The safety and efficacy of noncorticosteroid triple immunosuppressive therapy in the treatment of refractory chronic noninfectious uveitis in childhood.

OBJECTIVE: To assess the safety and efficacy of noncorticosteroid triple immunosuppressive therapy in the treatment of refractory chronic noninfectious childhood uveitis. METHODS: Subjects were retrospectively selected from a database. Patients were included if they were diagnosed with chronic, noninfectious uveitis at 16 years of age or under and treated with triple immunosuppressive therapy for at least 6 months (following failure of a combination of 2 immunosuppressants). Patient demographics, diagnoses, duration of uveitis, drug dosages, active joint inflammation, and ophthalmologic data were recorded. Efficacy outcomes for triple therapy were recorded at 6 months. RESULTS: Thirteen patients with bilateral uveitis were included. Using Standardized Uveitis Nomenclature (SUN) criteria, at 6 months only 11 eyes (42%) had a 2-step improvement in anterior chamber cell inflammation (n = 26). In addition, 2 patients required additional oral corticosteroid treatment. There were 4 significant infectious adverse events during a total of 21.9 patient-years (PY) on triple therapy (0.18 events per PY). CONCLUSION: In this group of children with refractory uveitis, addition of a third immunosuppressive agent did not confer substantial benefit in redressing ocular inflammation and was associated with significant infections in a minority of patients.

A structured interview guide for global impressions: increasing reliability and scoring accuracy for CNS trials.

BACKGROUND: The clinical global impression of severity (CGI-S) scale is a frequently used rating instrument for the assessment of global severity of illness in Central Nervous System (CNS) trials. Although scoring guidelines have been proposed to anchor these scores, the collection of sufficient documentation to support the derived score is not part of any standardized interview procedure. It is self evident that the absence of a standardized, documentary format can affect inter-rater reliability and may adversely affect the accuracy of the resulting data. METHOD: We developed a structured interview guide for global impressions (SIGGI) and evaluated the instrument in a 2-visit study of ambulatory patients with Major Depressive Disorder (MDD) or schizophrenia. Blinded, site-independent raters listened to audio recorded SIGGI interviews administered by site-based CGI raters. We compared SIGGI-derived CGI-S scores between the two separate site-based raters and the site-independent raters. RESULTS: We found significant intraclass correlations (p = 0.001) on all SIGGI-derived CGI-S scores between two separate site-based CGI raters with each other (r = 0.768) and with a blinded, site-independent rater (r = 0.748 and r = 0.706 respectively) and significant Pearson's correlations between CGI-S scores with all MADRS validity comparisons for MDD and PANSS comparisons for schizophrenia (p- 0.001 in all cases). Compared to site-based raters, the site-independent raters gave identical "dual" CGI-S scores to 67.6% and 68.2% of subjects at visit 1 and 77.1% at visit 2. CONCLUSION: We suggest that the SIGGI may improve the inter-rater reliability and scoring precision of the CGI-S and have broad applicability in CNS clinical trials.

Toward an integrative study of narcissism.

Comments on the article by Miller and Campbell (see record 2010-17135-004). The expression of narcissism spans the continuum from normal to pathological and has meaningful correlates in clinical and nonclinical populations. There is growing speculation that narcissism also contributes to major societal concerns (e.g., terrorism and corporate malfeasance). Improving our understanding of the psychological, interpersonal, and social expressions of narcissism should be one of the most important areas in behavioral science research. Unfortunately, the study of narcissism is fragmented and underpursued. Pathological narcissism (PN), primarily narcissistic personality disorder (NPD; American Psychiatric Association, 1994), has been studied mainly through clinical case reports and psychodynamic theory (Ronningstam, 2005), whereas the study of trait narcissism has utilized more empirical methods. Miller and Campbell contend that the current understanding of PN is speculative and empirically lacking. His proposed remedy is for psychiatric and clinical researchers to incorporate the strategies and tools used to study trait narcissism. Although research on PN should be more empirically based, the uncritical adoption of the trait narcissism paradigm seems ill advised. Rather, an integrative research perspective incorporating knowledge and methodologies across disciplines would seem more promising.

Exploring the validity of the comprehensive trail making test.

The present study is the first independent investigation of the Comprehensive Trail Making Test (CTMT; Reynolds, 2002) with both clinical and non-clinical samples. We examined convergent and divergent validity by exploring relationships between the CTMT and other measures. Discriminant validity was examined by comparing CTMT scores of non-clinical and clinical groups. Results indicate that the CTMT was largely unrelated to measures of processing speed and nonverbal reasoning, verbal processing, and psychiatric symptoms. The CTMT Composite score was able to differentiate between clinical and non-clinical groups with a large effect size. Overall, although further research is needed, results tentatively suggest that the CTMT may be a useful addition to a multifaceted neuropsychological test battery.