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1.
World Neurosurg ; 131: 104-107, 2019 Jul 29.
Artigo em Inglês | MEDLINE | ID: mdl-31369882

RESUMO

BACKGROUND: Transthyretin wild-type (ATTRwt) amyloidosis is a systemic process resulting in deposition of misfolded transthyretin protein in several different tissues throughout the body. It is known to be a cause of progressive, life-threatening cardiomyopathy and lumbar spinal stenosis and carpal tunnel syndrome. CASE DESCRIPTION: Here we present the case of a 71-year-old man who has clinical manifestations of all 3 entities over several years, providing a picture of the natural history of ATTRwt amyloidosis. This patient eventually underwent a heart transplant because of progressive cardiac amyloidosis (CA) resulting in end-stage heart failure. However, symptoms in carpal tunnel and lumbar spine manifested years before the symptoms of heart failure. ATTRwt amyloidosis may present as a clinical triad of lumbar stenosis, carpal tunnel syndrome, and heart failure. Recently developed medications have shown efficacy in slowing the progress of systemic and cardiac amyloidosis. CONCLUSIONS: Knowing that extracardiac symptoms may occur first, we propose that sending ligamentum flavum and flexor tenosynovium for pathologic evaluation may be a unique opportunity to screen and treat a population of patients at risk for developing CA and heart failure.

2.
Nat Neurosci ; 22(9): 1394-1401, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31358989

RESUMO

Post-traumatic stress disorder (PTSD) is a major problem among military veterans and civilians alike, yet its pathophysiology remains poorly understood. We performed a genome-wide association study and bioinformatic analyses, which included 146,660 European Americans and 19,983 African Americans in the US Million Veteran Program, to identify genetic risk factors relevant to intrusive reexperiencing of trauma, which is the most characteristic symptom cluster of PTSD. In European Americans, eight distinct significant regions were identified. Three regions had values of P < 5 × 10-10: CAMKV; chromosome 17 closest to KANSL1, but within a large high linkage disequilibrium region that also includes CRHR1; and TCF4. Associations were enriched with respect to the transcriptomic profiles of striatal medium spiny neurons. No significant associations were observed in the African American cohort of the sample. Results in European Americans were replicated in the UK Biobank data. These results provide new insights into the biology of PTSD in a well-powered genome-wide association study.

3.
Womens Health Issues ; 29 Suppl 1: S56-S66, 2019 06 25.
Artigo em Inglês | MEDLINE | ID: mdl-31253243

RESUMO

BACKGROUND: The Department of Veterans Affairs Million Veteran Program (MVP) is the largest ongoing cohort program of its kind, with 654,903 enrollees as of June 2018. The objectives of this study were to examine gender differences in the MVP cohort with respect to response and enrollment rates; demographic, health, and health care characteristics; and prevalence of self-reported health conditions. METHODS: The MVP Baseline Survey was completed by 415,694 veterans (8% women), providing self-report measures of demographic characteristics, health status, and medical history. RESULTS: Relative to men, women demonstrated a higher positive responder rate (23.0% vs. 16.0%), slightly higher enrollment rate (13.5% vs. 12.9%), and, among enrollees, a lower survey completion rate (59.7% vs. 63.8%). Women were younger, more racially diverse, had higher educational attainment, and were less likely to be married or cohabitating with a partner than men. Women were more likely to report good to excellent health status but poorer physical fitness, and less likely to report lifetime smoking and drinking than men. Compared with men, women veterans showed an increased prevalence of musculoskeletal conditions, thyroid problems, gastrointestinal conditions, migraine headaches, and mental health disorders, as well as a decreased prevalence of gout, cardiovascular diseases, high cholesterol, diabetes, and hearing problems. CONCLUSIONS: These results revealed some substantial gender differences in the research participation rates, demographic profile, health characteristics, and prevalence of health conditions for veterans in the MVP cohort. Findings highlight the need for tailoring recruitment efforts to ensure representation of the increasing women veteran population receiving care through the Veterans Health Administration.

