Clinical Outcomes of Mammographic BI-RADS 3 Lesions in the Community Hospital Setting.

OBJECTIVES: Per the Breast Imaging Reporting and Data System (BI-RADS) manual, a lesion designated as BI-RADS 3 should have less than a 2% chance of becoming malignancy. With this study, we evaluated the outcome of patients given a BI-RADS 3 designation in the community hospital. Specifically, whether our cancer detection rate for BI-RADS 3 lesions was less than 2% and comparable to rates obtained at other institutions. METHODS: The records of 1037 patients given a BI-RADS 3 on screening mammogram were reviewed over a 1-year period between May 2007 and May 2008. A total of 142 of these patients were lost to follow-up, leaving 885 patients. Some of these patients had more than 1 BI-RADS 3 lesion during this study period, yielding a total of 923 BI-RADS 3 lesions to evaluate out of the 885 patients remaining. Of these, 478 of the patients' lesions were biopsied. The pathology was then reviewed to determine whether the lesions were cancerous. RESULTS: Only 6 of the 882 lesions initially classified as a BI-RADS 3 were later diagnosed as cancer, or 0.65% of the study population. The positive predictive value of receiving a BI-RADS 3 was 99.3%, which demonstrates a high accuracy in predicting that a lesion is not cancerous. CONCLUSION: Most lesions that are diagnosed as a BI-RADS 3 have a very low probability of eventually being diagnosed as cancer. The findings from this study are comparable to studies performed at other institutions.

Delayed Intraperitoneal Catheter Erosion into the Small Bowel.

Intraperitoneal chemotherapy can be provided in cases of metastatic ovarian carcinoma. Although most complications arise during or immediately after insertion of the catheter, there are complications that can arise several months later or during therapy administration. One of these delayed complications is catheter erosion into adjacent bowel.

Impairment in local and global processing and set-shifting in body dysmorphic disorder.

Body dysmorphic disorder (BDD) is characterized by distressing and often debilitating preoccupations with misperceived defects in appearance. Research suggests that aberrant visual processing may contribute to these misperceptions. This study used two tasks to probe global and local visual processing as well as set-shifting in individuals with BDD. Eighteen unmedicated individuals with BDD and 17 non-clinical controls completed two global-local tasks. The embedded figures task requires participants to determine which of three complex figures contains a simpler figure embedded within it. The Navon task utilizes incongruent stimuli comprised of a large letter (global level) made up of smaller letters (local level). The outcome measures were response time and accuracy rate. On the embedded figures task, BDD individuals were slower and less accurate than controls. On the Navon task, BDD individuals processed both global and local stimuli slower and less accurately than controls, and there was a further decrement in performance when shifting attention between the different levels of stimuli. Worse insight correlated with poorer performance on both tasks. Taken together, these results suggest abnormal global and local processing for non-appearance related stimuli among BDD individuals, in addition to evidence of poor set-shifting abilities. Moreover, these abnormalities appear to relate to the important clinical variable of poor insight. Further research is needed to explore these abnormalities and elucidate their possible role in the development and/or persistence of BDD symptoms.

Disease-specific knowledge, coping, and adherence in patients with inflammatory bowel disease.

BACKGROUND: Little is known about the effects of disease-related education and knowledge in individuals with inflammatory bowel disease (IBD). The limited available research on this topic suggests there may be potential benefits to disease-related patient education. We hypothesized that individuals with greater IBD knowledge would have more coping strategies and higher medication adherence. METHODS: A total of 111 adults with IBD residing in the United States were recruited online by convenience sampling from IBD support group forums. IBD knowledge, coping, and medication adherence were assessed using standardized questionnaires. Data on seventeen clinico-demographic variables were also collected. A Pearson correlation was conducted to examine the relationship between IBD knowledge and use of coping strategies and also between IBD knowledge and medication adherence. Multivariate regression and one-way ANOVA tests were used to assess the continuous and categorical clinico-demographic variables, respectively, for potential confounding. RESULTS: A significant positive association was found between greater IBD knowledge and active coping scores (r = 0.189, P = 0.024), instrumental support scores (r = 0.160, P = 0.047), planning scores (r = 0.159, P = 0.048), and emotional support scores (r = 0.159, P = 0.048). A relationship between knowledge and adherence score was not found. Significant relationships were found between four clinico-demographic variables and coping. CONCLUSION: Greater IBD knowledge appears to be associated with the use of more adaptive coping strategies in patients with IBD, suggesting that providing disease-related patient education may enhance coping in this population. Future studies should explore the utility of formal disease-related patient education in improving these and other outcomes.

Clinical and subthreshold panic disorder.

