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Biomedical subjects

P Rohde

Publications and source records attributed to P Rohde.

At least 19 recordsLinked to original sources
PubMed2004

Severe exacerbation of chronic hepatitis B after emergence of lamivudine resistance in a cirrhotic patient: immediate switch to adefovir dipivoxil appears to be indicated.

INTRODUCTION: Lamivudine is a treatment option for the therapy of chronic hepatitis B with an excellent safety profile. Unfortunately, viral resistance to lamivudine is common in the course of therapy. The lamivudine resistant mutants are usually less pathogenic than the wild type, but development of viral resistance can also lead to acute exacerbation of the underlying hepatitis. The recently FDA approved nucleoside analogue adefovir dipivoxil has potent antiviral activity against lamivudine-resistant mutants and can prevent viral replication effectively. CASE REPORT: A 31-year-old man with pre-existing compensated liver cirrhosis developed resistance to lamivudine therapy leading to subacute liver failure. After referral adefovir dipivoxil 10 mg daily was initiated within an early access protocol. Since initiating therapy with adefovir dipivoxil progression of the subacute liver failure was delayed accompanied by a rapid decrease of ALT and decline of HBV viral load. Even so, the clinical course was not reverted but showed slower deterioration. This enabled the patient to undergo living-related liver transplantation. Adefovir dipivoxil was well tolerated in the acute phase of the disease and did not cause nephrotoxicity or favour the development of hepatorenal syndrome. CONCLUSION: Adefovir dipivoxil resulted in a delay of hepatic decompensation and enabled liver transplantation as final treatment option for this patient. Earlier initiation might even have prevented the need of liver transplantation. Thus, in patients with pre-existing liver cirrhosis an early switch to adefovir dipivoxil appears indicated after emergence of lamivudine resistance.

Adenine↗
PubMed2003

Family study of co-morbidity between major depressive disorder and anxiety disorders.

BACKGROUND: Numerous studies have documented high rates of co-morbidity between major depressive disorder (MDD) and the anxiety disorders (ANX). However, the reason for this is unclear. Family studies provide one potentially useful approach for addressing this issue. METHOD: We explored six explanations of the co-morbidity between MDD and ANX using a family study of a large community sample of young adults and their first-degree relatives. Participants included 112 probands with a lifetime history of both MDD and one or more ANX, 290 probands with a history of MDD but no ANX, 43 probands with a history of one or more ANX but no MDD. 352 probands with no lifetime history of either MDD or ANX, and the probands' 2608 first-degree relatives. Probands were assessed using semi-structured diagnostic interviews on two occasions in adolescence and a third time at age 24. Diagnostic data on relatives were collected using both direct and family history interviews. RESULTS: Compared with controls, MDD aggregated in the families of probands with MDD, whether or not they had co-morbid ANX; ANX aggregated in the families of probands with ANX, regardless of whether they had co-morbid MDD; and co-morbid MDD/ANX aggregated only in the families of probands with both MDD and ANX. The relatives of probands with ANX alone had a significantly higher rate of ANX than the relatives of probands with MDD alone, although none of the other comparisons between the depressed and anxious groups were significant. CONCLUSIONS: This pattern of findings is largely, although not completely, consistent with the view that MDD and ANX are transmitted independently within families, and suggests that the comorbidity between MDD and ANX is caused by non-familial aetiological factors.

Adolescent↗
PubMed2001

A family study of major depressive disorder in a community sample of adolescents.