4.
Biol Psychiatry ; 86(5): 365-376, 2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-31151762

RESUMO

BACKGROUND: Habitual alcohol use can be an indicator of alcohol dependence, which is associated with a wide range of serious health problems. METHODS: We completed a genome-wide association study in 126,936 European American and 17,029 African American subjects in the Veterans Affairs Million Veteran Program for a quantitative phenotype based on maximum habitual alcohol consumption. RESULTS: ADH1B, on chromosome 4, was the lead locus for both populations: for the European American sample, rs1229984 (p = 4.9 × 10-47); for African American, rs2066702 (p = 2.3 × 10-12). In the European American sample, we identified three additional genome-wide-significant maximum habitual alcohol consumption loci: on chromosome 17, rs77804065 (p = 1.5 × 10-12), at CRHR1 (corticotropin-releasing hormone receptor 1); the protein product of this gene is involved in stress and immune responses; and on chromosomes 8 and 10. European American and African American samples were then meta-analyzed; the associated region at CRHR1 increased in significance to 1.02 × 10-13, and we identified two additional genome-wide significant loci, FGF14 (p = 9.86 × 10-9) (chromosome 13) and a locus on chromosome 11. Besides ADH1B, none of the five loci have prior genome-wide significant support. Post-genome-wide association study analysis identified genetic correlation to other alcohol-related traits, smoking-related traits, and many others. Replications were observed in UK Biobank data. Genetic correlation between maximum habitual alcohol consumption and alcohol dependence was 0.87 (p = 4.78 × 10-9). Enrichment for cell types included dopaminergic and gamma-aminobutyric acidergic neurons in midbrain, and pancreatic delta cells. CONCLUSIONS: The present study supports five novel alcohol-use risk loci, with particularly strong statistical support for CRHR1. Additionally, we provide novel insight regarding the biology of harmful alcohol use.

5.
J Trauma Stress ; 32(2): 226-237, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31009556

RESUMO

We developed an algorithm for identifying U.S. veterans with a history of posttraumatic stress disorder (PTSD), using the Department of Veterans Affairs (VA) electronic medical record (EMR) system. This work was motivated by the need to create a valid EMR-based phenotype to identify thousands of cases and controls for a genome-wide association study of PTSD in veterans. We used manual chart review (n = 500) as the gold standard. For both the algorithm and chart review, three classifications were possible: likely PTSD, possible PTSD, and likely not PTSD. We used Lasso regression with cross-validation to select statistically significant predictors of PTSD from the EMR and then generate a predicted probability score of being a PTSD case for every participant in the study population (range: 0-1.00). Comparing the performance of our probabilistic approach (Lasso algorithm) to a rule-based approach (International Classification of Diseases [ICD] algorithm), the Lasso algorithm showed modestly higher overall percent agreement with chart review than the ICD algorithm (80% vs. 75%), higher sensitivity (0.95 vs. 0.84), and higher accuracy (AUC = 0.95 vs. 0.90). We applied a 0.7 probability cut-point to the Lasso results to determine final PTSD case-control status for the VA population. The final algorithm had a 0.99 sensitivity, 0.99 specificity, 0.95 positive predictive value, and 1.00 negative predictive value for PTSD classification (grouping possible PTSD and likely not PTSD) as determined by chart review. This algorithm may be useful for other research and quality improvement endeavors within the VA.

