Robert A Rosenheck

Yale University, New Haven, Connecticut, United States

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Publications (748)3027.16 Total impact

  • Kendell L Coker, Elina Stefanovics, Robert Rosenheck
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    ABSTRACT: Substantial rates of substance use comorbidity have been observed among veterans with Post-Traumatic Stress Disorder (PTSD), highlighting the need to identify patient and program characteristics associated with improved outcomes for substance abuse. Data were drawn from 12,270 dually diagnosed veterans who sought treatment from specialized intensive Veterans Health Administration PTSD programs between 1993 and 2011. The magnitude of the improvement in Addiction Severity Index (ASI) alcohol and drug use composite scores from baseline was moderate, with effect sizes (ES) of -.269 and -.287, respectively. Multivariate analyses revealed that treatment in longer-term programs, being prescribed psychiatric medication, and planned participation in reunions were all associated with slightly improved outcomes. Reductions in substance use measures were associated with robust improvements in PTSD symptoms and violent behavior. These findings suggest not only synergistic treatment effects linking improvement in PTSD symptoms with substance use disorders among dually diagnosed veterans with PTSD, but also to reductions in violent behavior. Furthermore, the findings indicate that proper discharge planning in addition to intensity and duration of treatment for dually diagnosed veterans with severe PTSD may result in better outcomes. Further dissemination of evidence-based substance abuse treatment may benefit this population. (PsycINFO Database Record (c) 2015 APA, all rights reserved).
    Psychological Trauma Theory Research Practice and Policy 06/2015; DOI:10.1037/tra0000061 · 0.89 Impact Factor
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    ABSTRACT: No large-scale randomized trial has compared the effect of different second-generation antipsychotic drugs and any first-generation drug on alcohol, drug and nicotine use in patients with schizophrenia. The Clinical Antipsychotic Trial of Intervention Effectiveness study randomly assigned 1432 patients formally diagnosed with schizophrenia to four second-generation antipsychotic drugs (olanzapine, risperidone quetiapine, and ziprasidone) and one first-generation antipsychotic (perphenazine) and followed them for up to 18 months. Secondary outcome data documented cigarettes smoked in the past week and alcohol and drug use severity ratings. At baseline, 61% of patients smoked, 35% used alcohol, and 23% used illicit drugs. Although there were significant effects of time showing reduction in substance use over the 18 months (all p < 0.0001), this study found no evidence that any antipsychotic was robustly superior to any other in a secondary analysis of data on substance use outcomes from a large 18-month randomized schizophrenia trial.
    The Journal of nervous and mental disease 06/2015; DOI:10.1097/NMD.0000000000000317 · 1.81 Impact Factor
  • Greg A. Greenberg, Robert A. Rosenheck
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    ABSTRACT: Past research has found that veterans are at modestly greater risk than non-veterans for homelessness. Most attempts to explain these findings have focused on sociodemographic risk factors such as age, race, and prevalent mental illness. Less attention has been given to a potential proximate explanation of homelessness, housing status (i.e., home ownership and housing cost burden). We used data from the 2006 American Community Survey to examine whether male veterans in age-race/ethnic groups at greatest risk of homelessness are also less likely to own a home than matched male non-veterans, and whether they have a greater likelihood of experiencing housing cost burdens that could put them at risk of homelessness. Compared to non-veterans, recently discharged veterans and veterans from the immediate post-Vietnam era, veteran cohorts at greatest relative risk of homelessness were significantly less likely than their non-veteran peers to own their home while other cohorts of veterans were significantly more likely to own their home. However, veterans of virtually all ethnic and age groups were significantly and substantially less likely than their non-veteran peers to experience severe housing cost burdens. These data suggest that housing status does not explain the increased risk of homelessness among selected veteran subgroups.
