Biomedical subjects

Ivan Miller

Publications and source records attributed to Ivan Miller.

8 recordsLinked to original sources

PubMed2007

A telephone-based intervention for depression in HIV patients: negative results from a randomized clinical trial.

To determine if a telephone support behavioral intervention improves depressive symptoms among HIV positive outpatients, we enrolled 177 persons with Beck Depression Inventory (BDI) scores scores of >/=10. Participants were randomized to receive up to 12 scheduled psycho-educational calls over 6 months or to an assessment-only control condition. Co-enrolled informal caregivers of HIV patients received the same telephone intervention in parallel. Among the 160 (90.4%) participants who were re-interviewed at 6 months, 56% were male, and 41% were Caucasian, with a mean baseline BDI score of 22.7. Overall, participants' mean BDI scores improved 5.3 points from baseline, but intervention group differences on depression outcomes including 50% or greater reduction in BDI scores and depression remission were not statistically significant. In the full cohort, men were significantly more likely to improve than women. We conclude that a psycho-educational telephone support intervention did not reduce depressive symptoms for HIV patients more than an assessment-only control condition.

Adult↗

PubMed2006

Personality pathology and its relation to couple functioning.

The study aimed at understanding the relationship between personality pathology and couple functioning, both in terms of general functioning and communication specifically, in a sample of 146 psychiatric outpatients. The results indicated that couple communication was best predicted by a combination of the symptoms within each of the three personality disorder clusters and the total number of personality disorder symptoms while general family functioning was best predicted by the total number of Axis I disorders. No demographic variables were found to be related to the level of couple functioning. Future research needs to focus on understanding what makes it difficult for people with personality disorder traits to function in relationships.

Adult↗

PubMed2005

Chronic depression: medication (nefazodone) or psychotherapy (CBASP) is effective when the other is not.

CONTEXT: Although various strategies are available to manage nonresponders to an initial treatment for depression, no controlled trials address the utility of switching from an antidepressant medication to psychotherapy or vice versa. OBJECTIVE: To compare the responses of chronically depressed nonresponders to 12 weeks of treatment with either nefazodone or cognitive behavioral analysis system of psychotherapy (CBASP) who were crossed over to the alternate treatment (nefazodone, n = 79; CBASP, n = 61). DESIGN: Crossover trial. SETTING: Twelve academic outpatient psychiatric centers. PATIENTS: There were 140 outpatients with chronic major depressive disorder; 92 (65.7%) were female, 126 (90.0%) were white, and the mean age was 43.1 years. Thirty participants dropped out of the study prematurely, 22 in the nefazodone group and 8 in the CBASP group. INTERVENTIONS: Treatment lasted 12 weeks. The dosage of nefazodone was 100 to 600 mg/d; CBASP was provided twice weekly during weeks 1 through 4 and weekly thereafter. MAIN OUTCOME MEASURES: The 24-item Hamilton Rating Scale for Depression, administered by raters blinded to treatment, the Clinician Global Impressions-Severity scale, and the 30-item Inventory for Depressive Symptomatology-Self-Report. RESULTS: Analysis of the intent-to-treat sample revealed that both the switch from nefazodone to CBASP and the switch from from CBASP to nefazodone resulted in clinically and statistically significant improvements in symptoms. Neither the rates of response nor the rates of remission were significantly different when the groups of completers were compared. However, the switch to CBASP following nefazodone therapy was associated with significantly less attrition due to adverse events, which may explain the higher intent-to-treat response rate among those crossed over to CBASP (57% vs 42%). CONCLUSIONS: Among chronically depressed individuals, CBASP appears to be efficacious for nonresponders to nefazodone, and nefazodone appears to be effective for CBASP nonresponders. A switch from an antidepressant medication to psychotherapy or vice versa appears to be useful for nonresponders to the initial treatment.

Adult↗

PubMed2005

Caregiver burden and depression among informal caregivers of HIV-infected individuals.

BACKGROUND: Few studies have examined the factors associated with depression in informal caregivers of HIV-infected persons. OBJECTIVE: To investigate the relationship between depression and caregiver burden among informal caregivers of HIV-infected individuals. DESIGN: Cross-sectional study using baseline data from an ongoing randomized trial of a supportive telephone intervention. PARTICIPANTS: One hundred seventy-six dyads of HIV patients and their informal caregiver. MEASUREMENTS: Depression was defined as a Beck Depression Inventory >10. A Caregiver Strain Index >6 identified informal caregivers with a high caregiver burden. We used logistic regression to identify characteristics that were associated with depression in the informal caregiver. RESULTS: Informal caregivers were 42 years old (SD, 13), 53% female, 59% nonwhite, and 30% had education beyond high school. Forty-seven percent of informal caregivers were the patient's partner, 18% a friend, and 35% a family member. Twenty-seven percent of informal caregivers had a high caregiver burden, and 50% were depressed. We found significantly greater odds of informal caregiver depression with high caregiver burden (OR, 6.08; 95% CI, 2.40 to 15.4), informal caregiver medical comorbidity besides HIV (OR, 2.32; 95% CI, 1.09 to 4.92), spending all day together (OR, 3.92; 95% CI, 1.59 to 9.69), having to help others besides the HIV patient (OR, 2.55; 95% CI, 1.14 to 5.74), and duration of the HIV patient's diagnosis (OR, 1.01 per month; 95% CI, 1.00 to 1.01). CONCLUSIONS: High caregiver burden was strongly associated with depression among HIV-infected individuals' informal caregivers, who themselves had difficult life circumstances. Informal caregivers of HIV patients may be in need of both mental health services and assistance in caregiving.

