Biomedical subjects

David J Kupfer

Publications and source records attributed to David J Kupfer.

106 records · Page 6Linked to original sources

PubMed2002

Combined pharmacotherapy and psychotherapy as maintenance treatment for late-life depression: effects on social adjustment.

OBJECTIVE: This study examined the effects of maintenance treatment for late-life depression on social adjustment. The authors hypothesized that elderly patients recovering from depression would have better social adjustment with medication and interpersonal psychotherapy than with medication or psychotherapy alone. METHOD: Patients aged 60 and older recovering from recurrent major depression were randomly assigned to one of four treatments: nortriptyline and interpersonal psychotherapy, nortriptyline and clinic visits, placebo and psychotherapy, or placebo and clinic visits. The Social Adjustment Scale was administered every 3 months until illness recurrence. Combined treatment was compared to monotherapy on scores over 1 year among patients who remained in recovery (N=49). RESULTS: Patients receiving nortriptyline and interpersonal psychotherapy maintained social adjustment, which declined in those receiving monotherapy. CONCLUSIONS: Treatment of late-life depression with nortriptyline and psychotherapy is more likely to maintain social adjustment than treatment with either alone. Combination therapy improves not only duration but quality of wellness.

Age Factors↗

PubMed2002

A descriptive analysis of minor depression.

OBJECTIVE: The authors provide a detailed clinical description of minor depression: its symptoms, level of disability, stability, and relationship to patient and family history of major depressive disorder. METHOD: Rigorous criteria for minor depression, including functional disability, were used to identify 226 individuals for a three-phase treatment study. This report presents data obtained on that study group during the first study phase, a 4-week placebo lead-in period. RESULTS: One hundred sixty-two subjects (72% of the initial study group) remained in the study for 4 weeks and continued to meet criteria for minor depression. Minor depression in these subjects was primarily characterized by mood and cognitive symptoms, not the classical neurovegetative signs and symptoms of depression. Approximately one-third of the subjects with minor depression had a past history of major depressive disorder, and nearly half had a family history of unipolar depressive disorder; however, neither factor affected the severity or quality of minor depressive symptoms. CONCLUSIONS: These data suggest that 1) minor depression is not evanescent; 2) minor depression is characterized by mood and cognitive symptoms rather than neurovegetative symptoms; 3) minor depression may occur either independently of a lifetime history of major depressive disorder or as a stage of illness in the course of recurrent unipolar depressive disorder; and 4) depressive disorders should be conceptualized as a continuum of severity.

Adolescent↗

PubMed2002

Suicide attempts in patients with bipolar I disorder during acute and maintenance phases of intensive treatment with pharmacotherapy and adjunctive psychotherapy.

OBJECTIVE: Lifetime rates of suicide attempts among patients with bipolar I disorder were compared to rates during a 2-year period of intensive treatment with pharmacotherapy and with one of two adjunctive psychosocial interventions. METHOD: Subjects entered the study during an acute mood episode. Subjects were treated with primarily lithium pharmacotherapy and with either psychotherapy specific to bipolar disorder, which included help in regularizing daily routines, or nonspecific, intensive clinical management involving regular visits with empathic clinicians. Data on prior suicide attempts were obtained retrospectively from interviews with the NIMH-Life-Chart method. Data on suicide attempts during the clinical trial were collected systematically throughout the protocol. RESULTS: The rate of suicide attempts was 1.05 per 100 person-months before patients entered the trial. Patients experienced a threefold reduction in the rate of suicide attempts during the acute treatment phase (until the patient achieved stabilization, defined by completion of 4 weeks during which the patient had a mean score of < or =7 on the 17-item Hamilton Depression Rating Scale and < or =7 on the Bech-Rafaelsen Mania Scale) and a 17.5-fold reduction during maintenance treatment. Poisson loglinear regression analysis modeling the relationship between the observed rates and the three protocol stages (pretreatment, acute, and maintenance) showed that the reductions were significant in the acute and maintenance phases, compared with the pretreatment phase. No patient with one or more suicide attempts before entering the trial attempted suicide during the protocol. CONCLUSIONS: A treatment program in a maximally supportive clinical environment can significantly reduce suicidal behavior in high-risk patients with bipolar I disorder.

Acute Disease↗

PubMed2002

A pilot study of community mental health care for depression in a supermarket setting.

