Cynthia Arfken - Academia.edu (original) (raw)

Papers by Cynthia Arfken

Journal of Immigrant and Minority Health, Jul 31, 2018

Little is known about mental health problems among newly arrived Syrian refugees in the US. It is... more Little is known about mental health problems among newly arrived Syrian refugees in the US. It is important to determine the prevalence of common consequences of exposure to trauma and high stress, and provide needed interventions, as these conditions if untreated, can be detrimental to mental and physical health. Adult Syrian refugees (n = 157, 47.1% women, 52.9% men) were screened at one-month mandatory primary care health visit for Posttraumatic Stress Disorder (PTSD), anxiety and depression using PTSD Checklist, and Hopkins Symptoms Checklist. Prevalence of possible diagnoses was high for PTSD (32.2%), anxiety (40.3%), and depression (47.7%). Possible prevalence of depression and anxiety were higher among women, but there was no gender difference for possible PTSD. We found a high prevalence of possible psychiatric disorders related to trauma and stress among Syrian refugees newly resettled in the US. Due to the high prevalence and feasibility of brief screening tools in primary care facilities, we recommend mental health screening during primary care health visits for resettled Syrian refugees.

Information Research, Oct 1, 2005

Introduction: Environmental scanning, as a component of absorptive capacity, has been shown to be... more Introduction: Environmental scanning, as a component of absorptive capacity, has been shown to be associated with increased use of innovative treatment techniques at substance abuse treatment programmes. As the transfer of innovative, evidence-based treatment techniques from research to practice is gaining attention, we aimed to identify variables associated with higher levels of environmental scanning among substance abuse treatment clinicians. Method: A cross-sectional survey was administered to 162 clinicians at fifteen substance abuse treatment clinics in Michigan, which were selected based upon treatment modality, population served, geographic location, and affiliation with the Clinical Trials Network. Measures: Environmental scanning was measured by frequency of use of the Internet, journals, seminars or conferences, and people at other treatment clinics for new substance abuse treatment information. Clinicians were asked for their perceptions of their clinic's openness to new treatment techniques and support for acquiring new information, access to and satisfaction with information sources at work, as well as if they feel it is their job to keep up to date with current treatment research. Additional measures included whether they intended to quit their jobs and whether they were emotionally drained from work. Findings: We found positive associations between environmental scanning and perceived clinic support for acquiring new information, perceived clinic openness to new treatment techniques, access to e-mail and Internet at work, and satisfaction with resources. Turnover intention and being emotionally drained were negatively associated with environmental scanning. Conclusions: Individual and organizational level variables were found to be associated with higher levels of environmental scanning activity. Although the causal directions of these associations are not known, the findings suggest ways to increase environmental scanning among clinicians.

Case reports in psychiatry, 2017

Telepsychiatry expands access to psychiatric care. However, telepsychiatry for elderly adults is ... more Telepsychiatry expands access to psychiatric care. However, telepsychiatry for elderly adults is only reimbursed in the US if the patient is assessed while in a clinical setting. This case study presents a homebound older woman previously hospitalized for schizophrenia who had not seen a psychiatrist in over 20 years. Care was provided with hybrid telepsychiatry (team-based practice with social worker traveling to the home with electronic tablet for connection with psychiatrist). The intervention resulted in detecting unrecognized depression and complex trauma. The treatment plan included adding an antidepressant and therapy plan, eliminating one psychiatric medication, and reducing dosage of pain medication. The outcomes were improved function and quality of life. The patient and caregiver were both highly satisfied with the services. This hybrid telepsychiatry is a reasonable option for homebound elderly patients living in urban areas and less expensive than nursing home admission.

Psychiatric Services, Jul 1, 2014

Reducing pharmacy costs without increasing adverse outcomes would relieve some pressure on mental... more Reducing pharmacy costs without increasing adverse outcomes would relieve some pressure on mental health budgets. This column describes the experience of a publicly funded provider network in a Michigan county that mandated generic use of psychotropic medications to address financial challenges. The percentage of brand-name medications and cost per prescription declined with the policy change, resulting in lower total pharmacy expenditures. No increase was noted in prescriptions per patient or psychiatric hospitalizations. Changes were sustained after the initial implementation period. Mandating generic use may be feasible as a tool for constraining pharmacy costs in mental health budgets.

