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Biomedical subjects

H M Rhoades

Publications and source records attributed to H M Rhoades.

At least 19 recordsLinked to original sources
PubMed2001

Fluoxetine treatment of cocaine-dependent patients with major depressive disorder.

Sixty-eight male and female individuals with both DSM-IV diagnoses of cocaine dependence and major depressive disorder were randomly assigned to one of two medication conditions (placebo vs. 40 mg per day) as part of a double-blind, placebo-controlled clinical efficacy trial of fluoxetine for the treatment of this dual diagnosis. During the 12-week outpatient treatment phase all participants also received individual cognitive-behavioral psychotherapy targeting both cocaine use and depression. Depressive symptoms remitted as a function of time in treatment, with no significant medication effects found. Fewer cocaine positive urines were found during the first 6 weeks of treatment in the placebo group compared with the 40-mg group. Cocaine use and depressive symptoms during treatment were significantly correlated. The findings fail to support the role of fluoxetine for treatment of cocaine use and depression in dually-diagnosed patients.

Adolescent↗
PubMed2001

Motivational interviewing with cocaine-dependent patients: a pilot study.

A brief motivational interviewing (MI) intervention was evaluated within the context of an outpatient, cocaine-detoxification program. MI was hypothesized to assist patients in completing the detoxification program and to improve outcomes during subsequent treatment. Participants (N = 105) were randomly assigned to MI or to detox-only conditions. Results indicated that although participants completed the detoxification program at equal rates, completers who received MI increased use of behavioral coping strategies and had fewer cocaine-positive urine samples on beginning the primary treatment. MI patients with lower initial motivation were more likely to complete detoxification.

Adult↗
PubMed2001

New subscales for an anchored version of the Brief Psychiatric Rating Scale: construction, reliability, and validity in acute psychiatric admissions.

Attending psychiatrists completed an anchored version of the 18-item Brief Psychiatric Rating Scale (BPRS-A) based on admission and evaluation information on a total of 2,921 adult patients treated at 1 public sector acute psychiatric teaching hospital. Exploratory factor analysis was applied to a 6-month sample to construct 4 nonoverlapping subscales: Resistance, Positive Symptoms, Negative Symptoms, and Psychological Discomfort. Confirmatory factor analysis compared these new subscales to 3 other published subscale models using a second 6-month sample. Internal consistency, rater influence, and interrater agreement were estimated in separate studies. Discriminant validity was explored by comparison of diagnosis-based samples. Application of the BPRS-A as a debriefing instrument in the study of symptomatic change and the multiple challenges inherent in psychometric study of such a rating scale in realistic hospital practice are discussed.

Adult↗
PubMed2000

Laboratory measures of methylphenidate effects in cocaine-dependent patients receiving treatment.

Two experiments examined the effects of methylphenidate in male and female patients enrolled in an outpatient treatment program for primary cocaine dependence. The first study was a component of a double-blind efficacy trial wherein 57 patients were first tested in a human laboratory for their initial responsiveness to medication. Patients were randomly assigned to receive either placebo or methylphenidate treatment and received their first dose in the human laboratory environment before continuing in outpatient treatment. Methylphenidate was given as a 20-mg sustained-release dose (twice daily) plus an additional 5-mg immediate-release dose combined with the morning dose. Methylphenidate increased heart rate and subjective ratings; however, the subjective effects were primarily of a "dysphoric" nature, and significant effects were limited to increases in anxiety, depression, and anger on the Profile of Mood States; shaky/jittery ratings on a visual analog scale; and dysphoria on the lysergic acid diethylamide (LSD) scale of the Addiction Research Center Inventory. Methylphenidate did not increase cocaine craving nor ratings suggesting abuse potential (i.e., Morphine-Benzedrine Group or drug-liking scores, etc.). None of the drug effects observed in the human laboratory was of clinical concern, and no subject was precluded from continuing in the outpatient study. After outpatient treatment completion, 12 patients were brought back into a second double-blind human laboratory study in which three doses (15, 30, and 60 mg) of immediate-release methylphenidate were administered in an ascending series preceded and followed by placebo. Methylphenidate produced dose-related increases in heart rate, subjective ratings of shaky/jittery, and LSD/dysphoria without significantly altering cocaine craving or stimulant euphoria ratings. These results suggest that stimulant substitution-type approaches to the treatment of cocaine dependence are not necessarily contraindicated because of cardiovascular toxicity or medication abuse potential. However, they also suggest that the subjective effects of methylphenidate may not be positive enough for an adequate replacement approach.

