We describe an inexpensive method for digital video recording of behavioral experiments and prese... more We describe an inexpensive method for digital video recording of behavioral experiments and present a simple, freely-redistributable software tool enabling ethographic analysis of these recordings via classification of video frames into user-defined categories. While high-end commercial solutions already exist for these purposes, we focus on minimizing equipment expenses and complexity for research projects or undergraduate laboratory courses employing compatible behavioral paradigms.
SUMMARY A mixed-eects propensity adjustment is described that can reduce bias in longitudinal stu... more SUMMARY A mixed-eects propensity adjustment is described that can reduce bias in longitudinal studies involving non-equivalent comparison groups. There are two stages in this data analytic strategy. First, a model of propensity for treatment intensity examines variables that distinguish among subjects who receive various ordered doses of treatment across time using mixed-eects ordinal logistic regression. Second, the eectiveness model examines
... unity Col Evan Dan Osc ... 4Chabot College (2007). 5See Visher, Wathington, Richburg-Hayes, a... more ... unity Col Evan Dan Osc ... 4Chabot College (2007). 5See Visher, Wathington, Richburg-Hayes, and Schneider (2008) and Smith, MacGregor, Matthews, and Gabelnick (2004) for a review of the literature. Also see Tinto (1997); Engstrom and Tinto (2008); and Malnarich (2003). ...
A mixed-effects propensity adjustment is described that can reduce bias in longitudinal studies i... more A mixed-effects propensity adjustment is described that can reduce bias in longitudinal studies involving non-equivalent comparison groups. There are two stages in this data analytic strategy. First, a model of propensity for treatment intensity examines variables that distinguish among subjects who receive various ordered doses of treatment across time using mixed-effects ordinal logistic regression. Second, the effectiveness model examines multiple times until recurrence to compare the ordered doses using a mixed-effects grouped-time survival model. Effectiveness analyses are initially stratified by propensity quintile. Then the quintile-specific results are pooled, assuming that there is not a propensity x treatment interaction. A Monte Carlo simulation study compares bias reduction in fully specified propensity model relative to misspecified models. In addition, type I error rate and statistical power are examined. The approach is illustrated by applying it to a longitudinal, observational study of maintenance treatment of major depression.
There are numerous alternatives to the so-called Bonferroni adjustment to control for familywise ... more There are numerous alternatives to the so-called Bonferroni adjustment to control for familywise Type I error among multiple tests. Yet, for the most part, these approaches disregard the correlation among endpoints. This can prove to be a conservative hypothesis testing strategy if the null hypothesis is false. The James procedure was proposed to account for the correlation structure among multiple continuous endpoints. Here, a simulation study evaluates the statistical power of the Hochberg and James adjustment strategies relative to that of the Bonferroni approach when used for multiple correlated binary variables. The simulations demonstrate that relative to the Bonferroni approach, neither alternative sacrifices power. The Hochberg approach has more statistical power for rho<or=0.50; whereas the James procedure provides more statistical power with higher rho, the common correlation among the multiple outcomes. A study of gender differences in New York City homicides is used to illustrate the approaches.
We describe an inexpensive method for digital video recording of behavioral experiments and prese... more We describe an inexpensive method for digital video recording of behavioral experiments and present a simple, freely-redistributable software tool enabling ethographic analysis of these recordings via classification of video frames into user-defined categories. While high-end commercial solutions already exist for these purposes, we focus on minimizing equipment expenses and complexity for research projects or undergraduate laboratory courses employing compatible behavioral paradigms.
National Center For Postsecondary Research, Jul 1, 2011
The low completion rates of students in community colleges have been well documented. Among stude... more The low completion rates of students in community colleges have been well documented. Among students who enroll in community colleges hoping to earn a credential or transfer to a four-year institution, only about half achieve this goal within six years. Many factors contribute to these low success rates, including lack of financial support, lack of motivation and direction, competing demands from family and jobs, and inadequate college-readiness skills. In an effort to address some of those barriers and to increase the number of students who achieve their education and career goals, community colleges are turning increasingly to learning communities -in which cohorts of students are coenrolled in two or sometimes three courses that are linked by a common theme and are taught by a team of instructors who collaborate with each other around the syllabi and assignments.
