Western Psychiatric Institute and Clinic

Pittsburgh, PA, United States

Western Psychiatric Institute and Clinic

Pittsburgh, PA, United States
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Dietz L.J.,University of Pittsburgh | Stoyak S.,University of Pittsburgh | Melhem N.,University of Pittsburgh | Porta G.,Western Psychiatric Institute and Clinic | And 4 more authors.
Biological Psychiatry | Year: 2013

Background: Parental bereavement is associated with increased risk for psychiatric illness and functional impairment in youth. Dysregulated hypothalamic-pituitary-adrenal (HPA) axis functioning may be one pathway through which bereaved children experience increased risk for poor outcomes. However, few studies have prospectively examined the association between parental bereavement and cortisol response while accounting for psychiatric disorders in both youth and their caregivers. Methods: One-hundred and eighty-one bereaved and nonbereaved offspring and their caregivers were assessed at multiple time points over a 5-year period after parental death. Offspring participated in an adaptation of the Trier Social Stress Task (TSST), and salivary cortisol samples were collected before and after exposure to social stressors. Mixed models for repeated measures were used to analyze the effects of bereavement status, psychiatric disorder in both offspring and caregiver, and demographic indices on trajectories of cortisol response. Results: After controlling for demographic variables and offspring depression, bereaved offspring demonstrated significantly different trajectories of cortisol response compared with nonbereaved offspring, characterized by higher total cortisol output and an absence of cortisol reactivity to acute social stress. Within the bereaved group, offspring of parents who died by sudden natural death demonstrated significant cortisol reactivity to social stress compared with offspring whose parents died by suicide, who demonstrated more blunted trajectory of cortisol response. Conclusions: Parentally bereaved youth demonstrate higher cortisol output than nonbereaved youth but are less able to mount an acute response in the face of social stressors. © 2013 Society of Biological Psychiatry.

Chase H.W.,University of Pittsburgh | Chase H.W.,Western Psychiatric Institute and Clinic | MacKillop J.,University of Georgia | MacKillop J.,Brown University | Hogarth L.,University of New South Wales
Psychopharmacology | Year: 2013

Rationale: Characterisation of drug dependence using principles from behavioural economics has provided a more detailed understanding of the disorder. Although questionnaires assessing economic demand for cigarettes have extended these principles to nicotine addiction, aspects of the reliability and selectivity of these questionnaires remain uncertain. Objective: Across two experiments, we attempted to reproduce significant associations of the cigarette purchase task with nicotine dependence in a young adult population of smokers and contrasted this measure with a novel chocolate purchase task. We also examined the association between these measures and performance on a preference task, measuring preference for cigarettes and chocolate. Methods: Questionnaire measures were used within a university setting. Results: In experiment 1, we observed associations between nicotine dependence and measures of behavioural economic demand for cigarettes, particularly O max. In experiment 2, we replicated these findings again and extended them to show that similar correlations between nicotine dependence and demand for chocolate were not observed. Moreover, the indices of demand and choices on a concurrent choice cigarette task were moderately associated with each other and independently associated with nicotine dependence. Conclusions: The two experiments clearly supported previous findings regarding the association between nicotine dependence and economic demand for cigarettes. We extend these observations by showing that the generalisation of economic demand across different commodities is relatively weak, but that generalisation across different procedures is strong. Our results therefore support behavioural economic models of nicotine addiction which emphasise a robust proximal role for the incentive value of cigarettes. © 2012 Springer-Verlag Berlin Heidelberg.

