The life review experience: Qualitative and quantitative characteristics.

BACKGROUND: The life-review experience (LRE) is a most intriguing mental phenomenon that fascinated humans from time immemorial. In LRE one sees vividly a succession of one's own life-events. While reports of LRE are abundant in the medical, psychological and popular literature, not much is known about LRE's cognitive and psychological basis. Moreover, while LRE is known as part of the phenomenology of near-death experience, its manifestation in the general population and in other circumstances is still to be investigated. METHODS: In a first step we studied the phenomenology of LRE by means of in-depth qualitative interview of 7 people who underwent full LRE. In a second step we extracted the main characters of LRE, to develop a questionnaire and an LRE-score that best reflects LRE phenomenology. This questionnaire was then run on 264 participants of diverse ages and backgrounds, and the resulted score was further subjected to statistical analyses. RESULTS: Qualitative analysis showed the LRE to manifest several subtypes of characteristics in terms of order, continuity, the covered period, extension to the future, valence, emotions, and perspective taking. Quantitative results in the normal population showed normal distribution of the LRE-score over participants. CONCLUSION: Re-experiencing one's own life-events, so-called LRE, is a phenomenon with well-defined characteristics, and its subcomponents may be also evident in healthy people. This suggests that a representation of life-events as a continuum exists in the cognitive system, and maybe further expressed in extreme conditions of psychological and physiological stress.

Reversible functional connectivity disturbances during transient global amnesia.

OBJECTIVE: Transient global amnesia (TGA), an abrupt occurrence of severe anterograde episodic amnesia accompanied by repetitive questioning, has been known for more than 50 years. Despite extensive research, there is no clear evidence for the underlying pathophysiological basis of TGA. Moreover, there is no neuroimaging method to evaluate TGA in real time. METHODS: Here we used resting-state functional magnetic resonance imaging recorded in 12 patients during the acute phase of TGA together with connectivity and cluster analyses to detect changes in the episodic memory network in TGA. RESULTS: Our results show a significant reduction in functional connectivity of the episodic memory network during TGA, which is more pronounced in the hyperacute phase than in the postacute phase. This disturbance is bilateral, and reversible after recovery. Although the hippocampus and its connections are significantly impaired, other parts of the episodic memory network are also impaired. Similar results were obtained for the analysis of the episodic memory network whether it was defined in a data-driven or literature-based manner. INTERPRETATION: These results suggest that TGA is related to a functional disturbance in the episodic memory network, and supply a neuroimaging correlate of TGA during the acute phase.

The Relationship Between the Perceived Risk of Harm by a Family Member with Mental Illness and the Family Experience.

Family members of people with serious mental illness (SMI) at times report that they act to stop their ill relative from self harm or harming others. This study examines the relationship between the perception of risk of harm and family distress, burden, empowerment, coping, physical and mental health, appraisal of the caregiving experience, family communication, and family functioning. The study is a secondary analysis of baseline data collected for a randomized study of the family-to-family peer driven education program (FTF). Four hundred thirty-four enrolled individuals who were seeking to participate in FTF completed survey items that asked if they had tried to stop or prevent their ill family member from harming themselves or others in the last 30 days. Participants who perceived a recent risk of harm by their ill relative reported more negative appraisals of caregiving, greater psychological distress, poorer mental health and greater objective burden compared with those who did not perceive a recent risk of harm. The results suggest that families of persons with SMI should be asked about perceived risk of harm to self and others, and the presence of perceived risk of harm should serve as a red flag indicating the need for further evaluation of the family experience and additional support for the family.

Prevalence of MTHFR C677T and MS A2756G polymorphisms in major depressive disorder, and their impact on response to fluoxetine treatment.