PubMed, Dec 1, 2018

The guilty but mentally ill (GBMI) verdict was first adopted in Michigan in part to provide treat... more The guilty but mentally ill (GBMI) verdict was first adopted in Michigan in part to provide treatment for offenders suffering from mental illness. Currently, little is known of its impact among women prisoners. Therefore, the primary aim of this study was to explore if GBMI women (n = 30) spent more time on acute and residential treatment program (RTP) units in prison and/or had a higher number of violence tickets, compared with matched guilty mentally ill prisoners (non-GBMI, n = 30). The secondary aim was to characterize Axis I and Axis II disorders in GBMI female prisoners. Finally, we analyzed the data to find which Axis I and II disorders, if any, were significantly associated with violence tickets in the first year of incarceration and time in acute and RTP settings. Results showed there were no significant differences in time on acute units or the number of violence tickets between groups. Across both groups, those diagnosed with Borderline Personality Disorder had a higher number of violence tickets in the first year of prison (p < .001). The results supported the arbitrariness of the GBMI verdict in the female population and advocated for Dialectical Behavioural Therapy (DBT) programs in prisons.

The purposes of this chapter are to describe the REM sleep control system for researchers not pri... more The purposes of this chapter are to describe the REM sleep control system for researchers not primarily working in that area and to recount the history of its use in psychiatric research. For the uninitiated, there are many quirks and complexities in the psychiatric sleep literature which make it difficult to synthesize the findings of papers from different decades.

Journal of Behavioral Health Services & Research, Mar 2, 2016

Academic Psychiatry, Oct 22, 2021

In 2020, 186 empirical report manuscripts were submitted to Academic Psychiatry and 26 were accep... more In 2020, 186 empirical report manuscripts were submitted to Academic Psychiatry and 26 were accepted for publication. Although there are many factors in deciding to accept a manuscript, including fit with journal scope and importance of findings, problems with design and analysis negatively impact the review. In a discussion among the editors, a few methodological and statistical issues were highlighted that occur frequently. This commentary will discuss these issues with the goal of alerting potential authors to common problems and potential solutions. All examples are hypothetical and do not reflect any specific manuscript.

Annals of Clinical Psychiatry, Apr 22, 2021

BACKGROUND The COVID-19 pandemic may adversely impact the mental health of health care workers (H... more BACKGROUND The COVID-19 pandemic may adversely impact the mental health of health care workers (HCWs). To address this issue, it is essential to determine levels of anxiety, depression, and traumatic stress, and sources of stress, and to identify subgroups of HCWs at a higher risk of adverse mental health outcomes during the COVID-19 pandemic. METHODS We conducted a cross-sectional study of symptoms of mental illness in HCWs in the area surrounding Detroit, Michigan. The online survey included questions about demographics, health and clinical factors, and sources of stress. Several tools were used to assess psychiatric symptoms among HCWs, including the Perceived Stress Scale, the Patient Health Questionnaire depression scale, the Generalized Anxiety Disorder 7-item assessment, and the Posttraumatic Stress Disorder Checklist for DSM-5. The adequacy of personal protective equipment, patient resources, and training for highly contagious diseases were rated. RESULTS The sample (N = 129) was predominantly female (51.2%) and White (65.9%), with 30.2% screening positive for clinical follow-up to assess anxiety, 20.9% for moderate to severe depression, and 16.3% for elevated traumatic stress. Differences were found by self-reported psychiatric diagnosis and chronic conditions, and role on treatment teams. CONCLUSIONS Frontline HCWs demonstrate high levels of stress and trauma symptoms. Timely screening and accommodations may be needed during health care crises, such as the COVID-19 pandemic.

