ImportanceThe months after psychiatric hospital discharge are a time of high risk for suicide. In... more ImportanceThe months after psychiatric hospital discharge are a time of high risk for suicide. Intensive postdischarge case management, although potentially effective in suicide prevention, is likely to be cost-effective only if targeted at high-risk patients. A previously developed machine learning (ML) model showed that postdischarge suicides can be predicted from electronic health records and geospatial data, but it is unknown if prediction could be improved by adding additional information.ObjectiveTo determine whether model prediction could be improved by adding information extracted from clinical notes and public records.Design, Setting, and ParticipantsModels were trained to predict suicides in the 12 months after Veterans Health Administration (VHA) short-term (less than 365 days) psychiatric hospitalizations between the beginning of 2010 and September 1, 2012 (299 050 hospitalizations, with 916 hospitalizations followed within 12 months by suicides) and tested in the hospit...
Objective:The aim of this study was to identify factors associated with acceptability and efficac... more Objective:The aim of this study was to identify factors associated with acceptability and efficacy of yoga training (YT) for improving cognitive dysfunction in individuals with schizophrenia (SZ).Methods:We analysed data from two published clinical trials of YT for cognitive dysfunction among Indians with SZ: (1) a 21-day randomised controlled trial (RCT, N = 286), 3 and 6 months follow-up and (2) a 21-day open trial (n = 62). Multivariate analyses were conducted to examine the association of baseline characteristics (age, sex, socio-economic status, educational status, duration, and severity of illness) with improvement in cognition (i.e. attention and face memory) following YT. Factors associated with acceptability were identified by comparing baseline demographic variables between screened and enrolled participants as well as completers versus non-completers.Results:Enrolled participants were younger than screened persons who declined participation (t = 2.952, p = 0.003). No othe...
Objective: This study aimed to prospectively assess outcomes for surgical autologous fat transfer... more Objective: This study aimed to prospectively assess outcomes for surgical autologous fat transfer (AFT) applied for traumatic and postsurgical craniofacial deformities. The minimally invasive nature of AFT has potential for reduced risk and superior outcomes compared with current reconstructive options. Background: Craniofacial deformities have functional and psychosocial sequelae and can profoundly affect quality of life. Traditional reconstructive options are invasive, invasive, complex, and often lack precision in outcomes. Although AFT is safe, effective, and minimally invasive, only anecdotal evidence exists for reconstruction of craniofacial deformities. Methods: In this Institutional Review Board-approved prospective cohort study, 20 subjects underwent AFT (average volume: 23.9 ± 13.2 mL). Volume retention over time was determined using high-resolution computed tomography. Flow cytometry was used to assess cellular subpopulations and viability in the stromal vascular fraction...
Objective-The examination to determine if a veteran has service-connected posttraumatic stress di... more Objective-The examination to determine if a veteran has service-connected posttraumatic stress disorder (PTSD) affects veterans' lives for years afterwards. This study examined factors potentially associated with veterans' perception of their examination's quality. Methods-Three hundred eighty-four veterans participated in a clinical trial in which they received either a semi-structured interview or the examiner's usual interview. Immediately after the interview, veterans completed confidential ratings of the examination's quality and of their examiners' interpersonal qualities and competence. Extensive data characterizing the veterans, the 33 participating examiners, and the examinations themselves were collected. Results-Forty-seven percent of Caucasian veterans versus 34% of African American veterans rated their examination quality as "excellent." In multivariate analysis, African Americans were less likely than Caucasians to assign a higher quality rating (odds ratio .61, 95% confidence interval .38 -.99). African Americans also rated their examiners as having significantly worse interpersonal qualities but not lower competence. Ratings were not significantly related to the veterans' age, gender, marital status, eventual diagnosis with PTSD, Global Assessment of Functioning score, the examiners' perception of the prevalence of malingering, or the presence of a third party in the examination. Conclusions-Ratings of disability examinations were generally high, although African American veterans' ratings were less favorable than Caucasian veterans' ratings. Veterans who claim a mental health condition was caused or exacerbated by their military service can apply for disability payments from the Department of Veterans Affairs. Once an application is filed, the veteran has an examination with a mental health professional that is central to assessing the claim. The approval or denial of a PTSD claim has far-reaching implications (1) as it can result in lifelong priority access to VA care, financial remuneration, and an official acknowledgement that the veteran was harmed by military service. As of 2009, there were 345,520 veterans receiving service-connected payments for PTSD (2), a number reflecting that disability awards are often continued for decades after the initial award (3). Many veterans find the PTSD Compensation interview to be stressful and indicate that the Compensation examinations are conducted by examiners who do not understand them, question them skeptically, and display unfamiliarity with the military (4). These views are shared by many representatives of organizations that support veterans with their applications (5). Veterans' perceptions that their examinations were of lower quality are damaging.
