Robert H. Pietrzak

Overweight and Obesity Are Associated With Psychiatric Disorders: Results From the National Epidemiologic Survey on Alcohol and Related Conditions

Objective: This study evaluated associations between body mass index (BMI) and psychiatric disorders. Methods: Data from 41,654 respondents in the National Epidemiologic Survey on Alcohol and Related Conditions were analyzed. Results: After controlling for demographics, the continuous variable of BMI was significantly associated with most mood, anxiety, and personality disorders. When persons were classified into BMI categories of underweight, normal weight, overweight, obese, and extremely obese, both obese categories had significantly increased odds of any mood, anxiety, and alcohol use disorder, as well as any personality disorder, with odds ratios (ORs) ranging from 1.21 to 2.08. Specific Diagnostic and Statistical Manual of Mental Disorders-revision IV mood and personality disorders associated with obesity included major depression, dysthmia, and manic episode (ORs, 1.45–2.70) and antisocial, avoidant, schizoid, paranoid, and obsessive-compulsive personality disorders (ORs, 1.31–2.55). Compared with normal weight individuals, being moderately overweight was significantly associated with anxiety and some substance use disorders, but not mood or personality disorders. Specific anxiety disorders that occurred at significantly higher rates among all categories of persons exceeding normal weight were generalized anxiety, panic without agoraphobia, and specific phobia (ORs, 1.23–2.60). Being underweight was significantly related to only a few disorders; it was positively related to specific phobia (OR, 1.31) and manic episode (OR, 1.83), and negatively associated with social phobia (OR, 0.60), panic disorder with agoraphobia (OR, 0.40), and avoidant personality disorder (OR, 0.59). Conclusion: These data provide a systematic and comprehensive assessment of the association between body weight and psychiatric conditions. Interventions addressing weight loss may benefit from integrating treatment for psychiatric disorders. NIAAA = National Institute on Alcohol Abuse and Alcoholism; NESARC = National Epidemiologic Survey on Alcohol and Related Conditions; AUDADIS = Alcohol Use Disorder and Associated Disabilities Interview Schedule; DSM-IV = Diagnostic and Statistical Manual of Mental Disorders- Fourth Edition; BMI = body mass index; OR = odds ratio; CI = confidence intervals.

Prevalence and Axis I Comorbidity of Full and Partial Posttraumatic Stress Disorder in the United States: Results from Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions

The present study used data from the Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions (n = 34,653) to examine lifetime Axis I psychiatric comorbidity of posttraumatic stress disorder (PTSD) in a nationally representative sample of U.S. adults. Lifetime prevalences ± standard errors of PTSD and partial PTSD were 6.4% ± 0.18 and 6.6% ± 0.18, respectively. Rates of PTSD and partial PTSD were higher among women (8.6% ± 0.26 and 8.6% ± 0.26) than men (4.1% ± 0.19 and 4.5% ± 0.21). Respondents with both PTSD and partial PTSD most commonly reported unexpected death of someone close, serious illness or injury to someone close, and sexual assault as their worst stressful experiences. PTSD and partial PTSD were associated with elevated lifetime rates of mood, anxiety, and substance use disorders, and suicide attempts. Respondents with partial PTSD generally had intermediate odds of comorbid Axis I disorders and psychosocial impairment relative to trauma controls and full PTSD.

Psychosocial buffers of traumatic stress, depressive symptoms, and psychosocial difficulties in veterans of Operations Enduring Freedom and Iraqi Freedom: The role of resilience, unit support, and postdeployment social support

BACKGROUND Little research has examined the role of protective factors such as psychological resilience, unit support, and postdeployment social support in buffering against PTSD and depressive symptoms, and psychosocial difficulties in veterans of Operations Enduring Freedom (OEF) and Iraqi Freedom (OIF). MATERIALS AND METHODS A total of 272 OEF/OIF veterans completed a survey containing PTSD and depression screening measures, and questionnaires assessing resilience, social support, and psychosocial functioning. RESULTS Lower unit support and postdeployment social support were associated with increased PTSD and depressive symptoms, and decreased resilience and psychosocial functioning. Path analyses suggested that resilience fully mediated the association between unit support and PTSD and depressive symptoms, and that postdeployment social support partially mediated the association between PTSD and depressive symptoms and psychosocial functioning. LIMITATIONS Generalizability of results is limited by the relatively low response rate and predominantly older and reserve/National Guard sample. CONCLUSIONS These results suggest that interventions designed to bolster unit support, resilience, and postdeployment support may help protect against traumatic stress and depressive symptoms, and improve psychosocial functioning in veterans.

Validity of the CogState Brief Battery: Relationship to Standardized Tests and Sensitivity to Cognitive Impairment in Mild Traumatic Brain Injury, Schizophrenia, and AIDS Dementia Complex

This study examined the validity of the four standard psychological paradigms that have been operationally defined within the CogState brief computerized cognitive assessment battery. Construct validity was determined in a large group of healthy adults. CogState measures of processing speed, attention, working memory, and learning showed strong correlations with conventional neuropsychological measures of these same constructs (rs = .49 to .83). Criterion validity was determined by examining patterns of performance on the CogState tasks in groups of individuals with mild head injury, schizophrenia, and AIDS dementia complex. Each of these groups was impaired on the CogState performance measures (Cohens ds = -.60 to -1.80) and the magnitude and nature of this impairment was qualitatively and quantitatively similar in each group. Taken together, the results suggest that the cognitive paradigms operationally defined in the CogState brief battery have acceptable construct and criterion validity in a neuropsychological context.