Psychiatric Quarterly, Jan 7, 2021

Both healthcare workers (HCWs) and psychiatric patients during the COVID-19 pandemic appear to ha... more Both healthcare workers (HCWs) and psychiatric patients during the COVID-19 pandemic appear to have elevated prevalence of psychiatric symptoms, but little is known about HCWs with psychiatric diagnoses. To examine their response to the pandemic, we analyzed their perspective, and association with psychiatric symptoms and stress among HCW with psychiatric diagnosis. Using an online survey of HCW, we analyzed demographics, work information, health factors, open-ended question, sources of stress and standardized mental health scales (Perceived Stress Scale (PSS), Generalized Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire-8 (PHQ-8), and Posttraumatic Stress Disorder Checklist (PCL)). Sixteen out of 129 HCWs reported a pre-existing psychiatric diagnosis (median age 32 years, 8 were females, 8 work in the emergency department). Their perception of the impact severity on symptoms was significantly correlated with all the mental health scales and with stress from avoiding physical contact. In multivariate analysis, PSS score and PCL score were associated with self-rated impact of the COVID-19 pandemic on symptoms (standardized beta = .51 for PCL and standardized beta = .55 for PSS). GAD-7 score was significantly related to both impact (standardized beta = .44) and stress from avoiding physical contact (standardized beta = .53). HCWs with psychiatric diagnoses reported a range of perception of the impact of the pandemic on their symptoms with increased severity associated with worse psychiatric outcomes and more stress from avoiding physical contact with others. There is a growing importance to protect HCWs mental health, including those with pre-existing psychiatric diagnosis, and proactively counter psychosocial consequences of healthcare crises.

PubMed, Nov 1, 1996

Serotonin acting on 5-hydroxytryptamine4 receptors increases membrane excitability in CA1 hippoca... more Serotonin acting on 5-hydroxytryptamine4 receptors increases membrane excitability in CA1 hippocampal pyramidal cells by reducing the slow calcium-activated afterhyperpolarization. This effect is mediated through an increase in cAMP and activation of protein kinase A, although subsequent steps have not been elucidated. We now report that a significant portion of the calcium responsible for the generation of the afterhyperpolarization originates from the release of intracellular calcium through a calcium-induced calcium-release mechanism. Thus, the afterhyperpolarization is enhanced by caffeine, whereas it is inhibited by dantrolene and ruthenium red, two blockers of calcium-induced calcium release. The afterhyperpolarization is also inhibited by thapsigargin, which depletes intracellular calcium stores. These observations raised the possibility that serotonin might reduce the afterhyperpolarization by regulating calcium-induced calcium release. Consistent with this possibility, administration of calcium-induced calcium-release blockers, as well as of thapsigargin, occluded the ability of serotonin to inhibit the afterhyperpolarization. Similarly, administration of caffeine, which enhances the contribution of calcium-induced calcium release to the afterhyperpolarization, enhanced the effect of serotonin. These results indicate that serotonin inhibits the afterhyperpolarization in the CA1 region of hippocampus by reducing the ability of extracellular calcium to trigger calcium release from intracellular stores. As such, they identify a physiological role for the calcium-induced calcium release in hippocampus and provide evidence for its regulation by G protein-coupled receptors and, more specifically, 5-hydroxytryptamine4 receptors.

