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Biomedical subjects

Jack R Cornelius

Publications and source records attributed to Jack R Cornelius.

At least 19 recordsLinked to original sources
PubMed2006

Early age of first sexual intercourse and affiliation with deviant peers predict development of SUD: a prospective longitudinal study.

OBJECTIVE: A recent study has reported that early sexual behavior predicts the development of substance use disorders (SUD). However, that relationship was considered by its authors to be only tentative, because it was based on cross-sectional data rather than longitudinal data. Another recent study reported that deviant activities of peers predict development of SUD, although that relationship has not yet been confirmed. The objective of this study was to assess whether early onset of sexual intercourse and affiliation with deviant peers serve as predictors of the development of SUD, using a prospective longitudinal study design. METHOD: We conducted a prospective longitudinal study of adolescents. These subjects were recruited at the age of 10-12years, with follow-up evaluations at ages 14, 16, 19, 22, and 25. The sample included 136 male subjects. Cox regression analyses were performed, with age of first intercourse, neurobehavioral disinhibition, exposure to drugs in the neighborhood, and deviant activities of peers as factors in the analyses. RESULTS: Earlier age at first intercourse and deviant activities of peers each predicted a significantly higher risk of subsequently developing a SUD (Wald=8.3, df=1, p=0.004; Wald=7.5, df=1, p=0.006, respectively). CONCLUSIONS: The results of this study confirm that early onset of sexual intercourse and affiliation with deviant peers predict the early development of substance use disorders, using a prospective longitudinal study design.

Adolescent↗
PubMed2006

Divalproex utility in bipolar disorder with co-occurring cocaine dependence: a pilot study.

OBJECTIVE: The aim of this open-label pilot study was to evaluate the utility of divalproex in decreasing cocaine use and stabilizing mood symptoms among patients with bipolar disorder with comorbid cocaine dependence. METHOD: Fifteen patients enrolled in the study and seven met final inclusion criteria of DSM-IV/SCID diagnoses of bipolar I disorder and comorbid cocaine dependence with active cocaine use. Patients were started on open-label divalproex. After stabilization on divalproex sodium, weekly assessments were undertaken for 8weeks. Subjects also attended dual recovery counseling. RESULTS: The results revealed significant improvement on % cocaine abstinent days, dollars spent on cocaine, ASI's drug use severity index, % alcohol abstinent days, drinks per drinking day, marijuana use and cigarettes smoking. They also had significant improvement on manic, depressive, and sleep symptoms and on functioning. There were no reported adverse events or increases in liver function tests. CONCLUSION: The results of this open-label study point to the potential utility of divalproex in patients with bipolar disorder and primary cocaine dependence. Double-blind, placebo-controlled studies to fully evaluate the efficacy of divalproex in this high risk clinical population are warranted.

Adolescent↗
PubMed2006

Substance use disorder trajectory classes: diachronic integration of onset age, severity, and course.

BACKGROUND: Substance use disorders (SUDs) may be characterized by onset age, severity, substance type, course, and outcomes. SUD phenotypes in the literature typically consider each of these features in isolation. Conceptual frameworks and data collection procedures for assessing SUD phenotypes are increasingly "diachronic" in approach, providing for characterizations "throughout time". The recent availability of statistical procedures for the identification of latent classes offers the possibility of developing SUD phenotypes integrating these developmental features. This article illustrates the utilization of SAS-TRAJ mixture modeling to characterize variations in SUD symptom trajectories to define phenotypes. METHODS: The subjects were 332 adult males with SUDs. Their course of symptoms from early adolescence through middle adulthood was retrospectively determined. Symptom trajectories were defined by the number of DSM-IV SUD symptoms by year of age. SAS-TRAJ mixture models identified trajectory classes. Model development, evaluation, and selection using this approach are discussed. RESULTS: Among these men with SUDs, six trajectory classes were identified, including groups characterized by early-onset and severe SUD symptoms persisting into adulthood, an early-onset group similar in adolescence but improving in adulthood, and other groups with symptoms emerging later with varying degrees of severity and persistence. The SUD trajectory classes were significantly different on comorbid psychopathology, particularly childhood disruptive behavior disorders. CONCLUSION: The results present a new method for the comprehensive depiction of heterogeneity in SUD symptoms. Future studies may determine the extent to which SUDs phenotypes based on the course of symptom development inform etiology, prevention and treatment research.

