Computerized ambulatory monitoring in psychiatry: a multi-site collaborative study of acceptability, compliance, and reactivity.

Computerized ambulatory monitoring overcomes a number of methodological and conceptual challenges to studying mental disorders, however concerns persist regarding the feasibility of this approach with severe psychiatric samples and the potential of intensive monitoring to influence data quality. This multi-site investigation evaluates these issues in four independent samples. Patients with schizophrenia (n = 56), substance dependence (n = 85), anxiety disorders (n = 45), and a non-clinical sample (n = 280) were contacted to participate in investigations using computerized ambulatory monitoring. Micro-computers were used to administer electronic interviews several times per day for a one-week period. Ninety-five percent of contacted individuals agreed to participate in the study, and minimum compliance was achieved by 96% of these participants. Seventy-eight percent of all programmed assessments were completed overall, and only 1% of micro-computers were not returned to investigators. There was no evidence that missing data or response time increased over the duration of the study, suggesting that fatigue effects were negligible. The majority of variables investigated did not change in frequency as a function of study duration, however some evidence was found that socially sensitive behaviors changed in a manner consistent with reactivity.

Feasibility and validity of computerized ecological momentary assessment in schizophrenia.

BACKGROUND: Computerized Ecological Momentary Assessment (EMAc) techniques permit the assessment of daily life behaviors and experiences. The present investigation examined the feasibility and validity of this assessment methodology in outpatients with schizophrenia. METHODS: Outpatients with schizophrenia or schizoaffective disorder (n = 54) received a battery of standard laboratory clinical and functional outcome measures and then completed electronic questionnaires on a personal digital assistant (PDA) microcomputer 4 times per day for 1 week. RESULTS: Generally good compliance (87%) with EMAc was found, and participants rated their experience with the study positively. The data collected in daily life demonstrated expected patterns across the assessment week and were significantly associated with scores from standard laboratory instruments measuring similar constructs. CONCLUSIONS: EMAc is a feasible and valid approach to data collection in community-dwelling people with schizophrenia, and it may provide important information that is inaccessible via standard clinical and functional outcome measures administered in the laboratory.

Reciprocal relationships among alcohol use, risk perception, and sexual victimization: a prospective analysis.

OBJECTIVE: The authors' purpose in this study was to assess longitudinally the relationships among alcohol use, risk perception, and sexual victimization. PARTICIPANTS: Three hundred and seventy-two women from 2 midsized universities made up the sample. METHODS: Participants filled out questionnaires regarding history of sexual victimization, alcohol use, and perceived personal risk for sexual assault in the following 2 months. The authors then reassessed participants at 2 follow-up periods. RESULTS: The pattern of results suggested that that the relationship between alcohol use and sexual victimization was complex and that alcohol use may moderate the relation between history of victimization and revictimization for women with sexual assault histories. In particular, results indicated an increase in risk for sexual revictimization with increases in alcohol use for women with a history of sexual victimization. The data did not, however, support a reciprocal relationship between sexual assault and drinking (eg, in that a sexual victimization during one time period did not predict drinking behaviors in subsequent time periods). CONCLUSIONS: These results underscore the importance of both alcohol and sexual assault programming on college campuses.

Psychiatric comorbidity does not predict interferon treatment completion rates in hepatitis C seropositive veterans.

GOALS: The aim of this study was to evaluate the impact of common psychiatric disorders on treatment completion of antiviral therapy prescribed to a series of hepatitis C virus (HCV) positive US veterans. BACKGROUND: Clinical experience suggests that preexisting psychiatric conditions may adversely affect the ability to tolerate combination antiviral therapy in patients with HCV infection. STUDY: We performed a retrospective chart review of 130 HCV positive veterans treated with combination antiviral therapy [interferon (IFN)/ribavirin] at VA San Diego from 2000 to 2004. We examined baseline psychiatric and substance use diagnoses, as well as demographic and comorbid medical disease variables for all patients started on treatment. RESULTS: Thirteen percent of patients in our cohort required treatment discontinuation for neuropsychiatric adverse effects. There was no association between treatment completion and any specific psychiatric diagnosis, baseline use of antidepressants, history of substance abuse/dependence, or combined psychiatric and substance use diagnoses for patient groups receiving either standard or pegylated IFN plus ribavirin therapies. Psychiatric and substance use disorders were not associated with dropout due to neuropsychiatric adverse effects. Baseline comorbid medical disorders also did not predict treatment completion. However, higher body weight did predict likelihood of treatment completion, especially for those > or =100 kg compared with thinner subjects (odds ratio=2.90; P=0.037). CONCLUSIONS: In this cohort of veterans, prior psychiatric or substance use history did not predict completion of recommended IFN/ribavirin treatment. These findings suggest that a larger pool of veterans with psychiatric or substance use disorders may be considered candidates for antiviral therapy when provided with multidisciplinary support.

