40 results on '"Ostacher M"'
Search Results
2. Stratifying risk using large-scale electronic health records data
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Perlis, R Y, McCoy, T, Wiste, A, Ostacher, M, and Castro, V
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- 2015
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3. Medication adherence in a comparative effectiveness trial for bipolar disorder
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Sylvia, L. G., Reilly-Harrington, N. A., Leon, A. C., Kansky, C. I., Calabrese, J. R., Bowden, C. L., Ketter, T. A., Friedman, E. S., Iosifescu, D. V., Thase, M. E., Ostacher, M. J., Keyes, M., Rabideau, D., and Nierenberg, A. A.
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- 2014
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4. General medical burden in bipolar disorder: findings from the LiTMUS comparative effectiveness trial
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Kemp, D. E., Sylvia, L. G., Calabrese, J. R., Nierenberg, A. A., Thase, M. E., Reilly-Harrington, N. A., Ostacher, M. J., Leon, A. C., Ketter, T. A., Friedman, E. S., Bowden, C. L., Rabideau, D. J., Pencina, M., and Iosifescu, D. V.
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- 2014
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5. Collaborative framework for a multisite clinical trial in bipolar disorder and comorbid substance abuse: varenicline in bipolar smokers: 69
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Ostacher, M
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- 2013
6. Aims and Results of the NIMH Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD)
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Bowden, C. L., Perlis, R. H., Thase, M. E., Ketter, T. A., Ostacher, M. M., Calabrese, J. R., Reilly-Harrington, N. A., Gonzalez, J. M., Singh, V., Nierenberg, A. A., and Sachs, G. S.
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- 2012
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7. Correlates of subjective and objective burden among caregivers of patients with bipolar disorder
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Ostacher, M. J., Nierenberg, A. A., Iosifescu, D. V., Eidelman, P., Lund, H. G., Ametrano, R. M., Kaczynski, R., Calabrese, J., Miklowitz, D. J., Sachs, G. S., and Perlick, D. A.
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- 2008
8. RE-EVALUATING DSM-IV CRITERIA FOR ALCOHOL DEPENDENCE IN BIPOLAR DISORDER: 1009
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Ostacher, M. J., Nierenberg, A. A., Ametrano, R. M., Bhagat, S. M., Desrosiers, A., Salloum, I. M., Sachs, G. S., and Weiss, R. D.
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- 2008
9. LITHIUM USE FOR BIPOLAR DISORDER STUDY (LITMUS): RATIONALE, DESIGN, AND INNOVATIONS
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Nierenberg, A A, Marangell, L B, Bowden, C L, Ketter, T A, Calabrese, J R, Thase, M E, Friedman, E, Ostacher, M J, Reilly-Harrington, N, Iosifescu, D, and Leon, A C
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- 2008
10. Recovery from depression in patients with bipolar disorder and comorbid substance and alcohol use disorders: prospective findings from the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD): RC8
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Ostacher, M J, Perlis, R S, Nierenberg, A A, Calabrese, J R, Salloum, I M, Fossey, M D, Thase, M E, Sachs, G S, and Weiss, R D
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- 2007
11. Seasonal changes in clinical status in bipolar disorder: a prospective study in 1000 STEP-BD patients
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Friedman, E., Gyulai, L., Bhargava, M., Landen, M., Wisniewski, S., Foris, J., Ostacher, M., Medina, R., and Thase, M.
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- 2006
12. Medication adherence in a comparative effectiveness trial for bipolar disorder
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Sylvia, L. G., primary, Reilly-Harrington, N. A., additional, Leon, A. C., additional, Kansky, C. I., additional, Calabrese, J. R., additional, Bowden, C. L., additional, Ketter, T. A., additional, Friedman, E. S., additional, Iosifescu, D. V., additional, Thase, M. E., additional, Ostacher, M. J., additional, Keyes, M., additional, Rabideau, D., additional, and Nierenberg, A. A., additional
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- 2013
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13. Gene-expression differences in peripheral blood between lithium responders and non-responders in the Lithium Treatment-Moderate dose Use Study (LiTMUS)
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Beech, R D, primary, Leffert, J J, additional, Lin, A, additional, Sylvia, L G, additional, Umlauf, S, additional, Mane, S, additional, Zhao, H, additional, Bowden, C, additional, Calabrese, J R, additional, Friedman, E S, additional, Ketter, T A, additional, Iosifescu, D V, additional, Reilly-Harrington, N A, additional, Ostacher, M, additional, Thase, M E, additional, and Nierenberg, A, additional
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- 2013
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14. Functional recovery is limited in people with bipolar disorder
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Ostacher, M. J, primary
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- 2004
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15. General medical burden in bipolar disorder: findings from the Li TMUS comparative effectiveness trial.
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Kemp, D. E., Sylvia, L. G., Calabrese, J. R., Nierenberg, A. A., Thase, M. E., Reilly‐Harrington, N. A., Ostacher, M. J., Leon, A. C., Ketter, T. A., Friedman, E. S., Bowden, C. L., Rabideau, D. J., Pencina, M., and Iosifescu, D. V.
- Subjects
BIPOLAR disorder ,THERAPEUTIC use of lithium ,DRUG dosage ,COMORBIDITY ,COMPARATIVE studies ,CROSS-sectional method - Abstract
Objective This study examined general medical illnesses and their association with clinical features of bipolar disorder. Method Data were cross-sectional and derived from the Lithium Treatment - Moderate Dose Use Study (Li TMUS), which randomized symptomatic adults ( n = 264 with available medical comorbidity scores) with bipolar disorder to moderate doses of lithium plus optimized treatment ( OPT) or to OPT alone. Clinically significant high and low medical comorbidity burden were defined as a Cumulative Illness Rating Scale ( CIRS) score ≥4 and <4 respectively. Results The baseline prevalence of significant medical comorbidity was 53% ( n = 139). Patients with high medical burden were more likely to present in a major depressive episode ( P = .04), meet criteria for obsessive-compulsive disorder ( P = .02), and experience a greater number of lifetime mood episodes ( P = 0.02). They were also more likely to be prescribed a greater number of psychotropic medications ( P = .002). Sixty-nine per cent of the sample was overweight or obese as defined by body mass index ( BMI), with African Americans representing the racial group with the highest proportion of stage II obesity ( BMI ≥35; 31%, n = 14). Conclusion The burden of comorbid medical illnesses was high in this generalizable sample of treatment-seeking patients and appears associated with worsened course of illness and psychotropic medication patterns. [ABSTRACT FROM AUTHOR]
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- 2014
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16. Assuring that double-blind is blind.