OBJECTIVE: Women with depression whose diagnosis is made in community mental health clinics attend relatively few treatment sessions. A pilot project was undertaken to test the feasibility of providing psychotherapy for depressed women in a supermarket, a novel setting that may minimize barriers to care such as stigma associated with visiting a mental health clinic. METHODS: Twelve women who met DSM-IV criteria for a depressive disorder were recruited from a rural mental health clinic and offered 16 weekly sessions of supportive psychotherapy with cognitive-behavioral elements in an administrative conference room of a local supermarket. Outcomes measured were treatment attendance, depressive symptoms, and satisfaction with treatment. RESULTS: Six of the women completed the study. For the entire group, the mean number of sessions attended was 5.2. Those who completed the study attended an average of 8.7 sessions and showed significant improvement on measures of depression and anxiety. They rated their treatment experience as "very satisfactory." For the two therapists, conducting therapy in the supermarket presented some logistical problems, such as limited access to telephones and the absence of a check-in desk. The therapists also reported that providing therapy in this setting was challenging to their professional identities. CONCLUSIONS: The women in the study found treatment in the supermarket to be an appealing alternative to the mental health clinic because of greater accessibility, a perceived reduction in stigma, and convenient "one-stop shopping" for both groceries and mental health treatment.

Community Health Services↗

PubMed2002

Demographic and clinical characteristics of individuals in a bipolar disorder case registry.

BACKGROUND: The goal of this analysis was to characterize a cohort of 3000 persons who self-identified as having bipolar disorder by demographic, clinical, and treatment characteristics and to document the burden that this disorder imposed on their lives. METHOD: The Stanley Center Bipolar Disorder Registry used a variety of recruitment methods to reach people with bipolar disorder. The cohort included those currently in treatment and those active in support groups. Registrants completed an interviewer-administered questionnaire to obtain information on demographic characteristics, clinical history, and treatment history. RESULTS: The median age of the 2839 patients who were analyzed was 40.1 years, 64.5% were women, and over 90% were white. The median age at onset was 17.5 years, and the mean was 19.8 years. Despite the fact that over 60% completed at least some college and 30% completed college, 64% were currently unemployed. The patients' family histories point to a high prevalence of mental disorder in the families, especially mood disorders. Patients were concurrently taking multiple medications, and more than one third were taking at least 3 types of psychotropic medications. This pattern of pharmacotherapy was consistent with participants' overall mood ratings, which demonstrated how unusual it was for them to be symptom-free over a 6-month period. CONCLUSION: Our present findings point to the chronicity and severity of bipolar disorder as experienced in the community. We still need to develop better interventions, ensure access to care consistent with current consensus guidelines, and initiate care as early as possible in the course of the condition.

Adolescent↗

PubMed2002

Prevalence of obesity and weight change during treatment in patients with bipolar I disorder.

BACKGROUND: Obesity is a major public health concern in the United States and its prevalence is increasing. Individuals with bipolar disorder tend to be overweight, and their treatment may exacerbate obesity and increase the risk of concurrent medical disease in this population. METHOD: This retrospective report from the Pittsburgh Study of Maintenance Therapies in Bipolar Disorder examines the prevalence of overweight (body mass index [BMI] = 25.0-29.9) and obesity (BMI > or = 30.0) in 50 consecutive subjects with bipolar I disorder (DSM-IV) and evaluates weight change during acute treatment and the first year of maintenance treatment. RESULTS: At entry into the study, 34 (68%) of the patients in this sample with bipolar disorder were obese or overweight. The prevalence of obesity was high (16 [32%] of the 50 patients in our sample). The number of previous depressive episodes contributed to the likelihood of being overweight or obese at study entry. During the trial, most of the weight gain occurred during acute treatment rather than during maintenance treatment. During acute treatment, the amount of increase of BMI was positively related to the score on the Hamilton Rating Scale for Depression and negatively related to the score on Bech-Rafaelsen Mania Scale. There was a negative relationship between BMI and tendency to gain weight, during both acute and maintenance treatment. CONCLUSION: The high prevalence of obesity in subjects with bipolar disorder emphasizes the need for specific treatment strategies and programs for weight control for these individuals. The minimal weight gain during the maintenance phase, the relationship of acute depressive episodes to weight gain, and the fact that stabilization on maintenance medication may facilitate the participation in specific interventions for weight loss provide additional support for the practice of maintenance treatment.

Adult↗

PubMed1975

Relationship of certain childhood 'traits' to adult psychiatric disorders.

