Psychiatry and Psychology Commons^™

Clobazam Therapeutic Drug Monitoring: A Comprehensive Review Of The Literature With Proposals To Improve Future Studies, Jose De Leon, Edoardo Spina, Francisco J. Diaz

Psychiatry Faculty Publications

Background: Clobazam was recently approved for Lennox–Gastaut syndrome in the United States. There is no published review article focused on clobazam therapeutic drug monitoring (TDM) in English.

Methods: More than 200 clobazam articles identified by a PubMed search were carefully reviewed for information on clobazam pharmacokinetics. Clobazam is mainly metabolized by a cytochrome P450 (CYP) isoenzyme, CYP3A4, to its active metabolite, N-desmethylclobazam. Then, N-desmethylclobazam is mainly metabolized by CYP2C19 unless the individual has no CYP2C19 activity [poor metabolizer (PM)].

Results: Using a mechanistic approach to reinterpret the published findings of steady-state TDM and single-dosing pharmacokinetic studies, 4 different serum clobazam …

Venlafaxine-Induced Orthostatic Hypotension In A Geriatric Patient, Vidyashree Chikkaramanjegowda, Jose De Leon

Psychiatry Faculty Publications

Venlafaxine is not usually associated with risk of orthostatic hypotension. A 65-year-old US Caucasian female taking 225 mg/day of venlafaxine extended-release developed symptomatic orthostatic hypotension. The systolic and diastolic blood pressure dropped by 25 and 18 mm Hg, respectively, from supine position to standing position within 3 minutes. The patient was otherwise healthy and the orthostatic hypotension resolved with venlafaxine discontinuation. This was a probable venlafaxine adverse drug reaction according to the Naranjo scale. This case contributes to the scarce literature that indicates that clinicians need to be aware that occasionally venlafaxine can induce clinically significant orthostatic hypotension, particularly in …

Methylphenidate And Atomoxetine Treatment During Adolescence In The Spontaneously Hypertensive Rat: Mechanisms Underlying High Cocaine Abuse Liability In Attention Deficit/Hyperactivity Disorder, Sucharita S. Somkuwar

Theses and Dissertations--Pharmacy

Effects of pharmacotherapies for Attention Deficit/Hyperactivity Disorder (ADHD) on cocaine abuse liability in ADHD are not understood. Spontaneously Hypertensive Rats (SHR), an ADHD model, exhibited greater cocaine self-administration than control Wistar-Kyoto and Wistar rats. Methylphenidate, but not atomoxetine during adolescence enhanced cocaine self-administration in adult SHRs compared to controls. The mesocortical dopaminergic system, including medial prefrontal (mPFC) and orbitofrontal (OFC) cortices, is important for ADHD and cocaine addiction. Dopamine and norepinephrine transporter (DAT and NET) are molecular targets for methylphenidate, atomoxetine and cocaine action.

In the current studies, SHR, Wistar-Kyoto and Wistar were administered methylphenidate (1.5 mg/kg/day, p.o.), atomoxetine (0.3 …

United States: Mental Health Issues In An Adolescent Medicine Clinic Patient Population, Abdel Salous, Linah Al-Alem, Hatim A. Omar

Pharmacology and Nutritional Sciences Faculty Publications

The correlation between exposure to forms of violence and development of mental disorders in victims is well established. The purpose of this chapter was to identify mental health problems in an adolescent medicine clinic population in Lexington, Kentucky and to investigate potential correlation of mental disorders with psychosocial factors. Data were gathered from the charts of 169 adolescent clinic patients (age 10-22) seen in the clinic for mental health care and analyzed using Excel. Of the patient population, 68% were urban, whereas 32% were rural. In terms of gender, 40% of the patients were male and 60% were female, 80% …

Reinforcing, Subjective, And Cognitive Effects Of Methamphetamine During D-Amphetamine Maintenance, Erika Pike

