Holly A Swartz

Chatham University, Pittsburgh, Pennsylvania, United States

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Publications (57)250.69 Total impact

  • Holly A Swartz
    American Journal of Psychiatry 06/2014; 171(6):603-606. DOI:10.1176/appi.ajp.2014.14020217 · 13.56 Impact Factor
  • Holly A. Swartz, Nancy K. Grote, Patricia Graham
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    ABSTRACT: Brief Interpersonal Psychotherapy (IPT-B) is an eight-session adaption of Interpersonal Psychotherapy (IPT), an evidence-based psychotherapy for depression. The rationale for developing a briefer form of IPT rests on the paucity of empirical evidence linking increased therapy “dose” to enhanced therapeutic effects. The goal of IPT-B is to allow individuals who are unlikely to attend 16 sessions of psychotherapy—because of external or internal constraints—to receive the full benefits of IPT in fewer sessions. We provide an overview of IPT-B and describe the modifications made to standard IPT to adjust for the truncated time course. We then review the empirical evidence supporting this briefer model of IPT, including four open studies, one matched case-control study, and three randomized controlled trials. We conclude that IPT-B offers the dual advantages of rapid relief from suffering and decreased resource utilization.
    American journal of psychotherapy 01/2014; 68(4).
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    ABSTRACT: OBJECTIVE Despite widespread use of individual outpatient psychotherapies among community mental health centers (CMHCs), few studies have examined implementation of these psychotherapies. This exploratory qualitative study identified key themes associated with the implementation of an empirically supported psychotherapy in CMHCs. METHODS The authors conducted semistructured interviews with 12 key informants from four CMHCs that had implemented interpersonal and social rhythm therapy (IPSRT). Their responses were categorized into key themes. RESULTS Five major themes were identified: pretraining familiarity with IPSRT, administrative support for implementation, IPSRT fit with usual practice and clinic culture, implementation team and plan, and supervision and consultation. Discussion of these themes varied among participants from clinics considered successful or unsuccessful implementers. CONCLUSIONS Participants identified both key themes and several strategies for facilitating implementation. The findings suggest that when these key factors are present, outcome-enhancing treatments can be implemented and sustained, even in clinics with limited resources.
    Psychiatric services (Washington, D.C.) 12/2013; 64(12):1263-6. DOI:10.1176/appi.ps.201200508 · 2.81 Impact Factor
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    ABSTRACT: This study evaluated whether exposure to maternal pre- or postnatal depression or anxiety symptoms predicted psychopathology in adolescent offspring. Growth mixture modeling was used to identify trajectories of pre- and postnatal depression and anxiety symptoms in 577 women of low socioeconomic status selected from a prenatal clinic. Logistic regression models indicated that maternal pre- and postnatal depression trajectory exposure was not associated with offspring major depression, anxiety, or conduct disorder, but exposure to the high depression trajectory was associated with lower anxiety symptoms in males. Exposure to medium and high pre- and postnatal anxiety was associated with the risk of conduct disorder among offspring. Male offspring exposed to medium and high pre- and postnatal anxiety had higher odds of conduct disorder than did males with low exposure levels. Females exposed to medium or high pre- and postnatal anxiety were less likely to meet conduct disorder criteria than were females with lower exposure. To the best of our knowledge, this is the first study to examine the effect of pre- and postnatal anxiety trajectories on the risk of conduct disorder in offspring. These results suggest new directions for investigating the etiology of conduct disorder with a novel target for intervention.
