Assessing change in suicidal ideation intensity for youth in treatment for pediatric bipolar disorder

2021 ◽  
pp. 135910452199676
Author(s):  
Meredith A Gruhn ◽  
Amy West ◽  
Elissa Hamlat ◽  
Sally Weinstein
Keyword(s):  
Risk Factors ◽  
Bipolar Disorder ◽  
Suicidal Ideation ◽  
Post Treatment ◽  
Longitudinal Change ◽  
Pediatric Bipolar Disorder ◽  
Treatment Conditions ◽  
The Family ◽  
Related Quality ◽  
Pre Treatment

Objective: Suicidal ideation (SI) is significantly higher for youth with pediatric bipolar disorder (PBD), yet clinical correlates of suicidality remain poorly understood in this population. The current study investigates how change in risk factors for SI relate to change in SI intensity over a 6-month period of treatment. Method: Children ages 9 to 13 ( N = 71; 41% female; 54% Caucasian; Mean age = 9.17) engaged in one of two psychotherapy treatment conditions and completed assessments of SI risk factors and psychopathology symptoms at baseline (pre-treatment), 4 and 8 weeks (during treatment), 12 weeks (post-treatment), and 39 weeks (follow-up assessment at 6 months post-treatment). Children also completed assessments of SI intensity at baseline, post-treatment (12 weeks), and 6 months post-treatment. Results: Mixed-effects regression models indicate that increases in health-related quality of life in the family, mobilization of the family to acquire/accept help for PBD, and child self-concept were associated with decreased SI intensity over time. Conclusions: Findings highlight the importance of family and child level factors in influencing longitudinal change in SI intensity in youth with PBD. Clinical implications and future directions are discussed.

A Pilot Study of Antidepressant-Induced Mania in Pediatric Bipolar Disorder: Characteristics, Risk Factors, and the Serotonin Transporter Gene

2006 ◽  
Vol 60 (9) ◽  
pp. 1005-1012 ◽  
Author(s):  
Fiona M. Baumer ◽  
Meghan Howe ◽  
Kim Gallelli ◽  
Diana Iorgova Simeonova ◽  
Joachim Hallmayer ◽  
...  
Keyword(s):  
Risk Factors ◽  
Bipolar Disorder ◽  
Pilot Study ◽  
Serotonin Transporter ◽  
Serotonin Transporter Gene ◽  
Pediatric Bipolar Disorder ◽  
Transporter Gene

Risk factors for suicide attempts in patients with bipolar disorder misdiagnosed with major depressive disorder: results from a national survey in China

2020 ◽  
Author(s):  
Lin Chen ◽  
Yu-Yu Xu ◽  
Jing-Ge Du ◽  
Li-Min Xin ◽  
Su-Li Wang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Bipolar Disorder ◽  
Suicidal Ideation ◽  
Clinical Characteristics ◽  
Suicide Attempts ◽  
Multiple Logistic Regression ◽  
Regression Analyses ◽  
Major Depressive ◽  
Suicide Attempters ◽  
Depressive Episodes

Abstract Background: Bipolar disorder (BD) is a kind of mental disorder with the greatest risk of suicide, but it is often misdiagnosed as major depressive disorder (MDD) clinically. This study aimed to analyze the sociodemographic factors and clinical characteristics associated with suicide attempts (SA) in patients with BD misdiagnosed with MDD in China. Methods: A total of 1487 MDD patients were consecutively enrolled in 13 mental health centers in China. Data on patients’ sociodemographic and clinical characteristics were collected using a standardized protocol. Of these, 306 BD patients were misdiagnosed with MDD according to the Mini International Neuropsychiatric Interview (MINI). Suicide attempters and non-attempters were classified by the suicidality module of the MINI. Multiple logistic regression analyses were performed to assess the association between the independent variables of interest and SA in BD patients misdiagnosed with MDD. Results: Of the 306 BD patients misdiagnosed with MDD, 225 (73.5%) were non-attempters and 81 (26.5%) were attempters. Compared to non-attempters, attempters were older (Z =2.2, p = 0.03) and had more admissions(χ2 =6.1, p = 0.013), more frequent depressive episodes, more atypical characteristics (e.g. increased appetite, weight gain, and more sleep time)(χ2 = 5.8, p = 0.016), more suicidal ideation (χ2 = 27.3, p < 0.001), more psychotic symptoms (χ2 = 7.4, p = 0.006) and more seasonal depressive episodes (χ2 = 5.6, p = 0.018). Multiple logistic regression analyses revealed that attempters were characterized by more suicidal ideation (OR = 5.7, 95% CI: 2.6–12.5) and frequent depressive episodes (OR = 2.4, 95% CI: 1.3–4.6). The limitations of this study include its cross-sectional design and data collection by suicide attempters’ retrospective recall. Conclusions: The findings of this study suggest that BD patients misdiagnosed with MDD are at a higher risk of suicide, and more frequent depressive episodes and suicidal ideation are risk factors for attempted suicide. Early identification of and interventions for these risk factors might reduce the risk of suicide in BD patients misdiagnosed with MDD.

