Providence, RI, United States
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Kroumpouzos G.,Brown Medical School
Expert Review of Dermatology | Year: 2010

Specific dermatoses of pregnancy include herpes (pemphigoid) gestationis, polymorphic eruption of pregnancy (also known as pruritic urticarial papules and plaques of pregnancy), prurigo of pregnancy and pruritic folliculitis of pregnancy. This article focuses on what is currently known about the epidemiology, clinical characteristics, etiopathogenesis and management of these disorders. Moreover, it discusses the intrahepatic cholestasis of pregnancy and 'atopic eruption of pregnancy', which were recently reclassified as specific dermatoses of pregnancy, as well as debates related to the prevalence and diagnostic criteria of the latter. Finally, it addresses the suggested overlap between 'atopic eruption of pregnancy' and specific dermatoses of pregnancy, such as prurigo and pruritic folliculitis. © 2010 Expert Reviews Ltd.


Zimmerman M.,Brown Medical School
Journal of Nervous and Mental Disease | Year: 2015

Compared with bipolar disorder, borderline personality disorder (BPD) is as frequent (if not more frequent), as impairing (if not more impairing), and as lethal (if not more lethal). Yet, BPD has received less than one-tenth the funding from the National Institutes of Health than has bipolar disorder. More than other reviewers of the literature on the interface between bipolar disorder and BPD, Paris and Black (Paris J and Black DW (2015) Borderline Personality Disorder and Bipolar Disorder: What is the Difference and Why Does it Matter? J Nerv Ment Dis 203: 3-7) emphasize the clinical importance of correctly diagnosing BPD and not overdiagnosing bipolar disorder, with a focus on the clinical feature of affective instability and how the failure to recognize the distinction between sustained and transient mood perturbations can result in misdiagnosing patients with BPD as having bipolar disorder. The review by Paris and Black, then, is more of an advocacy for BPD than other reviews in this area have been. In the present article, the author will illustrate how the bipolar disorder research community has done a superior job of advocating for and "marketing" their disorder compared with researchers of BPD. Specifically, researchers of bipolar disorder have conducted multiple studies highlighting the problem with underdiagnosis, written commentaries about the problem with underdiagnosis, developed and promoted several screening scales to improve diagnostic recognition, published numerous studies of the operating characteristics of these screening measures, attempted to broaden the definition of bipolar disorder by advancing the concept of the bipolar spectrum, and repeatedly demonstrated the economic costs and public health significance of bipolar disorder. In contrast, researchers of BPD have almost completely ignored each of these issues and thus have been less successful in highlighting the public health significance of the disorder. © 2014 Lippincott Williams & Wilkins.


Marsland A.L.,University of Pittsburgh | McCaffery J.M.,Brown Medical School | Muldoon M.F.,University of Pittsburgh | Manuck S.B.,University of Pittsburgh
Metabolism: Clinical and Experimental | Year: 2010

The metabolic syndrome is conceptualized as a clustering of risk factors-including insulin resistance, dyslipidemia, central adiposity, and elevated blood pressure (BP)-that increase the risk for cardiovascular disease and type 2 diabetes mellitus. Recent evidence suggests that markers of systemic inflammation may be included in the definition of the syndrome and play some role in its pathogenesis. In this study, we use a statistical modeling technique, confirmatory factor analysis, to evaluate relationships of systemic inflammation, as measured by plasma concentrations of C-reactive protein and interleukin-6, with the component factors of the metabolic syndrome (insulin resistance, dyslipidemia, central adiposity, and elevated BP) and to examine whether inflammation is a potential common pathway linking established components to the full syndrome. Subjects were 645 community volunteers aged 30 to 54 years (48% male, 82% European American, 18% African American). Consistent with existing literature, structural equation modeling adjusting for age, sex, and race confirmed a higher-order common factor underlying the covariation of insulin resistance, dyslipidemia, adiposity, and BP. Inflammation was positively associated with this common factor, accounting for 54% of its variance and partially mediating statistical aggregation of the component factors comprising the metabolic syndrome. These results were particularly strong for adiposity, raising the possibility that inflammatory processes stimulated by intraabdominal adipose tissue contribute to the development of the metabolic syndrome. The inclusion of inflammatory markers in the clinical definition of metabolic syndrome seems warranted and may improve prognostic assessment of risk of type 2 diabetes mellitus and cardiovascular disease. © 2010 Elsevier Inc. All rights reserved.