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Perlis RH, Ostacher M, Fava M, Nierenberg AA, Sachs GS, and Rosenbaum JF
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- 2010
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17. Corrigendum to: Antidepressants worsen rapid-cycling course in bipolar disorder: A STEP-BD randomized clinical trial. J. Affect. Disord. (Jun. 10, 2015); http://dx.doi.org/10.1016/j.jad.2015.04.054.
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El-mallakh, RS, Vohringer, PA, Ostacher, MM, Baldassano, CF, Holtzman, NS, Whitham, EA, Thommi, SB, Goodwin, FK, Ghaemi, SN, El-Mallakh, R S, Vohringer, P A, Ostacher, M M, Baldassano, C F, Holtzman, N S, Whitham, E A, Thommi, S B, Goodwin, F K, and Ghaemi, S N
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PUBLISHED errata , *PUBLISHING , *PERIODICAL articles , *PERIODICAL publishing , *PUBLISHED articles - Published
- 2016
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18. Single-dose psilocybin for U.S. military Veterans with severe treatment-resistant depression - A first-in-kind open-label pilot study.
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Ellis S, Bostian C, Feng W, Fischer E, Schwartz G, Eisen K, Lean M, Conlan E, Ostacher M, Aaronson S, and Suppes T
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- Adult, Female, Humans, Male, Middle Aged, Antidepressive Agents adverse effects, Antidepressive Agents therapeutic use, Antidepressive Agents administration & dosage, Depressive Disorder, Major drug therapy, Hallucinogens administration & dosage, Hallucinogens adverse effects, Pilot Projects, Psychiatric Status Rating Scales, Treatment Outcome, United States, Depressive Disorder, Treatment-Resistant drug therapy, Psilocybin administration & dosage, Psilocybin adverse effects, Psilocybin pharmacology, Psilocybin therapeutic use, Veterans psychology, Veterans statistics & numerical data
- Abstract
Background: The enduring and severe depression often suffered by Veterans causes immense suffering and is associated with high rates of suicide and disability. This is the first study to evaluate the efficacy and safety of psilocybin in Veterans with severe treatment-resistant depression (TRD)., Methods: 15 Veterans with severe TRD (major depressive episode failing to respond to ≥5 treatments, or lasting >2 years) received 25 mg of psilocybin. Primary outcome was change in Montgomery-Åsberg Depression Rating scale (MADRS) at 3 weeks posttreatment. Response was defined s ≥ 50 % reduction in MADRS, and remission as ≤10 MADRS score. Psychedelic experience was assessed using the Five-Dimensional Altered States of Consciousness scale (5D-ASC). Safety measures included assessment of suicidality and adverse events. Participants on antidepressants were tapered to avoid drug interactions., Results: Of 15 participants, 60 % met response and 53 % met remission criteria at Week 3. At 12 weeks, 47 % maintained response, and 40 % remission. Co-morbid PTSD did not significantly influence study outcomes. The psychedelic experience reported in 5D-ASC did not correlate with response. Participants judged to need antidepressants were restarted and considered non-responders from that timepoint (n = 4). No unexpected adverse events occurred., Limitations: Limitations include the small sample size, and the uncontrolled and unblinded nature of the study., Conclusions: In this first study on psilocybin for Veterans with severe TRD, a surprising response and remission was seen. Many Veterans had PTSD though no moderating impact of response was observed. The degree of psychedelic experience did not correlate with depression changes. Further study is warranted., Trial Registration: ClinicalTrials.gov Identifier: NCT04433858., Competing Interests: Declaration of competing interest TS reported stock options from Psilotec outside the submitted work. ML served as a paid consultant in therapy training for Compass Pathways during the conduct of the study. MO is a consultant for Neurocrine. SA reported grants and nonfinancial support (supply of drug) from Compass Pathways during the conduct of the study and personal fees from LivaNova, Neuronetics, Genomind, and Sage Therapeutics outside the submitted work. No other disclosures were reported., (Published by Elsevier B.V.)
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- 2025
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19. A double-blind, randomized, placebo-controlled plus open trial of adjunctive suvorexant for treatment-resistant insomnia in patients with bipolar disorder.
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Cafaro R, Macellaro M, Suppes T, Dell'Osso B, Ketter T, Ostacher M, Miller S, Chang L, Lyu J, and Wang PW
- Abstract
Background: Sleep pattern alteration is a core feature of bipolar disorder (BD), often challenging to treat and affecting clinical outcomes. Suvorexant, a hypnotic agent that decreases wakefulness, has shown promising results in treating primary insomnia. To date, data on its use in BD are lacking. This study evaluated the efficacy and tolerability of adjunctive suvorexant for treatment-resistant insomnia in BD patients., Methods: Thirty-six BD outpatients (19 BDI, 69.4% female, 48.9 [±15.2] years) were randomized for 1 week to double-blind suvorexant (10-20 mg/day) versus placebo. Then, all subjects who completed the randomized phase were offered open suvorexant for 3 months. Subjective total sleep time (sTST) and objective total sleep time (oTST) were assessed., Results: During the randomized control trial (RCT) phase, an overall increase in the oTST emerged, which was statistically significant for the Cole-Kripke algorithm ( p = 0.035). The comparison between the suvorexant and placebo groups was limited by significant differences between measurements at baseline. During the open phase, no significant improvement was detected relative to either sTST and oTST. No adverse events nor major intolerances were reported., Discussion: Efficacy results are inconsistent. During the RCT phase, only a small increase in the objective oTST emerged, while during the open phase, no significant improvement was detected. While this is the first ever study of suvorexant in BD-related insomnia, the limitation of the small sample and the high rate of dropouts limits the generalizability of these findings. Larger studies are needed to assess suvorexant in treating BD-related insomnia.
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- 2024
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20. Alcohol Use Patterns During and After the COVID-19 Pandemic Among Veterans in the United States.