Risk and protective factors associated with suicidal ideation in veterans of Operations Enduring Freedom and Iraqi Freedom

BACKGROUND Little is known about variables associated with suicidality in veterans of Operations Enduring Freedom and Iraqi Freedom (OEF/OIF). METHODS A total of 272 OEF/OIF veterans completed a survey containing measures of psychopathology, resilience, and social support. Thirty-four respondents (12.5%) reported contemplating suicide in the two weeks prior to completing the survey. RESULTS Suicide contemplators were more likely to screen positive for posttraumatic stress disorder (PTSD), depression, and an alcohol problem, and scored higher on measures of psychosocial difficulties, stigma, and barriers to care, and lower on measures of resilience and social support. Logistic regression analysis revealed that positive PTSD and depression screens, and increased psychosocial difficulties were associated with suicidal ideation, and that increased postdeployment social support and sense of purpose and control were negatively associated with suicidal ideation. CONCLUSIONS Interventions for PTSD, depression, and psychosocial difficulties, and to bolster postdeployment social support and resilience may be helpful in preventing suicidal ideation in OEF/OIF veterans.

Cognitive effects of immediate-release methylphenidate in children with attention-deficit/hyperactivity disorder

A growing body of literature has examined the cognitive effects of immediate-release methylphenidate in children with attention-deficit/hyperactivity disorder (ADHD). However, a clear understanding of the types and magnitude of such effects are difficult to discern from such a large and varied collection of published reports. This review evaluated a total of 40 relevant placebo-controlled studies published since Rapport and Kellys [1993. Psychostimulant effects on learning and cognitive function. In: Matson, J.L. (Ed.), Handbook of Hyperactivity in Children. Allyn & Bacon, Boston, pp. 97-136] original review of cognitive effects of methylphenidate in children with ADHD. Of these published studies, 63.5% identified some improvement in cognitive function following methylphenidate treatment. Methylphenidate improved performance on saccadic eye movement, planning/cognitive flexibility, attention/vigilance, and inhibitory control tasks in 83.3%, 71.4%, 70.6%, and 69.7% of studies, respectively. A total 58.3% and 50% of studies that evaluated the effect of methylphenidate on tasks of memory and working memory/divided attention, respectively, noted improvement. Variability of findings across studies may be explained by differential effects of methylphenidate on brain function, intra- and inter-individual variability in medication response, methodological limitations, and problems associated with repeated neuropsychological assessment and metric properties of commonly utilised neuropsychological instruments.

Persistence of multiple illnesses in World Trade Center rescue and recovery workers: a cohort study.

BACKGROUND More than 50,000 people participated in the rescue and recovery work that followed the Sept 11, 2001 (9/11) attacks on the World Trade Center (WTC). Multiple health problems in these workers were reported in the early years after the disaster. We report incidence and prevalence rates of physical and mental health disorders during the 9 years since the attacks, examine their associations with occupational exposures, and quantify physical and mental health comorbidities. METHODS In this longitudinal study of a large cohort of WTC rescue and recovery workers, we gathered data from 27,449 participants in the WTC Screening, Monitoring, and Treatment Program. The study population included police officers, firefighters, construction workers, and municipal workers. We used the Kaplan-Meier procedure to estimate cumulative and annual incidence of physical disorders (asthma, sinusitis, and gastro-oesophageal reflux disease), mental health disorders (depression, post-traumatic stress disorder [PTSD], and panic disorder), and spirometric abnormalities. Incidence rates were assessed also by level of exposure (days worked at the WTC site and exposure to the dust cloud). FINDINGS 9-year cumulative incidence of asthma was 27·6% (number at risk: 7027), sinusitis 42·3% (5870), and gastro-oesophageal reflux disease 39·3% (5650). In police officers, cumulative incidence of depression was 7·0% (number at risk: 3648), PTSD 9·3% (3761), and panic disorder 8·4% (3780). In other rescue and recovery workers, cumulative incidence of depression was 27·5% (number at risk: 4200), PTSD 31·9% (4342), and panic disorder 21·2% (4953). 9-year cumulative incidence for spirometric abnormalities was 41·8% (number at risk: 5769); three-quarters of these abnormalities were low forced vital capacity. Incidence of most disorders was highest in workers with greatest WTC exposure. Extensive comorbidity was reported within and between physical and mental health disorders. INTERPRETATION 9 years after the 9/11 WTC attacks, rescue and recovery workers continue to have a substantial burden of physical and mental health problems. These findings emphasise the need for continued monitoring and treatment of the WTC rescue and recovery population. FUNDING Centers for Disease Control and Prevention and National Institute for Occupational Safety and Health.

Elevated brain cannabinoid CB1 receptor availability in post-traumatic stress disorder: a positron emission tomography study.