A prospective analysis of the relationship between childhood sexual victimization and perpetration of dating violence and sexual assault in adulthood.

The majority of studies evaluating the relationship between childhood sexual assault and subsequent sexual assault perpetration by men have been conducted retrospectively and with incarcerated populations. The present study seeks to improve on previous research by prospectively investigating the relationship between childhood sexual assault and subsequent perpetration of dating violence in adulthood in men. Although there is a significant relationship between childhood sexual abuse and history of sexual assault perpetration at baseline, prospective analyses indicate that childhood sexual assault is not predictive of perpetration during the follow-up period. The role of family factors, including parental conflict resolution, is implicated in subsequent sexual aggression. These results are supportive of the idea that the effects of childhood sexual abuse may be mediated by a variety of factors.

A comprehensive review of behavioral interventions for weight management in schizophrenia.

BACKGROUND: Obesity in patients with schizophrenia has been associated with both lifestyle habits and the side effects of medications, with serious implications for physical and mental health, and mortality. Behavioral techniques to mitigate weight gain have been employed with variable success in patients with schizophrenia. This review seeks to assess the potential of behavioral therapy for the management of obesity in individuals diagnosed with schizophrenia through a comprehensive review of all available literature on this subject. METHODS: An electronic search of published articles pertaining to the use of behavioral interventions in individuals with schizophrenia was conducted using PsycINFO and Medline. RESULTS: The search strategy produced 23 articles that met inclusion criteria, with an aggregate sample of 701 participants. The types of behavioral interventions consisted of behavioral modification techniques, caloric restriction, and psychoeducation. Weight loss was reported in 19 studies, while the remaining studies showed either maintenance of baseline weight or minimal weight gain. CONCLUSIONS: Much of the literature is anecdotal, methodologically unsound, poorly documented, or applicable only to inpatient settings. Nonetheless, recent data from controlled studies suggest that behavioral interventions in patients diagnosed with schizophrenia may prevent future weight gain, and in some instances promote weight loss. High drop-out rates, and the absence of extended post-treatment follow-up still limit the conclusions regarding general efficacy of behavioral treatment of obesity in patients with schizophrenia.

Prevalence of the metabolic syndrome in veterans with schizophrenia.

UNLABELLED: The metabolic syndrome has become a focus of clinical attention due to its high prevalence in the United States (23%) and impact on cardiovascular risk, yet limited data exist on the prevalence of this syndrome among U.S. veterans with schizophrenia. METHODS: A convenience sample of patients diagnosed with schizophrenia or schizoaffective disorder was obtained from inpatient units and outpatient clinics at Veterans Affairs medical centers in San Diego and Los Angeles. RESULTS: In this predominantly male (92.5%) sample of 80 veterans, with mean age of 49.0 years, the age-adjusted prevalence of the metabolic syndrome was 51.2%, more than twice the age-adjusted prevalence in the general U.S. population. The female cohort was small (n = 6), but had a greater mean body mass index and higher prevalence of metabolic syndrome than the male subjects. CONCLUSIONS: The metabolic syndrome is highly prevalent in this sample of patients with schizophrenia and represents an enormous source of cardiovascular disease risk. Clinicians who treat patients with schizophrenia should monitor for the parameters that define the metabolic syndrome as part of the ongoing management of patients treated with antipsychotics.

Child and adolescent abuse and subsequent victimization: a prospective study.

