Carolyn M. Mazure

Magnetic resonance imaging-based measurement of hippocampal volume in posttraumatic stress disorder related to childhood physical and sexual abuse—a preliminary report

We have previously reported smaller hippocampal volume and deficits in short-term memory in patients with combat-related posttraumatic stress disorder (PTSD) relative to comparison subjects. The purpose of this study was to compare hippocampal volume in adult survivors of childhood abuse to matched controls. Magnetic resonance imaging was used to measure volume of the hippocampus in adult survivors of childhood abuse (n = 17) and healthy subjects (n = 17) matched on a case-by-case basis for age, sex, race, handedness, years of education, body size, and years of alcohol abuse. All patients met criteria for PTSD secondary to childhood abuse. PTSD patients had a 12% smaller left hippocampal volume relative to the matched controls (p < .05), without smaller volumes of comparison regions (amygdala, caudate, and temporal lobe). The findings were significant after controlling for alcohol, age, and education, with multiple linear regression. These findings suggest that a decrease in left hippocampal volume is associated with abuse-related PTSD.

Evolving Knowledge of Sex Differences in Brain Structure, Function and Chemistry

Clinical and epidemiologic evidence demonstrates sex differences in the prevalence and course of various psychiatric disorders. Understanding sex-specific brain differences in healthy individuals is a critical first step toward understanding sex-specific expression of psychiatric disorders. Here, we evaluate evidence on sex differences in brain structure, chemistry, and function using imaging methodologies, including functional magnetic resonance imaging (fMRI), positron emission tomography (PET), single photon emission computed tomography (SPECT), and structural magnetic resonance imaging (MRI) in mentally healthy individuals. MEDLINE searches of English-language literature (1980-November 2006) using the terms sex, gender, PET, SPECT, MRI, fMRI, morphometry, neurochemistry, and neurotransmission were performed to extract relevant sources. The literature suggests that while there are many similarities in brain structure, function, and neurotransmission in healthy men and women, there are important differences that distinguish the male from the female brain. Overall, brain volume is greater in men than women; yet, when controlling for total volume, women have a higher percentage of gray matter and men a higher percentage of white matter. Regional volume differences are less consistent. Global cerebral blood flow is higher in women than in men. Sex-specific differences in dopaminergic, serotonergic, and gamma-aminobutyric acid (GABA)ergic markers indicate that male and female brains are neurochemically distinct. Insight into the etiology of sex differences in the normal living human brain provides an important foundation to delineate the pathophysiological mechanisms underlying sex differences in neuropsychiatric disorders and to guide the development of sex-specific treatments for these devastating brain disorders.

Gender differences in the effects of bereavement-related psychological distress in health outcomes

BACKGROUND This study examined whether traumatic grief, depressive and anxiety symptoms formed three distinct factors for widows and widowers. In addition, we examined whether high symptom levels of traumatic grief, depression and anxiety predicted different mental and physical health outcomes for widows and widowers. METHOD Ninety-two future widows and 58 future widowers were interviewed at the time of their spouses hospital admission and then at 6 weeks, 6, 13 and 25 month follow-ups. Principal axis factor analyses tested the distinctiveness of traumatic grief, depressive and anxiety symptoms, by gender. Repeated measures ANOVA tested for gender differences and changes over time in mean symptom levels of traumatic grief, depression and anxiety. Linear and logistic regression models estimated the effects of high symptom levels of traumatic grief, depression and anxiety at 6 months on health outcomes at 13 and 25 months post-intake by gender. RESULTS Three distinct symptom clusters (i.e. traumatic grief, depressive and anxiety symptoms) were found to emerge for both widows and widowers. Widows had higher mean levels of traumatic grief, depressive and anxiety symptoms. High symptom levels of traumatic grief measured at 6 months predicted a physical health event (e.g. cancer, heart attack) at 25 months post-intake for widows. High symptom levels of anxiety measured at 6 months predicted suicidal ideation at 25 months for widowers. CONCLUSIONS The results suggest that there are gender differences in the levels of psychological symptoms resulting from bereavement and in their effects on subsequent mental and physical health for widows and widowers.

