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Biomedical subjects

Amy Wagner

Publications and source records attributed to Amy Wagner.

10 recordsLinked to original sources
PubMed2006

Efficacy of tegaserod in chronic constipation in men.

OBJECTIVES: Chronic constipation/idiopathic constipation is highly prevalent in western countries and traditional treatments are suboptimal. This multicenter study evaluated the efficacy and safety of tegaserod, a selective 5-HT(4) agonist and promotility agent, in men with chronic constipation. METHODS: After screening and baseline phases, men with chronic constipation were randomized to receive either tegaserod 6 mg twice daily or placebo in a double-blind manner for 12 wk. Patients recorded symptoms using a diary. Primary efficacy variable was the response rate for an increase in complete spontaneous bowel movements (CSBMs) during the first 4 wk of double-blind treatment. Other efficacy measures included patient assessment of symptoms and satisfaction with symptom relief. Safety and tolerability were also evaluated. RESULTS: In total, 322 patients were randomized to tegaserod (N = 158) or placebo (N = 164). Increases of at least one CSBM per wk during the first 4 wk of treatment observed for tegaserod compared with placebo (40.5%vs 29.3%, P= 0.03) were sustained throughout the 12-wk treatment period. Response rate for CSBM was also superior for tegaserod (P= 0.04 vs placebo) over the treatment period. Benefits for tegaserod over placebo were also observed for some secondary efficacy variables, however, statistical significance was not achieved at all weeks. Frequency of adverse events was similar with tegaserod and placebo. CONCLUSIONS: Tegaserod 6 mg twice daily was effective and well tolerated in the treatment of chronic constipation in men. Tegaserod provided rapid relief of constipation within 1 wk and the effects were sustained for up to 12 wk.

Administration, Oral↗
PubMed2006

Suicide Attempt Self-Injury Interview (SASII): development, reliability, and validity of a scale to assess suicide attempts and intentional self-injury.

The authors describe the development of the Suicide Attempt Self-Injury Interview (SASII), an instrument designed to assess the factors involved in nonfatal suicide attempts and intentional self-injury. Using 4 cohorts of participants, authors generated SASII items and evaluated them with factor and content analyses and internal consistency statistics. The final measure was assessed for reliability and validity with collateral measures. The SASII assesses variables related to method, lethality and impulsivity of the act, likelihood of rescue, suicide intent or ambivalence and other motivations, consequences, and habitual self-injury. The SASII was found to have very good interrater reliability and adequate validity.

Adult↗
PubMed2005

Affective dysregulation and dissociative experience in female patients with borderline personality disorder: a startle response study.

Affective dysregulation and dissociation are currently discussed as core features of borderline personality disorder (BPD). Affective dysregulation is hypothesized to be correlated with increased amygdala functioning and dissociation is linked to inhibited processing on the amygdala and dampened autonomic output, according to the corticolimbic disconnection model of dissociation from Sierra and Berrios [Biological Psychiatry 44 (1998) 898]. We assessed startle response, which is mainly mediated by the amygdala, to investigate the relationship between affective dysregulation and dissociation. We hypothesized that patients with BPD would reveal enhanced responses to startling tones, but that these would be lessened by the presence of state dissociative experiences. 21 unmedicated female patients with BPD and 21 healthy female controls listened to 15 startling tones (95-dB, 500-ms, 1000-Hz) while heart rate, skin conductance and orbicularis oculi electromyogram responses were measured. Covariance analysis showed that the BPD group had a significantly higher startle response in the electromyogram as compared to controls. Furthermore, present-state dissociative experiences significantly influenced the startle response. Patients with low dissociative experiences revealed enhanced startle responses whereas patients with high dissociative experiences showed reduced responses. Our data support affective dysregulation in BPD as well as the corticolimbic disconnection model of dissociation, at least for EMG. Furthermore, it highlights the importance of assessing present-state dissociation in basic research as well as psychotherapy.

Adult↗
PubMed2004

A randomized effectiveness trial of stepped collaborative care for acutely injured trauma survivors.