Background.Cognitive impairments, which contribute to the profound functional deficits observed i... more Background.Cognitive impairments, which contribute to the profound functional deficits observed in psychotic disorders, have found to be associated with abnormalities in trial-level cognitive control. However, neural tasks operate within the context of sustained cognitive states, which can be assessed with ‘background connectivity’ following the removal of task effects. To date, little is known about the integrity of brain processes supporting the maintenance of a cognitive state in individuals with psychotic disorders. Thus, here we examine background connectivity during executive processing in a cohort of participants with first-episode psychosis (FEP).Methods.The following fMRI study examined background connectivity of the dorsolateral prefrontal cortex (DLPFC), during working memory engagement in a group of 43 patients with FEP, relative to 35 healthy controls (HC). Findings were also examined in relation to measures of executive function.Results.The FEP group relative to HC showed significantly lower background DLPFC connectivity with bilateral superior parietal lobule (SPL) and left inferior parietal lobule. Background connectivity between DLPFC and SPL was also positively associated with overall cognition across all subjects and in our FEP group. In comparison, resting-state frontoparietal connectivity did not differ between groups and was not significantly associated with overall cognition, suggesting that psychosis-related alterations in executive networks only emerged during states of goal-oriented behavior.Conclusions.These results provide novel evidence indicating while frontoparietal connectivity at rest appears intact in psychosis, when engaged during a cognitive state, it is impaired possibly undermining cognitive control capacities in FEP.
Biological Psychiatry: Cognitive Neuroscience and Neuroimaging, May 1, 2019
Background: A longer duration of untreated psychosis (DUP) has been linked with poor clinical out... more Background: A longer duration of untreated psychosis (DUP) has been linked with poor clinical outcomes, as well as variation in resting-state striatal connectivity with central executive regions. However, the link between DUP and task-based activation of executive neurocognition has not previously been examined. The following fMRI study examined the association between DUP and both activation and frontostriatal functional connectivity during a visual working memory (WM) paradigm in patients with first-episode psychosis (FEP). Methods: Patients with FEP (N=37) underwent fMRI scanning while performing a visual WM task. At the single-subject level, task conditions were modeled; at the group level, each condition was examined along with DUP. Activation was examined within the dorsolateral prefrontal cortex (DLPFC), a primary region supporting visual WM activation. Frontostriatal functional connectivity during the WM was examined via psychophysical interaction between the dorsal caudate and the DLPFC. Results were compared to a reference range of connectivity values in a matched group of healthy volunteers (N=25). Task performance was also examined in relation to neuroimaging findings. Results: No significant association was observed between DUP and WM activation. Longer DUP showed less functional frontostriatal connectivity with the maintenance of increasing WM load. Results were not related to task performance measures, consistent with prior work. Conclusions: Our data suggest that DUP may affect frontostriatal circuitry that supports executive functioning. Future work is necessary to examine if these findings contribute to the mechanism underlying the relationship between DUP and worsened clinical outcomes.
