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Biomedical subjects

Javaid I Sheikh

Publications and source records attributed to Javaid I Sheikh.

At least 19 recordsLinked to original sources
PubMed2006

Hippocampal volume, PTSD, and alcoholism in combat veterans.

Studies imposing rigorous control over lifetime alcohol intake have usually not found smaller hippocampal volumes in persons with posttraumatic stress disorder. Because the majority of negative studies have used adolescent samples, it has been suggested that chronicity is a necessary condition for such findings. To test the hypothesis that a smaller hippocampus in PTSD is unrelated to comorbid alcoholism or to chronicity, this study estimated hippocampal volume in a relatively large group (N=99) of combat veterans in which PTSD, lifetime alcohol abuse/dependence, and Vietnam versus Gulf War service were crossed. In subjects with histories of alcoholism, unadjusted hippocampal volume was 9% smaller in persons with PTSD than in those without PTSD. In nonalcoholic subjects, the PTSD-related difference in hippocampal volume was 3%. The failure to observe a strong association between PTSD and hippocampal volume in nonalcoholic subjects was not ascribable to younger age, reduced PTSD chronicity, or lower PTSD symptom severity. The possibility that smaller hippocampal volume is limited to groups in which PTSD is compounded by comorbid alcoholism is not necessarily incompatible with results suggesting a smaller hippocampus is predispositional to PTSD. Further examination of the role of alcoholism and other comorbid conditions in studies of brain structure and function in PTSD appears warranted.

Adult↗
PubMed2005

Underreporting of behavioral problems in older hospitalized patients.

This descriptive study examined reports of behavioral problems among older patients hospitalized in acute care medical settings. Greater numbers of behavioral problems were reported by nursing staff on the Neuropsychiatric Inventory-Questionnaire than were documented in medical charts over the same time period. Such underreporting may have clinical and administrative implications.

Aged↗
PubMed2005

Tolerability and effectiveness of lamotrigine in complex elderly patients.

There is paucity of medical literature on the use of lamotrigine in elderly patients who have behavior problems and diverse psychiatric syndromes. This article is a retrospective case series summarizing the authors' experience with this medication. In a 20-patient case series from an institutional review board-approved retrospective chart review, the tolerability and efficacy of lamotrigine was evaluated for the management of agitated and aggressive behaviors in nursing home patients with a range of psychiatric and medical diagnoses. Nineteen of the elderly nursing home patients tolerated lamotrigine treatment, and 18 showed modest clinical improvement. These results support the authors' belief that controlled clinical investigations of this medication should be performed.

Aged↗
PubMed2005

Mixed anxiety and depression in older adults: clinical characteristics and management.

The frequent comorbidity of anxiety and depression, particularly among elderly, is widely recognized by clinicians, but the debate continues as to whether the combined diagnostic designation is merited. This article reviews the debate over the mixed diagnosis, discusses treatment implications, and reviews a small treatment study undertaken with elderly patients. Ten community-dwelling, older adults diagnosed with generalized anxiety disorder and subsyndromal depression (n = 6) or generalized anxiety disorder and major depressive disorder (n = 4) were started on a 12-week, open-label trial of nefazodone. Clinicians' ratings on the Clinical Global Impression of Change and patients' self-ratings of symptoms on the Beck Depression Inventory and the Beck Anxiety Inventory identified statistically significant gains in patients' overall pre/post functioning. Nefazodone was efficacious in symptom alleviation in patients with comorbid anxiety and depression. Further double-blind, randomized investigations with newer antidepressant medications are required to extend these preliminary findings with nefazodone.

Aged↗
PubMed2005

Interaction of sleep disturbances and anxiety in later life: perspectives and recommendations for future research.

Both sleep disturbances and anxiety are quite common in older adults. Although increasing research efforts have investigated sleep disturbances and anxiety in older adults, little has been written concerning the relation between sleep disturbances and anxiety in this population. This article reviews the epidemiological and clinical literature concerning the overall prevalence of sleep disturbances and relations between sleep and anxiety in later life. The article begins with a discussion of the prevalence of sleep and anxiety problems in older individuals, continues with a clinical review of the complex interrelationship between sleep and anxiety in older adults, and briefly considers possible neurobiological underpinnings of this interrelationship. This is followed by a brief discussion of the impact of medical illness on both anxiety and sleep disturbances. The article ends with a summary of findings from this review and provides recommendations for future research.

