Papers by Shannon Rae Robinson
Research Articles, 2020
Being responsive to the experiences, ideas, and stories of others is an essential trait for democ... more Being responsive to the experiences, ideas, and stories of others is an essential trait for democratic citizens. Responsiveness promotes the general welfare, it shows respect for others, and allows for what Tony Laden has called the social practice of reasoning. Political theorists have shown how responsiveness is a middle ground between dominance and acquiescence, where citizens show a willingness to be moved by those around them. Responsiveness is tested, though, when citizens interact with those who hold what are thought to be immoral or unjust beliefs. The key question: Is it possible to engage responsively with those who hold morally suspect beliefs, to be legitimately “moved” by those around us, without necessarily acquiescing to the moral problems? We argue that such engagement is both possible and desirable. There are at least five different ways to be moved by others in a productive, civic sense. We describe these modes, explain their moral depth, and give some examples. Ci...
IEEE Computer Graphics and Applications, 2018
We present RNNbow, an interactive tool for visualizing the gradient flow during backpropagation t... more We present RNNbow, an interactive tool for visualizing the gradient flow during backpropagation training in recurrent neural networks. RNNbow is a web application that displays the relative gradient contributions from Recurrent Neural Network (RNN) cells in a neighborhood of an element of a sequence. We describe the calculation of backpropagation through time (BPTT) that keeps track of itemized gradients, or gradient contributions from one element of a sequence to previous elements of a sequence. By visualizing the gradient, as opposed to activations, RNNbow offers insight into how the network is learning. We use it to explore the learning of an RNN that is trained to generate code in the C programming language. We show how it uncovers insights into the vanishing gradient as well as the evolution of training as the RNN works its way through a corpus.
Archives of psychiatric nursing, 2018
87 female and 10 male adult outpatients with BPD diagnoses presenting with acute suicidal and sel... more 87 female and 10 male adult outpatients with BPD diagnoses presenting with acute suicidal and self-harm behaviors were offered a 12-Month Intensive DBT Program delivered by an interdisciplinary team of psychotherapists, including social workers, nurses, and a psychologist. Clients were administered self-report measures at pre-treatment, and at 3-, 6-, and 12-month intervals in a single-group longitudinal design. Our analyses of treatment outcomes (ANOVA and Bonferroni-corrected comparisons) considered: BPD-specific symptoms, using the BSL-23 (n = 44), ZAN-BPD (n = 39), and DBT-WCCL Adaptive Skills Use and Dysfunctional Coping subscales (n = 43); transdiagnostic psychiatric symptoms, using the BSL Global Severity Index (n = 35); and quality of life, using QOLI t-scores (n = 42). We also evaluated changes in the proportions of clients who used services for mental health-related crises, visited the ER, or were admitted as inpatients. Significant reductions in both BPD-specific and tran...
Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association, Jan 24, 2015
Patients with hepatitis C virus (HCV) infection with psychiatric disorders and/or substance abuse... more Patients with hepatitis C virus (HCV) infection with psychiatric disorders and/or substance abuse face significant barriers to antiviral treatment. New strategies might be needed to improve treatment rates and outcomes. We investigated whether an integrated care (IC) protocol, which includes multi-disciplinary care coordination and patient case management, could increase the proportion of patients with chronic HCV infection who receive antiviral treatment (a combination of interferon-based and direct acting antiviral agents) and achieve a sustained virologic response (SVR). We performed a prospective, randomized trial at 3 medical centers in the US. Participants (n=363 patients attending HCV clinics) had been screened and tested positive for depression, post-traumatic stress disorder, and/or substance use; they were randomly assigned (1:1) to groups that received IC or usual care (controls) from March 2009 through February 2011. A mid-level mental health practitioner was placed in e...
The American Journal of Gastroenterology, 2008
The prevalence of hepatitis C virus (HCV) infection is higher among veterans than nonveterans, bu... more The prevalence of hepatitis C virus (HCV) infection is higher among veterans than nonveterans, but only about 14% of all identified infected veterans have ever received antiviral therapy. High rates of comorbid psychiatric and substance use disorders are major barriers to receiving antiviral treatment for veterans, and characteristics associated with poor virologic response are more common in this population. However, accumulating evidence indicates that patients with psychiatric and substance use disorders can successfully receive interferon-based antiviral therapies in an integrated or multidisciplinary health-care setting. The broad aims of integrated care models include reducing fragmentation and improving continuity and coordination of care. Although, to date, there are no randomized controlled trials of specific care models for patients with HCV, studies of integrated care for other chronic diseases suggest several strategies for optimizing outcomes for patients with HCV. Components of an HCV clinic incorporating these principles have been tested in a nonrandomized setting and include routine screening of all patients for psychiatric and substance use disorder risk factors, collaboration with mental health providers within the HCV clinic, following a defined integrated medical/psychiatric clinical protocol, provision of ongoing integrated support during antiviral treatment or retreatment, and educating patients on principles of chronic disease self-management.
