Biomedical subjects

Duncan B Clark

Publications and source records attributed to Duncan B Clark.

43 records · Page 3Linked to original sources

PubMed2003

Fluoxetine for the treatment of childhood anxiety disorders.

OBJECTIVE: To assess the efficacy and tolerability of fluoxetine for the acute treatment of children and adolescents with generalized anxiety disorder, separation anxiety disorder, and/or social phobia. METHOD: Anxious youths (7-17 years old) who had significant functional impairment were randomized to fluoxetine (20 mg/day) (n = 37) or placebo (n = 37) for 12 weeks. RESULTS: Fluoxetine was effective in reducing the anxiety symptoms and improving functioning in all measures. Using intent-to-treat analysis, 61% of patients taking fluoxetine and 35% taking placebo showed much to very much improvement. Despite this improvement, a substantial group of patients remained symptomatic. Fluoxetine was well tolerated except for mild and transient headaches and gastrointestinal side effects. Youths with social phobia and generalized anxiety disorder responded better to fluoxetine than placebo, but only social phobia moderated the clinical and functional response. Severity of the anxiety at intake and positive family history for anxiety predicted poorer functioning at the end of the study. CONCLUSIONS: Fluoxetine is useful and well tolerated for the acute treatment of anxious youths. Investigations regarding the optimization of treatment to obtain full anxiety remission and the length of treatment necessary to prevent recurrences are warranted.

Adolescent↗

PubMed2003

Psychiatric disorders among older adolescents treated in emergency departments on weekends: a comparison with a matched community sample.

OBJECTIVE: This study was undertaken to explore the characteristics of young patients treated in emergency departments (EDs) who follow through with an evaluation for psychiatric disorders as defined in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) and to investigate differences in rates of psychiatric disorders between ED-treated adolescents and demographically similar adolescents recruited from the community. METHOD: Sixty three older adolescents (40 males) who were treated at two urban university hospital EDs were matched one-to-one on age, gender and race with 63 adolescents recruited from the community for participation in studies at an alcohol research center. Comprehensive psychiatric interviews were conducted with both groups. RESULTS: ED-treated adolescents were diagnosed with higher rates of current alcohol use disorders (AUDs), current drug use disorders and current major depression than were community controls. The ED sample had a particularly high rate of the DSM-IV "hazardous use" of alcohol symptom. ED-treated adolescents also had a higher rate of lifetime comorbid alcohol use disorders and drug use disorders, as well as a higher rate of lifetime comorbid alcohol use disorders and major depression, compared with the community controls. CONCLUSIONS: Adolescents who are treated in EDs should be routinely assessed for the presence of AUD, drug involvement and depressive disorders.

Adolescent↗

PubMed2002

Increased prevalence of herpes simplex virus type 2 among adolescent women with alcohol use disorders.

PURPOSE: To determine the relationship between alcohol use disorders (AUDs) and herpes simplex virus type 2 (HSV-2), hepatitis B virus (HBV), and human immunodeficiency virus (HIV) infections among a sample of sexually active adolescents. METHODS: Subjects were 240 sexually active male and female adolescents aged 14 to 21 years (mean 17.5 years) recruited from clinical and community settings in western Pennsylvania between 1991 and 1995; 55% had a lifetime history of AUDs (63 females, 69 males) and 45% did not have a lifetime history of AUDs (57 females, 51 males). Participants provided information about demographic factors and sexual behaviors as well as a serum sample that was assayed for antibodies to HSV-2, HBV, and HIV infections. Multivariate logistic regression was used to determine the independent relationship of AUDs to HSV-2 infections among females. RESULTS: The seroprevalence of HSV-2 infections was 15% among females and 0% among males; the overall prevalence of HBV (1.2%) and HIV (0.4%) infections was very low. Among adolescent females, the seroprevalence of HSV-2 infections was significantly higher among those with an AUD (19%), compared with those without an AUD (10.5%) (adjusted odds ratio 8.1, 95% confidence interval 1.5-44.8, p =.017). CONCLUSIONS: Adolescent women with an AUD appear to be at substantially increased risk of HSV-2 infection. These results highlight the need to address sexually transmitted diseases among adolescents with alcohol problems.