Theses and Dissertations--Psychology

Translational research suggests that agonist replacement may be a viable treatment approach for managing methamphetamine dependence. This study sought to determine the effects of d-amphetamine maintenance on methamphetamine self-administration in stimulant using participants. A cognitive battery was used to determine the performance effects of methamphetamine alone and during d-amphetamine maintenance. During each maintenance condition, participants first sampled a dose of intranasal methamphetamine then had the opportunity to respond on a progressive ratio task to earn portions of the sampled dose. Subject-rated drug-effect and physiological measures were completed prior to and after sampling methamphetamine. Methamphetamine was self-administered as function …

Expression Of Borderline Personality Disorder Symptoms Across The Ovulatory Cycle: A Multilevel Investigation, Tory A. Eisenlohr-Moul

Theses and Dissertations--Psychology

Borderline Personality Disorder (BPD) is a disabling condition characterized by chronic emotion dysregulation and behavioral impulsivity. Prospective studies that test proposed mechanisms of within-person change in BPD hold the key to improving symptom predictability and control in this disorder. A small body of evidence suggests that fluctuations in estradiol such as those occurring naturally at ovulation during the monthly female reproductive cycle may increase symptoms in women with BPD (DeSoto et al., 2003). Furthermore, there is preliminary evidence that both self-esteem and feelings of social rejection are highest at ovulation, when estradiol peaks (Durante and Hill, 2009; Eisenlohr-Moul et al., …

Lamotrigine Augmentation Of Serotonin Reuptake Inhibitors In Severe And Long-Term Treatment-Resistant Obsessive-Compulsive Disorder, Manuel Arrojo-Romero, María Tajes Alonso, Jose De Leon

Psychiatry Faculty Publications

The treatment recommendations in obsessive-compulsive disorder (OCD) after lack of response to selective serotonin reuptake inhibitors (SSRIs) include augmentation with other drugs, particularly clomipramine, a more potent serotonin reuptake inhibitor (SRI), or antipsychotics. We present two cases of response to lamotrigine augmentation in treatment-refractory OCD; each received multiple SRI trials over a >10-year period. The first patient had eleven years of treatment with multiple combinations including clomipramine and SSRIs. She had a >50% decrease of Y-BOCS (from 29 to 14) by augmenting paroxetine (60 mg/day) with lamotrigine (100 mg/day). The second patient had 22 years of treatment with multiple combinations, …

Neurological Soft Signs In Persons With Amnestic Mild Cognitive Impairment And The Relationships To Neuropsychological Functions, Hui-Jie Li, Peng-Yun Wang, Yang Jiang, Raymond C.K. Chan, Hua-Li Wang, Juan Li

Behavioral Science Faculty Publications

BACKGROUND: Neurological abnormalities have been reported in people with amnestic mild cognitive impairment (aMCI). The current study aimed to examine the prevalence of neurological soft signs (NSS) in this clinical group and to examine the relationship of NSS to other neuropsychological performances.

METHODS: Twenty-nine people with aMCI and 28 cognitively healthy elderly people were recruited for the present study. The NSS subscales (motor coordination, sensory integration, and disinhibition) of the Cambridge Neurological Inventory and a set of neuropsychological tests were administered to all the participants.

RESULTS: People with aMCI exhibited significantly more motor coordination signs, disinhibition signs, and total NSS …

Genetics Of Schizophrenia And Smoking: An Approach To Studying Their Comorbidity Based On Epidemiological Findings, Jose De Leon, Francisco J. Diaz

Psychiatry Faculty Publications

The association between schizophrenia and tobacco smoking has been described in more than 1,000 articles, many with inadequate methodology. The studies on this association can focus on: (1) current smoking, ever smoking or smoking cessation; (2) non-psychiatric controls or controls with severe mental illness (e.g., bipolar disorder); and (3) higher smoking frequency or greater usage in smokers. The association with the most potential for genetic studies is that between ever daily smoking and schizophrenia; it may reflect a shared genetic vulnerability. To reduce the number of false-positive genes, we propose a three-stage approach derived from epidemiological knowledge. In the first …

Evidence-Based Medicine Versus Personalized Medicine: Are They Enemies?, Jose De Leon

Psychiatry Faculty Publications

No abstract provided.