    06/2015; 36(1):75-94. DOI:10.1080/08882746.2009.11430571
  • Jack Tsai, Robert A Rosenheck, Wesley J Kasprow, Vincent Kane
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    ABSTRACT: The study examined the number of homeless veterans with minor children in their custody ("children in custody"), compared sociodemographic and clinical characteristics among homeless veterans with and without children in custody, and observed differences in referral and admission patterns among veterans with and without children in custody for a variety of U.S. Department of Veterans Affairs (VA) programs for homeless veterans. Data were obtained from the VA Homeless Operations Management and Evaluation System for 89,142 literally homeless and unstably housed veterans. Sociodemographic, housing, health, and psychosocial characteristics of veterans were analyzed. Among literally homeless veterans, 9% of men and 30% of women had children in custody; among unstably housed veterans, 18% of men and 45% of women had children in custody. Both male and female veterans with children in custody were younger and less likely to have chronic general medical conditions and psychiatric disorders compared with other veterans, but, notably, 11% of homeless veterans with children in custody had psychotic disorders. Veterans with children in custody were more likely than other veterans to be referred and admitted to the VA's permanent supported housing program, and women were more likely than men to be admitted to the program. A substantial proportion of homeless veterans served by the VA have severe mental illness and children in custody, which raises concerns about the parenting environment for their children. Particular focus should be directed at VA's supported-housing program, and the practical and ethical implications of serving homeless parents and their children need to be considered.
    Psychiatric services (Washington, D.C.) 05/2015; DOI:10.1176/ · 1.99 Impact Factor
  • Gihyun Yoon, Ismene L Petrakis, Robert A Rosenheck
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    ABSTRACT: This study assesses medical and psychiatric comorbidities, service utilization, and psychotropic medication prescriptions in veterans with comorbid major depressive disorder (MDD) and alcohol use disorder (AUD) relative to veterans with MDD alone. Using cross-sectional administrative data (fiscal year [FY]2012: October 1, 2011-September 30, 2012) from the Veterans Health Administration (VHA), we identified veterans with a diagnosis of current (12-month) MDD nationally (N = 309,374), 18.8% of whom were also diagnosed with current (12-month) AUD. Veterans with both MDD and AUD were compared to those with MDD alone on sociodemographic characteristics, current (12-month) medical and psychiatric disorders, service utilization, and psychotropic prescriptions. We then used logistic regression analyses to calculate odds ratio and 95% confidence interval of characteristics that were independently different between the groups. Dually diagnosed veterans with MDD and AUD, relative to veterans with MDD alone, had a greater number of comorbid health conditions, such as liver disease, drug use disorders, and bipolar disorder as well as greater likelihood of homelessness and higher service utilization. Dually diagnosed veterans with MDD and AUD had more frequent medical and psychiatric comorbidities and more frequently had been homeless. These data suggest the importance of assessing the presence of comorbid medical/psychiatric disorders and potential homelessness in order to provide appropriately comprehensive treatment to dually diagnosed veterans with MDD and AUD and indicate a need to develop more effective treatments for combined disorders. (Am J Addict 2015;XX:XX -XX). © American Academy of Addiction Psychiatry.
    American Journal on Addictions 05/2015; DOI:10.1111/ajad.12219 · 1.74 Impact Factor
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    ABSTRACT: This quantitative study sought to compare beliefs about the manifestation, causes and treatment of mental illness and attitudes toward people with mental illness among health professionals from five countries: the United States, Brazil, Ghana, Nigeria, and China. A total of 902 health professionals from the five countries were surveyed using a questionnaire addressing attitudes towards people with mental illness and beliefs about the causes of mental illness. Chi-square and analysis of covariance (ANCOVA) were used to compare age and gender of the samples. Confirmatory factor analysis was employed to confirm the structure and fit of the hypothesized model based on data from a previous study that identified four factors: socializing with people with mental illness (socializing), belief that people with mental illness should have normal roles in society (normalizing), non-belief in supernatural causes (witchcraft or curses), and belief in bio-psycho-social causes of mental illness (bio-psycho-social). Analysis of Covariance was used to compare four factor scores across countries adjusting for differences in age and gender. Scores on all four factors were highest among U.S. professionals. The Chinese sample showed lowest score on socializing and normalizing while the Nigerian and Ghanaian samples were lowest on non-belief in supernatural causes of mental illness. Responses from Brazil fell between those of the U.S. and the other countries. Although based on convenience samples of health professional robust differences in attitudes among health professionals between these five countries appear to reflect underlying socio-cultural differences affecting attitudes of professionals with the greater evidence of stigmatized attitudes in developing countries.
