Alexander J. Steiner

Patient-reported Outcomes of Quality of Life, Functioning, and Gi/psychiatric Symptom Severity in Patients with Inflammatory Bowel Disease (ibd)

Background: Patients with inflammatory bowel disease (IBD) are at risk for psychiatric disorders that impact symptom experience and health-related quality of life (HRQOL). Therefore, comprehensive biopsychosocial assessments should be considered in ambulatory care settings. Patient-Reported Outcomes Measurement Information System (PROMIS) measures created by the National Institutes of Health have shown construct validity in a large IBD internet-based cohort, but their validity in ambulatory settings has not been examined. We sought to validate PROMIS patient-reported measures of HRQOL, functioning, and psychiatric symptom severity at a tertiary IBD clinic. Methods: Adult patients (n = 110) completed the PROMIS Global Health scale, PROMIS-29, SF-12, and WHODAS 2.0. Pearsons correlation coefficients (r) determined the relationships between scores to validate the PROMIS Global Health Physical and Mental metrics, compared with the SF-12 and WHODAS 2.0. We compared these measures by disease subtype of Crohns disease or ulcerative colitis. Results: PROMIS measures were highly correlated (r range = 0.64–0.82) with standard measures of HRQOL and functioning. On the PROMIS Global Health measures, 20.9% had impaired physical health, and 13.7% had impaired mental health. Impairments were reported in pain interference (20% of patients), anxiety (18.2%), satisfaction with social role (15.5%), physical functioning (10.9%), fatigue (10%), depression (7.3%), and sleep disturbance (5.5%). Patients with Crohns disease had worse scores than those with ulcerative colitis on measures of the global physical health (P = 0.027), physical functioning (P = 0.047), and pain interference (P = 0.0009). Conclusions: PROMIS instruments provide valid assessment of HRQOL and functioning in ambulatory adults with IBD. Of note, patients with Crohns disease demonstrated significantly worse impairments than those with ulcerative colitis.

Discrepancies between bilinguals' performance on the Spanish and English versions of the WAIS Digit Span task: Cross-cultural implications.

ABSTRACT This study explored within-subjects differences in the performance of 40 bilingual participants on the English and Spanish versions of the Wechsler Adult Intelligence Scale (WAIS) Digit Span task. To test the linguistic hypothesis that individuals would perform worse in Spanish because of its syllabic demand, we compared the number of syllables correctly recalled by each participant for every correct trial. Our analysis of the correct number of syllables remembered per trial showed that participants performed significantly better (i.e., recalling more syllables) in Spanish than in English on the total score. Findings suggest the Spanish version of the Digit Span (total score) was significantly more difficult than the English version utilizing traditional scoring methods. Moreover, the Forward Trial, rather than the Backward Trial, was more likely to show group differences between both language versions. Additionally, the Spanish trials of the Digit Span were correlated with language comprehension and verbal episodic memory measures, whereas the English trials of the Digit Span were correlated with confrontational naming and verbal fluency tasks. The results suggest that more research is necessary to further investigate other cognitive factors, rather than just syllabic demand, that might contribute to performance and outcome differences on the WAIS Digit Span in Spanish-English bilinguals.

The impact of posttraumatic stress disorder on the quality of life: a systematic review.

Aim s:To review the relevant literature on Quality of Life (QOL) impairment in PTSD and the impact of treatment interventions on QOL. Methods: A database search from 1980-2012 was conducted using Medline, PsycINFO, and the PILOTS database using the keywords: �PTSD �, �posttraumatic stress disorder �,

Diagnostic utility of the HIV dementia scale and the international HIV dementia scale in screening for HIV-associated neurocognitive disorders among Spanish-speaking adults