An investigation of 174 adult psychiatric outpatients reporting on nine different difficulties they may have experienced as children suggests certain links between childhood difficulties and lifelong personality traits, as well as adult psychiatric symptomatology. Findings suggest that the childhood traits related to schizophrenia might be manifestations of minimal organic brain dysfunctioning.

Adult↗

PubMedDate not supplied

Prospective assessment of sexual function in women treated for recurrent major depression.

Although multiple factors may influence the sexual function of depressed women over the course of treatment, the independent contributions of these factors are poorly understood. The current study examined the effects of depression, SSRI treatment, and sexual partner availability on women's sexual function. The sexual function of 68 recurrently depressed women was assessed at 3-month intervals over a 1-year course of treatment with interpersonal psychotherapy with or without adjunctive SSRI treatment. Random regression models assessing changes in sexual function were conducted to test the effects of three time-dependent covariates: depression symptom scores, sexual partner availability, and SSRI medication status. Controlling for the other variables, depressive symptoms were associated with decrements in sexual desire, sexual cognition/fantasy, sexual arousal, orgasmic function, and global evaluations of sexual function. SSRI treatment was associated with orgasmic difficulty only. The availability of a sexual partner was associated with increased sexual arousal, orgasmic function, and sexual behavior. Among treatment remitters, patient reports of severe sexual dysfunction did not change over the course of treatment, although mild improvement was observed in patients' global assessment of the quality of their sexual function. This report illustrates the prevalence and persistence of sexual dysfunction in this sample, and highlights the importance of monitoring both pharmacologic and psychosocial variables that can affect the sexual function of recurrently depressed women throughout the course of treatment.

Adult↗

PubMedDate not supplied

Adult separation anxiety: psychometric properties of a new structured clinical interview.

Separation anxiety has traditionally been characterized and assessed as a disorder that is unique to childhood. Yet the core symptoms of separation anxiety, i.e. excessive and often disabling distress when faced with actual or perceived separation from major attachment figures, may persist or even arise during adulthood. We report on the psychometric properties of a new structured clinical interview designed to assess symptoms of separation anxiety as experienced both during childhood and adulthood. This instrument, called the Structured Clinical Interview for Separation Anxiety Symptoms (or SCI-SAS), was administered as part of an assessment battery to 91 adult psychiatric outpatients and 20 non-psychiatric controls. Results indicate that this instrument displays excellent psychometric properties, including good internal consistency, a clear factor structure, and exceptional levels of convergent and discriminate validity. These results highlight the feasibility and potential clinical utility of assessing age-appropriate symptoms of separation anxiety experienced during adulthood.

Adult↗

PubMedDate not supplied

MRI investigation of temporal lobe structures in bipolar patients.

Previous anatomical MRI studies have suggested abnormalities in amygdala volumes in bipolar disorder, whereas hippocampus, temporal lobe (TL), and superior temporal gyri (STG) measures have been reported to be normal. This study further investigated the existence of anatomical abnormalities in these brain structures in bipolar subjects, to attempt to replicate previously reported findings. Twenty-four DSM-IV bipolar patients (mean age+/-S.D.=35+/-10 years) and 36 healthy controls (mean age+/-S.D.=37+/-10 years) were studied. 3D SPGR images were obtained with a 1.5T-GE Signa magnet (TR=25 ms, TE=5 ms, FOV=24 cm, slice-thickness=1.5 mm, matrix-size=256 x 192). Volumetric measurements of TL, hippocampus, amygdala, and STG were performed blindly, with a semi-automated software. Bipolar patients had significantly larger left amygdala volumes compared with controls (mean volumes+/-S.D.=2.57+/-0.69 vs. 2.17+/-0.58 ml, respectively; ANCOVA, age, gender, ICV as covariates; F=4.42, df=1/55, P=0.04). The volumes of the other temporal lobe structures did not differ significantly between the two groups (ANCOVA, age, gender, and ICV as covariates, P>0.05). Our findings of enlarged left amygdala in bipolar patients are in agreement with prior MRI studies, suggesting that abnormalities in this brain structure may be implicated in pathophysiology of the illness. Longitudinal studies in high-risk offspring and first-episode patients will be needed to examine whether such abnormalities precede the appearance of symptoms, or whether they may appear subsequently as a result of illness course.

Adult↗

PubMedDate not supplied

Addressing depression in obstetrics/gynecology practice.