Aged↗
PubMed2005

Assessment of trauma exposure and post-traumatic stress in long-term care veterans: preliminary data on psychometrics and post-traumatic stress disorder prevalence.

This article reports preliminary data on trauma and post-traumatic stress disorder (PTSD) prevalence, as well as test psychometrics, among 35 cognitively intact veterans residing in long-term care settings. Participants received a traumatic event screening, the Mini-Mental Status Examination, Combat Exposure Scale (CES), PTSD Checklist (PCL), and Mississippi Combat PTSD Scale (M-PTSD). Results demonstrated adequate reliability for the CES, PCL, and M-PTSD for use in these settings, with several significant intercorrelations. A high prevalence of trauma exposure was found, in particular combat. Based on the PCL and M-PTSD, although most veterans did not meet full PTSD diagnostic criteria, a moderate proportion met partial criteria. The need for assessment and treatment of trauma exposure and PTSD in Veterans Affairs long-term care settings is emphasized.

Aged↗
PubMed2004

VA practice patterns and practice guidelines for treating posttraumatic stress disorder.

Little is known about how recent ISTSS practice guidelines (E. B. Foa, T. M. Keane, & M. J. Friedman, 2000) compare with prevailing PTSD treatment practices for veterans. Prior to guideline dissemination, clinicians in 6 VA medical centers were surveyed in 1999 (n = 321) and in 2001 (n = 271) regarding their use of various assessment and treatment procedures. Practices most consistent with guideline recommendations included psychoeducation, coping skills training, attention to trust issues, depression and substance use screening, and prescribing of SSRIs, anticonvulsants, and trazodone. PTSD and trauma assessment, anger management, and sleep hygiene practices were provided less consistently. Exposure therapy was rarely used. Additional research is needed on training, clinical resources, and organizational factors that may influence VA implementation of guideline recommendations.

Depression↗
PubMed2004

Posttraumatic stress disorder and current relationship functioning among World War II ex-prisoners of war.

This study examined the association of posttraumatic stress disorder (PTSD) with the quality of intimate relationships among present-day male World War II ex-prisoners of war (POWs). Ex-POWs had considerable marital stability; those with PTSD were no less likely to be in an intimate relationship. Ex-POWs in an intimate relationship who had PTSD (N=125 ) were compared with ex-POWs in a relationship who did not have PTSD (N=206). Marital functioning was within a range expected for persons without traumatic exposure. Yet, over 30% of those with PTSD reported relationship problems compared with only 11% of those without PTSD. Ex-POWs with PTSD reported poorer adjustment and communication with their partners and more difficulties with intimacy. Emotional numbing was significantly associated with relationship difficulties independent of other symptom complexes and severity of PTSD. Implications for clinical practice are discussed.

Aged↗
PubMed2004

Efficacy, safety, and tolerability of sertraline in patients with late-life depression and comorbid medical illness.

OBJECTIVES: To report on the efficacy, safety, and tolerability of sertraline in the treatment of elderly depres-sed patients with and without comorbid medical illness. SETTING: Multicenter. DESIGN: Randomized, double-blind, placebo-controlled study. PARTICIPANTS: A total of 752 patients aged 60 and older with diagnosis of major depressive disorder according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, diagnosis. MEASUREMENTS: Outcome measures included the 17-item Hamilton Depression Scale (HAMD); the Clinical Global Depression-Severity/Improvement (CGI-S/CGI-I); efficacy and safety/adverse event assessments; Quality of Life, Enjoyment, and Satisfaction Questionnaire; and the Medical Outcomes Study 36-Item Short-Form Health Status Survey. RESULTS: In the overall sample, sertraline was superior to placebo on all three primary outcome measures, HAMD, and overall clinical severity and change (CGI-S/CGI-I). Furthermore, therapeutic response to sertraline was comparable in those with or without medical comorbidity, and there were no treatment-by-comorbidity group interactions. Sertraline was also associated with a faster time to response than placebo in the comorbid group (P<.006). Sertraline-treated patients in the comorbid group had similar adverse events and discontinuations when compared to those in the noncomorbid group. CONCLUSION: Sertraline was efficacious in reducing depressive symptomatology, regardless of the presence of comorbid medical illness. Sertraline was safe and well tolerated by patients with or without medical illness.

Aged↗
PubMed2003

Sleep in post-traumatic stress disorder and panic: convergence and divergence.