6.
Int J Methods Psychiatr Res ; 28(1): e1767, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30767326

RESUMO

OBJECTIVES: Heritability in the risk for developing posttraumatic stress disorder (PTSD) has been established, but most genome-wide association studies (GWASs) of PTSD involve relatively small sample sizes and limited identification of associated genetic loci. This report describes the methodology of a Veterans Affairs (VA) Cooperative Studies Program GWAS of PTSD among combat-exposed U.S. veterans. METHODS: Probable cases (with PTSD) and probable controls (without PTSD) were identified from among veterans enrolled in the VA Million Veteran Program (MVP) with an algorithm developed using questionnaire responses and electronic health record information. This algorithm, based on a statistical model, relied on medical chart reviews as a reference standard and was refined using telephone interviews. Subsequently, to evaluate the impact of probabilistic phenotyping on statistical power, the threshold probability for case-control selection was varied in simulations. RESULTS: As of September 2018, >695,000 veterans have enrolled in MVP. For current analyses, genotyping data were available for >353,000 participants, including >83,000 combat-exposed veterans. A threshold probability of 0.7 for case and control designation yielded an interim >16,000 cases and >33,000 controls. CONCLUSIONS: A formal methodological approach was used to identify cases and controls for subsequent GWAS analyses to identify genetic risk loci for PTSD.

7.
Artigo em Inglês | MEDLINE | ID: mdl-30307533

RESUMO

Background: Frailty is a key determinant of clinical outcomes. We sought to describe frailty among U.S. Veterans and its association with mortality. Methods: Nationwide retrospective cohort study of regular Veterans Affairs (VA) users, aged at least 65 years in 2002-2012, followed through 2014, using national VA administrative and Medicare/Medicaid data. A frailty index (FI) for VA (VA-FI) was calculated using the cumulative deficit method. Thirty-one age-related deficits in health from diagnostic and procedure codes were included and were updated biennially. Survival analysis assessed associations between VA-FI and mortality. Results: A VA-FI was calculated for 2,837,152 Veterans over 10 years. In 2002, 36.7% were non-frail (FI = 0-0.10), 33.3% were pre-frail (FI = 0.11-0.20), 18.6% were mildly frail (FI = 0.21-0.30), 8.0% were moderately frail (FI = 0.31-0.40), and 3.4% were severely frail (FI > 0.40). From 2002 to 2012, the prevalence of moderate frailty increased to 12.6%and severe frailty to 12.3%. Frailty was strongly associated with survival and was independent of age, sex, race, and smoking; the VA-FI better predicted mortality than age alone. Although prevalence of frailty rose over time, compared to non-frail Veterans, 2 years' hazard ratios (95% confidence intervals) for mortality declined from a peak in 2004 of 2.05 (2.02-2.09), 3.72 (3.67, 3.78), 6.43 (6.33-6.53), and 11.11 (10.93-11.29) for pre-frail, mildly, moderately, and severely frail, respectively, to 1.53 (1.51, 1.55), 2.48 (2.44-2.51), 3.96 (3.90-4.01), 6.98 (6.89-7.07) in 2014. At every frailty level, risk of mortality was lower for women versus men and higher for blacks versus whites. Conclusions: Frailty affects 3 of every 10 U.S. Veterans aged at least 65 years, and is strongly associated with mortality. The VA-FI could be used to more accurately estimate life expectancy and individualize care for Veterans.

8.
Contemp Clin Trials Commun ; 4: 149-154, 2016 Dec 15.
Artigo em Inglês | MEDLINE | ID: mdl-29736478

RESUMO

Background: The estimation of an effect size is an important step in designing an adequately powered, feasible clinical trial intended to change clinical practice. During the planning phase of VA Cooperative Study #590, "Double-Blind Placebo-Controlled Study of Lithium for Preventing Repeated Suicidal Self-Directed Violence in Patients with Depression or Bipolar Disorder (Li+)," it was not clear what effect size would be considered large enough to influence prescribing behavior among practicing clinicians. Methods: We conducted an online survey of VA psychiatrists to assess their interest in the study question, their clinical experience with lithium, and their opinion about what suicide reduction rate would change their prescribing habits. The 9-item survey was hosted on SurveyMonkey© and VA psychiatrists were individually emailed an invitation to complete an anonymous online survey. Three email waves were sent over three weeks. Results: Overall, 862 of 2713 VA psychiatrists (response rate = 31.8%) responded to the anonymous survey. 74% of the respondents would refer a patient to the proposed trial, 9% would not, and 17% were unsure. Presented with suicide reduction rates in 10% increments ranging from 10 to 100%, 61% of respondents indicated that they would use lithium if suicide attempts were reduced by at least 40%; 83% would use lithium if it reduced attempts by at least 50%. Conclusions: Even with the limitations of response bias and the reliability of responses on future prescribing behavior, a survey of potential users of a clinical trial's results offers a convenient, empirical method for determining and justifying clinically relevant effect sizes.