Over the past few decades, a postsecondary credential has become increasingly important in the la... more Over the past few decades, a postsecondary credential has become increasingly important in the labor market, and college attendance has become more common. Unfortunately, however, many students leave college before receiving a degree, particularly those who are academically underprepared for collegelevel work. Many postsecondary institutions operate learning communities to promote students' involvement and persistence in college. Learning communities typically place groups of students in two or more linked courses with mutually reinforcing themes and assignments. They seek to build peer relationships, intensify connections to faculty, and deepen understanding of coursework. While learning communities are increasingly popular, little rigorous evidence on their effects exists.
Patients with bipolar I or II major depression are often misdiagnosed with unipolar major depress... more Patients with bipolar I or II major depression are often misdiagnosed with unipolar major depression. The goal of this study was to develop and validate a brief instrument to screen for bipolar disorder in patients actively ill with major depression. The sample consisted of subjects who enrolled in the National Institute of Mental Health-Collaborative Program on the Psychobiology of Depression-Clinical Studies from 1978 to 1981 during an episode of major depression and included 91 subjects with bipolar I major depression, 52 with bipolar II major depression, and 338 with unipolar major depression diagnosed according to Research Diagnostic Criteria. Most of the subjects were inpatients at the time of enrollment, and subjects were prospectively followed for up to 20 years. In order to create, test, and cross-validate the screening instrument, a split-sample data analytic procedure was performed. This procedure yielded 3 groups of subjects: the bipolar I index sample, the bipolar I cross-validation sample, and the bipolar II cross-validation sample. Each group included subjects with bipolar major depression and subjects with unipolar major depression. Within the bipolar I index sample, subjects with bipolar I major depression at study intake were compared with subjects with unipolar major depression at study intake on a pool of 59 sociodemographic and clinical candidate variables. The 3 variables showing the greatest disparity between bipolar I subjects and unipolar subjects were selected for the screen, the Screening Assessment of Depression-Polarity (SAD-P). The operating characteristics of the SAD-P were then examined within the bipolar I index sample, bipolar I cross-validation sample, and bipolar II cross-validation sample. The items selected for the screening instrument were (1) presence of delusions during the current episode of major depression, (2) number of prior episodes of major depression, and (3) family history of major depression or mania. The screen identified bipolar major depression with a sensitivity of 0.82 in the bipolar I index sample, 0.72 in the bipolar I cross-validation sample, and 0.58 in the bipolar II cross-validation sample. With regard to misclassifying subjects with unipolar major depression, the screen provided a positive predictive value of 0.36 in the bipolar I index sample, 0.29 in the bipolar I cross-validation sample, and 0.27 in the bipolar II cross-validation sample. We suggest using the 3-item SAD-P as a preliminary screen for bipolar disorder in patients who present with an active episode of major depression.
This observational study examined the antidepressant treatment patterns of a novel New York City ... more This observational study examined the antidepressant treatment patterns of a novel New York City methadone maintenance treatment program (MMTP), founded for the treatment of adolescents and now targeting young adults and older patients with special problems. The goal of the study was to investigate demographic or clinical characteristics that were associated with prescribing patterns, as well as whether antidepressant use was associated with sobriety. The method of data collection was a thorough chart review. Antidepressant treatment was significantly associated with gender, education, marital status, and relapse. However, after controlling for demographic and clinical characteristics, antidepressant treatment was not significantly associated with a reduction in relapse risk. Further research is needed to explore these relationships, as well as their generalizability to adult methadone clinics, and to examine the underlying factors that lead to similarities and distinctions in antidepressant prescribing practices between various types of clinics (i.e., general outpatient vs. methadone maintenance).