Does Emotional Memory Enhancement Assist The Memory-Impaired?, Lucas S. Broster, Lee X. Blonder, Yang Jiang

Behavioral Science Faculty Publications

We review recent work on emotional memory enhancement in older adults and patients with mild cognitive impairment (MCI) or Alzheimer dementia (AD) and evaluate the viability of incorporating emotional components into cognitive rehabilitation for these groups. First, we identify converging evidence regarding the effects of emotional valence on working memory in healthy aging. Second, we introduce work that suggests a more complex role for emotional memory enhancement in aging and identify a model capable of unifying disparate research findings. Third, we survey the neuroimaging literature for evidence of a special role for the amygdala in MCI and early AD in …

Drug Dosage Individualization Based On A Random-Effects Linear Model, Francisco J. Diaz, Myladis R. Cogollo, Edoardo Spina, Vincenza Santoro, Diego M. Rendon, Jose De Leon

Psychiatry Faculty Publications

This article investigates drug dosage individualization when the patient population can be described with a random-effects linear model of a continuous pharmacokinetic or pharmacodynamic response. Specifically, we show through both decision-theoretic arguments and simulations that a published clinical algorithm may produce better individualized dosages than some traditional methods of therapeutic drug monitoring. Since empirical evidence suggests that the linear model may adequately describe drugs and patient populations, and linear models are easier to handle than the nonlinear models traditionally used in population pharmacokinetics, our results highlight the potential applicability of linear mixed models to dosage computations and personalized medicine.

Lower Gastrointestinal Bleeding And Paroxetine Use: Two Case Reports, Hilario Blasco-Fontecilla, Jose De Leon

Psychiatry Faculty Publications

Paroxetine is a selective serotonin reuptake inhibitor (SSRI), and an effective long-term treatment for social anxiety and major depression. SSRIs in general, and paroxetine in particular, were described as associated with depletion of serotonin in platelets. Serotonin is involved in platelet aggregation, and the association of bleeding and SSRI use was suggested two decades ago. In the last few years, some reviews have confirmed that initial fear. In contrast with aspirin, SSRIs seem to be related to non-ulcer, non-variceal gastrointestinal bleeds. SSRIs are usually associated with upper gastrointestinal bleeding but there is surprisingly little literature on lower gastrointestinal bleeding (LGIB) …

Interactions Between Antiepileptics And Second-Generation Antipsychotics, Jose De Leon, Vincenza Santoro, Concetta D'Arrigo, Edoardo Spina

Psychiatry Faculty Publications

INTRODUCTION: Pharmacokinetic and pharmacodynamic drug interactions (DIs) can occur between antiepileptics (AEDs) and second-generation antipsychotics (SGAPs). Some AED and SGAP pharmacodynamic mechanisms are poorly understood. AED-SGAP combinations are used for treating comorbid illnesses or increasing efficacy, particularly in bipolar disorder.

AREAS COVERED: This article provides a comprehensive review of the interactions between antiepileptics and second-generation antipsychotics. The authors cover pharmacokinetic AED-SGAP DI studies, the newest drug pharmacokinetics in addition to the limited pharmacodynamic DI studies.

EXPERT OPINION: Dosing correction factors and measuring SGAP levels can help to compensate for the inductive properties of carbamazepine, phenytoin, phenobarbital and primidone. Further studies …

Psychosis And Smoking Cessation: Difficulties In Quitting Associated With Sex And Substance Abuse, Ana González-Pinto, Susana Alberich, Sonia Ruiz De Azúa, Mónica Martínez-Cengotitabengoa, Miryan Fernández, Miguel Gutiérrez, Margarita Saenz, Ariadna Besga, Paloma Galdós, Jose De Leon

