Jessica Garno - Academia.edu (original) (raw)

Papers by Jessica Garno

Impulsivity and hostility are often thought to be interrelated among depressed patients with suic... more Impulsivity and hostility are often thought to be interrelated among depressed patients with suicidal behavior, but few studies have examined this relationship empirically. In this study, we assessed trait impulsivity and hostility among 52 DSM-IV bipolar subjects with and without histories of suicide attempts. Impulsivity and hostility were correlated among attempters (r = .41, p = .03) but not non-attempters (r = .22, p = .28). As compared to non-attempters, attempters had significantly higher levels of overall hostility, more extensive subcomponents of hostility, and a trend toward higher overall impulsivity. Associations between lifetime suicide attempts and overall hostility were significant while controlling for current depression severity and lifetime illness duration. Aggression and impulsivity appear linked among bipolar patients with lifetime suicide attempts but may be independent constructs among non-attempters. The presence of both factors may elevate risk for suicidal behavior.

Biological Psychiatry, 1996

Journal of Psychiatric Research, Mar 1, 1999

This study evaluates the relationship between interviewer level of experience and the positive pr... more This study evaluates the relationship between interviewer level of experience and the positive predictive value and cost of telephone screening of subjects for randomized clinical trials[ This is a previously uninvestigated area[ Respondents to advertisements for chronic depression treatment research received brief\ semi!structured telephone interviews "N 236# either by research assistants "RAs# or by a senior investigator "SI#[ Those who met criteria based on the phone interview were then interviewed in person using the SCID!P[ The RAs did not signi_cantly di}er from the SI in the proportion of phone screen positives who were also SCID positive or the proportion of phone screen positives who were randomized[ While the SI performed phone interviews signi_cantly faster than the RAs\ the SI|s higher salary generated a phone screening cost per randomized subject 45) more than that of RAs[ The results suggest that trained research assistants are more cost e}ective than senior investigators for initial screening of depressed patients for research protocols[ Further studies are needed to determine whether the _ndings reported would generalize to other research settings or patient populations[ Þ 0888 Elsevier Science Ltd[ All rights reserved[ Corresponding author[ Payne Whitney Clinic\ New York Hospital! Cornell Medical Center\ Box 036\ 414 East 57th St[\ New York\ NY 09910\ USA[ Tel[] ¦0!101!710!9611^fax] ¦0!101!710!9681[

The Journal of Clinical Psychiatry, Mar 15, 2005

Because of their overlapping phenomenology and mutually chronic, persistent nature, distinctions ... more Because of their overlapping phenomenology and mutually chronic, persistent nature, distinctions between bipolar disorder and cluster B personality disorders remain a source of unresolved clinical controversy. The extent to which comorbid personality disorders impact course and outcome for bipolar patients also has received little systematic study. One hundred DSM-IV bipolar I (N = 73) or II (N = 27) patients consecutively underwent diagnostic evaluations with structured clinical interviews for DSM-IV Axis I and cluster B Axis II disorders, along with assessments of histories of childhood trauma or abuse. Cluster B diagnostic comorbidity was examined relative to lifetime substance abuse, suicide attempt histories, and other clinical features. Thirty percent of subjects met DSM-IV criteria for a cluster B personality disorder (17% borderline, 6% antisocial, 5% histrionic, 8% narcissistic). Cluster B diagnoses were significantly linked with histories of childhood emotional abuse (p = .009), physical abuse (p = .014), and emotional neglect (p = .022), but not sexual abuse or physical neglect. Cluster B comorbidity was associated with significantly more lifetime suicide attempts and current depression. Lifetime suicide attempts were significantly associated with cluster B comorbidity (OR = 3.195, 95% CI = 1.124 to 9.088), controlling for current depression severity, lifetime substance abuse, and past sexual or emotional abuse. Cluster B personality disorders are prevalent comorbid conditions identifiable in a substantial number of individuals with bipolar disorder, making an independent contribution to increased lifetime suicide risk.

