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Berger R.P.,University of Pittsburgh | Hayes R.L.,Banyan Biomarkers, Inc. | Richichi R.,Statistical Analysis and Measurement Consultants Inc. | Beers S.R.,Western Psychiatric Institute and Clinic | Wang K.K.W.,University of Florida
Journal of Neurotrauma | Year: 2012

Predicting outcome after pediatric traumatic brain injury (TBI) is important for providing information to families and prescribing rehabilitation services. Previously published studies evaluating the ability of serum biomarkers to predict outcome after pediatric TBI have focused on three markers: neuron-specific enolase (NSE), S100B, and myelin-basic protein (MBP), all of which have important limitations. The study objectives were to measure serum concentrations of two novel serum biomarkers, ubiquitin C-terminal hydrolase (UCH-L1) and αII-spectrin breakdown product 145kDa (SBDP145), in children with TBI and healthy controls and to assess the ability of these markers to predict outcome as assessed by a dichotomous Glasgow Outcome Scale (GOS) score. We also sought to compare the predictive ability of UCH-L1 and SBDP145 to that of the clinical gold standard, the Glasgow Coma Scale (GCS) score, and to that of the well-accepted biomarkers NSE, S100B, and MBP. Serum UCH-L1 and SBDP145 concentrations were significantly greater in subjects than in controls. The increase in UCH-L1 and SBDP145 was exclusively seen in subjects with moderate and severe TBI; there was no increase after mild TBI. Both markers had a significant negative partial correlation with the GCS after controlling for age. Both UCH-L1 and SBDP145 were correlated with GOS, and this correlation was stronger than the correlations with NSE, S100B, or MBP. These results suggest that these two markers may be useful in assessing outcome after moderate and severe pediatric TBI. © 2012, Mary Ann Liebert, Inc.

Fanniff A.M.,Palo Alto University | Kolko D.J.,University of Pittsburgh | Kolko D.J.,Western Psychiatric Institute and Clinic
Sexual Abuse: Journal of Research and Treatment | Year: 2012

Adolescents adjudicated for sexual offenses are a heterogeneous group. The identification of more homogeneous subgroups of offenders may enable improved treatment, as the specific risks and needs presented by each group could be more effectively targeted. The current study examines three subgroups derived based on the age of victim(s), a popular method of subtyping that has mixed empirical support, using a sample of 176 males adjudicated for a sexual offense and court-ordered to participate in a community-based collaborative intervention program that integrates treatment and probationary services. Differences expected between groups based on theories regarding victim-age based subtypes are examined, in addition to differences consistently identified in prior research. Results indicate that these three subgroups are more similar than different, although some expected differences were found. Juveniles with child victims were more likely to have male victims and biologically related victims. Juveniles with peer/adult victims were more likely to have poor monitoring by their parents and more likely to have been arrested again. Juveniles with mixed types of victims appeared similar to juveniles with child victims on some variables and similar to those with peer/adult victims on others. Treatment implications and future directions for research are discussed. Typologies based on clinical characteristics of the youth rather than offense characteristics may have more promise for identifying meaningful subgroups. © The Author(s) 2012.

Scharf D.,Western Psychiatric Institute and Clinic
Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco | Year: 2011

We examined prescribing patterns for nicotine replacement therapies (NRTs) in a large psychiatric hospital, before and after the implementation of a smoking ban. We extracted 5 years of NRT utilization data from hospital pharmacy records. The ban went into effect on January 1, 2007. Data reflect NRT prescriptions from 2 years before and 3 years after the ban, and N = 30,908 total inpatient hospital admissions. The monthly rate of total NRT prescriptions increased after the ban from M = 254.25 (SD = 126.60) doses per month to M = 4,467.52 (SD = 1,785.87) doses per month (>1,700% increase, p < .0001). After the smoking ban, clinicians prescribed higher doses of transdermal (but not oral) NRT (Tukey, p < .0001). Comparisons of NRT prescribing across hospital units tentatively suggested that patients being treated on the substance use disorders unit were prescribed more doses of NRT, as well as higher doses of NRT compared with patients on other units. Analysis of trends over time showed no apparent downward trend for NRT usage during the 3 years following the smoking ban, suggesting that clinicians continued to treat nicotine dependence after smoking was restricted. Clinicians are more likely to identify and treat symptoms of nicotine withdrawal when smoking is restricted. Hospitals should consider monitoring prescriptions for NRT as part of their ongoing quality assurance practices so that patients receive aggressive treatment of nicotine withdrawal symptoms--an essential component of high-quality patient care.

Turecki G.,McGill University | Brent D.A.,Western Psychiatric Institute and Clinic
The Lancet | Year: 2016

Summary Suicide is a complex public health problem of global importance. Suicidal behaviour differs between sexes, age groups, geographic regions, and sociopolitical settings, and variably associates with different risk factors, suggesting aetiological heterogeneity. Although there is no effective algorithm to predict suicide in clinical practice, improved recognition and understanding of clinical, psychological, sociological, and biological factors might help the detection of high-risk individuals and assist in treatment selection. Psychotherapeutic, pharmacological, or neuromodulatory treatments of mental disorders can often prevent suicidal behaviour; additionally, regular follow-up of people who attempt suicide by mental health services is key to prevent future suicidal behaviour. © 2016 Elsevier Ltd.

Hopwood C.J.,Michigan State University | Wright A.G.C.,Western Psychiatric Institute and Clinic | Ansell E.B.,Yale University | Pincus A.L.,Pennsylvania State University
Journal of Personality Disorders | Year: 2013

The purpose of this article is to demonstrate that personality pathology is, at its core, fundamentally interpersonal. The authors review the proposed DSM-5 Section 3 redefinition of personality pathology involving self and interpersonal dysfunction, which they regard as a substantial improvement over the DSM-IV (and Section 2) definition. They note similarities between the proposed scheme and contemporary interpersonal theory and interpret the Section 3 definition using the underlying assumptions and evidence base of the interpersonal paradigm in clinical psychology. The authors describe how grounding the proposed Section 3 definition in interpersonal theory, and in particular a focus on the "interpersonal situation," adds to its theoretical texture, empirical support, and clinical utility. They provide a clinical example that demonstrates the ability of contemporary interpersonal theory to augment the definition of personality pathology. The authors conclude with directions for further research that could clarify the core of personality pathology, and how interpersonal theory can inform research aimed at enhancing the Section 3 proposal and ultimately justify its migration to Section 2. © 2013 The Guilford Press.

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