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Biomedical subjects

J R Cornelius

Publications and source records attributed to J R Cornelius.

At least 19 recordsLinked to original sources
PubMed2001

Treating the substance-abusing suicidal patient.

Studies concerning the treatment of substance-abusing suicidal patients are scarce despite the frequent presence of suicidal behavior among this population. Indeed, suicidality (ideation or behavior) is generally an exclusion criterion for participation in treatment studies of subjects with alcohol or drug abuse. Consequently, to date, little is known about the optimal treatment of this population. The first study involving substance-abusing suicidal patients was an open-label trial conducted in the early 1990s. This study involved 12 patients, all of whom demonstrated recent suicidal ideations and had made a lifetime suicide attempt. The results of that open-label study demonstrated significant within-group improvement in both depressive symptoms (including suicidal ideations) and level of drinking. However, substantial residual depressive symptoms and drinking persisted at the end of the trial. Also, because no placebo control group was utilized, the authors of that study could not rule out the possibility that the apparent therapeutic effect from fluoxetine was the result of the placebo effect. To date, only one double-blind, placebo-controlled study of subjects with alcohol or substance abuse has included substantial numbers of suicidal patients. The study involved 51 subjects, of whom 20 (39%) had made a suicide attempt in the current depressive episode, 31 (61%) had made a suicide attempt in their lifetime, and 46 (90%) had reported suicidal ideations in the week before hospitalization. The results of that double-blind, placebo-controlled study suggest that fluoxetine was effective in decreasing but not eliminating both the depressive symptoms (including suicidal ideations) and the level of alcohol consumption among a study group of subjects with comorbid major depressive disorder and alcohol dependence, many of whom displayed suicidal ideations. A secondary data analysis from that study suggested that cigarette smoking is also significantly decreased by fluoxetine, but the magnitude of the decrease is limited and few of these patients totally quit smoking with fluoxetine treatment alone. Another secondary data analysis from that study suggested that marijuana smoking was also significantly decreased in a subgroup of subjects who demonstrated cannabis abuse and that the magnitude of this improvement was robust. A third secondary data analysis from that study suggested that cocaine abuse acts as a predictor of poor outcome for both depressive symptoms (including suicidality) and level of alcohol use in this population. The results of a 1-year naturalistic follow-up study involving the patients from that study suggest that the benefits of fluoxetine in decreasing depressive symptoms and level of drinking persist 1 year after entering the treatment program. To date, no other double-blind, placebo-controlled studies involving substantial numbers of substance-abusing suicidal patients have been reported to either confirm or refute these findings. Further studies are clearly warranted to evaluate the efficacy of various pharmacotherapeutic agents and various psychotherapies in the treatment of substance-abusing suicidal patients.

Adult↗
PubMed1998

Drug use problem awareness and treatment readiness in dual-diagnosis patients.

Problem awareness and treatment readiness are factors that influence treatment-seeking behavior, and thus, morbidity and outcome. The authors elucidated patterns of problem awareness and treatment readiness among hospitalized dually diagnosed patients by administering the Problem Awareness and Readiness for Treatment subscales of the Alcohol Use Inventory to 67 psychiatric inpatients with comorbid substance-related disorders and using a multivariate model approach to data analysis. The results suggested differential and interactive effects of gender, ethnicity, voluntary admission status, and a diagnosis of major depression (MDD) on drug abuse problem awareness and treatment readiness. Female gender, voluntary admission status, and a comorbid diagnosis of MDD were associated with increased awareness and readiness for treatment.

Adult↗
PubMed1998

Naltrexone utility in depressed alcoholics.

The aim of this open-label pilot study was to evaluate the utility of naltrexone (50 mg per day) in decreasing alcohol use and to examine its impact on depressive symptoms among depressed alcoholics who have failed to abstain from alcohol use despite treatment with a selective serotonin reuptake inhibitor (SSRI). Fourteen ambulatory care patients, aged 18 to 65 years, with DSM-III-R comorbid diagnoses of alcohol dependence and major depressive disorder, who failed to abstain despite treatment with an antidepressant medication were enrolled in the study. Patients were followed for 12 weeks with weekly assessment of drinking behavior, depressive symptoms, functioning, alcohol craving, and side effects. The results of this study indicated a significant decrease in alcohol use and in urges to drink alcohol in the presence of the usual triggers. There was also a trend suggesting improvement in depressive symptoms and overall functioning. Naltrexone was well tolerated, with mild side effects reported at the onset of treatment.

