Medicine and Health Sciences Commons^™

Focusing On Drug Versus Disease Mechanisms And On Clinical Subgrouping To Advance Personalised Medicine In Psychiatry, Jose De Leon

Psychiatry Faculty Publications

Personalised medicine has finally been featured in psychiatric journals, but psychiatrists have mainly focused on the promise of using disease mechanisms to personalise treatment. Psychiatric disorders such as schizophrenia and depression are not diseases, in the medical sense, and are probably more like syndromes. Instead of spending much time and effort focusing on the mechanisms of diseases that may instead be syndromes, the author believes that psychiatrists should (1) learn more about personalising prescription via drug mechanisms, a pharmacological approach to personalised medicine; and (2) reconsider prior attempts by traditional clinical psychopharmacologists to use sophisticated clinical approaches that try to …

Qt Interval Prolongation Associated With Intramuscular Ziprasidone In Chinese Patients: A Case Report And A Comprehensive Literature Review With Meta-Analysis, Xian-Bin Li, Yi-Lang Tang, Wei Zheng, Chuan-Yue Wang, Jose De Leon

Psychiatry Faculty Publications

Intramuscular (IM) ziprasidone has been associated with QTc interval prolongations in patients with preexisting risk factors. A 23-year-old male Chinese schizophrenia patient experienced an increase of QTc interval of 83 milliseconds (ms) after receiving 20 mg IM ziprasidone (baseline and increased QT/QTc were, respectively, 384/418 and 450/501). This was rated as a probable adverse drug reaction (ADR) by the Liverpool ADR causality assessment tool. A systematic review including all types of trials reporting the effect of IM ziprasidone on the QTc interval prolongation identified 19 trials with a total of 1428 patients. Mean QTc change from baseline to end of …

Pharmacokinetic And Pharmacodynamic Interactions Between Antiepileptics And Antidepressants, Domenico Italiano, Edoardo Spina, Jose De Leon

Psychiatry Faculty Publications

INTRODUCTION: Antiepileptic-antidepressant combinations are frequently used by clinicians; their pharmacokinetic (PK) and pharmacodynamic (PD) drug interactions (DIs) have not been well studied but are frequently likely to be clinically relevant.

AREAS COVERED: This article provides a comprehensive review of PK DIs between antiepileptics and antidepressants. In the absence of PD DI studies, PD information on pharmacological mechanisms and studies on efficacy and safety of individual drugs are reviewed.

EXPERT OPINION: The clinical relevance of the inductive properties of carbamazepine, phenytoin, phenobarbital and primidone and the inhibitory properties of valproic acid and some antidepressants are well understood; correction factors are provided …

Paradoxes Of Us Psychopharmacology Practice In 2013: Undertreatment Of Severe Mental Illness And Overtreatment Of Minor Psychiatric Problems, Jose De Leon

Psychiatry Faculty Publications

No abstract provided.

False Negative Studies May Systematically Contaminate The Literature On The Effects Of Inducers In Neuropsychopharmacology. Part Ii: Focus On Bipolar Disorder, Jose De Leon

Psychiatry Faculty Publications

No abstract provided.

Dsm-5 And Research Domain Criteria: One Hundred Years After Jaspers’ General Psychopathology, Jose De Leon

Psychiatry Faculty Publications

No abstract provided.

Management Of Suicidal Behavior: Is The World Upside Down?, Paula Artieda-Urrutia, Isabel Parra Uribe, Gema Garcia-Pares, Diego Palao, Jose De Leon, Hilario Blasco-Fontecilla

Psychiatry Faculty Publications

No abstract provided.

Clinically Relevant Interactions Between Newer Antidepressants And Second-Generation Antipsychotics, Edoardo Spina, Jose De Leon

Psychiatry Faculty Publications

INTRODUCTION: Combinations of newer antidepressants and second-generation antipsychotics (SGAs) are frequently used by clinicians. Pharmacokinetic drug interaction (PK DI) and poorly understood pharmacodynamic (PD) drug interaction (PD DI) can occur between them.

AREAS COVERED: This paper comprehensively reviews PD DI and PK DI studies.

EXPERT OPINION: More PK DI studies are needed to better establish dose correction factors after adding fluoxetine and paroxetine to aripiprazole, iloperidone and risperidone. Further PK DI studies and case reports are also needed to better establish the need for dose correction factors after adding i) fluoxetine to clozapine, lurasidone, quetiapine and olanzapine; ii) paroxetine to …

Grandparents As Parents: Investigating The Health And Well-Being Of Trauma-Exposed Families, Ginny Sprang, Moon Choi, Jessica Eslinger, Adrienne Whitt-Woosley, Rachel Looff

Center on Trauma and Children Reports

An excerpt from the introduction:

Over the past two decades, the number of grandparents serving as primary caregivers for their grandchildren has steadily increased. Nationally, 42% of all grandparents living with grandchildren function as the primary caregivers (U.S. Census, 2006).