Psychiatry Faculty Publications

No prospective studies of first psychotic episodes have explored sex differences in smoking cessation. The aim of this study was to determine the influence of sex and substance abuse on smoking cessation during an 8-year follow-up of patients after a first psychotic episode. Logistic regression modeling was used to identify factors associated with smoking cessation by sex. To examine for sex variable interactions, the following two methods were used: 1) for other clinical variables, mixed analyses were calculated; and 2) for use of other substances, logistic regression models were performed only in the substance users. At baseline, 79% of men …

Can The Holmes-Rahe Social Readjustment Rating Scale (Srrs) Be Used As A Suicide Risk Scale? An Exploratory Study, Hilario Blasco-Fontecilla, David Delgado-Gomez, Teresa Legido-Gil, Jose De Leon, M. Mercedes Perez-Rodriguez, Enrique Baca-Garcia

Psychiatry Faculty Publications

The objective of this research was to examine whether the Holmes-Rahe Social Readjustment Rating Scale, a life event scale, can be used to identify suicide attempters. The Holmes-Rahe Social Readjustment Rating Scale's ability to identify suicide attempters was tested in 1183 subjects (478 suicide attempters, 197 psychiatric inpatients, and 508 healthy controls) using the Fisher Linear Discriminant Analysis and traditional psychometric methods. The Fisher Linear Discriminant Analysis outperformed traditional psychometric approaches (area under the curve: 0.85 vs. 0.78; p < 0.05) and indicated that this scale may be used to identify suicide attempters. The life events that better characterized suicide attempters were change in frequency of arguments, marital separation, and personal injury. The Holmes-Rahe Social Readjustment Rating Scale may help identify suicide attempters.

Using The Scrambled Sentences Test To Examine Relationships Between Cognitive Bias, Thought Suppression And Borderline Personality Features, Paul Jefferson Geiger

Theses and Dissertations--Psychology

Cognitive bias and thought suppression are two maladaptive patterns of thinking that have been associated with borderline personality disorder (BPD). Negative cognitive biases related to BPD include thoughts that they are bad, powerless, or vulnerable and that the world is dangerous. Thought suppression is a maladaptive emotion regulation strategy where unwanted thoughts are intentionally pushed out of one’s consciousness. However, previous research has connected thought suppression and cognitive biases to BPD only via self-report measures. The present study examined whether a laboratory task meant to measure cognitive bias and thought suppression (Scrambled Sentences Test) would predict BPD features over and …

The Design Of A Psychiatric Residential Treatment Facility In Wheelwright, Kentucky Serving Adolescent Males, Jenna Clem

Kaleidoscope

During the spring semester of 2010, I have been working on the design of a psychiatric residential treatment facility in Wheelwright, Kentucky as part of the requirements for ID 659, Interior Design Graduate Studio. I am a senior, but was allowed permission to enroll in this class because of my interest in research-based design. The facility will offer therapy services in a home environment for seven adolescents between the ages of ten and seventeen. This paper describes the process that I followed throughout the design process and the specific issues that were addressed in the final solution. The design process …

Smoking Cessation Outcomes Among Individuals With Substance Use And/Or Psychiatric Disorders, Milan Khara, Chizimuzo T.C. Okoli

Nursing Faculty Publications

Objectives: The population of individuals with substance use (SUD) and/or psychiatric disorders (PD) has a high prevalence of smoking and a consequent increase in tobacco-related morbidity and mortality when compared to the general population. The aim of this study is to examine the outcomes of a program in a real-life setting which takes a tailored approach to smoking cessation among individuals with SUD and/or PD.

