Biomedical subjects

Stephan Arndt

Publications and source records attributed to Stephan Arndt.

At least 37 records · Page 2Linked to original sources

PubMed2004

Major depression following traumatic brain injury.

BACKGROUND: Major depression is a frequent psychiatric complication among patients with traumatic brain injury (TBI). To our knowledge, however, the clinical correlates of major depression have not been extensively studied. OBJECTIVE: To determine the clinical, neuropsychological, and structural neuroimaging correlates of major depression occurring after TBI. DESIGN: Prospective, case-controlled, surveillance study conducted during the first year after the traumatic episode occurred. Settings University hospital level I trauma center and a specialized rehabilitation unit. METHODS: The study group consisted of 91 patients with TBI. In addition, 27 patients with multiple traumas but without evidence of central nervous system injury constituted the control group. The patients' conditions were evaluated at baseline and at 3, 6, and 12 months after the traumatic episode. Psychiatric diagnosis was made using a structured clinical interview and DSM-IV criteria. Neuropsychological testing and quantitative magnetic resonance imaging were performed at the 3-month follow-up visit. RESULTS: Major depressive disorder was observed in 30 (33%) of 91 patients during the first year after sustaining a TBI. Major depressive disorder was significantly more frequent among patients with TBI than among the controls. Patients with TBI who had major depression were more likely to have a personal history of mood and anxiety disorders than patients who did not have major depression. Patients with major depression exhibited comorbid anxiety (76.7%) and aggressive behavior (56.7%). Patients with major depression had significantly greater impairment in executive functions than their nondepressed counterparts. Major depression was also associated with poorer social functioning at the 6-and 12-month follow-up, as well as significantly reduced left prefrontal gray matter volumes, particularly in the ventrolateral and dorsolateral regions. CONCLUSIONS: Major depression is a frequent complication of TBI that hinders a patient's recovery. It is associated with executive dysfunction, negative affect, and prominent anxiety symptoms. The neuropathological changes produced by TBI may lead to deactivation of lateral and dorsal prefrontal cortices and increased activation of ventral limbic and paralimbic structures including the amygdala.

Adult↗

PubMed2004

Association among outcomes in a naturalistic statewide assessment of substance user treatment.

Substance user treatment outcome measurement is important for research and policy questions, yet little literature has addressed the relationships among outcome measures of treatment success. Ideally, treatment outcomes would correlate to at least a moderate degree. The Iowa Department of Public health requires substance user treatment programs receiving public funds to provide client information. Demographic information, "substance abuse" history, current use, arrests, and hospitalizations were ascertained at admission and a 6-month follow-up for 1374 clients (from January 1999 to December 2000). Abstinence, arrests, and hospitalizations were good outcome measures of substance user treatment success. Reduction in frequency of use was negatively associated with arrests, substance use-related hospitalizations, and increased income. Full-time employment at follow-up produced different results depending on the client's sex. However, all associations among outcomes were modest. Specificity may be reasonable in some instances; however, other situations might require a broad-spectrum approach that ideally would produce a wide range of benefits.

Adolescent↗

PubMed2004

Use of the Mini International Neuropsychiatric Interview (MINI) as a screening tool in prisons: results of a preliminary study.

The authors describe a pilot study in which the Mini International Neuropsychiatric Interview (MINI) was used to assess a random sample of offenders newly committed to the Iowa Department of Corrections. Following sessions in which correctional personnel were trained to administer the MINI, the instrument was administered to 67 offenders. The interview took from 20 to 105 minutes (mean, 41 minutes) to administer, and all but 13 (19%) offenders were positive for a lifetime MINI disorder. Twenty-six (39%) subjects had a lifetime mood disorder, 20 (30%) a lifetime anxiety disorder, 12 (18%) a lifetime psychotic disorder, and 53 (79%) a substance use disorder. Seven (10%) subjects met criteria for a lifetime attention deficit hyperactivity disorder, while 13 (19%) had a lifetime antisocial personality disorder. Subjects had a mean of 2.8 disorders. The potential use of the MINI as a screening tool in prison settings is discussed.