The Yale-Brown-Cornell eating disorder scale: Development, use, reliability and validity

Patients with eating disorders present with a wide range of eating-related preoccupations and or rituals. Yet, eating disorder assessments traditionally have measured a finite number of specific eating-disordered thoughts or actions. The current work presents a new instrument, the Yale-Brown-Cornell Eating Disorder Scale (YBC-EDS), that does not limit assessment to a particular set of eating-related concerns or behaviors. Rather, it assesses the severity of illness associated with an individuals unique symptomatology. Reliability and validity of this new, clinician-rated instrument was tested in two independent samples of DSM-III-R eating disorder patients. The YBC-EDS eight-item scale assessing severity of preoccupations and rituals, and a set of six provisional items for assessing motivation for change were both frequently endorsed and found to have excellent interrater reliability. Internal consistency was shown to be good for the set of eight core items and the set of six items related to motivation for change. The eight-item scale demonstrated aspects of convergent validity with other assessments of eating disorder symptomatology. The set of six provisional items for assessing motivation for change was inversely related to measures to diet restriction, drive for thinness, and body dissatisfaction. This paper presents the eight-item Yale-Brown-Cornell Eating Disorder Scale for assessing illness severity in eating-disordered patients with an extensive range of symptomatology. An accompanying set of six provisional items for assessing motivation for change are also presented. Initial findings showed excellent reliability and indications of validity for both the eight-item YBC-EDS and the set of six provisional items.

DIAGNOSTIC CRITERIA FOR TRAUMATIC GRIEF

This article reviews the rationale for the development of diagnostic criteria for Traumatic Grief. Traumatic Grief is a new nosologic entity that a panel of experts recently proposed. It is a direct descendent of the concept of pathologic grief, and it has roots in attachment behavior, separation distress, and traumatic distress. We present consensus, diagnostic criteria for Traumatic Grief and discuss them in relation to another recently proposed set of criteria. In conclusion, we recommend the development of empirically tested, consensus, diagnostic criteria for Traumatic Grief. Diagnostic criteria would facilitate early detection and intervention for those bereaved persons afflicted by this disorder and lead to additional studies of the prevalence, the nature, and the treatment of the disorder.This article reviews the rationale for the development of diagnostic criteria for Traumatic Grief. Traumatic Grief is a new nosologic entity that a panel of experts recently proposed. It is a direct descendent of the concept of pathologic grief, and it has roots in attachment behavior, separation distress, and traumatic distress. We present consensus, diagnostic criteria for Traumatic Grief and discuss them in relation to another recently proposed set of criteria. In conclusion, we recommend the development of empirically tested, consensus, diagnostic criteria for Traumatic Grief. Diagnostic criteria would facilitate early detection and intervention for those bereaved persons afflicted by this disorder and lead to additional studies of the prevalence, the nature, and the treatment of the disorder.

Combining norepinephrine and serotonin reuptake inhibition mechanisms for treatment of depression: a double-blind, randomized study

BACKGROUND Although several antidepressants are now available, all have limited efficacy and a delayed onset of action. The current study was undertaken as a proof of the concept that combining norepinephrine and serotonin reuptake inhibition would be more effective and act more rapidly than either drug alone. METHODS Inpatients with nonpsychotic unipolar major depression and a Hamilton Depression Rating Scale (HAMD) score of at least 18 after 1 week of hospitalization without antidepressant medication were randomized to 6 weeks of treatment with fluoxetine (FLX) 20 mg/day, desipramine (DMI) adjusted to an adequate plasma level, or the combination of FLX 20 mg/day and DMI, given under double-blind conditions. Twenty-four-hour DMI levels were used to rapidly adjust DMI dose to achieve a therapeutic level and to anticipate the enzyme-inhibiting effects of FLX. Treatment-resistant patients were stratified. Patients were rated with the HAMD and the Montgomery-Asberg Depression Rating Scale (MADRS). RESULTS Thirty-nine patients began treatment. One patient withdrew consent. The DMI-FLX combination was significantly more likely to result in remission on the MADRS than either FLX or DMI alone [53.8% vs. 7.1% and 0%, respectively; chi(2)(2) = 13.49, p =.001]. The advantage for combined treatment was not explained by history of treatment resistance or by drug plasma concentrations. Rapid response, at 1 or 2 weeks, was neither statistically nor meaningfully greater with combined treatment. CONCLUSIONS This study supports the hypothesis that the combination of a noradrenergic and serotonergic agent is more likely to result in remission than either selective agent alone during a 6-week treatment period.

