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D Pine

Publications and source records attributed to D Pine.

14 recordsLinked to original sources
PubMed1999

Promoting tobacco cessation in primary care practice.

Promoting tobacco cessation is an important part of the work of clinicians and staff in primary care practice. This article describes the significant public health impact of helping patients quit using tobacco through the use of an effective clinic-based intervention. The most effective strategies are to develop organization commitment, ask every patient about tobacco use at every visit and document it, advise all tobacco users to quit, assess readiness to quit, provide at least brief behavioral counseling, provide follow-up soon after quit date, conduct at least basic evaluations of each component of the process, and assess the quit rate for the practice as a whole.

Ambulatory Care↗
PubMed1999

Plasma anti-serotonin and serotonin anti-idiotypic antibodies are elevated in panic disorder.

The psychoneuroimmunology of panic disorder is relatively unexplored. Alterations within brain stress systems that secondarily influence the immune system have been documented. A recent report indicated elevations of serotonin (5-HT) and ganglioside antibodies in patients with primary fibromyalgia, a condition with documented associations with panic disorder. In line with our interest in dysregulated 5-HT systems in panic disorder (PD), we wished to assess if antibodies directed at the 5-HT system were elevated in patients with PD in comparison to healthy volunteers. Sixty-three patients with panic disorder and 26 healthy volunteers were diagnosed by the SCID. Employing ELISA, we measured anti-5-HT and 5-HT anti-idiotypic antibodies (which are directed at 5-HT receptors). To include all subjects in one experiment, three different batches were run during the ELISA. Plasma serotonin anti-idiotypic antibodies: there was a significant group effect [patients > controls (p = .007)] and batch effect but no interaction. The mean effect size for the three batches was .76. Following Z-score transformation of each separate batch and then combining all scores, patients demonstrated significantly elevated levels of plasma serotonin anti-idiotypic antibodies. Neither sex nor age as covariates affected the significance of the results. There was a strong correlation between anti-serotonin antibody and serotonin anti-idiotypic antibody measures. Plasma anti-serotonin antibodies: there was a significant diagnosis effect [patients > controls (p = .037)]. Mean effect size for the three batches was .52. Upon Z-score transformation, there was a diagnosis effect with antibody elevations in patients. Covaried for sex and age, the result falls below significance to trend levels. The data raise the possibility that psychoimmune dysfunction, specifically related to the 5-HT system, may be present in PD. Potential interruption of 5-HT neurotransmission through autoimmune mechanisms may be of pathophysiologic significance in certain patients with panic disorder. It remains to be demonstrated if the peripheral autoimmunity is representative of CNS 5-HT neuronal alterations. Replication appears warranted.

Adult↗
PubMed1998

Hierarchically ordered oxides

Porous silica, niobia, and titania with three-dimensional structures patterned over multiple length scales were prepared by combining micromolding, polystyrene sphere templating, and cooperative assembly of inorganic sol-gel species with amphiphilic triblock copolymers. The resulting materials show hierarchical ordering over several discrete and tunable length scales ranging from 10 nanometers to several micrometers. The respective ordered structures can be independently modified by choosing different mold patterns, latex spheres, and block copolymers. The examples presented demonstrate the compositional and structural diversities that are possible with this simple approach.

Journal Article↗
PubMed1998

Assessment issues in treatment research of pediatric anxiety disorders: what is working, what is not working, what is missing, and what needs improvement.

Reviewing the strengths and weaknesses of the rating scales for anxiety disorders makes it possible to select appropriate measures for use in a multisite treatment study of children and adolescents with DSM-IV-diagnosed anxiety disorders. Categorical diagnosis for study inclusion is provided by the K-SADS-PL, which has strong published psychometrics for anxiety disorders. Broadband symptom ratings of diverse pediatric psychiatric disorder can be obtained at baseline by the parent-scored Child Behavior Checklist. Anxiety symptom monitoring may be provided by the use of two psychometrically strong self-report measures, the MASC and the SCARED. Weekly global ratings are provided by the CGI whose scale points have been enhanced by detailed anchors; in addition, the raters all trained on practice vignettes to calibrate their scoring. Clinician-based ratings of the patient's anxiety symptoms can be carried out in adolescent patients using the HAM-A. The newly developed Children's Anxiety Rating Scale promises to cover the full pediatric age range as a clinician-based anxiety rating instrument, but must first be subjected to formal psychometric and treatment sensitivity evaluation.