Objectives: Under-recognition of bipolar disorder (BD) is common and incurs significant costs for individuals and society. Clinicians are often encouraged to use screening instruments to help them identify patients with the disorder. The Mood Disorder Questionnaire (MDQ) is the most widely studied measure for this purpose. Some studies, however, have used the MDQ as a case-finding instrument rather than a screening scale. Such inappropriate use of screening scales risks distorting perceptions about many facets of BD, from its prevalence to its consequences. Methods: Studies using the MDQ were reviewed to identify those reports that have used the scale as a case-finding measure rather than a screening scale. Results: Multiple studies were identified in the BD literature that used the MDQ as a diagnostic proxy. The findings of these studies were misinterpreted because of the failure to make the distinction between screening and case-finding. Conclusions: Inappropriate conclusions have been drawn regarding the prevalence, morbidity, and diagnostic under-recognition of BD in studies that rely on the MDQ as a diagnostic proxy. A conceptual critique is offered against the use of self-administered screening questionnaires for the detection of BD in psychiatric settings. © 2012 John Wiley and Sons A/S.


Zimmerman M.,Brown Medical School | Zimmerman M.,Bayside Medical Center | Morgan T.A.,Brown Medical School
Current Psychiatry Reports | Year: 2013

It is clinically important to recognize both bipolar disorder and borderline personality disorder (BPD) in patients seeking treatment for depression, and it is important to distinguish between the two. The most studied question on the relationship between BPD and bipolar disorder is their diagnostic concordance. Across studies approximately 10 % of patients with BPD had bipolar I disorder and another 10 % had bipolar II disorder. Likewise, approximately 20 % of bipolar II patients were diagnosed with BPD, though only 10 % of bipolar I patients were diagnosed with BPD. While the comorbidity rates are substantial, each disorder is, nonetheless, diagnosed in the absence of the other in the vast majority of cases (80-90 %). In studies examining personality disorders broadly, other personality disorders were more commonly diagnosed in bipolar patients than was BPD. Likewise, the converse is also true: other axis I disorders such as major depression, substance abuse, and post-traumatic stress disorder are more commonly diagnosed in patients with BPD than is bipolar disorder. Studies comparing patients with BPD and bipolar disorder find significant differences on a range of variables. These findings challenge the notion that BPD is part of the bipolar spectrum. While a substantial literature has documented problems with the under-recognition and under-diagnosis of bipolar disorder, more recent studies have found evidence of bipolar disorder over-diagnosis and that BPD is a significant contributor to over-diagnosis. Re-conceptualizing the Diagnostic and Statistical Manual of Mental Disorders, fifth edition, diagnostic criteria for bipolar disorder as a type of test, rather than the final word on diagnosis, shifts the diagnostician from thinking solely whether a patient does or does not have a disorder to considering the risks of false-positive and false-negative diagnoses, and the ease by which each type of diagnostic error can be corrected by longitudinal observation. © 2013 Springer Science+Business Media New York.


Hopp J.L.,University of Maryland Baltimore County | Lafrance W.C.,Brown Medical School | Lafrance W.C.,Rhode Island Hospital
Neurologist | Year: 2012

BACKGROUND:: Psychogenic neurological disorders (PNDs) represent a significant problem in neurology, due to the difficulty in diagnosis and lack of effective and widely available treatment options. Treatment options for this population are limited. Preliminary evidence reveals cognitive behavioral therapy (CBT) may be useful in these disorders. REVIEW SUMMARY:: The types of PNDs and their presentations are summarized, and the utilization of CBT in treatment of these disorders is reviewed. Accurate and timely diagnosis of the disorders is paramount and provides direction for implementing appropriate treatment. CONCLUSIONS:: Neurologists should be familiar with the types of PNDs, clinical findings, and treatment principles of CBT. Early and accurate diagnosis may lead to improved treatment outcomes. Controlled treatment trials for this population are needed to determine efficacy. Further study of CBT in these patients may also help to elucidate the underlying etiology of these disorders by contributing to the understanding of associated psychopathology. Copyright © 2012 by Lippincott Williams & Wilkins.


Silk J.S.,University of Pittsburgh | Siegle G.J.,University of Pittsburgh | Lee K.H.,University of Pittsburgh | Nelson E.E.,National Institute of Mental Health | And 2 more authors.
Social Cognitive and Affective Neuroscience | Year: 2014