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Wong RJ, Yang Z, Ostacher M, Zhang W, Satre D, Monto A, Khalili M, Singal AK, and Cheung R
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- Male, Humans, Female, United States epidemiology, Pandemics, Ethnicity, COVID-19 epidemiology, Alcoholism epidemiology, Veterans
- Abstract
Background: Veterans may be especially susceptible to increased alcohol consumption following the COVID-19 pandemic. We aim to evaluate trends in alcohol use among US Veterans prior to, during, and following the onset of the COVID-19 pandemic., Methods: All US Veterans utilizing Veterans Affairs health care facilities in the United States from March 1, 2018 to February 28, 2023 with ≥1 AUDIT-C score were categorized into 1) No alcohol use (AUDIT-C = 0), 2) Low-risk alcohol use (AUDIT-C 1-2 for women, 1-3 for men), and 3) High-risk alcohol use (AUDIT-C ≥ 3 for women, ≥ 4 for men). Trends in the proportion of Veterans reporting high-risk alcohol use, stratified by sex, age, race/ethnicity, and urbanicity were evaluated., Results: Among a cohort of 2.15 to 2.60 million Veterans, 15.5% reported high-risk alcohol use during March 2018-February 2019, which decreased to 14.6% during the first year of the pandemic, increased to 15.2% in the second year, and then decreased to 14.9% from March 2022-February 2023. Among non-Hispanic whites, African Americans, Asians, and Hispanics, the proportion of women reporting high-risk alcohol use surpassed that of men during the onset of the pandemic and beyond. The greatest proportion of high-risk alcohol use was observed among young Veterans ages 18-39 years (17%-27%), which was consistent across all race/ethnic groups., Conclusions: High-risk alcohol use among US Veterans has increased since the COVID-19 pandemic onset, and in the third year following pandemic onset, 15% of Veterans overall and over 20% of young Veterans ages 18-39 years reported high-risk alcohol use., (Published by Elsevier Inc.)
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- 2024
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21. Treatments for Depression in Bipolar II Disorder: Reply to Durgam et al.
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Ostacher M
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- Benzodiazepines therapeutic use, Depression, Humans, Antipsychotic Agents therapeutic use, Bipolar Disorder drug therapy
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- 2022
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22. A pilot trial of quetiapine, lithium, or placebo added to divalproex sodium for hypomanic or manic episodes in ambulatory adults with bipolar I disorder.
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Cosgrove VE, Allende S, Gwizdowski I, Grace Fischer E, Ostacher M, and Suppes T
- Abstract
Background: Many patients with bipolar I disorder do not respond to monotherapy treatment with mood-stabilizing medications, and combination regimens are commonly used in both inpatient and outpatient settings for the acute and maintenance treatment of bipolar disorder. We studied whether combination therapy is more effective than monotherapy for the acute treatment of subjects with bipolar I disorder currently experiencing manic symptoms. The primary hypothesis was that combination treatments would be associated with greater reductions in symptoms of mania and hypomania than monotherapy alone. The secondary hypothesis was that combination therapies would be associated with lower depression levels than monotherapy alone. Last, a post-hoc exploratory aim was used to examine whether the effect of side effect severity on risk-of-dropout would be greater in combination therapies than in monotherapy alone., Results: In this 12-week, double-blind, placebo-controlled ambulatory pilot trial, participants (n = 75) with bipolar I disorder were randomly assigned to: (1) monotherapy divalproex plus placebo (DVP + PBO), (2) combination therapy of divalproex plus blinded lithium (DVP + Li) or (3) divalproex plus blinded quetiapine (DVP + QTP). Combination therapies (vs. monotherapy) were not associated with improved symptoms of mania, hypomania or depression. The effect of side effect severity on study retention did not differ between combination therapies and monotherapy. However, the risk-of-dropout was significantly greater in the DVP + Li arm versus the DVP + PBO arm., Conclusions: No longitudinal differences in mania, hypomania or depression were found between combination therapies and monotherapy. The effect of side effect severity on study retention did not differ between groups. Due to the small sample size and differential rates of attrition between treatment arms, results of this pilot trial must be interpreted with caution. Trial registration ClinicalTrials.gov identifier: NCT00183443., (© 2022. The Author(s).)
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- 2022
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23. Pilot Randomized Controlled Trial of Web-Delivered Acceptance and Commitment Therapy Versus Smokefree.gov for Smokers With Bipolar Disorder.
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Heffner JL, Kelly MM, Waxmonsky J, Mattocks K, Serfozo E, Bricker JB, Mull KE, Watson NL, and Ostacher M
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- Bipolar Disorder complications, Bipolar Disorder epidemiology, Female, Humans, Male, Middle Aged, Pilot Projects, Tobacco Use Disorder complications, Tobacco Use Disorder epidemiology, United States epidemiology, Acceptance and Commitment Therapy methods, Bipolar Disorder therapy, Health Behavior, Internet statistics & numerical data, Smokers psychology, Smoking Cessation methods, Tobacco Use Disorder prevention & control
- Abstract
Introduction: Smokers with bipolar disorder (BD) are less successful at quitting than the general population. In this study, we evaluated in a pilot randomized controlled trial a novel, targeted, web-based intervention for smokers with BD based on acceptance and commitment therapy (ACT) and designed for reach and disseminability., Aims and Methods: Daily smokers (n = 51) with bipolar I or II disorder were recruited from four US sites and randomly assigned to one of two web-based smoking cessation interventions-ACT-based WebQuit Plus (n = 25) or Smokefree.gov (n = 26) over a 10-week treatment period. All participants received nicotine patch for 8 weeks. Key outcomes were trial design feasibility, intervention acceptability, and cessation at end of treatment and 1-month follow-up., Results: We screened 119 to enroll 51 participants (target sample size = 60) over 24 months. The most common reason for ineligibility was the inability to attend study appointments. Retention was 73% at end of treatment and 80% at follow-up, with no differences by arm. The mean number of logins was twice as high for WebQuit Plus (10.3 vs. 5.3). The usefulness of program skills was rated higher for WebQuit Plus (75% vs. 29%). Biochemically confirmed, 7-day abstinence at end of treatment was 12% in WebQuit Plus versus 8% in Smokefree.gov (odds ratio = 1.46, 95% confidence interval = 0.21 to 9.97). At follow-up, abstinence rates were 8% in both arms., Conclusions: Trial design produced favorable retention rates, although alternative recruitment methods will be needed for a larger trial. At end of treatment, acceptability and estimated effect size of WebQuit Plus relative to Smokefree.gov were promising and support continued program refinement and evaluation., Implications: In this first randomized controlled trial of a targeted intervention for smokers with BD, we found that the ACT-based WebQuit Plus intervention, delivered in combination with the nicotine patch, had promising acceptability and cessation outcomes relative to Smokefree.gov. The observed signals for acceptability and cessation suggest that the WebQuit Plus program should be refined based on participant feedback and evaluated in a larger trial. Feasibility findings from this study also provide direction for refining trial procedures to enhance the recruitment of smokers with BD., (© The Author(s) 2019. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)
- Published
- 2020
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24. Using big data to advance mental health research.
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Duffy A, Faurholt-Jepsen M, and Ostacher M
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- Humans, Big Data, Biomedical Research, Mental Health
- Abstract
Competing Interests: Competing interests: None declared.
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- 2020
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25. How genome-wide association studies (GWAS) made traditional candidate gene studies obsolete.