    Psychiatric Quarterly 05/2015; DOI:10.1007/s11126-015-9363-5 · 1.26 Impact Factor
  • Eric D.A. Hermes, Jack Tsai, Robert Rosenheck
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    ABSTRACT: This study examined interest in computerized psychotherapies (CPTs) and its relation to use of information technology among individuals receiving Veterans Health Administration (VHA) outpatient treatment. Veterans receiving treatment in a VHA substance use disorder outpatient clinic completed a self-report questionnaire. The survey addressed recent experience using information technology and potential interest in using CPTs for symptoms/functional problems associated with substance use and mental health disorders. Demographic, diagnostic, and information technology use data were compared between those expressing interest in CPT and those not expressing an interest, as well as with nationally representative veteran data from the 2010 National Survey of Veterans (NSV). Of 151 respondents, 82% were interested in CPT for at least one problem, and 60% were interested for more than one. The most commonly selected CPTs were for substance use (46%), depression (45%), problem solving (43%), and insomnia (42%). None of the 23 measures of information technology use was associated with interest in CPTs. Compared with respondents not interested in any CPTs, those interested in CPT were older (t150=2.1, p=0.042) and more likely to be African American [χ(2)(1)=8.8, p=0.032], to have reported a drug use disorder [χ(2)(1)=4.2, p=0.041], and to have reported more than one substance use or psychiatric disorder [χ(2)(1)=8.5, p=0.014]. The majority of respondents reported use of Internet and e-mail (65% and 64%, respectively), proportions comparable to respondents to the NSV. Among veterans receiving outpatient substance use treatment, interest in CPT is high and unrelated to information technology use. Efforts to implement CPTs may interest this population.
    Telemedicine and e-Health 04/2015; DOI:10.1089/tmj.2014.0215 · 1.54 Impact Factor
  • Carla Marienfeld, Robert A Rosenheck
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    ABSTRACT: Co-morbidity and co-prescription patterns of people with serious mental illness in methadone maintenance may complicate their treatment and have not been studied. The goal of this study was to examine the care and characteristics of people with serious mental illness in methadone maintenance treatmentnationally in the Veterans health Administration (VHA). Using national VHA data from FY2012, bivariate and multiple logistic regression analyses were used to compare veterans in methadone maintenance treatment who had a serious mental illness (schizophrenia, bipolar disorder or major affective disorder) to patients in methadone maintenance treatment without serious mental illness and patients with serious mental illness who were not in methadone maintenance treatment. Only a small fraction of patients with serious mental illness were receiving methadone maintenance treatment (0.65%), but a relatively large proportion in methadone maintenance treatment had a serious mental illness (33.2%). Compared to patients without serious mental illness, patients with serious mental illness in methadone maintenance treatment were more likely to have been homeless, have had a recent psychiatric hospitalization; more likely to be over 50% disabled, more fills for more classes of psychotropic drugs. Compared to other patients with serious mental illness, patients with serious mental illness in methadone maintenance treatment were more likely to have a drug abuse diagnosis and to reside in large urban areas. One third of patients in methadone maintenance treatment have serious mental illness have more frequent psychiatric comorbidity, and homelessness and are more likely to use psychiatric and general health services and fill more types of psychiatric prescriptions. Further study and clinical awareness of potential drug-drug interactions in this high medication and service using population are needed.