    Development and Psychopathology 11/2013; 25(4pt1):1045-1063. DOI:10.1017/S0954579413000369 · 4.40 Impact Factor
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    ABSTRACT: Little is known about physical activity and sedentary behavior of adults with bipolar disorder (BP). Physical activity and sedentary behaviors may be modifiable factors associated with elevated rates of obesity, diabetes, cardiovascular disease, metabolic syndrome, and mortality in adults with BP. Sixty adult outpatients treated for BP (>18yr) wore accelerometers for seven consecutive days. Each minute epoch was assigned an activity level based on the number of counts per minute; sedentary(<100 counts), light(101-1951 counts), or moderate/vigorous(>1952 counts). Adults with BP were matched 1:1 to users and non-users of mental health services (MHS) (NHANES 2003-2004) by gender, closest BMI, and age. On average, adults with BP wore actigraphs over 17h/day. The majority of monitoring time (78%) was classified as sedentary (approximately 13.5h/day). Light physical activity accounted for 21% of the monitoring time/day (215min/day). None achieved 150min/wk of moderate/vigorous activity as recommended by national guidelines. Adults with BP were significantly less active and more sedentary than MHS users and non-users in NHANES 2003-2004 (p<0.01). Majority of the participants were relatively asymptomatic with most (87%) having no more than mild depressive symptoms and none experiencing severe manic symptoms. The sedating effects of medications on physical activity were not investigated. From clinical perspectives, these findings justify physical activity interventions targeting adults with BP as a possible means to improve their physical and mental health and to reduce the elevated risk of commonly observed medical comorbidities in this high-risk population.
    Journal of Affective Disorders 09/2013; 152. DOI:10.1016/j.jad.2013.09.009 · 3.76 Impact Factor
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    ABSTRACT: Objective: We demonstrate the utility of the time-varying effect model (TVEM) for the analysis of psychotherapy data, with the aim of elucidating complex patterns of change over time and dynamic associations between constructs of interest. Specifically, we examine the association between depression and co-occurring anxiety in a sample of adults treated with interpersonal psychotherapy (IPT) for depression or a variant designed to address both depression and co-occurring anxiety (IPT-PS, IPT for depression with panic and anxiety symptoms). Method: Seventy-eight (82% female) adult outpatients with major depression and co-occurring anxiety were assessed at each of 16 outpatient treatment sessions using the Hamilton rating scales for depression and anxiety. Results: On average, depressive symptoms declined in a quadratic form over the course of treatment. While the association between anxiety and depression was modest early in treatment, it strengthened over the middle and latter treatment phases. Finally, exploratory analyses suggest that while IPT and IPT-PS were similarly effective in reducing depressive symptoms, IPT-PS may be more effective at uncoupling the association between core anxiety and depressive symptoms. Conclusions: Findings point to the utility of the TVEM for psychotherapy research and the importance of assessing anxiety in the course of treating depression, especially following the initial phase of treatment (i.e., after Session 5). (PsycINFO Database Record (c) 2013 APA, all rights reserved).
    Journal of Consulting and Clinical Psychology 09/2013; 82(5). DOI:10.1037/a0034430 · 4.85 Impact Factor
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    ABSTRACT: BACKGROUND: Independently, maternal depression and maternal history of childhood abuse confer risk for impaired parenting. These associations may be compounded when depressed mothers with histories of childhood abuse are faced with the challenge of parenting offspring who themselves struggle with mental health problems. This study examined the relationships among maternal history of childhood abuse, maternal depression, and parenting style in the context of parenting a psychiatrically ill child, with an emphasis on examining maternal emotional abuse and neglect. We hypothesized that maternal childhood emotional abuse would be associated with maladaptive parenting strategies (lower levels of maternal acceptance and higher levels of psychological control), independent of maternal depression severity and other psychosocial risk factors. METHOD: Ninety-five mother-child dyads (children ages 7-18) were recruited from child mental health centers where children were receiving treatment for at least one internalizing disorder. Participating mothers met DSM-IV criteria for major depressive disorder. Mothers reported on their own childhood abuse histories and children reported on their mothers' parenting. RESULTS: Regression analyses demonstrated that maternal childhood emotional abuse was associated with child reports of lower maternal acceptance and greater psychological control, controlling for maternal depression severity, and other psychosocial risk factors. CONCLUSIONS: When treating psychiatrically ill children, it is important for a child's clinician to consider mothers' childhood abuse histories in addition to their history of depression. These mothers appear to have additional barriers to effective parenting.