Drug and Alcohol Review, Aug 3, 2020

Introduction and AimsOpioids and benzodiazepines (O/BZD) are increasingly involved in drug overdo... more Introduction and AimsOpioids and benzodiazepines (O/BZD) are increasingly involved in drug overdose deaths in the USA. Expanding treatment capacity may reduce these deaths. Knowledge about co‐occurring O/BZD admissions compared to opioid admissions (opioid) is needed to plan this expansion.Design and MethodsUS treatment admissions to specialty facilities for 2011–2017 were analysed for trends and 2017 for group differences. Due to 1.9 million admissions in 2017, comparisons between O/BZD and opioid admissions were summarised as effect sizes. Additional analysis compared the administratively pre‐coded category ‘other opiates and synthetics’ to other opiates and synthetics/benzodiazepines admissions to control for possible similarity in drug source. Differences within O/BZD admissions by primary drug were explored.ResultsAlthough opioid admissions showed a steady increase over time (25.9% to 38.2%), O/BZD admissions showed increases until decline in 2017 (3.2% to 4.0%). In 2017 no factor reached moderate effect size (≥0.2) in group comparisons or within the O/BZD admissions. Heroin was self‐reported in 70% of both O/BZD and opioid admissions.Discussion and ConclusionsNo meaningful US national differences on data routinely collected were found for O/BZD compared to opioid admissions including the subgroup with other opiates and synthetics only. Efforts to expand existing opioid treatment in specialty treatments may help reduce opioid and O/BZD deaths. However, the analysis could not address whether changes in treatment would improve outcomes.

Academic Psychiatry, Jul 13, 2017

Academic Psychiatry, Nov 6, 2017

International Journal of Social Psychiatry, Dec 3, 2020

Background: Exposure to armed conflict and fleeing country of origin for refugees has been associ... more Background: Exposure to armed conflict and fleeing country of origin for refugees has been associated with poorer psychological health. Methods: Within the first month following their arrival in the United States, 152 Syrian and Iraqi refugees were screened in a primary care setting for posttraumatic stress disorder (PTSD), anxiety, and depression and rated their perceived health, and perceived level of adversity of violence, armed conflict/flight. The moderating effects of psychiatric symptoms on the relation between perceived adversity and perceived health were assessed. Results: Three models based on diagnosis (PTSD, anxiety, and depression) were tested. While significant effects were found on perceived adversity negatively influencing perceived health across diagnoses, slightly different patterns emerged based on diagnosis. Discussion: Findings suggest that refugees’ perception regarding adversity of violence, armed conflict, and flight may contribute to perceived health, with a moderating role of clinically significant symptoms of PTSD, anxiety, and depression.

Archives of internal medicine, Nov 28, 1994

The development and progression of diabetic retinopathy in African Americans with insulin-depende... more The development and progression of diabetic retinopathy in African Americans with insulin-dependent diabetes mellitus is not known. Two hundred subjects with insulin-dependent diabetes mellitus with duration of diabetes 16 years or less at first visit were studied; 58 were African Americans and 142 were whites. All had gradable stereoscopic color fundus photographs (seven standard fields) from at least two visits (mean time between first and second visit was 4.1 years). Subjects with hemoglobinopathy or proliferative retinopathy or subjects who had evidence of treatment for proliferative retinopathy at first visit were excluded. Masked grading of photographs was conducted using the modified Airlie House classification scheme. African Americans were older, heavier, had higher systolic blood pressure (all P &amp;amp;lt; .05), and marginally higher hemoglobin A1 (HbA1) values (P = .06) than the whites at first visit. African Americans had a lower rate of two steps or more progression from preexistent retinopathy (19%) than whites (43%). Progression to proliferative retinopathy or treatment was similar by race. Multivariate analysis predicting development oe progression of retinopathy, while controlling for length of follow-up, found higher HbA1 (odds ratio [OR] = 2.15), longer duration of insulin-dependent diabetes mellitus (OR = 1.69), higher serum creatinine concentration (OR = 1.59), and white race (OR = 2.62) to be independent risk factors. These data suggest a previously unsuspected reduction in the adjusted risk for development and progression of retinopathy in African Americans. The reason for this apparently reduced risk are not known.