Sensitivity to social evaluation has been proposed as a potential marker or risk factor for depression, and has also been theorized to increase with pubertal maturation. This study utilized an ecologically valid paradigm to test the hypothesis that adolescents with major depressive disorder (MDD) would show altered reactivity to peer rejection and acceptance relative to healthy controls in a network of ventral brain regions implicated in affective processing of social information. A total of 48 adolescents (ages 11-17), including 21 with a current diagnosis of MDD and 27 age- and gender-matched controls, received rigged acceptance and rejection feedback from fictitious peers during a simulated online peer interaction during functional neuroimaging. MDD youth showed increased activation to rejection relative to controls in the bilateral amygdala, subgenual anterior cingulate, left anterior insula and left nucleus accumbens. MDD and healthy youth did not differ in response to acceptance. Youth more advanced in pubertal maturation also showed increased reactivity to rejection in the bilateral amygdala/parahippocampal gyrus and the caudate/subgenual anterior cingulate, and these effects remained significant when controlling for chronological age. Findings suggest that increased reactivity to peer rejection is a normative developmental process associated with pubertal development, but is particularly enhanced among youth with depression. © The Author (2013). Published by Oxford University Press.


Weinstock M.A.,Brown Medical School | Fisher D.E.,Harvard University
JNCCN Journal of the National Comprehensive Cancer Network | Year: 2010

Recreational indoor tanning with ultraviolet (UV) radiation has become popular in recent decades, particularly among teenagers and young adults. The consequences for public health have become an important area of concern. The link between this form of UV exposure and both melanoma and non-melanoma skin cancers has been clarified through multiple lines of evidence from epidemiology and laboratory science reflected in recent reports by multiple prestigious bodies. Some have suggested that this form of indoor tanning has a role in vitamin D generation, but a review of existing evidence suggests that indoor tanning is neither a reliable nor advisable source. In addition, laboratory data suggest that tanning promotes a common molecular intermediate in skin carcinogenesis, DNA damage, which thus precludes the concept of a "safe tan." Finally, emerging evidence links UV signaling in skin to dependency/addiction, thus having implications for the organic (rather than cosmetic) impact of the process. This article presents the epidemiologic and mechanistic data relevant to the safety considerations for indoor tanning. © Journal of the National Comprehensive Cancer Network.


Zimmerman M.,Brown Medical School | Morgan T.A.,Brown Medical School
Dialogues in Clinical Neuroscience | Year: 2013

It is clinically important to recognize both bipolar disorder and borderline personality disorder (BPD) in patients seeking treatment for depression, and it is important to distinguish between the two. Research considering whether BPD should be considered part of a bipolar spectrum reaches differing conclusions. We reviewed the most studied question on the relationship between BPD and bipolar disorder: their diagnostic concordance. Across studies, approximately 10% of patients with BPD had bipolar I disorder and another 10% had bipolar II disorder. Likewise, approximately 20% of bipolar II patients were diagnosed with BPD, though only 10% of bipolar I patients were diagnosed with BPD. While the comorbidity rates are substantial, each disorder is nontheless diagnosed in the absence of the other in the vast majority of cases (80% to 90%). In studies examining personality disorders broadly, other personality disorders were more commonly diagnosed in bipolar patients than was BPD. Likewise, the converse is also true: other axis I disorders such as major depression, substance abuse, and post-traumatic stress disorder are also more commonly diagnosed in patients with BPD than is bipolar disorder. These findings challenge the notion that BPD is part of the bipolar spectrum. © 2013, AICH.


Zimmerman M.,Brown Medical School | Zimmerman M.,Bayside Medical Center
Personality Disorders: Theory, Research, and Treatment | Year: 2012

The DSM-5 Personality and Personality Disorders (PDs) Work Group has recommended a reformulation of the PD section. In the present review I examined the empirical support for the Work Group's criticisms of the DSM-IV approach that were central to the justification for radically changing the diagnostic criteria. The Work Group indicated that comorbidity among the DSM-IV PDs is excessive, and to reduce comorbidity they recommended deleting five PDs. The studies they cited demonstrating high levels of comorbidity were of samples of psychiatric patients. A review of the epidemiological literature shows that comorbidity rates are much lower than in patient samples, and this challenges the proposition that high comorbidity is due to the diagnostic criteria. Moreover, the empirical support for the exclusion of some disorders over others is lacking. The Work Group noted that the diagnostic stability of the PDs is modest. However, modest levels of diagnostic stability may be largely attributable to methodological factors such test-retest unreliability, state effects, regression to the mean, and measurement error due to repeated assessments, rather than a reflection of inadequacies of the diagnostic system. Thus, modest stability is likely to be found in any approach toward diagnosing PDs. The present review therefore suggests that several of the core problems linked to the DSM-IV approach toward diagnosing PDs are more likely due to methodological factors than inadequacies of the criteria themselves. The Work Group's recommendation to delete five PDs is inconsistent with the explicit guidelines established for making revisions for DSM-5 which specify that for a disorder to be deleted there should be a thorough review of that disorder's clinical utility and validity. © 2011 American Psychological Association.

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