Adult↗

PubMed2003

Initial magnetic resonance imaging volumetric brain measurements and outcome in schizophrenia: a prospective longitudinal study with 5-year follow-up.

BACKGROUND: Several demographic and phenomenological variables have been identified as predictors of outcome in schizophrenia. Far fewer studies have examined the relationships between brain morphology assessed at illness onset and subsequent outcome, and their results have been contradictory. METHODS: The relationships between magnetic resonance imaging (MRI) regional brain volumes at illness onset and outcome five years later were studied in 123 schizophrenia patients using regression and correlation analysis. Outcome measures included psychosocial functioning, weeks per year receiving inpatient treatment, and persistence of severe psychotic, disorganized and negative symptoms. RESULTS: Temporal lobe tissue volume at onset was predictive of outcome. Smaller temporal lobe gray matter volume (both left and right) was associated with persistence of hallucinations during follow-up. There were no significant associations between hallucinations and temporal white matter, or between delusions and temporal white or gray matter volumes. None of the other volumetric brain measures were predictive of outcome. CONCLUSIONS: The association between initial temporal lobe gray matter volume and subsequent persistent hallucinations may help identify individuals who are at higher risk for poor outcome and help guide their treatment planning. However, regional brain volumes assessed near illness onset, in general, do not appear to be indicative of subsequent outcome in schizophrenia.

Age of Onset↗

PubMed2003

Progressive structural brain abnormalities and their relationship to clinical outcome: a longitudinal magnetic resonance imaging study early in schizophrenia.

BACKGROUND: Many studies have shown that structural brain abnormalities in schizophrenia are already present by the time of index evaluation of first-episode patients. However, whether these abnormalities progressively worsen during the subsequent course of the disorder remains unresolved. METHODS: To study the longitudinal progression of structural brain abnormalities, high-resolution multispectral magnetic resonance images obtained on 73 recent-onset schizophrenic patients and 23 controls were analyzed using state-of-the-art, well-validated, and highly reliable neuroimaging tools. The mean duration between initial and follow-up MRIs was 3 years. Repeated-measures analysis of covariance was carried out to determine (1) whether brain volume changes differed between patients and controls and (2) the significance of regional brain changes on functional outcome in schizophrenia. RESULTS: We found accelerated enlargement in cortical sulcal cerebrospinal fluid spaces early in the course of schizophrenia. Instead of the usual trajectory of volume enlargement, patients showed progressive reduction in frontal lobe white matter volume. A reciprocal increase in frontal lobe cerebrospinal fluid volume also occurred at a more rapid rate in patients than in controls. In keeping with most of our a priori hypotheses, patients with poor outcome had greater lateral ventricular enlargement over time than patients with good outcome. Progressive decrement in frontal lobe white matter volume and enlargement in frontal lobe cerebrospinal fluid volume were associated with greater negative symptom severity. Reductions in frontal lobe gray and white matter volumes correlated with poorer executive functioning. CONCLUSIONS: There are ongoing changes in the brains of schizophrenic patients during the initial years after diagnosis despite ongoing antipsychotic drug treatment. These progressive changes seem to be most evident in the frontal lobes and to correlate with functional impairment. Disruptions in neurodevelopment or neural plasticity may act alone or in combination to bring about these progressive brain deficits in schizophrenia.

Adult↗

PubMed2003

Neuropsychological functioning pretreatment and posttreatment in an inpatient eating disorders program.

OBJECTIVE: This study was conducted to determine whether neuropsychological dysfunction associated with anorexia nervosa resolves with inpatient treatment. METHOD: Subjects were 28 women being treated for anorexia nervosa. Main study variables included body mass index (BMI), Beck Depression Inventory-II, and neuropsychological test scores. Subjects were tested at admission and discharge. RESULTS: Neuropsychological functioning improved across the course of treatment, with significant changes on tests of memory and psychomotor speed. This improvement was not significantly associated with change in BMI or with the other variables that were studied. DISCUSSION: Patients with anorexia nervosa exhibit subtle neuropsychological dysfunction, which resolves at least partially during treatment. This improvement does not appear to be associated with an increase in BMI. However, it is possible that BMI is not a sufficiently sensitive indicator of nutritional status or that longer-term follow-up is necessary to reveal the nutrition-cognition relationship that we were seeking.