Bipolar Disorders, Mar 1, 2009

The relationship between bipolar disorder and cluster B personality disorders remains phenomenolo... more The relationship between bipolar disorder and cluster B personality disorders remains phenomenologically complex and controversial. We sought to examine the relationship between early age at onset of bipolar disorder and development of comorbid borderline personality disorder. A total of 100 adults in an academic specialty clinic for bipolar disorder underwent structured diagnostic interviews and clinical assessments to determine lifetime presence of comorbid borderline personality disorder, histories of childhood trauma, and clinical illness characteristics. Logistic regression indicated that increasing age at onset of bipolar disorder was associated with a lower probability of developing comorbid borderline personality disorder (odds ratio = 0.91, 95% confidence interval: 0.83-0.99) while controlling for potential confounding factors, including a history of severe child trauma/abuse. Early onset of bipolar disorder increases the probability of developing comorbid borderline personality disorder, independent of the effects of severe childhood trauma/abuse. In patients with borderline personality disorder, prospective studies of new-onset bipolar disorder may underestimate the prevalence of true comorbidity unless they capture the primary risk window for first-episode mania arising before the end of adolescence.

Current Psychiatry Reports, 2005

American Journal of Psychiatry, 1998

The authors' goal was to examine suicidality in relation to acute symptom remission in in... more The authors' goal was to examine suicidality in relation to acute symptom remission in inpatients with mixed and pure bipolar disorder. Using chart review of 184 adult inpatients with bipolar I disorder, the authors assessed patients' past and current suicidality, other psychopathology, treatment, and remission. Past, current, and recurrent suicidality were significantly more common among patients with mixed mania than among those with pure mania. The probability of remission declined by 49% for every suicide attempt made before the index manic episode. Mixed mania, multiple previous hospitalizations, and previous suicide attempts were significantly associated with current suicidality. Suicidality is linked with mixed manic states and may be a clinical marker for recurrent dysphoric mania. Multiple suicide attempts are associated with nonremission from mixed manic episodes.

Suicide and Life-Threatening Behavior, 2004

Psychiatry Research, 2009

The objective of this study was to assess psychomotor functioning and attention in individuals wi... more The objective of this study was to assess psychomotor functioning and attention in individuals with bipolar disorder during the depressed phase of illness. Measures of attention and psychomotor functioning were administered to a sample of 24 bipolar I and II patients and a matched sample of healthy controls. Relative to the healthy controls, the bipolar sample demonstrated evidence of psychomotor slowing and revealed deficits on measures of effortful attention, yet demonstrated comparable performance on measures of automatic attention. In the bipolar sample, we detected significant correlations among measures of psychomotor functioning and some aspects of attention and a strong relationship between the severity of depression and psychomotor functioning, but no direct relationship between attention deficits and depressive symptomatology. These results suggest an attentional impairment during the depressed phase of bipolar disorder that may be specific to effortful processing, while automatic processes remain relatively intact. Associations among indices of attention deficits and psychomotor slowing may be indicative of similarities in the underlying neurobiology of these frequently co-occurring symptom domains in depressed individuals with bipolar disorder.

Journal of Psychiatric Research, 2008

Research on phenotypic markers of vulnerability to bipolar disorder has focused on the identifica... more Research on phenotypic markers of vulnerability to bipolar disorder has focused on the identification of personality traits uniquely associated with the illness. To expand knowledge in this area, we compared Cloninger's seven temperament and character dimensions in 85 euthymic/subsyndromal bipolar I inpatients and outpatients and 85 age and sex matched community controls. We also examined associations between Cloninger's personality traits and mood state in the patient group. Bipolar subjects were administered the Structured Clinical Interview for DSM-IV (SCID), Hamilton Rating Scale for Depression, and Clinician-Administered Rating Scale for Mania. Controls received the SCID, a family psychiatric history questionnaire, and urine toxicology screen to confirm healthy status. Both groups competed the 240-item Temperament and Character Inventory (TCI). A multivariate analysis of covariance, accounting for demographic factors, was conducted to compare the groups on the TCI. Bipolar I patients scored higher on harm avoidance, lower on self-directedness, and higher on self-transcendence compared to controls. Harm avoidance and self-directedness were correlated with residual depressive symptoms positively and negatively, respectively; persistence was correlated with residual manic symptoms; and selftranscendence was correlated with residual psychotic symptoms in patients. The results indicate that bipolar I subjects do possess personality traits that are significantly different from non-ill individuals. However, only a prospective, longitudinal study may determine whether these traits mark a vulnerability to the disorder, or represent the scarring effect of affective episodes and chronic subsyndromal symptoms.

