Faculty Bibliography
Searched for:
school:SOM
Department/Unit:Child and Adolescent Psychiatry
Total Results:
11211
A Randomized Double-Blinded Placebo Controlled Trial of Clazakizumab for the Treatment of COVID-19 Pneumonia With Hyperinflammation
OBJECTIVES/OBJECTIVE:We designed this study to test whether clazakizumab, a direct interleukin-6 inhibitor, benefits patients hospitalized with severe or critical COVID-19 disease accompanied by hyperinflammation. DESIGN/METHODS:Multicenter, randomized, double-blinded, placebo-controlled, seamless phase II/III trial. SETTING/METHODS:Five U.S. medical centers. PATIENTS/METHODS:Adults inpatients with severe COVID-19 disease and hyperinflammation. INTERVENTIONS/METHODS:Eighty-one patients enrolled in phase II, randomized 1:1:1 to low-dose (12.5 mg) or high-dose (25 mg) clazakizumab or placebo. Ninety-seven patients enrolled in phase III, randomized 1:1 to high-dose clazakizumab or placebo. MEASUREMENTS AND MAIN RESULTS/RESULTS:The primary outcome was 28-day ventilator-free survival. Secondary outcomes included overall survival ,frequency and duration of intubation, and frequency and duration of ICU admission. Per Data Safety and Monitoring Board recommendations, additional secondary outcomes describing clinical status and status changes, as measured by an ordinal scale, were added. Bayesian cumulative proportional odds, logistic, and Poisson regression models were used. The low-dose arm was dropped when the phase II study suggested superiority of the high-dose arm. We report on 152 patients, 74 randomized to placebo and 78 to high-dose clazakizumab. Patients receiving clazakizumab had greater odds of 28-day ventilator-free survival (odds ratio [OR] = 3.84; p [OR > 1] 99.9%), as well as overall survival at 28 and 60 days (OR = 1.75; p [OR > 1] 86.5% and OR = 2.53; p [OR > 1] 97.7%). Clazakizumab was associated with lower odds of intubation (OR = 0.2; p [OR] < 1; 99.9%) and ICU admission (OR = 0.26; p [OR < 1] 99.6%); shorter durations of ventilation and ICU stay (risk ratio [RR] < 0.75; p [RR < 1] > 99% for both); and greater odds of improved clinical status at 14, 28, and 60 days (OR = 2.32, p [OR > 1] 98.1%; OR = 3.36, p [OR > 1] 99.6%; and OR = 3.52, p [OR > 1] 99.8%, respectively). CONCLUSIONS:Clazakizumab significantly improved 28-day ventilator-free survival, 28- and 60-day overall survival, as well as clinical outcomes in hospitalized patients with COVID-19 and hyperinflammation.
PMID: 35583232
ISSN: 1530-0293
CID: 5249242
Preconception Health and Disability Status Among Women of Reproductive Age Participating in the National Health and Nutrition Examination Surveys, 2013-2018
PMID: 35041530
ISSN: 1931-843x
CID: 5131472
Journal of the American Academy of Child & Adolescent Psychiatry. 2022:61(9):1182-1188.DOI: 10.1016/j.jaac.2022.04.023
Structural Brain Correlates of Childhood Inhibited Temperament: An ENIGMA-Anxiety Mega-analysis
Temperament involves stable behavioral and emotional tendencies that differ between individuals, which can be first observed in infancy or early childhood and relate to behavior in many contexts and over many years.1 One of the most rigorously characterized temperament classifications relates to the tendency of individuals to avoid the unfamiliar and to withdraw from unfamiliar people, objects, and unexpected events. This temperament is referred to as behavioral inhibition or inhibited temperament (IT).2 IT is a moderately heritable trait1 that can be measured in multiple species.3 In humans, levels of IT can be quantified from the first year of life through direct behavioral observations or reports by caregivers or teachers. Similar approaches as well as self-report questionnaires on current and/or retrospective levels of IT1 can be used later in life.
PMCID:9434711
PMID: 36038199
ISSN: 1527-5418
CID: 5364822
Family-level correlates of disruptive behavior challenges among children in Southwestern Uganda
Introduction: This exploratory study sought to examine the extent to which family-level factors are associated with disruptive behavioral disorder (DBD) symptoms, including oppositional defiant disorder (ODD) and conduct disorder (CD) among school children in Uganda, a low-resource country in SSA. The examination of key influences within the SSA context is important to guide needed investments in mental health care and family-level support. Importantly, identifying families at higher risk can inform the development of contextualized family interventions that reinforce positive parenting practices. Method: We analyzed baseline data (N = 2110) from the NIH-funded Strengthening Mental health And Research Training in Africa (SMART Africa) scale-up study in Southwestern Uganda. Children aged 8-13 and their caregivers were recruited from 30 public primary schools. DBDs were examined using the DBD rating scale, Iowa Conners, and Impairment scales. Logistic regression analysis using cluster adjusted robust standard errors to adjust for within-school clustering was conducted to assess the association between DBD symptoms and family-level factors, including parenting practices, marital status, and family size. Results: Results indicate that poor parental supervision (OR = 1.17; CI: 1.13, 1.21; P < .001), divorced families (OR = 1.33; CI: 1.03, 1.72; P < .05), and widowed families (OR = 1.48; CI: 1.10, 2.00; P < .01) were associated with higher DBD symptoms among children. On the other hand, caregiver age (OR = 0.99; CI: 0.98, 0.99; P < .01) was associated with lower DBD symptoms among children. Moreover, caregiver employment and parental education were not statistically significant in the model. Conclusion: Findings from the study reveal an association between family-level factors and behavioral difficulties among children in Uganda suggesting that divorced and widowedfamilies may benefit from additional support in caring for children. Moreover, caregivers may also benefit from programs that provide tools for effective parental supervision. (PsycInfo Database Record (c) 2022 APA, all rights reserved)
PSYCH:2022-84662-001
ISSN: 1873-7765
CID: 5295722
Journal of the American Academy of Child & Adolescent Psychiatry. 2022:61(9):1071-1073.DOI: 10.1016/j.jaac.2022.03.015
COVID-19 and Youth Who Have Experienced Commercial Sexual Exploitation: A Role for Child Mental Health Professionals During and in the Aftermath of a Pandemic [Editorial]
The COVID-19 pandemic has exacerbated some of the most pressing social problems and structural inequities, with a disproportionate impact on some of the most vulnerable youth. The goal of this article is to raise awareness among child mental health professionals of the ways in which the pandemic has likely exacerbated the commercial sexual exploitation of children in the United States. A second goal is to promote child mental health professionals' ability to identify and care for these resilient yet underresourced youth.