Methods: A retrospective chart review of tailored tobacco dependence treatment was performed on individuals with histories of SUD and/or PD attending a Tobacco Dependence Clinic (TDC) program in Vancouver, British Columbia, Canada. Participants of the …

Response To An Abnormal Ovarian Cancer-Screening Test Result: Test Of The Social Cognitive Processing And Cognitive Social Health Information Processing Models, Michael A. Andrykowski, Edward J. Pavlik

Behavioral Science Faculty Publications

All cancer screening tests produce a proportion of abnormal results requiring follow up. Consequently, the cancer-screening setting is a natural laboratory for examining psychological and behavioural response to a threatening health-related event. This study tested hypotheses derived from the social cognitive processing and cognitive-social health information processing models in trying to understand response to an abnormal ovarian cancer (OC) screening test result. Women (n = 278) receiving an abnormal screening test result a mean of 7 weeks earlier were assessed prior to a repeat screening test intended to clarify their previous abnormal result. Measures of disposition (optimism, informational coping style), …

Route Of Administration For Illicit Prescription Opioids: A Comparison Of Rural And Urban Drug Users, April M. Young, Jennifer R. Havens, Carl G. Leukefeld

Behavioral Science Faculty Publications

BACKGROUND: Nonmedical prescription opioid use has emerged as a major public health concern in recent years, particularly in rural Appalachia. Little is known about the routes of administration (ROA) involved in nonmedical prescription opioid use among rural and urban drug users. The purpose of this study was to describe rural-urban differences in ROA for nonmedical prescription opioid use.

METHODS: A purposive sample of 212 prescription drug users was recruited from a rural Appalachian county (n = 101) and a major metropolitan area (n = 111) in Kentucky. Consenting participants were given an interviewer-administered questionnaire examining sociodemographics, psychiatric disorders, and self-reported …

Increasing Complexity: Resisting Simplification In Forensic Psychology, Diane R. Follingstad

CRVAW Faculty Journal Articles

The American Academy of Forensic Psychology annually presents a Distinguished Contribution in Forensic Psychology Award to an individual whose work has significantly moved the field forward. Dr. Follingstad received this award for decades of productive research, testimony, and public education regarding family, adolescent, and women's issues, all areas in which she has received numerous research grants over the years. Following is her acceptance speech, presented at the American Psychology-Law Association convention in Vancouver, B.C. in March 2010.

Fagerstrom Test For Nicotine Dependence Vs Heavy Smoking Index In A General Population Survey, M. Pérez-Ríos, M. I. Santiago-Pérez, B. Alonso, A. Malvar, X. Hervada, Jose De Leon

Psychiatry Faculty Publications

BACKGROUND: The Fagerström Test for Nicotine Dependence (FTND) is used for assessing nicotine dependence. A shorter test derived from the FTND used for the general population is the Heavy Smoking Index (HSI) (six questions vs. two). The objective of this study is to compare the validity of the HSI versus the FTND.

METHODS: A survey of tobacco use in the general population was carried out in the northern Spanish region of Galicia using both the FTND and the HSI to study a representative sample of 1655 daily smokers. The HSI was compared with the FTND, considered the gold standard. Measures …

A Retrospective Claims Analysis Of Combination Therapy In The Treatment Of Adult Attention-Deficit/Hyperactivity Disorder (Adhd), Gerhardt M. Pohl, David L. Van Brunt, Wenyu Ye, William W. Stoops, Joseph A. Johnston

Behavioral Science Faculty Publications

BACKGROUND: Combination therapy in managing psychiatric disorders is not uncommon. While combination therapy has been documented for depression and schizophrenia, little is known about combination therapy practices in managing attention-deficit/hyperactivity disorder (ADHD). This study seeks to quantify the combination use of ADHD medications and to understand predictors of combination therapy.

METHODS: Prescription dispensing events were drawn from a U.S. national claims database including over 80 managed-care plans. Patients studied were age 18 or over with at least 1 medical claim with a diagnosis of ADHD (International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM] code 314.0), a pharmacy claim for …

Drug Abuse Treatment Beyond Prison Walls, Carl Leukefeld, Carrie B. Oser, Jennifer Havens, Michele Staton Tindall, Jennifer Mooney, Jamieson B. Duvall, Hannah Knudsen

Behavioral Science Faculty Publications

The period surrounding release from prison is a critical time for parolees, bearing the potential for a drug-free and crime-free life in the community but also high risks for recidivism and relapse to drugs. The authors describe two projects. The first illustrates the use of a formal Delphi process to elicit and combine the expertise of treatment providers, researchers, corrections personnel, and other stakeholders in a set of statewide guidelines for facilitating re-entry. The second project is a six-session intervention to enable women to protect themselves against acquiring or transmitting HIV in their intimate relationships.