OBJECTIVE: To examine the prevalence of the C677T polymorphism of the methylene tetrahydrofolate reductase (MTHFR) gene and the A2756G polymorphism of methionine synthase (MS), and their impact on antidepressant response. METHODS: We screened 224 subjects (52% female, mean age 39 ± 11 years) with SCID-diagnosed major depressive disorder (MDD), and obtained 194 genetic samples. 49 subjects (49% female, mean age 36 ± 11 years) participated in a 12-week open clinical trial of fluoxetine 20-60 mg/day. Association between clinical response and C677T and A2756G polymorphisms, folate, B12, and homocysteine was examined. RESULTS: Prevalence of the C677T and A2756G polymorphisms was consistent with previous reports (C/C = 41%, C/T = 47%, T/T = 11%, A/A = 66%, A/G = 29%, G/G = 4%). In the fluoxetine-treated subsample (n = 49), intent-to-treat (ITT) response rates were 47% for C/C subjects and 46% for pooled C/T and T/T subjects (nonsignificant). ITT response rates were 38% for A/A subjects and 60% for A/G subjects (nonsignificant), with no subjects exhibiting the G/G homozygote. Mean baseline plasma B12 was significantly lower in A/G subjects compared to A/A, but folate and homocysteine levels were not affected by genetic status. Plasma folate was negatively associated with treatment response. CONCLUSION: The C677T and A2756G polymorphisms did not significantly affect antidepressant response. These preliminary findings require replication in larger samples.

Gender, depressive symptoms and patterns of alcohol use among college students.

BACKGROUND: Serious alcohol-related negative consequences are associated with a number of drinking behaviors among college students. Thus, it is critical to identify students who are at greater risk for hazardous drinking. Although some studies have shown that depressive symptoms may be associated with alcohol use in this population, findings are not consistent. The current study extends previous research by investigating the relationship between depressive symptoms, daily alcohol use and compulsive drinking among college students and whether gender moderates these relationships. SAMPLING AND METHODS: The participants were 904 college students (495 females; mean age = 20.07 ± 1.85 years) who filled out questionnaires that focused on drinking behaviors and severity of depressive symptoms. RESULTS: Gender moderated the relationship between depressive symptoms and daily alcohol consumption. In male college students, worse depressive symptoms were associated with increased daily alcohol use and with greater risk for compulsive drinking. In female college students, worse depressive symptoms increased the risk for compulsive drinking, but not for greater daily alcohol use. CONCLUSIONS: Results suggest that prevention programs aimed at decreasing harmful alcohol use among college students must take into consideration the role of both gender and depressive symptoms in the development of problematic drinking behaviors.

A critical overview of the pharmacologic management of treatment-resistant depression.

Major depressive disorder is a frequent, serious disorder that usually responds partially to treatment and leaves many patients with treatment resistance. This article reviews and critically evaluates the evidence for the management of treatment-resistant depression and examines pharmacologic approaches to alleviate the suffering of patients who benefit insufficiently from initial treatment.

See, Test & Treat: A 5-Year Experience of Pathologists Driving Cervical and Breast Cancer Screening to Underserved and Underinsured Populations.

CONTEXT: - See, Test & Treat is a pathologist-driven program to provide cervical and breast cancer screening to underserved and underinsured patient populations. This program is largely funded by the CAP Foundation (College of American Pathologists, Northfield, Illinois) and is a collaborative effort among several medical specialties united to address gaps in the current health care system. OBJECTIVE: - To provide an outline for administering a See, Test & Treat program, using an academic medical center as a model for providing care and collating the results of 5 years of data on the See, Test & Treat program's findings. DESIGN: - Sources include data from patients seen at Tufts Medical Center (Boston, Massachusetts) who presented to the See, Test & Treat program and institutional data between 2010 and 2014 detailing the outline of how to organize and operationalize a volunteer cancer-screening program. RESULTS: - During the 5-year course of the program, 203 women were provided free cervical and breast cancer screening. Of the 169 patients who obtained Papanicolaou screening, 36 (21.3%) had abnormal Papanicolaou tests. In addition, 16 of 130 patients (12.3%) who underwent mammography had abnormal findings. CONCLUSIONS: - In general, women from ethnic populations have barriers that prevent them from participating in cancer screening. However, the CAP Foundation's See, Test & Treat program is designed to reduce those barriers for these women by providing care that addresses cultural, financial, and practical issues. Although screening programs are helpful in identifying those who need further treatment, obtaining further treatment for these patients continues to be a challenge.

The pancake phenomenon contributes to the inaccuracy of margin assessment in patients with breast cancer.