PbSe is a very important photoconductive material extensively used as IR detector for military ap... more PbSe is a very important photoconductive material extensively used as IR detector for military applications and may be considered one of the most useful materials for detection in the MIR range. In the last years the opening of its production for wide civil use has allowed the conception of new detection systems based on this semiconductor. Considering some possible applications
ABSTRACT This observational study examined the antidepressant treatment patterns of a novel New Y... more ABSTRACT This observational study examined the antidepressant treatment patterns of a novel New York City methadone maintenance treatment program (MMTP), founded for the treatment of adolescents and now targeting young adults and older patients with special problems. The goal of the study was to investigate demographic or clinical characteristics that were associated with prescribing patterns, as well as whether antidepressant use was associated with sobriety. The method of data collection was a thorough chart review. Antidepressant treatment was significantly associated with gender, education, marital status, and relapse. However, after controlling for demographic and clinical characteristics, antidepressant treatment was not significantly associated with a reduction in relapse risk. Further research is needed to explore these relationships, as well as their generalizability to adult methadone clinics, and to examine the underlying factors that lead to similarities and distinctions in antidepressant prescribing practices between various types of clinics (i.e., general outpatient vs. methadone maintenance).
National Center For Postsecondary Research, Jul 1, 2011
The low completion rates of students in community colleges have been well documented. Among stude... more The low completion rates of students in community colleges have been well documented. Among students who enroll in community colleges hoping to earn a credential or transfer to a four-year institution, only about half achieve this goal within six years. Many factors contribute to these low success rates, including lack of financial support, lack of motivation and direction, competing demands from family and jobs, and inadequate college-readiness skills. In an effort to address some of those barriers and to increase the number of students who achieve their education and career goals, community colleges are turning increasingly to learning communities -in which cohorts of students are coenrolled in two or sometimes three courses that are linked by a common theme and are taught by a team of instructors who collaborate with each other around the syllabi and assignments.
... unity Col Evan Dan Osc ... 4Chabot College (2007). 5See Visher, Wathington, Richburg-Hayes, a... more ... unity Col Evan Dan Osc ... 4Chabot College (2007). 5See Visher, Wathington, Richburg-Hayes, and Schneider (2008) and Smith, MacGregor, Matthews, and Gabelnick (2004) for a review of the literature. Also see Tinto (1997); Engstrom and Tinto (2008); and Malnarich (2003). ...
Patients with bipolar I or II major depression are often misdiagnosed with unipolar major depress... more Patients with bipolar I or II major depression are often misdiagnosed with unipolar major depression. The goal of this study was to develop and validate a brief instrument to screen for bipolar disorder in patients actively ill with major depression. The sample consisted of subjects who enrolled in the National Institute of Mental Health-Collaborative Program on the Psychobiology of Depression-Clinical Studies from 1978 to 1981 during an episode of major depression and included 91 subjects with bipolar I major depression, 52 with bipolar II major depression, and 338 with unipolar major depression diagnosed according to Research Diagnostic Criteria. Most of the subjects were inpatients at the time of enrollment, and subjects were prospectively followed for up to 20 years. In order to create, test, and cross-validate the screening instrument, a split-sample data analytic procedure was performed. This procedure yielded 3 groups of subjects: the bipolar I index sample, the bipolar I cross-validation sample, and the bipolar II cross-validation sample. Each group included subjects with bipolar major depression and subjects with unipolar major depression. Within the bipolar I index sample, subjects with bipolar I major depression at study intake were compared with subjects with unipolar major depression at study intake on a pool of 59 sociodemographic and clinical candidate variables. The 3 variables showing the greatest disparity between bipolar I subjects and unipolar subjects were selected for the screen, the Screening Assessment of Depression-Polarity (SAD-P). The operating characteristics of the SAD-P were then examined within the bipolar I index sample, bipolar I cross-validation sample, and bipolar II cross-validation sample. The items selected for the screening instrument were (1) presence of delusions during the current episode of major depression, (2) number of prior episodes of major depression, and (3) family history of major depression or mania. The screen identified bipolar major depression with a sensitivity of 0.82 in the bipolar I index sample, 0.72 in the bipolar I cross-validation sample, and 0.58 in the bipolar II cross-validation sample. With regard to misclassifying subjects with unipolar major depression, the screen provided a positive predictive value of 0.36 in the bipolar I index sample, 0.29 in the bipolar I cross-validation sample, and 0.27 in the bipolar II cross-validation sample. We suggest using the 3-item SAD-P as a preliminary screen for bipolar disorder in patients who present with an active episode of major depression.