BACKGROUND: Family studies provide a useful approach to exploring the continuities and discontinuities between major depressive disorder (MDD) in children and adolescents and MDD in adults. We report a family study of MDD in a large community sample of adolescents. METHODS: Probands included 268 adolescents with a history of MDD, 110 adolescents with a history of nonmood disorders but no history of MDD through age 18 years, and 291 adolescents with no history of psychopathology through age 18 years. Psychopathology in their 2202 first-degree relatives was assessed with semistructured direct and family history interviews, and best-estimate diagnoses were derived with the use of all available data. RESULTS: The relatives of adolescents with MDD exhibited significantly elevated rates of MDD (hazard ratio [HR], 1.77; 95% confidence interval [CI], 1.46-2.31), dysthymia (HR, 1.79; 95% CI, 1. 11-2.87), and alcohol abuse or dependence (HR, 1.29; 95% CI, 1.05-1. 53), but not anxiety disorders, drug abuse or dependence, or antisocial and borderline personality disorder. In contrast, anxiety, substance use, and disruptive behavior disorders in adolescents were not associated with elevated rates of MDD in relatives. However, the relatives of probands with anxiety and substance use disorders exhibited elevated rates of anxiety and substance use disorders, respectively. CONCLUSIONS: The results provide evidence of the familial aggregation of adolescent MDD, and also indicate that there is a considerable specificity in the pattern of familial transmission. In addition, we found preliminary evidence of the familial aggregation of adolescent anxiety and substance use disorders.

Adolescent↗
PubMed2001

Depression, suicidal ideation and STD-related risk in homeless older adolescents.

Goals of this study were to examine the frequency of depression and related constructs of suicidal ideation and hopelessness in a sample of homeless older adolescents and their associations with behaviors that may increase the risk of sexually transmitted disease (STD). Diagnostic interviews and blood/urine samples were obtained from 523 homeless adolescents (mean age=17.8). Overall, 12.2 per cent had a current DSM-IV diagnosis of major depression and 6.5 per cent had dysthymia, with higher rates for female and older participants. Depression appeared to precede rather than follow homelessness and was associated with biologically verified STDs (in older participants), infrequent condom use, a non-heterosexual orientation (in older participants), and lifetime homosexual experience. Unlike depression, suicidal ideation and hopelessness were associated with higher rates of intravenous drug use but lower rates of multiple sex partners and, in young homeless women, less sexual coercion. Depression is frequent in homeless older adolescents and has a complex association with STD-related behaviors.

Adolescent↗
PubMed2001

Childhood sexual abuse, adolescent sexual coercion and sexually transmitted infection acquisition among homeless female adolescents.

OBJECTIVE: To examine the relationship between childhood experiences of sexual abuse, sexual coercion during adolescence, and the acquisition of sexually transmitted infections (STIs) in a population of homeless adolescents. METHOD: Homeless adolescent females (N = 216) from a northwestern United States city were recruited by street outreach workers for a longitudinal study of STI epidemiology. Baseline data on childhood abuse and recent history of sexual coercion were used to predict physiologically confirmed STI acquisition over the subsequent 6 months. RESULTS: About 38% of all girls reported a history of childhood sexual abuse (CSA). Girls with a history of CSA were more likely to report recent sexual coercion. In turn, sexual coercion in the last three months was significantly associated with a higher number of sexual partners (but not with a greater frequency of intercourse or with lower rates of condom use). Number of sexual partners significantly predicted the future acquisition of an STI within 6 months. CONCLUSIONS: Interventions to reduce risky sexual behaviors in homeless adolescent females may need to consider the impact of CSA, particularly on the number of sexual partners during adolescence. However, it also should be noted that engagement in intercourse often results from coercion and is not voluntary in this population.

Adolescent↗
PubMed2001

The relevance of hierarchies, territories, defeat for depression in humans: hypotheses and clinical predictions.