Adolescent↗
PubMed2006

Quality of care for substance use disorders in patients with serious mental illness.

We assessed the quality of care for substance use disorders (SUDs) among 8,083 patients diagnosed with serious mental illness from the VA mid-Atlantic region. Using data from the National Patient Care Database (2001-2002), we assessed the percentage of patients receiving a diagnosis of SUD, percentage beginning SUD treatment 14 days or earlier after diagnosis, and percentage receiving continued SUD care 30 days or less. Overall, 1,559 (19.3%) were diagnosed with an SUD. Of the 1,559, 966 (62.0%) initiated treatment and 847 (54.3%) received continued care. Although patients diagnosed with bipolar disorder were more likely to receive a diagnosis of SUD than those diagnosed with schizophrenia or schizoaffective disorder (22.7%, 18.9%, and 17.7%, respectively; chi(2) = 26.02, df = 2, p < .001), they were less likely to initiate (49.1%, 70.7%, and 68.6%, respectively; chi(2) = 59.29, df = 2, p < .001) or continue treatment (39.9%, 63.2%, and 62.2%, respectively; chi(2) = 72.25, df = 2, p <. 001). Greater efforts are needed to diagnose and treat SUDs in patients with serious mental illness, particularly for those with bipolar disorder.

Adult↗
PubMed2006

Predicting risky drinking outcomes longitudinally: what kind of advance notice can we get?

This paper summarizes the proceedings of a symposium presented at the 2005 Research Society on Alcoholism meeting in Santa Barbara, California, that spans the interval from toddlerhood to early middle adulthood and addresses questions about how far ahead developmentally we can anticipate alcohol problems and related substance use disorder and how such work informs our understanding of the causes and course of alcohol problems and alcohol use disorder. The context of these questions both historically and developmentally is set by Robert Zucker in an introductory section. Next, Maria Wong and colleagues describe the developmental trajectories of behavioral and affective control from preschool to early adolescence in a high risk for alcoholism longitudinal study and demonstrate their ability to predict alcohol and drug outcomes in adolescence. Duncan Clark and Jack Cornelius follow with a report on the predictive utility of parental disruptive behavior disorders in predicting onset of alcohol problems in their adolescent offspring in late adolescence. Next, Kenneth Leonard and Gregory Homish report on adult development study findings relating baseline individual, spouse, and peer network drinking indicators at marriage onset that distinguish different patterns of stability and change in alcohol problems over the first 2 years of marriage. In the final paper, John Schulenberg and colleagues, utilizing national panel data from the Monitoring the Future Study, which cover the 18- to 35-year age span, show how trajectories of alcohol use in early adulthood predict differential alcohol abuse and dependence outcomes at age 35. Finally, Robert Zucker examines the degree to which the core symposium questions are answered and comments on next step research and clinical practice changes that are called for by these findings.

Adolescent↗
PubMed2005

Alcohol use disorder symptoms and risk-taking behavior as predictors of alcohol-related medical events among young adults treated in emergency departments.