Smoking and mental illness in the US population

Objectives Those with any psychiatric diagnosis have substantially greater rates of smoking and are less likely to quit smoking than those with no diagnosis. Using nationally representative data, we sought to provide estimates of smoking and longitudinal cessation rates by specific psychiatric diagnoses and mental health service use. Design and participants Data were analysed from a two-wave cohort survey of a US nationally representative sample (non-institutionalised adults): the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC; 2001–2002, n=43 093; 2004–2005, n=34 653). Main outcome measures We examined smoking rates (lifetime, past year and past year heavy) and cross-sectional quit rates among those with any lifetime or past year psychiatric diagnosis (DSM-IV). Importantly, we examined longitudinal quit rates and conducted analyses by gender and age categories. Results Those with any current psychiatric diagnosis had 3.23 (95% CI 3.11 to 3.35) times greater odds of currently smoking than those with no diagnosis, and were 25% less likely to have quit by follow-up (95% CI 20% to 30%). Prevalence varied by specific diagnoses (32.4% to 66.7%) as did cessation rates (10.3% to 17.9%). Comorbid disorders were associated with higher proportions of heavy smoking. Treatment use was associated with greater prevalence of smoking and lower likelihood of cessation. Conclusions Those with psychiatric diagnoses remained much more likely to smoke and less likely to quit, with rates varying by specific diagnosis. Our findings highlight the need to improve our ability to address smoking and psychiatric comorbidity both within and outside of healthcare settings. Such advancements will be vital to reducing mental illness-related disparities in smoking and continuing to decrease tobacco use globally.

Gender differences in referral to cardiac rehabilitation programs after revascularization.

BACKGROUND This study examines the influence of gender on the healthcare providers secondary prevention instruction and cardiac rehabilitation (CR) referral after coronary revascularization procedures such as balloon angioplasty/coronary stenting and coronary bypass surgery (CABG). Cardiac rehabilitation decreases mortality and morbidity, yet only a small percentage of women and men are referred to these programs. The patient population of our university-affiliated CR program consisted of 88% men and 12% women. METHODS In a matched case observational study, 80 patients (40 men, 40 women) who had undergone coronary revascularization procedures between 1997 and 1998 completed a questionnaire on secondary prevention instruction and written referral to CR programs. Patients were matched for age and coronary revascularization procedure. RESULTS Women were less likely to be instructed on secondary prevention strategies and CR or referred to CR as compared to men despite being matched for age and undergoing the same procedure. The data demonstrate a gender difference in hospital teaching and referral information for CR after revascularization (P < 0.001). Being a woman was associated with a decreased likelihood of receiving a physician referral to CR after revascularization (P < 0.001). CONCLUSION The instruction of patients concerning secondary prevention and CR postrevascularization procedures is poor. Within that group, women were far less likely to have CR discussed or referrals made by healthcare professionals. This study demonstrates the need for education initiatives of all healthcare providers on the comprehensive nature and benefits of CR in the secondary prevention of cardiovascular disease, with a particular emphasis on women.

A Gender-based Examination of Past-year Recreational Gamblers

BackgroundMost adults gamble recreationally yet few studies have systematically investigated for gender-related differences in recreational gamblers.MethodsLogistic regression analyses were performed on data from a nationally representative sample of respondents from the 1998 Gambling Impact and Behavior Study. ResultsFemale gamblers versus non-gamblers were more likely to report use of alcohol and drugs. Male gamblers versus non-gamblers were more likely to report alcohol use and abuse/dependence, any substance abuse/dependence, and lifetime incarceration. An analysis of gambling by gender group interaction effects did not identify significant differences in health-related measures. Male as compared with female gamblers reported beginning gambling earlier, experiencing higher past-year maximal losses and wins, and finding favorite and engaging in different types of gambling.ConclusionsDespite heavier gambling in male as compared with female recreational gamblers, similar mental health functioning was observed in female and male past-year recreational gamblers. Types of gambling problematic for men and women are reflected in the gambling preferences of recreational gamblers.

Depression in late life: age of onset as marker of a subtype

Late-onset depression may be pathogenetically and prognostically distinct from early-onset, recurrent affective disorder. The authors reviewed records of 94 consecutively admitted unipolar major depressives over the age of 60 years, divided subjects into groups based on their age of onset, and examined demographic and clinical features. Late-onset elderly depressives had a lower incidence of family history of affective illness, longer hospital stay, and more residual symptoms at discharge. However, there was no demonstrable relationship between age of onset and presence of psychosis, melancholia, medical illness, symptom severity at admission, or indicators of neuropathology. Although late-onset elderly depressives did less well than those with early-onset illness, the data do not support the notion of late-onset depression as a distinct pathological process.