    Depression and Anxiety 09/2013; 30(9). DOI:10.1002/da.22116 · 4.29 Impact Factor
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    ABSTRACT: BACKGROUND: Bipolar disorder II (BPII) and unipolar depression (UD) are both characterized by episodes of major depression (MDE), however DSM-IV criteria for MDE are identical, regardless of diagnosis. As a result, misdiagnosis of BP II and UD is common, leading to inappropriate treatment. Because women are twice as likely as men to experience MDE, differentiating UD from BP II in the context of depression is especially important for women. We examined symptoms and clinical features of MDE in women with UD and BPII to compare presentations of the two disorders in women. METHODS: We compared characteristics of depressed women meeting DSM-IV criteria for BPII (n=48) or UD (n=48), matched on age. RESULTS: Feelings of worthlessness occurred in 98% of participants with UD versus 85% with BPII (p=0.03). Participants with UD experienced either insomnia or hypersomnia, but participants with BPII were more likely to experience both simultaneously (p=0.04). Those with UD were significantly less likely to have >5 prior mood episodes compared to those with BP II (12% versus 61%; p<0.0001) and had a later age of onset (p=0.003). LIMITATIONS: Small sample size and exclusion criteria (i.e., comorbid substance abuse) may limit generalizability of findings. CONCLUSIONS: Among a sample of women, number of prior episodes, feelings of worthlessness, age of onset, and sleep patterns distinguished between UD and BP II depressive episodes. A better understanding of differential presentation of BP II versus UD depression in women may help guide clinicians to more accurate diagnoses and, ultimately, better treatment.
    Journal of Affective Disorders 05/2013; DOI:10.1016/j.jad.2013.05.003 · 3.76 Impact Factor
  • Holly A Swartz, Andrea Fagiolini
    The Journal of Clinical Psychiatry 12/2012; 73(12):1563-5. DOI:10.4088/JCP.12ac08227 · 5.81 Impact Factor
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    ABSTRACT: Childhood abuse and neglect have been linked with increased risks of adverse mental health outcomes in adulthood and may moderate or predict response to depression treatment. In a small randomized controlled trial treating depression in a diverse sample of nontreatment-seeking, pregnant, low-income women, we hypothesized that childhood trauma exposure would moderate changes in symptoms and functioning over time for women assigned to usual care (UC), but not to brief interpersonal psychotherapy (IPT-B) followed by maintenance IPT. Second, we predicted that trauma exposure would be negatively associated with treatment response over time and at the two follow-up time points for women within UC, but not for those within IPT-B who were expected to show remission in depression severity and other outcomes, regardless of trauma exposure. Fifty-three pregnant low-income women were randomly assigned to IPT-B (n = 25) or UC (n = 28). Inclusion criteria included ≥ 18 years, >12 on the Edinburgh Postnatal Depression Scale, 10-32 weeks gestation, English speaking, and access to a phone. Participants were evaluated for childhood trauma, depressive symptoms/diagnoses, anxiety symptoms, social functioning, and interpersonal problems. Regression and mixed effects repeated measures analyses revealed that trauma exposure did not moderate changes in symptoms and functioning over time for women in UC versus IPT-B. Analyses of covariance showed that within the IPT-B group, women with more versus less trauma exposure had greater depression severity and poorer outcomes at 3-month postbaseline. At 6-month postpartum, they had outcomes indicating remission in depression and functioning, but also had more residual depressive symptoms than those with less trauma exposure. Childhood trauma did not predict poorer outcomes in the IPT-B group at 6-month postpartum, as it did at 3-month postbaseline, suggesting that IPT including maintenance sessions is a reasonable approach to treating depression in this population. Since women with more trauma exposure had more residual depressive symptoms at 6-month postpartum, they might require longer maintenance treatment to prevent depressive relapse.