In the southern region of the country, this phenomenon is particularly salient, and expected to continue, with estimates that range from 7% to 15% higher than in 2000 (U.S. Census, 2004). Kentucky is no exception, with 67,394 children living with their grandparents, 58.8% of those grandchildren fall under the responsibility of their grandparents (American Community Survey, 2005). In fact, Region …

False-Negative Studies May Systematically Contaminate The Literature On The Effects Of Inducers In Neuropsychopharmacology. Part I: Focus On Epilepsy, Jose De Leon

Psychiatry Faculty Publications

No abstract provided.

From Blue To Green: The Development And Implementation Of A Horticultural Therapy Program For Residents Of A Battered Women’S Shelter, Claire M. Renzetti, Diane R. Follingstad, Diane Fleet

CRVAW Faculty Presentations

No abstract provided.

Linking Brain Electrical Signals Elicited By Current Outcomes With Future Risk Decision-Making, Dandan Zhang, Ruolei Gu, Lucas S. Broster, Yang Jiang, Wenbo Luo, Jian Zhang, Yue-Jia Luo

Behavioral Science Faculty Publications

The experience of current outcomes influences future decisions in various ways. The neural mechanism of this phenomenon may help to clarify the determinants of decision-making. In this study, thirty-nine young adults finished a risky gambling task by choosing between a high- and a low-risk option in each trial during electroencephalographic data collection. We found that risk-taking strategies significantly modulated mean amplitudes of the event-related potential (ERP) component P3, particularly at the central scalp. The event-related spectral perturbation and the inter-trial coherence measurements of the independent component analysis (ICA) data indicated that the “stay” vs. “switch” electrophysiological difference associated with subsequent …

Pharmacogenomics In Psychiatry: From Therapeutic Drug Monitoring To Genomic Medicine, Séverine Crettol, Jose De Leon, Christoph Hiemke, Chin B. Eap

Psychiatry Faculty Publications

Psychiatry is increasingly combining new pharmacogenomic findings with therapeutic drug monitoring (TDM) to improve the safety and efficacy of pharmacotherapy. However, a distinction should be made between “nice to know” and “need to know” pharmacogenomic data because many results are statistically significant in meta-analyses but are not clinically relevant due to their low effect sizes. Some examples will illustrate this integration.

One Hundred Years Of Limited Impact Of Jaspers’ General Psychopathology On Us Psychiatry, Jose De Leon

Psychiatry Faculty Publications

Jaspers, a German psychiatrist, published General Psychopathology in 1913. Jaspers, Schneider, and Mayer-Gross were members of the Heidelberg school. General Psychopathology, indirectly through Schneider’s and Mayer-Gross’ textbooks and directly by its English translation in 1963, led to a narrow set of schizophrenia criteria in the United Kingdom. General Psychopathology had very limited direct impact on US psychiatry, which adopted a broader schizophrenia definition. The difference between UK and US schizophrenia was a key element in the Diagnostic and Statistical Manual of Mental Disorders, Third Edition, and the neo-Kraepelinian revolution. General Psychopathology contains two essential interrelated ideas: a) psychiatry is …

The Old And The New Eastern State Hospital In Lexington, Kentucky, Jose De Leon, Shane Shoemaker, Allen Brenzel

Psychiatry Faculty Publications

No abstract provided.

Children, Adolescents And Firesetting, Joav Merrick, Carrie Howell Bowling, Hatim A. Omar

Pediatrics Faculty Publications

The research of firesetting has been conducted in different ways and lacks a coherent, consistent and comprehensive set of empirical findings. A recent review concluded that despite a number of risk factors being repeatedly identified, an understanding of the etiology behind firesetting behavior and potential developmental trajectories remains theoretically rather than empirically based. Existing theories do not take sufficient account of the complexities of firesetting behavior and there is not yet a typology and accompanying assessment that has undergone thorough empirical testing and is of significant clinical utility. Due to the relationship between firesetting and antisocial behavior there is a …

Firesetting And Maltreatment, Amy L. Burnett, Hatim A. Omar

Pediatrics Faculty Publications

In this chapter we try to determine if a link exists between firesetting offenders and a past history of maltreatment. A literature review was performed using research from various studies and populations. Firesetting is a significant problem that affects the world's youth today. Even though there is substantial loss of property and life from juvenile firesetters, there is not a great deal of research to provide insight into early identification of those at risk. In the literature review performed, 6 of 7 studies found a link with maltreatment and firesetting behaviors. There does seem to be a correlation between the …

Firesetting Behavior And Psychiatric Disorders, Stephanie Stockburger, Hatim A. Omar

Pediatrics Faculty Publications

Firesetting behavior results in serious damage to lives and property every year. Firesetting has been linked to a number of comorbid psychiatric disorders including depression, substance abuse, conduct disorder, antisocial personality disorder, obsessive compulsive disorder, psychotic disorder, schizoid personality disorder, and schizophrenia. Psychiatric disorders differ by gender. In addition, juvenile firesetters have history of a separate set of psychiatric comorbidities. The strong correlation between psychiatric comorbidities and firesetting behavior illustrates the need for fire service and mental health collaboration.