Adult↗

PubMed2003

Brain tissue volume segmentation in patients with anorexia nervosa before and after weight normalization.

OBJECTIVE: To examine whether gray and white matter volumes are preferentially reduced and cerebral spinal fluid (CSF) increased with starvation in patients with anorexia nervosa compared with healthy controls and to determine what changes occur with weight normalization. METHOD: Whole intracranial volumes of patients and controls were segmented into gray matter, white matter, and CSF volumes and results compared. A subgroup of patients were rescanned after weight normalization. RESULTS: Total white matter and several regional white matter volumes were significantly reduced and total and regional CSF volumes were significantly increased in patients versus controls whereas gray matter was not significantly reduced. Total and regional CSF volumes were significantly decreased in patients upon weight normalization whereas white and gray matter volumes increased. DISCUSSION: These changes in brain tissue may be related to a variety of pathophysiologic mechanisms. We hypothesize that insulin-like growth factor-1 may be involved.

Adult↗

PubMed2003

Locations of facilities with special programs for older substance abuse clients in the US.

BACKGROUND: Given the growth of our aging population, developing strategies for managing late-life alcoholism is increasingly important. OBJECTIVE: We compared substance abuse treatment facilities with and without services designed for older adults and explored the location of these services relative to the regional distribution of older adults across the United States. METHODS: A public use dataset from a national survey of facilities offering substance abuse treatment was used to address this issue. This survey included all identified substance abuse/dependence treatment facilities in the US and surveyed the facilities' treatment services, services for special groups, number of clients admitted, type of ownership (e.g. public, private for profit), and whether or not the facility was associated with a hospital, as well as questions about licensure and income sources. RESULTS: Of the 13 749 responding facilities, relatively few programs (17.7%) were specifically designed for older adults (i.e. over age 65). Facilities with such programs tended to be associated with hospitals, particularly those with a psychiatric inpatient service. Importantly, the number of facilities with special programs for older adults did not correlate with size of the older population in each state. CONCLUSION: Despite an increasing need for older adult substance abuse services, there are relatively few programs available designed for this age group. The setting where patients with substance abuse are identified (e.g. in a hospital) may partially explain the pattern of locations of age-specific programs.

Aged↗

PubMed2003

The comparative effects of sevoflurane and methohexital for electroconvulsive therapy.

The standard anesthetic agent for electroconvulsive therapy (ECT) has been methohexital. We compared sevoflurane, a short-acting halogenated anesthetic, to methohexital for induction in ECT. Twelve subjects received sevoflurane or methohexital on alternating treatment days. Seizure duration, time to administering ECT, emergence and recovery, as well as several hemodynamic measures were recorded. A total of 69 treatments were analyzed. When sevoflurane was used, seizure durations recorded by observation and by EEG, were shorter by 10 and 23 seconds, respectively. With sevoflurane, seizure duration remained, however, within a clinically acceptable range. Methohexital allowed faster administration of ECT and discharge from the recovery room (3.8 vs. 6.2 minutes and 40.8 vs. 47.0 minutes, respectively). No difference in the post-ECT hemodynamic changes was found between the two treatments. We conclude that, when indicated, sevoflurane could provide a suitable alternative treatment option to methohexital, but some limitations, including shortened seizure duration and potential side effects, should be kept in mind.

Adult↗

PubMed2003

Untreated initial psychosis: relation to cognitive deficits and brain morphology in first-episode schizophrenia.