    Journal of Dual Diagnosis 03/2015; 11(2). DOI:10.1080/15504263.2015.1025024 · 0.80 Impact Factor
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    ABSTRACT: We used national data for fiscal year 2012 to examine demographic, psychiatric and medical diagnoses, indications for psychotropics, and service use correlates of psychotropic medication fills in Veterans with at least 10 opioid prescriptions during the year (the highest 29% of opioid users); and whether the Veteran was treated in a specialty mental health clinic. Of the 328,398 Veterans who filled at least 10 opioid prescriptions, 77% also received psychotropics, of whom: 74% received antidepressants, 55% anxiolytics/sedatives/hypnotics, and 26% three or more classes of psychotropic medications. Altogether, 87% had a psychiatric or medical indication; and 54% received mental health treatment. Veterans treated in a mental health clinic were prescribed more psychotropics and were more likely to have a documented psychiatric or medical indication than those treated solely in other settings. Indicated psychiatric diagnoses were the strongest predictors of specific class of psychotropics prescribed; anxiety disorder and insomnia were most strongly associated with anxioloytics/sedatives/hypnotics receipt. Since psychotropics and opioids can produce harmful side effects, especially when combined, and since they are likely prescribed by separate providers in different settings, coordinated consideration of the risks and benefits of co-prescribing these medications may be needed, along with further study of related adverse events. Copyright © 2015. Published by Elsevier Ireland Ltd.
    03/2015; 227(2-3). DOI:10.1016/j.psychres.2015.03.006
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    ABSTRACT: Comprehensive coordinated specialty care programs for first-episode psychosis have been widely implemented in other countries but not in the United States. The National Institute of Mental Health's Recovery After an Initial Schizophrenia Episode (RAISE) initiative focused on the development and evaluation of first-episode treatment programs designed for the U.S. health care system. This article describes the background, rationale, and nature of the intervention developed by the RAISE Early Treatment Program project-known as the NAVIGATE program-with a particular focus on its psychosocial components. NAVIGATE is a team-based, multicomponent treatment program designed to be implemented in routine mental health treatment settings and aimed at guiding people with a first episode of psychosis (and their families) toward psychological and functional health. The core services provided in the NAVIGATE program include the family education program (FEP), individual resiliency training (IRT), supported employment and education (SEE), and individualized medication treatment. NAVIGATE embraces a shared decision-making approach with a focus on strengths and resiliency and on collaboration with clients and family members in treatment planning and reviews. The NAVIGATE program has the potential to fill an important gap in the U.S. health care system by providing a comprehensive intervention specially designed to meet the unique treatment needs of persons recovering from a first episode of psychosis. A cluster-randomized controlled trial comparing NAVIGATE with usual community care has recently been completed.
    Psychiatric services (Washington, D.C.) 03/2015; DOI:10.1176/ · 1.99 Impact Factor
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    ABSTRACT: The premise of the National Institute of Mental Health Recovery After an Initial Schizophrenia Episode Early Treatment Program (RAISE-ETP) is to combine state-of-the-art pharmacologic and psychosocial treatments delivered by a well-trained, multidisciplinary team in order to significantly improve the functional outcome and quality of life for first-episode psychosis patients. The study is being conducted in non-academic (ie, real-world) treatment settings, using primarily extant reimbursement mechanisms. We developed a treatment model and training program based on extensive literature review and expert consultation. Our primary aim is to compare the experimental intervention to "usual care" on quality of life. Secondary aims include comparisons on remission, recovery, and cost-effectiveness. Patients 15-40 years old with a first episode of schizophrenia, schizoaffective disorder, schizophreniform disorder, psychotic disorder not otherwise specified, or brief psychotic disorder according to DSM-IV and no more than 6 months of treatment with antipsychotic medications were eligible. Patients are followed for a minimum of 2 years, with major assessments conducted by blinded, centralized raters using live, 2-way video. We selected 34 clinical sites in 21 states and utilized cluster randomization to assign 17 sites to the experimental treatment and 17 to usual care. Enrollment began in July 2010 and ended in July 2012 with 404 subjects. The results of the trial will be published separately. The goal of the article is to present both the overall development of the intervention and the design of the clinical trial to evaluate its effectiveness. We believe that we have succeeded in both designing a multimodal treatment intervention that can be delivered in real-world clinical settings and implementing a controlled clinical trial that can provide the necessary outcome data to determine its impact on the trajectory of early phase schizophrenia. identifier: NCT01321177. © Copyright 2015 Physicians Postgraduate Press, Inc.