Disturbed sleep is a common clinical problem in anxiety disorders, particularly in patients with post-traumatic stress disorder (PTSD) and panic disorder (PD). Several studies have attempted to validate the subjective sleep complaints of these disorders using laboratory polysomnography. These attempts, typically focusing on PTSD or PD independently, have demonstrated inconsistent results. To our knowledge, no such studies have attempted to directly compare and contrast sleep disturbances in PTSD and PD together. Our review of the studies of subjective sleep disturbances, sleep architecture, and sleep-related biologic phenomena suggests that a comparative characterization of sleep disturbances in these two disorders is timely. Such an inference is based on our identification of several areas of convergence and divergence between PTSD and PD found in the published literature, as well as our own preliminary investigations. Specifically, PTSD and PD seem to converge on several sleep-related parameters, namely, sleep quality, presence of episodic parasomnias, and movement time. They also appear to diverge in other important sleep-related areas such as respiratory disturbances and the particular phenomenological nature of episodic parasomnias, namely nightmares or nocturnal panic attacks. Investigations focusing on such overlapping phenomena may provide groundwork for further elucidation of central fear systems underlying these two disorders. Additionally, such sleep studies have the potential to provide important insights into ongoing efforts to develop a cohesive conceptual framework into the patho-physiologies of these disorders.

Animals↗
PubMed2003

Sleep respiratory concomitants of comorbid panic and nightmare complaint in post-traumatic stress disorder.

Posttraumatic stress disorder (PTSD) patients with comorbid panic disorder (PD) may express additive symptoms of central fear system disturbance. They endorse elevated levels of sleep and nightmare disturbance [Leskin GA, et al., J Psychiatr Res 2002;36:449-452], and demonstrate movement suppression during laboratory sleep [Woodward SH, et al., Sleep 2002;25:681-688]. We estimated respiratory rate and rate variability separately for rapid-eye movement (REM) and non-rapid-eye movement (NREM) sleep. Subjects were 49 Vietnam combat-related PTSD inpatients (11 with comorbid PD and 38 without) and 15 controls. Computer-based estimates of respiratory rate and variability were derived from 10 to 18 hr of baseline sleep collected over two or three nights. Neither rate nor rate variability distinguished PTSD patients with comorbid PD from those without, or PTSD patients from controls; however, PTSD patients failed to exhibit the expected differences between REM and NREM respiratory rates. Moreover, the difference between REM and NREM respiratory rate was inversely related to a continuous measure of PTSD severity. PTSD patients with trauma-related nightmare complaint exhibited higher sleep respiration rates over both REM and NREM sleep. Conversely, in addition to slowed respiration, nightmare-free patients exhibited reduced respiratory rate variability in REM relative to NREM sleep, which was a reversal of the normal pattern. These finding are discussed in light of known telencephalic regulatory influences upon respiration rate.

Adult↗
PubMed2003

Anxiety disorders in older adults.

Recent epidemiologic surveys indicate that anxiety disorders in older adults are more common than previously believed. Despite this, knowledge regarding the clinical characteristics of anxiety disorders in elderly patients is emerging slowly. In addition, detection of anxiety symptoms in elders is complicated by several factors, including a confounding of symptom picture by high medical comorbidity, frequent use of multiple prescribed and over-the-counter medications, difficulty of differentiating anxiety from depression, and a tendency of some older adults to resist psychiatric evaluation. Nonetheless, a comprehensive evaluation that includes a clinical interview, self-report measures, and laboratory results, can improve detection and accurate assessment of anxiety in elderly patients. Empirically validated knowledge regarding appropriate pharmacologic interventions in elderly patients is still sparse, and inferences from data in young and middle-aged populations typically form the basis of clinical practice in elderly patients. SSRIs and SNRIs are considered first-line interventions because of their efficacy and relative tolerability in elderly patients. Psychotherapy, particularly cognitive-behavioral therapy, also has been found to be efficacious for older adults with anxiety disorders. Collaborative care models that address physician, patient, and healthcare service delivery barriers, also hold promise for adequately treating anxiety disorders experienced by older adults.

Aged↗
PubMed2003

Age differences in symptoms of depression and anxiety: examining behavioral medicine outpatients.