PMCID:8959778
PMID: 35364251
ISSN: 1527-5418
CID: 5201412
The process of learning the designed actions of toys
Many everyday objects require "hidden" affordances to use as designed (e.g., twist open a water bottle). Previous work found a reliable developmental progression in children's learning of designed actions with adult objects such as containers and zippers-from non-designed exploratory actions, to the basics of the designed action, to successful implementation. Many objects designed for children (e.g., toys) also entail designed actions (e.g., interlocking bricks) but might not require a protracted period of discovery and implementation. We encouraged 12- to 60-month-old children (n = 91) and a comparative sample of 20 adults to play with six Duplo bricks to test whether the developmental progression identified for children's learning of adult objects with hidden affordances holds for a popular toy expressly designed for children. We also examined whether children's moment-to-moment behaviors with Duplo bricks inform on general processes involved in discovery and implementation of hidden affordances. With age, children progressed from non-designed exploratory actions, to attempts to interlock, to success, suggesting that the three-step developmental progression revealed with everyday adult objects broadly applies to learning hidden affordances regardless of object type. Detailing the process of learning (the type and timing of children's non-designed actions and attempts to interlock) revealed that the degree of lag between steps of the progression depends on the transparency of the required actions, the availability of perceptual feedback, and the difficulty of the perceptual-motor requirements. Findings provide insights into factors that help or hinder learning of hidden affordances.
PMID: 35525170
ISSN: 1096-0457
CID: 5249442
Psychiatric Consequences of Skin Conditions: Multiple Case Study Analysis with Literature Review
This review of current literature demonstrates the psychological implications of skin conditions. Skin conditions of varying severity can impact the quality of patients' lives and have psychiatric consequences. This impact provides a need for healthcare providers to consider the psychological implications of one's skin conditions and their effect on quality of life. The psychological challenges that arise from varying skin conditions show the potential need for both dermatological and psychiatric interventions. The following literature review details the psychiatric consequences of skin conditions under various conditions. It first looks at literature highlighting the psychiatric consequences experienced through various age ranges, from adults to adolescents and children. The paper then explores multiple skin conditions and their psychological effect before highlighting some of the interactions that stress has on the skin that could further exacerbate one's condition. Finally, it examines how patients characterize their experience with their skin condition and goes into some clinical case studies of patients with psychological implications as a result of their skin disorder. The paper also highlights the magnitude of dermatologic patients experiencing psychological conditions in conjunction with their skin conditions.
PMID: 35771406
ISSN: 1573-6709
CID: 5281282
Author Correction: A multi-country test of brief reappraisal interventions on emotions during the COVID-19 pandemic
PMID: 36002766
ISSN: 2397-3374
CID: 5374292
Longitudinal relationships among posttraumatic stress disorder symptom clusters in response to positive memory processing
BACKGROUND AND OBJECTIVES:Avoidance, inherent to posttraumatic stress disorder (PTSD) symptomatology, is theoretically and empirically linked to the maintenance of PTSD symptom severity. While research indicates traumatized individuals avoid positive and trauma memories, several PTSD treatments focus exclusively on traumatic memories. We examined the mediating role of PTSD's avoidance in the relationship between processing positive memories and PTSD cluster severity (intrusion, mood/cognitions, arousal). METHODS: = 22.52; 86.10% female) were randomly assigned to 3 conditions: narrating/processing, writing/processing, or control (same task across baseline [T0] and follow-up [T1]). RESULTS:Half-longitudinal mediation models indicated participation in the narrating vs. writing and control conditions predicted decreases in T1 intrusion severity via reduction in T1 avoidance severity. Similarly, participation in the narrating vs. writing and control conditions predicted decreases in T1 mood/cognitions' severity via reduction in T1 avoidance severity. Participation in the narrating vs. writing condition predicted decreases in T1 arousal severity via reduction in T1 avoidance severity. LIMITATIONS:Data was obtained from an analogue small-size sample of university students. In addition, sessions were only 6-8 days apart, with the processing component of each session lasting ∼30 min. CONCLUSIONS:Processing positive memories may relate to lower PTSD severity via a reduction in PTSD's avoidance, paralleling effects of processing trauma memories. Our findings support future investigations of the mechanisms underlying impacts of positive memory processing in the context of PTSD treatments.
PMID: 35738684
ISSN: 1873-7943
CID: 5344852
An integrative study of the microbiome gut-brain-axis and hippocampal inflammation in psychosis: Persistent effects from mode of birth
The mechanism producing psychosis appears to include hippocampal inflammation, which could be associated with the microbiome-gut-brain-axis (MGBS). To test this hypothesis we are conducting a multidisciplinary study, herein described. The procedures are illustrated with testing of a single subject and group level information on the impact of C-section birth are presented.
PMID: 34625336
ISSN: 1573-2509
CID: 5067852
