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Aims: The aim of this study is to demonstrate the utility of recursive partitioning (RP) for analyzing process and outcome data in drug treatment research. The basic methodology of RP is introduced and applied to the prediction of treatment retention., Methods: A total of 315 individuals randomly assigned to one of two treatment conditions; 289 (91.7%) completed a comprehensive baseline assessment battery. Treatment retention was assessed at a 52-week follow-up interview., Findings: The RP approach was successful in generating a parsimonious decision tree that predicted drug treatment retention from the 195 input variables. Severity of drug use (as indicated by length of time speedballing), criminal behavior (as indicated by history of property crimes), level of insight, social network, and age at intake were predictive of treatment retention. The model is estimated to explain 32% of the variability in the population., Conclusions: RP supports the notion that there are early indicators of treatment retention and that specific approaches that are tailored to individuals' needs will be potentially more successful in treatment engagement and retention than the typical "one size fits all" approach. The results also demonstrate the utility of RP for the detection of complex relationships between diverse and interdependent predictors.

Background: Prenatal antidepressant use has been associated with shorter pregnancy duration and an increased risk for preterm birth. This study measured saliva levels of estriol, a hormone that increases exponentially in the few weeks before spontaneous labor, in pregnant women with and without antidepressant treatment., Methods: Saliva estriol levels were obtained across the day at three time points during pregnancy in 77 subjects with a history of DSM-IV major depressive disorder (MDD) who were treated with antidepressants in pregnancy (Group 1), a history of DSM-IV MDD who were not treated or had limited exposure to antidepressants during pregnancy (Group 2), and a normal control group (Group 3)., Results: Mean estriol levels in the second half of pregnancy were significantly higher for Group 1 (history of MDD, on meds) than Group 2 (history of MDD, off meds) or Group 3 (control)., Conclusions: Prenatal antidepressant use was associated with significantly higher saliva estriol levels in the second half of pregnancy. Whether estriol reflects a causal mechanism by which women on antidepressants have shorter pregnancy duration remains to be further studied.

Brain atrophy and decline in executive functioning have been reported during late life, but the relationship between the 2 phenomena is not clear. To examine associations between executive tasks and morphometry, MRIs of the prefrontal cortex from 23 healthy elders were manually masked and automatically segmented. Total brain matter of the bilateral orbitofrontal, anterior cingulate, gyrus rectus, precentral gyrus, and middle frontal gyrus were computed as ratios of intracranial volume. A neuropsychological battery of five clinical tests of executive function was administered. Better performance on a response inhibition task was associated with larger volume in anterior cingulate, and performance on a nonverbal inductive reasoning task was associated with larger gyrus rectus volumes. In contrast, larger orbitofrontal volumes were associated with lower verbal and nonverbal generative output. An aggregated error index from 4 executive tests correlated negatively with a regional composite brain index. In conclusion, some executive abilities correlate with volumes of specific prefrontal subregions despite a robust neural interconnectedness between the subregions., (PsycINFO Database Record (c) 2008 APA, all rights reserved.)

Objective: Self-perceived emotional vitality, intact mood, physical activity, and social engagement are recognized as important indicators for lowered rates of morbidity and increased longevity in late-life, but little is known about their underlying neural substrates. This study examined relationships between self-reported levels of general functioning and the combined volume of three integrated prefrontal structures associated with self-perception and emotion., Design: Cross-sectional., Setting: UCLA Semel Institute for Neuroscience, Los Angeles., Participants: Depressed (N = 43) and comparison (N = 41) elderly subjects., Measurements: Magnetic resonance images of orbitofrontal, gyrus rectus, and anterior cingulate gray and white matter volumes were corrected for intracranial volume and combined across structures to form white matter and gray matter scales. Subjects completed the RAND Short-Form 36 Questionnaire, a self-report evaluation of daily functioning. Subscales used for analysis were physical function, energy, and general health, which were not correlated with depression., Results: White matter volumes were associated with self-perceptions of Energy for healthy as well as depressed individuals, and gray matter volume was associated with General Health. This latter association was strongest among patients with late-onset of depression, i.e., onset > age 50, although it appeared in all diagnostic groups., Conclusions: Although mild to moderate atrophy is expected in late-life, prefrontal atrophy may represent changes to neuroanatomic substrates that qualitatively modulate self-perceptions of energy and general health for both depressed and nondepressed persons.

Non-adherence with recommended immunosuppressant medications is common post-pediatric liver transplant and is the most important reason for organ rejection in long-term survivors. However, there is currently no validated, standard method to measure adherence, with a well-defined threshold, making it extremely difficult to evaluate interventions to improve adherence. Previous studies have suggested that the degree of fluctuation of medication blood levels over time can provide an idea about how regularly the medication is being taken. The present study, conducted at UCLA medical center, sought to identify a specific threshold value of the s.d. of individual tacrolimus blood levels in pediatric liver transplant recipients which would be associated with rejection episodes in these patients. A threshold of 3.0 has been identified in other studies, and was supported by the analysis of retrospective data from 96 subjects. However, further analysis found that a s.d. of 2.5 appeared to have a better fit with the data. These findings suggest the utility of monitoring the s.d. of routine tacrolimus blood levels in pediatric liver transplant recipients for detecting non-adherence to immunosuppressant medication prior to clinical rejection, allowing earlier interventions.