OBJECTIVE: Studies of patients experiencing their first episode of psychosis have demonstrated that they typically remain undiagnosed and untreated for 1-2 years. It has been postulated that prolonged untreated psychosis may have serious effects: poor response to neuroleptic medications, poor clinical outcomes, and direct neurotoxicity. This study investigated the relationships between duration of untreated initial psychosis and neurocognitive functioning and high-resolution imaging brain measurements. METHOD: A total of 156 subjects with DSM-IV schizophrenia, schizophreniform disorder, or schizoaffective disorder were evaluated during their first episode of psychosis. Measurements included nine domains of neurocognitive functioning, volumetric measures of total brain tissue, gray and white matter, and CSF, and measures of brain surface anatomy. RESULTS: The mean duration of untreated initial psychosis was 74.3 weeks. Correlations between neurocognitive functioning, brain volumetric measurements, and surface anatomy measurements with duration of untreated initial psychosis were weak; none reached statistical significance. When the group was divided on the basis of median duration of untreated initial psychosis, there were again no significant differences between the groups with long and short duration of untreated initial psychosis except on two measures (verbal memory and cortical sulcal depth). CONCLUSIONS: The absence of strong correlations suggests that untreated initial psychosis has no direct toxic neural effects. These results suggest that large-scale initiatives designed to prevent neural injury through early intervention in the prepsychotic or early psychosis phase may be based on incorrect assumptions that neurotoxicity or cognitive deterioration may be avoided. Nevertheless, early treatment is justified because it reduces suffering.

Adult↗

PubMed2003

Mortality and poststroke depression: a placebo-controlled trial of antidepressants.

OBJECTIVE: Poststroke depression has been shown to increase mortality for more than 5 years after the stroke. The authors assessed whether antidepressant treatment would reduce poststroke mortality over 9 years of follow-up. METHOD: A total of 104 patients were randomly assigned to receive a 12-week double-blind course of nortriptyline, fluoxetine, or placebo early in the recovery period after a stroke. Mortality data were obtained for all 104 patients 9 years after initiation of the study. Demographic and clinical measurements were collected at 3, 6, 9, 12, 18, and 24 months after the stroke. Survival data were analyzed by using the Kaplan-Meier method. RESULTS: Of the 104 patients, 50 (48.1%) had died by the time of the 9-year follow-up. Of 53 patients who were given full-dose antidepressants, 36 (67.9%) were alive at follow-up, compared with only 10 (35.7%) of 28 placebo-treated patients, a significant difference. Logistic regression analysis showed that the beneficial effect of antidepressants remained significant both in patients who were depressed and in those who were nondepressed at enrollment, after the effects of other factors associated with mortality (i.e., age, coexisting diabetes mellitus, and chronic relapsing depression) were controlled. There were no intergroup differences in severity of stroke, impairment in cognitive functioning and activities of daily living impairment, and other medications received. CONCLUSIONS: Treatment with fluoxetine or nortriptyline for 12 weeks during the first 6 months poststroke significantly increased the survival of both depressed and nondepressed patients. This finding suggests that the pathophysiological processes determining the increased mortality risk associated with poststroke depression last longer than the depression itself and can be modified by antidepressants.

Adrenergic Uptake Inhibitors↗

PubMed2003

The influence of cognitive impairment and behavioral dysregulation on daily functioning in the nursing home setting.

OBJECTIVE: The influence of psychiatric symptoms and cognitive impairment on daily living skills was explored in a series of nursing home residents. Three categories of symptoms were examined: behavioral disturbances, depression, and delusions. METHOD: Nursing home residents (N=69) underwent comprehensive psychiatric evaluations. Relationships among psychiatric symptoms, cognitive function, and daily living skills were assessed by using regression and correlation analyses. RESULTS: Cognitive decline had the greatest effect on functional impairment in a standard least squares model, followed by behavioral disturbances. Psychiatric symptoms correlated positively with each other and with functional impairment, and correlated inversely with cognitive functioning. CONCLUSIONS: Cognitive decline appears to confer the greatest burden of functional disability in the nursing home setting. After cognitive effects were accounted for, behavioral dysregulation was also associated with functional impairment. In conclusion, interventions to enhance cognition and ameliorate behavioral disturbances are important areas for future studies in long-term care.

Activities of Daily Living↗

PubMed2003

Attitudes about impairment and depression in elders suffering from chronic heart failure.