Major depressive disorder is usually a recurring illness, and maintenance treatment is used to fo... more Major depressive disorder is usually a recurring illness, and maintenance treatment is used to forestall or prevent recurrent episodes of depression. This study describes recurrence of major depression despite maintenance pharmacotherapy, termed tachyphylaxis. The study sample consisted of 103 subjects who participated in the NIMH Collaborative Depression Study, a multicenter longitudinal observational study of the mood disorders. Subjects diagnosed with unipolar major depressive disorder according to Research Diagnostic Criteria were enrolled from 1978-1981 and prospectively followed for up to 20 years. As an observational study, treatment was recorded but not controlled by anyone connected with the study. Subjects were selected for the present study if at some point during follow-up they received antidepressant medication for treatment of an episode of major depressive disorder, recovered from this episode, and subsequently received maintenance pharmacotherapy. Some subjects were successfully treated for multiple episodes of major depressive disorder and then received maintenance medication after each of these episodes, resulting in multiple maintenance treatment intervals. Data were collected using the Longitudinal Interval Follow-Up Evaluation, and mixed-effects logistic regression was used to test the association of sociodemographic and clinical variables with tachyphylaxis. For the 103 subjects, there were 171 maintenance treatment intervals in which a subject received maintenance pharmacotherapy after having recovered from an episode of major depressive disorder. The median duration of maintenance treatment was 20 weeks. Tachyphylaxis occurred during 43 (25%) of these 171 maintenance treatment intervals. The subtype of melancholic (endogenous) major depressive disorder significantly elevated the risk of tachyphylaxis during the subsequent maintenance treatment interval. Despite the use of maintenance pharmacotherapy, major depression recurs in a considerable number of patients. Improved prophylaxis for these patients requires other treatment strategies based upon a greater understanding of recurrence.
We describe an inexpensive method for digital video recording of behavioral experiments and prese... more We describe an inexpensive method for digital video recording of behavioral experiments and present a simple, freely-redistributable software tool enabling ethographic analysis of these recordings via classification of video frames into user-defined categories. While high-end commercial solutions already exist for these purposes, we focus on minimizing equipment expenses and complexity for research projects or undergraduate laboratory courses employing compatible behavioral paradigms.
SUMMARY A mixed-eects propensity adjustment is described that can reduce bias in longitudinal stu... more SUMMARY A mixed-eects propensity adjustment is described that can reduce bias in longitudinal studies involving non-equivalent comparison groups. There are two stages in this data analytic strategy. First, a model of propensity for treatment intensity examines variables that distinguish among subjects who receive various ordered doses of treatment across time using mixed-eects ordinal logistic regression. Second, the eectiveness model examines
... unity Col Evan Dan Osc ... 4Chabot College (2007). 5See Visher, Wathington, Richburg-Hayes, a... more ... unity Col Evan Dan Osc ... 4Chabot College (2007). 5See Visher, Wathington, Richburg-Hayes, and Schneider (2008) and Smith, MacGregor, Matthews, and Gabelnick (2004) for a review of the literature. Also see Tinto (1997); Engstrom and Tinto (2008); and Malnarich (2003). ...
A mixed-effects propensity adjustment is described that can reduce bias in longitudinal studies i... more A mixed-effects propensity adjustment is described that can reduce bias in longitudinal studies involving non-equivalent comparison groups. There are two stages in this data analytic strategy. First, a model of propensity for treatment intensity examines variables that distinguish among subjects who receive various ordered doses of treatment across time using mixed-effects ordinal logistic regression. Second, the effectiveness model examines multiple times until recurrence to compare the ordered doses using a mixed-effects grouped-time survival model. Effectiveness analyses are initially stratified by propensity quintile. Then the quintile-specific results are pooled, assuming that there is not a propensity x treatment interaction. A Monte Carlo simulation study compares bias reduction in fully specified propensity model relative to misspecified models. In addition, type I error rate and statistical power are examined. The approach is illustrated by applying it to a longitudinal, observational study of maintenance treatment of major depression.