Objective: The authors evaluated the effects of prenatal antidepressant exposure and maternal depression on infant gestational age at birth and risk of preterm birth., Method: Ninety women were followed in a prospective, naturalistic design through pregnancy with monthly assessments of symptoms of depression and anxiety using the Structured Clinical Interview for DSM-IV mood module for depression, the Hamilton Depression Rating Scale, the Beck Depression Inventory, and the Perceived Stress Scale. Participants included 49 women with major depressive disorder who were treated with antidepressants during pregnancy (group 1), 22 women with major depressive disorder who were either not treated with antidepressants or had limited exposure to them during pregnancy (group 2), and 19 healthy comparison subjects (group 3). The primary outcome variables were the infants' gestational age at birth, birth weight, 1- and 5-minute Apgar scores, and admission to the special care nursery., Results: Groups 1, 2, and 3 differed significantly in gestational age at birth (38.5 weeks, 39.4 weeks, 39.7 weeks, respectively), rates of preterm birth (14.3%, 0%, 5.3%, respectively), and rates of admission to the special care nursery (21%, 9%, 0%, respectively). Birth weight and Apgar scores did not differ significantly between groups. Mild to moderate depression during pregnancy did not affect outcome measures., Conclusions: Prenatal antidepressant use was associated with lower gestational age at birth and an increased risk of preterm birth. Presence of depressive symptoms was not associated with this risk. These results suggest that medication status, rather than depression, is a predictor of gestational age at birth.

Objectives: Patients with bipolar disorder (BD) have an increased risk of obesity as well as psychotropic-associated weight gain. The objective of this study was to compare sibutramine and topiramate as adjunctive treatments for psychotropic-associated weight gain in overweight or obese outpatients with BD., Methods: In this 24-week, open-label, flexible-dose, comparison trial, 46 outpatients with bipolar disorders who had a body mass index (BMI) > or =30 kg/m(2), or > or =27 kg/m(2) with obesity-related comorbidities, and psychotropic-associated weight gain were randomly assigned to receive sibutramine (n = 18; 5-15 mg/day) or topiramate (n = 28; 25-600 mg/day). The primary outcome measure was weight loss. Secondary measures included changes in BMI, percent body weight loss, and mood symptoms., Results: Patients randomized either to sibutramine or topiramate lost comparable amounts of weight (4.1 +/- 5.7 and 2.8 +/- 3.5 kg, respectively) and displayed similar rates of weight loss (0.85 and 0.82 kg/week, respectively). However, only four (22%) patients receiving sibutramine and six (21%) patients receiving topiramate completed the 24-week trial. In addition, the attrition patterns for the two drugs were different, with patients discontinuing topiramate doing so early in treatment and patients discontinuing sibutramine doing so throughout treatment. Also, higher ratings of manic and depressive symptoms significantly increased risk for early topiramate discontinuation compared to that for sibutramine., Conclusions: Adjunctive sibutramine and topiramate may have comparable weight loss effects in overweight or obese bipolar patients with psychotropic-associated weight gain, but are each associated with similarly high discontinuation rates. In addition, they may have different attrition profiles. Compared to sibutramine, discontinuation of topiramate may be more likely to occur early in treatment and may be more dependent upon manic and depressive symptoms.

Background: This study examined health related quality of life (HRQOL) and its predictors among African-, Asian-, Latina-, and European American breast cancer survivors (BCS) using a socio-ecologically and culturally contextual theoretical model of HRQOL., Methods: We employed a case-control, cross sectional design with a population-based sample from the California Cancer Registry. Descriptive, bivariate, and multivariate regression analyses were conducted., Results: The sample included 703 BCS: 135 (19%) African-, 206 (29%) Asian-, 183 (26%) Latina-, and 179 (26%) European Americans. Latinas reported the lowest HRQOL (p < 0.0001). The final regression model explained 70% of variance in HRQOL. Years since diagnosis, number of comorbidities, role limitation, emotional wellbeing, quality of doctor-patient relationship, social support, and life stress are significant HRQOL determinants. Exploratory regression analyses indicate ethnic differences in significant predictors for HRQOL., Conclusions: HRQOL among this multiethnic sample ranged from fair to good. Bivariate analysis suggests that ethnic differences in HRQOL exist. However, regression analyses demonstrated that socio-ecological factors in conjunction with medical characteristics are more salient to HRQOL outcomes, and that ethnic group membership may be a proxy for socio-ecological context. Furthermore, the influence of ethnicity, culture, and social-ecology are complex; research with large, population-based samples are necessary to disentangle the impact of contextual factors on HRQOL.