Journal of Substance Abuse Treatment, Apr 1, 2017

Journal of Immigrant and Minority Health, Jul 31, 2018

Little is known about mental health problems among newly arrived Syrian refugees in the US. It is... more Little is known about mental health problems among newly arrived Syrian refugees in the US. It is important to determine the prevalence of common consequences of exposure to trauma and high stress, and provide needed interventions, as these conditions if untreated, can be detrimental to mental and physical health. Adult Syrian refugees (n = 157, 47.1% women, 52.9% men) were screened at one-month mandatory primary care health visit for Posttraumatic Stress Disorder (PTSD), anxiety and depression using PTSD Checklist, and Hopkins Symptoms Checklist. Prevalence of possible diagnoses was high for PTSD (32.2%), anxiety (40.3%), and depression (47.7%). Possible prevalence of depression and anxiety were higher among women, but there was no gender difference for possible PTSD. We found a high prevalence of possible psychiatric disorders related to trauma and stress among Syrian refugees newly resettled in the US. Due to the high prevalence and feasibility of brief screening tools in primary care facilities, we recommend mental health screening during primary care health visits for resettled Syrian refugees.

Information Research, Oct 1, 2005

Introduction: Environmental scanning, as a component of absorptive capacity, has been shown to be... more Introduction: Environmental scanning, as a component of absorptive capacity, has been shown to be associated with increased use of innovative treatment techniques at substance abuse treatment programmes. As the transfer of innovative, evidence-based treatment techniques from research to practice is gaining attention, we aimed to identify variables associated with higher levels of environmental scanning among substance abuse treatment clinicians. Method: A cross-sectional survey was administered to 162 clinicians at fifteen substance abuse treatment clinics in Michigan, which were selected based upon treatment modality, population served, geographic location, and affiliation with the Clinical Trials Network. Measures: Environmental scanning was measured by frequency of use of the Internet, journals, seminars or conferences, and people at other treatment clinics for new substance abuse treatment information. Clinicians were asked for their perceptions of their clinic's openness to new treatment techniques and support for acquiring new information, access to and satisfaction with information sources at work, as well as if they feel it is their job to keep up to date with current treatment research. Additional measures included whether they intended to quit their jobs and whether they were emotionally drained from work. Findings: We found positive associations between environmental scanning and perceived clinic support for acquiring new information, perceived clinic openness to new treatment techniques, access to e-mail and Internet at work, and satisfaction with resources. Turnover intention and being emotionally drained were negatively associated with environmental scanning. Conclusions: Individual and organizational level variables were found to be associated with higher levels of environmental scanning activity. Although the causal directions of these associations are not known, the findings suggest ways to increase environmental scanning among clinicians.

Case reports in psychiatry, 2017

Telepsychiatry expands access to psychiatric care. However, telepsychiatry for elderly adults is ... more Telepsychiatry expands access to psychiatric care. However, telepsychiatry for elderly adults is only reimbursed in the US if the patient is assessed while in a clinical setting. This case study presents a homebound older woman previously hospitalized for schizophrenia who had not seen a psychiatrist in over 20 years. Care was provided with hybrid telepsychiatry (team-based practice with social worker traveling to the home with electronic tablet for connection with psychiatrist). The intervention resulted in detecting unrecognized depression and complex trauma. The treatment plan included adding an antidepressant and therapy plan, eliminating one psychiatric medication, and reducing dosage of pain medication. The outcomes were improved function and quality of life. The patient and caregiver were both highly satisfied with the services. This hybrid telepsychiatry is a reasonable option for homebound elderly patients living in urban areas and less expensive than nursing home admission.

Psychiatric Services, Jul 1, 2014

Reducing pharmacy costs without increasing adverse outcomes would relieve some pressure on mental... more Reducing pharmacy costs without increasing adverse outcomes would relieve some pressure on mental health budgets. This column describes the experience of a publicly funded provider network in a Michigan county that mandated generic use of psychotropic medications to address financial challenges. The percentage of brand-name medications and cost per prescription declined with the policy change, resulting in lower total pharmacy expenditures. No increase was noted in prescriptions per patient or psychiatric hospitalizations. Changes were sustained after the initial implementation period. Mandating generic use may be feasible as a tool for constraining pharmacy costs in mental health budgets.