There is growing evidence suggesting that abnormalities in cortical-basal ganglia circuitry may p... more There is growing evidence suggesting that abnormalities in cortical-basal ganglia circuitry may play a significant role in determining outcomes in schizophrenia. The globus pallidus (GP), a critical structure within this circuitry, unique in its role as a mediator of competing inputs through the striatum, has not been well characterized in schizophrenia. The following study examined functional interactions of the GP in individuals with first-episode schizophrenia (FES). To probe the large-scale intrinsic connectivity of the GP, resting-state fMRI scans were obtained from patients with FES and sex and age-matched healthy controls. Participants with FES were also evaluated after 6 months via the Strauss-Carpenter Outcomes Scale to assess overall functional trajectory. The GP was parcellated to generate seeds within its substructures, and connectivity maps were generated. Our FES cohort showed significantly lower functional connectivity between the left GP interna and a network of regions including the dorsolateral prefrontal cortex, caudate, and cerebellum at baseline. In addition, FES participants with lower overall scores of functioning at 6 months showed significantly decreased connectivity between the GP interna and the dorsal anterior cingulate and bilateral insula, all regions important for motivational salience. These results provide novel evidence for unique abnormalities in functional interactions of the GP with key prefrontal cortical regions in FES. Our findings also suggest that reduced prefrontal-pallidal connectivity may serve as a predictor of early functional outcome.
Background and Hypothesis: Quantitative models of psychopathology can empirically guide subclassi... more Background and Hypothesis: Quantitative models of psychopathology can empirically guide subclassification of heterogeneous clinical presentations such as psychosis; they are particularly well-equipped to capture the nuanced symptomatology observed in first-episode psychosis. As well, components may be better aligned with biological variables. The current study sought to confirm and extend knowledge of the hierarchical structure of psychosis symptoms in first-episode psychosis. Based on past hierarchical work, we hypothesized that a 4 component level would be most closely associated with longitudinal disability. Study Design: Participants with early-stage psychosis (N = 370) underwent clinical assessment with the scale for the assessment of positive symptoms (SAPS), scale for assessment of negative symptoms (SANS), and global assessment scale(GAS). A subset was assessed at 6 months (N = 221) and 1 year (N = 207). Hierarchical symptom components were extracted at 12 levels. The predictive utility of the components for global functioning was tested. Study Results: As predicted, the 4-component model (reality distortion, thought disorder, inexpressivity, apathy/asociality) provided a superior prediction of functioning over other levels of the hierarchy. Baseline apathy/asociality longitudinally predicted functioning beyond the shared variance of the components at 6 months (b = −4.83, t(216) = −5.37, p < .001, R 2 adj = 0.12) and 1-year (b = −4.49, t(202) = −4.38, p < .001, R 2 adj = 0.09). Conclusions: The hierarchical structure of psychotic symptomatology and its external validity have been robustly established in independent, longitudinal first-episode psychosis samples. The established model incorporates multiple levels of granularity that can be flexibly applied based on the level that offers the greatest predictive utility for external validators.
B ecause treatments that have proved efficacious in academic settings over the past 30 years have... more B ecause treatments that have proved efficacious in academic settings over the past 30 years have rarely been adopted by community agencies (1,2), there is a need to develop ways to translate and disseminate useful programs to community settings. One such treatment is family psychoeducation (3-5). The results of more than 30 experimental trials have established family psychoeducation as an evidence-based practice (6,7) routinely recommended as the gold standard for care of persons and families coping with schizophrenia (1,8-11). However, results from the seminal Schizophrenia Patient Outcomes Research Team study showed that although 77% of those with schizophrenia live with or have ongoing contact with their families, only a small proportion have an outpatient claim for any family intervention (<1% Medicare and 7% Medicaid) (2). These data led us to design a randomized feasibility trial of an adapted telehealth family psychoeducational intervention provided to users' homes to increase community dissemination. Online interventions have the potential to overcome several barriers to dissemination and community care for persons with serious mental illness, including the limited number of persons with schizophrenia in some clinics, the high costs of training staff
This study investigated whether a higher frequency of reported childhood trauma would be found in... more This study investigated whether a higher frequency of reported childhood trauma would be found in depressed adults with higher levels of trait impulsivity, aggression, and suicidal behavior. Method: In 136 depressed adult inpatients, the authors assessed trait impulsivity, aggression history, and number of lifetime suicide attempts as well as the medical lethality and the intent to die associated with the most lethal attempt. These variables were then compared between those with and those without a reported history of childhood physical or sexual abuse. Results: Subjects who reported an abuse history were more likely to have made a suicide attempt and had significantly higher impulsivity and aggression scores than those who did not report an abuse history. Impulsivity and aggression scores were significantly higher in subjects with a history of at least one suicide attempt. A logistic regression analysis revealed that abuse history remained significantly associated with suicide attempt status after adjustment for impulsivity, aggression history, and presence of borderline personality disorder. Among those who attempted suicide, there were no significant differences in severity of suicidal behavior between those with and without a childhood history of abuse. Conclusions: Abuse in childhood may constitute an environmental risk factor for the development of trait impulsivity and aggression as well as suicide attempts in depressed adults. Alternatively, impulsivity and aggression may be inherited traits underlying both childhood abuse and suicidal behavior in adulthood disorders. Additional research is needed to estimate the relative contributions of heredity and environmental experience to the development of impulsivity, aggression, and suicidal behavior.