There are numerous alternatives to the so-called Bonferroni adjustment to control for familywise ... more There are numerous alternatives to the so-called Bonferroni adjustment to control for familywise Type I error among multiple tests. Yet, for the most part, these approaches disregard the correlation among endpoints. This can prove to be a conservative hypothesis testing strategy if the null hypothesis is false. The James procedure was proposed to account for the correlation structure among multiple continuous endpoints. Here, a simulation study evaluates the statistical power of the Hochberg and James adjustment strategies relative to that of the Bonferroni approach when used for multiple correlated binary variables. The simulations demonstrate that relative to the Bonferroni approach, neither alternative sacrifices power. The Hochberg approach has more statistical power for rho<or=0.50; whereas the James procedure provides more statistical power with higher rho, the common correlation among the multiple outcomes. A study of gender differences in New York City homicides is used to illustrate the approaches.
We describe an inexpensive method for digital video recording of behavioral experiments and prese... more We describe an inexpensive method for digital video recording of behavioral experiments and present a simple, freely-redistributable software tool enabling ethographic analysis of these recordings via classification of video frames into user-defined categories. While high-end commercial solutions already exist for these purposes, we focus on minimizing equipment expenses and complexity for research projects or undergraduate laboratory courses employing compatible behavioral paradigms.
National Center For Postsecondary Research, Jul 1, 2011
The low completion rates of students in community colleges have been well documented. Among stude... more The low completion rates of students in community colleges have been well documented. Among students who enroll in community colleges hoping to earn a credential or transfer to a four-year institution, only about half achieve this goal within six years. Many factors contribute to these low success rates, including lack of financial support, lack of motivation and direction, competing demands from family and jobs, and inadequate college-readiness skills. In an effort to address some of those barriers and to increase the number of students who achieve their education and career goals, community colleges are turning increasingly to learning communities -in which cohorts of students are coenrolled in two or sometimes three courses that are linked by a common theme and are taught by a team of instructors who collaborate with each other around the syllabi and assignments.
Over the past few decades, a postsecondary credential has become increasingly important in the la... more Over the past few decades, a postsecondary credential has become increasingly important in the labor market, and college attendance has become more common. Unfortunately, however, many students leave college before receiving a degree, particularly those who are academically underprepared for collegelevel work. Many postsecondary institutions operate learning communities to promote students' involvement and persistence in college. Learning communities typically place groups of students in two or more linked courses with mutually reinforcing themes and assignments. They seek to build peer relationships, intensify connections to faculty, and deepen understanding of coursework. While learning communities are increasingly popular, little rigorous evidence on their effects exists.
Patients with bipolar I or II major depression are often misdiagnosed with unipolar major depress... more Patients with bipolar I or II major depression are often misdiagnosed with unipolar major depression. The goal of this study was to develop and validate a brief instrument to screen for bipolar disorder in patients actively ill with major depression. The sample consisted of subjects who enrolled in the National Institute of Mental Health-Collaborative Program on the Psychobiology of Depression-Clinical Studies from 1978 to 1981 during an episode of major depression and included 91 subjects with bipolar I major depression, 52 with bipolar II major depression, and 338 with unipolar major depression diagnosed according to Research Diagnostic Criteria. Most of the subjects were inpatients at the time of enrollment, and subjects were prospectively followed for up to 20 years. In order to create, test, and cross-validate the screening instrument, a split-sample data analytic procedure was performed. This procedure yielded 3 groups of subjects: the bipolar I index sample, the bipolar I cross-validation sample, and the bipolar II cross-validation sample. Each group included subjects with bipolar major depression and subjects with unipolar major depression. Within the bipolar I index sample, subjects with bipolar I major depression at study intake were compared with subjects with unipolar major depression at study intake on a pool of 59 sociodemographic and clinical candidate variables. The 3 variables showing the greatest disparity between bipolar I subjects and unipolar subjects were selected for the screen, the Screening Assessment of Depression-Polarity (SAD-P). The operating characteristics of the SAD-P were then examined within the bipolar I index sample, bipolar I cross-validation sample, and bipolar II cross-validation sample. The items selected for the screening instrument were (1) presence of delusions during the current episode of major depression, (2) number of prior episodes of major depression, and (3) family history of major depression or mania. The screen identified bipolar major depression with a sensitivity of 0.82 in the bipolar I index sample, 0.72 in the bipolar I cross-validation sample, and 0.58 in the bipolar II cross-validation sample. With regard to misclassifying subjects with unipolar major depression, the screen provided a positive predictive value of 0.36 in the bipolar I index sample, 0.29 in the bipolar I cross-validation sample, and 0.27 in the bipolar II cross-validation sample. We suggest using the 3-item SAD-P as a preliminary screen for bipolar disorder in patients who present with an active episode of major depression.