PubMed, Dec 1, 2018

The guilty but mentally ill (GBMI) verdict was first adopted in Michigan in part to provide treat... more The guilty but mentally ill (GBMI) verdict was first adopted in Michigan in part to provide treatment for offenders suffering from mental illness. Currently, little is known of its impact among women prisoners. Therefore, the primary aim of this study was to explore if GBMI women (n = 30) spent more time on acute and residential treatment program (RTP) units in prison and/or had a higher number of violence tickets, compared with matched guilty mentally ill prisoners (non-GBMI, n = 30). The secondary aim was to characterize Axis I and Axis II disorders in GBMI female prisoners. Finally, we analyzed the data to find which Axis I and II disorders, if any, were significantly associated with violence tickets in the first year of incarceration and time in acute and RTP settings. Results showed there were no significant differences in time on acute units or the number of violence tickets between groups. Across both groups, those diagnosed with Borderline Personality Disorder had a higher number of violence tickets in the first year of prison (p < .001). The results supported the arbitrariness of the GBMI verdict in the female population and advocated for Dialectical Behavioural Therapy (DBT) programs in prisons.

The purposes of this chapter are to describe the REM sleep control system for researchers not pri... more The purposes of this chapter are to describe the REM sleep control system for researchers not primarily working in that area and to recount the history of its use in psychiatric research. For the uninitiated, there are many quirks and complexities in the psychiatric sleep literature which make it difficult to synthesize the findings of papers from different decades.

Journal of Behavioral Health Services & Research, Mar 2, 2016

Academic Psychiatry, Oct 22, 2021

In 2020, 186 empirical report manuscripts were submitted to Academic Psychiatry and 26 were accep... more In 2020, 186 empirical report manuscripts were submitted to Academic Psychiatry and 26 were accepted for publication. Although there are many factors in deciding to accept a manuscript, including fit with journal scope and importance of findings, problems with design and analysis negatively impact the review. In a discussion among the editors, a few methodological and statistical issues were highlighted that occur frequently. This commentary will discuss these issues with the goal of alerting potential authors to common problems and potential solutions. All examples are hypothetical and do not reflect any specific manuscript.

Annals of Clinical Psychiatry, Apr 22, 2021

BACKGROUND The COVID-19 pandemic may adversely impact the mental health of health care workers (H... more BACKGROUND The COVID-19 pandemic may adversely impact the mental health of health care workers (HCWs). To address this issue, it is essential to determine levels of anxiety, depression, and traumatic stress, and sources of stress, and to identify subgroups of HCWs at a higher risk of adverse mental health outcomes during the COVID-19 pandemic. METHODS We conducted a cross-sectional study of symptoms of mental illness in HCWs in the area surrounding Detroit, Michigan. The online survey included questions about demographics, health and clinical factors, and sources of stress. Several tools were used to assess psychiatric symptoms among HCWs, including the Perceived Stress Scale, the Patient Health Questionnaire depression scale, the Generalized Anxiety Disorder 7-item assessment, and the Posttraumatic Stress Disorder Checklist for DSM-5. The adequacy of personal protective equipment, patient resources, and training for highly contagious diseases were rated. RESULTS The sample (N = 129) was predominantly female (51.2%) and White (65.9%), with 30.2% screening positive for clinical follow-up to assess anxiety, 20.9% for moderate to severe depression, and 16.3% for elevated traumatic stress. Differences were found by self-reported psychiatric diagnosis and chronic conditions, and role on treatment teams. CONCLUSIONS Frontline HCWs demonstrate high levels of stress and trauma symptoms. Timely screening and accommodations may be needed during health care crises, such as the COVID-19 pandemic.