Background: Suicidal thoughts and behaviors have been studied in association with a variety of ri... more Background: Suicidal thoughts and behaviors have been studied in association with a variety of risk factors. The aim of the present study was to determine if levels of child/adolescent aggression and/or variation in candidate genes previously associated with suicidal behaviors in adults would influence the presence of suicidal ideation in childhood/adolescence, and to determine if ideation was associated with young adult depression. Methods: A longitudinal study of children, adolescents and young adults who were at high or low risk for alcohol and other substance use disorders by familial background were assessed. The Child Behavior Checklist (CBCL) aggression scale scores with derived subtypes (physical and relational) and genetic variation (ANKK1, DRD2, COMT, SLC6A4, HTR2C) were used as predictors of the presence and onset of suicidal ideation in childhood using survival analysis. Structural equation models (SEM) were fit to determine the relative importance of the predictors controlling for background variables. Results: CBCL aggression was significantly associated with child/adolescent suicidal ideation. One SNP in the ANKK1 gene (rs1800497), one in the HTR2C gene (rs6318), and two haplotypes, AAAC in the ANKK1-DRD2 complex and the CCC haplotype of the HTR2C gene, were significantly associated with the presence and onset of child/adolescent suicidal ideation. Follow up in young adulthood showed a significant relationship between suicidal ideation in childhood/adolescence and young adult depression. Conclusions: Genetic variation and presence of elevated aggression scores from the childhood CBCL are significant predictors of childhood suicidal ideation. Suicidal ideation in childhood and being female are predictors of young adult depression.
ImportanceThe months after psychiatric hospital discharge are a time of high risk for suicide. In... more ImportanceThe months after psychiatric hospital discharge are a time of high risk for suicide. Intensive postdischarge case management, although potentially effective in suicide prevention, is likely to be cost-effective only if targeted at high-risk patients. A previously developed machine learning (ML) model showed that postdischarge suicides can be predicted from electronic health records and geospatial data, but it is unknown if prediction could be improved by adding additional information.ObjectiveTo determine whether model prediction could be improved by adding information extracted from clinical notes and public records.Design, Setting, and ParticipantsModels were trained to predict suicides in the 12 months after Veterans Health Administration (VHA) short-term (less than 365 days) psychiatric hospitalizations between the beginning of 2010 and September 1, 2012 (299 050 hospitalizations, with 916 hospitalizations followed within 12 months by suicides) and tested in the hospit...
Objective:The aim of this study was to identify factors associated with acceptability and efficac... more Objective:The aim of this study was to identify factors associated with acceptability and efficacy of yoga training (YT) for improving cognitive dysfunction in individuals with schizophrenia (SZ).Methods:We analysed data from two published clinical trials of YT for cognitive dysfunction among Indians with SZ: (1) a 21-day randomised controlled trial (RCT, N = 286), 3 and 6 months follow-up and (2) a 21-day open trial (n = 62). Multivariate analyses were conducted to examine the association of baseline characteristics (age, sex, socio-economic status, educational status, duration, and severity of illness) with improvement in cognition (i.e. attention and face memory) following YT. Factors associated with acceptability were identified by comparing baseline demographic variables between screened and enrolled participants as well as completers versus non-completers.Results:Enrolled participants were younger than screened persons who declined participation (t = 2.952, p = 0.003). No othe...
