Jichuan Wang

The prevalence of psychiatric disorder among a community sample of crack cocaine users: An exploratory study with practical implications

The Diagnostic Interview Schedule for DSM-IV was used to assess the lifetime prevalence of psychiatric disorder among not-in-treatment crack cocaine users (N = 313). The most common dependencies involved cocaine (59.7%), alcohol (37.7%), and cannabis (12.1%). The most common nondependency disorders were antisocial personality disorder (ASPD; 24%), depression (17.8%), and posttraumatic stress disorder (PTSD; 11.8%). Comorbidity was present in 36.4% of the sample. Proportionately more white than black users were dependent on cocaine, alcohol, amphetamine, and sedative-hypnotics. More white than black users experienced ASPD, depression, PTSD, and attention deficit disorder. Proportionately fewer black users suffered comorbid disorders. Proportionately more men had ASPD, whereas more women had PTSD and phobias. Multinominal modeling revealed that black users and users with a high school education were less likely to have comorbid disorders; married users were less likely to have nondependency disorders. White crack users were more likely to have comorbidity, complicating their treatment.

GFAP mutations, age at onset, and clinical subtypes in Alexander disease

Objective: To characterize Alexander disease (AxD) phenotypes and determine correlations with age at onset (AAO) and genetic mutation. AxD is an astrogliopathy usually characterized on MRI by leukodystrophy and caused by glial fibrillary acidic protein (GFAP) mutations. Methods: We present 30 new cases of AxD and reviewed 185 previously reported cases. We conducted Wilcoxon rank sum tests to identify variables scaling with AAO, survival analysis to identify predictors of mortality, and χ2 tests to assess the effects of common GFAP mutations. Finally, we performed latent class analysis (LCA) to statistically define AxD subtypes. Results: LCA identified 2 classes of AxD. Type I is characterized by early onset, seizures, macrocephaly, motor delay, encephalopathy, failure to thrive, paroxysmal deterioration, and typical MRI features. Type II is characterized by later onset, autonomic dysfunction, ocular movement abnormalities, bulbar symptoms, and atypical MRI features. Survival analysis predicted a nearly 2-fold increase in mortality among patients with type I AxD relative to those with type II. R79 and R239 GFAP mutations were most common (16.6% and 20.3% of all cases, respectively). These common mutations predicted distinct clinical outcomes, with R239 predicting the most aggressive course. Conclusions: AAO and the GFAP mutation site are important clinical predictors in AxD, with clear correlations to defined patterns of phenotypic expression. We propose revised AxD subtypes, type I and type II, based on analysis of statistically defined patient groups.

Pretreatment cognitive deficits and treatment effects on attention in childhood absence epilepsy

Objective: To determine the neurocognitive deficits associated with newly diagnosed untreated childhood absence epilepsy (CAE), develop a model describing the factorial structure of items measuring academic achievement and 3 neuropsychological constructs, and determine short-term differential neuropsychological effects on attention among ethosuximide, valproic acid, and lamotrigine. Methods: Subjects with newly diagnosed CAE entering a double-blind, randomized controlled clinical trial had neuropsychological testing including assessments of general intellectual functioning, attention, memory, executive function, and achievement. Attention was reassessed at the week 16–20 visit. Results: At study entry, 36% of the cohort exhibited attention deficits despite otherwise intact neurocognitive functioning. Structural equation modeling of baseline neuropsychological data revealed a direct sequential effect among attention, memory, executive function, and academic achievement. At the week 16–20 visit, attention deficits persisted even if seizure freedom was attained. More subjects receiving valproic acid (49%) had attention deficits than subjects receiving ethosuximide (32%) or lamotrigine (24%) (p = 0.0006). Parental assessment did not reliably detect attention deficits before or after treatment (p < 0.0001). Conclusions: Children with CAE have a high rate of pretreatment attentional deficits that persist despite seizure freedom. Rates are disproportionately higher for valproic acid treatment compared with ethosuximide or lamotrigine. Parents do not recognize these attentional deficits. These deficits present a threat to academic achievement. Vigilant cognitive and behavioral assessment of these children is warranted. Classification of evidence: This study provides Class I evidence that valproic acid is associated with more significant attentional dysfunction than ethosuximide or lamotrigine in children with newly diagnosed CAE.

The Prevalence and Correlates of Depressive Symptomatology Among a Community Sample of Crack-Cocaine Smokers

Abstract Depression has been identified as a disorder of clinical significance among cocaine users. Even so, its prevalence in cocaine-abusing populations is uncertain. This research employed a crosssectional design to determine the prevalence of current depressive symptomatology among a sample of 430 not-in-treatment crack-cocaine users. Depression was assessed with the Beck Depression Inventory (BDI). The mean BDI score was 19.1. Overall, 80% of the sample had BDI scores that suggested more than minimal depression, and 55% had symptoms of moderate to severe depression. The results of a cumulative logistic regression analysis showed that men, African-Americans, and individuals with some college education were less likely to be depressed. Individuals with higher Addiction Severity Index composite scores for family/social, medical, legal, and alcohol problems had a greater likelihood of reporting symptoms of depression. Frequency of cocaine use and perceived need for treatment were also positively associated with higher BDI scores. The results suggest that the prevalence of depression among crack users is higher than has been previously reported. Treatment programs should routinely screen crack-cocaine users for depression. The BDI may be a suitable tool for such efforts since it has an acceptable level of internal consistency when employed with crack users (a = 0.89).