BACKGROUND: Studies of alcohol-positive patients in emergency departments are not clear on the relationship between alcohol use disorder (AUD) symptoms and risk for injury. METHOD: Two-hundred three young adults (118 males (58%); mean age = 19.4 years) who were treated in two Level-1 emergency departments (ED) received comprehensive psychiatric interviews and completed the Alcohol Use Disorders Identification Test (AUDIT) and the Cognitive Appraisal of Risky Events (CARE). RESULTS: Males diagnosed with the AUD symptom of "drinking more or over a longer period than intended" are at greatest risk for requiring emergency care for an alcohol-related medical problem (OR = 10.8, 95% CI = 1.2,94.3, p < .04). Risk-taking behaviors increase risk for an alcohol-related medical event for both genders (OR = 2.6, 95% CI=1.1,5.6.1, p < .03). Alcohol use disorder severity related negatively to risk for experiencing an alcohol-related medical problem (OR = 0.6, 95% CI = 0.4,0.9, p < .04). CONCLUSIONS: Young adults treated for alcohol-related medical problems often exhibit DSM-IV defined symptoms of AUD and are engaging in risk-taking behaviors and should be referred for an in-depth assessment of alcohol use disorders and risk-taking activities.

Adolescent↗
PubMed2005

Acute phase and five-year follow-up study of fluoxetine in adolescents with major depression and a comorbid substance use disorder: a review.

This paper reviews the results of an acute phase trial and a five-year follow-up study of fluoxetine in adolescents with major depression and a substance use disorder (SUD). This study included a 12-week open label acute phase study of 13 comorbid adolescents, followed by comprehensive assessments conducted 1, 3, and 5 years after entry into an acute phase fluoxetine trial. The results of the acute phase study and of the 1, 3, and 5-year follow-up assessments have already been published in four papers. The current paper was designed to cover the results of the study across the entire 5-year time spectrum of the study, and to summarize the clinical results across that entire time period. The data from this pilot study suggest that the long-term (5-year) clinical course for the Alcohol Dependence, Cannabis Dependence, and academic functioning of comorbid adolescents following acute phase treatment with SSRIs is generally good. However, the long-term clinical course for the Major Depression of that comorbid adolescent population is surprisingly poor.

Adolescent↗
PubMed2005

Patient characteristics and treatment implications of marijuana abuse among bipolar alcoholics: results from a double blind, placebo-controlled study.

OBJECTIVE: Marijuana abuse, primarily a disorder of adolescents and young adults, is highly prevalent among patients with severely ill psychiatric population, especially those with bipolar disorder. Additional marijuana abuse may impact on the clinical presentation of bipolar illness and may potentially act as mediator of treatment response in this population. However, the characterization of bipolar disorder patients with additional marijuana abuse and the impact of such abuse on treatment outcome has been rarely examined. The aim of this study was to characterize bipolar alcoholic patients with comorbid marijuana abuse and test the impact of marijuana abuse on alcohol and mood outcome of patients with bipolar disorder and comorbid alcohol dependence. METHOD: We conducted secondary analyses of a randomized, double blind, placebo-controlled trial testing valproate in 52 bipolar alcoholics. Subjects had a comprehensive assessment at baseline using structured diagnostic assessments, and they were then assessed every 2 weeks for 24 weeks. RESULTS: Twenty-five subjects (48%) reported marijuana abuse. Those with co-occurring marijuana abuse were younger, had fewer years of education, and had significantly higher number of additional psychiatric comorbidity. They also had more severe alcohol and other drug use and were significantly more likely to present in the manic phase. The mixed model indicated that the placebo-treated marijuana abuse group had the worst alcohol use outcome. CONCLUSIONS: Marijuana abuse among patients with bipolar disorder and alcohol dependence is associated with higher degree of severity of alcohol and other drugs of abuse and may negatively impact on alcohol treatment outcome.

Adolescent↗
PubMed2005

Adolescent alcohol use disorders predict adult borderline personality.