This study examined whether symptoms of depression and concomitant anxiety differed between older and younger medical outpatients referred to a behavioral medicine clinic. In a sample of 178 male veterans aged 21-83 years, older adults (> or = 60 years) reported lower overall depressive symptoms on the Beck Depression Inventory (BDI) and anxiety symptoms on the State-Trait Anxiety Inventory than did younger adults ( < 60 years). Depressive symptoms were highly prevalent. Among older adults, 60.0% scored 10 or higher on BDI and 33.8% scored 16 or higher. Among younger adults, 70.8% scored 10 or higher on BDI, and 48.7% scored 16 or higher. The age difference in overall depressive symptoms was driven by cognitive-affective symptoms. While older adults had lower cognitive-affective symptoms than did younger adults, the two groups did not differ on somatic-performance symptoms. these results suggest the importance of assessing cognitive-affective depressive symptoms in both older and younger male medical outpatients.

Adult↗
PubMed2002

Cognitive status and behavioral problems in older hospitalized patients.

OBJECTIVES: (a) To determine the quantity and quality of behavioral problems in older hospitalized patients on acute care units; (b) to determine the burden of these behaviors on staff; and (c) to identify predictors of behavioral problems. METHODS: Upon admission, patients performed the Mini-Mental State Exam (MMSE), the Geriatric Depression Scale (GDS), and information was obtained on age, ethnicity, level of education, living arrangement, and psychiatric history. Two days post-admission, a clinical staff member caring for each patient, performed the Neuropsychiatric Inventory-Questionnaire (NPI-Q) to assess patients' behavioral problems and staff distress. PARTICIPANTS AND SETTING : Forty-two patients, over 60 years of age, admitted to medical and surgical units of the Veterans Affairs Hospitals in Palo Alto and San Francisco, participated. RESULTS: Twenty-three of 42 (55%) patients exhibited behavioral problems. Anxiety, depression, irritability, and agitation/aggression were the most frequently observed behaviors. The severity of the behavioral problems was significantly correlated with staff distress. Lower performance on the MMSE at admission was significantly associated with higher NPI-Q ratings. Specifically, of those cases with scores less than or equal to 27 on the MMSE, 66% had behavioral problems during hospitalization, compared to only 31% of those with scores greater than 27. CONCLUSION: Behavioral problems in older hospitalized patients appear to occur frequently, are a significant source of distress to staff, and can result in the need for psychiatric consultation. Assessment of the mental status of older adults at admission to hospital may be valuable in identifying individuals at increased risk for behavioral problems during hospitalization.

Journal Article↗
PubMed2002

Movement during sleep: associations with posttraumatic stress disorder, nightmares, and comorbid panic disorder.

STUDY OBJECTIVES: To corroborate findings from the National Comorbidy study with objective sleep data. DESIGN: Retrospective data review. SETTING: Sleep Laboratory, National Center for Posttraumatic Stress Disorder PARTICIPANTS: Male Vietnam combat veteran. INTERVENTIONS: N/A. MEASUREMENTS AND RESULTS: We reanalyzed laboratory sleep data obtained from subjects undergoing inpatient treatment for posttraumatic stress disorder. Comorbid panic disorder was not associated with a significant worsening of objective sleep in this sample. Posttraumatic stress disorder, comorbid panic disorder, and trauma-related nightmare complaint were all associated with significant and systematic reductions of sleep movement time. Analyses of potential "rescoring" artifacts provided further support for this effect. CONCLUSIONS: A curvilinear function may describe the relationship between anxiety symptom severity and sleep-movement time in both posttraumatic stress disorder and panic disorder. Evidence for movement suppression in association with pathologic levels of human anxiety is consistent with the suppression of movement ("freezing") exhibited by animals under conditions of perceived threat.

Adult↗
PubMed2002

Lifetime trauma history and panic disorder: findings from the National Comorbidity Survey.

OBJECTIVE: The purpose of this article is to examine prevalence of lifetime traumatic experiences in a community sample of panic disorder patients. METHOD: We examined trauma rates in a cohort of panic disorder patients. Also, we statistically disaggregated comorbid PTSD from individuals diagnosed with panic disorder in the National Comorbidity Survey. FINDINGS: Panic disorder patients suffer lifetime traumatic experiences at high rates. We found that 24.2% of females and 5% of males with panic disorder reported previous history of being sexually molested. CONCLUSIONS: These results suggest that trauma may act as a risk factor for panic disorder, as well as comorbid panic disorder and PTSD.

Adolescent↗