Adult↗
PubMed1998

Fluoxetine versus placebo in depressed alcoholic cocaine abusers.

To date, few double-blind, placebo-controlled studies with any selective serotonin reuptake inhibitor (SSRI) antidepressant in pure cocaine abusers or in cocaine abusers with comorbid disorders have been reported. In this study, 17 patients with DSM-III-R diagnoses of major depressive disorder, alcohol dependence, and cocaine abuse were included along with 34 non-cocaine-abusing depressed alcoholics in a pharmacotherapy trial involving the SSRI antidepressant fluoxetine. All 51 patients participated in a double-blind, parallel group study of fluoxetine versus placebo in depressed alcoholics. The principal focus of this article is the one-third of the depressed alcoholics who also abused cocaine and how the treatment response of those 17 patients compared with that of the 34 depressed alcoholics who did not abuse cocaine. During the study, no significant difference in treatment outcome was noted between the fluoxetine group (N = 8) and the placebo group (N = 9) for cocaine use, alcohol use, or depressive symptoms. In addition, no significant within-group improvement was noted for any of these outcome variables in either of the two treatment groups. Indeed, across the combined sample of 17 depressed alcoholic cocaine abusers, the mean Beck Depression Inventory (BDI) score worsened slightly from 19 to 21 during the course of the study, and 71 percent of the patients continued to complain of suicidal ideations at the end of the study. The 17 cocaine-abusing depressed alcoholics showed a significantly worse outcome than the 34 non-cocaine abusing depressed alcoholics on the 24-item Hamilton Rating Scale for Depression (HAM-D) and BDI depression scales and on multiple measures of alcohol consumption. These findings suggest that comorbid cocaine abuse acts as a robust predictor of poor outcome for the drinking and the depressive symptoms of depressed alcoholics.

Adult↗
PubMed1997

Fluoxetine in depressed alcoholics. A double-blind, placebo-controlled trial.

BACKGROUND: The selective serotonergic medication fluoxetine has demonstrated efficacy in the treatment of major depression and has suggested efficacy in the treatment of alcoholism. However, no completed trials with any selective serotonergic medication have been reported in patients who display both major depression and alcoholism, despite previous observations that both depression and alcoholism are associated with low serotonergic functioning. METHODS: Fifty-one patients diagnosed as having comorbid major depressive disorder and alcohol dependence were randomized to receive fluoxetine (n = 25) or placebo (n = 26) in a 12-week, double-blind, parallel-group trial. Weekly ratings of depression and alcohol consumption were obtained throughout the 12-week course of the study. RESULTS: The improvement in depressive symptoms during the medication trial was significantly greater in the fluoxetine group than in the placebo group. Total alcohol consumption during the trial was significantly lower in the fluoxetine group than in the placebo group. CONCLUSIONS: Fluoxetine is effective in reducing the depressive symptoms and the alcohol consumption of patients with comorbid major depressive disorder and alcohol dependence. It is unknown whether these results generalize to the treatment of less depressed and less suicidal alcoholics.

Adult↗
PubMed1997

Regulation of pigmentation in cultured skin substitutes by cytometric sorting of melanocytes and keratinocytes.

Unpredictable pigmentation in cultured skin substitutes (CSS) is an anatomic deficiency after wound treatment and can require years to normalize. Variable numbers of human melanocytes (HM) survive in cultures of human keratinocytes (HK) as demonstrated by focal areas of pigmentation in CSS after healing. The purposes of this study were to deplete HM from HK cultures and to regulate the numbers of HM contained in CSS. A highly pigmented HM cell strain was chosen for these studies to emphasize the differences in light scattering between HK and HM by flow cytometry. Cytometric gates were set with selective cultures of HM and HK and were used to sort a mixed population of HK + 4% HM. After sorting, CSS were prepared from human fibroblasts attached to collagen-glycosaminoglycan sponges combined with cells from the HK + 4% HM (pre-treatment control), the sorted HK (experimental), or sorted HK + 3% HM (post-treatment positive control) subpopulations and grafted to athymic mice. Grafted wounds were assessed for 6 wk by planimetry for area of pigment and by a Minolta Chromameter for color density and hue in situ. Histology and staining of HLA-ABC were performed at 6 wk. Data from percent pigmented area and chromameter measurements identified quantitative and statistically significant decreases in color of healed skin after flow cytometric separation of HK and HM. Therefore, a purified HK subpopulation depleted of HM was isolated by flow cytometry that generated healed skin with reduced pigmentation. These results suggest that HM can be selectively depleted from HK cultures and then added to cultured skin substitutes at specific densities to generate predictable pigmentation for improved function and cosmesis in healed wounds.