    Depression and Anxiety 07/2012; 29(7):563-73. DOI:10.1002/da.21929 · 4.29 Impact Factor
  • Holly A. Swartz, Jessica C. Levenson, Ellen Frank
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    ABSTRACT: Although bipolar II disorder is a highly prevalent, chronic illness that is associated with burdensome psychosocial impairment, relatively little is known about the best ways to treat the disorder. Moreover, psychosocial interventions for the management of bipolar II disorder have been largely unexplored, leaving psychologists with few evidence-based recommendations for best treatment practices. In this article, we provide information about interpersonal and social rhythm therapy (IPSRT), an empirically supported treatment for bipolar I disorder that has preliminary evidence supporting its efficacy in bipolar II disorder. After reviewing the phenomenology of bipolar II disorder and differentiating it from bipolar I disorder, we summarize the extant empirical support for using psychotherapy in the management of bipolar II disorder. We explore what is known about the role of psychotherapy in the management of bipolar II disorder as well as lacunae in the evidence base. Next, we introduce IPSRT and discuss how it has been adapted for use as a treatment for individuals suffering from bipolar II disorder. Specific strategies of the treatment are detailed, and preliminary evidence for the efficacy of IPSRT in bipolar II disorder is described. Finally, we present a case vignette demonstrating the use of IPSRT for an individual with bipolar II disorder.
    Professional Psychology Research and Practice 04/2012; 43(2):145-153. DOI:10.1037/a0027671 · 1.34 Impact Factor
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    Holly A Swartz, Ellen Frank, Yu Cheng
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    ABSTRACT: The differential roles of psychotherapy and pharmacotherapy in the management of bipolar (BP) II depression are unknown. As a first step toward exploring this issue, we conducted a pilot study to evaluate the feasibility and acceptability of comparing a BP-specific psychotherapy [Interpersonal and Social Rhythm Therapy (IPSRT)] to quetiapine as treatments for BP-II depression. Unmedicated individuals (n = 25) meeting DSM-IV criteria for BP-II disorder, currently depressed, were randomly assigned to weekly sessions of IPSRT (n = 14) or quetiapine (n = 11), flexibly dosed from 25-300 mg. Participants were assessed with weekly measures of mood and followed for 12 weeks. Treatment preference was queried prior to randomization. Using mixed effects models, both groups showed significant declines in the 25-item Hamilton Rating Scale for Depression [F(1,21) = 44, p < 0.0001] and Young Mania Rating Scale [F(1,21) = 20, p = 0.0002] scores over time but no group-by-time interactions. Dropout rates were 21% (n = 3) and 27% (n = 3) in the IPSRT and quetiapine groups, respectively. Overall response rates (defined as ≥ 50% reduction in depression scores without an increase in mania scores) were 29% (n = 4) in the IPSRT group and 27% (n = 3) in the quetiapine group. Measures of treatment satisfaction were high in both groups. Treatment preference was not associated with outcomes. Outcomes in participants with BP-II depression assigned to IPSRT monotherapy or quetiapine did not differ over 12 weeks in this small study. Follow-up trials should examine characteristics that predict differential response to psychotherapy and pharmacotherapy.
    Bipolar Disorders 03/2012; 14(2):211-6. DOI:10.1111/j.1399-5618.2012.00988.x · 4.62 Impact Factor
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    ABSTRACT: Background and Purpose: Mental health problems are a significant concern among children and adolescents (Health Canada, 2002; National Institute of Mental Health (NIMH), 2001), and associated with economic burden (Insel, 2008) and detrimental consequences, including criminality, academic failure, teen pregnancy, and suicide (NIMH, 2001). Mental health treatment may provide an opportunity to alleviate mental health problems and mitigate the related consequences. However, the impact of treatment is compromised by dropout rates estimated between 40-60% (Harpez-Rotem et al., 2004). Parental engagement strategies have demonstrated significant improvements in child mental health treatment attendance (see Gopalan et al., 2010). While parent engagement is important, it is also critical to engage the child/adolescent and understand their perceived barriers. To address this gap, a randomized pilot study was conducted examining the effectiveness of an engagement session (ES; Zuckoff et al., 2004) adapted for adolescents on outcomes including initial attendance (i.e., first 3 counseling sessions), self-efficacy, and treatment motivation. The associations between working alliance and treatment barriers on initial attendance were also explored. Methods: Recruited from four Toronto-based mental health agencies, participants included 51 adolescents (age M=16.2) accepted for non-mandated counseling. Among participants, 47.1% were immigrants and 58.8% lived in low-income neighborhoods. The week before receiving counseling, participants were randomized and received either ES plus self-reports (n=27) or self-reports only (n=24). Baseline self-reports included measures of psychological distress (Brief Symptom Inventory; Derogatis, 1975), self-efficacy (Generalized Self-Efficacy Scale; Schwarzer & Jerusalem, 1995), and intrinsic/extrinsic treatment motivation (Autonomous/Controlled Motivations for Treatment Questionnaire; Zuroff et al., 2005). At 6-week follow-up, agency counselors reported each participant's initial attendance (i.e., attendance of 0-3 sessions) and participants repeated baseline self-reports plus the Working Alliance Inventory (Tracey & Kokotovic, 1989) and an adapted treatment barriers measure (Barriers to Treatment Participation Scale; Kazdin et al., 1997). Group differences in outcomes were examined via one-way ANCOVAs and associations between alliance/barriers on attendance were explored via bivariate regression analyses. Results: After controlling for baseline extrinsic motivation differences, the ES group demonstrated marginally significantly greater initial attendance (M=2.1, SD=1.0) versus the control group (M=1.5, SD=1.2), (F(1,48)=3.70, p=.06), with a medium effect size (η2=.07). The ES group demonstrated marginally significantly higher intrinsic motivation at follow-up (F(1,47)=3.15., p=.08), with a medium effect size (η2=.06) , indicating that the ES group reported counseling to be more personally valuable than the control group. No significant between-group differences were observed for follow-up extrinsic motivation/self-efficacy. Among participants who attended at least one counseling session, alliance (F(1,40)=8.40, β= .260, p=.006) and barriers (F(1,40)=9.30, β= -.475, p=.004) were significantly associated with subsequent initial attendance, accounting for 14% and 19% of the variance, respectively. Higher self-reported barriers/lower alliance scores were associated with lower initial treatment attendance. Conclusions and Implications: The ES is a promising intervention for enhancing attendance and intrinsic treatment motivation in real world settings with encouraging medium effect sizes which will assist in guiding future ES evaluation efforts. Adolescent-reported working alliance and treatment barriers were significant predictors of subsequent initial attendance. Future research is necessary to explore the potential mediators of adolescent treatment attendance.
    Society for Social Work and Research Sixteenth Annual Conference Research That Makes A Difference: Advancing Practice and Shaping Public Policy; 01/2012
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    ABSTRACT: Interpersonal and social rhythm therapy (IPSRT) is an evidence-based psychotherapy for mood disorders. The goal of this quality improvement initiative was to demonstrate feasibility of implementing IPSRT across the continuum of outpatient and inpatient care within an academic medical center. A multidisciplinary work group was convened to implement IPSRT in outpatient (N=48), inpatient (N=602), and intensive outpatient (N=68) programs of an academic medical center. Quality improvement performance markers (including symptoms and group attendance rates) were collected. Institutional preference for group treatments required adaptation of IPSRT from an individual to group psychotherapy format. Iterative problem solving and protocol development resulted in models of group IPSRT appropriate for each level of care. Performance outcome markers were favorable, indicating feasibility of implementation. At a single, multisite, urban, academic medical center, IPSRT proved a feasible evidence-based psychotherapy for implementation across levels of care in routine practice.
    Psychiatric services (Washington, D.C.) 11/2011; 62(11):1377-80. DOI:10.1176/appi.ps.62.11.1377 · 2.81 Impact Factor
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    ABSTRACT: Individuals with depression and low social support are at elevated risk for developing cardiovascular disease--presumptively through mechanisms involving dysregulated stress physiology. While depressed individuals often report diminished social support and elevated levels of social distress, few studies have examined how social factors impact stress-related cardiovascular activity in depressed samples. Accordingly, we evaluated the social modulation of stress-related cardiovascular activity in a sample of 38 medically healthy, unmedicated depressed and nondepressed individuals. Cardiovascular and psychological measures were obtained before and after depressed and nondepressed women engaged in a speech stress task. To evaluate the impact of social factors on stress responses, half of the women completed the speech stress task first, while the other half completed the speech stress after engaging in a relationship-focused imagery task. Nondepressed women who first thought about a close relationship displayed global attenuations in blood pressure throughout the subsequent stress task, consistent with a stress-buffering effect of perceived social support. Conversely, depressed women who first thought about a close relationship displayed global elevations in blood pressure throughout the subsequent stress task, consistent with a stress-enhancing effect of perceived social distress in depressed women. Thinking about a close relationship differentially impacted subsequent cardiovascular activity during an evocative stressor in depressed and nondepressed women. Understanding the social context in which stress is experienced may aid in identifying, and ultimately attenuating, cardiovascular risks observed among patients with major depressive disorder.