BACKGROUND: To determine the effect on margin evaluation for patients with breast cancer, we prospectively quantified the "flattening" of the breast specimen after surgical removal. METHODS: The volume and height of 100 consecutive breast biopsy specimens were recorded independently by the operating surgeon and the pathologist. Five factors were analyzed that were thought to contribute to changes in specimen dimensions: patient age, breast tissue density, mammographic lesion type, specimen size, and the use of compression during specimen radiography. RESULTS: After surgical removal, mean volume and height of the breast specimens decreased from 46 cm(3) to 29 cm(3) (30%) and from 2.6 cm to 1.4 cm (46%), respectively. Flattening of the breast specimens occurred in all subgroups studied. CONCLUSIONS: Breast specimens are flattened after surgical removal, losing almost 50% of their original height. This "pancake" phenomenon has important implications for the accuracy of margin analysis.

Epidemiology of pain among outpatients in methadone maintenance treatment programs.

BACKGROUND: This analysis explored the prevalence and correlates of pain in patients enrolled in methadone maintenance treatment (MMT). METHODS: Patients in two MMT programs starting a hepatitis care coordination randomized controlled trial completed the Brief Pain Inventory Short-Form and other questionnaires. Associations between clinically significant pain (average daily pain≥5 or mean pain interference≥5 during the past week) and sociodemographic data, medical status, depressive symptoms, and health-related quality of life, and current substance use were evaluated in multivariate analyses. RESULTS: The 489 patients included 31.8% women; 30.3% Hispanics, 29.4% non-Hispanic Blacks, and 36.0% non-Hispanic Whites; 60.1% had hepatitis C, 10.6% had HIV, and 46.8% had moderate or severe depressive symptomatology. Mean methadone dose was 95.7mg (SD 48.9) and urine drug screening (UDS) was positive for opiates, cocaine, and amphetamines in 32.9%, 40.1%, and 2.9%, respectively. Overall, 237 (48.5%) reported clinically significant pain. Pain treatments included prescribed opioids (38.8%) and non-opioids (48.9%), and self-management approaches (60.8%), including prayer (33.8%), vitamins (29.5%), and distraction (12.7%). Pain was associated with higher methadone dose, more medical comorbidities, prescribed opioid therapy, and more severe depressive symptomatology; it was not associated with UDS or self-reported substance use. CONCLUSIONS: Clinically significant pain was reported by almost half of the patients in MMT programs and was associated with medical and psychological comorbidity. Pain was often treated with opioids and was not associated with measures of drug use. Studies are needed to further clarify these associations and determine their importance for pain treatment strategies.

Comparing the rapidity of response during treatment of major depressive disorder with bupropion and the SSRIs: a pooled survival analysis of 7 double-blind, randomized clinical trials.

OBJECTIVE: Several controlled studies, as well as a meta-analysis, suggest that the efficacy of bupropion, a norepinephrine-dopamine reuptake inhibitor, is comparable to that of the selective serotonin reuptake inhibitors (SSRIs). The current analysis was undertaken to determine if these antidepressants differ in rapidity of clinical effect. METHOD: Individual patient data were obtained from 7 double-blind, randomized studies of 8 weeks' duration that compared bupropion (N = 836) and SSRIs (sertraline, paroxetine, fluoxetine, and escitalopram; N = 836). Time to first response and first remission were compared between treatment groups with the use of Cox proportional hazards regression models, stratified by trial number, with depression severity at baseline as a covariate. A secondary analysis compared outcomes in the 2 bupropion versus escitalopram studies. Random-effects meta-analyses were then conducted to confirm the survival-analysis findings. RESULTS: There was no statistically significant difference between bupropion and the SSRIs in time to first response (hazard ratio [HR] = 0.955; p = .43) and first remission (HR = 1.00; p = .97). Similarly, there was no statistically significant difference between bupropion and escitalopram in time to first response (HR = 0.897; p = .29), and first remission (HR = 0.999; p = .99). These results were confirmed with the use of random-effects meta-analyses (p > .05, all 4 analyses). CONCLUSION: There does not appear to be any statistically detectable difference in the rapidity of antidepressant effect between bupropion and the SSRIs overall or escitalopram specifically.