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Duncan LE, Ostacher M, and Ballon J
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- Genetic Association Studies, Humans, Reproducibility of Results, Schizophrenia genetics, Genome-Wide Association Study, Mental Disorders genetics, Multifactorial Inheritance genetics
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- 2019
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26. A Novel Study Design to Systematically Explore the Impact of Trial Methodology on Psychopharmacological Treatment Outcome in Patients with Depression.
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Severus E, Sauer C, Bauer M, Ostacher M, and Anghelescu IG
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- Antidepressive Agents administration & dosage, Antidepressive Agents adverse effects, Clinical Trials as Topic methods, Decision Making, Shared, Double-Blind Method, Humans, Placebos, Antidepressive Agents therapeutic use, Depressive Disorder, Major drug therapy, Randomized Controlled Trials as Topic methods, Research Design
- Abstract
Introduction: Randomized, double-blind, placebo-controlled trials were developed to draw rather unbiased conclusions regarding the efficacy of antidepressants in the treatment of a major depressive episode (internal validity), mostly with the purpose of formal approval of new compounds in this indication. However, at the same time, data suggest that the very process of randomization and blinded administrations of placebo will have a significant impact on the efficacy of the antidepressant tested and therefore may limit the external validity of results obtained from this type of studies. Therefore, there is an urgent need to systematically study the impact of randomization/placebo control/blinding on patient population, efficacy, tolerability, and external validity in the psychopharmacological treatment of patients with a major depressive episode., Methods: To develop a study design that allows the systematic exploration of the impact of trial design on characteristics of included patient population and outcome., Results: We propose a study design including sample size calculation and statistical analysis in which patients with a major depressive episode are randomized to 3 distinct study designs that differ with regard to control, randomization, and blindness., Discussion: The results of the proposed study design may have substantial consequences when it comes to how to best interpret the results of traditional randomized, double-blind, placebo-controlled trials in the acute treatment of major depressive disorder. Furthermore, they may lead to the implementation of new study designs that may be more suitable for assessing the effectiveness of new antidepressant compounds in everyday clinical practice., Competing Interests: Dr. Severus declares that he has received speaker honoraria from Servier and Roche in the past 3 years. In addition Dr. Severus is Co-Chair of the joint ISBD-IGSLI lithium task force.Cathrin Sauer has no conflicts of interest.Prof. Michael Bauer declares that he was employed on an advisory board of Allergan, Aristo, Boehringer-Ingelheim, Janssen, Lundbeck, neuraxpharm, Otsuka, Servier, and Takeda, and has received lecture fees from AstraZeneca, GlaxoSmithKline, Lilly, neuraxpharm, Pfizer, and Servier in the past 3 years. His institution has received research grants from Deutsche Forschungsgemeinschaft (DFG), and Bundesministeriums für Bildung und Forschung (BMBF) in the past 3 years.Dr. Ostacher has been consultant to Acadia Pharmaceuticals, Genomind, Janssen/Johnson&Johnson, Lundbeck, Otsuka, Sage Therapeutics, Sunovion, and Supernus Pharmaceuticals, and has received research funding from Palo Alto Health Sciences.Prof. Ion-George Anghelescu: Speaker or scientific advisor honorariar for: Aristo, Bioehringer-Ingelheim, Janssen, Lundbeck, Otsuka, Schwabe, Trommsdorff., (© Georg Thieme Verlag KG Stuttgart · New York.)
- Published
- 2019
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27. Lurasidone compared to other atypical antipsychotic monotherapies for bipolar depression: A systematic review and network meta-analysis.
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Ostacher M, Ng-Mak D, Patel P, Ntais D, Schlueter M, and Loebel A
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- Antipsychotic Agents adverse effects, Humans, Lurasidone Hydrochloride adverse effects, Antipsychotic Agents pharmacology, Bipolar Disorder drug therapy, Lurasidone Hydrochloride pharmacology, Network Meta-Analysis
- Abstract
Objectives: To assess the efficacy and tolerability of lurasidone versus other atypical antipsychotic monotherapy agents in patients with bipolar depression, using a Bayesian network meta-analysis., Methods: Fourteen randomised clinical trials (6221 patients) of lurasidone, quetiapine (extended release and immediate release), aripiprazole, olanzapine, and ziprasidone for bipolar depression were included. Efficacy assessments included change in the Montgomery-Åsberg Depression Rating Scale (MADRS), rates of response (≥50% improvement in MADRS) and remission (MADRS ≤12 at study endpoint), and change in the Clinical Global Impressions-Bipolar Disorder-Severity (CGI-BP-S) scale. Tolerability outcomes included weight, somnolence, extrapyramidal symptoms (EPS), and all-cause discontinuation. Changes from baseline or odds ratios (OR) with 95% credible intervals (CrI) were evaluated., Results: Improvement in the MADRS associated with lurasidone treatment was significantly greater than placebo (-4.70, 95%CrI: -7.20, -2.21), aripiprazole (-3.62, 95%CrI: -7.04, -0.20), and ziprasidone (-3.38, 95%CrI: -6.68, -0.11), but not olanzapine (-0.15, 95%CrI: -3.12, 2.74) or quetiapine (0.10, 95%CrI: -2.68, 2.84). Results for improvement in the CGI-BP-S, and for response and remission were similar. Lurasidone was associated with less weight gain than olanzapine (-2.54 kg, 95%CrI: -3.42, -1.67) and quetiapine (-0.83kg, 95%CrI: -1.59, -0.08); and with lower rates of somnolence than quetiapine (OR: 0.33, 95%CrI: 0.11, 0.82) and ziprasidone (OR: 0.34, 95%CrI: 0.09, 0.93). No significant differences among atypical antipsychotic agents were observed in rates of discontinuation or in rates of EPS., Conclusions: In this network meta-analysis, lurasidone was found to be more efficacious than aripiprazole and ziprasidone, and was associated with less weight gain than quetiapine and olanzapine and less somnolence than quetiapine and ziprasidone.
- Published
- 2018
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28. Florida Best Practice Psychotherapeutic Medication Guidelines for Adults With Major Depressive Disorder.