    The Journal of Clinical Psychiatry 03/2015; 76(3):240-6. DOI:10.4088/JCP.14m09289 · 5.14 Impact Factor
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    ABSTRACT: Treatment guidelines suggest distinctive medication strategies for first-episode and multiepisode patients with schizophrenia. To assess the extent to which community clinicians adjust their usual treatment regimens for first-episode patients, the authors examined prescription patterns and factors associated with prescription choice in a national cohort of early-phase patients. Prescription data at study entry were obtained from 404 participants in the Recovery After an Initial Schizophrenia Episode Project's Early Treatment Program (RAISE-ETP), a nationwide multisite effectiveness study for patients with first-episode schizophrenia spectrum disorders. Treatment with antipsychotics did not exceed 6 months at study entry. The authors identified 159 patients (39.4% of the sample) who might benefit from changes in their psychotropic prescriptions. Of these, 8.8% received prescriptions for recommended antipsychotics at higher than recommended dosages; 32.1% received prescriptions for olanzapine (often at high dosages), 23.3% for more than one antipsychotic, 36.5% for an antipsychotic and also an antidepressant without a clear indication, 10.1% for psychotropic medications without an antipsychotic, and 1.2% for stimulants. Multivariate analysis showed evidence for sex, age, and insurance status effects on prescription practices. Racial and ethnic effects consistent with effects reported in previous studies of multiepisode patients were found in univariate analyses. Despite some regional variations in prescription practices, no region consistently had different practices from the others. Diagnosis had limited and inconsistent effects. Besides prescriber education, policy makers may need to consider not only patient factors but also service delivery factors in efforts to improve prescription practices for first-episode schizophrenia patients.
    American Journal of Psychiatry 03/2015; 172(3):237-48. DOI:10.1176/appi.ajp.2014.13101355 · 13.56 Impact Factor
  • Jack Tsai, Robert A Rosenheck
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    ABSTRACT: Objective: There has long been concern that public support payments are used to support addictive behaviors. This study examined the amount of money homeless veterans spend on alcohol and drugs and the association between public support income, including VA disability compensation, and expenditures on alcohol and drugs. Methods: Data were from 1,160 veterans from 19 sites on entry into the Housing and Urban Development-Veterans Affairs Supportive Housing program. Descriptive statistics and nonparametric analyses were conducted. Results: About 33% of veterans reported spending money on alcohol and 22% reported spending money on drugs in the past month. No significant association was found between public support income, VA disability compensation, and money spent on alcohol and drugs. Conclusions: A substantial proportion of homeless veterans spend some income on alcohol and drugs, but disability income, including VA compensation, does not seem to be related to substance use or money spent on addictive substances.