Journal of Psychiatric Research, 2005

Little is known about the nature and extent of posttraumatic stress disorder (PTSD) in adults wit... more Little is known about the nature and extent of posttraumatic stress disorder (PTSD) in adults with bipolar disorder, particularly in relation to the presence of past childhood or adult forms of abuse, and its impact on course of illness. The authors studied 100 consecutive DSM-IV bipolar patients who were evaluated for childhood physical, sexual and emotional abuse, traumatic events in adulthood, and lifetime PTSD. Adult comorbid PTSD was evident in 24% of subjects and was significantly associated with childhood sexual abuse, adult sexual assault, and adult survival of the suicide, homicide, or accidental death of a close friend or relative. Severe childhood abuse was reported by about half of bipolar patients, but only one-third of abused patients developed PTSD. Risk for PTSD rose in linear fashion to the number of childhood abuse subtypes present. Adult sexual assault was significantly more likely to be associated with PTSD if childhood sexual abuse was present rather than absent. The findings suggest that about one-third of bipolar patients with severe childhood abuse histories, particularly sexual abuse, manifest comorbid adult PTSD. Childhood sexual abuse, as well as severe interpersonal loss, may sensitize individuals who are predisposed to bipolar disorder also to develop eventual PTSD.

Journal of Psychiatric Research, 1999

The Journal of Clinical Psychiatry, 2005

The Journal of Clinical Psychiatry, 1999

Substance abuse frequently complicates the course of bipolar illness, promotes mixed states, and ... more Substance abuse frequently complicates the course of bipolar illness, promotes mixed states, and contributes to poor outcome in mania. Preliminary open trials suggest that anticonvulsant mood stabilizers may enhance remission rates and outcome for bipolar patients with substance abuse. This study compared remission patterns for mixed or pure manic episodes among bipolar inpatients with or without substance abuse histories. Hospital records were retrospectively reviewed for 204 DSM-III-R bipolar I inpatients. Clinical features were compared for those with or without substance abuse/dependence histories predating the index manic episode. Time until remission was analyzed by Kaplan-Meier survival analysis. Naturalistic treatment outcome with lithium or anticonvulsant mood stabilizers was compared for those with or without past substance abuse. Past substance abuse was evident in 34% of the bipolar sample and comprised most often alcoholism (82%), followed by cocaine (30%), marijuana (29%), sedative-hypnotic or amphetamine (21%), and opiate (13%) abuse. Substance abuse was more common among men (p < .05) and those with mixed rather than pure mania (p < .05). Remission during hospitalization was less likely among patients with prior substance abuse (p < .05), especially alcohol or marijuana abuse, and among mixed manic patients with past substance abuse (p < .05). Bipolar patients with substance abuse histories who received divalproex or carbamazepine remitted during hospitalization more often than did those who received lithium as the sole mood stabilizer (p < .05). These findings support previous reports suggesting that bipolar patients with past substance abuse have poorer naturalistic treatment outcomes, but may show a better response to anticonvulsant mood stabilizers than lithium.