ABSTRACT Given that neurocognitive impairment is a frequent complication of HIV-1 infection in Spanish-speaking adults, the limited number of studies assessing HIV-associated neurocognitive disorders (HAND) in this population raises serious clinical concern. In addition to being appropriately translated, instruments need to be modified, normed, and validated accordingly. The purpose of the current study was to examine the diagnostic utility of the HIV Dementia Scale (HDS) and International HIV Dementia Scale (IHDS) to screen for HAND in Spanish-speaking adults living with HIV infection. Participants were classified as either HAND (N = 47) or No-HAND (N = 53) after completing a comprehensive neuropsychological evaluation. Receiver operating characteristic analyses found the HDS (AUC = .706) was more sensitive to detecting HAND than the IHDS (AUC = .600). Optimal cutoff scores were 9.5 for the HDS (PPV = 65.2%, NPV = 71.4%) and 9.0 for the IHDS (PPV = 59.4%, NPV = 59.1%). Canonical Correlation Analysis found the HDS converged with attention and executive functioning. Findings suggest that while the IHDS may not be an appropriate screening instrument with this population, the HDS retains sufficient statistical validity and clinical utility to screen for HAND in Spanish-speaking adults as a time-efficient and cost-effective measure in clinical settings with limited resources.

Quality of Life, Functioning, and Depressive Symptom Severity in Older Adults With Major Depressive Disorder Treated With Citalopram in the STAR*D Study

OBJECTIVE Major depressive disorder (MDD) can substantially worsen patient-reported quality of life (QOL) and functioning. Prior studies have examined the role of age in MDD by comparing depressive symptom severity or remission rates between younger and older adults. This study examines these outcomes before and after SSRI treatment. On the basis of prior research, we hypothesized that older adults would have worse treatment outcomes in QOL, functioning, and depressive symptom severity and that nonremitters would have worse outcomes. METHODS A retrospective secondary data analysis was conducted from the National Institute of Mental Health-funded Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study (July 2001-September 2006). We analyzed data for 2,280 nonpsychotic adults with DSM-IV-TR-defined MDD who received citalopram monotherapy. Older adults were classified as adults aged 65 years and above. All subjects completed patient-reported QOL, functioning, and depressive symptom severity measures at entry and exit. Subjects included 106 older adults and 2,174 adults < 65. MDD remission status posttreatment was also determined. RESULTS Both older adults and adults < 65 experienced significant improvements and medium to large treatment responses across QOL, functioning, and depressive symptom severity (P < .001). Older adults had smaller treatment effect sizes for all outcomes, particularly functioning. Conversely, mean change scores from entry to exit were equivalent across all outcomes. Remitters at exit had significantly better responses to treatment than nonremitters for the majority of outcomes. CONCLUSION Findings suggest that older adults and younger adults have comparable treatment responses to citalopram monotherapy, with significant improvements in patient-reported depressive symptom severity, functioning, and QOL. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT00021528.

Evaluation and Treatment of Sexual Disorders Due to Medical Conditions

A major problem facing practicing physicians is the continued prevalence of sexual disorders due to medical conditions. There is a growing awareness surrounding their effect on patient well-being and life satisfaction. To date, our understanding of the impact that various medical conditions can have on optimal sexual function is a complex and difficult clinical phenomenon, which often has many competing etiological considerations and treatment options. Accordingly, there is growing concern pertaining to both the evaluation of, and treatment for, sexual disorders that are secondary to a variety of medical conditions. Previously, the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) characterized sexual disorders due to medical conditions as psychiatric diagnoses. However, recent changes in the classification system of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) have established new criteria for sexual disorders. Specifically, new guidelines require disorders of sexual dysfunction that are attributable to a medical condition to be viewed as non-psychiatric diagnoses. As such, the initial evaluation of presenting sexual disorders requires ruling out any comorbid medical condition(s) that may affect sexual function. Therefore, it is important for physicians to have a deep appreciation for and robust understanding of the innumerable medical conditions that can affect optimal sexual function. In this chapter, we discuss epidemiology, etiology, pathophysiology, diagnostic criteria, and best evidence-based practice and approaches to the diagnosis of sexual disorders due to medical conditions. We further provide a review of diagnostic tests frequently used by physicians to aid in diagnosis and monitoring of treatment outcomes for sexual disorders. We conclude by highlighting key findings from studies focused on the treatment of sexual disorders by reviewing evidence-based approaches to biological treatments (i.e., medications, devices), psychosocial treatments, and prognosis of sexual disorders.