BACKGROUND: Panic disorder (PD) is a highly prevalent and disabling condition, and subthreshold cases may be even more prevalent. This study examined psychiatric comorbidities, work functioning, and health-care utilization of individuals with subthreshold panic. The purpose of this study was to add to the accumulating evidence of significant comorbidity and disability associated with subthreshold PD. METHODS: Data are drawn from the Health Care for Communities study, a national household survey of the United States' adult, civilian, noninstitutionalized population (N=9585). Data assessing psychiatric disorders, employment and work productivity, and health-care utilization were collected. Seven categories of panic and subthreshold panic were created. RESULTS: The prevalence of clinical and subthreshold panic in the general population was 40%. Subthreshold panic was associated with increased odds of several comorbid disorders, including depression, dysthymia, psychosis, generalized anxiety disorder, bipolar disorder, and alcohol and drug use disorders. Subthreshold panic was also associated with greater likelihood of health-care service utilization but not with the intensity of mental health services. CONCLUSION: Psychiatric comorbidities and health-care utilization are common among patients with subthreshold panic. The relationship between varying degrees of panic symptomology and other mental health problems and indices of functioning impairment warrants further investigation. These results inform further research focusing on the course of subthreshold PD and its impact on quality of life.

Differential efficacy of memantine for obsessive-compulsive disorder vs. generalized anxiety disorder: an open-label trial.

OBJECTIVE: A substantial proportion of patients with obsessive-compulsive disorder (OCD) and generalized anxiety disorder (GAD) do not respond to, or are intolerant of, standard treatments. Additional treatment strategies are therefore necessary. Excessive action of the excitatory neurotransmitter glutamate may play a role in the pathophysiology of OCD and possibly GAD. Memantine blocks the excitatory action of glutamate at the N-methyl- D-aspartate (NMDA) receptor under pathological conditions. The objective of this study was to compare the efficacy and safety of memantine in OCD and GAD, and to probe relative effects on OCD and anxiety symptoms. METHOD: Ten OCD and 7 GAD subjects received 12 weeks of open-label memantine 10 mg twice daily, as either monotherapy or augmentation of their existing medication. Primary outcome measures were the Yale-Brown Obsessive Compulsive Scale ( YBOCS) for the OCD group, the Hamilton Anxiety Rating Scale (HARS) for the GAD group, and the Clinical Global Impression-Improvement Scale (CGII) for both groups. RESULTS: The OCD group experienced a significant mean 40.6% reduction in YBOCS scores at endpoint (t = 4.75, p < 0.001). Three of 10 of OCD subjects were classified as responders, although 7 of 10 experienced a >/= 45% reduction in YBOCS scores. The GAD group experienced a mean 22.4% reduction in HARS scores (t = 3.56, p = 0.012). None of the GAD subjects were responders, and none experienced a >/= 50% reduction in HARS scores. Memantine was well tolerated, and there were no serious adverse effects. CONCLUSIONS: These results suggest that memantine may have preferential efficacy in the treatment of OCD versus GAD. These preliminary findings warrant larger, placebo-controlled studies in OCD.

A preliminary study of fMRI-guided rTMS in the treatment of generalized anxiety disorder.

BACKGROUND: Repetitive transcranial magnetic stimulation (rTMS) is a noninvasive method that holds promise for treating several psychiatric disorders. Yet the most effective location and parameters for treatment need more exploration. Also, whether rTMS is an effective treatment for individuals with a DSM-IV diagnosis of generalized anxiety disorder (GAD) has not been empirically tested. The goal of this pilot study was to evaluate whether functional magnetic resonance imaging (fMRI)-guided rTMS is effective in reducing symptoms of GAD. METHOD: Ten participants with a DSM-IV diagnosis of GAD, recruited from the UCLA Anxiety Disorders Program, and between the ages of 18 and 56 years were enrolled in the study from August 2006 to March 2007. A pretreatment symptom provocation fMRI experiment was used to determine the most active location in the prefrontal cortex of the participants. Ten participants completed 6 sessions of rTMS over the course of 3 weeks, stereotactically directed to the previously determined prefrontal location. The primary efficacy measures were the Hamilton Rating Scale for Anxiety (HAM-A) and the Clinical Global Impressions-Improvement of Illness (CGI-I) scale. Response to treatment was defined as a reduction of 50% or more on the HAM-A and a CGI-I score of 1 or 2 ("very much improved" or "much improved," respectively). RESULTS: Overall, rTMS was associated with significant decreases in HAM-A scores (t = 6.044, p = .001) indicative of clinical improvement in GAD symptoms. At endpoint, 6 (60%) of the 10 participants who completed the study showed reductions of 50% or more on the HAM-A and a CGI-I score of 1 or 2; those 6 subjects also had an endpoint HAM-A score < 8, therefore meeting criteria for remission. CONCLUSION: Results of the current study suggest that fMRI-guided rTMS treatment may be a beneficial technique for the treatment of anxiety disorders. Limitations include a small sample size and open-label design with a technology that may be associated with a large placebo response. These limitations necessitate further research to determine whether rTMS is indeed effective in treating anxiety disorders.

A pilot study of cranial electrotherapy stimulation for generalized anxiety disorder.

