Female gender, dissatisfaction with weight, and number of IBD related surgeries as independent risk factors for eating disorders among patients with inflammatory bowel diseases.

BACKGROUND: The prevalence and risk factors of eating disorders among patients with IBD are poorly described in existing literature. Early recognition and intervention may influence clinical outcomes in both physical and mental health. The primary aims of this study were to describe the prevalence and identify risk factors for eating disorders among patients with IBD using a validated questionnaire, the EAT-26. METHODS: The EAT-26 was administered via email as an anonymous, unpaid, online survey to 1589 patients with an electronic medical record coded diagnosis of IBD (ulcerative colitis or Crohn's disease) who had visited our Digestive Health Center in the last 3 years. Demographics and IBD characteristics were also included in our survey. A score of 20 or higher on the EAT-26 portion of the survey was considered a positive screen for eating disorder risk. RESULTS: Fifteen (4.8%) survey participants screened positively for ED risk. These 15 participants who screened positively had statistically significant differences in self-identified gender (93% female, p = 0.031), happiness with current weight (80% dissatisfied with their current weight and trying to lose weight, p < 0.01), prior eating disorder diagnosis (20%, p < 0.01), and number of IBD related surgeries (27% having 3 or more, p = 0.013). CONCLUSIONS: This study identifies independent risk factors for eating disorder risk in patients with IBD including female gender, dissatisfaction with current weight, number of IBD related surgeries, and history of prior eating disorder diagnosis.

Sweet syndrome with perifollicular involvement because of koebnerization from facial hair plucking.

Sweet syndrome (SS), also known as acute febrile neutrophilic dermatosis, is an uncommon skin eruption characterized by fever, leukocytosis, and tender erythematous papules, nodules, and plaques. Histopathologically, SS lesions are characterized by marked superficial papillary edema with a dense neutrophilic infiltrate. SS is known to demonstrate both the Koebner phenomenon and pathergy. The majority of reported cases of these phenomena occur following significant cutaneous injury (e.g., biopsies, burns) rather than minor trauma such as pressure and friction. Here, we present the first known reported case of SS koebnerization secondary to minor grooming-related hair plucking. In addition, this is also the first reported case to our knowledge of SS with perifollicular involvement on histopathology.

Assessing the Clinical Utility of the MMPI-2-RF in Detecting Suicidal Ideation in a High Acuity, Partially-Hospitalized Veteran Sample.

The Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF; Ben-Porath & Tellegen, 2008/2011) has demonstrated utility in suicide risk assessment. Limited research with the MMPI-2-RF in higher acuity populations exists, particularly regarding the impact of possible underreporting on prediction of suicide risk. The current study serves to extend previous findings of the utility of clinically indicated MMPI-2-RF scales and proxy indices in 293 veterans (83.62% White, 85.32% male, and 74.40% with past-week suicide ideation) enrolled in a Veterans Affairs Medical Center partial psychiatric hospitalization program. Differences in self-report indicators and MMPI-2-RF scales and proxy indices relevant in assessing suicide ideation between veterans indicated as possibly underreporting and those who were not and the ability of the scales and proxy indices to predict current suicide ideation were examined. These indicators, scales, and proxy indices, with the exception of SUI, were significantly impacted by underreporting, and none of the examined scales or proxy indices (or their interaction) were consistently associated with self-reported suicide ideation after accounting for SUI. However, SUI was consistently associated with suicide ideation and was less influenced by under-reporting. In acutely ill psychiatric patients, SUI may be the most robust indicator of current suicide ideation.

Changes in D-dimer and inflammatory biomarkers before ischemic events in patients with peripheral artery disease: The BRAVO Study.

Whether circulating biomarker levels increase shortly before an ischemic heart disease (IHD) event is unknown. We studied whether levels of D-dimer, C-reactive protein (CRP), and serum amyloid A (SAA) are higher within 2 months of an IHD event compared to time periods more than 2 months before the IHD event. We assembled 595 participants with peripheral artery disease (PAD) and followed them for up to 3 years. Blood samples were obtained every 2 months. The primary outcome was IHD events: myocardial infarctions, unstable angina, or IHD death. We used a nested case-control design. Fifty participants (cases) had events and were each matched by age, sex, duration in the study, and number of blood draws to two controls without events. Among cases, the mean D-dimer value of 1.105 obtained within 2 months of the event was higher than values obtained 10 months (0.68 mg/L, p<0.001), 12 months (0.71 mg/L, p=0.001), 16 months (0.65 mg/L, p=0.008), 20 months (p=0.032), 22 months (p=0.033), 26 months (p=0.038), and 32 months (p=0.04) before the event. Compared to controls, median D-dimer levels in cases were higher 4 months (p=0.017), 6 months (p=0.005), and 8 months (p=0.028) before the event. Values of CRP and SAA obtained within two months of an IHD event not consistently higher than values obtained during the prior months. In PAD participants with an IHD event, D-dimer was higher within 2 months of the event, compared to most values obtained 10 to 32 months previously. D-dimer was also higher in cases as compared to controls during most visits within 8 months of the IHD event.