Efforts to improve the care of depression in primary care patients have largely ignored the potential of obstetrics/gynecology (OB/GYN) practices. We describe feasibility studies of a depression screening and care management intervention in three diverse OB/GYN practices. Patients were screened using the Patient Health Questionnaire. A depression care manager offered education and referral assistance to women who screened positive for depression. The prevalence of depression was higher in the hospital clinic (20.2%, 47/233) than the suburban clinic (10.7%, 8/75) or the office practice (8.2%, 48/583). Seventy-two women participated in the care management intervention. Patient satisfaction with the intervention was high and at 1-month follow-up, 31.9% of patients had kept or scheduled a new mental health appointment. Depression interventions developed in primary care can be successfully adapted for use with patients in OB/GYN practices. Additional modifications, particularly efforts to improve coordination of care with both general medical and mental health providers, are needed.

Adolescent↗

PubMedDate not supplied

Hypothyroidism in patients with bipolar I disorder treated primarily with lithium.

AIMS: This study evaluated the frequency and clinical significance of abnormal Thyroid Stimulating Hormone (TSH) and Free Thyroxine Index (FTI) in patients with bipolar I disorder treated primarily with lithium. METHOD: We evaluated the medical records of 143 participants in the Pittsburgh study of Maintenance Therapies in Bipolar Disorder who did not have a thyroid abnormality at entry. RESULTS: Thirty-six percent of the 143 patients developed abnormal TSH and/or FTI values. Thirty-eight percent of the 135 patients who received lithium developed abnormal TSH and/or FTI, spent significantly longer time in the acute treatment phase (t = -3.6, df = 133, p = .0004), and had significantly higher mean Hamilton Scale for Depression scores over the course of the maintenance phase (t = -2.3, df = 71.6, p = .03). Time on lithium and development of abnormal TSH and/or FTI were positively correlated (r = .25, p = .004). CONCLUSIONS: Thyroid dysfunction can be frequent in patients exposed to lithium treatment for bipolar I disorder; it also appears to be correlated with a slower response to acute treatment, and may be related to poorer quality of long-term remission. A prospective study is needed to confirm our findings and determine whether more aggressive thyroid replacement can optimize thyroid function to facilitate clinical recovery. DECLARATION OF INTEREST: Supported in part by National Institute of Mental Health Grants MH 029618 (Drs. Frank and Fagiolini) and MH 030915 (Drs. Kupfer and Fagiolini), and the Bosin Memorial Fund of The Pittsburgh Foundation (Drs. Fagiolini, Kupfer, Cook, Scott, Novick and Frank). Dr. Fagiolini is on the advisory board and a consultant to Pfizer Inc, and Bristol Myers Squibb, and is on the speaker bureau of Bristol Myers Squibb, Eli Lilly Italy, Pfizer Inc, and Shire. Dr. Frank is on the advisory board of Pfizer Inc. and Eli Lilly & Company, and is a consultant to Pfizer Italia and Servier Amerique. Dr. Kupfer is on the advisory board of Pfizer, Inc., Forest Pharmaceuticals, Inc., and Solvay-Wyeth Pharmaceuticals, and is a consultant to Servier Amerique.

Adult↗

PubMedDate not supplied

Healthy older adults' sleep predicts all-cause mortality at 4 to 19 years of follow-up.

OBJECTIVE: Evidence concerning whether sleep disturbances in older adults predict mortality is mixed. However, data are limited to self-reported sleep problems and may be confounded with other comorbidities. We examined whether electroencephalographic (EEG) sleep parameters predicted survival time independently of known predictors of all-cause mortality. METHODS: A total of 185 healthy older adults, primarily in their 60s through 80s, with no history of mental illness, sleep complaints, or current cognitive impairment, were enrolled in one of eight research protocols between October 1981 and February 1997 that included EEG sleep assessments. At follow-up (mean [SD] = 12.8 [3.7] years after baseline, range = 4.1-19.5), 66 individuals were positively ascertained as deceased and 118 remained alive (total N = 184). RESULTS: Controlling for age, gender, and baseline medical burden, individuals with baseline sleep latencies greater than 30 minutes were at 2.14 times greater risk of death (p =.005, 95% CI = 1.25-3.66). Those with sleep efficiency less than 80% were at 1.93 times greater risk (p =.014, CI = 1.14-3.25). Individuals with rapid eye movement (REM) sleep percentages in the lowest 15% or highest 15% of the total sample's distribution (percentage of REM <16.1 or >25.7) were at 1.71 times greater risk (p =.045, CI = 1.01-2.91). Percentage of slow-wave sleep was associated with time to death at the bivariate level, but not after controlling for potential confounders. CONCLUSIONS: Older adults with specific EEG sleep characteristics have an excess risk of dying beyond that associated with age, gender, or medical burden. The findings suggest that interventions to optimize and protect older adults' sleep initiation, continuity, and quality may be warranted.

