An exploration of clinical dementia phenotypes among individuals with and without traumatic brain injury.

OBJECTIVE: To characterize the clinical profiles of individuals with dementia who do and do not report a history of TBI. INTRODUCTION: Some evidence suggests that a history of traumatic brain injury (TBI) is associated with an increased risk of dementia later in life. The clinical features of dementia associated with TBI have not been well investigated. While there is some evidence that TBI is associated with increased risk of Alzheimer's disease (AD), there are also indications that dementia associated with TBI has prominent behavioral, affective, and motor symptoms, making it distinct from AD. METHODS: The current study involves secondary analysis of baseline data from the National Alzheimer's Coordinating Center (NACC) Uniform Data Set (UDS). RESULTS: Individuals with dementia who reported a history of TBI had higher fluency and verbal memory scores and later onset of decline, but they are on more medications, had worse cardiovascular and cerebrovascular health, were more likely to have received medical attention for depression, and were more likely to have a gait disorder, falls, and motor slowness. CONCLUSION: These findings suggest that dementia among individuals with a history of TBI may represent a unique clinical phenotype that is distinct from known dementia subtypes.

Predictors of attrition in HIV-positive subjects with peripheral neuropathic pain.

The objective of this paper was to identify predictors of attrition in a study designed to assess whether cognitive behavioural therapy (CBT) was more helpful than supportive therapy (SP) in reducing pain associated with peripheral neuropathy in HIV-positive patients. Sixty-one subjects were randomized into either CBT or SP for six weekly one-hour sessions. Twenty-eight subjects dropped out before week six. Demographic variables such as age, gender, ethnicity, socioeconomic status and level of education were not predictive of attrition. However, higher scores on the Hamilton Depression Inventory (HAM-D, 17-item) (t (59) = - 0.09, p<0.05) were predictive. These findings suggest that while dropouts were not more physically ill (e.g. CD4 counts, viral loads and opportunistic infections were not statistically higher), they reported greater psychological distress.

Altered expression of a-type but not b-type synapsin isoform in the brain of patients at high risk for Alzheimer's disease assessed by DNA microarray technique.

Using a cDNA microarray representing 6794 distinct human genes, we identified candidate genes whose expression is altered in cerebral cortex of cases of early Alzheimer's disease (AD); among these was the synaptic vesicle protein synapsin II, which plays an important role in neurotransmitter release. While other candidate genes are presently under investigation in our lab, in this study we discuss the regulation of synapsin gene expression during the transition from normal cognitive function to early AD. We found a selective decrease in the expression of the synapsin splice variants I-III of the a-type isoform in the entorhinal (EC, BM36) but not visual cortex (VC, BM17) of cases characterized by the earliest clinically detectable stage of AD. In contrast, we found no changes in synapsin splice variant II of the b-type isoform. Alteration of synapsin expression at the earliest clinical stage of AD may suggest novel strategies for improved treatment.

Personality disorder symptoms predict declines in global functioning and quality of life in elderly depressed patients.

The authors evaluated personality disorder symptoms as predictors of change in global functioning and quality of life among elderly depressed patients. Treated elderly patients (N=40) who no longer met RDC criteria for major depression were assessed for personality disorders, depression, global functioning, and quality of life after treatment of the acute episode and at 1-year follow-up. In interaction with persisting or recurrent depression, Cluster B personality disorder symptoms contributed to declines in global functioning and quality of life over a 1-year period. Personality disorder symptoms in elderly patients appear to operate as co-factors that amplify or exacerbate the impact of residual depression on long-term functioning and quality of life.

An exploratory study of ethnicity and psychotherapy outcome among HIV-positive patients with depressive symptoms.

Few data address the relationship between ethnic status and psychotherapy outcome. This study reports data from a four-cell, 16-week controlled clinical trial for HIV-positive patients with depressive symptoms. Patients (N = 101) were randomized to 16 weeks of treatment with interpersonal psychotherapy, cognitive-behavioral therapy (CBT), supportive psychotherapy, or imipramine plus supportive psychotherapy. Analyses found an ethnicity-by-treatment interaction wherein African-American subjects (n = 18) assigned to CBT (n = 4) had significantly poorer outcomes than other patients. This is the first study to uncover an ethnicity-by-specific psychotherapy interaction. Its meaning is unclear. This charged topic requires cautious treatment, particularly given the small sample size in this study, but warrants further research.

Morbidity of comorbid psychiatric diagnoses in the clinical presentation of panic disorder.

This study seeks to determine how panic disorder patients with anxiety and depression comorbidity differ from panic disorder patients without comorbidity at the time of presentation for treatment. One-hundred seventy-one panic disorder patients presenting for their initial assessment and treatment at the Payne Whitney Anxiety Disorders Clinic agreed to participate and completed self-report and diagnostic assessments. Sixty-seven percent of panic disorder subjects were found to have at least one comorbid anxiety or depression diagnosis. Age and gender ratio were not affected by the presence of comorbid diagnoses. Comorbidity significantly contributed to psychological distress and symptom load, overall impairment, and interpersonal impairment.

Psychotherapy adherence of therapists treating HIV-positive patients with depressive symptoms.

