This study of women Veterans Affairs (VA) health care patients screened for the prevalence of past-year smoking, hazardous and problem drinking, other drug abuse, and psychiatric disorders.
A survey ...was mailed to women veterans who had received care from VA Puget Sound Health Care System between October 1, 1996, and January 1, 1998. Screening measures included questions about cigarettes; questions from the Alcohol Use Disorders Identification Test about consumption (hazardous drinking); the TWEAK test (problem drinking); a drug abuse screen; the Patient Health Questionnaire (psychiatric conditions); and the PTSD (posttraumatic stress disorder) Checklist.
Of eligible patients, 1,257 (65 percent) returned surveys with complete substance use data. Patients reported a relatively high rate of past-year smoking (29.1 percent) and hazardous drinking, problem drinking, or both (31.1 percent). The rate of past-year drug use was much lower (4.9 percent). Younger age was strongly associated with greater substance abuse: 59 percent of women under age 35 screened positive for smoking, hazardous or problem drinking, or drug abuse. Screening positive for a psychiatric condition (N=504) was also associated with substance abuse: The rate of past-year drug abuse among women screening positive for a psychiatric condition (9.7 percent) was double the rate for the entire sample. Of the women who screened positive for depression, PTSD, eating disorders, or panic disorders, 57 percent screened positive for substance abuse (including smoking).
Substance abuse is common among women VA patients and is associated with younger age and with screening positive for other psychiatric conditions. Providers are expected to follow up on positive screening tests, and these data indicate substantial provider burden.
Early studies of posttraumatic stress disorder (PTSD) reported that abnormal function of the hypothalamic-pituitary-adrenocortical (HPA) system was associated with the disorder. However, subsequent ...studies attempting to identify a specific aspect of HPA dysfunction that characterizes PTSD have been marked by considerable inconsistency of results. A facet of HPA regulation that has been considered but not definitively investigated is the possibility that the responsiveness of the adrenal cortex to physiological concentrations of adrenocorticotropin (ACTH) is diminished in PTSD. Relationships between PTSD and the adrenal androgen dehydroepiandrosterone (DHEA) have also been postulated. In this study we investigated the magnitude and time course of changes in concentrations of plasma cortisol and DHEA in response to bolus infusions of physiological doses of ACTH (1-24) in PTSD patients and control subjects. We found no evidence for PTSD-related alterations in cortisol or DHEA secretion in response to stimulation by low doses of ACTH and conclude that adrenocortical responsiveness is normal in PTSD. Results from this and other studies suggest that the occurrence of defects in HPA function in PTSD may be specific responses to particular combinations of trauma type, genetic susceptibility, and individual history.
Brief primary care interventions for alcohol use should be tailored to patients' readiness to change; however, validated measures of readiness to change are too lengthy to be practical in most ...primary care settings. We compared a readiness to change drinking algorithm (RTC Algorithm) based on three standardized questions to a validated 12-item readiness to change questionnaire (Rollnick RTCQ) in 85 hazardous drinking female Veterans Affairs (VA) patients. Results from comparisons of mean Rollnick RTCQ scale scores across RTC Algorithm categories suggest good concurrent validity. Regular assessment using the RTC Algorithm questions may help primary care providers tailor alcohol-related discussions with hazardous drinking patients.
To estimate the prevalence of hysterectomy and associated factors in women veterans who access care at a Veterans Affairs medical center.
A survey that included questions regarding hysterectomy ...status, demographics, medical history and validated mental health measures was mailed to 1,935 women who received care at the VA Puget Sound Health Care System between October 1996 and January 1998.
The overall prevalence of hysterectomy was 32%, with 12% of 18-39-year-olds, 35% of 40-49-year-olds, and 57% of women 50 years old or older reporting having had a hysterectomy. In multivariable analyses, older age (OR 1.1, 95% CI 1.07-1.09), multiparity (OR 1.6, 1.14-2.2), self-reported polycystic ovary syndrome (OR 3.3, 1.81-5.9), chronic pelvic pain (OR 3.2, 2.1-4.9), irritable bowel syndrome (OR 1.8, 1.3-3.1) and premenstrual syndrome (OR 1.6, 1.1-2.3) were associated with prior hysterectomy. When factors associated with posttraumatic stress disorder in this population were omitted from the model, age (OR 1.07, 1.05-1.08), multiparity (OR 1.4, 1.0-1.9), a family history of ovarian cancer (OR 1.8, 1.2-2.8) and posttraumatic stress disorder (OR 1.4, 1.02-1.87) were associated with prior hysterectomy.
The prevalence of hysterectomy may be higher among women veterans as compared with published rates for the general population and may be related to chronic pain syndromes and/or posttraumatic stress disorder.
Clinical studies suggest involvement of brain noradrenergic systems in the pathophysiology of disruptive agitation in Alzheimer’s disease (AD). This behavioral problem is even more prevalent in ...dementia with Lewy bodies (DLB). Here we used receptor autoradiography with
125Ipara-iodoclonidine to estimate alpha-2 adrenergic receptor (A2R) density in locus coeruleus (LC) projection areas in postmortem brain tissue from age and gender comparable groups of DLB (
n = 6), AD (
n = 5) and normal (
n = 7) subjects. LC neuronal loss was substantial and equivalent in DLB and AD. A2R density was greater in DLB than in normals in the deep layers of the frontal cortex. A2R density was greater in DLB than in AD in hippocampus (CA-1, CA-3 and dentate hilus) and in the granule layer of the cerebellum. Increased A2R binding in DLB is consistent with expression of presynaptic A2R on fibers from surviving LC neurons involved in reinnervation of LC projection areas. These areas develop compensatory noradrenergic hyperinnervation in a rat model of partial LC ablation. It is also consistent with upregulation of post-synaptic A2R in response to loss of LC noradrenergic innervation. Either mechanism could lower the threshold for increased agitation in response to noradrenergic outflow in these dementing disorders.