    Health Psychology 05/2011; 30(3):276-84. DOI:10.1037/a0023005 · 3.95 Impact Factor
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    ABSTRACT: To evaluate the impact of acute stress and relationship-focused imagery on cardiac vagal control, as indicated by levels of respiratory sinus arrhythmia (RSA), in depressed and nondepressed women. Impairment in cardiac parasympathetic (vagal) control may confer risk for cardiac mortality in depressed populations. Electrocardiogram and respiratory rate were evaluated in 15 nonmedicated depressed women and 15 matched controls during two laboratory conditions: 1) a relationship-focused imagery designed to elicit vagal activation; and 2) a speech stressor designed to evoke vagal withdrawal. As expected, the relationship-focused imagery increased RSA (F(3,66) = 3.79, p = .02) and the speech stressor decreased RSA (F(3,66) = 4.36, p = .02) across women. Depressed women exhibited lower RSA during the relationship-focused imagery, and this effect remained after control for respiratory rate and trauma history (F(1,21) = 5.65, p = .027). Depressed women with a trauma history exhibited the lowest RSA during the stress condition (F(1,22) = 9.61, p = .05). However, after controlling for respiratory rate, Trauma History × Task Order (p = .02) but not Trauma History × Depression Group (p = .12) accounted for RSA variation during the stress condition. Depression in women is associated with lower RSA, particularly when women reflect on a close love relationship, a context expected to elicit vagal activation and hence increase RSA. In contrast, depression-related variation in stressor-evoked vagal activity seems to covary with women's trauma history. Associations between vagal activity and depression are complex and should be considered in view of the experimental conditions under which vagal control is assessed, as well as physiological and behavioral factors that may affect vagal function.
    Psychosomatic Medicine 03/2011; 73(4):336-43. DOI:10.1097/PSY.0b013e318213925d · 4.09 Impact Factor
  • Holly A Swartz, Michael E Thase
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    ABSTRACT: Bipolar II disorder is a common, recurrent, and disabling psychiatric illness, and yet little is known about how best to treat it. The pressing clinical need for evidence-based approaches to the treatment of bipolar II disorder, coupled with recent publication of pertinent studies, calls for an updated review of this literature. This review focuses on a critical examination of the evidence supporting the efficacy of treatments for acute depressive episodes in bipolar II disorder. A MEDLINE (via Ovid) search of journals, covering the period from January 1950 to January 2009, was performed to identify relevant studies. Keywords used were bipolar II disorder, bipolar disorder, bipolar depression, and pharmacotherapy. Studies were further limited to those that were in adult samples, published in peer-reviewed journals, and written in English. We examined all randomized trials evaluating the use of pharmacotherapy in the treatment of acute bipolar II depression. Studies with mixed samples of bipolar I and II or bipolar II and unipolar depression were examined as well. Twenty-one randomized trials were identified and reviewed. Therapeutic agents were rated according to the quality of evidence supporting their efficacy as treatments for bipolar II depression. Ninety percent of relevant trials were published after 2005. Quetiapine was judged as having compelling evidence supporting its efficacy. Lithium, antidepressants, and pramipexole were judged as having preliminary support for efficacy. Lamotrigine was considered to have mixed support. Although progress has been made, further research on bipolar II depression is warranted.