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McIntyre RS, Suppes T, Tandon R, and Ostacher M
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- Adult, Antidepressive Agents adverse effects, Depressive Disorder, Major classification, Depressive Disorder, Major diagnosis, Florida, Humans, Antidepressive Agents therapeutic use, Consensus Development Conferences as Topic, Depressive Disorder, Major therapy, Evidence-Based Medicine standards, Practice Guidelines as Topic standards
- Abstract
Objective: Herein we provide the 2015 update for the Florida Best Practice Psychotherapeutic Medication Guidelines (FPG) for major depressive disorder (MDD). The FPG represent evidence-based decision support for practitioners providing care to adults with MDD., Participants: The consensus meeting included representatives from the Florida Agency for Health Care Administration (FAHCA), advocacy members, academic experts in MDD, and multidisciplinary mental health clinicians, as well as health policy experts. The FAHCA provided funding support for the FPG., Evidence: Evidence was limited to results from adequately powered, randomized, double-blind, placebo-controlled trials; in addition, pooled-, meta-, and network-analyses were included. Recommendations were based on consensus arrived at by the multistakeholder Florida Expert Panel. Articles selected were identified on the electronic search engine PubMed with the dates 2010 to present. The search terms were major depressive disorder, psychopharmacology, antidepressants, psychotherapy, neuromodulation, complementary alternative medicines, pooled-analysis, meta-analysis, and network-analysis. Bibliographies of the identified articles were manually searched for additional citations not identified in the original search., Consensus Process: A consensus meeting comprising all representatives took place on September 25-26, 2015, in Tampa, Florida. Guiding principles (eg, emphasis on the most rigorous evidence for efficacy, safety, and tolerability) were discussed, defined, and operationalized prior to review of extant data. As MDD often pursues a recurrent and chronic course, principles of practice, measurement-based care, and comprehensive assessment and management of overall physical and mental health were emphasized. Evidence supporting pretreatment major depressive episode specifiers (eg, mixed features, anxious distress) and the role of pharmacogenomics (and other biological-behavioral markers) in informing treatment selection were comprehensively discussed. Algorithmic priority was assigned to agents with relatively greater therapeutic index (ie, efficacy) and minimal propensity for safety and tolerability disadvantages., Conclusions: The updated 2015 FPG provide concise, pragmatic, evidence-based decision support for treatment selection and sequencing for adults with MDD. Principles of practice include measurement-based care, priority to both psychiatric and medical comorbidity, identification of DSM-5-defined specifiers (eg, mixed features), suicide risk assessment, and evaluation of cognitive symptoms. The FPG have purposefully aimed to minimize emphasis on "expert opinion" and instead differentially emphasized extant evidence for pharmacologic treatments., (© Copyright 2017 Physicians Postgraduate Press, Inc.)
- Published
- 2017
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29. Guidelines for the recognition and management of mixed depression.
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Stahl SM, Morrissette DA, Faedda G, Fava M, Goldberg JF, Keck PE, Lee Y, Malhi G, Marangoni C, McElroy SL, Ostacher M, Rosenblat JD, Solé E, Suppes T, Takeshima M, Thase ME, Vieta E, Young A, Zimmerman M, and McIntyre RS
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- Algorithms, Antidepressive Agents adverse effects, Antimanic Agents adverse effects, Antimanic Agents therapeutic use, Antipsychotic Agents adverse effects, Antipsychotic Agents therapeutic use, Bipolar Disorder classification, Bipolar Disorder psychology, Depressive Disorder, Major classification, Depressive Disorder, Major psychology, Depressive Disorder, Treatment-Resistant classification, Depressive Disorder, Treatment-Resistant diagnosis, Depressive Disorder, Treatment-Resistant drug therapy, Depressive Disorder, Treatment-Resistant psychology, Diagnosis, Differential, Diagnostic and Statistical Manual of Mental Disorders, Drug Substitution, Drug Therapy, Combination, Electroconvulsive Therapy, Humans, Psychiatric Status Rating Scales, Self Report, Treatment Outcome, Antidepressive Agents therapeutic use, Bipolar Disorder diagnosis, Bipolar Disorder drug therapy, Depressive Disorder, Major diagnosis, Depressive Disorder, Major drug therapy, Guideline Adherence
- Abstract
A significant minority of people presenting with a major depressive episode (MDE) experience co-occurring subsyndromal hypo/manic symptoms. As this presentation may have important prognostic and treatment implications, the DSM-5 codified a new nosological entity, the "mixed features specifier," referring to individuals meeting threshold criteria for an MDE and subthreshold symptoms of (hypo)mania or to individuals with syndromal mania and subthreshold depressive symptoms. The mixed features specifier adds to a growing list of monikers that have been put forward to describe phenotypes characterized by the admixture of depressive and hypomanic symptoms (e.g., mixed depression, depression with mixed features, or depressive mixed states [DMX]). Current treatment guidelines, regulatory approvals, as well the current evidentiary base provide insufficient decision support to practitioners who provide care to individuals presenting with an MDE with mixed features. In addition, all existing psychotropic agents evaluated in mixed patients have largely been confined to patient populations meeting the DSM-IV definition of "mixed states" wherein the co-occurrence of threshold-level mania and threshold-level MDE was required. Toward the aim of assisting clinicians providing care to adults with MDE and mixed features, we have assembled a panel of experts on mood disorders to develop these guidelines on the recognition and treatment of mixed depression, based on the few studies that have focused specifically on DMX as well as decades of cumulated clinical experience.
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- 2017
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30. Mixed features in major depressive disorder: diagnoses and treatments.
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Suppes T and Ostacher M
- Subjects
- Anticonvulsants adverse effects, Antidepressive Agents adverse effects, Antipsychotic Agents adverse effects, Bipolar Disorder classification, Bipolar Disorder psychology, Comorbidity, Depressive Disorder, Major classification, Depressive Disorder, Major psychology, Diagnosis, Differential, Diagnostic and Statistical Manual of Mental Disorders, Drug Therapy, Combination, Humans, Prognosis, Treatment Outcome, Anticonvulsants therapeutic use, Antidepressive Agents therapeutic use, Antipsychotic Agents therapeutic use, Bipolar Disorder diagnosis, Bipolar Disorder drug therapy, Depressive Disorder, Major diagnosis, Depressive Disorder, Major drug therapy
- Abstract
For the first time in 20 years, the American Psychiatric Association (APA) updated the psychiatric diagnostic system for mood disorders in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Perhaps one of the most notable changes in the DSM-5 was the recognition of the possibility of mixed symptoms in major depression and related disorders (MDD). While MDD and bipolar and related disorders are now represented by 2 distinct chapters, the addition of a mixed features specifier to MDD represents a structural bridge between bipolar and major depression disorders, and formally recognizes the possibility of a mix of hypomania and depressive symptoms in someone who has never experienced discrete episodes of hypomania or mania. This article reviews historical perspectives on "mixed states" and the recent literature, which proposes a range of approaches to understanding "mixity." We discuss which symptoms were considered for inclusion in the mixed features specifier and which symptoms were excluded. The assumption that mixed symptoms in MDD necessarily predict a future bipolar course in patients with MDD is reviewed. Treatment for patients in a MDD episode with mixed features is critically considered, as are suggestions for future study. Finally, the premise that mood disorders are necessarily a spectrum or a gradient of severity progressing in a linear manner is argued.