Single-Cell Squamous Carcinoma: An Underreported High-Risk Variant.

BACKGROUND: There is increasing interest in establishing diagnostic and treatment guidelines for high-risk squamous cell carcinoma (SCC). Single-cell SCC has been recognized as a high-risk subtype but continues to be a less commonly reported and more poorly understood variant. OBJECTIVE: To present the current literature on single-cell SCC. MATERIALS AND METHODS: A review of the literature on single-cell squamous cell carcinoma. RESULTS: There are fewer than 100 cases of single-cell SCC in the literature. The reporting studies demonstrate an increase in the risk of metastasis compared with non-single-cell tumors. Confounding variables reported include other coexisting high-risk features: diameter >2 cm, depth >6 mm, and difficulty detecting single tumor cells. It is therefore unclear whether single-cell SCC is an independent risk factor for recurrence and regional spread. Studies have described use of immunostaining as a means to improve tumor detection. CONCLUSION: Single-cell SCC continues to be an underreported SCC variant. Given its apparent aggressive behavior, more studies are warranted to better understand its tumor biology and behavior and to improve patient outcomes. Based on our present knowledge, complete tumor excision with or without the aid of immunostaining and use of multidisciplinary care are recommended.

Dry Crusty Nose: Not Just Rhinosinusitis! Hidden IgG4-related Disease Without IgG4 Level Rise.

IgG4-related disease (IgG4-RD) is a fibro-inflammatory condition that can affect various organs. Localized sinonasal IgG4-RD is a rare condition characterized by bone and soft-tissue invasion. In this report, we present a case of a patient initially diagnosed with chronic rhinosinusitis, who underwent endoscopic sinus surgery and was later found to have biopsy proven IgG4-related sinonasal disease despite having normal serum levels of IgG4, resulting in erosion of the right lamina papyracea.

MMPI-2-RF validity scales add utility for predicting treatment engagement during partial psychiatric hospitalizations.

Partial psychiatric hospitalizations are resource-intensive clinical services designed to stabilize patients in the short term, prevent inpatient hospitalizations, and encourage long-term recovery. Typically, providers base their referral decisions on categorical diagnoses and subjective impressions of patient distress without closely considering the evidence for reporting biases. The present study followed veterans (n = 430) participating in partial psychiatric hospitalization services. We evaluated the extent to which clinical diagnoses at intake predicted treatment variables and changes in later mental health care utilization. Using hierarchical linear regressions with bootstrap confidence intervals, Minnesota Multiphasic Personality Inventory-2-Restructured Form content-based validity scales demonstrated incremental utility for predicting patient outcomes beyond intake diagnoses. Elevated Fp-r ("Infrequent Psychopathology Responses") scores independently predicted an increased number of times arriving late for partial hospitalization programming, self-report of worse current functioning at intake, and a relative increase in mental health care encounters in the 12 months following discharge. Low K-r ("Adjustment Validity") scores independently predicted self-report of worse current functioning at both intake and later discharge from partial hospitalization. Thus, indicators of severe psychopathology overreporting as well as the unlikely disavowal of emotional adjustment (i.e., high Fp-r, low K-r) predicted engagement with health care services and self-presentations of symptoms over and above the diagnostic impressions from referring providers. We discuss how indicators of content-based invalid responding on the Minnesota Multiphasic Personality Inventory-2-Restructured Form have real-world value for understanding patient behavior and shaping clinical interventions among vulnerable populations. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Neuropsychological outcomes of U.S. Veterans with report of remote blast-related concussion and current psychopathology.