OBJECTIVES: This study examines the relationship between functional impairment and depression in patients with heart failure using a new measure of Attitudes about Impairment. METHODS: Sixty-nine patients with chronic heart failure completed diagnostic interviews and questionnaires about mood, comorbid illness, functional impairment, and social support. Study design was case-control with cases selected because they met criteria for DSM-IV major or minor depression (n = 23). Controls reported no or very few depressive symptoms (n = 46). A preliminary study of the psychometric properties of a new 15-item measure of Attitudes about Impairment was conducted. RESULTS: The Attitudes about Impairment measure had a Cronbach's alpha = 0.81. A factor analysis revealed content domains of negative attitudes about dependency, lack of recreational activities, and concerns about being a burden both currently and in the future. This measure correlated highly with the Geriatric Depression Scale (r = 0.61) and remained high even after controlling for medical burden and social support. Patients were diagnosed with either major, minor or no depression using a DSM-IV based structured interview. Depressed patients had significantly more negative attitudes about impairment and the association between depression and physical impairment was no longer significant after controlling for scores on the Attitudes about Impairment measure. DISCUSSION: Negative attitudes about loss of autonomy, concerns about being a burden and having few recreational activities are strongly associated with depression in patients with heart failure. These attitudes account, in part, for the association between impairment and depression in these patients. The Attitudes about Impairment measure has adequate internal consistency and both convergent and discriminant validity with related measures of social support, functional disability and depression.

Adaptation, Psychological↗

PubMed2002

Effects of frequent marijuana use on memory-related regional cerebral blood flow.

It is uncertain whether frequent marijuana use adversely affects human brain function. Using positron emission tomography (PET), memory-related regional cerebral blood flow was compared in frequent marijuana users and nonusing control subjects after 26+ h of monitored abstention. Memory-related blood flow in marijuana users, relative to control subjects, showed decreases in prefrontal cortex, increases in memory-relevant regions of cerebellum, and altered lateralization in hippocampus. Marijuana users differed most in brain activity related to episodic memory encoding. In learning a word list to criterion over multiple trials, marijuana users, relative to control subjects, required means of 2.7 more presentations during initial learning and 3.1 more presentations during subsequent relearning. In single-trial recall, marijuana users appeared to rely more on short-term memory, recalling 23% more than control subjects from the end of a list, but 19% less from the middle. These findings indicate altered memory-related brain function in marijuana users.

Analysis of Variance↗

PubMed2002

The influence of cognitive impairment and psychiatric symptoms on daily functioning in nursing facilities: a longitudinal study.

The influence of psychiatric symptoms and cognitive status on daily living skills was explored among persons with dementia residing in skilled nursing facilities. Psychiatric symptoms were examined in three domains: 1) depression, 2) psychosis, and 3) behavioral disturbances. Twenty-eight subjects were followed for a 1-year duration in rural nursing facilities. The relationship between psychiatric symptoms, cognition, and daily living skills was assessed using correlation and regression analyses. Over a one-year period, cognitive and functional impairment progressed significantly. In contrast, psychiatric symptoms across all three domains did not necessarily persist or increase. Deterioration in cognitive function was significantly correlated with reduced functional status both cross-sectionally and longitudinally. Among psychiatric symptoms, only behavioral disturbances were significantly associated with functional impairment cross-sectionally. Cognitive decline and loss of social functioning may constitute the greatest source of disability among persons in nursing facilities. Furthermore, both impairments increase over time in contrast to psychiatric symptoms, which appear to have a more variable course. These findings may have implications for treatment interventions that seek to enhance functioning in the skilled nursing setting.

Activities of Daily Living↗

PubMed2002

Prevalence and correlates of depressive symptoms in a community sample of people suffering from heart failure.