BACKGROUND: This study investigated adolescent alcohol use disorders (AUDs) and other characteristics as predictors of adult borderline personality disorder (BPD) symptoms. METHODS: Adolescents with AUDs (n = 355) were recruited from clinical treatment sources and adolescents without AUDs (n = 169) were recruited from the community. During an adolescent assessment (age 16+/-1.3), childhood physical and/or sexual abuse history, AUDs and associated psychiatric disorders were measured via semi-structured interviews. Symptoms of BPD were measured in a young adult follow-up assessment (age 22+/-2.4). Latent class analysis was utilized to classify individuals into four categories based upon BPD symptom profiles. RESULTS: Multinomial regression models indicated that adolescent AUDs and other psychiatric disorders mediated the relationship between child physical and/or sexual abuse and adult BPD latent class. CONCLUSIONS: Results were consistent with a developmental conceptualization of BPD, with AUDs and other adolescent psychopathology antecedents representing developmentally relevant forms of dysregulation, and in their more severe forms culminating in borderline symptomatology.

Adolescent↗
PubMed2005

Joint trajectory analysis of treated adolescents' alcohol use and symptoms over 1 year.

OBJECTIVE: This study characterized treated adolescents' alcohol use and symptom trajectories over 1 year to describe the form of use trajectories and symptom trajectories, and the joint probability of membership in alcohol use and symptom trajectory groups. METHOD: 109 teens (age 14-18, 66% male, 94% white), recruited from addictions treatment, with a lifetime DSM-IV alcohol diagnosis, reported on daily alcohol use and symptoms in monthly phone contacts using the Time Line Follow-Back method. A group-based modeling method jointly estimated trajectories of use and symptoms. RESULTS: Four alcohol use trajectories were identified: "Abstinent" (31%), Low (36%), Increasing (28%), and High Use (5%). Three alcohol symptom trajectories were identified: Very Low severity (44%), Mild (44%), and High severity (12%). The most frequent joint outcome was "Abstinent" and Very Low symptom severity (32%). CONCLUSIONS: Symptom severity was moderately related to alcohol use pattern over 1 year. Findings have implications for moving beyond relapse defined as a return to "any use" to consideration of treatment outcome in terms of a broader pattern of alcohol use and problems.

Adolescent↗
PubMed2005

Reductions in and relations between "craving" and drinking in a prospective, open-label trial of ondansetron in adolescents with alcohol dependence.

Recently, we reported that ondansetron (a 5-HT3 antagonist) as an adjunct to cognitive behavioral therapy (CBT) produced significant within-group decreases (improvement) in drinking in adolescents with alcohol dependence. We previously have hypothesized that the mechanism of ondansetron treatment response in adolescents with alcohol dependence should be similar to early onset adult alcoholics, wherein blockade of serotonin-3 receptors may decrease dopamine release and subsequent alcohol consumption and craving. We now suggest that one mechanism by which ondansetron diminishes drinking in adolescents with alcohol dependence is through a reduction in "craving" as measured by the Adolescent Obsessive-Compulsive Drinking Scale (A-OCDS). We conducted an 8-week, prospective, open-label study of ondansetron (4 microg/kg b.i.d.) in 12 adolescents (age 14-20 years) who had alcohol dependence. Results showed that "irresistibility" and total scores as measured by the A-OCDS were correlated significantly with drinking indices (drinks/day, percent days abstinent) at the end of treatment, and that "irresistibility" and total A-OCDS scores decreased significantly by the end of treatment. These preliminary results suggest that the A-OCDS can be useful as an outcome measure in clinical studies of adolescents with alcohol dependence.

Adolescent↗
PubMed2005

Multidimensional assessment of nicotine dependence in adolescents.

