http://hdl.handle.net/10027/7812 Sun, 26 May 2013 09:08:51 GMT 2013-05-26T09:08:51Z http://hdl.handle.net/10027/8411 Dose Effects and Comparative Effectiveness of Extended Release Dexmethylphenidate and Mixed Amphetamine Salts Stein, Mark A.; Waldman, Irwin D.; Charney, Elizabeth; Aryal, Subhash; Sable, Craig; Gruber, Reut; Newcorn, Jeffrey H. Objective: To compare the dose effects of long-acting extended-release dexmethylphenidate (ER d-MPH) and ER mixed amphetamine salts (ER MAS) on attention-deficit/hyperactivity disorder (ADHD) symptom dimensions, global and specific impairments, and common adverse events associated with stimulants. Methods: Fifty-six children and adolescents with ADHD participated in an 8-week, double-blind, crossover study comparing ER d-MPH (10, 20, 25–30 mg) and ER MAS (10, 20, 25–30) with a week of randomized placebo within each drug period. Efficacy was assessed with the ADHD Rating Scale-IV (ADHD-RS-IV), whereas global and specific domains of impairment were assessed with the Clinical Global Impressions Severity and Improvement Scales and the parent-completed Weiss Functional Impairment Scale, respectively. Insomnia and decreased appetite, common stimulant-related adverse events, were measured with the parent-completed Stimulant Side Effects Rating Scale. Results: Both ER d-MPH and ER MAS were associated with significant reductions in ADHD symptoms. Improvement in Total ADHD and Hyperactivity/Impulsivity symptoms were strongly associated with increasing dose, whereas improvements in Inattentive symptoms were only moderately associated with dose. About 80% demonstrated reliable change on ADHD-RS-IV at the highest dose level of ERMAS compared with 79% when receiving ER d-MPH. Decreased appetite and insomnia were more common at higher dose levels for both stimulants. Approximately 43% of the responders were preferential responders to only one of the stimulant formulations. Conclusions: Dose level, rather than stimulant class, was strongly related to medication response. This is a copy of an article published in the Journal of Child and Adolescent Psychopharmacology © 2011 Copyright Mary Ann Liebert, Inc.; Journal of Child and Adolescent Psychopharmacology is available online at: http://www.liebertonline.com. DOI: 10.1089/cap.2011.0018 Thu, 01 Dec 2011 06:00:00 GMT http://hdl.handle.net/10027/8411 2011-12-01T06:00:00Z http://hdl.handle.net/10027/8298 A Mental Health Needs Assessment of Urban American Indian Youth and Families West, Amy E.; Williams, Ellen; Suzukovich, Eli; Strangeman, Kathlene; Novins, Douglas American Indian (AI) youth experience significant mental health disparities. The majority of AI youth live in urban areas, yet urban AI youth are underserved and unstudied. This manuscript describes a qualitative study of community mental health needs in an urban population of AI youth, conducted as part of the planning process for a system of care (SOC). Participants included 107 urban AI youth and families that participated in one of 16 focus groups assessing mental health needs and services. Forty-one percent of participants were youth or young adults. Data were coded and analyzed using qualitative software and then further analyzed and interpreted in partnership with a community research workgroup. Results indicated various community characteristics, mental health and wellness needs, and service system needs relevant to developing a system of care in this community. Key community, cultural, and social processes also emerged, reinforcing the importance of broader system changes to promote a sustainable SOC. These systems/policy changes are reviewed in the context of previous literature proposing necessary systems change to support behavioral health care in AI communities as well as to ensure that SOC implementation is consistent with core values and philosophy across all communities. © 2011 by Springer Verlag, American Journal of Community Psychology The final publication is available at www.springerlink.com DOI 10.1007/s10464-011-9474-6 Tue, 01 Mar 2011 06:00:00 GMT http://hdl.handle.net/10027/8298 2011-03-01T06:00:00Z http://hdl.handle.net/10027/8149 Double-Blind Randomized Trial of Risperidone Versus Divalproex in Pediatric Bipolar Disorder: fMRI Outcomes Pavuluri, Mani N.; Passarotti, Alessandra M.; Lu, Lisa H.; Carbray, Julie A.; Sweeney, John A. The aim of this research was to determine the relative effects of risperidone