Biomedical subjects

Thomas L Patterson

Publications and source records attributed to Thomas L Patterson.

At least 37 records · Page 2Linked to original sources

PubMed2006

Dementia severity of the care receiver predicts procoagulant response in Alzheimer caregivers.

BACKGROUND: The procoagulant factor D-dimer has been shown to be associated with thrombus formation and degradation as seen with conditions such as myocardial infarction and unstable angina. Research has demonstrated that spousal dementia caregivers have elevated levels of D-dimer relative to their non-caregiving peers. OBJECTIVE: The objective of this study was to determine the relationship of basal level and laboratory stressor-induced concentration of D-dimer to severity of dementia in spousal care recipients. METHODS: Seventy-one elderly caregivers were compared with a comparison group of 37 non-caregivers (average age: 71 years). Clinical Dementia Rating (CDR), a global measure of dementia, was used to assess severity of spousal dementia. Plasma D-dimer was measured at baseline and in response to an acute speech stressor. RESULTS: Regression analysis revealed a significant positive association between severity of spousal dementia and caregiver D-dimer, both at baseline and in response to acute stress, while controlling for age. The model examined an exponential relationship, with D-dimer increasing progressively across the span of dementia stages. DISCUSSION: Dementia severity of the care recipient was associated with increasing hypercoagulability among elderly caregivers. Effect size estimates suggest that such D-dimer increases may have clinical implications, particularly among late-stage caregivers.

Aged↗

PubMed2006

Personal mastery attenuates the effect of caregiving stress on psychiatric morbidity.

This study examined the protective effects of personal mastery on the relations between both objective and subjective stress and psychiatric morbidity in 79 spousal Alzheimer caregivers. Results indicated that with low mastery, the relations between patient problem behaviors and caregiver psychiatric symptoms was significant (t[71] = 2.03; p = 0.046). However, with high mastery, no significant association was found (t[71] = -0.76; p = 0.452). Similarly, the relations between role overload and psychiatric morbidity was significant when mastery was low (t[71] = 2.22; p = 0.029), but not high (t[71] = -1.49; p = 0.140). These results suggest that caregivers with a greater sense of personal mastery may be protected from the negative effects of caregiver stress.

Caregivers↗

PubMed2006

Correlates of health-related quality of well-being in older patients with schizophrenia.

Research on correlates of health-related quality of life (HRQOL) among older patients with schizophrenia has been very limited. This study evaluated the relative impact of positive, negative, and depressive symptoms, movement disorders, and cognitive impairment on HRQOL among middle-aged and older patients with schizophrenia or schizoaffective disorder. Participants were 199 patients aged 45 to 85 years. The study was cross-sectional. The primary outcome measure was the Quality of Well-Being scale, and correlates were measures of positive and negative symptoms, depression, abnormal movements, and cognitive performance. Severity of depressive symptoms and of cognitive impairment correlated significantly with HRQOL and independently affected HRQOL scores. The initiation/perseveration subscale of the Dementia Rating Scale had the largest impact. These findings suggest that depressive symptoms and cognitive functioning should be part of the routine assessment of older people with schizophrenia and may be targets for psychopharmacological and psychosocial interventions to improve HRQOL.

Age Factors↗

PubMed2006

Poor sleep is associated with higher plasma proinflammatory cytokine interleukin-6 and procoagulant marker fibrin D-dimer in older caregivers of people with Alzheimer's disease.