Aged↗

PubMedDate not supplied

Psychophysiological reactivity and coping styles influence the effects of acute stress exposure on rapid eye movement sleep.

OBJECTIVE: The goal of the present study was to investigate the roles of situational (ie, psychophysiological reactivity to acute stress) and dispositional variables (ie, neuroticism, coping styles) in shaping the effects of acute stress exposure on REM sleep. METHODS: Sixty-three healthy young adults slept in the laboratory after being randomized into CTL or EXP. Measures of psychophysiological reactivity (state anxiety, stress level, and mean arterial blood pressure) were collected before and immediately after randomization. All subjects completed the Neuroticism-Extroversion-Openness-Personality Inventory Revised and the Ways of Coping Checklist. RESULTS: A significant stress exposure by REM period interaction was found, and average RCs in the last REM period were significantly lower in EXP compared with CTL subjects (p =.005). The global slope of increase in average RC across successive REM sleep periods was less steep in EXP compared with CTL subjects (p =.02). Late-night RC was mediated by changes in subjective stress level from baseline to task notification, whereas REM latency was predicted by changes in state anxiety. Neuroticism and coping style did not directly moderate the effects of acute stress exposure on REM sleep. Rather, social coping and avoidance moderated psychological reactivity. CONCLUSIONS: The findings suggest that attenuation of REM sleep phasic activity after stress exposure may reflect adaptive regulation of waking emotional arousal. Mediation and moderation models are more informative than traditional bivariate approaches to investigating the relation between stress exposure and sleep alterations.

Acute Disease↗

PubMedDate not supplied

Assessment and treatment of depression in patients with cardiovascular disease: National Heart, Lung, and Blood Institute Working Group Report.

OBJECTIVE: The National Heart, Lung, and Blood Institute convened an interdisciplinary working group of experts to develop recommendations for the assessment and treatment of depression in patients with coronary heart disease (CHD). METHOD: Consensus of experts. RESULTS: Our current recommendations are that the Beck Depression Inventory-I be employed for epidemiological studies of depression and CHD, that the Patient Health Questionnaire 2-item version be employed for screening for trial eligibility, that the Depression Interview and Structured Hamilton (DISH) be employed for diagnostic ascertainment for trial inclusion, and that the Hamilton rating scale, which is part of the DISH, be employed for both depression symptom reduction and the remission criterion in any trial. We further recommend that a randomized controlled trial be undertaken to determine whether selective serotonin reuptake inhibitors, psychotherapy, or combined treatment can reduce the risk of CHD events and mortality associated with depression in CHD patients. CONCLUSIONS: This report summarizes the recommendations made by the working group and discusses the rationale for each recommendation, the strengths and weaknesses of alternative approaches to assessment and treatment, and the implications for future research in this area.

Antidepressive Agents↗

PubMedDate not supplied

A developmental model for enhancing research training during psychiatry residency.

OBJECTIVE: The authors describe a developmental model for enhancing residency research training for careers in academic psychiatry. Over the past 10 years, the University of Pittsburgh Department of Psychiatry has developed a research track (RT) for its residents. While the Department's plan has been to address the critical need of training physician-scientists in psychiatry, the RT continues to evolve as a structured extension of the University's residency-training program. Recently, the University's departmental leadership has taken several steps that address regulatory, institutional, and personal barriers to residency research training put forth by the 2003 Institute of Medicine (IOM) report. METHODS: The authors outline a model of residency research training, elements of which should be exportable to the majority of U.S. psychiatry residency programs. RESULTS: For residents in the RT, up to 50% of time in PGY-3 and up to 75% of time in PGY-4 can be devoted to research-related activities. The authors currently have 13 residents and fellows in their track. Over the past 10 years, 15 of 33 RT residents have become research postdocs or full-time grant-funded researchers in academic positions. CONCLUSION: The authors' experience suggests that it is possible to organize and implement an RT during psychiatry residency within the parameters presented by the Psychiatry Residency Review Committee (RRC).

Education, Medical↗