Despite the critical importance of adolescent smoking, the assessment of nicotine dependence during this developmental period has been the subject of relatively little research. In this study, 301 adolescents (ages 12 through 18 years) reporting daily smoking were recruited for a project on alcohol use disorders (AUDs). The sample included 140 females and 161 males, 251 subjects from clinical and 50 from community sources, and 176 subjects with AUDs at the baseline assessment. Subjects were evaluated with the Nicotine Dependence Syndrome Scale (NDSS), the Fagerstrom Test for Nicotine Dependence (FTND) and a determination of average number of cigarettes per day (cigarettes/day). A varimax factor analysis of 27 NDSS items revealed four factors: (1) Drive/Tolerance (13 items; Cronbach alpha = 0.91); (2) Continuity (five items; Cronbach alpha = 0.67); (3) Priority (three items; Cronbach alpha = 0.64); (4) Stereotypy (five items; Cronbach alpha = 0.66). The NDSS total score, refined by the removal of four items, was also examined (23 items; Cronbach alpha = 0.90). Predicting cigarettes/day at follow-up, initial smoking rate was the best predictor, with the FTND and NDSS Total score showing significant and similar predictive validity. The NDSS Total showed incremental validity in the prediction of smoking progression in a model including demographic characteristics, initial smoking rate and FTND. The findings suggest that the NDSS has acceptable psychometric properties when applied to adolescents, complementing smoking rate and FTND in a multidimensional smoking assessment.

Adolescent↗
PubMed2005

Childhood risk categories for adolescent substance involvement: a general liability typology.

Childhood risks for adolescent substance involvement include parental substance use disorders (SUDs), psychological dysregulation and early tobacco and alcohol experimentation. This study was designed to identify childhood risk categories predicting accelerated adolescent substance involvement across drug types and stages. The index subjects were 560 children recruited from high risk (n = 266) or low risk (n = 294) families based on fathers' SUDs. Assessments were conducted at approximately ages 11 (baseline), 13, 16, and 19 years. Childhood predictors included parent SUDs, early tobacco or alcohol use (i.e., substance use), and neurobehavior disinhibition (ND) as determined by indicators of cognitive, affective and behavioral disinhibition. A cluster analysis defined five risk categories based on baseline characteristics as follows: (1) High (n = 31; 100% had both parents with SUDs, 100% had early substance use, and the mean ND score = 58.9); (2) Intermediate-High (n = 76; 45% had one parent with SUD, 100% early substance use and ND = 51.9); (3) Intermediate (n = 76; 100% both parents with SUDs, 0% early substance use and ND = 51.4); (4) Intermediate-Low (n = 161; 100% with one SUD parent; 0% early substance use and ND = 49.9) and; (5) Low (n = 216; no parental SUD, no early substance use and ND = 47.5). Compared with all other groups, children in the High risk group had significantly accelerated substance involvement across all substance types and stages. The ordering of risk categories from low to high was also consistent for all substance involvement outcomes. The findings indicate that these five risk categories constitute general liability classes for adolescent substance involvement, and may identify homogeneous groups of children requiring distinct preventive interventions.

Adolescent↗
PubMed2005

Efficacy of valproate maintenance in patients with bipolar disorder and alcoholism: a double-blind placebo-controlled study.

BACKGROUND: More than half of all individuals with bipolar disorder have a substance abuse problem at some point in their lifetime. Patients with comorbid substance abuse disorders often are excluded from clinical trials. Thus, treatments targeting this high-risk clinical population are lacking. OBJECTIVE: To evaluate the efficacy of divalproex sodium (hereafter referred to as valproate) in decreasing alcohol use and stabilizing mood symptoms in acutely ill patients with bipolar disorder and alcoholism. DESIGN: A 24-week, double-blind, placebo-controlled, randomized parallel-group trial. SETTING: A university hospital serving as a primary catchment-area hospital and tertiary-care facility. PARTICIPANTS: Fifty-nine subjects with diagnoses of bipolar I disorder and alcohol dependence. Intervention All study subjects received treatment as usual, including lithium carbonate and psychosocial interventions, and were randomized to receive valproate or placebo. MAIN OUTCOME MEASURES: Primary alcohol use outcomes included changes in alcohol use as indicated by changes in proportion of heavy drinking days and number of drinks per heavy drinking day. Other alcohol use outcomes included proportion of any drinking days, number of drinks per drinking day, and relapse to sustained heavy drinking. Mood outcomes included changes in depressive and manic symptoms. We used the mixed model to analyze longitudinal data. The first model used time of assessment, bipolar subtype (mixed, manic, or depressed), and treatment group (placebo or valproate) as covariates. The second nested model included the additional covariate of medication adherence. RESULTS: The valproate group had a significantly lower proportion of heavy drinking days (P = .02) and a trend toward fewer drinks per heavy drinking day (P = .055) than the placebo group. When medication adherence was added as covariate, the valproate group had significantly fewer drinks per heavy drinking day (P = .02) and fewer drinks per drinking day (P = .02). Higher valproate serum concentration significantly correlated with improved alcohol use outcomes. Manic and depressive symptoms improved equally in both groups. Level of gamma-glutamyl transpeptidase was significantly higher in the placebo group compared with the valproate group. CONCLUSIONS: Valproate therapy decreases heavy drinking in patients with comorbid bipolar disorder and alcohol dependence. The results of this study indicate the potential clinical utility of the anticonvulsant mood stabilizer, valproate, in bipolar disorder with co-occurring alcohol dependence.