OBJECTIVES: To determine whether objective measures of sleep correlate with plasma levels of the proinflammatory cytokine interleukin (IL)-6 and the procoagulant marker fibrin D-dimer in caregivers of patients with dementia. DESIGN: Cross-sectional study. SETTING: Subjects' homes. PARTICIPANTS: Sixty-four community-dwelling spousal caregivers (69% women, mean age+/-standard deviation 72+/-9) and 36 sex-matched noncaregiving controls. MEASUREMENTS: All participants underwent in-home full-night polysomnography. Demographic and lifestyle factors, depression, diseases, and medication that could affect inflammation, coagulation, and sleep were controlled for in analyses regressing sleep variables and caregiver status and their interaction on plasma levels of IL-6 and D-dimer. RESULTS: Caregivers had higher levels of D-dimer (781+/-591 vs 463+/-214 ng/mL, P=.001) and IL-6 (1.42+/-1.52 vs 0.99+/-0.86 pg/mL, P<.06) and lower levels of total sleep time (369+/-70 vs 393+/-51 minutes, P=.049) and sleep efficiency (77+/-11 vs 82+/-9%, P=.04) than controls. After controlling for age and body mass index, longer wake time after sleep onset (change in coefficient of determination (DeltaR2)=0.039, P=.04) and the interaction between caregiver status and higher apnea-hypopnea index (DeltaR2=0.054, P=.01) were predictors of IL-6. Controlling for age, caregiver status independently predicted D-dimer levels (DeltaR2=0.047, P=.01). Controlling for age and caregiver status, lower sleep efficiency (DeltaR2=0.032, P=.03) and the interaction between caregiver status and more Stage 2 sleep (DeltaR2=0.037, P=.02) independently predicted plasma D-dimer levels. CONCLUSION: Poor sleep was associated with higher plasma IL-6 and D-dimer levels. These effects were most pronounced in caregivers of subjects with Alzheimer's disease. The findings suggest a mechanism that may explain how disturbed sleep might be associated downstream with cardiovascular risk, particularly in older people under chronic stress.

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PubMed2006

Improvement in social competence with short-term atypical antipsychotic treatment: a randomized, double-blind comparison of quetiapine versus risperidone for social competence, social cognition, and neuropsychological functioning.

OBJECTIVE: While neuropsychological test performance is correlated with social outcomes in patients with schizophrenia, there is little evidence to date that changes in neuropsychological performance are associated with changes in these outcomes. As part of an efficacy and tolerability study of atypical antipsychotics, the authors used a performance-based measure of social competence as a short-term outcome measure and examined the correlations between changes in social competence and improvements on neuropsychological tests. METHOD: Patients with schizophrenia were randomly assigned in a 1:1 ratio to receive treatment with either quetiapine (dose range: 200-800 mg/day) or risperidone (dose range: 2-8 mg/day) for an 8-week period. RESULTS: Of 673 patients initially randomized, 289 had baseline and endpoint neuropsychological and functional competence data. Scores on the performance-based measure of social competence significantly improved with both treatments, as did a number of aspects of neuropsychological performance. Improvements in several aspects of neuropsychological performance were correlated with the extent of improvement in social competence. There were no overall differences between the treatments in their impact on social competence and neuropsychological performance. CONCLUSIONS: Short-term treatment with both quetiapine and risperidone resulted in improvements in social competence, with these improvements associated with improvements on some of the neuropsychological measures. In addition to their clinical importance, these results support the use of performance-based competence assessments as outcome measures in clinical trials.

Adolescent↗

PubMed2006

Determinants of real-world functional performance in schizophrenia subjects: correlations with cognition, functional capacity, and symptoms.

OBJECTIVE: Impairments in adaptive life skills are a major source of disability in patients with schizophrenia. The relationship between adaptive life skills in real-world settings and performance on neuropsychological tests may be complicated by other factors that interfere with deployment of skills. Assessment of the ability to perform life skills under optimal conditions (i.e., assessment of functional capacity) has been proposed as a means to clarify these relationships. METHOD: The authors examined cross-sectional data from a study of the course of neuropsychological and adaptive life skills of older (age 50-85) schizophrenia patients (N=78). Functional capacity was examined with a performance-based measure (UCSD Performance-Based Skills Assessment), and case managers rated real-world adaptive functions (i.e., interpersonal skills, work skills, and community activities). Neuropsychological performance was assessed with a comprehensive battery, while symptoms were assessed with patient self-report and clinical ratings. RESULTS: Confirmatory path analyses were used to evaluate the effects of neuropsychological performance, functional capacity, and symptoms on the various domains of real-world functioning. Neuropsychological performance predicted functional capacity, which predicted all three domains of real-world functioning. Depression predicted interpersonal and work skills, while negative symptoms affected interpersonal skills independently of other predictors. CONCLUSIONS: Real-world adaptive life skills are predicted by neuropsychological performance, symptoms, and functional capacity. Neuropsychological performance contributes little to the prediction of real-world performance after accounting for functional capacity. In some domains, negative and depressive symptoms influenced real-world performance while not relating to functional capacity or neuropsychological performance.