PROMIS Pediatric Measures in Pediatric Oncology: Valid and Clinically Feasible Indicators of Patient-Reported Outcomes

Establishing the ability of children and adolescents with cancer to complete the NIH‐sponsored PROMIS pediatric measures electronically and the preliminary validity estimates of the measures (both full item banks and short forms) in pediatric oncology will contribute to our knowledge of the impact of cancer treatment on these young patients.

The Validity of Injection Drug Users Self-Reported Use of Opiates and Cocaine

In a study examining the correspondence between self-reported drug use and drug urinalysis, 128 injection drug users (IDUs), who were subjects in an AIDS prevention research project, were asked to provide urine samples, which would be tested for the presence of the metabolites of opiates and cocaine. Ninety-five IDUs provided samples for testing. Of these, twenty IDUs (21.1%) who reported abstinence from opiates and cocaine for the six months prior to the completion of a follow-up questionnaire had their claims contradicted by urinalysis results. Logit regression analyses revealed that IDUs whose primary drug of choice was both crack and injected cocaine and those who were black were significantly more likely to have misrepresented their current drug use status than other groups. The implications of these findings are discussed.

CRACKING THE CORNFIELDS: Recruiting Illicit Stimulant Drug Users in Rural Ohio

This article describes the process of recruiting research subjects for a natural history study of illicit stimulant use in rural Ohio using respondent-driven sampling and ethnographic methods. Participant observation, qualitative interviews, and focus groups were used to establish the project and to evaluate and modify the sampling process as it unfolded. We outline the steps taken in several different rural counties, using ethnographic data to illustrate local differences and obstacles that were faced. The article concludes that respondent-driven sampling is a promising method for identifying and recruiting members of hidden populations in rural areas. However, adequate time must be allotted to establish ethnographic footholds and to reach various networks in separate communities.

Predictors of drug abuse treatment entry among crack-cocaine smokers

The goal of this study was to identify factors that predicted drug abuse treatment program entry among a community sample of 430 crack-cocaine users. Subjects were recruited using a targeted sampling methodology and responded to interviewer-administered questionnaires at 6 months intervals over a 3-year period. At baseline, 40.5% (n=174) reported they had never been in a drug abuse treatment program. During the observation period, 37.7% (n=162) of the sample reported they had entered a program. Of these, 43.8% (n=71) reported that their treatment was court-ordered. Slightly more than one-quarter (n=44) entered treatment for the first time. A host of variables, including individual characteristics, frequency and duration of crack use, frequency of drunkenness, Addiction Severity Index (ASI) family/social, medical, and psychiatric status composite scores, perceived need for treatment, history of treatment, and medical insurance coverage, was explored. The results of Cox proportional hazards model suggested that younger people, users with more severe legal problems, people who perceived a need for treatment, and individuals with prior treatment experience had a greater likelihood of entering treatment. Developing a strategy to practically apply these findings may facilitate treatment entry among a population involved with a dangerous and debilitating drug.

Factorial structure of Rosenberg's Self-Esteem Scale among crack-cocaine drug users.

Nine different confirmatory factor analysis (CFA) models, including CFAs with correlated traits, uniquenesses, and methods, were employed to test the factorial structure of Rosenbergs (1965) self-esteem scale in a sample of crack-cocaine drug users. The results partially support earlier research and show that (a) there exists a single global self-esteem factor underlying responses to Rosenberg scale; (b) method effects associated with item wording exist; and (c) the method effects were associated primarily with positively, rather than negatively, worded items.

The epidemiology of physical attack and rape among crack-using women.

This prospective study examines the epidemiology of physical attack and rape among a sample of 171 not-in-treatment, crack-cocaine using women. Since initiating crack use, 62% of the women reported suffering a physical attack. The annual rate of victimization by physical attack was 45%. Overall, more than half of the victims sought medical care subsequent to an attack. The prevalence of rape since crack use was initiated was 32%, and the annual rate was 11%. Among those women having been raped since they initiated crack use, 83% reported they were high on crack when the crime occurred as were an estimated 57% of the perpetrators. Logistic regression analyses showed that duration of crack use, arrest for prostitution, and some college education were predictors of having experienced a physical attack. Duration of crack use and a history of prostitution were predictors of suffering a rape. Drug abuse treatment programs must be sensitive to high levels of violence victimization experienced by crack-cocaine using women. Screening women for victimization, and treating the problems that emanate from it, may help make drug abuse treatment more effective.