Jennifer L. Callahan

The effects of apolipoprotein E on non-impaired cognitive functioning: A meta-analysis

Nearly twice as many participants are represented in the current literature than were available at the time of the last major meta-analytic neurocognitive examination of apolipoprotein E (ApoE) epsilon allele combinations [Small, B.J., Rosnick, C.B., Fratiglioni, L., Backman, L., 2004. Apolipoprotein E and cognitive performance: a meta-analysis. Psychol. Aging 19, 592-600]. The meta-analysis in the current study sought to specifically examine (1) small effects and (2) possible moderating variables associated with ApoE allele combinations that may have been undiscoverable in previous examinations of smaller data sets. A total of 77 studies, representing 40,942 cognitively healthy adults were identified for inclusion in the current meta-analysis (random effects design). Results were congruent with the previous meta-analytic findings indicating that carriers of ApoE allele 4 (ɛ4) perform significantly worse on measures of episodic memory, executive functioning, and overall global cognitive ability. In addition, the current analysis revealed a small effect suggesting that ApoE allele 4 adversely impacts perceptual speed. In contrast to earlier studies, the results also indicate that increases in age result in significantly larger differences between ApoE ɛ4 carriers and ApoE non-ɛ4 carriers on measures of episodic memory and global cognitive ability. ApoE ɛ4 exerts broad, but specific, adverse small effects on a range of neurocognitive functions in cognitively healthy adults.

The impact of client treatment preferences on outcome: a meta-analysis

An important part of evidence-based practice is to include client preferences in the treatment decision-making process. However, based on previous reviews of the literature there is some question as to whether including client preferences actually has an effect on treatment outcome. This meta-analytic review summarized data from over 2,300 clients across 26 studies comparing the treatment outcome differences between clients matched to a preferred treatment and clients not matched to a preferred treatment. The findings indicate a small significant effect (r=.15, CI(.95): .09 to .21) in favor of clients who received a preferred treatment. The binomial effect size indicated that matched clients have a 58% chance of showing greater improvement, and further analysis indicate that they are about half as likely to drop-out of treatment when compared with clients not receiving a preferred treatment. Study design was seen to be a moderating variable in that partially randomized preference trials may underestimate the treatment preference effect. Implications for best practice standards are discussed.

Aripiprazole in the treatment of the psychosis prodrome

BACKGROUND Research studies for the treatment of the putative prodromal phase of psychotic disorders have begun to appear. AIMS To obtain preliminary evidence of the short-term efficacy and safety of aripiprazole treatment in people with the psychosis prodrome. METHOD Fifteen participants meeting prodrome criteria (mean age 17.1 years, s.d.=5.5) enrolled in an open-label, single-site trial with fixed-flexible dosing of aripiprazole (5-30 mg/day) for 8 weeks. RESULTS In the mixed-effects repeated-measures analysis, improvement from baseline on the Scale of Prodromal Symptoms total score was statistically significant by the first week. No participant converted to psychosis and 13 completed treatment. Neuropsychological measures showed no consistent improvement; mean weight gain was 1.2 kg. Akathisia emerged in 8 participants, but the mean Barnes Akathisia Scale score fell to baseline levels by the final visit. Adverse events were otherwise minimal. CONCLUSIONS Aripiprazole shows a promising efficacy and safety profile for the psychosis prodrome. Placebo-controlled studies are indicated.

Neuropsychological course in the prodrome and first episode of psychosis: Findings from the PRIME North America Double Blind Treatment Study

OBJECTIVE There is uncertainty regarding the onset timing of the cognitive deficiencies of schizophrenia. We investigated whether conversion to psychosis and/or olanzapine altered the neuropsychological course of subjects within the first-ever double blind medication study of the putative schizophrenia first episode prodrome. METHOD Sixty participants in a double blind trial of olanzapine as a treatment for putative prodromal states were assessed at entry (pre-randomization), and again at 6 and 12 months (if they remained non-psychotic), or at any of these points prior to psychosis followed by post-psychosis and 6 months post-psychosis assessments. RESULTS Participants who converted to psychosis did not differ from placebo non-converters in pre-randomization global neuropsychological status. Early converters did not differ from later converters in entry neuropsychological status. Subjects who converted after 6 months did not show neuropsychological declines during the initial, pre-psychosis, 6 months. Neuropsychological course did not differ between converters to psychosis and non-converters, or between olanzapine and placebo-assigned subjects. CONCLUSIONS Neither the onset of frank psychosis nor olanzapine treatment of the prodrome significantly alters neuropsychological course in persons considered to be at high risk at their initial (pre-psychosis) assessment. These findings suggest that the neuropsychological deficiencies associated with psychotic conditions largely pre-exist the first frank psychotic episode.