- Published
- 2017
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31. Stratifying Risk for Renal Insufficiency Among Lithium-Treated Patients: An Electronic Health Record Study.
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Castro VM, Roberson AM, McCoy TH, Wiste A, Cagan A, Smoller JW, Rosenbaum JF, Ostacher M, and Perlis RH
- Subjects
- Adult, Aged, Diabetes Mellitus epidemiology, Female, Glomerular Filtration Rate, Humans, Hypertension epidemiology, Linear Models, Lithium therapeutic use, Male, Middle Aged, Psychotic Disorders epidemiology, ROC Curve, Risk Factors, Schizophrenia drug therapy, Schizophrenia epidemiology, Electronic Health Records, Lithium adverse effects, Renal Insufficiency chemically induced, Renal Insufficiency epidemiology
- Abstract
Although lithium preparations remain first-line treatment for bipolar disorder, risk for development of renal insufficiency may discourage their use. Estimating such risk could allow more informed decisions and facilitate development of prevention strategies. We utilized electronic health records from a large New England health-care system between 2006 and 2013 to identify patients aged 18 years or older with a lithium prescription. Renal insufficiency was identified using the presence of renal failure by ICD9 code or laboratory-confirmed glomerular filtration rate below 60 ml/min. Logistic regression was used to build a predictive model in a random two-thirds of the cohort, which was tested in the remaining one-third. Risks associated with aspects of pharmacotherapy were also examined in the full cohort. We identified 1445 adult lithium-treated patients with renal insufficiency, matched by risk set sampling 1 : 3 with 4306 lithium-exposed patients without renal insufficiency. In regression models, features associated with risk included older age, female sex, history of smoking, history of hypertension, overall burden of medical comorbidity, and diagnosis of schizophrenia or schizoaffective disorder (p<0.01 for all contrasts). The model yielded an area under the ROC curve exceeding 0.81 in an independent testing set, with 74% of renal insufficiency cases among the top two risk quintiles. Use of lithium more than once daily, lithium levels greater than 0.6 mEq/l, and use of first-generation antipsychotics were independently associated with risk. These results suggest the possibility of stratifying risk for renal failure among lithium-treated patients. Once-daily lithium dosing and maintaining lower lithium levels where possible may represent strategies for reducing risk.
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- 2016
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32. An exploratory study of responses to low-dose lithium in African Americans and Hispanics.
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Gonzalez Arnold J, Salcedo S, Ketter TA, Calabrese JR, Rabideau DJ, Nierenberg AA, Bazan M, Leon AC, Friedman ES, Iosifescu D, Sylvia LG, Ostacher M, Thase M, Reilly-Harrington NA, and Bowden CL
- Subjects
- Adult, Drug Administration Schedule, Female, Humans, Kaplan-Meier Estimate, Male, Prospective Studies, White People statistics & numerical data, Black or African American psychology, Black or African American statistics & numerical data, Antimanic Agents administration & dosage, Attitude, Bipolar Disorder drug therapy, Hispanic or Latino psychology, Hispanic or Latino statistics & numerical data, Lithium Compounds administration & dosage
- Abstract
Objectives: Few prospective studies examine the impact of ethnicity or race on outcomes with lithium for bipolar disorder. This exploratory study examines differences in lithium response and treatment outcomes in Hispanics, African Americans, and non-Hispanic whites with bipolar disorder in the Lithium Treatment Moderate Dose Use Study (LiTMUS)., Methods: LiTMUS was a six-site randomized controlled trial of low-dose lithium added to optimized treatment (OPT; personalized, evidence-based pharmacotherapy) vs. OPT alone in outpatients with bipolar disorder. Of 283 participants, 47 African Americans, 39 Hispanics, and 175 non-Hispanic whites were examined. We predicted minority groups would have more negative medication attitudes and higher attrition rates, but better clinical outcomes., Results: African Americans in the lithium group improved more on depression and life functioning compared to whites over the 6 month study. African Americans in the OPT only group had marginal improvement on depression symptoms. For Hispanics, satisfaction with life did not significantly improve in the OPT only group, in contrast to whites and African Americans who improved over time on all measures. Attitudes toward medications did not differ across ethnic/racial groups., Conclusions: African Americans show some greater improvements with lithium than non-Hispanic whites, and Hispanics showed more consistent improvements in the lithium group. The impact of low-dose lithium should be studied in a larger sample as there may be particular benefit for African Americans and Hispanics. Given that the control group (regardless of ethnicity/race) had significant improvements, optimized treatment may be beneficial for any ethnic group., (Copyright © 2015 Elsevier B.V. All rights reserved.)
- Published
- 2015
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33. Association between bipolar spectrum features and treatment outcomes in outpatients with major depressive disorder.
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Perlis RH, Uher R, Ostacher M, Goldberg JF, Trivedi MH, Rush AJ, and Fava M
- Subjects
- Adolescent, Adult, Aged, Bipolar Disorder complications, Depressive Disorder, Major complications, Female, Humans, Male, Middle Aged, Patient Compliance psychology, Patient Compliance statistics & numerical data, Psychiatric Status Rating Scales, Self Report, Treatment Outcome, Bipolar Disorder diagnosis, Bipolar Disorder drug therapy, Citalopram therapeutic use, Depressive Disorder, Major drug therapy
- Abstract
Context: It has been suggested that patients with major depressive disorder (MDD) who display pretreatment features suggestive of bipolar disorder or bipolar spectrum features might have poorer treatment outcomes., Objective: To assess the association between bipolar spectrum features and antidepressant treatment outcome in MDD., Design: Open treatment followed by sequential randomized controlled trials., Setting: Primary and specialty psychiatric outpatient centers in the United States., Participants: Male and female outpatients aged 18 to 75 years with a DSM-IV diagnosis of nonpsychotic MDD who participated in the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study., Interventions: Open treatment with citalopram followed by up to 3 sequential next-step treatments., Main Outcome Measures: Number of treatment levels required to reach protocol-defined remission, as well as failure to return for the postbaseline visit, loss to follow-up, and psychiatric adverse events. For this secondary analysis, putative bipolar spectrum features, including items on the mania and psychosis subscales of the Psychiatric Diagnosis Screening Questionnaire, were examined for association with treatment outcomes., Results: Of the 4041 subjects who entered the study, 1198 (30.0%) endorsed at least 1 item on the psychosis scale and 1524 (38.1%) described at least 1 recent maniclike/hypomaniclike symptom. Irritability and psychoticlike symptoms at entry were significantly associated with poorer outcomes across up to 4 treatment levels, as were shorter episodes and some neurovegetative symptoms of depression. However, other indicators of bipolar diathesis including recent maniclike symptoms and family history of bipolar disorder as well as summary measures of bipolar spectrum features were not associated with treatment resistance., Conclusion: Self-reported psychoticlike symptoms were common in a community sample of outpatients with MDD and strongly associated with poorer outcomes. Overall, the data do not support the hypothesis that unrecognized bipolar spectrum illness contributes substantially to antidepressant treatment resistance.
