Randolph J. Canterbury

Daily left prefrontal repetitive transcranial magnetic stimulation in the acute treatment of major depression: Clinical predictors of outcome in a multisite, randomized controlled clinical trial

Randomized controlled trials support the antidepressant efficacy of transcranial magnetic stimulation (TMS); however, there is individual variability in the magnitude of response. Examination of response predictors has been hampered by methodological limitations such as small sample sizes and single-site study designs. Data from a multisite sham-controlled trial of the antidepressant efficacy of TMS provided an opportunity to examine predictors of acute outcome. An open-label extension for patients who failed to improve provided the opportunity for confirmatory analysis. Treatment was administered to the left dorsolateral prefrontal cortex at 10 pulses per second, 120% of motor threshold, for a total of 3000 pulses per day. Change on the Montgomery–Asberg Depression Rating Scale after 4 weeks was the primary efficacy outcome. A total of 301 patients with nonpsychotic unipolar major depression at 23 centers were randomized to active or sham TMS. Univariate predictor analyses showed that the degree of prior treatment resistance in the current episode was a predictor of positive treatment outcome in both the controlled study and the open-label extension trial. In the randomized trial, shorter duration of current episode was also associated with a better outcome. In the open-label extension study, absence of anxiety disorder comorbidity was associated with an improved outcome, but duration of current episode was not. The number of prior treatment failures was the strongest predictor for positive response to acute treatment with TMS. Shorter duration of current illness and lack of anxiety comorbidity may also confer an increased likelihood of good antidepressant response to TMS.

Prevalence of HIV-related risk behaviors and STDs among incarcerated adolescents

PURPOSE To determine the HIV-related risk behaviors and STDs in a population of incarcerated adolescents in order to strategically target education and prevention efforts. METHODS A single point-in-time prevalence study based on an analysis of intake medical records of 1,215 incarcerated youth were analyzed for HIV risk behaviors and STD history. RESULTS Incarcerated adolescents report high rates of risk behaviors for HIV infection and STDs, with 75% reporting three or more sex partners, 25% never using condoms and 19% having a current diagnosis of at least one STD. Significantly more females than males reported a history of STDs and had higher rates of current diagnoses of chlamydia/non-gonococcal urethritis, trichomonas and gonorrhea. CONCLUSIONS Ethnic/racial and gender differences were found in risk behaviors for STDs among a sample of incarcerated adolescents.

Delinquency and family problems in incarcerated adolescents with and without a history of inhalant use

In this retrospective study of incarcerated adolescents, inhalants were used by significantly more nonminority than minority youth. Among both minority and nonminority groups, family problems and delinquent behaviors were higher among those youth with a history of inhalant use than those who reported no use. Family problems included history of running away from home, breaking rules, fighting with parents, and having relatives who had attempted suicide. Delinquent behavior included earlier personal use of drugs, selling illegal drugs, buying drugs from dealers, committing crimes while under the influence, committing crimes to get money to buy drugs, and threatening to hurt people.

Suicidal behavior in patients with adjustment disorders

This retrospective study characterizes the suicidal behavior in 119 patients with Axis I adjustment disorders as assessed by psychiatrists at the University of Virginia Hospital. Results indicated that 72 patients (60.5%) had documented suicide attempts in the past, 96% had been suicidal during their admission to the hospital, and 50% had attempted suicide before their hospitalization. The most commonly used method of suicide attempts was overdosing. Of the sample group with suicide attempts in the past, 67% had Axis II diagnoses of borderline personality disorder and antisocial personality disorder. Adjustment disorder diagnosis in patients with the suicide attempts was associated with a high level of suicidality at admission, involuntary hospitalization and substance-abuse disorders. Axis II diagnoses in patients with adjustment disorders constituted risk factors for further suicidal behavior. Additional future prospective studies with reliability checks on diagnosis of adjustment disorders and suicidal behavior are needed.