Objective: This study aimed to prospectively assess outcomes for surgical autologous fat transfer... more Objective: This study aimed to prospectively assess outcomes for surgical autologous fat transfer (AFT) applied for traumatic and postsurgical craniofacial deformities. The minimally invasive nature of AFT has potential for reduced risk and superior outcomes compared with current reconstructive options. Background: Craniofacial deformities have functional and psychosocial sequelae and can profoundly affect quality of life. Traditional reconstructive options are invasive, invasive, complex, and often lack precision in outcomes. Although AFT is safe, effective, and minimally invasive, only anecdotal evidence exists for reconstruction of craniofacial deformities. Methods: In this Institutional Review Board-approved prospective cohort study, 20 subjects underwent AFT (average volume: 23.9 ± 13.2 mL). Volume retention over time was determined using high-resolution computed tomography. Flow cytometry was used to assess cellular subpopulations and viability in the stromal vascular fraction...
Objective-The examination to determine if a veteran has service-connected posttraumatic stress di... more Objective-The examination to determine if a veteran has service-connected posttraumatic stress disorder (PTSD) affects veterans' lives for years afterwards. This study examined factors potentially associated with veterans' perception of their examination's quality. Methods-Three hundred eighty-four veterans participated in a clinical trial in which they received either a semi-structured interview or the examiner's usual interview. Immediately after the interview, veterans completed confidential ratings of the examination's quality and of their examiners' interpersonal qualities and competence. Extensive data characterizing the veterans, the 33 participating examiners, and the examinations themselves were collected. Results-Forty-seven percent of Caucasian veterans versus 34% of African American veterans rated their examination quality as "excellent." In multivariate analysis, African Americans were less likely than Caucasians to assign a higher quality rating (odds ratio .61, 95% confidence interval .38 -.99). African Americans also rated their examiners as having significantly worse interpersonal qualities but not lower competence. Ratings were not significantly related to the veterans' age, gender, marital status, eventual diagnosis with PTSD, Global Assessment of Functioning score, the examiners' perception of the prevalence of malingering, or the presence of a third party in the examination. Conclusions-Ratings of disability examinations were generally high, although African American veterans' ratings were less favorable than Caucasian veterans' ratings. Veterans who claim a mental health condition was caused or exacerbated by their military service can apply for disability payments from the Department of Veterans Affairs. Once an application is filed, the veteran has an examination with a mental health professional that is central to assessing the claim. The approval or denial of a PTSD claim has far-reaching implications (1) as it can result in lifelong priority access to VA care, financial remuneration, and an official acknowledgement that the veteran was harmed by military service. As of 2009, there were 345,520 veterans receiving service-connected payments for PTSD (2), a number reflecting that disability awards are often continued for decades after the initial award (3). Many veterans find the PTSD Compensation interview to be stressful and indicate that the Compensation examinations are conducted by examiners who do not understand them, question them skeptically, and display unfamiliarity with the military (4). These views are shared by many representatives of organizations that support veterans with their applications (5). Veterans' perceptions that their examinations were of lower quality are damaging.
Background.Cognitive impairments, which contribute to the profound functional deficits observed i... more Background.Cognitive impairments, which contribute to the profound functional deficits observed in psychotic disorders, have found to be associated with abnormalities in trial-level cognitive control. However, neural tasks operate within the context of sustained cognitive states, which can be assessed with ‘background connectivity’ following the removal of task effects. To date, little is known about the integrity of brain processes supporting the maintenance of a cognitive state in individuals with psychotic disorders. Thus, here we examine background connectivity during executive processing in a cohort of participants with first-episode psychosis (FEP).Methods.The following fMRI study examined background connectivity of the dorsolateral prefrontal cortex (DLPFC), during working memory engagement in a group of 43 patients with FEP, relative to 35 healthy controls (HC). Findings were also examined in relation to measures of executive function.Results.The FEP group relative to HC showed significantly lower background DLPFC connectivity with bilateral superior parietal lobule (SPL) and left inferior parietal lobule. Background connectivity between DLPFC and SPL was also positively associated with overall cognition across all subjects and in our FEP group. In comparison, resting-state frontoparietal connectivity did not differ between groups and was not significantly associated with overall cognition, suggesting that psychosis-related alterations in executive networks only emerged during states of goal-oriented behavior.Conclusions.These results provide novel evidence indicating while frontoparietal connectivity at rest appears intact in psychosis, when engaged during a cognitive state, it is impaired possibly undermining cognitive control capacities in FEP.