BACKGROUND: Cranial electrotherapy stimulation (CES) is a noninvasive procedure that has been used for decades in the United States to treat anxiety, depression, and insomnia in the general population. Whether CES is an effective treatment for patients with a DSM-IV diagnosis of generalized anxiety disorder (GAD) has not previously been explored. The goal of this study was to evaluate the efficacy of CES in alleviating anxiety in patients with DSM-IV-diagnosed GAD. METHOD: Twelve patients from 29 to 58 years of age with a DSM-IV diagnosis of GAD were enrolled from August 2005 to March 2006 through the University of California, Los Angeles (UCLA) Anxiety Disorders Program. Cranial electrotherapy stimulation treatment was administered for 6 weeks using the Alpha-Stim Stress Control System at 0.5-Hz frequency and 300-muA intensity. The primary efficacy measures were the Hamilton Rating Scale for Anxiety (HAM-A) and the Clinical Global Impressions-Improvement (CGI-I) scale. Response to treatment was defined as a reduction of 50% or more on the HAM-A and a CGI-I score of 1 or 2 ("much improved" or "very much improved," respectively). RESULTS: Cranial electrotherapy stimulation was associated with a significant decrease in HAM-A scores (t = 3.083, p = .01). At endpoint, 6 patients (50% of the intent-to-treat sample and 67% of completers) had a 50% decrease in HAM-A score and a CGI-I score of 1 or 2. One additional patient significantly improved in anxiety scores but did not meet criteria for response. Adverse events were generally mild in severity, mostly consisting of headache and nausea. CONCLUSION: This preliminary study suggests that CES may reduce symptoms of anxiety in GAD. We hope that these preliminary results will encourage further research to explore the use of CES in clinical settings. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00539357.

A pilot controlled trial of bupropion XL versus escitalopram in generalized anxiety disorder.

OBJECTIVE: To compare the efficacy and safety of bupropion XL (150 to 300 mg/day) with the selective serotonin reuptake inhibitor escitalopram (10 to 20 mg/day) in outpatients diagnosed with generalized anxiety disorder (GAD). METHODS: Twenty-four participants with GAD between 18 and 64 years enrolled in a 12-week, double-blind, randomized trial. The primary efficacy measures were the Clinical Global Impression of Improvement (CGI-I) and the Hamilton Anxiety Rating Scale (HARS). RESULTS: Bupropion XL demonstrated comparable anxiolytic efficacy to escitalopram in outpatients with GAD. Both treatments were well-tolerated. CONCLUSION: Findings from this pilot project suggest that bupropion XL may be useful in treating GAD. These preliminary results warrant further research to explore the use of bupropion XL in the treatment of GAD.

A pilot study of Rhodiola rosea (Rhodax) for generalized anxiety disorder (GAD).

BACKGROUND: Rhodiola rosea is an herbal supplement that many in the general population in Russia and elsewhere in the world have used for decades to alleviate everyday anxiety, depression, and insomnia. Whether R. rosea is effective in reducing similar symptoms in clinical samples is unknown. The goal of this pilot study was to evaluate whether R. rosea is effective in reducing symptoms of generalized anxiety disorder (GAD). METHOD: Ten (10) participants with a DSM-IV diagnosis of GAD, recruited from the UCLA Anxiety Disorders Program and between the ages of 34 and 55, were enrolled in this study from November 2005 to May 2006. Participants received a total daily dose of 340 mg of R. rosea extract for 10 weeks. Assessments included the Hamilton Anxiety Rating Scale (HARS), the Four-Dimensional Anxiety and Depression Scale, and the Clinical Global Impressions of Severity/Improvement Scale. RESULTS: Individuals treated with R. rosea showed significant decreases in mean HARS scores at endpoint (t=3.27, p=0.01). Adverse events were generally mild or moderate in severity, the most common being dizziness and dry mouth. CONCLUSIONS: Significant improvement in GAD symptoms was found with R. rosea, with a reduction in HARS scores similar to that found in clinical trials. These preliminary findings warrant further exploration of treatment with R. rosea in clinical samples.

Spanish translation and reliability testing of the Child Depression Inventory.

The goal of this study was to test the internal reliability of a Spanish translation of the CDI, (i.e., CDI-LA), a potentially useful screening instrument for Hispanic youngsters in their native language at a primary-care level. Self-reported symptoms of depression were assessed with the CDI-LA in a school sample of 205 Hispanic students. Girls and boys ranging from 8 to 15 years (mean age 11.5 +/- 1.9 years) were tested on a designated day. The CDI-LA mean score was 9.7 +/- 7.2. Eleven percent of the subjects scored higher than the instruments' cutoff score (CDI > or = 19), and were considered at risk of clinical depression. Females scored higher than males, and children 8-12 years of age (mean CDI-LA = 8.8, SD = 6.6) had significantly (t = -2.07, 203 df, p < 0.05) lower mean CDI-LA total scores compared to those ages 13 or older (mean CDI-LA = 11.0, SD = 7.9). The internal consistency reliability of the CDI-LA was similar to that found in English speaking populations. These results suggest that the general psychometric properties of our Spanish translation of the 10 and 27 item versions of the CDI appear to be adequate according to a Cronbach's coefficient alpha estimate of internal reliability and Spearman correlation coefficient split-half reliability.