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2. Gamma Ventral Capsulotomy in Intractable Obsessive-Compulsive Disorder

Author

Rasmussen, Steven A, Noren, Georg, Greenberg, Benjamin D, Marsland, Richard, McLaughlin, Nicole C, Malloy, Paul J, Salloway, Stephen P, Strong, David R, Eisen, Jane L, Jenike, Michael A, Rauch, Scott L, Baer, Lee, and Lindquist, Christer

Subjects
Biological Psychology, Biomedical and Clinical Sciences, Psychology, Clinical Research, Brain Disorders, Behavioral and Social Science, Mental Health, Serious Mental Illness, Neurosciences, Mental health, Adult, Female, Humans, Internal Capsule, Male, Obsessive-Compulsive Disorder, Psychiatric Status Rating Scales, Psychosurgery, Radiation Injuries, Radiosurgery, Treatment Outcome, Anterior capsulotomy, Efficacy, Frontostriatal circuits, Gamma Knife, Obsessive-compulsive disorder, Safety, Biological Sciences, Medical and Health Sciences, Psychology and Cognitive Sciences, Psychiatry, Biological sciences, Biomedical and clinical sciences
Abstract

BACKGROUND:Despite the development of effective pharmacologic and cognitive behavioral treatments for obsessive-compulsive disorder (OCD), some patients continue to be treatment-refractory and severely impaired. Fiber tracts connecting orbitofrontal and dorsal anterior cingulate cortex with subcortical nuclei have been the target of neurosurgical lesions as well as deep brain stimulation in these patients. We report on the safety and efficacy of ventral gamma capsulotomy for patients with intractable OCD. METHODS:Fifty-five patients with severely disabling, treatment-refractory OCD received bilateral lesions in the ventral portion of the anterior limb of the internal capsule over a 20-year period using the Leksell Gamma Knife. The patients were prospectively followed over 3 years with psychiatric, neurologic, and neuropsychological assessments of safety and efficacy, as well as structural neuroimaging. RESULTS:Thirty-one of 55 patients (56%) had an improvement in the primary efficacy measure, the Yale-Brown Obsessive Compulsive Scale, of ≥35% over the 3-year follow-up period. Patients had significant improvements in depression, anxiety, quality of life, and global functioning. Patients tolerated the procedure well without significant acute adverse events. Five patients (9%) developed transient edema that required short courses of dexamethasone. Three patients (5%) developed cysts at long-term follow-up, 1 of whom developed radionecrosis resulting in an ongoing minimally conscious state. CONCLUSIONS:Gamma Knife ventral capsulotomy is an effective radiosurgical procedure for many treatment-refractory OCD patients. A minority of patients developed cysts at long-term follow-up, 1 of whom had permanent neurological sequelae.

Published
2018

5. Standardization of health outcomes assessment for depression and anxiety: recommendations from the ICHOM Depression and Anxiety Working Group

Author

Obbarius, Alexander, van Maasakkers, Lisa, Baer, Lee, Clark, David M., Crocker, Anne G., de Beurs, Edwin, Emmelkamp, Paul M. G., Furukawa, Toshi A., Hedman-Lagerlöf, Erik, Kangas, Maria, Langford, Lucie, Lesage, Alain, Mwesigire, Doris M., Nolte, Sandra, Patel, Vikram, Pilkonis, Paul A., Pincus, Harold A., Reis, Roberta A., Rojas, Graciela, Sherbourne, Cathy, Smithson, Dave, Stowell, Caleb, Woolaway-Bickel, Kelly, and Rose, Matthias

Published
2017
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7. Behavioral Strategies

Author

Chosak, Anne, Baer, Lee, Rosenbaum, Jerrold F., Series editor, Petersen, Timothy J., editor, E. Sprich, Susan, editor, and Wilhelm, Sabine, editor

Published
2016
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14. Attendees' Perceptions of Commercial Influence in Noncommercially Funded CME Programs

Author

Goldfarb, Elizabeth, Baer, Lee, and Fromson, John A.