Tinnitus: Pathophysiology and Treatment, 2007
Antidepressants are commonly prescribed for tinnitus. Research thus far provides some support for... more Antidepressants are commonly prescribed for tinnitus. Research thus far provides some support for that treatment, but the literature also raises concerns because tinnitus is a side effect of antidepressant medication. In this chapter, four published double blind placebo-controlled trials of antidepressants for tinnitus are reviewed. Explanations for the discrepant results are offered, including that antidepressants appear to work best for tinnitus patients who are depressed or anxious, who have more severe tinnitus or who are treated for a longer time with an adequate dose of medication. Possible mechanisms of action are reviewed, with serotonergic and antimuscarinic mechanisms appearing to be the most important. At this time there is no indication that one specific type of antidepressant is more likely to lead to tinnitus as a side effect, or have a beneficial effect on tinnitus. Given SSRIs are tolerated better, these antidepressants have advantages over tricyclic antidepressants and should be used as a first line of treatment.
Psychosomatic Medicine, 2005
Objective: To assess the efficacy of a selective serotonin reuptake inhibitor (paroxetine) for re... more Objective: To assess the efficacy of a selective serotonin reuptake inhibitor (paroxetine) for relief of tinnitus. Design: One hundred twenty tinnitus sufferers participated in a randomized double-blind placebo-controlled trial. Paroxetine or placebo was increased to a maximally tolerated dose (up to 50 mg/day), and patients were treated for a total of 31 days at the maximal dose. Methods: Patients with chronic tinnitus were recruited from our university-based specialty clinic by referral from otolaryngologists and audiologists in the local community and by advertisement. Patients with psychotic or substance use disorders or suicidal ideation were excluded, as were those using psychoactive medications (this resulted in only 1 subject with major depression in the study) or any other medications that interact with paroxetine and those with inability to hear at one's tinnitus sensation level. Fifty-eight percent of patients were male, 92% were Caucasian, and the average age was 57. Outcomes Measures: Tinnitus matching, the Tinnitus Handicap Questionnaire, the question: How severe (bothered, aggravating) is your tinnitus? Quality of Well-Being and other psychological questionnaires. Results: Paroxetine was not statistically superior to placebo on the following tinnitus measures (tinnitus matching, 5-or 10-db drop, Tinnitus Handicap Questionnaire, quality of well-being measures, how severe, how bothered, positive change). There was a significant improvement in the single item question, How aggravating is your tinnitus? for those in the paroxetine group compared with the placebo group. Conclusions: These results suggest that the majority of individuals in this study did not benefit from paroxetine in a consistent fashion. Further work remains to be done to determine if subgroups of patients (e.g., those who tolerate higher doses, those who are depressed) may benefit.
Leadership in Action, 2007
Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery, 2014
The American Academy of Otolaryngology--Head and Neck Surgery Foundation (AAO-HNSF) has published... more The American Academy of Otolaryngology--Head and Neck Surgery Foundation (AAO-HNSF) has published a supplement to this issue featuring the new Clinical Practice Guideline: Tinnitus. To assist in implementing the guideline recommendations, this article summarizes the rationale, purpose, and key action statements. The 13 recommendations developed address the evaluation of patients with tinnitus, including selection and timing of diagnostic testing and specialty referral to identify potential underlying treatable pathology. It will then focus on the evaluation and treatment of patients with persistent primary tinnitus, with recommendations to guide the evaluation and measurement of the impact of tinnitus and to determine the most appropriate interventions to improve symptoms and quality of life for tinnitus sufferers.