    Psychiatric services (Washington, D.C.) 03/2015; 66(6):appips201400245. DOI:10.1176/ · 1.99 Impact Factor
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    Hongbo He, Yanling Zhou, Bin Sun, Yaoguang Guo, Robert A Rosenheck
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    ABSTRACT: Caregiver burden is an important issue that needs to be addressed when developing management programs for persons with chronic mental illnesses, but there is, as yet, no reliable way for assessing this in China. Assess the validity and reliability of a brief adapted Chinese version of the Family Experience Interview Schedule (FEIS) among caregivers of inpatients with mental disorders in China. We first translated and back-translated the original 114-item FEIS and administered it to 606 primary caregivers of psychiatric inpatients. After excluding 9 items about sociodemographic variables and 9 items that over 15% of respondents were unable to answer, we conducted an exploratory factor analysis using a random half of the sample on the remaining 96 items and, based on the results of the factor analysis, selected the items to be included in the final shortened scale. Correlation analysis, confirmatory factor analysis, and internal consistency measures were used to assess the reliability and validity of the final scale using data from the second half of the sample. The final scale included 28 items that loaded on five dimensions: (a) patients' violent behavior; (b) patients' suicidal tendency; (c) caregivers' depression and anxiety; (d) disruption of caregivers' daily routines; and (e) caregivers' satisfaction with health services. These five dimensions explained 50.5% of the total variance. Confirmatory factor analysis found reasonable fit of this 5-factor model (χ (2) /df=2.94, p<0.001, goodness-of-fit index [GFI]=0.85, comparative fit index [CFI]=0.85, root-mean-square error of approximation [RMSEA]=0.08). The correlation coefficients between each item and the corresponding factor were all above 0.5. The Cronbach α coefficient of the entire scale was 0.76 and that for the five dimensions varied between 0.71 and 0.84. The five dimensions of family burden assessed by the 28-item brief Chinese version of FEIS have good internal consistency and, thus, appear to assess valid dimensions of family burden in Chinese caregivers of persons with serious mental illnesses. Further work is needed to assess the test-retest reliability of this scale and its sensitivity to change over time.
    02/2015; 27(1):55-61. DOI:10.11919/j.issn.1002-0829.214138
  • Jack Tsai, Robert A Rosenheck
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    ABSTRACT: Homelessness among US veterans has been a focus of research for over 3 decades. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, this is the first systematic review to summarize research on risk factors for homelessness among US veterans and to evaluate the evidence for these risk factors. Thirty-one studies published from 1987 to 2014 were divided into 3 categories: more rigorous studies, less rigorous studies, and studies comparing homeless veterans with homeless nonveterans. The strongest and most consistent risk factors were substance use disorders and mental illness, followed by low income and other income-related factors. There was some evidence that social isolation, adverse childhood experiences, and past incarceration were also important risk factors. Veterans, especially those who served since the advent of the all-volunteer force, were at greater risk for homelessness than other adults. Homeless veterans were generally older, better educated, and more likely to be male, married/have been married, and to have health insurance coverage than other homeless adults. More studies simultaneously addressing premilitary, military, and postmilitary risk factors for veteran homelessness are needed. This review identifies substance use disorders, mental illness, and low income as targets for policies and programs in efforts to end homelessness among veterans. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health 2015. This work is written by (a) US Government employee(s) and is in the public domain in the US.
    Epidemiologic Reviews 01/2015; 37(1). DOI:10.1093/epirev/mxu004 · 7.33 Impact Factor
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    ABSTRACT: Objective: This study is the first to examine duration of untreated psychosis (DUP) among persons receiving care in community mental health centers in the United States. Methods: Participants were 404 individuals (ages 15-40) who presented for treatment for first-episode psychosis at 34 nonacademic clinics in 21 states. DUP and individual- and site-level variables were measured. Results: Median DUP was 74 weeks (mean=193.5±262.2 weeks; 68% of participants had DUP of greater than six months). Correlates of longer DUP included earlier age at first psychotic symptoms, substance use disorder, positive and general symptom severity, poorer functioning, and referral from outpatient treatment settings. Conclusions: This study reported longer DUP than studies conducted in academic settings but found similar correlates of DUP. Reducing DUP in the United States will require examination of factors in treatment delay in local service settings and targeted strategies for closing gaps in pathways to specialty FEP care.