Activities of Daily Living↗

PubMed2006

Methamphetamine use, impulsivity, and sexual risk behavior among HIV-positive men who have sex with men.

This study examined impulsivity as a moderator of the relationship between meth use and sexual risk behavior in a sample of HIV-positive meth-using Men who have Sex with Men (MSM). Higher impulsivity was associated with less education, lower income, being unemployed, psychiatric diagnosis, and higher Beck depression scores. Intensity of meth use and sexual risk behavior were significantly correlated. In a multiple regression analysis, more education, greater intensity of meth use and higher levels of impulsivity predicted more unprotected sex. To test for moderating effects of impulsivity, an interaction term was added to the regression. The interactive effects model was statistically significant. A plot of the interaction revealed that the relationship between intensity of meth use and total unprotected sex was strongest among participants who had higher levels of impulsivity. This suggests that targeting impulsivity in interventions may help reduce sexual risk behaviors in high intensity meth-using HIV-positive MSM.

Adult↗

PubMed2006

Health-related quality of life and functioning of middle-aged and elderly adults with bipolar disorder.

OBJECTIVE: Data characterizing bipolar disorder in older people are scarce, particularly on functional status. We evaluated health-related quality of life and functioning (HRQoLF) among older outpatients with bipolar disorder as well as the relationship of HRQoLF to bipolar illness characteristics. METHOD: We compared community-dwelling middle-aged and older adults (age range, 45 to 85 years) with bipolar disorder (N=54; mean age=57.6 years), schizophrenia (N=55; mean age=58.5 years), or no psychiatric illnesses (N=38; mean age=64.7 years) on indicators of objective functioning (e.g., education, occupational attainment, medical comorbidity) and health status (e.g., Quality of Well-Being scale [QWB] and the Medical Outcomes Study-Short Form Health Survey [SF-36]). Within the group with bipolar disorder, we examined the relationship between HRQoLF and clinical variables (e.g., phase and duration of illness, psychotic symptoms, cognitive functioning). RESULTS: Patients with bipolar disorder were similar in educational and occupational attainment to the normal comparison group, but they obtained lower scores on the QWB and SF-36 (with large effect sizes). Compared with schizophrenia, bipolar disorder was associated with better educational and work histories but similar QWB and SF-36 scores and more medical comorbidity. Patients in remission from bipolar disorder had QWB scores that were worse than those of normal comparison subjects. Greater severity of psychotic and depressive symptoms and cognitive impairment were associated with lower HRQoLF. CONCLUSIONS: Bipolar disorder was associated with substantial disability in this sample of older adults, similar in severity to schizophrenia. Remission of bipolar disorder was associated with significant but incomplete improvement in functioning, whereas psychotic and depressive symptoms and cognitive impairment seemed to contribute to lower HRQoLF.

Age Factors↗

PubMed2006

Schizophrenia in late life: emerging issues.

Schizophrenia in late life is emerging as a major public health concern worldwide. We discuss several areas of research and clinical care that are particularly pertinent to older persons with schizophrenia, including the public health challenge and the cost of care. We then discuss clinical issues relevant to late-life schizophrenia (course of illness and cognition), medical care and comorbidity in older psychiatric patients (general and illness-related), and treatment concerns related to the use of atypical antipsychotics in older persons with psychosis (efficacy and side effects). Clinical care for this ever-increasing segment of our population requires special consideration of the unique characteristics of older persons with schizophrenia.

Age of Onset↗

PubMed2005

A review of performance-based measures of functional living skills.