Adult↗
PubMed1999

Use of BPRS-A percent change scores to identify significant clinical improvement: accuracy of treatment response classification in acute psychiatric inpatients.

Use of Brief Psychiatric Rating Scale [Overall J.E., Gorham D.R., 1988. The Brief Psychiatric Rating Scale (BPRS): recent developments in ascertainment and scaling. Psychopharmacology Bulletin 24, 97-99] percent change scores (PCSs) to measure treatment effects may be problematic because two different item-weighting systems (0-6 and 1-7) have been employed to represent the seven rating options and PCSs have demonstrated sensitivity to the item-weighting system used. This study compared the ability of a range of BPRS total scale PCS categories generated by both item-weighting procedures to predict estimates of clinical improvement in a large (N = 1415) heterogeneous acute sample of adult psychiatric inpatients. Results revealed significant differences between the two scaling systems in the proportion of patients classified into categories of PCS symptom improvement. Additional analysis suggested different optimal predictive PCS classifications for each item-weighting system: > 19% for 1-7 and > 39% for 0-6. Guidelines for BPRS publications are presented to facilitate study interpretation and replication. In light of their demonstrated limitations, it is suggested that the use of BPRS PCSs to measure treatment effects be reconsidered.

Adolescent↗
PubMed1999

Predictors of individual differences in alprazolam self-medication.

Twenty-seven patients with generalized anxiety or panic disorder participated in a 6-week outpatient study. Participants received capsules containing either alprazolam or placebo and were free to choose between them for anxiety treatment. Measures of drug use included alprazolam preference, amount, and frequency of use. Alprazolam clearly was preferred over placebo; however, there were large between-subjects differences in the amount of medication used. A variety of demographic, drug history, personality, mood, and expectational variables were examined for correlation with medication use. Findings indicated that a substantial amount of variance in medication use could be explained by patients' intake characteristics. Findings also suggested that the tendency to consume capsules frequently may signal a greater risk factor for dependence than does drug preference in and of itself.

Adult↗
PubMed1999

Smoking cessation in women with cardiac risk: a comparative study of two theoretically based therapies.

This gender-specific research study compares the relative effectiveness of two theory-based interventions targeting women who smoke. Women with coronary artery disease (CAD; n = 53) or CAD risk factors (n = 107) were randomly assigned to either coping-skills Relapse Prevention (RP) treatment or an educational/supportive treatment based on Health Belief Model (HBM) principles. RP was comparable, but not superior to HBM treatment, as indicated by the lack of differential smoking outcomes at 3 and 6 months. RP was more effective than HBM for women with low self-efficacy, as predicted. The presence of a smoking-related disease had a substantial effect on smoking status, in that the odds of being abstinent at 6 months were 2.2 times greater for non-diagnosed women when compared with CAD women. These findings indicate that more potent relapse prevention interventions are needed to increase cessation rates in women who smoke, especially those with established heart disease.

Adaptation, Psychological↗
PubMed1998

Impulsivity and history of drug dependence.

Impulsivity was contrasted between 32 subjects with a history of drug-dependence (DRUG+) and 26 subjects with no drug use history (DRUG-) using both behavioral and self-report measures. The hypothesis was that the DRUG+ group would be more impulsive than the DRUG- group. Subjects in the DRUG+ group self-reported more of a tendency toward impulsivity than the DRUG- group in the situations posed in questionnaires. In the behavioural paradigm involving a choice between a smaller intermediate reward and a larger but delayed reward, DRUG+ subjects selected the impulsive option more often, but these differences were not significant. The DRUG+ and DRUG- groups did differ on the mean delay interval for the larger reward, indicating less ability to tolerate longer delays for the larger reward. A frequency distribution of delay intervals for the larger reward indicated that DRUG+ subjects were more likely to maintain very short intervals and less likely to maintain longer intervals.

Adult↗
PubMed1998

Medication take-home doses and contingency management.

Two studies examined contingent take-home medication doses during treatment of opiate or cocaine dependence. In the first study, methadone maintenance patients were randomly assigned to one of two 8-week baseline take-home (TH) conditions differing in frequency of clinic visits per week. This was followed by a 12-week contingency management (CM) procedure in which frequent THs resulted from drug-free urines. Participants receiving more frequent THs during baseline had lower illicit drug use during the first 6 weeks of CM. In the second study, fluoxetine (0-, 20-, 40-mg) TH doses were similarly contingent in treatment of cocaine dependence. The 40-mg group used less cocaine during contingency than did other groups. The combination of fluoxetine and environmental contingencies may produce benefit where neither alone is sufficient.