BACKGROUND: Hierarchical and territorial behaviour are widespread in animals and humans. The consequences of defeat have been linked to depression in humans. However, hierarchical and territorial behaviours are not mentioned in ICD10 or DSM1V. I therefore investigated the coverage in relevant textbooks. METHOD: I searched the indices of books on Animal Behaviour, General Psychology and General Psychiatry for entries on Hierarchy, Territory and Dominance. RESULTS: A paradox is revealed. Hierarchical and territorial behaviour are widespread in both animals and humans but are neglected in textbooks of human behaviour and mental problems. Four hypotheses are put forward to explain this paradox and explore its implications. 1. That hierarchical and territorial behaviours evolved before human consciousness. They are available to consciousness but not in the forefront of awareness. 2. That human hierarchical and territorial behaviour are overlaid by a cultural veneer of manners, which conceal the true state of affairs. 3. That humans have internal, mental, hierarchical aims in addition to external physical hierarchical aims. 4. That failure to achieve internal hierarchical aims may produce diminution of well being and changes in behaviour by the same biological mechanisms that are active in external hierarchical defeat. Three testable predictions follow from these hypotheses. 1. That there are common genetic factors and similar patterns of brain activity in homologous structures during hierarchical and territorial behaviour in man, primates and lower vertebrates. 2. That brain structures involved in external hierarchical conflict, consciousness and imagery will be active during internal hierarchical conflict. 3. Defeat of internal hierarchical aims produce depressed mood and satisfying alternative hierarchical aims are protective. Case examples are given to illustrate the existence of, and the consequences of defeat on, internal hierarchies. LIMITATIONS: These hypotheses and predictions are theoretical and require confirmation or refutation by neuroimaging and prospective studies. CONCLUSIONS: A neglect of human hierarchical behaviour by clinicians is suggested and discussed. The concept of internal hierarchies, if confirmed, may throw light on human striving, the emotions of defeat and the therapy of depression.

Adult↗
PubMed2001

Evaluation of cognitive diathesis-stress models in predicting major depressive disorder in adolescents.

Diathesis-stress predictions regarding the onset of adolescent major depression and nonmood disorders were tested. Adolescents (N = 1,507) were assessed for dysfunctional attitudes and negative attributional style, as well as current depressive symptoms, current depressive and nondepressive diagnoses, and past and family histories of psychopathology. Approximately 1 year later, participants were reassessed on all measures. Analyses supported A. T. Beck's (1976) theory of depression (at the level of a trend) but not the hopelessness theory of depression. Findings were suggestive of a threshold view of vulnerability to depression; for those who experienced negative life events, depressive onset was related to dysfunctional attitudes but only when dysfunctional attitudes exceeded a certain level (low = intermediate < high). For participants who scored either very high or very low on both dysfunctional attitudes and negative attributional style, nonsignificant findings were obtained.

Adolescent↗
PubMed2001

Natural course of alcohol use disorders from adolescence to young adulthood.

OBJECTIVES: To examine the course of alcohol use disorder (AUD) and determine the extent to which AUD in adolescence is a risk factor for AUD and other psychopathology in young adulthood. METHOD: Nine hundred forty participants from a large community sample in western Oregon were interviewed twice during adolescence (14-18 years of age the first assessment; between 1987 and 1991) and once at age 24 (1993-1999). Between 1995 and 1998, parents were assessed for lifetime AUD. Participants were classified into nonproblematic use (NON), problem drinker (PROB) (symptoms of AUD but no diagnosis), and AUD groups. RESULTS: Adolescent AUD significantly predicted AUD, substance use disorder, depression, and elevated levels of antisocial and borderline personality disorder symptoms by age 24. Compared with the NON group, adolescents in the PROB group were at increased risk for AUD, substance use disorder, depression, and antisocial personality disorder symptoms. However, the PROB group had lower rates of future AUD and antisocial personality disorder symptoms than the adolescent AUD group. Gender interactions were nonsignificant. Daily smoking and conduct/oppositional defiant disorders predicted future AUD, when adolescent AUD and other disorders were controlled. Paternal, but not maternal, AUD was associated with greater risk of future AUD. CONCLUSIONS: For the majority of adolescents, AUD are not benign conditions that resolve over time. Assessment, treatment, and prevention recommendations are discussed.

Adolescent↗
PubMed2001

Gender differences in suicide attempts from adolescence to young adulthood.