There is growing recognition of the need to consider the effect of mental health treatments on functional independence/abilities, in addition to any effects on primary symptoms. A variety of performance-based measures of functional living skills have appeared in the medical literature over the past 25 years in discipline-specific journals, but there has been little attempt to synthesize this information to guide mental health clinicians and researchers in choosing among the available measures. Thus, the goal of the present review was (1) to identify and evaluate the strengths and weaknesses of currently available performance-based assessments of functional living skills for adult populations, and (2) to make specific recommendations regarding use of currently available instruments as well as recommendations for future instrument development. Through a comprehensive search of electronic citation databases for English-language articles on performance-based instruments, as well as via cross-referenced articles in the bibliography of each initially identified article, we identified 94 relevant articles covering 31 instruments, including 20 multi-domain instrument batteries, and 11 additional domain-specific performance-based instruments. Most identified instruments provided evidence of adequate reliability, but empirical data regarding the predictive validity of each scale in terms of actual "real world functioning" was less prevalent. Several good performance-based measures have been developed for individuals with dementia, psychiatric illnesses, and older healthy individuals. Future instrument development may benefit from a focus on brevity, empirical item selection as determined by patients/caregivers, predictive validity with an emphasis on change in functioning over time, and the relationship of performance to levels of competency required for the completion of everyday tasks.

Activities of Daily Living↗

PubMed2005

Development and pilot testing of a new psychosocial intervention for older Latinos with chronic psychosis.

Latinos constitute the largest minority in the United States, and there is an increasing number of Latino patients with schizophrenia and other psychoses living into old age. However, few specific behavioral interventions have been developed aimed at improving the functioning of this group. We evaluated a psychosocial intervention designed to improve the everyday living skills of middle-aged and older outpatients with very chronic psychotic disorders. Three psychiatric clinics, specializing in care of Latinos, were randomly assigned to (1) a 24-session intervention entitled Programa de Entrenamiento para el Desarrollo de Aptitudes para Latinos (PEDAL) group therapy (n = 21) targeting areas identified in our previous work as being problematic for this population (e.g., using public transportation) or (2) a time-equivalent friendly support group (SG; n = 8). Compared to the patients randomized to SG, PEDAL-treated patients' performance on everyday living skills improved significantly postintervention and was still significantly better at a 6-month maintenance follow-up period and at a 12-month no-treatment follow-up period. There was no significant change in psychopathology. Limitations of this pilot study are discussed. Results suggest that participation in this skills training program, designed specifically for older Latino patients with long-standing psychotic disorders, has the potential to significantly increase the patients' independence and improve functional skills.

Activities of Daily Living↗

PubMed2005

Historical trends in the production and consumption of illicit drugs in Mexico: implications for the prevention of blood borne infections.

Mexico has cultivated opium poppy since before the 1900's and has been an important transit route for South American cocaine for decades. However, only recently has drug use, particularly injection drug use, been documented as an important problem. Heroin is the most common drug used by Mexican injection drug users (IDUs). Increased cultivation of opium poppy in some Mexican states, lower prices for black tar heroin and increased security at U.S.-Mexican border crossings may be contributing factors to heroin use, especially in border cities. Risky practices among IDUs, including needle sharing and shooting gallery attendance are common, whereas perceived risk for acquiring blood borne infections is low. Although reported AIDS cases attributed to IDU in Mexico have been low, data from sentinel populations, such as pregnant women in the Mexican-U.S. border city of Tijuana, suggest an increase in HIV prevalence associated with drug use. Given widespread risk behaviors and rising numbers of blood borne infections among IDUs in Mexican-U.S. border cities, there is an urgent need for increased disease surveillance and culturally appropriate interventions to prevent potential epidemics of blood borne infections. We review available literature on the history of opium production in Mexico, recent trends in drug use and its implications, and the Mexican response, with special emphasis on the border cities of Ciudad Juarez and Tijuana.

Coca↗

PubMed2005

Methamphetamine-using HIV-positive men who have sex with men: correlates of polydrug use.

