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Interleukin (IL)-2, a T-cell cytokine used to treat malignant melanoma, can induce profound depression. To determine whether pretreatment with the antidepressant escitalopram could reduce IL-2-induced neuroendocrine, immune, and neurobehavioral changes, 20 patients with Stage IV melanoma were randomized to either placebo or the serotonin reuptake inhibitor, escitalopram (ESC) 10–20 mg/day, 2 weeks before, and during IL-2 treatment (720 000 units/kg Q8 h × 5 days (1 cycle) every 3 weeks × 4 cycles). Generalized estimation equations were used to examine HPA axis activity (plasma ACTH and cortisol), immune activation (plasma IL-6), and depressive symptoms (Hamilton Depression Rating Scale (HDRS) score). Tolerance of IL-2 treatment (concomitant medications required) and adherence (number of IL-2 doses received) were also assessed. Both the groups (ESC (n=9), placebo (n=11)) exhibited significant IL-2-induced increases in plasma cortisol, IL-6, and depressive symptoms (p

In patients at high risk for recurrence of malignant melanoma, interferon-α (IFN-α), a stimulator of innate immunity, appears to induce distinct neurobehavioral symptom dimensions: a mood and anxiety syndrome, and a neurovegetative syndrome, of which the former is responsive to prophylactic administration of paroxetine. We sought to determine whether symptom dimensions (and treatment responsiveness) arise in patients with hepatitis C administered IFN-α and ribavirin. In a randomized, double-blind, 6-month study, 61 patients with hepatitis C eligible for therapy with IFN-α and ribavirin received the antidepressant paroxetine (n=28) or a placebo (n=33). Study medication began 2 weeks before IFN-α/ribavirin therapy. Neuropsychiatric assessments included the 10-item Montgomery-Asberg Depression Rating Scale (MADRS). The items of the MADRS were grouped into depression, anxiety, cognitive dysfunction, and neurovegetative symptom dimensions, and analyzed using a mixed model. By 2 weeks of IFN-α/ribavirin therapy, all four dimensions increased, with the symptom dimensions of anxiety and cognitive dysfunction fluctuating and worsening, respectively, in both groups over time. The depression symptom dimension was significantly lower in the paroxetine treatment group (p=0.04); severity of the neurovegetative symptom dimension was similar in both groups. Similar to patients with malignant melanoma receiving high-dose IFN-α, the depression symptom dimension is more responsive to paroxetine treatment in individuals undergoing concomitant IFN-α/ribavirin therapy. However, the anxiety, cognitive dysfunction, and neurovegetative symptom dimensions appear less responsive to prophylactic paroxetine administration. Different neurobiologic pathways may contribute to the responsiveness of IFN-α-induced symptom dimensions to antidepressant treatment, requiring relevant psychopharmacologic strategies.

Few smoking cessation trials have focused on U.S. Hispanics. Consequently, little is known about culturally specific considerations for intervention delivery. The purpose of this study was to test the efficacy of a written smoking cessation intervention varying in cultural specificity and language. Participants (N = 222) were English-Spanish bilingual Hispanic smokers recruited from the community. A 2 (cultural specificity-culturally specific or standard) × 2 (receipt of preferred language materials-preferred or less preferred) between-subjects experiment was conducted. Participants were assessed at baseline and at a 2-week post intervention follow-up. Dependent variables measured intervention evaluations (intended utilization and content evaluation), cigarettes smoked per day, and smoking cessation (secondary outcome). We hypothesized independent effects of cultural specificity, receipt of preferred language materials, and an interaction effect. Results demonstrated that intended utilization was greater among participants who received the intervention in their preferred language, F(1, 213) = 9.772, p = .002, η2 = .044. No differences in content evaluations were observed. However, number of cigarettes smoked per day was lower, and self-reported cessation was significantly greater among participants who received a culturally specific intervention, F(1, 152) = 4.939, p = .028, partial η2 = .031, and materials in their preferred language, OR = 5.356, p = .037, 95% CI [1.106, 25.948], respectively. In conclusion, this study contributes to our understanding of dimensions influencing responses to smoking cessation interventions among Hispanics. Both cultural specificity and preferred language delivery appear to be causally related to the intended utilization of interventions and smoking behavior. (PsycINFO Database Record

Introduction Most research on racial/ethnic differences among smokers is outdated and does not focus on help seekers. The purpose of this study was to revisit racial/ethnic differences in variables related to cessation in a sample of smokers enrolled in a randomized trial. Methods Adult smokers (N = 417; n = 126 White; n = 123 Hispanic; n = 168 Black) completed measures of demographics, smoking history, alcohol use, depressive symptoms, and readiness to quit. Results We found significant differences in these factors across groups. Blacks were more likely to be older, less educated, single, low income, smoke menthol cigarettes, and report greater nicotine dependence. Hispanics were younger, reported fewer years smoking and cigarettes per day, lower nicotine dependence, preferred mentholated cigarettes, and reported greater alcohol use intensity. After controlling for demographics and smoking history, Blacks reported greater depressive symptoms and lower readiness to quit compared with Whites and Hispanics. Conclusions Help-seeking Blacks may exhibit more risk factors for difficulty quitting compared with other groups. Hispanics may have some protective factors, such as lower dependence, but require attention to alcohol use and menthol smoking. Identifying preintervention racial/ethnic differences in characteristics related to cessation is important for developing evidence-based and culturally specific interventions and for reducing tobacco-related health disparities.