This study explored whether remote blast-related MTBI and/or current Axis I psychopathology contribute to neuropsychological outcomes among OEF/OIF veterans with varied combat histories. OEF/OIF veterans underwent structured interviews to evaluate history of blast-related MTBI and psychopathology and were assigned to MTBI (n = 18), Axis I (n = 24), Co-morbid MTBI/Axis I (n = 34), or post-deployment control (n = 28) groups. A main effect for Axis I diagnosis on overall neuropsychological performance was identified (F(3,100) = 4.81; p = .004), with large effect sizes noted for the Axis I only (d = .98) and Co-morbid MTBI/Axis I (d = .95) groups relative to the control group. The latter groups demonstrated primary limitations on measures of learning/memory and processing speed. The MTBI only group demonstrated performances that were not significantly different from the remaining three groups. These findings suggest that a remote history of blast-related MTBI does not contribute to objective cognitive impairment in the late stage of injury. Impairments, when present, are subtle and most likely attributable to PTSD and other psychological conditions. Implications for clinical neuropsychologists and future research are discussed. (JINS, 2012, 18, 1-11).

Changes in social adjustment with cognitive processing therapy: effects of treatment and association with PTSD symptom change.

The current study sought to determine if different spheres of social adjustment, social and leisure, family, and work and income improved immediately following a course of cognitive processing therapy (CPT) when compared with those on a waiting list in a sample of 46 U.S. veterans diagnosed with posttraumatic stress disorder (PTSD). We also sought to determine whether changes in different PTSD symptom clusters were associated with changes in these spheres of social adjustment. Overall social adjustment, extended family relationships, and housework completion significantly improved in the CPT versus waiting-list condition, η(2) = .08 to .11. Hierarchical multiple regression analyses revealed that improvements in total clinician-rated PTSD symptoms were associated with improvements in overall social and housework adjustment. When changes in reexperiencing, avoidance, emotional numbing, and hyperarousal were all in the model accounting for changes in total social adjustment, improvements in emotional numbing symptoms were associated with improvements in overall social, extended family, and housework adjustment (ß = .38 to .55). In addition, improvements in avoidance symptoms were associated with improvements in housework adjustment (ß = .30), but associated with declines in extended family adjustment (ß = -.34). Results suggest that it is important to consider the extent to which PTSD treatments effectively reduce specific types of symptoms, particularly emotional numbing and avoidance, to generally improve social adjustment.

Neuropsychological evaluation of blast-related concussion: illustrating the challenges and complexities through OEF/OIF case studies.

BACKGROUND/OBJECTIVE: Soldiers of Operations Enduring Freedom (OEF) and Iraqi Freedom (OIF) sustain blast-related mild traumatic brain injury (concussion) with alarming regularity. This study discusses factors in addition to concussion, such as co-morbid psychological difficulty (e.g. post-traumatic stress) and symptom validity concerns that may complicate neuropsychological evaluation in the late stage of concussive injury. CASE REPORT: The study presents the complexities that accompany neuropsychological evaluation of blast concussion through discussion of three case reports of OEF/OIF personnel. DISCUSSION: The authors emphasize uniform assessment of blast concussion, the importance of determining concussion severity according to acute-injury characteristics and elaborate upon non-concussion-related factors that may impact course of cognitive limitation. The authors conclude with a discussion of the need for future research examining the impact of blast concussion (particularly recurrent concussion) and neuropsychological performance.

Does trauma survey research cause more distress than other types of survey research?

Members of institutional review boards who evaluate trauma research protocols frequently face the task of balancing potential risk with potential benefit. However, no known study has examined the relative effect of participating in a trauma-related survey compared to participating in a nontrauma survey. The authors randomly assigned participants receiving care in an outpatient PTSD treatment program to complete questionnaires assessing either trauma-related or nontrauma content. Participants completing trauma-related questionnaires reported feeling sadder and more tense than other participants, though they did not report differences in perceived gain from participation or retrospective willingness to participate. Results suggest that level of distress after participating in trauma research was insufficient to reduce willingness for, or perceived benefit from, participation in trauma survey research.

Perceived incompetence moderates the relationship between maladaptive perfectionism and disordered eating.

Maladaptive perfectionism and perceived incompetence are two factors associated with disordered eating. In this study, we examined whether perceived incompetence moderated the relationship between maladaptive perfectionism and disordered eating. Three hundred fifteen college women completed surveys assessing eating habits and levels of perceived incompetence and perfectionism. Results supported a moderating effect of perceived incompetence such that as levels of perceived incompetence increased, the relationship between maladaptive perfectionism and disordered eating became increasingly strong. These results imply that clinicians may want to focus efforts on helping clients learn to set healthy goals and improve their perception of competence in life domains.

Workplace social support in job satisfaction among veterans with posttraumatic stress symptoms: A preliminary correlational study.