Adult↗
PubMed1998

Retention, HIV risk, and illicit drug use during treatment: methadone dose and visit frequency.

OBJECTIVES: This study examined two major methadone treatment factors, visit frequency and methadone dose, posited to be important in reducing intravenous drug use and human immunodeficiency virus (HIV) transmission. METHODS: One hundred fifty opiate-dependent subjects randomly assigned to four groups received 50 or 80 mg of methadone and attended a clinic 2 or 5 days per week. RESULTS: Survival analysis indicated higher dropout rates for groups having five vs two visits per week (Chi2[1]=7.76). Higher proportions of opiate-positive results on urine screens were associated with lower methadone doses (F[1,91]=4.74). CONCLUSIONS: Receiving take-home doses early in treatment enhanced treatment retention. The 50-mg dose combined with five visits per week produced the worst outcome. Fewer visits enhanced retention at 50 mg, but opiate use rates were higher at this dose than they were for either 80-mg group. The HIV infection rate at entry was 9%. No subjects seroconverted during the study. Risk behaviors for acquired immunodeficiency syndrome declined over time regardless of group/dose assignment. These results have important implications for modification of regulatory and clinic policy changes.

Adult↗
PubMed1997

Subjects with a history of drug dependence are more aggressive than subjects with no drug use history.

Aggressive responding was compared between 29 subjects with a history of substance dependence and 24 subjects with no drug use history, using the Point Subtraction Aggression Paradigm. The hypothesis was that subjects from the substance dependence history group would emit more aggressive responses than subjects with no drug use history. The substance dependence history group emitted more aggressive responses per session than the non drug using group (F(1,49) = 14.867, P = 0.032). These results are consistent with previous studies that have reported an association between aggression and drug abuse or dependence.

Adult↗
PubMed1996

An alternative method for the quantitation of neuronal damage after experimental middle cerebral artery occlusion in rats: analysis of behavioral deficit.

We tested the hypothesis that increasing durations of focal ischemia that have been shown to result in enlargement of cortical infarct will be associated with progression of behavioral dysfunction that can be measured by a battery of tests sufficiently sensitive and reproducible to detect a positive effect of pharmacotherapy. Untreated or N-methyl-D-aspartate receptor antagonist (CNS-1102)-treated spontaneously hypertensive rats underwent 45, 60, 90, or 120 min of tandem middle cerebral and common carotid artery occlusion followed by reperfusion. We then evaluated the extent of damage and its recovery for up to 21 days using nine behavioral tests aimed at analyzing strength, coordination, and bilateral asymmetry. Also using a graded bioassay that employs a curve-fitting computer program (ALLFIT) to correlate duration of ischemia with degree of behavioral dysfunction, we calculated the average of maximal behavioral dysfunction and duration of ischemia required to produce half-maximal behavioral dysfunction and compared these values in untreated controls with analogous values obtained from animals treated with CNS-1102. Three behavioral tests, forearm flex, tape (somatosensory neutralization), and foot-fault placing, were each separately and combined able to distinguish between the degrees of damage produced by increasing durations of ischemia. The behavioral abnormalities assessed using the tape test were reversible within a week, whereas those using forearm flex or foot-fault tests persisted for at least 21 days. CNS-1102 significantly reduced behavioral dysfunction measured by all three tests. This analysis of behavioral dysfunction represents a useful experimental model to grade efficacy of therapies aimed at protecting the brain from damage produced by acute stroke and might also be used to assess recovery from preexisting ischemic damage.

Animals↗
PubMed1993

Factor stationarity and invariance of the POMS in cocaine patients.

The Profile of Mood States (POMS) factor scores are commonly used to evaluate the clinical pharmacologic effects of a drug. Two assumptions made when using the POMS in this manner are that its factor structure remains constant across time (factor stationarity) and that the factor structure is identical across experimental groups (factor invariance). If these assumptions are not met, then interpreting change in POMS factor scores becomes problematic. Structural equation modeling programs (e.g., LISREL) may be used to explicity test assumptions of factor stationarity and invariance. As part of a National Institute on Drug Abuse grant-funded, double-blind, placebo-controlled trial to assess effectiveness of treating cocaine-abusing patients with fluoxetine, POMS data were collected at baseline and at 6 weeks (n = 90). Applying a longitudinal factor analysis strategy, factor stationarity and invariance of two POMS factors were assessed in this patient sample.