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- 2011
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34. Suicidal ideation and depressive symptoms among bipolar patients as predictors of the health and well-being of caregivers.
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Chessick CA, Perlick DA, Miklowitz DJ, Dickinson LM, Allen MH, Morris CD, Gonzalez JM, Marangell LB, Cosgrove V, and Ostacher M
- Subjects
- Adolescent, Adult, Aged, Aged, 80 and over, Checklist methods, Family Health, Female, Humans, Longitudinal Studies, Male, Middle Aged, Observation, Predictive Value of Tests, Psychiatric Status Rating Scales, Retrospective Studies, Self Concept, Suicide statistics & numerical data, Time Factors, Young Adult, Bipolar Disorder complications, Bipolar Disorder psychology, Caregivers psychology, Depression etiology, Depression psychology, Suicide psychology
- Abstract
Objectives: Few studies have addressed the physical and mental health effects of caring for a family member with bipolar disorder. This study examined whether caregivers' health is associated with changes in suicidal ideation and depressive symptoms among bipolar patients observed over one year., Methods: Patients (N = 500) participating in the Systematic Treatment Enhancement Program for Bipolar Disorder and their primary caregivers (N = 500, including 188 parental and 182 spousal caregivers) were evaluated for up to one year as part of a naturalistic observational study. Caregivers' perceptions of their own physical health were evaluated using the general health scale from the Medical Outcomes Study 36-item Short-Form Health Survey. Caregivers' depression was evaluated using the Center for Epidemiological Studies of Depression Scale., Results: Caregivers of patients who had increasing suicidal ideation over time reported worsening health over time compared to caregivers of patients whose suicidal ideation decreased or stayed the same. Caregivers of patients who had more suicidal ideation and depressive symptoms reported more depressed mood over a one-year reporting period than caregivers of patients with less suicidal ideation or depression. The pattern of findings was consistent across parent caregivers and spousal caregivers., Conclusions: Caregivers, rightly concerned about patients becoming suicidal or depressed, may try to care for the patient at the expense of their own health and well-being. Treatments that focus on the health of caregivers must be developed and tested.
- Published
- 2009
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35. Retrospective age at onset of bipolar disorder and outcome during two-year follow-up: results from the STEP-BD study.
- Author
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Perlis RH, Dennehy EB, Miklowitz DJ, Delbello MP, Ostacher M, Calabrese JR, Ametrano RM, Wisniewski SR, Bowden CL, Thase ME, Nierenberg AA, and Sachs G
- Subjects
- Adolescent, Adult, Age Factors, Age of Onset, Bipolar Disorder classification, Child, Female, Humans, Longitudinal Studies, Male, Psychiatric Status Rating Scales, Quality of Life, Randomized Controlled Trials as Topic, Retrospective Studies, Surveys and Questionnaires, Treatment Outcome, Bipolar Disorder psychology, Bipolar Disorder therapy
- Abstract
Objective: Symptoms of bipolar disorder are increasingly recognized among children and adolescents, but little is known about the course of bipolar disorder among adults who experience childhood onset of symptoms., Methods: We examined prospective outcomes during up to two years of naturalistic treatment among 3,658 adult bipolar I and II outpatients participating in a multicenter clinical effectiveness study, the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD). Age at illness onset was identified retrospectively by clinician assessment at study entry., Results: Compared to patients with onset of mood symptoms after age 18 years (n = 1,187), those with onset before age 13 years (n = 1,068) experienced earlier recurrence of mood episodes after initial remission, fewer days of euthymia, and greater impairment in functioning and quality of life over the two-year follow-up. Outcomes for those with onset between age 13 and 18 years (n = 1,403) were generally intermediate between these two groups., Conclusion: Consistent with previous reports in smaller cohorts, adults with retrospectively obtained early-onset bipolar disorder appear to be at greater risk for recurrence, chronicity of mood symptoms, and functional impairment during prospective observation.
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- 2009
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36. Euthymic patients with bipolar disorder show decreased reward learning in a probabilistic reward task.
- Author
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Pizzagalli DA, Goetz E, Ostacher M, Iosifescu DV, and Perlis RH
- Subjects
- Adult, Affect, Association Learning, Attention, Bipolar Disorder diagnosis, Discrimination Learning, Female, Humans, Male, Mental Recall, Middle Aged, Pattern Recognition, Visual, Psychomotor Performance, Reinforcement Schedule, Bipolar Disorder psychology, Motivation, Probability Learning, Reward
- Abstract
Background: Bipolar disorder (BPD) features cycling mood states ranging from depression to mania with intermittent phases of euthymia. Bipolar disorder subjects often show excessive goal-directed and pleasure-seeking behavior during manic episodes and reduced hedonic capacity during depressive episodes, indicating that BPD might involve altered reward processing. Our goal was to test the hypothesis that BPD is characterized by impairments in adjusting behavior as a function of prior reinforcement history, particularly in the presence of residual anhedonic symptoms., Methods: Eighteen medicated BPD subjects and 25 demographically matched comparison subjects performed a probabilistic reward task. To identify putative dysfunctions in reward processing irrespective of mood state, primary analyses focused on euthymic BPD subjects (n = 13). With signal-detection methodologies, response bias toward a more frequently rewarded stimulus was used to objectively assess the participants' propensity to modulate behavior as a function of reinforcement history., Results: Relative to comparison subjects, euthymic BPD subjects showed a reduced and delayed acquisition of response bias toward the more frequently rewarded stimulus, which was partially due to increased sensitivity to single rewards of the disadvantageous stimulus. Analyses considering the entire BPD sample revealed that reduced reward learning correlated with self-reported anhedonic symptoms, even after adjusting for residual manic and anxious symptoms and general distress., Conclusions: The present study provides preliminary evidence indicating that BPD, even during euthymic states, is characterized by dysfunctional reward learning in situations requiring integration of reinforcement information over time and thus offers initial insights about the potential source of dysfunctional reward processing in this disorder.
- Published
- 2008
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37. Prevalence and correlates of burden among caregivers of patients with bipolar disorder enrolled in the Systematic Treatment Enhancement Program for Bipolar Disorder.