For Veterans managing PTSD symptoms, returning to vocational functioning is often challenging; identifying modifiable variables that can contribute to positive vocational adjustment is critical to improved vocational rehabilitation services. Workplace social support has proven to be important in vocational adjustment in both general population and vocational rehabilitation samples, but this area of inquiry has received little attention among Veterans with PTSD symptoms. In this small correlational study, employed Veterans (N = 63) presenting for outpatient PTSD treatment at a VA Health Care System completed surveys assessing demographic variables, PTSD symptoms, workplace social support, and job satisfaction. Workplace social support contributed to the prediction of job satisfaction. It is of note that workplace social support predicted a larger proportion of the variance in employment satisfaction than PTSD symptoms. Further research on workplace social support as a vocational rehabilitation resource for Veterans with PTSD is indicated.

Uptake of dietary milk miRNAs by adult humans: a validation study.

Breast milk is replete with nutritional content as well as nucleic acids including microRNAs (miRNAs). In a recent report, adult humans who drank bovine milk appeared to have increased circulating levels of miRNAs miR-29b-3p and miR-200c-3p. Since these miRNAs are homologous between human and cow, these results could be explained by xeno-miRNA influx, endogenous miRNA regulation, or both. More data were needed to validate the results and explore for additional milk-related alterations in circulating miRNAs. Samples from the published study were obtained, and 223 small RNA features were profiled with a custom OpenArray, followed by individual quantitative PCR assays for selected miRNAs. Additionally, small RNA sequencing (RNA-seq) data obtained from plasma samples of the same project were analyzed to find human and uniquely bovine miRNAs. OpenArray revealed no significantly altered miRNA signals after milk ingestion, and this was confirmed by qPCR. Plasma sequencing data contained no miR-29b or miR-200c reads and no intake-consistent mapping of uniquely bovine miRNAs. In conclusion, the results do not support transfer of dietary xenomiRs into the circulation of adult humans.

Vulnerable blood in high risk vascular patients: study design and methods.

BACKGROUND: Basic research suggests that rapid increases in circulating inflammatory and hemostatic blood markers may trigger or indicate impending plaque rupture and coronary thrombosis, resulting in acute ischemic heart disease (IHD) events. However, these associations are not established in humans. METHODS AND RESULTS: The Biomarker Risk Assessment in Vulnerable Outpatients (BRAVO) Study will determine whether levels of inflammatory and hemostatic biomarkers rapidly increase during the weeks prior to an acute IHD event in people with lower extremity peripheral artery disease (PAD). The BRAVO Study will determine whether biomarker levels measured immediately prior to an IHD event are higher than levels not preceding an IHD event; whether participants who experience an IHD event (cases) have higher biomarker levels immediately prior to the event and higher biomarker levels at each time point leading up to the IHD event than participants without an IHD event (controls); and whether case participants have greater increases in biomarkers during the months leading up to the event than controls. BRAVO enrolled 595 patients with PAD, a population at high risk for acute IHD events. After a baseline visit, participants returned every two months for blood collection, underwent an electrocardiogram to identify new silent myocardial infarctions, and were queried about new hospitalizations since their prior study visit. Mortality data were also collected. Participants were followed prospectively for up to three years. CONCLUSIONS: BRAVO results will provide important information about the pathophysiology of IHD events and may lead to improved therapies for preventing IHD events in high-risk patients.

Longitudinal predictors of desire to re-enlist in the military among male and female national guard soldiers.

Given the cost and burden associated with training and recruitment of military members, identifying predictors of military retention remains an important goal. The aim of the current study was to examine predictors of male and female service members' likelihood of remaining in the National Guard following combat deployment in support of Operation Iraqi Freedom. Using a prospective, longitudinal design, this study assessed a wide range of predictors including mental health functioning, personality variables, deployment stressors, and various domains of quality of life. Results indicated perceived unit support was the strongest predictor of intention to re-enlist for both male and female participants. However, significant gender differences emerged as predeployment depression and a trend toward perceived life threat during deployment were predictors of men's intention to re-enlist, whereas the predeployment personality dimension of introversion (low positive emotionality) and postdeployment life stressors were predictors of women's intention to re-enlist. Surprisingly, no postdeployment mental health variables predicted National Guard soldiers' intention to re-enlist. Findings from this study suggest factors associated with National Guard service members' retention or attrition from the military may be amenable to intervention.

Predictors of postdeployment alcohol use disorders in National Guard soldiers deployed to Operation Iraqi Freedom.