Women & Health, 2006
A behavioral analysis was conducted of various eating disorder behaviors and their relationship w... more A behavioral analysis was conducted of various eating disorder behaviors and their relationship with the lifetime use of different substances in a community-based sample of young adult women, aged 18-25 years. Women with particular eating disorder behaviors were selected from the 517 women who completed the Women's Health Survey. Analyses compared the frequencies of lifetime use of a range of licit and illicit substances as well as the abuse of prescription medications between each of the eating disorder groups and the normal control group. Results showed that as eating disorder behaviors became more severe, or were clustered together, the number of substance classes used, increased. Severe bingeing was consistently associated with alcohol use. Dieting and purging, with or without bingeing, was associated with the use of stimulants/ amphetamines and the abuse of sleeping pills. The results of this study suggest that the co-occurrence between subclinical levels of eating disorders and the use and abuse of a wide range of substances should inform assessment and treatment planning for adult women.
Psychopharmacology, 2002
Rationale: Responding for conditioned reinforcement is increased by the dopamine releasing agent ... more Rationale: Responding for conditioned reinforcement is increased by the dopamine releasing agent amphetamine, but reduced by drugs that enhance serotonin (5-HT) function. The amphetamine derivative 3,4methylenedioxymethamphetamine (MDMA, Ecstasy) releases both monoamines. Objectives: The primary purpose of this study was to examine the effects of MDMA on responding for conditioned reinforcement as well as on locomotor activity. The roles of several 5-HT receptor sub-types in mediating these behavioural effects of MDMA were also examined. Methods: Locomotion was measured in photocell activity monitors. For conditioned reinforcement experiments thirsty rats learned to associate a conditioned stimulus (CS) with water in operant chambers. Subsequently, two response levers were available; responding on one lever delivered the CS, while responding on the second lever had no consequences. Drug effects on this operant response were measured. Results: MDMA dose-dependently increased locomotion but reduced responding for conditioned reinforcement. This latter effect differs from that induced by amphetamine, which potentiates conditioned reinforcement responding. The stimulant effect of MDMA was attenuated by GR127935 and ketanserin, indicating facilitatory roles of 5-HT 1B and 5-HT 2A receptors in mediating this effect. The 5-HT 2C antagonist SB242084 enhanced the stimulant effect of MDMA. Only SB242084 attenuated the suppressant effect of MDMA on responding for conditioned reinforcement. Conclusions: The results show that 5-HT 2A and 5-HT 1B/1D receptors play a facilitatory role in mediating the stimulant effect of MDMA, whereas 5-HT 2C receptors are inhibitory. Activation of 5-HT 2C receptors also contributes to the deficit in operant responding. Multiple 5-HT receptor sub-types appear to contribute to the behavioural effects of MDMA.
Neuropsychopharmacology, 2001
Pre-exposure to (Ϯ)3,4-methylenedioxymeth-amphetamine (MDMA) elevates locomotor activity and extr... more Pre-exposure to (Ϯ)3,4-methylenedioxymeth-amphetamine (MDMA) elevates locomotor activity and extracellular dopamine levels in the nucleus accumbens following a cocaine challenge. The present study determined whether MDMA-induced sensitization to the effects of cocaine could be demonstrated in rats self-administering cocaine. Three groups of rats were treated with saline (Sal), 5 mg/kg MDMA (once per day for 10 days; MDMA-5) or 20 mg/kg MDMA (twice per day for 4 days; MDMA-20). Subsequently, spontaneous acquisition of cocaine selfadministration was measured in 12 daily 2-h sessions. During these test sessions, two response levers were present. Responses on one lever delivered infusions of 0.1 mg of cocaine; responses on the other lever had no programmed consequences. Group Sal showed a weak preference for the active lever; whereas, group MDMA-20 exhibited a stronger active lever preference. By day 12, the MDMA-20 group earned approximately twice the number of cocaine infusions as those in group SAL. At this time point, more than twice as many rats in group MDMA-20 were taking a minimum of 10 infusions per session, as compared to group Sal. Rats in group MDMA-5 did not seem to differ from group Sal in terms of lever discrimination, number of cocaine infusions, and percentage of rats obtaining a criterion of 10 infusions. These results indicate that pre-exposure to a high dose of MDMA may facilitate acquisition of cocaine selfadministration. This dosing regimen of MDMA is likely to release DA and to be neurotoxic to 5-HT neurons. Either or both of these mechanisms could contribute to the ability of MDMA to facilitate cocaine self-administration.