CONTEXT: Although posttraumatic stress disorder (PTSD) and alcohol abuse frequently occur among acutely injured trauma survivors, few real-world interventions have targeted these disorders. OBJECTIVE: We tested the effectiveness of a multifaceted collaborative care (CC) intervention for PTSD and alcohol abuse. DESIGN: Randomized effectiveness trial. PARTICIPANTS: We recruited a population-based sample of 120 male and female injured surgical inpatients 18 or older at a level I trauma center. INTERVENTION: Patients were randomly assigned to the CC intervention (n = 59) or the usual care (UC) control condition (n = 61). The CC patients received stepped care that consisted of (1) continuous postinjury case management, (2) motivational interviews targeting alcohol abuse/dependence, and (3) evidence-based pharmacotherapy and/or cognitive behavioral therapy for patients with persistent PTSD at 3 months after injury. MAIN OUTCOME MEASURES: We used the PTSD symptomatic criteria (PTSD Checklist) at baseline and 1, 3, 6, and 12 months after injury, and alcohol abuse/dependence (Composite International Diagnostic Interview) at baseline and 6 and 12 months after injury. RESULTS: Random-coefficient regression analyses demonstrated that over time, CC patients were significantly less symptomatic compared with UC patients with regard to PTSD (P =.01) and alcohol abuse/dependence (P =.048). The CC group demonstrated no difference (-0.07%; 95% confidence interval [CI], -4.2% to 4.3%) in the adjusted rates of change in PTSD from baseline to 12 months, whereas the UC group had a 6% increase (95% CI, 3.1%-9.3%) during the year. The CC group showed on average a decrease in the rate of alcohol abuse/dependence of -24.2% (95% CI, -19.9% to -28.6%), whereas the UC group had on average a 12.9% increase (95% CI, 8.2%-17.7%) during the year. CONCLUSIONS: Early mental health care interventions can be feasibly and effectively delivered from trauma centers. Future investigations that refine routine acute care treatment procedures may improve the quality of mental health care for Americans injured in the wake of individual and mass trauma.

Adult↗
PubMed2004

Insulin regulates hepatic apolipoprotein B production independent of the mass or activity of Akt1/PKBalpha.

Insulin is known to be a downregulator of apolipoprotein B (apoB) via the phosphatidylinositol 3-kinase (PI3K) pathway. Akt, also known as protein kinase B (PKB), is a serine/threonine kinase downstream target of PI3K. Recent studies in the fructose-fed hamster model of insulin resistance have shown that hepatic very-low-density lipoprotein (VLDL) secretion is associated with reduced phosphorylation of Akt, suggesting a potential link between Akt expression and/or activity and apoB production in hepatocytes. We hypothesized that overexpression of Akt1 downregulates apoB production. An expression vector with a constitutively active form of Akt1 was transfected in the rat hepatoma McArdle cells (McA RH-7777), McA cells stably expressing human apoB-15 and apoB-48 (15% and 48% of total apoB length), and human hepatoma HepG2. The overexpressed Akt1 was phosphorylated at Ser473 independent of acute insulin stimulation, suggesting that it was catalytically active. Despite dosage-dependent overexpression of Akt1 in both McA and HepG2 cells, neither intracellular nor secreted protein mass of intact apoB or transfected human apoB-15/apoB-48 was significantly affected by high intracellular levels of Akt1. Radiolabeling experiments also yielded no difference in the amount of newly synthesized apoB when comparing transfected and mock-transfected cells. Transfection in conjunction with high-dose insulin did not significantly decrease the secretion of either apoB-100 or apoB-48 in McA cells, or apoB-100 in HepG2 cells. HepG2 cells were more sensitive to the inhibitory effects of insulin on apoB secretion compared to McA cells, but neither model responded to Akt1. Overall, the data suggest that acute insulin-mediated inhibition of apoB may not be mediated by Akt1 and that insulin signaling molecules upstream of Akt1 may be more important in mediating control of apoB secretion.

Animals↗
PubMed2004

Post-traumatic bilateral facial palsy: a case report and literature review.