Adherence monitoring, a technology to specify research psychotherapies, was used in the NIMH Treatment of Depression Collaborative Research Program (TDCRP). The authors present adherence data from a similar randomized treatment trial of 56 depressed HIV-positive patients, comparing 16-week interventions with cognitive-behavioral therapy, interpersonal psychotherapy, and supportive psychotherapy alone or with imipramine. Therapists were certified in manualized treatments. Blind independent raters rated randomly selected taped sessions on an adaptation of the NIMH scale, yielding adherence scores for interventions and for therapist "facilitative conditions" (FC). All therapists were rated adherent. Interrater reliability was 0.89-0.99. The scale discriminated among the four treatments (P<0.0001), with each scoring highest on its own scale. FC, which might measure therapist competence independent of treatment technique, varied by intervention but did not predict treatment outcome. This study demonstrates the ability to reliably train adherence monitors and therapists able to deliver specified treatments. Its adherence findings provide the first replication of those from the landmark NIMH TDCRP study.

Late-life depression and functional disability: the role of goal-focused group psychotherapy.

This study compares the efficacy of two time-limited group psychotherapies for depression and functional disability in late life. Goal-focused group psychotherapy (GFGP) utilized focused psychoeducation and skills training to assist each patient in the achievement of individualized goals. Reminiscence therapy (RT) emphasized individual life review to facilitate discussion. Subjects (N = 13), ages 55 and above, with major depression were randomly assigned to one of the two groups. Most were receiving antidepressant treatment. All had failed to achieve full remission. Whereas both treatment groups improved in depressed mood and disability, GFGP subjects had a far greater change in depressive symptomatology and also improved in the areas of hope, hopelessness, anxiety and social functioning.

Treatment of depressive symptoms in human immunodeficiency virus-positive patients.

BACKGROUND: This randomized clinical trial compared 16-week interventions with interpersonal psychotherapy, cognitive behavioral therapy, supportive psychotherapy, and supportive psychotherapy with imipramine for human immunodeficiency virus (HIV)-positive patients with depressive symptoms. METHODS: Subjects (N = 101; 85 male, 16 female) with known HIV seropositivity for at least 6 months were randomized to 16 weeks of treatment. Inclusion criteria were 24-item Hamilton Depression Rating Scale score of 15 or higher, clinical judgment of depression, and physical health sufficient to attend outpatient sessions. Therapists were trained in manualized therapies specific for HIV-positive patients. Treatment adherence was monitored. RESULTS: Subjects randomized to interpersonal psychotherapy (n = 24) and supportive psychotherapy with imipramine (n = 26) had significantly greater improvement on depressive measures than those receiving supportive psychotherapy (n = 24) or cognitive behavioral therapy (n = 27). Similar results appeared in the completer subsample. CONCLUSIONS: Depressive symptoms appear treatable in HIV-positive patients. Interpersonal psychotherapy may have particular advantages as a psychotherapy for patients who have experienced the significant life events of HIV infection.

Personality disorder symptoms and functioning in elderly depressed patients.

The authors evaluated the relationship of personality disorder symptoms to disability and social and interpersonal functioning in geriatric depression. Measures of personality disorder and cognitive, affective, social, interpersonal, medical, socioeconomic factors, and instrumental activities of daily living (IADL) status were administered to 47 elderly patients at various levels of remission from major depression. Total personality disorder scores were inversely associated with IADL, sociability, and presence of a satisfying relationship, both alone and in interaction with depression. The associations between personality disorder and functioning were most prominent in subjects with low residual depression. Symptoms of personality disorder in elderly patients may be associated with disability and impaired social and interpersonal functioning after an acute depressive episode; personality disorder symptoms may also have treatment implications for geriatric depression.

Interpersonal improvement in chronically depressed patients treated with desipramine.

OBJECTIVE: Interpersonal difficulties of dysthymic patients are little studied. We used the Inventory of Interpersonal Problems (IIP) to assess baseline status and medication response in chronic depression. METHOD: 39 chronically depressed subjects answered the IIP at entry and after 10 weeks of desipramine (DMI). Seventeen DMI responders completed IIPs after a 16-week continuation phase. RESULTS: Mean scores improved on all six IIP subscales during acute treatment. Continuation phase IIP improved non-significantly, approaching normative scores. Baseline IIP score correlated inversely with treatment outcome. CONCLUSIONS: Findings replicate in greater interpersonal detail research demonstrating rapid social amelioration in chronically depressed responders to antidepressant medication. The IIP may be useful as a predictive and interpersonal sensitivity measure in treatment studies of chronic depression.

Distress reduction during the structured clinical interview for DSM-III-R.

In an attempt to assess the influence of standardized diagnostic interviews on psychological distress in research volunteers, the Visual Analogue Scale (VAS) was used to measure anxiety and depression during the Structured Clinical Interview for DSM-III-R, Non-patient version (SCID). Subjects were 50 adults with concerns related to the human immunodeficiency virus who were seeking testing and treatment in research trials. Repeated measures analysis of variance showed significant decreases in distress by the end of the interview: 72% of subjects reported diminished anxiety, and 54% reported diminished depression. Thus, the SCID appeared to provide a positive interview experience, a finding that may serve to reassure subjects, their families, and review boards regarding participation in studies that employ structured interviews.