9.
PLoS One ; 10(2): e0116173, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25646781

RESUMO

The predator-prey interactions in the offshore food web of Lake Superior have been well documented, but the sensory systems mediating these interactions remain unknown. The deepwater sculpin, (Myoxocephalus thompsoni), siscowet (Salvelinus namaycush siscowet), and kiyi (Coregonus kiyi) inhabit low light level environments. To investigate the potential role of vision in predator-prey interactions, electroretinography was used to determine visual sensitivity for each species. Spectral sensitivity curves revealed peak sensitivity at 525 nm for each species which closely corresponds to the prevalent downwelling light spectrum at depth. To determine if sufficient light was available to mediate predator-prey interactions, visual sensitivity was correlated with the intensity of downwelling light in Lake Superior to construct visual depth profiles for each species. Sufficient daytime irradiance exists for visual interactions to approximately 325 m for siscowet and kiyi and 355 m for the deepwater sculpin during summer months. Under full moon conditions, sufficient irradiance exists to elicit ERG response to light available at approximately 30 m for the siscowet and kiyi and 45 m for the deepwater sculpin. Visual interactions are therefore possible at the depths and times when these organisms overlap in the water column indicating that vision may play a far greater role at depth in deep freshwater lakes than had been previously documented.


Assuntos
Peixes/fisiologia , Lagos , Acuidade Visual/fisiologia , Animais , Eletrorretinografia , Luz , Comportamento Predatório
10.
J Trauma Stress ; 26(3): 329-37, 2013 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-23636815

RESUMO

This study used structural equation modeling to evaluate a mediation model of the relationship between trauma exposure, posttraumatic stress disorder (PTSD) symptoms, and perpetration of intimate partner physical and psychological aggression in trauma-exposed veterans and their cohabitating spouses (n = 286 couples; 88% male veteran and female spouse, 80.8% White, non-Hispanic). Dyadic data analyses were used to simultaneously evaluate actor and partner effects using the actor-partner interdependence model (Kashy & Kenny, 2000). The primary hypothesis was that PTSD would mediate the association between trauma exposure and intimate partner physical and psychological aggression with these effects evident both within and across members of a couple (i.e., actor and partner effects). The best-fitting model included (a) equivalent actor and partner direct effects of trauma on veterans' acts of psychological aggression (ß = .17 to .20, p = .001), and (b) equivalent actor and partner indirect effects via PTSD on veterans' acts of physical aggression (ß = .08 to .10, p < .001). There were no direct or indirect effects predicting the spouses' aggression. Results suggest it is important to consider the trauma histories and possible presence of PTSD in both partners as this may be a point of intervention when treating distressed couples.


Assuntos
Agressão/psicologia , Maus-Tratos Conjugais/psicologia , Transtornos de Estresse Pós-Traumáticos/psicologia , Veteranos/psicologia , Adulto , Idoso , Criança , Abuso Sexual na Infância/psicologia , Feminino , Humanos , Relações Interpessoais , Masculino , Pessoa de Meia-Idade , Modelos Psicológicos , Escalas de Graduação Psiquiátrica , Estupro/psicologia , Índice de Gravidade de Doença , Cônjuges/psicologia , Guerra , Adulto Jovem
11.
J Anxiety Disord ; 27(2): 240-51, 2013 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-23523947

RESUMO

This study examined the influence of trauma history and PTSD symptoms on the behavior of veterans and their intimate partners (287 couples; N=574) observed during conflict discussions and coded using the Rapid Marital Interaction Coding System (Heyman, 2004). Dyadic structural equation modeling analyses showed that PTSD was associated with more frequent displays of hostility and psychological abuse and fewer expressions of acceptance and humor in both veterans and their partners. Findings provide new insight into the social and emotional deficits associated with PTSD and emphasize the importance of addressing the trauma histories and PTSD of both partners when treating veteran couples with relationship disturbance.