Endocannabinoids and their attending cannabinoid type 1 (CB1) receptor have been implicated in animal models of post-traumatic stress disorder (PTSD). However, their specific role has not been studied in people with PTSD. Herein, we present an in vivo imaging study using positron emission tomography (PET) and the CB1-selective radioligand [11C]OMAR in individuals with PTSD, and healthy controls with lifetime histories of trauma (trauma-exposed controls (TC)) and those without such histories (healthy controls (HC)). Untreated individuals with PTSD (N=25) with non-combat trauma histories, and TC (N=12) and HC (N=23) participated in a magnetic resonance imaging scan and a resting PET scan with the CB1 receptor antagonist radiotracer [11C]OMAR, which measures the volume of distribution (VT) linearly related to CB1 receptor availability. Peripheral levels of anandamide, 2-arachidonoylglycerol, oleoylethanolamide, palmitoylethanolamide and cortisol were also assessed. In the PTSD group, relative to the HC and TC groups, we found elevated brain-wide [11C]OMAR VT values (F(2,53)=7.96, P=0.001; 19.5% and 14.5% higher, respectively), which were most pronounced in women (F(1,53)=5.52, P=0.023). Anandamide concentrations were reduced in the PTSD relative to the TC (53.1% lower) and HC (58.2% lower) groups. Cortisol levels were lower in the PTSD and TC groups relative to the HC group. Three biomarkers examined collectively—OMAR VT, anandamide and cortisol—correctly classified nearly 85% of PTSD cases. These results suggest that abnormal CB1 receptor-mediated anandamide signaling is implicated in the etiology of PTSD, and provide a promising neurobiological model to develop novel, evidence-based pharmacotherapies for this disorder.

Gender Differences in Associations Between Body Mass Index and DSM-IV Mood and Anxiety Disorders: Results from the National Epidemiologic Survey on Alcohol and Related Conditions

PURPOSE The purpose of this study is to examine gender differences in associations between body mass index (BMI) and affective disorders. METHODS We used logistic regression to examine the effects of BMI and gender on Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) mood and anxiety disorders in a sample of 40,790 adults. RESULTS Obesity (BMI >30.0) was associated with increased risk for any mood disorder, major depressive disorder, and dysthymic disorder, in both men and women (odds ratios [ORs], 1.35-1.88). Risk of bipolar I and II disorders was elevated in obese women (ORs, 1.70-2.41) but not men. Overweight (BMI = 25.0-29.9) predicted increased risk for any mood disorder and bipolar I disorder in women but not in men (ORs, 1.16-1.44). Obesity was associated with increased odds of any anxiety disorder and specific phobia in men and women (ORs, 1.35-1.79). Obese women were additionally at increased risk for social phobia. Overweight predicted increased risk of social phobia and specific phobia for women but not for men (ORs, 1.27-1.37). CONCLUSIONS Obese individuals of both genders are at increased risk for a range of mood and anxiety disorders, but women who are even moderately overweight experience increased risks for some disorders as well.

Health problems and medical utilization associated with gambling disorders: results from the National Epidemiologic Survey on Alcohol and Related Conditions.

Objective: Pathologic gambling is believed to be associated with adverse health consequences, but no prior studies have rigorously evaluated these relationships. We sought to examine medical disorders and health service utilization associated with problem and pathologic gambling. Method: A total of 43,093 adults aged 18 years and older were evaluated in the 2001 to 2002 National Epidemiologic Survey on Alcohol and Related Conditions. Self-reported medical diagnoses and past-year medical services used were assessed. Results: Pathologic gamblers were more likely than low-risk individuals to have been diagnosed with tachycardia (odds ratio [OR] = 1.77; 95% confidence interval [CI] = 1.05–2.97), angina (OR = 2.35; 95% CI = 1.33–4.15), cirrhosis (OR = 3.90; 95% CI = 1.11–13.72), and other liver disease (OR = 2.98; 95% CI = 1.07–8.26). Gambling severity was also associated with higher rates of medical utilization with pathologic gamblers more likely than low-risk individuals to have been treated in the emergency room in the year before the survey (OR = 1.98; 95% CI = 1.27–3.09). Significant effects of gambling severity remained even after controlling for demographic characteristics (age, gender, ethnicity, marital status, education, income, and region of the country) and behavioral risk factors such as body mass index, alcohol abuse and dependence, nicotine dependence, and mood and anxiety disorders. Conclusions: A lifetime diagnosis of pathologic gambling is associated with several medical disorders and increased medical utilization, perhaps leading to a burden on healthcare costs in the United States. AUDADIS-IV = Alcohol Use Disorder and Associated Disabilities Interview Schedule-IV; BMI = body mass index; CI = confidence interval; DSM-IV = Diagnostic and Statistical Manual of Mental Disorders–Fourth Edition; ER = emergency room; NESARC = National Epidemiologic Survey on Alcohol and Related Conditions; NIAAA = National Institute on Alcohol Abuse and Alcoholism; OR = odds ratio; SES = socioeconomic status; SF-12v2 = Short-Form Health Survey, Version 2.