Journal of Health Psychology, 2011
This study examined shared patterns of associations between disordered eating behaviors and subst... more This study examined shared patterns of associations between disordered eating behaviors and substance use in two different non-clinical samples of young women. Participants were recruited from a university (526 women) and varied community (517 women) settings. Participants completed the Women’s Health Survey, examining engagement in a wide range of licit and illicit substances and disordered eating patterns during the past 12 months. In both samples, the cluster of bingeing, dieting and purging was significantly associated with binge drinking, drinking associated with negative consequences, and with cocaine use. The cluster of dieting and purging was associated with the use of stimulants/amphetamines. Health services, including assessment and treatment, and health promotion activities, should consider these patterns of comorbidity.
Journal of Addiction Medicine, 2014
Objectives-Methamphetamine (MA) use has increased in the United States in the last 20 years and i... more Objectives-Methamphetamine (MA) use has increased in the United States in the last 20 years and is a risk factor for hepatitis C virus(HCV) infection. The purpose of this study was to determine the characteristics and HCV infection outcomes of patients with a history of MA use.
Gastroenterology, 2009
Methamphetamine (Me) use has increased in the US in the last 20 years and is a risk factor for he... more Methamphetamine (Me) use has increased in the US in the last 20 years and is a risk factor for hepatitis C (HCV). The US is second to Asia/Pacific Islands in the population percentage of amphetamine users, with an estimated 3.7 million current users in North America (UN World Drug Report 2008). No data exists regarding the potential impact of Me addiction or dependence on HCV patients in terms of compliance with HCV evaluation and treatment. The purpose of this study was to determine the characteristics and HCV-related outcomes of patients with Me dependence. Methods: Subjects consisted of newly entered patients in the VA HCV registry, a record of all HCV cases in the local VA system identified daily by new HCV antibody positivity or ICD9 diagnosis, from 1/1/04 to 6/30/04. Medical records were reviewed, and outcomes recorded included demographics, severity of substance use, psychiatric conditions, SUD treatment, HCV clinic attendance, and antiviral treatment outcomes through 2008. Results: 201 cases were entered into the local VA HCV registry. Of these, 28 were excluded based on severe illness or severe ESLD, leaving 173 new patients for analysis. Of the 173 patients, 34% had a history of Me use. One third of Me patients had documented active Me use at initial contact. Me patients were younger (mean 46.4 yrs) with fewer minority (34%) compared with non-Me patients (mean 53.4 yrs and 40% minority). Me users were 4 times more likely to be current or past marijuana users compared with non-Me patient (p<0.0001). 90% of the 173 patients had a history of alcohol (ETOH) use with 52% reporting active abuse. Multivariate analyses indicated that Me use did not adversely affect referral, evaluation, or treatment rates compared with patients without Me use and patients with prior ETOH abuse. Active ETOH users had lower treatment initiation and success rates compared with Me groups. Patients actively using illicit drugs were 66% less likely to attend a liver biopsy (p=0.015). Conclusions: Me use is common in recent US veterans diagnosed with hepatitis C and occurs in younger patients with frequent concomitant marijuana use. Prior history or recent/active Me use alone does not appear to adversely affect overall HCV clinic referral, testing, evaluation, or treatment compared with new HCV patients without Me use and patients with prior ETOH abuse. Although, overall rates of treatment initiation are low in all groups at 17-20% and tended to be lowest in patients with active ETOH abuse (12%). These data indicate that facilitated access to SUD treatment in HCV clinics may be of benefit for multiple SUD issues to increase HCV treatment rates.(VA HSR&D grant IIR 07-101-3) M1779
Eating Disorders, 2007
The study investigated the adverse consequences on varied life domains of dieting, binging, vomit... more The study investigated the adverse consequences on varied life domains of dieting, binging, vomiting and laxative use and compared them to the adverse consequences of alcohol drinking, tobacco smoking, and marijuana use. Results showed that the percentages of women who reported adverse consequences related to eating disordered behaviors were often comparable, if not higher, than the percentages of women who reported adverse consequences related to their substance use. This is the first study to compare the adverse consequences of disordered eating patterns and substance use behaviors. Results suggest the importance of recognizing the adverse consequences of disordered eating patterns.