Assuntos
Conflito Familiar/psicologia , Parceiros Sexuais/psicologia , Transtornos de Estresse Pós-Traumáticos/psicologia , Veteranos/psicologia , Adulto , Idoso , Feminino , Hostilidade , Humanos , Relações Interpessoais , Masculino , Casamento , Pessoa de Meia-Idade , Comportamento Sexual , Transtornos de Estresse Pós-Traumáticos/diagnóstico , Adulto Jovem
12.
Educ Psychol Meas ; 76(6): 913-934, 2013 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-25705052

RESUMO

Determining sample size requirements for structural equation modeling (SEM) is a challenge often faced by investigators, peer reviewers, and grant writers. Recent years have seen a large increase in SEMs in the behavioral science literature, but consideration of sample size requirements for applied SEMs often relies on outdated rules-of-thumb. This study used Monte Carlo data simulation techniques to evaluate sample size requirements for common applied SEMs. Across a series of simulations, we systematically varied key model properties, including number of indicators and factors, magnitude of factor loadings and path coefficients, and amount of missing data. We investigated how changes in these parameters affected sample size requirements with respect to statistical power, bias in the parameter estimates, and overall solution propriety. Results revealed a range of sample size requirements (i.e., from 30 to 460 cases), meaningful patterns of association between parameters and sample size, and highlight the limitations of commonly cited rules-of-thumb. The broad "lessons learned" for determining SEM sample size requirements are discussed.

13.
Sleep Med ; 13(6): 752-8, 2012 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-22542787

RESUMO

OBJECTIVE: The Pittsburgh Sleep Quality Index (PSQI) is a widely used measure of subjective sleep disturbance in clinical populations, including individuals with posttraumatic stress disorder (PTSD). Although the severity of sleep disturbance is generally represented by a global symptom score, recent factor analytic studies suggest that the PSQI is better characterized by a two- or three-factor model than a one-factor model. This study examined the replicability of two- and three-factor models of the PSQI, as well as the relationship between PSQI factors and health outcomes, in a female sample with PTSD. METHODS: The PSQI was administered to 319 women with PTSD related to sexual or physical assault. Confirmatory factor analyses tested the relative fit of one-, two-, and three-factor solutions. Bivariate correlations were performed to examine the shared variance between PSQI sleep factors and measures of PTSD, depression, anger, and physical symptoms. RESULTS: Confirmatory factor analyses supported a three-factor model with Sleep Efficiency, Perceived Sleep Quality, and Daily Disturbances as separate indices of sleep quality. The severity of symptoms represented by the PSQI factors was positively associated with the severity of PTSD, depression, and physical symptoms. However, these health outcomes correlated as much or more with the global PSQI score as with PSQI factor scores. CONCLUSIONS: These results support the multidimensional structure of the PSQI. Despite this, the global PSQI score has as much or more explanatory power as individual PSQI factors in predicting health outcomes.