This observational study examined the antidepressant treatment patterns of a novel New York City ... more This observational study examined the antidepressant treatment patterns of a novel New York City methadone maintenance treatment program (MMTP), founded for the treatment of adolescents and now targeting young adults and older patients with special problems. The goal of the study was to investigate demographic or clinical characteristics that were associated with prescribing patterns, as well as whether antidepressant use was associated with sobriety. The method of data collection was a thorough chart review. Antidepressant treatment was significantly associated with gender, education, marital status, and relapse. However, after controlling for demographic and clinical characteristics, antidepressant treatment was not significantly associated with a reduction in relapse risk. Further research is needed to explore these relationships, as well as their generalizability to adult methadone clinics, and to examine the underlying factors that lead to similarities and distinctions in antidepressant prescribing practices between various types of clinics (i.e., general outpatient vs. methadone maintenance).
PbSe is a very important photoconductive material extensively used as IR detector for military ap... more PbSe is a very important photoconductive material extensively used as IR detector for military applications and may be considered one of the most useful materials for detection in the MIR range. In the last years the opening of its production for wide civil use has allowed the conception of new detection systems based on this semiconductor. Considering some possible applications
ABSTRACT This observational study examined the antidepressant treatment patterns of a novel New Y... more ABSTRACT This observational study examined the antidepressant treatment patterns of a novel New York City methadone maintenance treatment program (MMTP), founded for the treatment of adolescents and now targeting young adults and older patients with special problems. The goal of the study was to investigate demographic or clinical characteristics that were associated with prescribing patterns, as well as whether antidepressant use was associated with sobriety. The method of data collection was a thorough chart review. Antidepressant treatment was significantly associated with gender, education, marital status, and relapse. However, after controlling for demographic and clinical characteristics, antidepressant treatment was not significantly associated with a reduction in relapse risk. Further research is needed to explore these relationships, as well as their generalizability to adult methadone clinics, and to examine the underlying factors that lead to similarities and distinctions in antidepressant prescribing practices between various types of clinics (i.e., general outpatient vs. methadone maintenance).
National Center For Postsecondary Research, Jul 1, 2011
The low completion rates of students in community colleges have been well documented. Among stude... more The low completion rates of students in community colleges have been well documented. Among students who enroll in community colleges hoping to earn a credential or transfer to a four-year institution, only about half achieve this goal within six years. Many factors contribute to these low success rates, including lack of financial support, lack of motivation and direction, competing demands from family and jobs, and inadequate college-readiness skills. In an effort to address some of those barriers and to increase the number of students who achieve their education and career goals, community colleges are turning increasingly to learning communities -in which cohorts of students are coenrolled in two or sometimes three courses that are linked by a common theme and are taught by a team of instructors who collaborate with each other around the syllabi and assignments.
... unity Col Evan Dan Osc ... 4Chabot College (2007). 5See Visher, Wathington, Richburg-Hayes, a... more ... unity Col Evan Dan Osc ... 4Chabot College (2007). 5See Visher, Wathington, Richburg-Hayes, and Schneider (2008) and Smith, MacGregor, Matthews, and Gabelnick (2004) for a review of the literature. Also see Tinto (1997); Engstrom and Tinto (2008); and Malnarich (2003). ...