Biological Psychiatry: Cognitive Neuroscience and Neuroimaging, May 1, 2019
Background: A longer duration of untreated psychosis (DUP) has been linked with poor clinical out... more Background: A longer duration of untreated psychosis (DUP) has been linked with poor clinical outcomes, as well as variation in resting-state striatal connectivity with central executive regions. However, the link between DUP and task-based activation of executive neurocognition has not previously been examined. The following fMRI study examined the association between DUP and both activation and frontostriatal functional connectivity during a visual working memory (WM) paradigm in patients with first-episode psychosis (FEP). Methods: Patients with FEP (N=37) underwent fMRI scanning while performing a visual WM task. At the single-subject level, task conditions were modeled; at the group level, each condition was examined along with DUP. Activation was examined within the dorsolateral prefrontal cortex (DLPFC), a primary region supporting visual WM activation. Frontostriatal functional connectivity during the WM was examined via psychophysical interaction between the dorsal caudate and the DLPFC. Results were compared to a reference range of connectivity values in a matched group of healthy volunteers (N=25). Task performance was also examined in relation to neuroimaging findings. Results: No significant association was observed between DUP and WM activation. Longer DUP showed less functional frontostriatal connectivity with the maintenance of increasing WM load. Results were not related to task performance measures, consistent with prior work. Conclusions: Our data suggest that DUP may affect frontostriatal circuitry that supports executive functioning. Future work is necessary to examine if these findings contribute to the mechanism underlying the relationship between DUP and worsened clinical outcomes.
There is growing evidence suggesting that abnormalities in cortical-basal ganglia circuitry may p... more There is growing evidence suggesting that abnormalities in cortical-basal ganglia circuitry may play a significant role in determining outcomes in schizophrenia. The globus pallidus (GP), a critical structure within this circuitry, unique in its role as a mediator of competing inputs through the striatum, has not been well characterized in schizophrenia. The following study examined functional interactions of the GP in individuals with first-episode schizophrenia (FES). To probe the large-scale intrinsic connectivity of the GP, resting-state fMRI scans were obtained from patients with FES and sex and age-matched healthy controls. Participants with FES were also evaluated after 6 months via the Strauss-Carpenter Outcomes Scale to assess overall functional trajectory. The GP was parcellated to generate seeds within its substructures, and connectivity maps were generated. Our FES cohort showed significantly lower functional connectivity between the left GP interna and a network of regions including the dorsolateral prefrontal cortex, caudate, and cerebellum at baseline. In addition, FES participants with lower overall scores of functioning at 6 months showed significantly decreased connectivity between the GP interna and the dorsal anterior cingulate and bilateral insula, all regions important for motivational salience. These results provide novel evidence for unique abnormalities in functional interactions of the GP with key prefrontal cortical regions in FES. Our findings also suggest that reduced prefrontal-pallidal connectivity may serve as a predictor of early functional outcome.
Background and Hypothesis: Quantitative models of psychopathology can empirically guide subclassi... more Background and Hypothesis: Quantitative models of psychopathology can empirically guide subclassification of heterogeneous clinical presentations such as psychosis; they are particularly well-equipped to capture the nuanced symptomatology observed in first-episode psychosis. As well, components may be better aligned with biological variables. The current study sought to confirm and extend knowledge of the hierarchical structure of psychosis symptoms in first-episode psychosis. Based on past hierarchical work, we hypothesized that a 4 component level would be most closely associated with longitudinal disability. Study Design: Participants with early-stage psychosis (N = 370) underwent clinical assessment with the scale for the assessment of positive symptoms (SAPS), scale for assessment of negative symptoms (SANS), and global assessment scale(GAS). A subset was assessed at 6 months (N = 221) and 1 year (N = 207). Hierarchical symptom components were extracted at 12 levels. The predictive utility of the components for global functioning was tested. Study Results: As predicted, the 4-component model (reality distortion, thought disorder, inexpressivity, apathy/asociality) provided a superior prediction of functioning over other levels of the hierarchy. Baseline apathy/asociality longitudinally predicted functioning beyond the shared variance of the components at 6 months (b = −4.83, t(216) = −5.37, p < .001, R 2 adj = 0.12) and 1-year (b = −4.49, t(202) = −4.38, p < .001, R 2 adj = 0.09). Conclusions: The hierarchical structure of psychotic symptomatology and its external validity have been robustly established in independent, longitudinal first-episode psychosis samples. The established model incorporates multiple levels of granularity that can be flexibly applied based on the level that offers the greatest predictive utility for external validators.