    Psychiatric services (Washington, D.C.) 01/2015; DOI:10.1176/ · 1.99 Impact Factor
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    ABSTRACT: Lack of insight into illness has long been recognized as a central characteristic of schizophrenia. Although recent theories have emphasized neurocognitive dysfunction as a central impairment in schizophrenia it remains unclear whether the lack of insight in schizophrenia is more strongly associated with measures of symptom severity or neuropsychological dysfunction. Seventy-four consecutive inpatients with chronic schizophrenia were enrolled in a cross-sectional study. All subjects were assessed with the Positive and Negative Syndrome Scale (PANSS, five-factor model), the Insight and Treatment Attitudes Questionnaire (ITAQ), and the Measurement and Treatment Research to Improve Cognition in Schizophrenia (MATRICS) Consensus Cognitive Battery (MCCB). Bivariate association and multiple linear regression analyses were used to investigate the relationship between insight and both symptoms and neurocognition. On bivariate correlation, the positive, negative, disorganized and excited factors of the PANSS showed a negative correlation with insight but there was no significant association between the MCCB total score or any component subscale and insight. Multiple regression analysis showed that positive symptoms, disorganized/concrete symptoms and excited symptoms contributed to awareness of mental illness; positive and disorganized/concrete symptoms were significant contributors to awareness of the need for treatment; but there were no significant associations with the MCCB. Insight in this sample of patients with chronic schizophrenia is significantly associated with clinical symptoms but not with neuropsychological functioning. Copyright © 2014 Elsevier B.V. All rights reserved.
    Schizophrenia Research 12/2014; 161(2-3). DOI:10.1016/j.schres.2014.12.009 · 4.43 Impact Factor
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    ABSTRACT: Three of the most common trauma-related mental disorders—posttraumatic stress disorder (PTSD), major depressive disorder (MDD), and generalized anxiety disorder (GAD)—are highly comorbid and share common transdiagnostic symptom dimensions of threat (i.e., fear) and loss (i.e., dysphoria) symptomatology. However, empirical evaluation of the dimensional structure of component aspects of these disorders is lacking.Methods Using structured clinical interview data from U.S. military veterans with chronic military-related PTSD, we evaluated the transdiagnostic dimensional structure of PTSD, MDD, and GAD symptoms. We then examined the relationship between the best-fitting transdiagnostic model of these symptoms, and measures of physical and mental functioning, and life satisfaction and well-being.ResultsExploratory factor analysis revealed that a 3-factor transdiagnostic model comprised of loss (i.e., dysphoria), threat (i.e., anxious arousal, re-experiencing, and avoidance symptoms), and somatic anxiety (i.e., physiological manifestations of anxiety) symptoms provided the best representation of trauma-related PTSD, MDD, and GAD symptoms. Somatic anxiety symptoms were independently associated with physical functioning, while loss symptoms were independently associated with mental functioning and life satisfaction and well-being.LimitationsEvaluation of study aims in a relatively homogeneous sample of veterans with chronic, military-related PTSD.Conclusions Results of this study suggest that a 3-factor transdiagnostic model best characterizes the dimensional structure of PTSD, MDD, and GAD symptoms in military veterans with chronic military-related PTSD. This model evidenced external validity in demonstrating differential associations with measures of physical and mental functioning, and life satisfaction and well-being. Results provide support for emerging contemporary models of psychopathology, which emphasize transdiagnostic and dimensional conceptualizations of mental disorders. Such models may have utility in understanding the functional status of trauma survivors.
    Journal of Affective Disorders 10/2014; 172. DOI:10.1016/j.jad.2014.10.025 · 3.71 Impact Factor
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    ABSTRACT: The fact that individuals with schizophrenia have high cardiovascular morbidity and mortality is well established. However, risk status and moderators or mediators in the earliest stages of illness are less clear.