OBJECTIVE: We investigated the possible reciprocal relationship between victimization experiences and psychological functioning by assessing abuse experiences in childhood, adolescence, and during a 2-month follow-up period. METHOD: At the beginning of the study (Time 1), abuse histories, trauma and depressive symptoms, and interpersonal functioning were assessed in 551 college women. Subsequent victimization experiences and psychological outcomes were assessed at the follow-up (Time 2). RESULTS: Path analyses indicated that verbal abuse by the mother and father were predictive of various psychological outcomes as measured at Time 1 and emerged as the only significant predictors of adolescent dating violence. Adolescent dating violence subsequently predicted the experience of dating violence during the 2-month follow-up period. Paternal physical abuse predicted adolescent sexual victimization which subsequently predicted all symptom measures at Time 1. Conversely, the experience of adolescent physical dating violence was not predictive of any of the symptom measures at Time 1. For those women who experienced dating violence during the follow-up, however, the severity of their abusive experiences was related to both depression and interpersonal problems assessed at Time 2. In comparison, for those women who experienced sexual victimization during the follow-up period, the severity of their abusive experiences was related to trauma symptoms. Interpersonal problems emerged as both an aftereffect of adolescent sexual victimization experience and a predictor of a subsequent sexual victimization experience during the follow-up. CONCLUSIONS: Given that emotional abuse emerged as a predictor of adolescent dating violence and psychological outcomes, researchers and clinicians need to continue to explore this problem. Further, it is important to assess how interpersonal problems contribute to the risk of subsequent sexual victimization and to try to break the cycle between adolescent abuse experiences and subsequent physical and sexual assaults.

A prospective analysis of sexual assault perpetration: risk factors related to perpetrator characteristics.

This study prospectively evaluated perpetrator risk factors for sexual assault perpetration, including peer influences, beliefs and attitudes about sexuality, alcohol use, and token resistance. Perpetration of sexual assault was evaluated at three time periods: pretest, 3-month follow-up, and 7-month follow-up. Retrospective and prospective analyses yielded differential predictors of sexually aggressive behavior. However, perpetration of sexual assault at any particular assessment period was a predictor of perpetration during the subsequent follow-up period. Furthermore, several variables that have previously been demonstrated in the literature to be related to the perpetration of sexual assault were not significant in regression analyses, indicating that these variables may be rendered insignificant when accounting for past perpetration in prospective analyses. These findings may have significant potential impact on development of sexual assault prevention programming with men.

Quetiapine-induced diabetes with metabolic acidosis.

Medication adherence with antipsychotics is adversely impacted by the burden of untoward adverse effects. In particular, sexual side-effects may interfere with compliance, but are often underreported by patients. Sexual dysfunction related to hyperprolactinemia is commonly described, but ejaculatory disturbance due to potent alpha1 adrenergic antagonism may also occur, and has been reported frequently with certain typical antipsychotics such as thioridazine, but rarely with atypical antipsychotics. Presented here is the case of a 51 year old male with schizophrenia who developed retrograde ejaculation on high dose risperidone therapy (8 mg/day) with prompt resolution of symptoms upon dose reduction. The absence of decreased libido or erectile dysfunction indicates that alpha1 adrenergic antagonism and not low serum testosterone due to hyperprolactinemia is the etiology for this side-effect. This case illustrates another mechanism for sexual adverse effects, and the need for routine inquiry into sexual dysfunction during atypical antipsychotic therapy.

Risperidone-induced retrograde ejaculation: case report and review of the literature.

Medication adherence with antipsychotics is adversely impacted by the burden of untoward adverse effects. In particular, sexual side-effects may interfere with compliance, but are often underreported by patients. Sexual dysfunction related to hyperprolactinemia is commonly described, but ejaculatory disturbance due to potent alpha1 adrenergic antagonism may also occur, and has been reported frequently with certain typical antipsychotics such as thioridazine, but rarely with atypical antipsychotics. Presented here is the case of a 51 year old male with schizophrenia who developed retrograde ejaculation on high dose risperidone therapy (8 mg/day) with prompt resolution of symptoms upon dose reduction. The absence of decreased libido or erectile dysfunction indicates that alpha1 adrenergic antagonism and not low serum testosterone due to hyperprolactinemia is the etiology for this side-effect. This case illustrates another mechanism for sexual adverse effects, and the need for routine inquiry into sexual dysfunction during atypical antipsychotic therapy.