Assuntos
Psicometria/métodos , Psicometria/normas , Transtornos do Sono-Vigília/complicações , Transtornos do Sono-Vigília/diagnóstico , Sono , Transtornos de Estresse Pós-Traumáticos/complicações , Adolescente , Adulto , Idoso , Ira/fisiologia , Depressão/complicações , Depressão/diagnóstico , Depressão/psicologia , Feminino , Humanos , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Índice de Gravidade de Doença , Transtornos do Sono-Vigília/psicologia , Transtornos de Estresse Pós-Traumáticos/psicologia , Inquéritos e Questionários/normas , Adulto Jovem
14.
Compr Psychiatry ; 53(6): 679-90, 2012 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-22305866

RESUMO

This study examined attention-deficit/hyperactivity disorder (ADHD) comorbidity in military veterans with a high prevalence of posttraumatic stress disorder (PTSD) and evaluated the relationships between the 2 disorders and exposure to traumatic events. The sample included 222 male and female military veterans who were administered structured clinical interviews based on the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Results show that 54.5% met the criteria for current PTSD, 11.5% of whom also met the criteria for current adult ADHD. Level of trauma exposure and ADHD severity were significant predictors of current PTSD severity. Evaluation of the underlying structure of symptoms of PTSD and ADHD using confirmatory factor analysis yielded a best-fitting measurement model that comprised 4 PTSD factors and 3 ADHD factors. Standardized estimates of the correlations among PTSD and ADHD factors suggested that the largest proportion of shared variance underlying PTSD-ADHD comorbidity is related to problems with modulating arousal levels that are common to both disorders (ie, hyperarousal and hypoarousal).


Assuntos
Transtorno do Deficit de Atenção com Hiperatividade/epidemiologia , Distúrbios de Guerra/epidemiologia , Acontecimentos que Mudam a Vida , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Veteranos/psicologia , Adulto , Idoso , Transtorno do Deficit de Atenção com Hiperatividade/diagnóstico , Distúrbios de Guerra/diagnóstico , Comorbidade , Manual Diagnóstico e Estatístico de Transtornos Mentais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Índice de Gravidade de Doença , Transtornos de Estresse Pós-Traumáticos/diagnóstico , Inquéritos e Questionários
15.
J Abnorm Psychol ; 121(1): 256-62, 2012 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-21574669

RESUMO

Prior research using the Brief Form of the Multidimensional Personality Questionnaire (MPQ-BF; Patrick, Curtin, & Tellegen, 2002) has shown evidence of 3 temperament-based subtypes--termed internalizing, externalizing, and simple PTSD--among individuals with symptoms of posttraumatic stress disorder (PTSD; Miller, Greif, & Smith, 2003). This study sought to replicate and extend research in this area by conducting a latent profile analysis of higher order temperament scales from the MPQ-BF using a new sample of 208 veterans with symptoms of PTSD. Results suggest that a 3-class solution reflecting internalizing, externalizing, and simple subtypes of posttraumatic psychopathology provided the best fit to the data. The externalizing subtype was characterized by features of antisocial, borderline, histrionic, and narcissistic personality disorders on the International Personality Disorder Examination (Loranger, 1999) as well as low levels of constraint and high levels of negative emotionality on the MPQ-BF. In contrast, individuals in the internalizing class exhibited features of schizoid and avoidant personality disorders, low levels of positive emotionality, and high levels of negative emotionality. The simple subtype was defined by low levels of comorbid personality disorder features and relatively normal personality profiles. Findings support the reliability of this typology and support the relevance of the internalizing and externalizing model to the structure of personality disorders.


Assuntos
Controle Interno-Externo , Inventário de Personalidade , Transtornos de Estresse Pós-Traumáticos/psicologia , Veteranos/psicologia , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Modelos Psicológicos , Transtornos da Personalidade/psicologia , Índice de Gravidade de Doença , Inquéritos e Questionários , Adulto Jovem
16.
Psychol Assess ; 23(4): 911-24, 2011 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-21767029