Adult↗
PubMed1991

Factor analysis of the Diagnostic Inventory of Personality and Symptoms.

The Diagnostic Inventory of Personality and Symptoms (DIPS; Vincent, 1985) is a self-rating instrument that yields 14 clinical scale scores and a validity scale score. The scale scores present diagnostic classification information derived from major DSM-III diagnostic categories. This study replicates and extends a previous factor study by Vincent and Duthie (1986). DIPS data were collected from 170 psychiatric inpatients and outpatients. Both a principal components analysis and an oblique, cluster-oriented, marker variable factor analysis of the 14 clinical scale scores resulted in four factors, the first three of which reproduced the pattern of factor loadings found by Vincent and Duthie (1986). The results support the existing distinction between DSM-III Axis I psychotic and neurotic disorders, and Axis II characterological disorders.

Adolescent↗
PubMed1991

Altered cerebral blood flow and glucose metabolism in patients with liver disease and minimal encephalopathy.

We measured CBF and the CMRglc in normal controls and in patients with severe liver disease and evidence for minimal hepatic encephalopathy using positron emission tomography. Regions were defined in frontal, temporal, parietal, and visual cortex; the thalamus; the caudate; the cerebellum; and the white matter along with a whole-slice value obtained at the level of the thalamus. There was no difference in whole-slice CBF and CMRglc values. Individual regional values were normalized to the whole-slice value and subjected to a two-way repeated measures analysis of variance. When normalized CBF and CMRglc values for regions were compared between groups, significant differences were demonstrated (F = 5.650, p = 0.00014 and F = 4.58, p = 0.0073, respectively). These pattern differences were due to higher CBF and CMRglc in the cerebellum, thalamus, and caudate in patients and lower values in the cortex. Standardized coefficients extracted from a discriminant function analysis permitted correct group assignment for 95.5% of the CBF studies and for 92.9% of the CMRglc studies. The similarity of the altered pattern of cerebral metabolism and flow in our patients to that seen in rats subjected to portacaval shunts or ammonia infusions suggests that this toxin may alter flow and metabolism and that this, in turn, causes the clinical expression of encephalopathy.

Brain↗
PubMed1990

CGS-19755, a competitive NMDA receptor antagonist, reduces calcium-calmodulin binding and improves outcome after global cerebral ischemia.

We evaluated several doses of cis-4-(phosphonomethyl)-2-piperidine-carboxylic acid (CGS-19755), a potent competitive N-methyl-D-aspartate (NMDA) receptor antagonist, systemically administered either before or after 20 to 30 minutes of global ischemia in rats. We measured outcome by mortality, histological damage by light microscopy, and learning ability on an eight-arm maze, and determined the drug's mechanism of action by an immunohistochemical assay of calcium-calmodulin binding. High-dose treatment begun prior to ischemia resulted in reduced cellular damage in severely ischemic hippocampal tissue, but also caused high mortality due to respiratory depression. Treatment begun 30 minutes after ischemia resulted in little histological protection but significantly improved learning ability when tested 1 month after ischemia, and did not increase mortality. Furthermore, CGS-19755, 10 mg/kg intraperitoneally, begun either before or after ischemia substantially reduced calcium influx into ischemic neurons as evidenced by reduced calcium-calmodulin binding. We conclude that CGS-19755 prevents calcium entry into ischemic neurons and may be effective therapy for very acute cerebral ischemia.

Animals↗
PubMed1990

Using the CES-D scale to screen for depression and anxiety: effects of language and ethnic status.

The purpose of this report is to present data on the effects of language (English/Spanish) and ethnic status (white/non-Hispanic or Mexican origin) on the ability of the Center for Epidemiologic Studies Depression (CES-D) scale to detect cases of clinical depression and generalized anxiety identified using the Diagnostic Interview Schedule (DIS) in psychiatric treatment settings. The agreement between the CES-D scale and the DIS diagnoses of major depressive disorder (MDD) and generalized anxiety disorder (GAD) was poor, especially among Mexican-origin patients interviewed in Spanish. Multiple regression analysis revealed that the CES-D scale was positively associated with MDD in all groups. In addition, GAD also was associated with the CES-D scale in Anglos and English-speaking Mexican-Americans but not in Spanish-speaking Mexican-Americans.

Anxiety Disorders↗