Psychiatric Quarterly, Jan 7, 2021

Both healthcare workers (HCWs) and psychiatric patients during the COVID-19 pandemic appear to ha... more Both healthcare workers (HCWs) and psychiatric patients during the COVID-19 pandemic appear to have elevated prevalence of psychiatric symptoms, but little is known about HCWs with psychiatric diagnoses. To examine their response to the pandemic, we analyzed their perspective, and association with psychiatric symptoms and stress among HCW with psychiatric diagnosis. Using an online survey of HCW, we analyzed demographics, work information, health factors, open-ended question, sources of stress and standardized mental health scales (Perceived Stress Scale (PSS), Generalized Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire-8 (PHQ-8), and Posttraumatic Stress Disorder Checklist (PCL)). Sixteen out of 129 HCWs reported a pre-existing psychiatric diagnosis (median age 32 years, 8 were females, 8 work in the emergency department). Their perception of the impact severity on symptoms was significantly correlated with all the mental health scales and with stress from avoiding physical contact. In multivariate analysis, PSS score and PCL score were associated with self-rated impact of the COVID-19 pandemic on symptoms (standardized beta = .51 for PCL and standardized beta = .55 for PSS). GAD-7 score was significantly related to both impact (standardized beta = .44) and stress from avoiding physical contact (standardized beta = .53). HCWs with psychiatric diagnoses reported a range of perception of the impact of the pandemic on their symptoms with increased severity associated with worse psychiatric outcomes and more stress from avoiding physical contact with others. There is a growing importance to protect HCWs mental health, including those with pre-existing psychiatric diagnosis, and proactively counter psychosocial consequences of healthcare crises.

PubMed, Nov 1, 1996

Serotonin acting on 5-hydroxytryptamine4 receptors increases membrane excitability in CA1 hippoca... more Serotonin acting on 5-hydroxytryptamine4 receptors increases membrane excitability in CA1 hippocampal pyramidal cells by reducing the slow calcium-activated afterhyperpolarization. This effect is mediated through an increase in cAMP and activation of protein kinase A, although subsequent steps have not been elucidated. We now report that a significant portion of the calcium responsible for the generation of the afterhyperpolarization originates from the release of intracellular calcium through a calcium-induced calcium-release mechanism. Thus, the afterhyperpolarization is enhanced by caffeine, whereas it is inhibited by dantrolene and ruthenium red, two blockers of calcium-induced calcium release. The afterhyperpolarization is also inhibited by thapsigargin, which depletes intracellular calcium stores. These observations raised the possibility that serotonin might reduce the afterhyperpolarization by regulating calcium-induced calcium release. Consistent with this possibility, administration of calcium-induced calcium-release blockers, as well as of thapsigargin, occluded the ability of serotonin to inhibit the afterhyperpolarization. Similarly, administration of caffeine, which enhances the contribution of calcium-induced calcium release to the afterhyperpolarization, enhanced the effect of serotonin. These results indicate that serotonin inhibits the afterhyperpolarization in the CA1 region of hippocampus by reducing the ability of extracellular calcium to trigger calcium release from intracellular stores. As such, they identify a physiological role for the calcium-induced calcium release in hippocampus and provide evidence for its regulation by G protein-coupled receptors and, more specifically, 5-hydroxytryptamine4 receptors.

Drug and Alcohol Review, Aug 3, 2020

Introduction and AimsOpioids and benzodiazepines (O/BZD) are increasingly involved in drug overdo... more Introduction and AimsOpioids and benzodiazepines (O/BZD) are increasingly involved in drug overdose deaths in the USA. Expanding treatment capacity may reduce these deaths. Knowledge about co‐occurring O/BZD admissions compared to opioid admissions (opioid) is needed to plan this expansion.Design and MethodsUS treatment admissions to specialty facilities for 2011–2017 were analysed for trends and 2017 for group differences. Due to 1.9 million admissions in 2017, comparisons between O/BZD and opioid admissions were summarised as effect sizes. Additional analysis compared the administratively pre‐coded category ‘other opiates and synthetics’ to other opiates and synthetics/benzodiazepines admissions to control for possible similarity in drug source. Differences within O/BZD admissions by primary drug were explored.ResultsAlthough opioid admissions showed a steady increase over time (25.9% to 38.2%), O/BZD admissions showed increases until decline in 2017 (3.2% to 4.0%). In 2017 no factor reached moderate effect size (≥0.2) in group comparisons or within the O/BZD admissions. Heroin was self‐reported in 70% of both O/BZD and opioid admissions.Discussion and ConclusionsNo meaningful US national differences on data routinely collected were found for O/BZD compared to opioid admissions including the subgroup with other opiates and synthetics only. Efforts to expand existing opioid treatment in specialty treatments may help reduce opioid and O/BZD deaths. However, the analysis could not address whether changes in treatment would improve outcomes.