RESUMO

This study evaluated the psychometric characteristics of the Schedule for Nonadaptive and Adaptive Personality (SNAP; Clark, 1996) in 280 individuals who screened positive for posttraumatic stress disorder (PTSD). The SNAP validity, trait, temperament, and personality disorder (PD) scales were compared with scales on the Brief Form of the Multidimensional Personality Questionnaire (Patrick, Curtin, & Tellegen, 2002). In a subsample of 86 veterans, the SNAP PD, trait, and temperament scales were also evaluated in comparison to the International Personality Disorder Examination (IPDE; Loranger, 1999), a semistructured diagnostic interview. Results revealed that the SNAP scales have good convergent validity, as evidenced by their pattern of associations with related measures of personality and PD. However, evidence for their discriminant validity in relationship to other measures of personality and PD was more mixed, and test scores on the SNAP trait and temperament scales left much unexplained variance in IPDE-assessed PDs. The diagnostic scoring of the SNAP PD scales greatly inflated prevalence estimates of PDs relative to the IPDE and showed poor agreement with the IPDE. In contrast, the dimensional SNAP scores yielded far stronger associations with continuous scores on the IPDE. The SNAP scales also largely evidenced expected patterns of association with a measure of PTSD severity. Overall, findings support the use of this measure in this population and contribute to our conceptualization of the association between temperament, PTSD, and Axis II psychopathology.


Assuntos
Adaptação Psicológica , Transtornos da Personalidade/diagnóstico , Testes de Personalidade/estatística & dados numéricos , Psicometria , Estatística como Assunto , Transtornos de Estresse Pós-Traumáticos/diagnóstico , Adulto , Idoso , Manual Diagnóstico e Estatístico de Transtornos Mentais , Feminino , Humanos , Acontecimentos que Mudam a Vida , Masculino , Pessoa de Meia-Idade , Personalidade , Transtornos da Personalidade/psicologia , Testes de Personalidade/normas , Escalas de Graduação Psiquiátrica/estatística & dados numéricos , Autorrelato , Índice de Gravidade de Doença , Transtornos de Estresse Pós-Traumáticos/psicologia , Temperamento , Veteranos/psicologia , Adulto Jovem
17.
Violence Vict ; 26(1): 73-87, 2011.
Artigo em Inglês | MEDLINE | ID: mdl-21776830

RESUMO

This study examined the relative contributions of the three forms of childhood family violence exposure on physical intimate partner violence (IPV) victimization among recent robbery victims and tested a gender-matching modeling prediction for IPV risk. Data from a sample of 103 male and 93 female victims of a robbery were analyzed to investigate the effects of exposure to childhood physical abuse (CPA), childhood sexual abuse (CSA), and witnessing parental violence on the likelihood of IPV in adulthood. As expected, witnessing parental violence was associated with a 2.4-fold increase in IPV for both men and women. Neither CPA nor CSA was significantly associated with IPV after accounting for the effect of witnessing parental violence. There was support for the gender-matching hypothesis with men more likely to report IPV if they had witnessed mother-to-father violence and women more likely to report IPV if they had witnessed father-to-mother violence. Witnessing parental violence is strongly associated with risk for IPV victimization, particularly when the victim is the same-gender parent. Future directions and clinical implications are discussed.


Assuntos
Vítimas de Crime/estatística & dados numéricos , Maus-Tratos Conjugais/estatística & dados numéricos , Sobreviventes/estatística & dados numéricos , Roubo/estatística & dados numéricos , Adulto , Idoso , Vítimas de Crime/psicologia , Feminino , Humanos , Relações Interpessoais , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Parceiros Sexuais , Fatores Socioeconômicos , Maus-Tratos Conjugais/psicologia , Sobreviventes/psicologia , Roubo/psicologia , Estados Unidos/epidemiologia , Adulto Jovem
18.
J Trauma Stress ; 23(5): 631-8, 2010 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-20839312

RESUMO

Research on the structure of posttraumatic stress disorder (PTSD) symptoms has yielded support for two 4-factor models: the King (King, Leskin, King, & Weathers, 1998) and Simms/Watson models (Simms, Watson, & Doebbeling, 2002). This study evaluated them using data drawn from 1,128 Vietnam veterans by comparing associations with a latent internalizing comorbidity variable and five scales from the MMPI-2 Restructured Clinical (RC) Scales (Tellegen et al., 2003). The Simms/Watson dysphoria factor failed to show evidence of superior convergent or discriminant validity in association with external measures relative to the numbing or hyperarousal factors of the King model. Findings raise questions about proposals to abandon the distinction between numbing and hyperarousal symptoms in favor of a dysphoria-based model.