B ecause treatments that have proved efficacious in academic settings over the past 30 years have... more B ecause treatments that have proved efficacious in academic settings over the past 30 years have rarely been adopted by community agencies (1,2), there is a need to develop ways to translate and disseminate useful programs to community settings. One such treatment is family psychoeducation (3-5). The results of more than 30 experimental trials have established family psychoeducation as an evidence-based practice (6,7) routinely recommended as the gold standard for care of persons and families coping with schizophrenia (1,8-11). However, results from the seminal Schizophrenia Patient Outcomes Research Team study showed that although 77% of those with schizophrenia live with or have ongoing contact with their families, only a small proportion have an outpatient claim for any family intervention (<1% Medicare and 7% Medicaid) (2). These data led us to design a randomized feasibility trial of an adapted telehealth family psychoeducational intervention provided to users' homes to increase community dissemination. Online interventions have the potential to overcome several barriers to dissemination and community care for persons with serious mental illness, including the limited number of persons with schizophrenia in some clinics, the high costs of training staff
This study investigated whether a higher frequency of reported childhood trauma would be found in... more This study investigated whether a higher frequency of reported childhood trauma would be found in depressed adults with higher levels of trait impulsivity, aggression, and suicidal behavior. Method: In 136 depressed adult inpatients, the authors assessed trait impulsivity, aggression history, and number of lifetime suicide attempts as well as the medical lethality and the intent to die associated with the most lethal attempt. These variables were then compared between those with and those without a reported history of childhood physical or sexual abuse. Results: Subjects who reported an abuse history were more likely to have made a suicide attempt and had significantly higher impulsivity and aggression scores than those who did not report an abuse history. Impulsivity and aggression scores were significantly higher in subjects with a history of at least one suicide attempt. A logistic regression analysis revealed that abuse history remained significantly associated with suicide attempt status after adjustment for impulsivity, aggression history, and presence of borderline personality disorder. Among those who attempted suicide, there were no significant differences in severity of suicidal behavior between those with and without a childhood history of abuse. Conclusions: Abuse in childhood may constitute an environmental risk factor for the development of trait impulsivity and aggression as well as suicide attempts in depressed adults. Alternatively, impulsivity and aggression may be inherited traits underlying both childhood abuse and suicidal behavior in adulthood disorders. Additional research is needed to estimate the relative contributions of heredity and environmental experience to the development of impulsivity, aggression, and suicidal behavior.
Background: Suicidal thoughts and behaviors have been studied in association with a variety of ri... more Background: Suicidal thoughts and behaviors have been studied in association with a variety of risk factors. The aim of the present study was to determine if levels of child/adolescent aggression and/or variation in candidate genes previously associated with suicidal behaviors in adults would influence the presence of suicidal ideation in childhood/adolescence, and to determine if ideation was associated with young adult depression. Methods: A longitudinal study of children, adolescents and young adults who were at high or low risk for alcohol and other substance use disorders by familial background were assessed. The Child Behavior Checklist (CBCL) aggression scale scores with derived subtypes (physical and relational) and genetic variation (ANKK1, DRD2, COMT, SLC6A4, HTR2C) were used as predictors of the presence and onset of suicidal ideation in childhood using survival analysis. Structural equation models (SEM) were fit to determine the relative importance of the predictors controlling for background variables. Results: CBCL aggression was significantly associated with child/adolescent suicidal ideation. One SNP in the ANKK1 gene (rs1800497), one in the HTR2C gene (rs6318), and two haplotypes, AAAC in the ANKK1-DRD2 complex and the CCC haplotype of the HTR2C gene, were significantly associated with the presence and onset of child/adolescent suicidal ideation. Follow up in young adulthood showed a significant relationship between suicidal ideation in childhood/adolescence and young adult depression. Conclusions: Genetic variation and presence of elevated aggression scores from the childhood CBCL are significant predictors of childhood suicidal ideation. Suicidal ideation in childhood and being female are predictors of young adult depression.
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