Effects of State-Trait Anxiety and Task Difficulty on Paired-Associate Learning

1977 ◽  
Vol 41 (1) ◽  
pp. 179-185 ◽  
Author(s):  
Robert A. Reeves ◽  
William W. May
Keyword(s):  
Paired Associate ◽  
Paired Associate Learning ◽  
Post Treatment ◽  
Associate Learning ◽  
Trait Theory ◽  
Learning Tasks ◽  
Treatment Conditions ◽  
Pre Treatment ◽  
Trait Groups ◽  
Better Than

The prediction from state-trait theory and drive theory that high A-State subjects will perform better than low A-State subjects on an easy task and more poorly on a more difficult task was tested using paired-associate learning tasks. This prediction was not supported, as low A-State subjects made fewer errors than high A-State subjects on both the easy and difficult tasks. High A-Trait groups responded with higher A-State in both pre- and post-treatment conditions than did low A-Trait groups as predicted by state-trait theory. Low A-Trait groups showed greater gains in pre-treatment to post-treatment A-State than did high A-Trait groups, a result which supported neither state-trait theory nor Saltz's (1970) hypothesis. Implications for research were discussed.

scholarly journals P.068 Discrepancy between post-treatment infarct volume and 90-day outcome in ischemic stroke: A validation study in the ESCAPE-NA1 randomized controlled trial

2021 ◽  
Vol 48 (s3) ◽  
pp. S38-S39
Author(s):  
A Ganesh ◽  
JM Ospel ◽  
BK Menon ◽  
AM Demchuk ◽  
RG Nogueira ◽  
...  
Keyword(s):  
Risk Factors ◽  
Infarct Volume ◽  
Controlled Trial ◽  
Care Quality ◽  
Vascular Risk Factors ◽  
Post Treatment ◽  
Vascular Risk ◽  
Escape Trial ◽  
Modifiable Factors ◽  
Pre Treatment

Background: Some patients do poorly despite small infarcts after endovascular therapy(EVT) whilst others with large infarcts do well. We validated exploratory findings from the ESCAPE trial regarding factors associated with such discrepancies, in the ESCAPE-NA1 trial(NCT02930018). Methods: We identified “discrepant cases” with modified Rankin Scale(mRS)≥3 despite small follow-up infarct volume(FIV≤25th-percentile) on 24-hour CT/MRI or mRS≤2 despite large FIV(volume≥75th-percentile). We compared area-under-the-curve(AUC) of pre-specified logistic models containing (a)pre-treatment factors(age/cancer/vascular risk-factors) and (b)treatment-related/post-treatment factors(serious adverse events/SAEs) in identifying small-FIV/mRS≥3 and large-FIV/mRS≤2, with stepwise regression-derived models. Results: Among 1,091 patients, 42/287(14.6%) with FIV≤7mL(25th-percentile) had mRS≥3; 65/275(23.6%) with FIV≥92mL(75th-percentile) had mRS≤2. Pre-specified pre-treatment factors(age/cancer/vascular risk-factors) were associated with FIV≤7mL/mRS≥3; stepwise models selected similar variables(similar AUCs:0.92-0.93,p=0.42). SAEs(infarct-in-new-territory/recurrent stroke/pneumonia/heart failure) were strongly associated with FIV≤7mL/mRS≥3; stepwise models also identified onset-to-needle time and hemoglobin(24-hours) as treatment-related/post-treatment factors(similar AUCs:0.92-0.94,p=0.14). Younger age was associated with FIV≥92mL/mRS≤2; stepwise models also selected diabetes absence and baseline hemoglobin(similar AUCs:0.76-0.77,p=0.82). Absence of SAEs(stroke progression/pneumonia/intracerebral hemorrhage) was strongly associated with FIV≥92mL/mRS≤2; stepwise models also identified 24-hour hemoglobin, glucose, and BP(similar AUCs:0.79-0.80,p=0.030). Conclusions: FIV-mRS discrepancies are associated with pre-treatment factors like age/comorbidities; and post-treatment complications related to stroke evolution, secondary prevention, and post-acute care quality. Optimizing thrombolysis speed, BP, glucose, and hemoglobin are modifiable factors meriting further study.