Academic Psychiatry, Jul 13, 2017

Academic Psychiatry, Nov 6, 2017

International Journal of Social Psychiatry, Dec 3, 2020

Background: Exposure to armed conflict and fleeing country of origin for refugees has been associ... more Background: Exposure to armed conflict and fleeing country of origin for refugees has been associated with poorer psychological health. Methods: Within the first month following their arrival in the United States, 152 Syrian and Iraqi refugees were screened in a primary care setting for posttraumatic stress disorder (PTSD), anxiety, and depression and rated their perceived health, and perceived level of adversity of violence, armed conflict/flight. The moderating effects of psychiatric symptoms on the relation between perceived adversity and perceived health were assessed. Results: Three models based on diagnosis (PTSD, anxiety, and depression) were tested. While significant effects were found on perceived adversity negatively influencing perceived health across diagnoses, slightly different patterns emerged based on diagnosis. Discussion: Findings suggest that refugees’ perception regarding adversity of violence, armed conflict, and flight may contribute to perceived health, with a moderating role of clinically significant symptoms of PTSD, anxiety, and depression.

Archives of internal medicine, Nov 28, 1994

The development and progression of diabetic retinopathy in African Americans with insulin-depende... more The development and progression of diabetic retinopathy in African Americans with insulin-dependent diabetes mellitus is not known. Two hundred subjects with insulin-dependent diabetes mellitus with duration of diabetes 16 years or less at first visit were studied; 58 were African Americans and 142 were whites. All had gradable stereoscopic color fundus photographs (seven standard fields) from at least two visits (mean time between first and second visit was 4.1 years). Subjects with hemoglobinopathy or proliferative retinopathy or subjects who had evidence of treatment for proliferative retinopathy at first visit were excluded. Masked grading of photographs was conducted using the modified Airlie House classification scheme. African Americans were older, heavier, had higher systolic blood pressure (all P &amp;amp;lt; .05), and marginally higher hemoglobin A1 (HbA1) values (P = .06) than the whites at first visit. African Americans had a lower rate of two steps or more progression from preexistent retinopathy (19%) than whites (43%). Progression to proliferative retinopathy or treatment was similar by race. Multivariate analysis predicting development oe progression of retinopathy, while controlling for length of follow-up, found higher HbA1 (odds ratio [OR] = 2.15), longer duration of insulin-dependent diabetes mellitus (OR = 1.69), higher serum creatinine concentration (OR = 1.59), and white race (OR = 2.62) to be independent risk factors. These data suggest a previously unsuspected reduction in the adjusted risk for development and progression of retinopathy in African Americans. The reason for this apparently reduced risk are not known.

Journal of Substance Abuse Treatment, Apr 1, 2017

Successful community integration and connection is essential in promoting positive growth and dev... more Successful community integration and connection is essential in promoting positive growth and development for young Muslim converts, as well as providing emotional and psychological benefits (Plante & Sherman, 2001; Hill & Pargament, 2008). Challenges unique to gender and race may impede successful community integration, thus impacting the degree of community connection and support received. Scant research has explored experiences of certain racial groups or gendered experiences of converts, no research could be found examining the integration experiences by gender or race. In addition, no research that we are aware of has explored convert re-integration experiences with mainstream society. Understanding these barriers will allow for the development of appropriate support systems addressing the unique challenges of young converts. This presentation will report the findings of our pilot study which examines integration experiences of converts by gender and race and into the Muslim community and general society. This study used semi-structured interviews with 25 participants from White, African American, Latino, South Asian and other ethnic background, between the ages of 18-30. Interviews were transcribed, coded, and analyzed for specific themes. Preliminary analyses suggest that support and integration were associated with gender. The findings on race appeared to differ by race. Limitations and implications are discussed