Major Depressive Disorder in Patients With Doctoral Degrees: Patient-reported Depressive Symptom Severity, Functioning, and Quality of Life Before and After Initial Treatment in the STAR*D Study

Objective: This study examined patients with medical or doctoral degrees diagnosed with major depressive disorder (MDD) by analyzing patient-reported depressive symptom severity, functioning, and quality of life (QOL) before and after treatment of MDD. Methods: Analyses were conducted in a sample of 2280 adult outpatient participants with MDD from the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study with complete entry and exit scores for the level 1 (citalopram monotherapy) trial. The sample contained 62 participants who had completed medical or doctoral degrees (DOCS) and 2218 participants without medical or doctoral degrees (non-DOCS). QOL was assessed with the Quality of Life Enjoyment and Satisfaction Questionnaire, functioning was assessed with the Work and Social Adjustment Scale, and depressive symptom severity was assessed with the Quick Inventory of Depressive Symptomatology-Self Report. Results: Both groups (DOCS and non-DOCS) had significant improvement in depressive symptom severity, functioning, and QOL following treatment (with equivalent improvements in mean change values). However, the DOCS group demonstrated larger effect sizes in symptom reduction for depression, increase in functioning, and improvement in QOL compared with the non-DOCS group. Participants who achieved remission from MDD at exit showed significantly greater improvement than nonremitters on functioning and QOL. Conclusions: Findings from this study indicated that, following citalopram monotherapy, the participants in the DOCS group achieved greater reductions in depressive symptom severity (based on effect sizes) than the participants in the non-DOCS group. For both treatment groups, the findings also showed the positive effect that remission status from MDD can have on QOL and functioning.

Analysis of Patient-reported Outcomes of Quality of Life and Functioning Before and After Treatment of Major Depressive Disorder Comorbid With Alcohol Use Disorders.

OBJECTIVE Alcohol use disorders (AUDs) are common among persons with major depressive disorder (MDD) and have an adverse impact on course of illness and patient outcomes. The aim of this study was to examine whether AUD adversely impacted patient-centered outcomes in a sample of research subjects evaluated as part of a large clinical trial for depression. The outcomes of interest to this post hoc analysis are quality of life (QOL), functioning, and depressive symptom severity. METHODS We analyzed 2280 adult MDD outpatient research subjects using data from the Sequenced Treatment Alternatives to Relieve Depression trial. We compared entry and post-selective serotonin reuptake inhibitors (SSRI) treatment QOL, functioning, and depressive symptom severity scores between 121comorbid MDD with AUD (MDD + AUD) subjects and 2159 MDD-no-AUD subjects, and also differences between subjects categorized as remitters versus nonremitters within each group at exit. RESULTS At entry, MDD + AUD subjects reported similar QOL, functioning, and depressive symptom severity compared with the MDD-no-AUD subjects. After treatment with citalopram, both groups showed significant improvements throughout treatment; however, 36% to 55% of subjects still suffered from severely impaired QOL and functioning at exit. CONCLUSIONS The overall study population demonstrated a significant response to treatment with large effect sizes in depressive symptom reduction, but to a lesser extent in QOL and functioning. Findings suggest that subjects with MDD + AUD benefited equally as MDD-no-AUD from treatment with selective serotonin reuptake inhibitors (SSRI) medication, yet both groups continue to experience reduced QOL and functioning after treatment. Monitoring QOL and functioning is critical to determine whether interventions that improve clinical outcomes also impact patient-centered outcomes, and our analysis suggests that there is a pressing need for innovative interventions that effectively improve these outcomes.