Assuntos
Comorbidade , Modelos Teóricos , Transtornos de Estresse Pós-Traumáticos/fisiopatologia , Adulto , Humanos , Masculino , Entrevista Psiquiátrica Padronizada , Pessoa de Meia-Idade , Veteranos/psicologia , Guerra do Vietnã
19.
J Abnorm Child Psychol ; 38(2): 173-84, 2010 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-19731006

RESUMO

The objective of the current study was to evaluate how the inclusion of 3 Sluggish Cognitive Tempo (SCT) symptoms in Attention-Deficit/Hyperactivity Disorder (ADHD) diagnostic criteria influences the external validity of the ADHD subtypes. The sample comprised 228 children (166 boys, 62 girls) ranging in age from 5-18 years who were referred to clinics for attentional, behavioral, and/or learning problems and diagnosed with DSM-IV ADHD (124 Combined type, 81 Inattentive type, 23 Hyperactive-Impulsive type). Parent ratings of ADHD symptoms were obtained using the Emory Combined Rating Scale (ECRS), which assesses symptoms of the common DSM-IV childhood psychiatric disorders. Regression analyses incorporating planned comparisons were conducted to examine how the inclusion of SCT symptoms affects differences among ADHD subtypes on several external validity indicators (i.e., gender, age-of-onset, and overlapping conditions). The regression analyses did not yield any significant differences in gender ratios, mean age-The objective of the current study was to evaluate how the inclusion of 3 Sluggish Cognitive Tempo (SCT) symptoms in Attention-Deficit/Hyperactivity Disorder (ADHD) diagnostic criteria influences the external validity of the ADHD subtypes. The sample comprised 228 children (166 boys, 62 girls) ranging in age from 5-18 years who were referred to clinics for attentional, behavioral, and/or learning problems and diagnosed with DSM-IV ADHD (124 Combined type, 81 Inattentive type, 23 Hyperactive-Impulsive type). Parent ratings of ADHD symptoms were obtained using the Emory Combined Rating Scale (ECRS), which assesses symptoms of the common DSM-IV childhood psychiatric disorders. Regression analyses incorporating planned comparisons were conducted to examine how the inclusion of SCT symptoms affects differences among ADHD subtypes on several external validity indicators (i.e., gender, age-of-onset, and overlapping conditions). The regression analyses did not yield any significant differences in gender ratios, mean age-of- onset, or overlapping externalizing or internalizing problems when the ADHD Inattentive type was subdivided into high- versus low-SCT groups. In conclusion, the current results suggest that the inclusion of parent-reported SCT symptoms in the ADHD diagnostic criteria has limited utility for isolating diagnostically meaningful subgroups of the Inattentive type or for enhancing the external validity of the ADHD subtypes in clinic-referred samples.


Assuntos
Transtornos de Deficit da Atenção e do Comportamento Disruptivo/classificação , Transtornos de Deficit da Atenção e do Comportamento Disruptivo/diagnóstico , Cognição , Adolescente , Idade de Início , Atenção , Transtornos de Deficit da Atenção e do Comportamento Disruptivo/psicologia , Distribuição de Qui-Quadrado , Criança , Pré-Escolar , Transtornos Cognitivos/classificação , Transtornos Cognitivos/diagnóstico , Transtornos Cognitivos/psicologia , Manual Diagnóstico e Estatístico de Transtornos Mentais , Feminino , Humanos , Hipercinese/psicologia , Comportamento Impulsivo/psicologia , Masculino , Testes Neuropsicológicos , Seleção de Pacientes , Determinação da Personalidade , Análise de Regressão , Índice de Gravidade de Doença
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