Anxiety Disorders↗
PubMed1997

Clinical improvement with fluoxetine therapy and noradrenergic function in patients with panic disorder.

BACKGROUND: Central noradrenergic (NA) dysregulation has provided a major theoretical framework for understanding the pathogenesis of panic disorder (PD). Using clonidine, an alpha 2-adrenergic receptor agonist, as a probe of NA function, we investigated the hypothesis that the antipanic efficacy of the selective serotonin reuptake inhibitors may be associated with normalization of a putatively dysregulated NA system. METHODS: We report further analyses on data from 17 subjects with PD and 16 healthy volunteers who underwent measurement of the plasma NA metabolite 3-methoxy-4-hydroxyphenylglycol (MHPG) immediately before and after oral clonidine administration. Thirteen patients with PD were rechallenged after 12 weeks during open fluoxetine hydrochloride treatment using the same clonidine paradigm; 13 healthy volunteers were rechallenged at 12 weeks, not having received treatment between challenges. RESULTS: Patients with PD, compared with healthy volunteers, have markedly elevated plasma MHPG volatility during the first clonidine challenge. Volatility describes the magnitude of within-subject plasma MHPG oscillatory activity as assessed by the root of the mean square successive difference. A greater degree of clinical global improvement was predicted by a greater magnitude of basal MHPG reduction with fluoxetine treatment. Antipanic response to fluoxetine was accompanied by a significant decrease of MHPG volatility to volunteer levels. Volunteer MHPG volatility remained unchanged from the first to second clonidine challenge. CONCLUSIONS: Further evidence is provided for the hypothesis of NA dysregulation in PD as reflected by elevations of within-subjects plasma MHPG volatility during clonidine challenge. Effective selective serotonin reuptake inhibitor-antipanic treatment in this clinical sample was paralleled by normalization of dysregulated NA function.

Adult↗
PubMed1997

Panic disorder with smothering symptoms: evidence for increased risk in first-degree relatives.

Klein's (1993: Arch Gen Psychiatry 50:306-317) "false suffocation alarm" theory of spontaneous panic attacks posits that central receptors compare CO2, O2, and lactate levels and trigger panic when an impending "false" state of suffocation is detected. Several investigators have found abnormalities of respiratory physiology in subjects with panic disorder. Twin and family studies have suggested that both panic disorder and tidal volume response to CO2 are inherited. We hypothesized that, if smothering symptoms are a marker for a hypersensitive suffocation detector and if this hypersensitivity is familial, then relatives of panic subjects with smothering symptoms would have higher rates of panic with smothering than relatives of panic subjects without smothering. We conducted a family study involving 104 panic disorder probands and 247 of their interviewed first-degree relatives. Probands and their relatives were interviewed using the Schedule for Affective Disorders and Schizophrenia--Lifetime Version for Anxiety Disorders to determine their panic disorder and smothering symptom status. Relatives of panic probands with smothering symptoms had an almost threefold higher risk for panic and an almost sixfold higher risk for panic with smothering symptoms when compared with relatives of panic probands without smothering. We conclude that panic disorder with smothering symptoms may be a subtype of panic disorder associated with increased familial risk and may be a group of interest to genetic investigators. These findings provide the first empiric evidence from a family study in support of Klein's false suffocation alarm theory of spontaneous panics.

Adult↗
PubMed1996

Psychopathy in instrumental and reactive violent offenders.

Can violent offenders who commit acts of instrumental aggression for goal-oriented purposes such as robbery be distinguished from those who commit acts of reactive (or hostile) aggression in response to provocation? Because violent offenders often have a history of both instrumental and reactive aggression, this study distinguished between offenders with a history of at least 1 instrumental violent offense and offenders with a history of reactive violent offenses. Two studies tested the hypothesis that instrumental offenders would score higher than reactive offenders and nonviolent offenders on R. D. Hare's (1991) Psychopathy Checklist. The first study sample consisted of 106 violent and nonviolent offenders recruited from a medium-security correctional facility. The second study sample consisted of 50 violent offenders referred for pretrial forensic evaluation. In both samples, instrumental offenders could be reliably distinguished from reactive offenders on the basis of violent crime behavior and level of psychopathy. Group differences could not be attributed to participant age, race, length of incarceration, or extent of prior criminal record.