Acute Stress Disorder Following Diagnosis of Cancer

We conducted a study to examine prevalence, predictors, and concomitants of acute stress disorder (ASD) following diagnosis of cancer among 89 patients. In addition to other measures, each participant completed the Stanford Acute Stress Reaction Questionnaire (SASRQ). One-third (33%) of the sample met all ASD symptom criteria. Significantly more women than men met criteria for ASD. For women, predictors for ASD symptoms included being of a younger age, having no prior life-threatening illness, perceiving less social support from friends, and reporting less satisfaction with how the diagnosis got communicated to them. A statistical trend was evident between higher religious/spiritual commitment and fewer ASD symptoms. For men, no factors were significantly related to ASD symptoms. Overall among cancer patients, those who met symptom criteria for ASD reported significantly more impulsive spending, desire to run away to avoid contact with people, giving away personal belongings, thinking about suicide, and forgetting medical information following cancer diagnosis than did cancer patients who did not meet criteria for ASD.

Psychiatric Functioning and Substance Use: Factors Associated with HIV Risk Among Incarcerated Adolescents

This study examined several types of psychiatric functioning (neuropsychiatric, emotional, and cognitive functioning) and substance use in relation to HIV risk behavior among 894 incarcerated girls and boys. Youth remanded to juvenile correctional facilities in a southern US state completed a structured interview regarding abuse history, emotional and behavioral difficulties, and demographics. Adolescents who experienced sullen affect were significantly more likely to engage in behaviors that put them at risk for HIV infection. Moreover, higher levels of alcohol use predicted HIV risk behavior. HIV prevention efforts need to address emotional distress as well as substance use among delinquent adolescents to reduce HIV risk behavior. Implications for treatment and future research are discussed.

Delinquents safe sex attitudes. Relationships with demographics resilience factors and substance use.

This study examined demographic and psychosocial factors associated with safe sex attitudes among incarcerated adolescents. Researchers and correction staff interviewed 820 adolescents (691 males and 129 females) incarcerated in the Virginia juvenile justice system concerning safe sex attitudes, gender, age, ethnicity, length of time lived with biological father and mother, HIV/AIDS knowledge, self-esteem, hopefulness, perceived social support from family, alcohol use, and drug use. The results indicated that safe sex attitudes were positively related to being female, being African American, and having higher HIV/AIDS knowledge, self-esteem, and hopefulness, and they were negatively related to alcohol use and drug use. Resilience factors such as HIV/AIDS knowledge, self-esteem, and hopefulness may be an especially salient component of HIV prevention in incarcerated adolescents.

Consistency in Drug Use Self-Reported by Incarcerated Adolescents to Correctional Staff vs. Research Interviewers

Abstract Incarcerated adolescents are typically evaluated for their substance abuse treatment needs, often based on self-report information if their offense is not related to abuse. This study tests consistency of self-reports of alcohol and drug use by comparing responses youth give to corrections staff and to university research interviewers only weeks apart. Significantly more incarcerated adolescents (n= 894) report lifetime drug and alcohol use to researchers than to correctional staff. Sex and ethnic differences were found. Overall, a correlation of .57 is found between prevalence of alcohol and drug use as measured by the correctional staff and that measured by the researchers.

Alcoholism and Drug Abuse

One of the greatest public health problems in the United States today is alcoholism and drug abuse. Alcoholism alone is responsible for more morbidity than all the cancers and respiratory diseases combined. The lifetime incidence of alcoholism has been estimated at approximately 10% for men and 3% for women. There is a strong familial trend for the disease evidenced by the two times or greater risk for the identical twin of an alcoholic to share the disease as compared to a fraternal twin. Adoption studies demonstrate a fourfold increase in the incidence of alcoholism in children of alcoholic biological parents adopted at birth as compared to adopted children of nonalcoholic biological parents.1,2 Not only is the disease a major one today, but its prevalence appears to be increasing. It is estimated that the consumption of alcohol in the United States has increased by 30% during the last 20 years resulting, in the current mean consumption per year by Americans over the age of 14 of 2.75 gallons of absolute ethanol.3