Individual psychotherapies for depressed HIV-positive patients.

OBJECTIVE: The authors present preliminary data from two treatment modalities of a randomized clinical trial in which they compared 16-week interventions of interpersonal psychotherapy to supportive psychotherapy. METHOD: HIV-positive patients who were not acutely medically ill and had scores of 15 or higher on the Hamilton Depression Rating Scale were randomly assigned to one of four treatment modalities. They were assessed by the Hamilton scale and Beck Depression Inventory at 8 and 16 weeks. Most subjects who underwent either interpersonal psychotherapy (N = 16) or supportive psychotherapy (N = 16) were male, gay or bisexual, white, and college educated. RESULTS: Results of last-observation-carried-forward and completer analyses showed that scores on the Hamilton scale and Beck Depression Inventory decreased significantly for both treatments. Differential improvement for interpersonal psychotherapy appeared by midtreatment (week 8) and persisted at termination. CONCLUSIONS: This is the first controlled study of individual psychotherapies for depressed HIV-positive patients. Results suggest that a specific antidepressant psychotherapy, interpersonal psychotherapy, has advantages over a supportive therapy.

Genetic mapping and non-Mendelian segregation of mating type loci in the oomycete, Phytophthora infestans.

DNA markers linked to the determinants of mating type in the oomycete, Phytophthora infestans, were identified and used to address the genetic basis of heterothallism in the normally diploid fungus. Thirteen loci linked to the A1 and A2 mating types were initially identified by bulked segregant analysis using random amplified polymorphic DNA markers (RAPDs) and subsequently scored in three crosses polymorphisms (SSCP), cleaved amplified polymorphisms (CAPS), or allele-specific polymerase chain reaction markers (AS-PCR). All DNA markers mapped to a single region, consistent with a single locus determining both mating types. Long-range restriction mapping also demonstrated the linkage of the markers to one region and delimited the mating type locus to a 100-kb region. The interval containing the mating type locus displayed non-Mendelian segregation as only two of the four expected genotypes were detected in progeny. This is consistent with a system of balance lethal loci near the mating type locus. A model for mating type determination is presented in which the balanced lethals exclude form progeny those with potentially conflicting combinations of mating type alleles, such as those simultaneously expressing A1 and A2 functions.

Future-event schemas and certainty about the future: automaticity in depressives' future-event predictions.

The proposition was tested that depressives make predictions about the future based on a pessimistic future-event schema. Participants varying in depression predicted whether positive and negative events would happen to them (or to an average person) in the future by pressing yes or no at a computer terminal as quickly as possible, either under a concurrent attentional load or under no such load. As hypothesized, depressives predicted more negative events and fewer positive events than did mild depressives or nondepressives and showed greater automaticity in their predictions. That is, the attentional load did not increase depressives' response latencies for either negative or positive events, even though it did so reliably for both mildly depressed and nondepressed individuals. Depressives may thus possess a highly developed future-event schema that operates efficiently in enabling future-event predictions.

Dominance and recessiveness at loci for virulence against potato and tomato in Phytophthora infestans.

In this study we investigated the genetic control of virulence in the diploid fungal pathogen, Phytophthora infestans, against host resistance genes R1, R2, R3, and R4 (potato) and Ph1 (tomato). For four of these virulence traits, the presence or absence of segregation indicated conclusively which phenotype was dominant. We observed a 3∶1 (virulent∶avirulent) segregation on R2 in the progeny of parents which were both virulent, suggesting that virulence is dominant and both parents are heterozygous. In a cross in which one parent was virulent and the other avirulent on potato gene R3, all progeny tested were avirulent, so avirulence against R3 is dominant. The same virulent parent crossed with a different avirulent parent produced virulent and avirulent progeny in a 1∶3 ratio, indicating that a second locus may be involved. The progeny of two parents virulent on R4 segregated for virulence and avirulence, so virulence against R4 is dominant. For Ph1, a 1∶3 segregation in the progeny of two avirulent parents showed that the avirulent phenotype is dominant, and a 3∶1 ration in a second cross suggested the involvement of a second locus. The segregations for virulence against R1 did not indicate which phenotype was dominant, but did suggest singlelocus control.

Redefinition of school nursing practice: integrating the developmentally disabled.

Results of three needs assessment studies which had the purpose of providing direction for school nursing practices which would address some of the unmet health needs of today's children and adolescents are reported. Results provide specific examples of how school nurses have not been meeting school health needs through an analysis of one specific need -- integrating the developmentally disabled into the regular school setting. Data were collected from parents, teachers and other supportive personnel in schools by interview and survey methods. Environmental assessments were conducted and the policies and procedures governing health-related activities required by special need students were reviewed. The data indicated that for developmentally disabled students, nurses were not performing the commonly accepted functions of nursing and were not transposing their knowledge of the components of health care ordinarily provided in health care settings to care provided in nontraditional health care settings. Examples of nursing functions and the activities needed to fulfill those functions are provided.