Methamphetamine use has become a major problem among communities of men having sex with men (MSM), where it has been associated with high-risk behaviors. Methamphetamine is often combined with other drugs that may increase its risks and adverse health consequences. To examine differences in background characteristics, HIVrisk behaviors, and psychosocial variables among polydrug-using HIV-positive MSM, the researchers classified a sample of 261 HIV-positive, methamphetamine-using MSM into three user groups: (1) methamphetamine only; (2) methamphetamine, marijuana, and poppers (light polydrug users); and (3) methamphetamine and other drugs (e.g., cocaine, heroin, hallucinogens, and ketamine; heavy polydrug users). Only 5% reported using only methamphetamine during the past 2 months; 31% were classified as light polydrug users, and 64% were classified as heavy polydrug users. Heavy polydrug users were significantly younger than light polydrug users (35.6 vs. 38.4, P<.01) and reported using methamphetamine for significantly fewer years (10.3 vs. 14.2 years, P<.001), but did not differ in the amount and frequency of methamphetamine or alcohol consumed. Heavy polydrug users reported significantly more sex partners of HIV-negative and unknown serostatus and had more unprotected sex with these partners. Heavy polydrug users had significantly higher scores on impulsivity and negative self-perceptions, as compared with those of light polydrug users. In this sample of HIV-positive MSM, most of those who used methamphetamine had a pattern of polydrug use. Heavy polydrug users reported significantly more high-risk sexual behaviors and tended toward higher levels of impulsivity than light polydrug users. The implications of these findings are two-fold: (1) Longitudinal research is needed to establish causal relationships among methamphetamine use, impulsivity, negative self-perceptions, and sexual risk behavior in this target population; (2) behavioral interventions should evaluate whether methamphetamine use and sexual risk behavior can be reduced by modifying impulsivity and negative self-perceptions.

Adult↗

PubMed2005

Impulsivity and methamphetamine use.

The purpose of this study was to explore the relationship between methamphetamine (meth) use and impulsivity in a sample of 385 HIV-negative heterosexually identified meth users. Participants who scored highest on a self-report measure of impulsivity were compared with those who scored lower in terms of background characteristics, meth use patterns, use of alcohol and other illicit drugs, sexual risk behavior, and psychiatric health variables. Methamphetamine users in the high impulsivity group were younger, less educated, used larger quantities of meth, were more likely to be binge users, had a larger number of sexual partners, engaged in more unprotected vaginal and oral sex, and scored higher on the Beck Depression Inventory as compared with those in the low impulsivity group. In a logistic regression analysis, Beck depression was the factor that best distinguished between meth users who scored high and those who scored low on impulsivity. Neurophysiological pathways that may underlie the relationship between impulsivity and meth use are discussed.

Adolescent↗

PubMed2005

Negative self-perceptions and sexual risk behavior among heterosexual methamphetamine users.

This research examined the relationship between negative self-perceptions and sexual risk behavior in a sample of 156 heterosexually identified, methamphetamine users from San Diego, California. The Beck Depression Inventory and the Self Esteem Rating Scale, respectively, were used to assess depression and negative self-perceptions. Measures of sexual risk behavior and methamphetamine use were developed specifically for this research. Data were gathered in 2001-2002. Participants were primarily male (76%), Caucasian (56%), never married (51%), and unemployed (73%), with a mean age of 39.1 years. Participants with high levels of negative self-perceptions evidenced the greatest degree of sexual risk behavior, including significantly more unprotected vaginal sex and a larger number of sexual partners as compared to individuals with low levels of negative self-perceptions. In cross-sectional analyses, negative self-perceptions predicted intensity of methamphetamine use and depressive symptoms. However, neither of these variables were found to mediate the relationship between negative self-perceptions and sexual risk behavior. Findings are discussed in relation to the need for further research into the role of negative self-perceptions as a determinant of sexual risk behavior among methamphetamine users.

Adolescent↗

PubMed2005

Brain mitochondrial injury in human immunodeficiency virus-seropositive (HIV+) individuals taking nucleoside reverse transcriptase inhibitors.

