Sandeep Vaishnavi

An abbreviated version of the Connor-Davidson Resilience Scale (CD-RISC), the CD-RISC2: psychometric properties and applications in psychopharmacological trials.

Resilience may be an important component of the prevention of neuropsychiatric disease. Resilience has proved to be quantifiable by scales such as the Connor-Davidson Resilience Scale (CD-RISC). Here, we introduce a two-item version of this scale, the CD-RISC2. We hypothesize that this shortened version of the scale has internal consistency, test-retest reliability, convergent validity, and divergent validity as well as significant correlation with the full scale. Additionally, we hypothesize that the CD-RISC2 can be used to assess pharmacological modification of resilience. We test these hypotheses by utilizing data from treatment trials of post-traumatic stress disorder, major depression, and generalized anxiety disorder with setraline, mirtazapine, fluoxetine, paroxetine, venlafaxine XR, and kava as well as data from the general population, psychiatric outpatients, and family medicine clinic patients.

Neuropsychiatric Problems After Traumatic Brain Injury: Unraveling the Silent Epidemic

BACKGROUND Traumatic brain injury (TBI) is a significant public health concern. According to the Centers for Disease Control and Prevention, about 1.4 million people in the United States sustain a TBI annually. OBJECTIVE This review places particular emphasis on the current knowledge of effective treatment of TBI symptoms, and proposes directions for future research. RESULTS Neuropsychiatric problems are more prevalent and longer-lasting in TBI patients than in the general population. About 40% of TBI victims suffer from two or more psychiatric disorders, and a similar percentage experience at least one unmet need for cognitive, emotional, or job assistance 1 year after injury. The entire spectrum of TBI severity, from mild to severe, is associated with an increase in psychiatric conditions. CONCLUSION Despite the high incidence of severe consequences of TBI, there are scarce empirical data to guide psychiatric treatment. Some approaches that have been helpful include cognitive and behavioral therapy and pharmacologic treatment. The authors list specific research recommendations that could further identify useful therapeutic interventions.

Aggression after traumatic brain injury: prevalence and correlates

Aggression after traumatic brain injury (TBI) is common but not well defined. Sixty-seven participants with first-time TBI were evaluated for aggression within 3 months of injury. The prevalence of aggression was found to be 28.4%, predominantly verbal aggression. Post-TBI aggression was associated with new-onset major depression (p=0.02), poorer social functioning (p=0.04), and increased dependency in activities of daily living (p=0.03), but not with a history of substance abuse or adult/childhood behavioral problems. Implications of the study include early screening for aggression, evaluation for depression, and consideration of psychosocial support in aggressive patients.

Prevalence and types of sleep disturbances acutely after traumatic brain injury

Primary objective: To assess the prevalence of and risk factors for sleep disturbances in the acute post-traumatic brain injury (TBI) period. Research design: Longitudinal, observational study. Methods and procedures: Fifty-four first time closed-head injury patients were recruited and evaluated within 3 months after injury. Pre-injury and post-injury sleep disturbances were compared on the Medical Outcome Scale for Sleep. The subjects were also assessed on anxiety, depression, medical comorbidity and severity of TBI. Main outcomes and results: Subjects were worse on most sleep measures after TBI compared to before TBI. Anxiety disorder secondary to TBI was the most consistent significant risk factor to be associated with worsening sleep status. Conclusions: Anxiety is associated with sleep disturbances after TBI. Further studies need to be done to evaluate if this is a causal relationship.

Subitizing and counting depend on different attentional mechanisms: Evidence from visual enumeration in afterimages

Two experiments showed that, when selective eye movements were disabled by the presentation of stimuli in the form of afterimages, increased inspection time and facilitative stimulus configurations failed to increase the subitizing limit of 4 objects. Afterimages of two to eight dots induced by a photographic flashgun were shown to 3 adult subjects. For more than 4 objects, enumeration errors occurred at a rate of 20%–30%. Enumeration was effectively perfect for 2–4 linearly configured dots, with occasional errors surprisingly occurring in that range when dots appeared in groups of up to 3 items. No errors occurred in nonafterimage control conditions. Enumeration errors were attributed to failures of individuating dots to be counted due to the deactivation of selective eye movements in afterimages. A third experiment supported this interpretation by disabling eye movements with briefly presented stimuli and producing results much like those of the afterimage conditions.

Quetiapine as monotherapy for social anxiety disorder: a placebo-controlled study.