Self-Reported Juvenile Firesetting, Carrie Howell Bowling, Hatim A. Omar

Pediatrics Faculty Publications

In this chapter we address gaps in existing research by examining the relationship between academic performance and attention problems with juvenile firesetting. Two datasets from the Achenbach System for Empirically Based Assessment (ASEBA) were used. The Factor Analysis Dataset (N = 975) was utilized and results indicated that adolescents who report lower academic performance are more likely to set fires. Additionally, adolescents who report a poor attitude toward school are even more likely to set fires. Logistic regressions were run to determine if attention problems predicted firesetting and the findings indicated that attention problems are predictive of self-reported firesetting. The …

Adolescent Bereavement, Leslie Robin, Hatim A. Omar

Pediatrics Faculty Publications

Depending on cognitive and emotional development, an adolescent may grieve very differently than a child or an adult. While mature enough to understand death's irreversibility, adolescents may not fully comprehend the enduring consequences of a loved one's death. As the desire to separate from their families and forge new intimate relationships with peers assumes increasing priority, adolescents can seem egocentric in their reaction to death, a response which often frustrates and perplexes adults. Because volatile behavior is characteristic of adolescence, health providers struggle to differentiate between normal and complicated bereavement. Here we review the commonly-accepted characteristics of normal and complicated …

Are Major Repeater Patients Addicted To Suicidal Behavior?, Hilario Blasco-Fontecilla, Paula Artieda-Urrutia, Nuria Berenguer-Elias, Juan Manuel Garcia-Vega, Monica Fernandez-Rodriguez, Cesar Rodriguez-Lomas, Isabel Gonzalez-Villalobos, Luis Iruela-Cuadrado, Jose De Leon

Psychiatry Faculty Publications

The literature provides support for the hypothesis that some major repeaters (individuals with >=5 lifetime suicide attempts) are addicted to suicidal behavior (SB). This study explores whether major repeaters are addicted to SB or not using 7 criteria: tolerance (Criterion 1), withdrawal (Criterion 2), loss of control (Criterion 3), problems in quitting/cutting down (Criterion 4), much time spent using (Criterion 5), substantial reduction in activities (Criterion 6), and adverse physiological/physical consequences (Criterion 7). Total dependence on SB was indicated by the presence of 3 or more of the 7 criteria in the last 12 months. This cross-sectional study at Puerta …

Dopamine And Glutamate Dysfunction In A Rodent Model Of Attention-Deficit/Hyperactivity Disorder: Implications For Future Neuropharmacology, Erin M. Miller

Theses and Dissertations--Neuroscience

Attention-deficit/hyperactivity disorder (ADHD) is one of the most common disorders of childhood. It is theorized to be caused by catecholamine dysfunction in the striatum (Str) and frontal cortex (FC). The spontaneously hypertensive rat (SHR) has been used as a model for ADHD because of its attention deficits, impulsiveness, and hyperactivity. Prior studies of dopamine (DA) in the Str and FC have revealed conflicting results in the SHR compared to control, indicative of a need for a better understanding of DA dynamics in this model. In addition to the DA hypothesis, studies have begun implicating glutamate in the etiology of ADHD. …

Trajectories Of Symptom Dimensions In Short-Term Response To Antipsychotic Treatment In Patients With A First Episode Of Non-Affective Psychosis, J. M. Pelayo-Terán, Francisco J. Diaz, R. Pérez-Iglesias, P. Suárez-Pinilla, R. Tabarés-Seisdedos, Jose De Leon, B. Crespo-Facorro

Psychiatry Faculty Publications

Background Trajectory patterns of positive, disorganized and negative dimension symptoms during antipsychotic treatment in drug-naive patients with first-episode psychosis have yet to be examined by using naturalistic data.

Method This pragmatic clinical trial randomized 161 drug-naive patients with a first episode of psychosis to olanzapine, risperidone or haloperidol. Patients were assessed with the Scale for the Assessment of Negative Symptoms (SANS) and Positive Symptoms (SAPS) at baseline and at the end of weeks 1, 2, 3, 4 and 6 of antipsychotic treatment. Censored normal models of response trajectories were developed with three dimensions of the SAPS-SANS scores (positive, disorganized and …

A Post-Dsm-Iii Wake-Up Call To European Psychiatry, Jose De Leon

Psychiatry Faculty Publications

No abstract provided.

Eating Disorder Onset In Young Girls: A Longitudinal Trajectory Analysis, Carolyn M. Pearson

Theses and Dissertations--Psychology

To investigate whether there are different patterns of development for binge eating and purging behavior among pre-adolescent and early adolescent girls, I conducted trajectory analyses of those behaviors in 938 girls across eight waves of data from the spring of 5^th grade (the last year of elementary school) through the spring of 9^th grade (the first year of high school). Analyses revealed four separate developmental trajectories for binge eating behavior (labeled none, increasing, decreasing, and high steady) and three separate developmental trajectories for purging behavior (labeled none, dabble, and increasing). Fifth grade scores on risk factors that were …