Nucleoside reverse transcriptase inhibitors (NRTIs) suppress human immunodeficiency virus (HIV) replication, but are often associated with mitochondrial toxicity. Although well studied outside of the central nervous system, no investigation has examined the effects of these drugs on brain mitochondria of individuals living with HIV. The authors used proton magnetic resonance spectroscopy to evaluate NRTI-related changes in brain mitochondria. N-acetylaspartate (NAA; sensitive to alterations in mitochondrial integrity) was measured in frontal lobe white and gray matter of 18 HIV+ individuals taking didanosine and/or stavudine (two NRTIs likely to cause mitochondrial toxicity), 14 HIV+ individuals taking zidovudine and lamivudine, 16 HIV+ individuals not currently taking antiretrovirals, and 17 HIV- controls. The HIV+ groups were comparable on demographic measures, estimates of illness severity, and estimated length of HIV infection. Those taking didanosine and/or stavudine had a significant 11.4% decrease in concentrations of frontal white matter NAA compared to HIV- controls, whereas NAA levels of the other HIV+ groups were intermediate. Group differences in metabolites were not found in frontal gray matter. Lower levels of frontal white matter NAA were associated with longer periods of didanosine and/or stavudine treatment (r = -.41, P = .06). Levels of NAA were not related to length of zidovudine/lamivudine treatment (r = -.04, P = .44). Furthermore, taking more than one of stavudine, didanosine, and abacavir increased the likelihood of having reduced NAA. The results are consistent with previous studies finding HIV-related changes in neuronal integrity. However, because NRTIs can injure mitochondria, we propose that the observed reductions in NAA in individuals taking didanosine and/or stavudine may be the result of depleted brain mitochondria and/or alterations in cellular respiration. Measurement of brain metabolites sensitive to impairments in energy metabolism, including NAA, may aid in early detection of subclinical NRTI-mediated mitochondrial toxicity.

Adult↗

PubMed2005

Sleep in spousal caregivers of people with Alzheimer's disease.

STUDY OBJECTIVE: This study examined differences in objective and subjective measures of sleep between caregivers and noncaregivers. DESIGN: Cross-sectional design. SETTING: All assessments were conducted within the home. PARTICIPANTS: Seventy-three community-dwelling spousal caregivers of patients with Alzheimer's disease and 40 noncaregiving controls. MEASUREMENTS AND RESULTS: Subjects completed a semistructured interview on sociodemographics, cognitive status of the care recipient, self-reported sleep quality, and functional outcome. A polysomnogram was conducted. Caregivers of patients with moderate to severe Alzheimer's disease reported significantly more sleep problems (P<.05) and more functional impairment as a result of sleepiness than noncaregivers (P<.01). Objectively, older caregivers of those with moderate to severe Alzheimer's disease slept less than older noncaregivers (P<.05); there were no other significant differences in objective sleep measures. There was a main effect for age, with older caregivers and older noncaregivers having lower sleep efficiency, less slow-wave sleep, and more stage 1 sleep than younger caregivers and noncaregivers (P<.05). CONCLUSIONS: This study suggests that nighttime sleep is shorter but not otherwise disrupted in caregivers of patients with moderate to severe Alzheimer's disease compared with noncaregivers, and the impact of caregiving on sleep disturbance may be most salient for older caregivers. It is possible that these older caregivers are more vulnerable to the effects of sleep disruption and thus have trouble falling back to sleep when the time is afforded them. Future work is needed to examine the differences in care practices in caregivers by age and dementia severity. Perhaps more importantly, studies examining the health consequences of shortened sleep in this group are needed.

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PubMed2005

Psychological interventions for late-life anxiety: a review and early lessons from the CALM study.

The authors review the literature on psychological treatment for anxiety in older adults, focusing on randomized, controlled trials. Evidence exists for the efficacy of relaxation training for subjective anxiety symptoms and cognitive-behavioral therapy for generalized anxiety disorder and miscellaneous anxiety syndromes, including panic disorder. The authors also present the rationale for the CALM Study (Controlling Anxiety in Later-life Medical Patients), an ongoing randomized trial in which a modular psychotherapeutic intervention for anxiety in older primary care patients is compared with treatment as usual. Data are presented from 2 pilot patients in the CALM Study, and preliminary lessons are discussed.

Age of Onset↗