Animals↗
PubMed1997

Double-blind fluoxetine in depressed alcoholic smokers.

Treatment trials involving smoking in alcoholics with major depression are scarce, despite the common co-occurrence of these disorders. In this study, 25 smokers with DSM-III-R diagnoses of both major depressive disorder and alcohol dependence were randomized to fluoxetine or placebo in a 12-week, double-blind, parallel group trial. Almost half (48%) of the patients had made a suicide attempt in the week before hospitalization (where recruitment was performed), and 84 percent reported suicidal ideations during that week. Those in the fluoxetine group demonstrated a significant within-group decrease in smoking during the course of the study, whereas those in the placebo group did not. Those in the fluoxetine group smoked 27 percent fewer cigarettes than those in the placebo group, although this difference was not statistically significant. Cumulative alcohol consumption during the 12 weeks of the pharmacotherapy trial was four times as high in the placebo group as in the fluoxetine group, though this difference was not statistically significant in this limited-sized sample. The change in smoking was significantly associated with a change in drinking. These preliminary findings suggest that fluoxetine has the potential for treating the smoking and drinking behaviors of depressed alcoholic smokers.

Adult↗
PubMed1996

Patterns of suicidality and alcohol use in alcoholics with major depression.

The aims of this study were (1) to comprehensively characterize a population of alcoholics with major depression in a psychiatric hospital, (2) to determine the prevalence of suicidal behavior in this sample, and (3) to determine whether quantity of alcohol ingested was associated with level of suicidality. Ratings of drinking, depression, and suicidality were obtained using both self-rated and observer-rated instruments. The prevalence of suicide attempts in the week before hospitalization was remarkably high, approaching 40%, whereas 70% had made a suicide attempt at some point in their lifetime. These suicide attempts were typically impulsive in nature, involving little if any premeditation. Most subjects reported drinking more heavily than usual on the day of their suicide attempt. Recent suicidal behavior was significantly associated with recent very heavy drinking (< or = 70 drinks per week) and with number of drinks per drinking day. Quantity of drinking per drinking day was also significantly higher in those making a recent suicide attempt. However, no association was found between quantity of alcohol consumption and suicidal ideation. These findings suggest that recent heavy alcohol use primarily affects suicidality by increasing the likelihood of acting on suicidal ideation rather than by inducing suicidal ideation.

Adult↗
PubMed1996

Disproportionate lethality in psychiatric patients with concurrent alcohol and cocaine abuse.

OBJECTIVE: The aim of this study was to examine the association between active, concomitant cocaine and alcohol abuse and the prevalence and severity of current suicidal and homicidal behavior among hospitalized psychiatric patients. METHOD: Three groups of patients--with cocaine and alcohol abuse (N = 38), alcohol abuse only (N = 38), and cocaine abuse only (N = 25)--consecutively admitted to a psychiatric and substance abuse dual-diagnosis unit were comparatively examined for the presence of current suicidal and homicidal behavior. RESULTS AND CONCLUSIONS: Logistic regression analysis revealed that the alcohol and cocaine abuse group had a higher likelihood of associated current homicidal behavior than the alcohol-only and the cocaine-only groups.

Adult↗
PubMed1995

Disproportionate suicidality in patients with comorbid major depression and alcoholism.

OBJECTIVE: The two purposes of this study were to provide a comprehensive description of the clinical features of patients who presented to an intake psychiatric setting with major depression and alcohol dependence and to determine which clinical features distinguished this dual-diagnosis group from patients with the two relevant single diagnoses. METHOD: During a recent 5-year period, a total of 107 patients who came to a psychiatric facility for initial evaluation were diagnosed as having both major depression and alcohol dependence. The clinical profile of this dual-diagnosis group was compared to that of nondepressed alcoholics (N = 497) and nonalcoholic patients with major depression (N = 5,625), assessed at the same facility, on the basis of information from the Initial Evaluation Form, a semistructured instrument containing a standardized symptom inventory that includes ratings of severity. RESULTS: The psychiatric symptom that most strongly distinguished the depressed alcoholics from the two comparison groups was the level of suicidality. The depressed alcoholics differed significantly from the nonalcoholic depressed patients on only two depressive symptoms, suicidality (59% higher) and low self-esteem (22% higher); they were also significantly distinguished from the nonalcoholic depressed patients by factors such as greater impulsivity, functional impairment, and abnormal personal and social history markers. CONCLUSIONS: Suicidality was disproportionately greater than other psychiatric symptoms in the depressed alcoholics. The clinical profile of depressed alcoholics suggests that they suffer an additive or synergistic effect of two separate disorders, resulting in a disproportionately high level of acute suicidality upon initial psychiatric evaluation.