    The Journal of Clinical Psychiatry 03/2011; 72(3):356-66. DOI:10.4088/JCP.09r05192gre · 5.81 Impact Factor
  • Bipolar Disorder, 08/2010: pages 430 - 442; , ISBN: 9780470661277
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    ABSTRACT: Although interpersonal psychotherapy (IPT) is an efficacious treatment for acute depression, the relative efficacy of treatment in each of the four IPT problem areas (grief, role transitions, role disputes, interpersonal deficits) has received little attention. We evaluated the specificity of IPT by comparing treatment success among patients whose psychotherapy focused on each problem area. Moreover, we sought to understand how the patient characteristics and interpersonal problems most closely linked to the onset of a patient's current depression contributed to IPT success. Patients meeting DSM-IV criteria for an episode of major depressive disorder (n=182) were treated with weekly IPT. Remission was defined as an average Hamilton Rating Scale for Depression 17-item score of 7 or below over 3 weeks. Personality disorders were diagnosed using the Structured Clinical Interview for DSM-IV Personality Disorders. Contrary to our prediction that patients whose treatment was focused on interpersonal deficits would take longer to remit, survival analyses indicated that patients receiving treatment focused on each of the four problem areas did not differ in their times to remission. Nor were patients in the interpersonal deficits group more likely to have an Axis II diagnosis. Patients whose treatment focused on role transitions remitted faster than those whose treatment focused on role disputes, after controlling for covariates. With skillful use of IPT strategies and tactics and with careful medication management where appropriate, patients in this study whose treatment focused on each problem area were treated with equal success by trained IPT clinicians.
    Depression and Anxiety 05/2010; 27(5):434-40. DOI:10.1002/da.20661 · 4.29 Impact Factor
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    Danielle M Novick, Holly A Swartz, Ellen Frank
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    ABSTRACT: The prevalence of suicide attempts (SA) in bipolar II disorder (BPII), particularly in comparison to the prevalence in bipolar I disorder (BPI), is an understudied and controversial issue with mixed results. To date, there has been no comprehensive review of the published prevalence data for attempted suicide in BPII. We conducted a literature review and meta-analysis of published reports that specified the proportion of individuals with BPII in their presentation of SA data. Systematic searching yielded 24 reports providing rates of SA in BPII and 21 reports including rates of SA in both BPI and BPII. We estimated the prevalence of SA in BPII by combining data across reports of similar designs. To compare rates of SA in BPII and BPI, we calculated a pooled odds ratio (OR) and 95% confidence interval (CI) with random-effect meta-analytic techniques with retrospective data from 15 reports that detailed rates of SA in both BPI and BPII. Among the 24 reports with any BPII data, 32.4% (356/1099) of individuals retrospectively reported a lifetime history of SA, 19.8% (93/469) prospectively reported attempted suicide, and 20.5% (55/268) of index attempters were diagnosed with BPII. In 15 retrospective studies suitable for meta-analysis, the prevalence of attempted suicide in BPII and BPI was not significantly different: 32.4% and 36.3%, respectively (OR = 1.21, 95% CI: 0.98-1.48, p = 0.07). The contribution of BPII to suicidal behavior is considerable. Our findings suggest that there is no significant effect of bipolar subtype on rate of SA. Our findings are particularly alarming in concert with other evidence, including (i) the well-documented predictive role of SA for completed suicide and (ii) the evidence suggesting that individuals with BPII use significantly more violent and lethal methods than do individuals with BPI. To reduce suicide-related morbidity and mortality, routine clinical care for BPII must include ongoing risk assessment and interventions targeted at risk factors.
    Bipolar Disorders 02/2010; 12(1):1-9. DOI:10.1111/j.1399-5618.2009.00786.x · 4.62 Impact Factor

Publication Stats

2k Citations
250.69 Total Impact Points


  • 2013
    • Chatham University
      Pittsburgh, Pennsylvania, United States
  • 2001–2013
    • Western Psychiatric Institute and Clinic
      Pittsburgh, Pennsylvania, United States
  • 1999–2013
    • University of Pittsburgh
      • Department of Psychiatry
      Pittsburgh, Pennsylvania, United States
  • 2008
    • The University of Edinburgh
      Edinburgh, Scotland, United Kingdom