Abstract

Introduction: The controversy surrounding commercial support for continuing medical education (CME) programs has led to policy changes, but data show no significant difference in perceived bias between commercial and noncommercial CME. Indeed, what attendees perceive as commercial influence is not fully understood. We sought to clarify what "sources" contribute to attendees' perceptions of commercial influence in non-industry-supported CME programs, and how attendees perceive that this influence manifests itself on both speaker and program levels. Methods: Evaluation forms were received from 1 544 attendees at 14 live noncommercially supported CME programs in 2006, 2007, and 2010. Attendees rated perceived commercial influence for each lecture and the entire program. Using open-ended and "check all that apply" questions, participants specified perceived "sources" and "manifestations" of commercial influence. Results: Attendees rating individual lectures but not the entire program as commercially influenced accounted for 59.9% of those who identified bias. The most frequently endorsed source of commercial influence was individual speakers' funding, and the most listed manifestations were speakers' mentions of pharmaceuticals and expressions of personal opinions. Rating the entire program commercially influenced correlated with whether attendees considered the funding of referenced research a source of influence. Discussion: CME attendees consider a broad spectrum of factors when reporting commercial influence. Evaluation forms should include bias questions per lecture as well as items to clarify perceived sources and manifestations of commercial influence. (Contains 3 tables and 1 figure.)

Published
2012
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16. Web-Based Simulation in Psychiatry Residency Training: A Pilot Study

Author

Gorrindo, Tristan, Baer, Lee, and Sanders, Kathy M.

Abstract

Background: Medical specialties, including surgery, obstetrics, anesthesia, critical care, and trauma, have adopted simulation technology for measuring clinical competency as a routine part of their residency training programs; yet, simulation technologies have rarely been adapted or used for psychiatry training. Objective: The authors describe the development of a web-based computer simulation tool intended to assess physician competence in obtaining informed consent before prescribing antipsychotic medication to a simulated patient with symptoms of psychosis. Method: Eighteen residents participated in a pilot study of the Computer Simulation Assessment Tool (CSAT). Outcome measures included physician performance on required elements, pre- and post-test measures of physician confidence in obtaining informed consent, and levels of system usability. Results: Data suggested that the CSAT increased physician confidence in obtaining informed consent and that it was easy to use. Conclusions: The CSAT was an effective educational tool in simulating patient-physician interactions, and it may serve as a model for use of other web-based simulations to augment traditional teaching methods in residency education.

Published
2011
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17. M-Rated Video Games and Aggressive or Problem Behavior among Young Adolescents

Author

Olson, Cheryl K., Kutner, Lawrence A., Baer, Lee, Beresin, Eugene V., Warner, Dorothy E., and Nicholi, Armand M., II

Abstract

This research examined the potential relationship between adolescent problem behaviors and amount of time spent with violent electronic games. Survey data were collected from 1,254 7th and 8th grade students in two states. A "dose" of exposure to Mature-rated games was calculated using Entertainment Software Rating Board ratings of titles children reported playing "a lot in the past six months," and average days per week of video game play. Analyses were conducted using simultaneous logistic regression for binary outcome variables, and simultaneous multiple linear regression for continuous outcome variables, controlling for a series of potential confounders. M-rated game dose predicted greater risk for bullying (p less than 0.01) and physical fights (p less than 0.001), but not for delinquent behaviors or being a victim of bullies. When analyzed separately, these associations became weaker for boys and stronger for girls. (Contains 3 tables.)

Published
2009
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31. Development of a Brief Screening Instrument : The HANDS

Author

Baer, Lee, Jacobs, Douglas G., Meszler-Reizes, Joelle, Blais, Mark, Fava, Maurizio, Kessler, Ronald, Magruder, Kathryn, Murphy, Jane, Kopans, Barbara, Cukor, Peter, Leahy, Linda, and O’Laughlen, John

Published
2000

45. Connections among symptoms of obsessive--compulsive disorder and posttraumatic stress disorder: a case series

Author

Gershuny, Beth S., Baer, Lee, Radomsky, Adam S., Wilson, Kimberly A., and Jenike, Michael A.

Subjects
Obsessive-compulsive disorder -- Research, Psychology and mental health
Abstract

Theoretical, clinical, and empirical implications of the functional connections between symptoms of obsessive-compulsive disorder (OCD) and posttraumatic stress disorder (PTSD) are abundant. As such, four cases are presented here of men and women who met criteria for comorbid OCD and PTSD. All had been diagnosed with treatment-resistant OCD and were seeking treatment from an OCD specialty clinic or institute, all reported a history of traumatic experiences prior to the onset of OCD, and all appeared to demonstrate negative treatment outcomes. Upon examination, it appeared that symptoms of OCD and PTSD were connected such that decreases in OCD-specific symptoms related to increases in PTSD-specific symptoms, and increases in OCD-specific symptoms related to decreases in PTSD-specific symptoms. Speculations about the function of OCD symptoms in relation to post-traumatic psychopathology are put forth; and theoretical, research, and treatment implications are discussed. Keywords: Obsessive--compulsive disorder; Posttraumatic stress disorder; Comorbid; Symptom connection

Published
2003

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