    JAMA Psychiatry 10/2014; 71(12). DOI:10.1001/jamapsychiatry.2014.1314 · 12.01 Impact Factor
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    ABSTRACT: The 30-item Positive and Negative Syndrome Scale (PANSS) is used worldwide in the assessment of symptom severity in schizophrenia. The present study uses confirmatory factor analysis (CFA) to compare three different factorial models and to evaluate the best-fitting representation of schizophrenia symptom structure on the (PANSS) across four samples of patients diagnosed with schizophrenia from the U.S. (the CATIE schizophrenia trial), São Paulo, Brazil, and from Beijing and Changsha, China. We examine the goodness of fit of several previously proposed models. The traditional trifactorial model for the PANSS and two 5-factor models were evaluated using absolute and incremental indices. Single group CFA found that the 5-factor model proposed by NIMH researchers on the basis of an extensive literature review demonstrates the best fit in each of the 4 samples. This model used 20 of the 30 PANSS item grouped into five factors: positive, negative, disorganized, excited, and depressed symptoms. Subgroups defined by age, gender, nationality, hospitalization status, and severity of illness also did not differ in overall symptom structure as assessed by several standard indices. Our findings suggest that five factor NIMH model showed the best representation among all four samples from different countries and potentially contrasting cultures.
    Psychiatry Research 10/2014; 219(2). DOI:10.1016/j.psychres.2014.04.041 · 2.68 Impact Factor

Publication Stats

23k Citations
3,027.16 Total Impact Points


  • 1990–2015
    • Yale University
      • Department of Psychiatry
      New Haven, Connecticut, United States
  • 1998–2014
    • Yale-New Haven Hospital
      • Department of Laboratory Medicine
      New Haven, Connecticut, United States
  • 2011
    • University of South Florida
      Tampa, Florida, United States
  • 2010
    • University of Massachusetts Boston
      • Gerontology Institute
      Boston, MA, United States
  • 2002–2010
    • West Haven University
      West Haven, Connecticut, United States
    • University of Maryland, Baltimore
      • Department of Psychiatry
      Baltimore, Maryland, United States
    • Oregon Health and Science University
      • School of Dentistry
      Portland, OR, United States
    • California State University, Los Angeles
      Los Ángeles, California, United States
  • 2009
    • Penn State Hershey Medical Center and Penn State College of Medicine
      • Public Health Sciences
      Hershey, Pennsylvania, United States
  • 2008
    • University of Illinois at Chicago
      Chicago, Illinois, United States
    • Medical University of South Carolina
      Charleston, South Carolina, United States
  • 2006–2008
    • Columbia University
      • Department of Psychiatry
      New York, New York, United States
    • University of North Carolina at Chapel Hill
      • Department of Psychiatry
      Chapel Hill, NC, United States
    • Duke University Medical Center
      • Department of Psychiatry and Behavioral Science
      Durham, NC, United States
    • Brown University
      • Center for Gerontology and Health Care Research
      Providence, Rhode Island, United States
  • 2007
    • Mount Sinai School of Medicine
      • Department of Psychiatry
      Manhattan, NY, United States
    • Emory University
      Atlanta, Georgia, United States
  • 2005–2007
    • Duke University
      Durham, North Carolina, United States
    • University of Massachusetts Amherst
      • Department of Sociology
      Amherst Center, MA, United States
  • 2004
    • Boston University
      Boston, Massachusetts, United States
    • Edward Hines, Jr. VA Hospital
      Hines, Oregon, United States
    • University of Southern California
      • Marshall School of Business
      Los Angeles, California, United States
    • Hospital Nuestra Señora del Rosario
      Madrid, Madrid, Spain
  • 2003
    • Harvard University
      Cambridge, Massachusetts, United States
  • 2001
    • Boston College, USA
      Boston, Massachusetts, United States
  • 1997–2001
    • University of Connecticut
      Storrs, Connecticut, United States
  • 2000
    • University of Washington Seattle
      Seattle, Washington, United States
  • 1998–2000
    • National Center for PTSD
      Washington, Washington, D.C., United States
  • 1999
    • Wesleyan University
      • Department of Psychology
      Middletown, CT, United States
    • San Francisco VA Medical Center
      San Francisco, California, United States
  • 1992–1997
    • Minneapolis Veterans Affairs Hospital
      Minneapolis, Minnesota, United States