Background Effective depression treatment does not reliably reduce glycosylated hemoglobin (HbA1c) in depressed patients with type 2 diabetes, possibly in part due to deficits in functional capacity, i.e. performance of certain everyday living skills, essential for effective diabetes self-management. We sought to determine: a) the magnitude of deficits in functional capacity among urban, African American (AA) patients with type 2 diabetes, and b) whether these deficits were associated with poorer glycemic control. Methods At their initial visit to an inner-city diabetes clinic, 172 AA patients with type 2 diabetes were assessed with a variety of instruments, including the Mini International Neuropsychiatric Interview (MINI) and the UCSD Performance Skills Assessment-Brief (UPSA-B). They then entered a comprehensive diabetes management intervention, whose success was indexed by HbA1c levels at up to four reassessments over a one-year period. A mixed-effects model repeated-measures method was used to predict HbA1c. Results The prevalence of depression was 19%; the mean UPSA-B score was 81 ± 17. After multivariate adjustment, increased HbA1c levels over time were predicted by the presence of major depression ( B = .911, p = .002) and decreasing (worse) scores on the UPSA-B ( B = −.016, p = .027), respectively. Further adjustment for increasing the dosage of oral or insulin during the treatment eliminated the association between the UPSA score and HbA1c level ( B = −.010, p = .115). Conclusions Depression, as well as deficits in functional capacity, predicted reduced effectiveness of a diabetes self-management intervention. Future studies will determine whether interventions targeted at both improve glycemic control.

Objective Previous research has documented disparities in smoking cessation between African Americans and Caucasians. Many low-income African American smokers face a range of circumstances that may inhibit effective coping during quit attempts, yet previous research has not considered factors that influence coping in this population. This study examined (a) affect (positive and negative) and (b) perceived social support in association with coping strategies. Methods The baseline assessment of African American smokers ( N = 168) enrolled in a randomized controlled trial included the Positive and Negative Affect Schedule, the Multidimensional Scale of Perceived Social Support, and the Brief COPE. A factor analysis of the Brief COPE resulted in two factors, adaptive and maladaptive strategies. Results Participants were mostly single (64%), women (61%), with ≥ 12 years of education (68%), and low-income. They were middle aged ( M = 46.1, SD = 8.7), smoked 21.8 ( SD = 13.3) cigarettes/day for 24.3 ( SD = 11) years, and were moderately nicotine dependent. Results demonstrated that adaptive coping was positively correlated with positive affect and social support. Maladaptive coping was positively correlated with negative affect, and inversely related to positive affect and social support. Multivariate analyses revealed that positive affect and social support were independently associated with adaptive coping strategies. In contrast, maladaptive coping was independently associated with negative affect, but not social support. Conclusions Interventions that harness positive resources, such as social support and positive mood, may facilitate adaptive coping. Also, addressing negative affect among low-income African American smokers may be important to reduce maladaptive coping strategies.

African-Americans suffer disproportionately from tobacco-associated morbidity and mortality. Considering the relationship between cultural variables and cessation may be important for reducing disparities. This study aimed to examine acculturation as a predictor of smoking cessation following a standard group intervention. Treatment-seeking smokers (N = 140) participated in a group intervention for cessation plus transdermal nicotine patch therapy and completed the African American Acculturation Scale—Revised at baseline. The primary outcome was self-reported 7-day point prevalence abstinence at the end-of-counseling and 3 and 6 months postintervention. Adjusted logistic regression analyses found that acculturation predicted end-of-counseling and 3-month 7-day point prevalence abstinence; traditional African-Americans (i.e., less acculturated) were less likely to quit smoking. Cultural superstitions, religious beliefs and practices, and interracial attitudes were predictive of smoking cessation. Acculturation was associated with cessation following a group-based intervention. Culturally specific adaptations to established interventions might improve outcomes for traditional smokers.

Venous thromboembolism (VTE), that is, formation of a blood clot within the venous system and subsequent embolisation, haunts every service in the hospital, and psychiatry is no exception. When arising in the deep veins of the lower extremities, these thrombi put patients at risk for potentially fatal pulmonary embolism (PE). Virchow’s well-known triad describes the three factors that influence thrombogenesis: (1) damage to the endothelial lining of the blood vessels, (2) stasis or turbulence of blood flow, and (3) blood hypercoaguability. Conditions that increase a patient’s risk of developing VTE include smoking, chronic obstructive pulmonary disease, congestive heart failure, pregnancy, cancer, inherited hypercoaguable states, inflammatory bowel disease, obesity, surgery, and history of previous VTE. Medical inpatients carry a 10% to 20% risk of developing clots in their deep veins, although only a portion of these occur in proximal locations most likely to embolize to the lungs. Deep venous thrombosis (DVT) occurs in about one per 1000 persons per year, and is the third most common reason for hospital deaths. Two-thirds of VTE occur as DVT alone, while one-third of the cases of VTE present as PE. Approximately 350,000 to 600,000 Americans each year suffer from DVT and PE, and at least 100,000 deaths may be directly or indirectly related to these diseases. Like healthcare-associated infections, PE is largely preventable when healthcare workers, including those in mental health, implement current recommendations for prevention, screening, and management. A recent review noted over 100 guidelines related to DVT and PE prevention, diagnosis, and treatment in general and specific populations. A risk assessment tool and management algorithm for psychiatric inpatient settings has been proposed to guide VTE prophylaxis. However, even in medical