Patients with bipolar I or II major depression are often misdiagnosed with unipolar major depress... more Patients with bipolar I or II major depression are often misdiagnosed with unipolar major depression. The goal of this study was to develop and validate a brief instrument to screen for bipolar disorder in patients actively ill with major depression. The sample consisted of subjects who enrolled in the National Institute of Mental Health-Collaborative Program on the Psychobiology of Depression-Clinical Studies from 1978 to 1981 during an episode of major depression and included 91 subjects with bipolar I major depression, 52 with bipolar II major depression, and 338 with unipolar major depression diagnosed according to Research Diagnostic Criteria. Most of the subjects were inpatients at the time of enrollment, and subjects were prospectively followed for up to 20 years. In order to create, test, and cross-validate the screening instrument, a split-sample data analytic procedure was performed. This procedure yielded 3 groups of subjects: the bipolar I index sample, the bipolar I cross-validation sample, and the bipolar II cross-validation sample. Each group included subjects with bipolar major depression and subjects with unipolar major depression. Within the bipolar I index sample, subjects with bipolar I major depression at study intake were compared with subjects with unipolar major depression at study intake on a pool of 59 sociodemographic and clinical candidate variables. The 3 variables showing the greatest disparity between bipolar I subjects and unipolar subjects were selected for the screen, the Screening Assessment of Depression-Polarity (SAD-P). The operating characteristics of the SAD-P were then examined within the bipolar I index sample, bipolar I cross-validation sample, and bipolar II cross-validation sample. The items selected for the screening instrument were (1) presence of delusions during the current episode of major depression, (2) number of prior episodes of major depression, and (3) family history of major depression or mania. The screen identified bipolar major depression with a sensitivity of 0.82 in the bipolar I index sample, 0.72 in the bipolar I cross-validation sample, and 0.58 in the bipolar II cross-validation sample. With regard to misclassifying subjects with unipolar major depression, the screen provided a positive predictive value of 0.36 in the bipolar I index sample, 0.29 in the bipolar I cross-validation sample, and 0.27 in the bipolar II cross-validation sample. We suggest using the 3-item SAD-P as a preliminary screen for bipolar disorder in patients who present with an active episode of major depression.
Major depressive disorder is usually a recurring illness, and maintenance treatment is used to fo... more Major depressive disorder is usually a recurring illness, and maintenance treatment is used to forestall or prevent recurrent episodes of depression. This study describes recurrence of major depression despite maintenance pharmacotherapy, termed tachyphylaxis. The study sample consisted of 103 subjects who participated in the NIMH Collaborative Depression Study, a multicenter longitudinal observational study of the mood disorders. Subjects diagnosed with unipolar major depressive disorder according to Research Diagnostic Criteria were enrolled from 1978-1981 and prospectively followed for up to 20 years. As an observational study, treatment was recorded but not controlled by anyone connected with the study. Subjects were selected for the present study if at some point during follow-up they received antidepressant medication for treatment of an episode of major depressive disorder, recovered from this episode, and subsequently received maintenance pharmacotherapy. Some subjects were successfully treated for multiple episodes of major depressive disorder and then received maintenance medication after each of these episodes, resulting in multiple maintenance treatment intervals. Data were collected using the Longitudinal Interval Follow-Up Evaluation, and mixed-effects logistic regression was used to test the association of sociodemographic and clinical variables with tachyphylaxis. For the 103 subjects, there were 171 maintenance treatment intervals in which a subject received maintenance pharmacotherapy after having recovered from an episode of major depressive disorder. The median duration of maintenance treatment was 20 weeks. Tachyphylaxis occurred during 43 (25%) of these 171 maintenance treatment intervals. The subtype of melancholic (endogenous) major depressive disorder significantly elevated the risk of tachyphylaxis during the subsequent maintenance treatment interval. Despite the use of maintenance pharmacotherapy, major depression recurs in a considerable number of patients. Improved prophylaxis for these patients requires other treatment strategies based upon a greater understanding of recurrence.
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