Bipolar and Related Disorders

2018 ◽  
Author(s):  
Sarah R. Black ◽  
Mary Fristad
Keyword(s):  
Risk Factors ◽  
Bipolar Disorder ◽  
Psychological Factors ◽  
Developmental Differences ◽  
Assessment Tools ◽  
Future Research ◽  
Pediatric Bipolar Disorder ◽  
Statistical Manual ◽  
Diagnostic And Statistical Manual ◽  
Considerable Research

Bipolar disorder (BD) in children has received considerable research and clinical attention in the last two decades and remains a challenging disorder to diagnose and treat. This chapter begins by describing the diagnoses included under the bipolar and related disorders section of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders and providing guidance regarding developmental differences in symptom presentations and differential diagnosis. It then provides a brief overview of risk factors for bipolar disorder, including genetic, neurobiological, and psychological factors. Assessment tools designed to aide clinicians in diagnosing pediatric bipolar disorder are reviewed, as are empirically validated psychopharmacological and psychosocial treatments. A case example highlights the use of these tools and treatment approaches; finally, directions for future research are discussed.

Discrepancy between post-treatment infarct volume and 90-day outcome in the ESCAPE randomized controlled trial

2020 ◽  
pp. 174749302092994 ◽  
Author(s):  
Aravind Ganesh ◽  
Bijoy K Menon ◽  
Zarina A Assis ◽  
Andrew M Demchuk ◽  
Fahad S Al-Ajlan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Infarct Volume ◽  
Controlled Trial ◽  
Post Treatment ◽  
Sensitivity Analyses ◽  
Vascular Risk ◽  
Factors Associated ◽  
Post Stroke ◽  
Randomized Controlled ◽  
Pre Treatment

Background Some patients with ischemic stroke have poor outcomes despite small infarcts after endovascular thrombectomy, while others with large infarcts sometimes fare better. Aims We explored factors associated with such discrepancies between post-treatment infarct volume (PIV) and functional outcome. Methods We identified patients with small PIV (volume ≤ 25th percentile) and large PIV (volume ≥ 75th percentile) on 24–48-h CT/MRI in the ESCAPE randomized-controlled trial. Demographics, comorbidities, baseline, and 24–48-h stroke severity (NIHSS), stroke location, treatment type, post-stroke complications, and other outcome scales like Barthel Index, and EQ-5D were compared between “discrepant cases” – those with 90-day modified Rankin Scale(mRS) ≤ 2 despite large PIV or mRS ≥ 3 despite small PIV – and “non-discrepant cases”. Multi-variable logistic regression was used to identify pre-treatment and post-treatment factors associated with small-PIV/mRS ≥ 3 and large-PIV/mRS ≤ 2. Sensitivity analyses used different definitions of small/large PIV and good/poor outcome. Results Among 315 patients, median PIV was 21 mL; 27/79 (34.2%) patients with PIV ≤ 7 mL (25th percentile) had mRS ≥ 3; 12/80 (15.0%) with PIV ≥ 72 mL (75th percentile) had mRS ≤ 2. Discrepant cases did not differ by CT versus MRI-based PIV ascertainment, or right versus left-hemisphere involvement ( p = 0.39, p = 0.81, respectively, for PIV ≤ 7 mL/mRS ≥ 3). Pre-treatment factors independently associated with small-PIV/mRS ≥ 3 included older age ( p = 0.010), cancer, and vascular risk-factors; post-treatment factors included 48-h NIHSS ( p = 0.007) and post-stroke complications ( p = 0.026). Absence of vascular risk-factors ( p = 0.004), CT-based lentiform nucleus sparing ( p = 0.002), lower 24-hour NIHSS ( p = 0.001), and absence of complications ( p = 0.013) were associated with large-PIV/mRS ≤ 2. Sensitivity analyses yielded similar results. Conclusions Discrepancies between functional ability and PIV are likely explained by differences in age, comorbidities, and post-stroke complications, emphasizing the need for high-quality post-thrombectomy stroke care. Clinical trial registration https://clinicaltrials.gov/ct2/show/NCT01778335 .

A Simulation Study to Estimate Effects of Wildfire and Forest Management on Hydrology and Sediment in a Forested Watershed, Northwestern U.S.