Adolescent↗

PubMed2002

Measuring risks and outcomes in substance use disorders prevention research.

Assessment planning in substance use disorder prevention research entails the identification of measurement domains and the selection of corresponding instruments needed to fulfill specific project goals. The study design, developmental periods examined, feasibility constraints, and anticipated statistical analyses are important considerations in optimally designing the assessment protocol. As a conceptual framework to organize the domains considered here as examples, the multifactorial model of complex disorders with elaborations emphasized by the discipline of developmental psychopathology is applied. Risks reviewed include family history, childhood maltreatment, peer relationships, and psychopathology. The substance involvement dimensions germane as outcomes include substance type, consumption quantity and frequency, and substance-related problems. Comprehensive diachronic evaluation over critical developmental periods provides the technical foundation for etiology and intervention research.

Adolescent↗

PubMed2002

Alcohol use disorders in adolescents: epidemiology, diagnosis, psychosocial interventions, and pharmacological treatment.

Alcohol (ethanol) abuse and dependence are the most common substance use disorders among adolescents. Binge drinking occurs in up to one-third of adolescents, and alcohol use disorders occur in about 6% of this age group. Adolescents with alcohol use disorders also typically have problems with other substances and comorbid mental disorders. Validated measures are available for the clinical detection and diagnosis of adolescent alcohol use disorders and related problems. Psychosocial interventions promoting abstinence are the most common treatments for alcohol use disorders, with empirical support particularly strong for family-based approaches. Pharmacological interventions may diminish the effects of alcohol withdrawal, prevent a return to alcohol consumption, or treat comorbid mental disorders. In this population, pharmacological interventions require further investigation and, where indicated, are generally considered to be supplementary to psychosocial approaches.

Adolescent↗

PubMedDate not supplied

Cardiovascular risk factors in adolescents with alcohol use disorders.

Among adults, chronic alcohol dependence is associated with cardiovascular disease (CVD). While it is unlikely that adolescents with alcohol use disorders (AUDs) would exhibit CVD, they might show elevated CVD risk factors. The purpose of this study was to compare CVD risk factors in adolescents with AUDs and an adolescent reference group. Adolescents with AUDs were recruited from treatment sources and reference adolescents were recruited from the community. Information about smoking behavior, exercise, and diet were gathered from interview and self-report measures. Body mass index and blood pressure were determined by physical exam and a blood sample was drawn to measure serum cholesterol and triglycerides. Compared with the reference group, adolescents with AUDs reported significantly more smoking, were less likely to report exercising regularly, and were less likely to report eating a balanced diet. Adolescents with AUDs were not more likely to be overweight or to exhibit hypertension, and lipid levels were also not significantly elevated. These results indicated that adolescents with AUDs endorsed problematic health behaviors while not yet exhibiting the consequences of these behaviors. Interventions focusing on health behaviors in conjunction with addiction treatment might help improve long-term health outcomes in adolescents with AUDs.

Adolescent↗

PubMedDate not supplied

Alcohol use frequency as a screen for alcohol use disorders in adolescents.

While screening tools have been developed to identify adolescents likely to have alcohol use disorders (AUDs), none of the available methods are optimal for general medical settings. This study explored the sensitivity and specificity of the frequency of drinking episodes in the prior month as an initial screen for AUDs. The subjects were 219 adolescents (ages 12 through 18) systematically recruited from the community, who participated in a baseline assessment as well as 1-year, 3-year, and 5-year follow-up visits. Subjects completed a self-report form indicating their frequency of use of different substances in the month prior to the assessment. DSM-IV AUD diagnoses were determined by SCID. At baseline, 10 of 219 subjects met DSM-IV criteria for an AUD. At a threshold of 3 or more drinking episodes in the past month, the screen was 90% sensitive, correctly classifying 9 of 10 AUD cases, and 83.7% specific, correctly classifying 175 of 209 cases without AUDs. The diminishing specificity of this screen over the follow-up assessments indicated that this method may be useful for adolescents, but not for young adults. These results indicate that an assessment of the frequency of alcohol use in the prior month provides an initial screen with acceptable sensitivity and specificity for use with adolescents.

Adolescent↗