- Author
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Perlick DA, Rosenheck RA, Miklowitz DJ, Chessick C, Wolff N, Kaczynski R, Ostacher M, Patel J, and Desai R
- Subjects
- Adaptation, Psychological, Adult, Demography, Female, Follow-Up Studies, Health Care Costs, Humans, Male, Prevalence, Social Support, Surveys and Questionnaires, Bipolar Disorder economics, Bipolar Disorder epidemiology, Caregivers psychology, Caregivers statistics & numerical data, Cost of Illness, Program Development
- Abstract
Objectives: Caring for a relative with schizophrenia or dementia is associated with reports of high caregiver burden, symptoms of depression, poor physical health, negligence of the caregiver's own health needs, elevated health service use, low use of social supports, and financial strain. This study presents the design and preliminary data on the costs and consequences of caring for a relative or friend with bipolar disorder from the Family Experience Study, a longitudinal study of the primary caregivers to 500 patients enrolled in the Systematic Treatment Enhancement Program for Bipolar Disorder., Methods: Subjects were primary caregivers of 500 patients with bipolar disorder diagnosed by the Mini International Neuropsychiatric Interview and the Affective Disorder Evaluation. Caregivers were evaluated within 1 month after patients entered Systematic Treatment Enhancement Program using measures of burden, coping, health/mental health, and use of resources and costs., Results: Eighty-nine percent, 52%, and 61% of caregivers, respectively, experienced moderate or higher burden in relation to patient problem behaviors, role dysfunction, or disruption of household routine. High burden caregivers reported more physical health problems, depressive symptoms, health risk behavior and health service use, and less social support than less burden caregivers. They also provided more financial support to their bipolar relative., Conclusions: Burdens experienced by family caregivers of people with bipolar disorder are associated with problems in health, mental health, and cost. Psychosocial interventions targeting the strains of caregiving for a patient with bipolar disorder are needed.
- Published
- 2007
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38. Aripiprazole-related tardive dyskinesia.
- Author
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Maytal G, Ostacher M, and Stern TA
- Subjects
- Aripiprazole, Female, Humans, Middle Aged, Antipsychotic Agents adverse effects, Depressive Disorder, Major drug therapy, Dyskinesia, Drug-Induced etiology, Piperazines adverse effects, Quinolones adverse effects
- Abstract
The low prevalence of extrapyramidal symptoms associated with atypical antipsychotics has led to their widespread use during the past decade. Aripiprazole, the newest medication in this class, has been associated with extrapyramidal symptoms (eg, akathisia) and with improvement of tardive dyskinesia (TD), but to date it has not been associated with the development of TD. We report a case of TD associated with the use of aripiprazole 15 mg/day for 18 months for refractory depression. Symptoms of TD resolved within several weeks of discontinuation of aripiprazole.
- Published
- 2006
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39. Long-term implications of early onset in bipolar disorder: data from the first 1000 participants in the systematic treatment enhancement program for bipolar disorder (STEP-BD).
- Author
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Perlis RH, Miyahara S, Marangell LB, Wisniewski SR, Ostacher M, DelBello MP, Bowden CL, Sachs GS, and Nierenberg AA
- Subjects
- Adolescent, Adult, Age of Onset, Anxiety Disorders diagnosis, Anxiety Disorders epidemiology, Anxiety Disorders psychology, Bipolar Disorder drug therapy, Comorbidity, Demography, Female, Humans, Interview, Psychological, Male, Prevalence, Program Evaluation, Quality of Life psychology, Retrospective Studies, Risk Factors, Substance-Related Disorders diagnosis, Substance-Related Disorders epidemiology, Substance-Related Disorders psychology, Suicide statistics & numerical data, Surveys and Questionnaires, Time, Treatment Outcome, Bipolar Disorder epidemiology, Bipolar Disorder therapy
- Abstract
Background: Early onset of mood symptoms in bipolar disorder has been associated with poor outcome in many studies; however, the factors that might contribute to poor outcome have not been adequately investigated., Methods: The first consecutive 1000 adult bipolar patients enrolled in the National Institute of Mental Health's Systematic Treatment Enhancement Program for Bipolar Disorder were assessed at study entry to determine details of their age of onset of mood symptoms. Clinical course, comorbidity, and functional status and quality of life were compared for groups with very early (age < 13 years), early (age 13-18 years), and adult (age > 18 years) onset of mood symptoms., Results: Of 983 subjects in whom age of onset could be determined, 272 (27.7%) experienced very early onset, and 370 (37.6%) experienced early onset. Earlier onset was associated with greater rates of comorbid anxiety disorders and substance abuse, more recurrences, shorter periods of euthymia, greater likelihood of suicide attempts and violence, and greater likelihood of being in a mood episode at study entry., Conclusions: Very early or early onset of bipolar disorder might herald a more severe disease course in terms of chronicity and comorbidity. Whether early intervention might modify this risk merits further investigation.
- Published
- 2004
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40. Association between borderline personality structure and history of childhood abuse in adult volunteers.
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Salzman JP, Salzman C, Wolfson AN, Albanese M, Looper J, Ostacher M, Schwartz J, Chinman G, Land W, and Miyawaki E
- Subjects
- Adolescent, Adult, Age Factors, Borderline Personality Disorder epidemiology, Child, Child Abuse epidemiology, Child Abuse, Sexual diagnosis, Child Abuse, Sexual epidemiology, Comorbidity, Female, Humans, Male, Prevalence, Borderline Personality Disorder diagnosis, Child Abuse diagnosis
- Abstract
Childhood abuse has been implicated as a leading factor in the development of borderline personality disorder (BPD). Data in this report, drawn from an ongoing study of the therapeutic effect of fluoxetine in BPD patients, were gathered in an attempt to replicate previous findings indicating a history of physical abuse in 71% and sexual abuse in 67% of adult BPD subjects. Thirty-one subjects for a study of the pharmacological treatment of BPD or BPD traits met criteria for the study. Those who had been previously hospitalized for a psychiatric disorder, who had recently been suicidal, or who had recent histories of self-mutilation were excluded. Specific information about childhood abuse was gathered using questions from a previous study of abuse histories in BPD patients. All subjects were then interviewed in greater depth regarding past experiences of abuse as part of the ongoing study of the relationship of childhood attachment experience and adult psychopathology. Six of 31 subjects (19.4%) reported a definite history of childhood physical and/or sexual abuse. Four of these subjects met criteria for full BPD, and two met criteria for BPD traits. Three of 31 subjects reported a history of physical abuse (9.7%); five reported a history of sexual abuse (16.1%). Two of the six who reported abuse reported both physical and sexual abuse. A history of childhood abuse is not necessarily linked to the development of BPD or BPD traits in all individuals. The following hypothesis is suggested: BPD may represent a spectrum of symptomatic severity.(ABSTRACT TRUNCATED AT 250 WORDS)
- Published
- 1993
- Full Text
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