Bilateral facial paralysis due to basilar skull fracture involving the temporal bone is rare and, unlike unilateral facial palsy, it can be difficult to recognize because of a lack of facial asymmetry. Thorough clinical history and physical exam, high-resolution CT scan and electrodiagnostic tests can help to make the diagnosis of bilateral facial nerve palsy and early detection, evaluation and intervention may be important for optimal functional recovery. A 16-year-old male sustained closed head injury after motor vehicle collision. The initial head CT scan showed bilateral temporal bone fractures. On admission to the neurotrauma intensive care unit, his Glasgow Coma Score was 9T. On post-injury day 4, the patient was noted to have incomplete closure of both eyes and 3 days later he had difficulty with bilateral facial muscle movement during a feeding trial. Electrodiagnostic testing confirmed the diagnosis of bilateral facial nerve injury without evidence of significant distal axonal degeneration. A high-resolution CT scan showed bilateral temporal bone fractures without involvement of the fallopian canals. There was no surgical intervention based on the high-resolution CT scan and the delayed onset of facial palsy. A short course of prednisone was administered. By 10 months, the patient showed nearly complete recovery of his bilateral facial nerve function. Early detection, evaluation and intervention are important for optimal functional recovery after facial nerve injury. When the temporal bone is fractured, high suspicion for facial nerve injury, either unilateral or bilateral, is warranted.

Adolescent↗
PubMed2004

Posttraumatic distress, alcohol disorders, and recurrent trauma across level 1 trauma centers.

BACKGROUND: Injured survivors of individual and mass trauma receive their initial evaluation in acute care. Few investigations have comprehensively screened for posttraumatic stress disorder (PTSD) symptoms and related comorbidities across sites. METHODS: This investigation included 269 randomly selected injury survivors hospitalized at two level 1 trauma centers. All patients were screened for PTSD, depressive, and peritraumatic dissociative symptoms during their surgical inpatient admission. Prior traumatic life events and alcohol abuse/dependence also were assessed. RESULTS: In this study, 58% of the patients demonstrated high levels of immediate posttraumatic distress or alcohol abuse/dependence. Regression analyses identified greater prior trauma, female gender, nonwhite ethnicity, and site as significant independent predictors for high levels of posttraumatic distress. CONCLUSIONS: High levels of posttraumatic distress, recurrent trauma, and alcohol abuse/dependence were present in more than half of acute care inpatients. Early mental health screening and intervention procedures that target both PTSD and alcohol use should be developed for acute care settings.

Adult↗
PubMed2004

Primary care perspectives on generalized anxiety disorder.

Recently, there has been increased interest in the impact and treatment of anxiety disorders. However, one type of anxiety disorder, generalized anxiety disorder (GAD), has received less attention than other disorders, such as panic disorder, despite the prevalence and amenability of this disorder to treatment in the primary care setting. Rates of GAD have been found to be between 2.8% and 8.5%, with a median prevalence of 5.8%-at least twice the rate reported in the National Comorbidity Survey. Up to one third of patients presenting to primary care clinics with somatic complaints had a mood or anxiety disorder. Generalized anxiety disorder is linked to the overuse of medical services: emergency department visits, hospitalizations, diagnostic and laboratory tests, pharmacy costs, and so on. Recognition of anxiety and depression in primary care is poor, with only 23% of pure anxiety cases being recognized compared with 56% of depression cases. The various stakeholders (patients, family members, employers, and insurers) in a patient's outcome often complicate treatment of anxiety. Barriers to effective treatment include time constraints, acute disease orientation of most care systems, lack of planned follow-up and monitoring, and relative unavailability of specialist access. The collaborative care approach is designed to overcome these barriers. With this approach, the patient is provided with additional educational materials, physicians are supported by physician extenders (nurses, social workers, or expert consultants) who provide case-based feedback, follow-up, extra visits, and telephone calls to patients. Providing efficacious treatment to primary care for GAD will require improving knowledge of providers and increasing patient engagement.

Anxiety Disorders↗
PubMed2003

Subtype differentiation of patients with borderline personality disorder using a circumplex model of interpersonal behavior.

The considerable heterogeneity of symptomatology in persons with borderline personality disorder (BPD) has led some to suggest the existence of subtypes within this diagnosis. However, no study to date has examined subtypes according to differences in interpersonal functioning, despite the central role of interpersonal problems in the BPD diagnosis. The interpersonal problems of 95 patients with BPD were investigated using the German version of the Inventory of Interpersonal Problems, a self-report measure based on a circumplex model of interpersonal functioning. Data were analyzed by means of cluster analysis. The results supported the existence of two distinct subtypes of persons with BPD, labeled "autonomous" and "dependent." Four-month longitudinal assessment indicated that these types were stable over time, suggesting the categorization reflected trait, as opposed to state, patterns of interpersonal behavior. Implications of these findings for future research and management of BPD are discussed.

Adolescent↗