Adult↗
PubMed1995

Uncoupling of the noradrenergic-hypothalamic-pituitary-adrenal axis in panic disorder patients.

In this paper the authors examine the interrelationship of both the noradrenergic (NA) system and the hypothalamic-pituitary-adrenal (HPA) axis and its implications for panic disorder (PD). Seventeen PD patients and 16 healthy volunteers were challenged orally 12 weeks apart with the alpha 2-agonist clonidine (13 healthy volunteers and 12 patients repeated the challenge). Between challenges, PD patients were treated with fluoxetine, with 10 of 12 improving at least moderately. Both during the acute phase of the illness and during the phase of pharmacological improvement, patients demonstrated a greater percentage of reductions of plasma 3-methoxy-4-hydroxyphenylglycol (MHPG) and plasma cortisol during clonidine challenge. We used correlational matrices to examine the relationship between the NA system, as reflected by plasma MHPG, and the HPA axis, as reflected by plasma cortisol measures. Healthy volunteers exhibited multiple significant "couplings" between either baseline or maximal decrease (delta max) of plasma MHPG, with either baseline or delta max plasma cortisol measures both within the first and second challenges and between the first and second challenges. In contrast, PD patients demonstrated "uncoupling" of the NA system and the HPA axis, with no significant correlations observed between either baseline and/or maximal decrease (delta max) measures of MHPG with the same cortisol measures for either the first or second challenge. The same uncoupling was observed for NA/HPA correlations between the first and second challenges. These data suggest that the hyperresponsivity to clonidine in PD patients persists during fluoxetine treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

Adrenal Cortex↗
PubMed1995

Persistence of blunted human growth hormone response to clonidine in fluoxetine-treated patients with panic disorder.

OBJECTIVE: The authors determined the effects of antipanic treatment with fluoxetine on human growth hormone (GH) response to the alpha 2 agonist clonidine. METHOD: Seventeen patients with panic disorder and 15 healthy volunteers were challenged with clonidine. Thirteen of the patients and 12 of the volunteers were given a second challenge with clonidine 12 weeks later. The patients received open fluoxetine and the healthy subjects received no treatment between challenges. Subjects with high baseline human GH levels (greater than 2 ng/ml) at the first and second challenges were excluded from further analysis. RESULTS: The patients with panic disorder (N = 13 for the first challenge and N = 9 for the second) had significantly lower human GH responses to clonidine than the healthy subjects (N = 14 during the first challenge and N = 9 for the second) during both challenges, despite clinical improvement in eight of the nine patients at the time of the second challenge. CONCLUSIONS: Blunted secretion of human GH in response to clonidine in patients with panic disorder persists despite clinical recovery.

Clonidine↗
PubMed1994

Employers.

By shifting employees into managed care, demanding accountability from providers, and negotiating in groups, employers have helped lower their health care costs.

Cost Control↗
PubMed1993

Persistent emotional disorder in children with neurological soft signs.

OBJECTIVE: This paper provides clinical details in the form of case vignettes from a prospective epidemiological study that found the combination of childhood "soft" signs and anxious behavior to be a strong risk factor for adolescent emotional disorders. METHOD: The original study conducted a neuropsychiatric assessment of adolescents who had been followed through childhood. RESULTS: The at-risk subjects are shown to exhibit a persistent and specific pattern of both motor abnormalities and anxiety, obsessional compulsive, or depressive symptoms over time. DISCUSSION: The form of their neurological and psychiatric abnormalities is consistent with neuropsychiatric research linking motor system abnormalities to emotional disorders. It is recommended that children who present with anxious and depressive symptoms be examined for motor soft signs.

Adolescent↗
PubMedDate not supplied

Effects of a systematic approach to tobacco cessation in a community-based practice.

Studies suggest that the absence of a systematic approach is a barrier to the provision of tobacco cessation counseling services in clinical practice. A systematic intervention was shown to be feasible and effective at a faculty practice site. Our pilot study examined the feasibility of implementation at a community-based practice and assessed the effect of the tobacco cessation counseling system on our patients' smoking behavior. Systematic assessment (smoking status, "readiness to quit"), brief counseling at each visit, and follow-up (for those ready to quit) were provided by a physician and nurse team. Our results suggest that the office-based tobacco cessation counseling system can work in a community-based practice and is an effective strategy for helping smokers quit and in preparing to quit.

Adult↗