Adult↗

PubMed2003

Randomized, placebo-controlled trial of nefazodone maintenance treatment in preventing recurrence in chronic depression.

BACKGROUND: Maintenance treatment to prevent recurrences is recommended for chronic forms of major depressive disorder (MDD), but few studies have examined maintenance efficacy of antidepressants with chronic MDD. This randomized, placebo-controlled study of the efficacy and safety of nefazodone in preventing recurrence was conducted for patients with chronic MDD. METHODS: A total of 165 outpatients with chronic, nonpsychotic MDD, MDD plus dysthymic disorder ("double-depression"), or recurrent MDD with incomplete inter-episode recovery, who achieved and maintained a clinical response during acute and continuation treatment with either nefazodone alone or nefazodone combined with psychotherapy, were randomized to 52 weeks of double-blind nefazodone (maximum dose 600 mg/day) or placebo. The occurrence of major depressive episodes during maintenance treatment was assessed with the 24-item Hamilton Rating Scale for Depression, a DSM-IV MDD checklist, and a blinded review of symptom exacerbations by a consensus committee of research clinicians. RESULTS: Application of a competing-risk model that estimated the conditional probability of recurrence among those patients remaining on active therapy revealed a significant (p =.043) difference between nefazodone (n = 76) and placebo (n = 74) when the latter part of the 1-year maintenance period was emphasized. At the end of 1 year, the conditional probability of recurrence was 30.3% for nefazodone-treated patients, compared with 47.5% for placebo-treated patients. Prior concomitant psychotherapy during acute/continuation treatment, although enhancing the initial response, was not associated with lower recurrence rates. Discontinuations due to adverse events were relatively low for both nefazodone (5.3%) and placebo (4.8%). Somnolence was significantly greater among the patients taking active medication (15.4%), compared with placebo (4.6%). CONCLUSIONS: Nefazodone is well-tolerated and is an effective maintenance therapy for chronic forms of MDD.

Acute Disease↗

PubMed2003

Depression severity and drug injection HIV risk behaviors.

OBJECTIVE: This study examined the association of depression severity and drug injection HIV risk behavior among injection drug users. METHOD: Injection drug users who met the DSM-IV criteria for major depressive disorder, dysthymia, or substance-induced mood disorder lasting at least 3 months were asked how often they used "needles or syringes that someone else had used" (injection risk behavior) in the past 90 days. Depression severity was measured by using the Modified Hamilton Rating Scale for Depression. RESULTS: Of the 109 subjects, 63% were male, 82% were Caucasian, and 10% were HIV positive. The subjects' mean modified Hamilton depression scale score was 21.0 (SD=3.9). The mean number of reported instances of injection risk behavior (needle sharing) in the past 90 days was 57.5 (SD=134.7). In a logistic regression analysis in which the effects of age, race, gender, number of days on which injection drugs were used (injection days), and average number of injections per injection day were controlled, depression severity was associated with injection risk (odds ratio=1.5; 95% confidence interval=1.1-2.3). CONCLUSIONS: Greater severity of depression is associated with greater frequency of injection risk behavior among depressed injection drug users. Risk reduction programs that target depressed injection drug users need to be designed.

Adult↗

PubMed2002

Does psychosocial functioning improve independent of depressive symptoms? A comparison of nefazodone, psychotherapy, and their combination.

BACKGROUND: Although it is known that antidepressant treatment improves psychosocial functioning, whether such changes occur independent of depressive symptoms is not known. This study compared efficacy of nefazodone, psychotherapy, and their combination in improving psychosocial functioning in chronically depressed outpatients. METHODS: Patients with chronic forms of major depressive disorder were randomized to 12 weeks of nefazodone, Cognitive Behavioral Analysis System of Psychotherapy (CBASP), or combined nefazodone/CBASP. Psychosocial assessments measured overall psychosocial functioning, work functioning, interpersonal functioning, and general health. RESULTS: Relative to community norms, patients with chronic major depression evidenced substantially impaired psychosocial functioning at baseline. Combined treatment produced significantly greater psychosocial improvement than either CBASP alone or nefazodone alone on all primary measures. Combined treatment remained superior to nefazodone on primary measures of work, social, and overall functioning, and superior to CBASP on social functioning when depressive symptoms were controlled. Unlike the two groups receiving nefazodone, CBASP alone's effect on psychosocial function was relatively independent of symptom change. Psychosocial functioning improved more slowly than depressive symptoms, and moderate psychosocial impairments remained at end point. CONCLUSIONS: Combined treatment had greater effect than either monotherapy. Change in depressive symptoms did not fully explain psychosocial improvement. Moderate residual psychosocial impairment remained, suggesting the need for continuation/maintenance treatment.

Adult↗

PubMedDate not supplied

Coping and burden among informal HIV caregivers.

OBJECTIVE: The aim of this study was to examine the role of coping on caregiver burden among a heterogeneous group of caregivers of persons living with HIV during the era of highly active antiretroviral therapy. METHODS: Burden and coping were examined among 176 caregivers of persons living with HIV. Three styles of coping were examined using a 7-item scale: active-approach (task), blame-withdrawal (emotion), and distancing (avoidance). RESULTS: A total of 58.8% of the caregivers were women. They had a mean age of 42 years; 61.9% cohabited with the persons living with HIV who had a mean CD4 count of 401. All three styles of coping were significantly positively correlated with caregiver burden. After controlling for demographic variables and caregiver depression, active-approach coping and distancing coping independently moderated the relationship between perceived severity of HIV-related symptoms (stress) and caregiver burden; however, some caregivers experienced burden even at low levels of stress. CONCLUSIONS: These results indicate that in the era of highly active antiretroviral therapy, coping mitigates the effect of stress on burden.

Adaptation, Psychological↗