (CCQ) and the Early Adolescent Temperament Questionnaire (EATQ). RESULTS: Rate of co-occurrence of ADHD-BD was 18% lifetime and 10% current diagnosis. Patients with ADHD-BD (aADHD-BD+cADHD-BD) reported a significantly earlier onset of mood disorder, higher number of previous mood episodes, and significantly higher impulsivity than BD patients without ADHD. aADHD-BD showed a significantly earlier BD onset, higher number of previous mood episodes, higher impulsivity, decreased Reactive Control and higher Negative Emotionality temperamental scores than cADHD patients. CONCLUSION: Findings suggest that patients with aADHD-BD present a clinical phenotype distinct from that of patients with BD without ADHD or with a childhood ADHD diagnosis that remitted with the age. This appealing hypothesis of a BD-distinct phenotype that can be detected early due to its associated maladaptive temperamental traits requires further investigation in larger samples, supported by neuropsychological, genetic and imaging data.

OBJECTIVE: Spinal cord injury (SCI) is accompanied by disruption of the blood-spinal cord barrier and subsequent extravasation of fluid and proteins, which results in edema (increased water content) at the site of injury. However, the mechanisms that control edema and the extent to which edema impacts outcome after SCI are not well elucidated. METHODS: Here, we examined the role of aquaporin-4 (AQP4) water channels after experimental contusion injury in mice, a clinically relevant animal model of SCI. RESULTS: Mice lacking AQP4 (AQP4(-/-) mice) exhibited significantly impaired locomotor function and prolonged bladder dysfunction compared with wild-type (WT) littermates after contusion SCI. Consistent with a greater extent of functional deterioration, AQP4(-/-) mice showed greater neuronal loss and demyelination, with prominent cyst formation, which is generally absent in mouse SCI. The extent of spinal cord edema, as expressed by percentage water content, was persistently increased above control levels in AQP4(-/-) mice but not WT mice at 14 and 28 days after injury. Immunohistochemical analysis indicated that blood vessels in the vicinity of the lesion core had incomplete barrier function because of sparse tight junctions. INTERPRETATION: These results suggest that AQP4 plays a protective role after contusion SCI by facilitating the clearance of excess water, and that targeting edema after SCI may be a novel therapeutic strategy

Summary. Permutation tests based on distances among multivariate observations have found many applications in the biological sciences. Two major testing frameworks of this kind are multiresponse permutation procedures and pseudo-F tests arising from a distance-based extension of multivariate analysis of variance. In this article, we derive conditions under which these two frameworks are equivalent. The methods and equivalence results are illustrated by reanalyzing an ecological data set and by a novel application to functional magnetic resonance imaging data

The Evidence-Based Practice Attitude Scale (EBPAS) assesses mental health and social service provider attitudes toward adopting evidence-based practices. Scores on the EBPAS derive from 4 subscales (i.e., Appeal, Requirements, Openness, and Divergence) as well as the total scale, and preliminary studies have linked EBPAS scores to clinic structure and policies, organizational culture and climate, and first-level leadership. EBPAS scores are also related to service provider characteristics, including age, education level, and level of professional development. The present study examined the factor structure, reliability, and norms of EBPAS scores in a sample of 1,089 mental health service providers from a nationwide sample drawn from 100 service institutions in 26 states in the United States. The study also examined associations of provider demographic characteristics with EBPAS subscale and total scores. Confirmatory factor analysis supported a second-order factor model, and reliability coefficients for the subscales ranged from .91 to .67 (total scale = .74). The study establishes national norms for the EBPAS so that comparisons can be drawn for U.S. local as well as international studies of attitudes toward evidence-based practices. The results suggest that the factor structure and reliability are likely generalizable to a variety of service provider contexts and different service settings and that the EBPAS subscales are associated with provider characteristics. Directions for future research are discussed.

This study examined cross-sectional patterns of association between childhood psychiatric disorders and non-fatal injuries. The study population consisted of 763,251 youth between the ages of five and 18 years. Having any psychiatric diagnosis increased the odds of injury by a factor of two (OR = 2.12, CI 2.08-2.16). Strong associations were found between poisoning and unipolar depression (OR = 5.45, 95% CI 5.02-5.93), bipolar mood disorders (OR = 7.00, 95% CI 6.15-7.95) and major depression (OR = 9.63; 95% CI 8.51-10.89). Medicaid data provide an important resource to examine the intersection of psychiatric diagnosis and injury on a population basis.