Leveraging the Full Continuum of Care to Prevent Opioid Use Disorder.

Substance use disorder prevention programs are most effective when matched appropriately to the baseline risk of the population. Individuals who misuse opioids often have unique risk profiles different from those who use other substances such as alcohol or cannabis. However, most substance use prevention programs are geared toward universal audiences, neglecting key inflection points along the continuum of care. The HEAL Prevention Cooperative (HPC) is a unique cohort of research projects that represents a continuum of care, from community-level universal prevention to indicated prevention among older adolescents and young adults who are currently misusing opioids or other substances. This paper describes the theoretical basis for addressing opioid misuse and opioid use disorder across the prevention continuum, using examples from research projects in the HPC.

The impact of conversion from prograf to generic tacrolimus in liver and kidney transplant recipients with stable graft function.

Bioequivalence of the recently available generic tacrolimus formulation, manufactured by Sandoz, to the reference product (Prograf; Astellas Pharma, Tokyo, Japan) has been demonstrated in healthy subjects. However, the safety and efficacy of substitution with generic tacrolimus in transplant patients have not been evaluated. Tacrolimus trough concentrations and indices of liver and kidney function were recorded before and after generic substitution in 48 liver and 55 kidney transplant recipients. In liver transplant patients, the mean tacrolimus concentration/dose (C/D) ratio (± SD) was 184.1 (± 123.2) ([ng/mL]/[mg/kg/day]) for the reference product and 154.7 (± 87.8) ([ng/mL]/[mg/kg/day]) for the generic product (p < 0.05). The mean C/D-ratios in kidney transplant patients were 125.3 (± 92.7) and 110.4 (± 79.2) ([ng/mL]/[mg/kg/day]) for the reference and generic products, respectively (p < 0.05). Actual trough concentrations declined by an average of 1.98 ng/mL in liver and 0.87 ng/mL in kidney transplant patients following the switch, after accounting for all significant covariates. No change was observed in biochemical indices of liver or kidney function and no cases of acute rejection occurred following the substitution. These results suggest that transplant patients currently taking the reference tacrolimus formulation may be safely switched to the Sandoz-generic product provided trough concentrations are closely monitored following the substitution.

Structure and validity of people in my life: A self-report measure of attachment in late childhood.

No self-report measure of attachment is well validated for middle-childhood. This study examined the validity and factor structure of the People in My Life (PIML) measure in 320 urban, fifth and sixth graders. Validity analyses consisted of correlational analyses between PIML subscales and the Child Behavior Checklist, Delinquency Rating Scale for Self and Others, Heath Resources Inventory, and Reynolds Child Depression Scale. Validity correlations were consistent with a-priori hypotheses. Confirmatory factor analyses consisted of comparison of model fit indices between seven models. Two models fit the data well and both models were consistent with the traditionally used PIML scoring protocol. Moreover, both models were consistent with the Inventory of Parent and Peer Attachment (IPPA), on which the PIML is modeled, as well as the theoretical underpinnings of attachment in childhood. The PIML and IPPA provide instruments for obtaining a continuous self-report measure of attachment from middle-childhood through adulthood.

Reliability of self-reported antisocial personality disorder symptoms among substance abusers.

It is estimated that from 20 to 60% of substance abusers meet criteria for Antisocial Personality Disorder (APD). An accurate and reliable diagnosis is important because persons meeting criteria for APD, by the nature of their disorder, are less likely to change behaviors and more likely to relapse to both substance abuse and high risk behaviors. To understand more about the reliability of the disorder and symptoms of APD, the Diagnostic Interview Schedule Version III-R (DIS) was administered to 453 substance abusers ascertained from treatment programs and from the general population (St Louis Epidemiological Catchment Area (ECA) follow-up study). Estimates of the 1 week, test-retest reliability for the childhood conduct disorder criterion, the adult antisocial behavior criterion, and APD diagnosis fell in the good agreement range, as measured by kappa. The internal consistency of these DIS symptoms was adequate to acceptable. Individual DIS criteria designed to measure childhood conduct disorder ranged from fair to good for most items; reliability was slightly higher for the adult antisocial behavior symptom items. Finally, self-reported 'liars' were no more unreliable in their reports of their behaviors than 'non-liars'.

Discriminant function analysis of malingerers' and neurological headache patients' self-reports of neuropsychological symptoms.

Interpretation of a patient's neuropsychological examination involves the determination of the role motivational and psychiatric factors may have played. The ability to detect malingering becomes crucial, particularly when the examination occurs as a result of litigation. Moreover, falsely identifying a performance as distorted has serious consequences for the patient. The present study was conducted to replicate previous research that discriminated between malingered and nonmalingered responses to a neuropsychological self-report inventory. An overall hit rate of 84% for malingerers and neurologic headache patients demonstrated replication of the inventory's ability to identify malingerers. Of those predicted to be malingerers, 27% were false positives indicating the need to use this inventory in conjunction with other neuropsychological measures.

Parkinson's disease and neuropsychological assessment.

Neurological aspects of Parkinson's disease including symptomology, etiology, and chemotherapy are briefly reviewed. Recent developments in each area are also presented. Clinical considerations relevant to neuropsychological testing with the Parkinson's disease patient are discussed in terms of confounds that may hinder the accuracy of test result interpretation.