and divalproex on brain function in pediatric mania. This is a double-blind 6-week fMRI trial with 24 unmedicated manic patients randomized to risperidone or divalproex, and 14 healthy controls (HCs) matched for IQ and demographic factors (mean age: 13.1±3.3 years). A pediatric affective color matching task, in which subjects matched the color of a positive, negative or neutral word with one of two colored circles, was administered. The primary clinical measure was the Young Mania Rating Scale (YMRS). The risperidone group, relative to HC, showed an increase in activation from pre- to post-treatment in right pregenual and subgenual anterior cingulate cortex and decreased activation in bilateral middle frontal gyrus during the negative condition; and decreased activation in left inferior and medial, and right middle frontal gyri, left inferior parietal lobe, and right striatum with positive condition. In the divalproex group, relative to HC, there was an increased activation in right superior temporal gyrus in the negative condition; and in left medial frontal gyrus and right precuneus with the positive condition. Greater pre-treatment right amygdala activity with negative and positive condition in the risperidone group, and left amygdala activity with positive condition in divalproex group, predicted poor response on YMRS. Risperidone and divalproex yield differential patterns of prefrontal activity during an emotion processing task in pediatric mania. Increased amygdala activity at baseline is a potential biomarker predicting poor treatment response to both the risperidone and divalproex. NOTICE: this is the author’s version of a work that was accepted for publication in Psychiatry Research. Changes resulting from the publishing process, such as peer review, editing, corrections, structural formatting, and other quality control mechanisms may not be reflected in this document. Changes may have been made to this work since it was submitted for publication. A definitive version was subsequently published in Psychiatry Research, Vol 193, Issue 1, (July 30, 2011) DOI: 10.1016/j.pscychresns.2011.01.005. The original publication is available at www.elsevier.com. Sat, 30 Jul 2011 05:00:00 GMT http://hdl.handle.net/10027/8149 2011-07-30T05:00:00Z http://hdl.handle.net/10027/7752 Fronto-limbic Dysfunction in Mania Pre-Treatment and Persistent Amygdala Over-activity Post-Treatment in Pediatric Bipolar Disorder Passarotti, Alessandra M.; Sweeney, John A.; Pavuluri, Mani N. Rationale. Neural deficits at the interface of affect and cognition may improve with pharmacotherapy in pediatric bipolar disorder (PBD). Objectives. We examined lamotrigine treatment impact on the neural interface of working memory and affect in PBD. Methods. Un-medicated, acutely-ill, patients with mania and hypomania (n=17) and healthy controls (HC; n=13) (mean age = 13.36 ± 2.55) performed an affective 2-back fMRI task with blocks of angry vs neutral faces (i.e., angry face condition) or happy vs neutral faces (i.e., happy face condition) before treatment and at follow-up, after 8-week treatment with second generation antipsychotics (SGAs) followed by 6 weeks of lamotrigine monotherapy. Results. At baseline, for the angry face condition, PBD, relative to HC, showed reduced activation in left ventrolateral prefrontal cortex (VLPFC) and right caudate; for the happy face condition, they showed increased activation in bilateral PFC, and right amygdala and middle temporal gyrus. Post treatment, PBD showed greater activation in right amygdala relative to HC, for both conditions. Patients, relative to HC, exhibited greater changes over time in right VLPFC and amygdala, left subgenual anterior cingulated cortex (ACC) and left caudate for the angry face condition, and in right middle temporal gyrus for the happy face condition. Conclusions. Pharmacotherapy resulted in symptom improvement and normalization of higher cortical emotional and cognitive regions in patients relative to HC, suggesting that VLPFC dysfunction may be state-specific in PBD. Amygdala was overactive in PBD, relative to HC, regardless of reduction in manic symptoms, and may be a trait marker of PBD. Post print version of article may differ from published version. The original publication is available at www.springerlink.com; DOI: 10.1007/s00213-011-2243-2. Thu, 10 Mar 2011 06:00:00 GMT http://hdl.handle.net/10027/7752 2011-03-10T06:00:00Z