Modification of the Perinatal PTSD Questionnaire to enhance clinical utility

Objective:To enhance the clinical utility of the Perinatal Post-Traumatic Stress Disorder (PTSD) Questionnaire (PPQ), the current study sought to refine the measure by changing the item response options from dichotomous choices to a likert scale format.Study Design:Using a convergent/divergent validity design and two data sources (traditional survey and World Wide Web), 58 high-risk and 86 low-risk mothers answered four questionnaires.Results:Principal components analysis of items on the modified PPQ revealed three components conceptually similar to the diagnostic criterion associated with PTSD. In addition, convergent and divergent validity of the modified measure was supported. The clinical utility of the modified PPQ was established with a strong positive likelihood ratio.Conclusion:The modified PPQ is a useful clinical tool for identifying mothers experiencing significant emotional distress during the postnatal period so they may be referred for mental health services.

Using clinically significant change to identify premature termination.

Research examining treatment dropout is hindered by the inconsistencies in the methods used to operationalize the construct. In this article an operationalization based on the criteria of attaining clinically significant change prior to treatment discontinuation is reintroduced and compared with other existing dropout classification systems. A dropout rate of 77% was found in a university-based training clinic sample by using the clinically significant change (CSC) definition. This classification showed little agreement to classifications made by other popularly used definitions of dropout (median split, intake only, missed appointment, and therapist judgment). Further analysis indicated that the other popularly used definitions frequently classified clients as treatment dropouts when recovery had occurred or as treatment completers when recovery had not occurred. Uses and limitations of the CSC method and other popular definitions of treatment dropout are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved).

Decreasing treatment dropout by addressing expectations for treatment length

Abstract Therapy dropout or premature termination is a significant problem which impedes the delivery of psychotherapy services. In this study, a method aimed to reduce the occurrence of premature termination by addressing clients’ duration expectations was examined. Sixty-three adult clients seeking psychotherapy services from a psychology department training clinic were randomized into control (n=32) and education groups (n=31). On average, those clients in the education group, who were provided information about the dose-effect model prior to their intake appointment, were found to stay in treatment significantly longer (d=0.55) and were more likely to be classified as therapy completers (RR=3.55) when compared to clients in the control group.

Models of Psychotherapy Outcome: Are They Applicable in Training Clinics?

To explore whether psychotherapy models are applicable in the training clinic setting, the dose-effect model of psychotherapy outcome was tested in the outpatient clinic of an American Psychological Association-approved doctoral training program in clinical psychology. Outcome data, using the Outcome Questionnaire 45.2, were gathered immediately prior to each psychotherapy session during the course of treatment (mean total number of sessions: 14.81). Sixty-one clients, treated by 21 trainee clinicians, participated. Although a similar pattern emerged, response to treatment was not as rapid as the dose-effect model would predict. Ideas for future research are proposed. The dose-effect model of psychotherapy outcome (Howard, Kopta, Krause, & Orlinsky, 1986) emerged from meta-analytic findings spanning 30 years and has spawned renewed interest and research into psychotherapy research. However, those analyses did not examine possible site differences (e.g., whether the site was a training clinic) in the dose-effect response.

Test of the Phase Model of Psychotherapy in a Training Clinic

Recent publications suggest that psychotherapy models generated in outpatient settings do not fully generalize to the training clinic. A possible explanation for these findings is that the nature in which change occurs during psychotherapy may actually differ according to setting. To examine this possibility, the phase model of psychotherapy was tested in an outpatient training clinic. Results partially support the phase model, suggesting that the nature of change during effective psychotherapy within the training clinic setting does not differ from that in other outpatient settings. That is, clients who completed effective courses of treatment in the training clinic environment generally experience an improvement in subjective well-being before evidencing a reduction in symptom distress. Obtaining success in role performances (i.e., work or school) appears to emerge last. Practitioners may enhance treatment outcomes by targeting interventions that are congruent with the phase of the individual client presenting for treatment.

A Delay Discounting Measure of Great Expectations and the Effectiveness of Psychotherapy

Many clients prematurely terminate therapy before they have recovered. One possible explanation for treatment dropout is unmet expectations. Although the effects of unmet role expectations have received much attention in the literature, little is known about unmet outcome expectations. Two studies were designed to look at duration and effectiveness outcome expectations held by individuals within a primary referral base for a training clinic setting—a setting with a slower rate of recovery than other outpatient settings. Study 1 (N 110) used a delay discounting method to find rate-of-recovery expectations associated with differing treatment lengths. Results indicated expectations much higher than the demonstrated effectiveness of therapy associated with training clinics. Study 2 (N 307) replicated Study 1 and examined the possibility of altering outcome expectations through education. Study 2 results indicated that outcome expectations may be altered through client education. Both studies’ results are discussed in terms of reducing premature termination and overall treatment outcome.