A note on issues in meta-analysis for behavioral genetic studies using categorical phenotypes.

Meta-analysis of behavioral genetic studies would provide (i) tighter confidence intervals around parameter estimates, (ii) clarification of apparently discrepant study findings, and (iii) a mechanism for analyzing systematic causes of between-study differences. We examined some key issues that arise in the meta-analysis of categorical phenotypes. Data were simulated under a multifactorial threshold model that assumed an underlying normal liability distribution, and summary statistics (probandwise concordance rate, recurrence risk ratio, odds ratio, kappa) compared for given values of the liability correlation between relatives and given population prevalence. Although the odds ratio and kappa statistic performed well at moderate to high values of the population prevalence (15-50%), at low values all of these statistics were sensitive to overall prevalence. In cases where the assumption of a multifactorial threshold model is reasonable, direct estimation of genetic and environmental parameters from the summary statistics from all studies appears to be a preferable strategy. For cases where data from non-randomly ascertained samples are used, the impact of misspecification of the model for ascertainment was examined. For some parameter values, such misspecifications led to quite serious biases to estimates of genetic and environmental parameters. These biases varied in complex ways as a function of research design and of the true causes of variation in the population, so that the same misspecification could lead to an overestimate of the importance of genetic influences in twin data but an underestimation in adoption data or to an overestimate of the importance of genetic effects from twin data if shared environmental as well as genetic influences were simulated but an underestimate of genetic effects if shared environmental effects were assumed unimportant. These complexities emphasize the importance of being sensitive to the effects of misspecifying ascertainment corrections in any meta-analysis of behavioral genetic data.

An exploratory stepwise discriminant function analysis of malingered and nondistorted responses to the Neuropsychological Symptom Inventory.

Clinicians are often asked to evaluate a patient's potential for malingering during a neuropsychological examination. This problem is particularly crucial when financial gain may hinge on the results of the assessment. Response distortion may occur even when a head injury has been verified by radiological means (e.g., MRI). Research in the identification of malingering has yet to produce results that are effective in the clinical setting. The present study addressed several shortcomings of past research with the use of a self-report symptom inventory. The responses of 242 subjects told to distort symptomology were compared to 128 nonmalingerers. A discriminant function analysis of these data produced a 90% hit rate overall with 2.3% false positives. The results were discussed in terms of clinical utility.

Further evidence that the family assessment device should be reorganized: response to Miller and colleagues.

Ridenour, Daley, and Reich's (1999) factor analyses of the Family Assessment Device (FAD) indicated that the FAD be reorganized. Miller and colleagues (2000) contend that the FAD be used in its original format based on the FAD's theoretical foundation; however, this does not preclude the importance of scientific scrutiny of an instrument's construct validity to determine how well an instrument represents its theoretical base. Subscale factor analyses (exploratory and confirmatory), item-level factor analysis, and the clinical and psychometric studies cited by Miller and colleagues suggest a more parsimonious FAD configuration and were consistent with Ridenour and colleagues' factor analyses.

Factor analyses of the family assessment device.

The Family Assessment Device (FAD) operationalizes the McMaster Model of Family Functioning, which has been used in numerous studies, translated into seven languages, and is regarded as one of the most researched family assessment tools available. However, exploratory and confirmatory factor analyses using the 7-by-7 matrix of subscale correlations from the original validity study on the FAD (Epstein, Baldwin, & Bishop, 1983) indicated that the FAD subscales overlap substantially and do not assess unique dimensions of family functioning. Results of our study suggest that the conservatively best use of the FAD is using the General Functioning subscale as a summary score. A model that fits the data marginally better than the General Functioning score and a Measurement Error model, however, consisted of "Collaboration" and "Commitment" latent factors. These results illustrated the need for more extensive validity research on the FAD, because interpretation of the factors and subscales had to rely heavily on face validity.

"Profile" analysis of the personality characteristics of child molesters using the MMPI-2.

Identification of child sexual molesters has been attempted for at least half a century without success. This is due, in part, to the heterogeneity of child molesters. Child sexual molesters were studied in three ways. First, a discriminant function analysis was conducted to evaluate how well the MMPI-2 would distinguish child molesters from controls. Hit rates of 81% and 88% were found for clinical scales alone and the clinical and supplemental scales, respectively. Second, a cluster analysis of MMPI-2 data identified four groups that resembled clusters found previously with the MMPI. Third, when followed in treatment, all subgroups achieved significant progress ratings and no significant difference in treatment progress was found between clusters.

Attribute-treatment interaction research using nonexperimental data and the allocation average.

Attribute-treatment interaction (ATI) research attempts to answer the question, "Which treatment is best for whom?" Recent critical reviewers of ATI methodology have cited numerous pragmatic and methodological shortcomings of traditional experimental designs and argued that successful ATI research will require an alternative approach. This manuscript describes a purely correlational ATI method that addresses the more serious criticisms of experimental ATI research. This paper also presents use of the allocation average for ATI research that is either experimental or correlational in nature. The allocation average estimates the clinical utility of differential treatment assignment based on ATI data in terms of improved treatment outcomes. The proposed method is illustrated with hypothetical psychotherapy data and data from a recent educational study.