This study
evaluated the prevalence and associated risks of binge drinking, defined as
having ≥4 drinks on an occasion in the past year, in a female patient
population. Of 1,259 female Veterans ...Affairs patients surveyed, 780 reported
drinking alcohol in the past year, and 305 (24% of respondents, 39% of drinkers)
reported binge drinking in the past year; 84 (11% of drinkers) had done so
monthly or more often. Age-adjusted logistic regression analyses indicated that
women who reported past-year binge drinking monthly or more often reported
significantly increased odds of morning drinking (odds ratio OR = 40.3),
others worrying about their drinking (OR = 38.6), arguments after drinking (OR =
13.5), hepatitis or cirrhosis (OR = 3.1), frequent injuries (OR = 2.6), smoking
(OR = 3.7), drug use (OR = 22.2), and multiple sexual partners (OR = 4.6).
Background: The optimal brief questionnaire for alcohol screening among female patients has not yet been identified. This study compared the performance of the TWEAK (tolerance, worried, eye‐opener, ...amnesia, cutdown), the Alcohol Use Disorders Identification Test (AUDIT), and the AUDIT Consumption (AUDIT‐C) as self‐administered screening tests for hazardous drinking and/or active alcohol abuse or dependence among female Veterans Affairs (VA) outpatients.
Methods: Women were included in the study if they received care at VA Puget Sound and completed both a self‐administered survey containing the AUDIT and TWEAK screening questionnaires and subsequent in‐person interviews with the Alcohol Use Disorders and Associated Disabilities Interview Schedule. Sensitivities, specificities, positive and negative likelihood ratios, and areas under Receiver Operating Characteristic curves were computed for each screening questionnaire compared with two interview‐based comparison standards: (1) active DSM‐IV alcohol abuse or dependence and (2) hazardous drinking and/or active DSM‐IV alcohol abuse or dependence, the more appropriate target for primary care screening.
Results: Of 393 women who completed screening questionnaires and interviews, 39 (9.9%) met diagnostic criteria for alcohol abuse or dependence, and 89 (22.7%) met criteria for hazardous drinking or alcohol abuse or dependence. The TWEAK had relatively low sensitivities (0.62 and 0.44) but adequate specificities (0.86 and 0.89) for both interview‐based comparison standards, even at its lowest cut‐point (≥1). The AUDIT and AUDIT‐C were superior, with the following areas under the receiver operating characteristic curve for active alcohol abuse or dependence and hazardous drinking and/or active alcohol abuse or dependence, respectively: AUDIT, 0.90 95% confidence interval (CI), 0.85–0.95 and 0.87 (95% CI, 0.84–0.91); AUDIT‐C, 0.91 (95% CI, 0.88–0.95) and 0.91 (95% CI, 0.88–0.94); and TWEAK, 0.76 (95% CI, 0.66–0.86) and 0.67 (95% CI, 0.60–0.74).
Conclusions: The TWEAK has low sensitivity as an alcohol‐screening questionnaire among female VA outpatients and should be evaluated further before being used in other female primary care populations. The three‐item AUDIT‐C was the optimal brief alcohol‐screening questionnaire in this study.
Exploration of the genetic architecture of specific endophenotypes may be a powerful strategy for understanding the genetic basis of schizophrenia.
To characterize the genetic architecture of some ...key endophenotypic measures selected for their reported heritabilities in schizophrenia.
Family-based heritability study.
Seven sites across the United States.
At the time of these initial data analyses, the members of 183 nuclear families ascertained through probands with schizophrenia had been assessed for these endophenotypes.
Variance component models were used to assess the heritability of and the environmental and genetic correlations among the endophenotypes. The Consortium on the Genetics of Schizophrenia assesses the neurophysiologic measures of prepulse inhibition of acoustic startle, P50 event-related potential suppression, and the antisaccade task for eye movements and the neurocognitive measures of the Continuous Performance Test (Degraded Stimulus version), the California Verbal Learning Test, the Letter-Number Sequencing test, and 6 measures from the University of Pennsylvania Computerized Neurocognitive Battery. The heritabilities of these 12 measures are the focus of this article.
All of the endophenotypes and the University of Pennsylvania Computerized Neurocognitive Battery measures were found to be significantly heritable (P < or = .005), with heritabilities ranging from 24% to 55%. Significant environmental and genetic correlations were also observed between many of the endophenotypic measures.
This is the first large-scale, multisite, family-based heritability study of a collection of endophenotypes for schizophrenia and suggests that endophenotypes are important measures to consider in characterizing the genetic basis of schizophrenia.
The effects of one week of estrogen replacement on choline acetyltransferase (
ChAT) and
trkA mRNA expression are examined in young and aged rodents to determine whether estrogen continues to affect ...cholinergic neurons in aging brain. Significant increases in
ChAT and
trkA are observed in the nucleus basalis of Meynert (nBM) of both age groups.
ChAT expression is also increased in the HDB without changes in
trkA expression. Results indicate modulation of
ChAT expression by estrogen is retained in the aged rodent brain and suggests the possibility that changes in
ChAT expression may be dissociated from concurrent alterations in
trkA.
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