2018 ◽  
Vol 61 (5) ◽  
pp. 1579-1601 ◽  
Author(s):  
Anurag Srivastava ◽  
Joan Q. Wu ◽  
William J. Elliot ◽  
Erin S. Brooks ◽  
Dennis C. Flanagan
Keyword(s):  
Sediment Yield ◽  
Post Treatment ◽  
Water Yield ◽  
National Forest ◽  
Fuel Reduction ◽  
Fuel Treatments ◽  
Peak Flows ◽  
Treatment Conditions ◽  
Forest Fuel ◽  
Pre Treatment

Abstract. Suitable fuel reduction treatments are needed in the Colville National Forest, Washington, to reduce the risk of severe wildfire. This study aimed to identify high-risk erosion hillslopes following wildfire to aid in forest fuel reduction planning and to evaluate the effects of fuel treatments on the watershed hydrological response. The specific objectives were (1) to assess the soil burn severity associated with wildfires and use that information to identify critical hillslopes for forest fuel treatments, and (2) to evaluate the potential changes in water yield and peak flows from pre-treatment (undisturbed forest) to post-treatment (thinning and prescribed burn) conditions, in the East Deer Creek Watershed (EDCW), a subwatershed of the Colville National Forest. Assessments were made using a modeling approach for hypothetical wildfire and fuel treatment scenarios. FlamMap, a fire behavior model, was used to predict the spatial distribution of wildfire intensity for a hypothetical event under current vegetation conditions. WEPP simulations were subsequently completed to obtain sediment and water yields based on fire intensity and topography. WEPP erosion estimations following a simulated wildfire showed hillslope sediment yield varying from 0 to 49.4 Mg ha-1 year-1 from the 777 hillslopes, which were ranked in descending order of sediment yield to identify critical hillslopes for fuel treatments. The WEPP model calibrated for a nearby gauged watershed was then applied to the EDCW for pre-treatment and post-treatment conditions. At the watershed scale, the increase in water yield from pre-treatment to post-treatment conditions ranged from 0.7% to 5.6% on hillslopes delivering 10% to 50% of the predicted post-fire sediment. Simulated water balance components at the treated hillslopes showed substantial changes. Surface runoff, subsurface lateral flow, and deep percolation increased 150% (5 mm), 50% (9 mm), and 40% (41 mm), respectively, whereas evapotranspiration (ET) decreased 23% (124 mm). The relative differences between pre- and post-harvest peak flows showed no clear trends as treatment area increased. The results suggest that thinning and prescribed burns to treated hillslopes in the EDCW may lead to an increase in water yield and significant alterations in hydrological processes. Keywords: Fuel treatments, Modeling, Peak flows, Sediment, Water yield, Wildfire.

scholarly journals Ultrasound-guided radiofrequency ablation (RFA) of benign symptomatic thyroid nodules – initial UK experience

2019 ◽  
pp. 20190026
Author(s):  
Susan Jawad ◽  
Simon Morley ◽  
Sofia Otero ◽  
Timothy Beale ◽  
Steven Bandula
Keyword(s):  
Radiofrequency Ablation ◽  
Thyroid Nodules ◽  
Post Treatment ◽  
Published Data ◽  
Thyroid Function Tests ◽  
Related Quality ◽  
Autonomously Functioning Thyroid Nodules ◽  
Nodule Volume ◽  
Pre Treatment

Objective: To report on the use of RFA for the treatment of symptomatic benign and autonomously functioning thyroid nodules (AFTNs) in the first reported UK cohort. Methods: Patients treated over a 19-month period were retrospectively reviewed. Nodules were assessed pre-treatment and at 1 and 6 months post-treatment. Nodule volume was calculated and cosmetic assessment and thyroid-related quality of life (QoL) scores were recorded at each time point. Thyroid function tests (TFTs) were recorded at all three time points for patients with ATFNs. Results: 46 patients with 50 nodules were treated with no complications. The mean volume reduction 1-month post-treatment was 53 +- 14.9 % ( p < 0.0001). Six month data was available for 31 nodules and showed a mean 67 +- 17.6% vol reduction ( p < 0.0001). Five of the six patients with ATFNs were euthyroid at 1-month post-procedure. 6-month data was available on three of these patients, and all remained euthyroid. The thyroid-related QoL and cosmetic scores also improved. Data from 23 patients was available pre-treatment and at 6 months post-treatment and there was a significant ( p < 0.0001) reduction in QoL score. Pre-treatment, 82 % of nodules were readily visible at rest, decreasing to 12.5 % 6 months after treatment ( p < 0.0001). Conclusions: Results align with published data suggesting that RFA is effective at reducing nodule volume and at treating ATFNs and leads to improvement in thyroid-related QoL and cosmetic scores. Advances in knowledge: This early UK experience demonstrates that day-case radiofrequency ablation can provide safe and effective treatment of benign symptomatic thyroid nodules.

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