OBJECTIVE: To examine associations of age, gender, and psychosocial factors during adolescence with risk of suicide attempt between ages 19 and 23 years. METHOD: Initial assessments were conducted with 1,709 adolescents (aged 14-18) in western Oregon between 1987 and 1989. One year later, 1,507 participants returned for a second assessment. A subset of participants (n = 941; 57.2% women) had a third diagnostic assessment after turning 24 (between 1993 and 1999). Information on suicidal behavior, psychosocial risk factors, and lifetime DSM-III-R psychiatric diagnosis was collected at each assessment. RESULTS: The suicide attempt hazard rate for female adolescents was significantly higher than for male adolescents (Wilcoxon chi 2(1)[n = 941] = 12.69, p < .001). By age 19, the attempt hazard rate for female adolescents dropped to a level comparable with that of male adolescents. Disappearance of the gender difference for suicide attempts by young adulthood was not paralleled by a decrease in the gender difference for major depression. Adolescent suicidal behavior predicted suicide attempt during young adulthood for female, but not male, participants. Adolescent psychosocial risk factors for suicide attempt during young adulthood were identified separately for girls and boys. CONCLUSIONS: Unlike depression, the elevated incidence rate of suicide attempts by adolescent girls is not maintained into young adulthood. Screening and prevention implications are discussed.

Adolescent↗
PubMed2001

Impact of comorbidity on a cognitive-behavioral group treatment for adolescent depression.

OBJECTIVE: Examine hypotheses concerning the negative impact of lifetime psychiatric comorbidity on participation in, and benefit from, a cognitive-behavioral group treatment for depression in adolescents (e.g., greater severity at intake, less recovery and more recurrence, less participation in treatment). METHOD: Across two previous studies conducted between 1986 and 1993, 151 depressed adolescents (aged 14-18) were randomly assigned to one of three treatment conditions (two active treatments and a waitlist control) and followed for 24 months posttreatment. Forty percent of participants had one or more lifetime comorbid diagnoses at intake. RESULTS: Comorbid anxiety disorders were associated with higher depression measure scores at intake and greater decrease in depression scores by posttreatment. Overall lifetime comorbidity was unrelated to diagnostic recovery, but lifetime substance abuse/dependence was associated with slower time to recovery. Participants with attention-deficit and disruptive behavior disorders were more likely to experience depression recurrence posttreatment. Associations between comorbidity and participation or therapy process measures were nonsignificant. CONCLUSIONS: Although some outcomes were worse for some comorbid diagnoses, the reassuring overall conclusion is that the presence of psychiatric comorbidity is generally not a contraindication for the use of structured group cognitive-behavioral interventions for depressed adolescents.

Adolescent↗
PubMed2001

Incidence and prevalence of chlamydia, herpes, and viral hepatitis in a homeless adolescent population.

BACKGROUND: High rates of unprotected intercourse and illegal drug use have been reported among homeless adolescents. As a transient population with the potential to act as disease vectors from one location to another, incidence and prevalence of sexually transmitted infections in this population are of particular concern. GOAL: To assess a homeless adolescent population for incidence and prevalence of Chlamydia trachomatis, herpes simplex virus type 2, hepatitis B virus, hepatitis C virus, HIV, and psychosocial correlates of the acquisition of sexually transmitted infections. STUDY DESIGN: Longitudinal with assessments at baseline, 3 months, and 6 months (n = 536; 319 males and 217 females). RESULTS: Baseline prevalence of C trachomatis was 4.17% for males and 6.30% for females. Prevalence of herpes simplex virus type 2 was 5.73% for males and 12.50% for females. Hepatitis B virus and hepatitis C virus prevalences were 3.60% and 5.0%, respectively. HIV seroprevalence was 0.3%. The incidence of sexually transmitted infections was significantly higher among females than among males (16.7% versus 9.8%) and was associated with inconsistent condom use and, for females, number of partners and sex with older partners. Incident hepatitis B virus and hepatitis C virus infection rates were 3.44% and 6.61%, respectively; both were associated with injection drug use. CONCLUSIONS: Among females, the incidence of herpes simplex virus type 2 (> 25%) and C trachomatis (12%) was relatively high. Inconsistent condom use was the primary factor associated with a significantly greater risk of incident sexually transmitted infections. This was especially true for females with multiple partners. Homeless adolescents also are at high risk for hepatitis B virus and hepatitis C virus infection, primarily associated with self-reported injection drug use.

Adolescent↗
PubMed2000

The 2nd:4th digit ratio, sexual dimorphism, population differences, and reproductive success. evidence for sexually antagonistic genes?