OBJECTIVES: To examine the rates and correlates of depressive symptoms and syndromal depression in people with self-reported heart failure participating in a community study of people aged 70 and older. DESIGN: Cross-sectional. SETTING: Community-based epidemiological study of older people from the continental United States. PARTICIPANTS: Six thousand one hundred twenty-five older people participating in the longitudinal study of Assets and Health Dynamics. Participants had to be born in 1923 or earlier. MEASUREMENTS: The short-form Composite International Diagnostic Interview assessed syndromal depression, and a revised version of the Center for Epidemiologic Studies-Depression scale assessed depressive symptoms. Medical illness was based on self-report. The authors compared the rates of syndromal depression and individual depressive symptoms in people with self-reported heart failure (n = 199) with those in people with other heart conditions (n = 1,856) and with no heart conditions (n = 4,070). RESULTS: Eleven percent of those with heart failure met criteria for syndromal depression, compared with 4.8% of people with other heart conditions and 3.2% of those with no heart conditions. The association between heart failure and depression held even after controlling for disability, reported fatigue and breathlessness, and number of comorbid chronic illnesses. CONCLUSION: Community-living older people with self-reported heart failure were at approximately twice the risk for syndromal depression of the rest of the community. Although fatigue and functional disability were also related to depression in this sample, these variables did not account for the association between syndromal depression and self-reported heart failure.

Aged↗

PubMed2002

Risperidone versus clonidine in the treatment of children and adolescents with Tourette's syndrome.

OBJECTIVE: To evaluate the efficacy and tolerability of risperidone in comparison with clonidine in the treatment of children and adolescents with Tourette's syndrome (TS). METHOD: Following a 7- to 14-day single-blind, placebo lead-in, 21 subjects aged 7 to 17 years were randomly assigned to 8 weeks of double-blind treatment with clonidine or risperidone. Research scales evaluated tics and comorbid obsessive-compulsive and attention-deficit/hyperactivity symptoms. RESULTS: Risperidone and clonidine appeared equally effective in the treatment of tics in an intent-to-treat analysis, as rated by the Yale Global Tic Severity Scale (YGTSS). Risperidone produced a mean reduction in the YGTSS of 21%; clonidine produced a 26% reduction. Among subjects with comorbid obsessive-compulsive symptoms, 63% of the risperidone group and 33% of the clonidine group responded to treatment (not significant). The most common adverse event seen with both treatments was sedation, which was mild to moderate in severity. Sedation subsequently resolved with continued administration of the medication or with a dose reduction. No clinically significant extrapyramidal symptoms were observed. CONCLUSIONS: In this pilot study, risperidone demonstrated efficacy equivalent to clonidine in the treatment of tic symptoms in children and adolescents with TS. Further research is needed to clarify the role of atypical antipsychotics in TS and to delineate potential benefits for comorbid obsessive-compulsive and attention-deficit/hyperactivity symptoms.

Adrenergic alpha-Agonists↗

PubMed2002

Putamen lesions and the development of attention-deficit/hyperactivity symptomatology.

OBJECTIVE: To investigate the association between focal stroke lesions of the putamen and either attention-deficit/hyperactivity disorder or traits of the disorder (ADHD/Traits). METHOD: Twenty-five children with focal stroke lesions were studied with standardized psychiatric assessments and anatomic brain magnetic resonance imaging. The pattern of lesion overlap in subjects with ADHD/Traits was determined. RESULTS: Fifteen of 25 subjects had ADHD/Traits. The densest area of overlapping lesions (n = 7) in subjects with ADHD/Traits included the posterior ventral putamen. The median lesion volume was 9.7 cm3, and the distribution was highly skewed. Lesion volume was not associated with ADHD/Traits. Therefore the following analyses focused on the 13 subjects with lesions < 10 cm3: ADHD/Traits were exhibited in 6/7 subjects with putamen lesionsversus 2/6 with no putamen lesions (Fisherexacttestp= .1). Half (4/8) of the subjects with ADHD/Traits had overlapping lesions encompassing the posterior ventral putamen. None of the 5 subjects without ADHD/Traits had lesions in this empirically derived region of interest (Fisher exact test p = .1). CONCLUSIONS: Lesions within the dopamine-rich ventral putamen, which is part of the ventral or limbic striatum, tended to increase the risk of ADHD/Traits. ADHD/Traits may therefore be a disinhibition syndrome associated with dysfunction in this cortical-striato-thalamocortical loop.

Adolescent↗