Behaviour Research and Therapy, 2009
The study investigated the effects of writing and self-help information on severity of psychologi... more The study investigated the effects of writing and self-help information on severity of psychological symptoms in traumatic injury patients at risk for developing post-traumatic stress disorder (PTSD). Patients attending Accident and Emergency (A &amp;amp;amp;amp;amp;amp;amp; E), were screened for Acute Stress Disorder and randomised to an information control group (n=36) or a writing and information group (n=31). Participants in both groups
The American Journal on Addictions, 2011
Low attendance in addiction treatment, particularly in cases of comorbidity, has been identified ... more Low attendance in addiction treatment, particularly in cases of comorbidity, has been identified as a pervasive challenge. We examine predictors of treatment retention in a sample of veterans (N = 253) participating in a clinical trial comparing two types of psychotherapy for co-occurring depression and substance use disorders. The study protocol included 24 weeks of outpatient group psychotherapy in either a newly developed Integrated Cognitive Behavioral Therapy (ICBT) or Twelve Step Facilitation Therapy (TSF). Using a model of treatment utilization developed by Aday and Anderson, we analyzed predictors categorized into predisposing factors, enabling resources, need for treatment, and type of treatment received. Outcome included total number of sessions attended (maximum of 36 sessions). Treatment retention did not differ between the two study interventions. Bivariate analyses indicated that predisposing factors were most predictive, with older participants, Caucasians, and those using only alcohol in the month before treatment attending more sessions, and individuals who had recently experienced a health event remained in treatment longer. Importantly, several factors were not related to treatment retention: marital status, education, neuropsychological functioning, financial stress, chronic health problems, treatment motivation, and psychiatric severity. In the combined model of predisposing, enabling and need factors, age and ethnicity were the only significant predictors.
Alcoholism: Clinical and Experimental Research, 2010
Background: A low level of response (LR) to alcohol is an important endophenotype associated with... more Background: A low level of response (LR) to alcohol is an important endophenotype associated with an increased risk of alcoholism. However, little is known about how neural functioning may differ between individuals with low and high LRs to alcohol. This study examined whether LR group effects on neural activity varied as a function of acute alcohol consumption. Methods: A total of 30 matched high-and low-LR pairs (N = 60 healthy young adults) were recruited from the University of California, San Diego, and administered a structured diagnostic interview and laboratory alcohol challenge followed by two functional magnetic resonance imaging (fMRI) sessions under placebo and alcohol conditions, in randomized order. Task performance and blood oxygen level-dependent response contrast to high relative to low working memory load in an event-related visual working memory (VWM) task were examined across 120 fMRI sessions. Results: Both LR groups performed similarly on the VWM task across conditions. A significant LR group by condition interaction effect was observed in inferior frontal and cingulate regions, such that alcohol attenuated the LR group differences found under placebo (p < 0.05). The LR group by condition effect remained even after controlling for cerebral blood flow, age, and typical drinking quantity. Conclusions: Alcohol had differential effects on brain activation for low-and high-LR individuals within frontal and cingulate regions. These findings represent an additional step in the search for physiological correlates of a low LR and identify brain regions that may be associated with the low LR response.
Alcoholism: Clinical and Experimental Research, 2006
Background: Risk and protective factors for alcohol use disorders (AUDs) are complex and reflect ... more Background: Risk and protective factors for alcohol use disorders (AUDs) are complex and reflect both environmental and genetic factors. Genetic components account for about 50% of the variation and influence several phenotypes, including the level of response (LR) to alcohol as well as alcohol-metabolizing enzyme polymorphisms. Variations in the ADH1B and ADH1C genes may influence the LR to alcohol by increasing levels of acetaldehyde during alcohol metabolism, although most data on this question come from Asian populations. Methods: This study evaluated associations of ADH1B and ADH1C genotypes in a non-Asian sample. Participants (N 5 117, 69.2% female) were 18-to 29-year-old men and women, primarily Caucasian (70.1%) and black (26.5%), recruited in San Diego, California. The Semi-Structured Assessment for the Genetics of Alcoholism Interview was used to assess demographic, substance use, and psychiatric history information, and the Family History Assessment Module was used to determine first-degree family history of alcohol dependence. An alcohol challenge paradigm was used to gather data on the LR to alcohol over 210 minutes. Results: Participants with the ADH1B Ã 1/ Ã 2 genotype had a higher LR to alcohol early in the alcohol challenge (i.e., 30, 60, and 90 minutes after drinking) as measured by both alcohol-related changes in subjective feelings of intoxication and body sway, even when controlling for sex and Russian/Eastern European ancestry. A similar trend was seen for ADH1C Ã 1/ Ã 1 genotype, although the results were not significant. Conclusions: These findings suggest that studies searching for genes relating to the LR to alcohol as a vulnerability factor for AUDs should consider controlling for ADH1B genotype, as the ADH1B Ã 2 allele could obscure the impact of other genetic polymorphisms.
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Papers by Shannon Rae Robinson