Adolescent↗
PubMed2005

Treatment of co-occurring alcohol, drug, and psychiatric disorders.

Comorbid psychiatric disorders and drug use disorders (DUDs) are common among adolescents with alcohol use disorders (AUDs). These comorbid disorders have a large potential significance on the clinical course of the AUDs among adolescents, and can predict a shorter time to relapse of alcohol use. The use of medication for treatment of the various comorbid adolescent populations has increased dramatically in recent years, despite the lack of double-blind, placebo-controlled studies that demonstrate their safety and efficacy. Consequently, to date, no empirically proven treatment exists for most of these comorbid disorders. This chapter reviews the state of the art regarding the treatment of comorbid adolescents. This chapter also identifies gaps in knowledge regarding the treatment of comorbid adolescents, and outlines directions for future research in this field.

Adolescent↗
PubMed2005

Fluoxetine in adolescents with comorbid major depression and an alcohol use disorder: a 3-year follow-up study.

The goal of this 3-year follow-up evaluation was to determine whether the decreases in drinking and in depressive symptoms that were noted during our acute phase study with fluoxetine in comorbid adolescents persisted at a 3-year follow-up evaluation. At the 3-year follow-up evaluation, the group continued to demonstrate significantly fewer DSM criteria for an AUD and fewer BDI depressive symptoms and also consumed fewer standard drinks than they had demonstrated at the baseline of the acute phase study. However, 7 of the 10 participants demonstrated MDD at the 3-year follow-up assessment, and 4 demonstrated an AUD. The presence of a MDD was significantly correlated with the presence of an AUD at both the 1-year and the 3-year follow-up assessments. Four of the participants restarted SSRI medications during the follow-up period. Half of the subjects graduated from college during the 3-year assessment period, despite their residual depressive symptoms and drinking. We conclude that the long-term therapeutic effects of an acute phase trial of fluoxetine plus psychotherapy slowly decrease but did not disappear when fluoxetine is discontinued shortly after the acute phase trial. The high rate of MDD at follow-up suggests that longer term antidepressant medication treatment may be needed for at least some comorbid adolescents.

Adolescent↗
PubMed2005

General-medical conditions in older patients with serious mental illness.

OBJECTIVE: The burden of medical comorbidities was compared between older (> or =60 years) and younger patients with serious mental illness. METHODS: Patients (N=8,083) diagnosed with schizophrenia, schizoaffective disorder, or bipolar disorder in 2001 were identified from VA facilities in the mid-Atlantic region. Medical comorbidities were identified by an ICD-9-based clinical classification algorithm. RESULTS: Older, versus younger, patients were more likely to be diagnosed with cardiovascular or pulmonary conditions, and less likely to be diagnosed with substance-use disorders or hepatic conditions. CONCLUSIONS: More aggressive detection and management of general-medical comorbidities in older patients with serious mental illness is paramount.

Bipolar Disorder↗