The Future (Or Lack Of Future) Of Personalized Prescription In Psychiatry, Jose De Leon

Psychiatry Faculty Publications

Rapid technological advances in genetics have created conceptual chaos regarding the genetics of drug response. Terms for differing concepts are used interchangeably: pharmacogenetics with pharmacogenomics, personalized medicine with personalized prescription. Biomarker has many definitions. The author prefers the concept of personalized prescription and uses it with implications beyond pharmacogenetics by considering all scientific information valid for prescribing medication. Genetics may not be crucial for all drugs. In this comprehensive view, clinicians must consider genetic, environmental and personal variables when prescribing medication and incorporate some basic pharmacological principles: (1) safety and efficacy, (2) pharmacokinetics and pharmacodynamics, (3) therapeutic window and prescriber's …

Caffeine Use: Association With Nicotine Use, Aggression, And Other Psychopathology In Psychiatric And Pediatric Outpatient Adolescents, Catherine A. Martin, Circe Cook, John H. Woodring, Gretchen Burkhardt, Greg Guenthner, Hatim A. Omar, Tom H. Kelly

Psychiatry Faculty Publications

The objective of this study was to evaluate the relationship between caffeine use, other drug use, and psychopathology in adolescents, using self-report measures. The study group consisted of 132 adolescents (average age 14.01 ± 2.06 years, 52% female, 19% African American, 5% other categories, 76% Caucasian). Most (47%) were recruited from a child psychiatry clinic with emphasis on youth with disruptive disorders, with 35% from an adolescent pediatric clinic with emphasis on prevention of risk-taking behavior and 18% from a pediatric clinic for families with limited resources. Subjects were consecutively recruited before or after regular clinic visits. Consent was obtained …

The Health Implications Of Violence Against Women: Untangling The Complexities Of Actual And Chronic Effects: Part Two, Carol E. Jordan

Office for Policy Studies on Violence Against Women Publications

No abstract provided.

Stress, Coping, Social Support, And Prostate Cancer Risk Among Older African American And Caucasian Men, Ann L. Coker, Maureen Sanderson, Gary L. Ellison, Mary Kay Fadden

CRVAW Faculty Journal Articles

Objectives: While psychosocial stress and high effort coping have been associated with reduced immune function, no epidemiologic study has addressed psychological stress and risk of prostate cancer. The purpose of this analysis was to investigate the association between stress, coping, social support, and risk of prostate cancer among older men (age 65–79 years). Design: Population-based case-control study in South Carolina.

Participants: Cases were 400 incident, histologically confirmed prostate cancer cases identified through the South Carolina Central Cancer Registry between 1999 and 2001 (70.6% response rate). Controls were 385 men identified through the 1999 Health Care Financing Administration Medicare beneficiary file …

A Pilot Study: Attention Deficit Hyperactivity Disorder, Sensation Seeking, And Pubertal Changes, Catherine A. Martin, Greg Guenthner, Christopher Bingcang, W. Jackson Smith, Thomas E. Curry, Hatim A. Omar, Mary Kay Rayens, Tom H. Kelly

Pediatrics Faculty Publications

This study was designed to examine the relationship of pubertal changes and sensation seeking (SS) in adolescents with Attention Deficit Hyperactivity Disorder (ADHD). Patients with current or past histories of uncomplicated stimulant medication use for ADHD between the ages of 11 and 15 (13 ± 1.5) were recruited from a Child Psychiatry and a General Pediatric Clinic. SS was measured using the SS Scale for Children. Pubertal development was measured using Tanner staging, free testosterone, and DHEAS. Subjects and their parent were interviewed with the Diagnostic Interview Schedule for Children (DISC). SS total score was correlated with Tanner stage, free …