Alcohol use in the military is a significant problem. The goal of this study was to examine the associations between personality, posttraumatic stress disorder (PTSD) symptoms, and postdeployment alcohol use disorders (AUDs) among a group of Operation Iraqi Freedom (OIF) deployed National Guard soldiers, with a focus on differentiating predeployment and postdeployment onset AUDs. Participants were 348 National Guard soldiers deployed to Iraq from March 2006 to July 2007 drawn from the Readiness and Resilience in National Guard Soldiers (RINGS) study. Participants completed self-report measures one month before deployment and 3 to 6 months postdeployment; current and lifetime history of AUDs were assessed 6 to 12 months postdeployment, using the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders (4th ed. text rev.; DSM-IV; American Psychiatric Association, 2000). Overall, 13% of the panel was diagnosed with a current AUD. Of those who met criteria for a current AUD, 38% had an AUD that developed following return from deployment (new onset AUD). The development of new onset AUDs was uniquely predicted by higher levels of PTSD symptom severity, higher levels of avoidance-specific PTSD symptoms, and lower levels of positive emotionality. AUDs with onset prior to deployment were predicted by higher levels of negative emotionality and disconstraint. Results of this study suggest that combat deployed soldiers with current AUDs are a heterogeneous group and point to the influence of combat-related PTSD symptoms in the development of AUDs following deployment.

Psychiatric diagnoses, comorbidity, and functioning in National Guard troops deployed to Iraq.

OBJECTIVE: Over 1.8 million troops have been deployed to Iraq (OIF) and Afghanistan. Estimates of mental health problems postdeployment have been based on screening instruments; no studies have examined the postdeployment mental health of troops returning from OIF using structured diagnostic interviews. The goal of the current study is to (a) report on rates of mental health diagnoses and comorbidity in soldiers after deployment to OIF using clinical interviews, and (b) examine the relationship between mental health diagnoses and overall functioning and quality of life. METHOD: Participants were 348 National Guard soldiers drawn from the Readiness and Resilience in National Guard Soldiers (RINGS) study, a longitudinal study of mental health after deployment to OIF from March 2006 to July 2007. Participants completed clinical interviews, including the Clinician Administered PTSD Scale and the Structured Clinical Interview for the DSM-IV, and self-report measures of social adjustment and quality of life 6-12 months following deployment. RESULTS: Most participants did not meet criteria for a mental health diagnosis. Non-PTSD anxiety disorders and depressive disorders were the most common. Mental health diagnoses were associated with poorer functioning and quality of life. PTSD had the strongest relationship with social functioning and quality of life. For those with PTSD, comorbid diagnoses were not associated with an incremental decrease in functioning or quality of life. CONCLUSIONS: The findings highlight the significant rate and burden of mental health disorders among this population and suggest that while PTSD is relatively uncommon, it is a particularly deleterious disorder.

Self-report of psychological function among OEF/OIF personnel who also report combat-related concussion.

MMPI-2 RF profiles of 128 U.S. soldiers and veterans with history of concussion were examined. Participants evaluated in forensic (n = 42) and clinical (n = 43) settings showed significantly higher validity and clinical elevations relative to a research group (n = 43). In the full sample, a multivariate GLM identified main effects for disability claim status and Axis I diagnosis across numerous MMPI-2 RF scales. Participants with co-morbid PTSD and concussion showed significant Restructured Clinical and Specific Problem scale elevations relative to those without Axis I diagnosis. Participants with PTSD and active disability claims were especially prone to elevate on FBS/FBS-r and RBS. Implications for neuropsychologists who routinely administer the MMPI-2/RF in the context of combat-related concussion are discussed.

Evaluation context impacts neuropsychological performance of OEF/OIF veterans with reported combat-related concussion.

Although soldiers of Operations Iraqi Freedom (OIF) and Enduring Freedom (OEF) encounter combat-related concussion at an unprecedented rate, relatively few studies have examined how evaluation context, insufficient effort, and concussion history impact neuropsychological performances in the years following injury. The current study explores these issues in a sample of 119 U.S. veterans (OEF/OIF forensic concussion, n = 24; non-OEF/OIF forensic concussion, n = 20; OEF/OIF research concussion, n = 38; OEF/OIF research without concussion, n = 37). The OEF/OIF forensic concussion group exhibited significantly higher rates of insufficient effort relative to the OEF/OIF research concussion group, but a comparable rate of insufficient effort relative to the non-OEF/OIF forensic concussion group. After controlling for effort, the research concussion and the research non-concussion groups demonstrated comparable neuropsychological performance. Results highlight the importance of effort assessment among OEF/OIF and other veterans with concussion history, particularly in forensic contexts.