Social anxiety disorder (SAD) is one of the most common anxiety disorders. Reports have suggested an effect of the atypical antipsychotic quetiapine in anxiety disorders. Given these considerations, we conducted a controlled trial of quetiapine monotherapy in SAD. Fifteen patients were randomized to quetiapine (up to 400 mg/day) or placebo for 8 weeks. The Brief Social Phobia Scale (BSPS) and the Clinical Global Impression of Improvement Scale (CGI-I) were the primary outcome measures, while the Social Phobia Inventory (SPIN) and the Sheehan Disability Inventory (SDI) were secondary measures. There was no significant difference on the BSPS score at endpoint between the quetiapine and placebo groups. There was a significant time effect but not a significant time x treatment group interaction, indicating that both the quetiapine and placebo patients did better over the course of the trial. 20% of the quetiapine patients had a 50% or greater drop in BSPS score at the end of the trial compared to baseline, while 0% had such a drop in the placebo group. There was no significant difference in responders (CGI-I score of 1 or 2) versus non-responder (CGI-I score of 3 or more) across the groups. However, 40% of quetiapine patients and 0% of the placebo patients showed much or very much improvement on the CGI-I. The Number Needed to Treat (NNT) to be a responder on the CGI-I was 3. Significant time effects were noted for the SPIN and SDI, as well as a significant time x treatment effect in favor of quetiapine on the SPIN. Additionally, quetiapine showed a large effect size on the SPIN.

Perceived stress in anxiety disorders and the general population: A study of the Sheehan stress vulnerability scale

The objectives of this study were to (1) validate and establish normative values for a single-item, self-rated measure of perceived stress, the Stress Vulnerability Scale (SVS); and (2) compare levels of perceived stress in patients with anxiety disorders with the general population. The sample was drawn from the general population (n=630) and from participants in pharmacotherapy trials of anxiety disorders (social phobia, n=127; posttraumatic stress disorder, n=116). The SVS was administered at baseline in all groups and following treatment in the placebo-controlled clinical trial samples. The SVS demonstrated good reliability and validity. Pretreatment scores in the anxiety disorders were significantly greater than in the general population. Perceptions of vulnerability to the effects of daily stress are considerably greater in anxiety disorders compared to the general population and also differ within the anxiety disorders.

Modafinil for atypical depression: effects of open-label and double-blind discontinuation treatment.

Abstract: Atypical depression, with features of hypersomnia, hyperphagia, anergia, and rejection sensitivity, is a common presentation of major depressive disorder. There are few available effective therapies for this disorder. We test modafinil, a novel wake-promoting agent, as monotherapy for atypical depression in a double-blind, placebo-controlled, relapse prevention trial after open-label treatment. We found that modafinil significantly improved atypical depression symptoms during 12 weeks of open-label treatment (mean ± SD Hamilton Depression Scale (29-item version) score changed from 34 ± 8.2 at baseline to 9.7 ± 9.3, P < 0.0001), and that benefits were maintained alike in both the continuation and placebo arms during the double-blind treatment phase (P = 0.92). Modafinil was well tolerated and the drug was associated with significant weight loss compared with placebo (P = 0.01).

Neuroimaging in late-life depression.

Late-life depression may be associated with vasculopathy. Neuroimaging has been a critical tool in exploring the relationship between this form of depression and vascular factors. Magnetic resonance imaging has been the most widely used tool, but there is potential to use other structural imaging techniques as well as functional neuroimaging methodologies. Neuroimaging may potentially be utilized at some point as a biomarker for late-life depression, thus helping with diagnosis and guiding treatment.

A deficit of intermediate vision: Experimental observations and theoretical implications

Abstract The nervous system constructs visual representations hierarchically. Elementary features are extracted from the visual scene and grouped to form candidate objects, which may then be selected for attentional scrutiny. We wished to learn if intermediate vision (pre-attentive and effortiess grouping processes) can be damaged selectively and, if so, what the consequences of such damage might be. We present a patient with slgnificant visual disabilities following a traumatic brain injury. Her early vision was preserved. However, she had a deficit of intermediate vision as evidenced by an inability to: (i) link visual attributes into perceptual wholes effortlessly, (ii) search for visual targets pre-attentively and (iii) accurately perceive illusory contours. By contrast, she could deploy attention both panoramically and selectively. She also recognized real objects and described pictures. We conclude that intermediate vision can be damaged selectively. Attention can be deployed on a visual scene which...