News Article | November 30, 2016
Site: www.eurekalert.org

CHAPEL HILL, NC - Eight years ago, researchers at the University of North Carolina at Chapel Hill launched a new kind of clinical trial to compare the effectiveness of online therapy - delivered through group chat sessions - to face-to-face group therapy for the treatment of bulimia nervosa, an eating disorder marked by recurrent episodes of binge eating (or eating an unusually large amount of food and feeling out of control) coupled with purging behaviors such as vomiting, laxative abuse, or excessive exercise. Now results from the study, published online by the journal Psychotherapy and Psychosomatics, show that online group therapy can be just as effective as face-to-face treatment, although the pace of recovery may be slower. "Bulimia nervosa is a devastating and sometimes deadly illness, and research has shown for years that cognitive-behavioral therapy (CBT) for bulimia is the most effective treatment, said Stephanie Zerwas, PhD, first author of the study, associate professor of psychiatry in the UNC School of Medicine, and clinical director of the UNC Center of Excellence for Eating Disorders. "I know that too many people have to travel for hours to find expert eating disorders treatment. Online treatment could help us bridge that gap." In the study, 179 adults started 16 sessions of group therapy with a therapist at one of two study sites: UNC-Chapel Hill and Western Psychiatric Institute and Clinic (WPIC) of the University of Pittsburgh Medical Center. Assignment to either the online group or the traditional face-to-face group was completely random. Researchers compared the results of the two groups at the end of treatment, and then again 12 months later. Immediately after treatment, the face-to-face group produced better results than the online group, when it came to helping patients reach a point where they were completely free of binge eating and purging. But by the 12-month follow-up, the gap in treatment results between the two groups had narrowed dramatically; neither method of delivery (online versus face-to-face therapy) was better than the other. "We have evidence-based treatments that are effective for many people with bulimia, but many people don't have access to specialist care," said Cynthia M. Bulik, PhD, Distinguished Professor of Eating Disorders at UNC, founding director of the UNC Center of Excellence for Eating Disorders, and director of the Center for Eating Disorders Innovation at Karolinska Institutet in Stockholm, Sweden. "This study encourages us to use technology to bring treatment to the patients who can't come to us." This study was funded by the National Institute of Mental Health with additional funding from the Alexander von Humboldt Foundation. In addition to Drs. Zerwas and Bulik, authors of the study were Hunna J. Watson, Sara M. Hofmeier, Michele D. Levine, Robert M. Hamer, Ross D. Crosby, Cristin D. Runfola, Christine M. Peat, Jennifer R. Shapiro, Benjamin Zimmer, Markus Moessner, Hans Kordy, and Marsha D. Marcus.

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.

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.

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.

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.

Keshavan M.S.,Beth Israel Deaconess Medical Center | Keshavan M.S.,Western Psychiatric Institute and Clinic | Giedd J.,Brain Imaging Section | Lau J.Y.F.,Institute of Psychiatry | And 2 more authors.
The Lancet Psychiatry | Year: 2014

Adolescence is a time of extensive neuroanatomical, functional, and chemical reorganisation of the brain which parallels substantial maturational changes in cognition and affect regulation. This period is characterised by stabilisation of synapses to diminish redundancy and increase efficiency of neural function, fine-tuning of excitatory and inhibitory neurotransmitter systems, beginning of integration between late maturing and early maturing brain structures, and development of effective connections. In effect, these so-called moving parts create a state of dynamic change that might underlie adolescent behaviours. Imbalances or changes in timing of these developmental processes clearly increase the risk for psychiatric disorders. Genetic, environmental, and epigenetic factors that shape brain development and hormonal changes that affect stress reactivity could be reasons why some, but not all, adolescents are at a heightened risk of developing a psychopathological disorder. In this Series paper, we assess the neurobiology of the changing adolescent brain, implications of this knowledge, and future research in major psychiatric disorders, particularly for psychotic disorders. © 2014 Elsevier Ltd.

Mezick E.J.,University of Pittsburgh | Hall M.,Western Psychiatric Institute and Clinic | Matthews K.A.,University of Pittsburgh
Sleep Medicine Reviews | Year: 2011

Sleep duration, sleep continuity, and depression are associated with cardiovascular disease and metabolic disorders. Despite the well-established relationship between sleep and depression, few studies examine these characteristics simultaneously in the development of cardiometabolic disease. Here, we review available studies that include measures of both sleep and depression in relation to cardiometabolic outcomes (cardiovascular disease, diabetes, and the metabolic syndrome). In general, data show that independent of depression, sleep continuity is a risk factor for cardiovascular disease, and short or long sleep duration is a risk factor for diabetes and the metabolic syndrome. Results for associations between sleep duration and cardiovascular disease, and associations between sleep continuity and metabolic disease, are more mixed. Regarding depression, there is preliminary evidence that depression increases risk for cardiovascular disease, independent of sleep continuity. However, there are insufficient data to address whether relationships between depression and cardiovascular and metabolic disease are independent of sleep duration. A number of biobehavioral mechanisms, including inflammation, hypothalamic and sympathetic dysregulation, and obesity and health behaviors, may account for the relationships among sleep, depression, and cardiometabolic disease. After summarizing these mechanisms, we discuss limitations of the extant literature and suggest directions for future research. © 2010 Elsevier Ltd.

Brent D.A.,Western Psychiatric Institute and Clinic
Psychiatric Clinics of North America | Year: 2016

We review the evidence that antidepressants either increase or decrease the risk for suicidal ideation and behavior in adolescents. Meta-analyses of randomized clinical trials (RCTs) indicate a small increased risk for suicidal events in adolescents and young adults, but a protective effect in older adults. In contrast, pharmacoepidemiologic studies show a protective effect across the life span. Explanations for occurrence of suicidal events in younger patients and for the apparent contradiction between RCT and pharmacoepidemiologic studies are offered. Guidance for clinicians is provided on explaining the risk-benefit ratio of antidepressants and how to monitor and attenuate for suicidal risk. © 2016 Elsevier Inc.

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