Adult↗
PubMed1995

Preliminary report: double-blind, placebo-controlled study of fluoxetine in depressed alcoholics.

The selective serotonergic agonist fluoxetine has demonstrated efficacy in the treatment of depression and has possible efficacy in the treatment of nondepressed and depressed alcoholics. However, no double-blind, placebo-controlled trials with any selective serotonergic medication have been reported in patients who have both major depression and alcoholism. In this study, 21 patients with DSM-III-R diagnoses of both major depressive disorder and alcohol dependence were randomized to fluoxetine or placebo in a 12-week, double-blind, parallel group trial. The patients reported a high level of current episode (52.4%), prior episode (61.9%), and lifetime (76.2%) suicidal behavior. Total alcohol consumption during the 12-week treatment course was significantly lower in the fluoxetine group than the placebo group, after controlling for baseline differences in consumption. The fluoxetine group demonstrated a four-fold greater improvement in depressive symptoms, but this difference did not reach statistical significance in this small sample. These preliminary findings suggest that fluoxetine has potential for treating the excessive alcohol ingestion of depressed alcoholics and may have potential for treating the depressive symptoms of these patients as well.

Adolescent↗
PubMed1995

The utility of diazepam loading in the treatment of alcohol withdrawal among psychiatric inpatients.

The aim of this study was to assess the usefulness of an objective rating scale (the modified Clinical Institute Withdrawal Assessment for Alcohol [CIWA-A]) and a diazepam loading dose (20 mg) in the management of alcohol withdrawal among hospitalized psychiatric patients. The sample consisted of 152 adult, hospitalized, psychiatric patients with comorbid alcohol dependence. Of the 152 subjects, 115 (75.7%) completed detoxification with supportive therapy only. Among the 37 patients who required pharmacotherapy (24%), 15 (40.5%) required only one 20-mg dose of diazepam, 14 (38%) required 40 mg to 100 mg, and 8 (21.6%) required doses ranging from 120 mg to 220 mg. There were no complications related to this treatment. The results suggest that the use of the objective rating scale and the diazepam loading dose appears to be safe and effective, and is a useful method for the management of alcohol withdrawal among psychiatric patients.

Adolescent↗
PubMed1995

Monoamine oxidase inhibitor dietary restrictions: what are we asking patients to give up?

BACKGROUND: Though the list of possible indications for monoamine oxidase inhibitors (MAOIs) continues to expand, many psychiatrists remain hesitant about prescribing MAOIs, citing concerns about dietary prohibitions and hypertensive reactions. Data about psychiatric patients' frequency of consumption of foods, beverages, and medications prohibited during MAOI use are lacking. METHOD: We conducted a survey of 139 psychiatric patients admitted to either an inpatient unit specializing in the treatment of mood disorders or an outpatient anxiety disorders clinic specializing in the treatment of social phobia. At inclusion, patients were not being treated with MAOIs, although they might have received such treatment afterward. All patients completed a self-report questionnaire created for this study to ascertain their consumption of food, beverage, and medication items frequently found on MAOI diet lists. Demographic and diagnostic information was also recorded. RESULTS: The most frequently used high-risk items were the hard cheeses. Ninety percent of patients reported daily or weekly consumption of some food containing cheese, while less than 1% of patients reported never eating hard cheese. Yeast products, dry sausage, corned beef, broad beans, sauerkraut, and beer were used at least monthly by more than 50% of patients. Of the intermediate-risk foods, chocolate was the most frequently consumed, with almost 30% of the patients eating some chocolate daily. Over 40% of patients reported using over-the-counter cold preparations on a monthly basis. CONCLUSION: A wide variety of tyramine-containing foods and contraindicated medications were commonly used by our patients prior to evaluation for possible MAOI pharmacotherapy. The number and diversity of frequently consumed items do not support recommendations to reduce the breadth of restrictions in MAOI diets. Individually targeted dietary assessment and education are recommended to reduce the risks of prescribing MAOIs.

Adult↗
PubMed1994

Patterns and covariates of tobacco use in a recent sample of pregnant teenagers.