The ratio between the length of the 2nd and 4th digit (2D:4D) is sexually dimorphic, with mean male 2D:4D lower than mean female 2D:4D. It recently was suggested that 2D:4D is negatively correlated with prenatal testosterone and positively correlated with prenatal estrogen. It is argued that high prenatal testosterone and low estrogen (indicated by low 2D:4D) favors the male fetus and low prenatal testosterone and high estrogen (indicated by high 2D:4D) favors the female fetus. The patterns of expression of 2D:4D are interpreted in terms of sexually antagonistic genes.We report data on the following. (a) reproductive success and 2D:4D from England, Germany, Spain, Hungary (ethnic Hungarians and Gypsy subjects), Poland, and Jamaica (women only). Significant negative associations were found between 2D:4D in men and reproductive success in the English and Spanish samples and significant positive relationships between 2D:4D in women and reproductive success in the English, German, and Hungarian samples. The English sample also showed that married women had higher 2D:4D ratios than unmarried women, suggesting male choice for a correlate of high ratio in women, and that a female 2D:4D ratio greater than male 2D:4D predicted high reproductive success within couples. Comparison of 2D:4D ratios of 62 father:child pairs gave a significant positive relationship. This suggested that genes inherited from the father had some influence on the formation of the 2D:4D ratio. Waist:hip ratio in a sample of English and Jamaican women was negatively related to 2D:4D. (b) Sex and population differences in mean 2D:4D in samples from England, Germany, Spain, Hungary (including ethnic Hungarians and Gypsy subjects), Poland, Jamaica, Finland, and South Africa (a Zulu sample). Significant sex and population differences in mean 2D:4D were apparent.

Journal Article↗
PubMed2000

Inactive free : total prostate specific antigen ratios in ejaculate from men with suspected and known prostate cancer, compared with young control men.

OBJECTIVE: To measure free : total prostate specific antigen (PSA) ratios in ejaculate from men with suspected and known prostate cancer, and in young control men, to determine if this ratio might be useful in discriminating benign from malignant prostatic conditions. Patients, subjects and methods Forty-seven men with prostate cancer (positive biopsies), 52 men with suspected prostate cancer but who had negative biopsies and 28 young men (< 30 years old) and with no family history of cancer, provided either a single ejaculate specimen (total 59) or multiple specimens (total 193) on subsequent occasions. Free and total PSA were measured using appropriate assays. All specimens were diluted in a PSA-negative female serum pool. RESULTS: The median free : total PSA ratios were 0.76-0.81 among the patient groups and control men, and there was no statistical difference between the groups. These data presumably only reflect the inactive component of free PSA, given that any alpha2-macroglobulin or alpha1-antichymotrypsin in the assay serum diluent was likely to have bound the active free PSA component in these samples. Similar results were obtained from those providing single and multiple samples, suggesting that a single specimen is sufficient to reflect the seminal plasma free : total PSA ratio over that period. There was no relationship between seminal plasma free : total PSA ratio and age for the controls or the positive biopsy group, although there was a negative relationship (i.e. a decline with age) that almost reached significance in those with negative biopsies (P = 0.058, R2 = 0.07). CONCLUSIONS: This is the first report of free : total PSA ratios in the ejaculate of men with suspected and known prostate cancer compared with young control men. Although no significant changes were detected in the free : total PSA ratios in ejaculate, these results may be confounded by differences in ratios with age, as is the case for serum PSA or different molecular forms of PSA. Indeed, these data suggest that a large proportion of free PSA in seminal plasma may be inactive. Further studies are needed to determine the potential utility of measuring free : total PSA, or other candidate markers, in ejaculate to better discriminate benign from malignant prostate disease.

Adult↗
PubMed2000

The OADP-CDS: a brief screener for adolescent conduct disorder.