PURPOSE: Little is known about the prevalence and patterns of smoking among pregnant teenagers. We provide a comprehensive description of the prevalence, patterns and correlates of smoking from a recent sample of 199 pregnant adolescents. METHODS: We interviewed pregnant teenagers at mid-pregnancy and delivery to obtain information on tobacco and other substance use before and during pregnancy and on demographic, medical and psychosocial status. RESULTS: The average age was 16.1 years (range 12-18); 70% were African-American. Smoking was prevalent and increased from first (59%) to third (62%) trimesters. This increase was in sharp contrast to decreases in other substances. Caucasians had higher rates of smoking and heavier smoking. For Caucasians, third trimester smoking was predicted by peer smoking and early onset of sexual activity. For African-Americans, third trimester smoking was related to older age, not living with parent(s), dissatisfaction with social support, early pregnancy binge drinking, peer smoking, and early onset of sexual activity. CONCLUSIONS: The high prevalence and increasing pattern of prenatal smoking in teenagers is a major public health concern. Effective education and cessation programs must be targeted at pregnant teenagers.

Adolescent↗
PubMed1994

A comparison of prenatal drinking in two recent samples of adolescents and adults.

The drinking patterns of 124 pregnant teenagers are described and compared with those of 267 pregnant adults attending the same prenatal clinic in Pittsburgh. Adults had a significantly higher average daily volume of alcohol prior to pregnancy than adolescents, but that higher level was no longer significant during pregnancy. However, the rate of binge drinking during the first trimester was higher in the teenage sample than in the adult sample. Rates of binge drinking and heavy drinking were highest among the white teenage group. Use of marijuana and cocaine/crack decreased precipitously during pregnancy for both teenagers and adults. Tobacco use also decreased among the adults, but increased from 56% to 71% during pregnancy in the teenage sample. Based on our findings, patterns of drinking among adult pregnant women do not generalize to pregnant adolescents. Offspring of white adolescents, in particular, may be at higher risk for intermittent high peak alcohol exposure farther into the pregnancy than are offspring of older women.

Adolescent↗
PubMed1993

Drinking patterns and correlates of drinking among pregnant teenagers.

Many adolescents drink, and the rate of teenage pregnancy is increasing, yet the effect of drinking among pregnant teenagers has received little attention. We present a description of the drinking patterns of 124 pregnant teenagers attending a prenatal clinic in Pittsburgh. Sixty-nine percent of the women were African-American, and the average age was 16 years (range 13-18 years). Eighty-two percent drank the year before pregnancy, while 54%, 19%, and 15% drank during the first, second, and third trimesters, respectively. All substance use decreased between the first and third trimesters, with the exception of tobacco, which rose significantly. Binge drinking (5+ drinks/occasion) occurred in 31% of the sample before pregnancy, rose to 35% in the first trimester, and then fell precipitously. Binge drinkers during pregnancy were more likely to be white and heavier users of tobacco, marijuana, and cocaine. Binge drinkers experienced alcohol and tobacco use and sexual intercourse earlier than nonbinge drinkers. Binge drinking in the first trimester may be considered a risk factor for infants of adolescents.

Adolescent↗
PubMed1993

Continuation pharmacotherapy of borderline personality disorder with haloperidol and phenelzine.

OBJECTIVE: The aim of this study was to assess the effectiveness of low-dose neuroleptic medication and monoamine oxidase inhibitor (MAOI) antidepressant medication in continuation pharmacotherapy of patients with borderline personality disorder. METHOD: The authors conducted a double-blind, placebo-controlled study comparing continuation therapy with a neuroleptic (up to 6 mg/day of haloperidol), an MAOI antidepressant (up to 90 mg/day of phenelzine), and placebo in 14 men and 40 women with borderline personality disorder. Continuation medication trials lasted 16 weeks, following 5 weeks of acute therapy. RESULTS: Continuing haloperidol demonstrated efficacy only for the treatment of irritability. Higher levels of depression, hypersomnia, and leaden paralysis were noted in the patients who received haloperidol than in those who received phenelzine and those who received placebo. The dropout rate during the first 8 weeks of the continuation study was significantly higher for the patients receiving haloperidol (64%) than for those receiving placebo (28%). Continued phenelzine demonstrated only modest efficacy for the treatment of depression and irritability. An activating effect of phenelzine was shown on measures of excitement and reactivity. CONCLUSIONS: No evidence of efficacy was found for continuation therapy with haloperidol in the treatment of borderline personality disorder other than in the treatment of irritability. Little evidence of efficacy was found for continuation therapy with phenelzine for borderline personality disorder other than modest improvements in irritability and depressive symptoms. There is currently no clear pharmacological treatment of choice for the continuation therapy of borderline personality disorder.

Adult↗