OBJECTIVES: To examine the ability of a very brief (6-item) self-report screener, the Oregon Adolescent Depression Project Conduct Disorder Screener (OADP-CDS), to identify adolescents with a lifetime diagnosis of conduct disorder and to examine its ability to predict antisocial personality disorder by age 24. Relevant scales from the Yough Self-Report and the Child Behavior Checklist were examined for comparison purposes. METHOD: A total of 1,709 high school students completed an initial questionnaire and diagnostic interview assessment (T1); 1,507 participants returned approximately 1 year later for a second assessment (T2). A third (T3) assessment was conducted with selected T2 participants (n = 940) after they had turned 24 years of age. RESULTS: The OADP-CDS had good internal consistency, test-retest stability, and screening properties. Differences in the screening ability of the OADP-CDS as a function of gender and social desirability were nonsignificant. The efficacy of the measure as a screener did not differ significantly from that of longer adolescent- and parent-report measures. Perhaps most importantly, the OADP-CDS was able to identify future cases of antisocial personality disorder in young adulthood. CONCLUSIONS: Results suggest that self-report screening for conduct disorder with older adolescents is possible and should be explored further.

Adolescent↗
PubMed2000

Natural course of adolescent major depressive disorder in a community sample: predictors of recurrence in young adults.

OBJECTIVE: The primary purpose was to identify factors related to the recurrence of major depressive disorder during young adulthood (19-23 years of age) in a community sample of formerly depressed adolescents. METHOD: A total of 274 participants with adolescent-onset major depressive disorder were assessed twice during adolescence and again after their 24th birthday. Lifetime psychiatric information was obtained from their first-degree relatives. Adolescent predictor variables included demographic characteristics, psychosocial variables, characteristics of adolescent major depressive disorder, comorbidity, family history of major depressive disorder and nonmood disorder, and antisocial and borderline personality disorder symptoms. RESULTS: Low levels of excessive emotional reliance, a single episode of major depressive disorder in adolescence, low proportion of family members with recurrent major depressive disorder, low levels of antisocial and borderline personality disorder symptoms, and a positive attributional style (males only) independently predicted which formerly depressed adolescents would remain free of future psychopathology. Female gender, multiple major depressive disorder episodes in adolescence, higher proportion of family members with recurrent major depressive disorder, elevated borderline personality disorder symptoms, and conflict with parents (females only) independently predicted recurrent major depressive disorder. Comorbid anxiety and substance use disorders in adolescence and elevated antisocial personality disorder symptoms independently distinguished adolescents who developed recurrent major depressive disorder comorbid with nonmood disorder from those who developed pure major depressive disorder. CONCLUSIONS: Formerly depressed adolescents with the risk factors identified in this study are at elevated risk for recurrence of major depressive disorder during young adulthood and therefore warrant continued monitoring and preventive or prophylactic treatment.

Adolescent↗
PubMed1999

IQ scores among homeless older adolescents: characteristics of intellectual performance and associations with psychosocial functioning.

Intellectual performance and the associations of IQ with the quality of psychosocial functioning were studied in a sample of homeless older adolescents. Fifty homeless older adolescents (ages 16-21) completed the Wechsler Adult Intelligence Scale-Revised (WAIS-R) and a questionnaire assessing psychosocial functioning and sexual risk factors. The WAIS-R scores were comparable to population means, with performance IQ scores tending to be higher than verbal IQ scores. The IQ was unrelated to the duration of homelessness. Higher IQ scores were significantly correlated with only a minority of the measures of psychosocial functioning, including less self-reported depression and lower reported delinquency, but also less self-control in high-risk sexual situations, less perceived peer support for safer sex, and a higher perceived likelihood of acquiring HIV.

Adolescent↗
PubMed1999

Life events and depression in adolescence: relationship loss as a prospective risk factor for first onset of major depressive disorder.

Although stressful life events have consistently been linked to the onset of major depressive disorder (MDD), most research has not distinguished 1st episodes from recurrences. In a large epidemiologic sample of older adolescents (N = 1,470) assessed at 2 time points, the risk conferred by a recent romantic break-up was examined as a predictor of 1st onset versus recurrence of MDD. Results indicated a heightened likelihood of 1st onset of MDD during adolescence if a recent break-up had been reported; in contrast, a recent break-up did not predict recurrence of depression. These results held for both genders and remained significant after controlling for gender. Additional analyses to determine the discriminant validity and specificity of these findings strongly supported the recent break-up as a significant risk factor for a 1st episode of MDD during adolescence. Implications of these findings and subsequent research directions are discussed.

Adolescent↗