The Journal of Clinical Psychiatry, 2011

We conducted a retrospective investigation of potential clinical, demographic, and neuropsycholog... more We conducted a retrospective investigation of potential clinical, demographic, and neuropsychological risk factors for suicide attempts in patients diagnosed with bipolar disorder. Participants included 67 adult inpatients and outpatients aged 18-60 years meeting DSM-IV criteria for bipolar disorder (bipolar I and II disorders, bipolar disorder not otherwise specified). We assessed demographic factors, mood symptoms, psychosis, trauma history, trait impulsivity, trait aggression, and reasons for living. The primary outcome measures were the Barratt Impulsiveness Scale-version II, Aggression Questionnaire, and 10 cognitive outcome variables. The cognitive outcome variables assessed cognitive performance across several domains, including processing speed, attention, verbal learning, and executive function. Another aspect of cognitive function, decision making, was assessed using the Iowa Gambling Task. The study was conducted from July 2007-July 2009. We found that nonattempters reported significantly higher trait impulsivity scores on the Barratt Impulsiveness Scale compared to attempters (t(57) = 2.2, P = .03) and that, among attempters, lower trait impulsivity score was associated with higher scores of lethality of prior attempts (r(25) = -0.53, P = .01). Analyses revealed no other group differences on demographic, clinical, or neurocognitive variables when comparing attempters versus nonattempters. Regression models failed to identify any significant predictors of past suicide attempt. The largely negative results of our study are particularly important in highlighting the clinical dilemma faced by many clinicians when trying to predict which patients will make serious suicide attempts and which patients are at a lower risk for acting on suicidal thoughts. A limitation of our work is that we examined stable trait measures of impulsivity among a euthymic sample rather than mood state or the impact of mood state on traits. Overall, we conclude that suicidal behavior is extremely difficult to predict, even when comprehensive clinical and neurocognitive information is available.

The Journal of Clinical Psychiatry, 1998

Recent investigations have suggested that the antimanic agents divalproex sodium and carbamazepin... more Recent investigations have suggested that the antimanic agents divalproex sodium and carbamazepine may each hasten hospital discharge and be especially beneficial in treating mixed-state mania. This study retrospectively compared the time to remission for pure versus mixed manic bipolar inpatients who were taking lithium, divalproex, or carbamazepine, or their combination, under naturalistic conditions. Records were reviewed for 120 bipolar inpatients from 1991 to 1995. Research DSM-III-R diagnoses of pure or mixed mania were assigned along standardized guidelines. Data were obtained on daily symptoms, medication doses, and blood levels. Weekly improvement was evaluated by Kaplan-Meier survival analysis of Clinical Global Impressions scale scores. Variables associated with "remission" versus "nonremission" were examined by logistic regression. Mixed mania (N = 70) was more common than pure mania (N = 50). No significant differences were observed in the time to remission for mixed or pure manic bipolar patients who took lithium compared with those who took divalproex or carbamazepine. In patients who remained symptomatic with lithium as a single-agent mood stabilizer despite therapeutic serum lithium levels, the addition of a second mood stabilizer led to rapid symptom improvement. Among all medication subgroups, the speed with which patients achieved therapeutic blood levels of any of these agents significantly affected the time to remission. Mixed manic bipolar patients taking lithium, divalproex, or carbamazepine under naturalistic conditions remit at comparable rates. Those failing to respond to single-agent mood stabilizers often receive combinations of mood stabilizers. However, delays in optimizing a medication regimen may attenuate short-term outcome, regardless of the mood stabilizer selected. Rapid achievement of therapeutic blood levels of any antimanic agent appears to be strongly related to swift symptom remission.

Journal of Affective Disorders, 1999

Background: Previous investigations have reported that suicidal ideation and behavior are more pr... more Background: Previous investigations have reported that suicidal ideation and behavior are more prevalent during mixed than pure mania. Uncertainties exist about whether suicidality in mania arises from multiple concurrent depressive symptoms, or rather, as a categorical phenomenon, reflecting dysphoria without necessarily a full major depression. To elucidate the relationship between suicidal ideation and dysphoric mania, we analyzed clinical and demographic features associated with suicidal versus nonsuicidal dysphoric manic inpatients. Methods: Records were reviewed for 100 DSM-III-R bipolar I manic inpatients at the Payne Whitney Clinic of New York Hospital from 1991-1995. All had > 2 concomitant depressive symptoms (other than suicidality). Affective and psychotic symptoms, past suicide attempts, prior illness, and related clinical / demographic variables were assessed by a standardized protocol. Results: Suicidal ideation was significantly more common among dysphoric manics who were caucasian, took antidepressant medications in the week prior to admission, had histories of alcohol abuse / dependence, and made past suicide attempts. Suicidal ideation was evident for nearly half of dysphoric manic patients with # 3 depressive symptoms who did not meet DSM criteria for a mixed state. No individual manic or depressive symptoms other than dysphoric mood were more common among suicidal than nonsuicidal patients. Limitations: Findings from this retrospective study require confirmation using a prospective assessment. Treatments were naturalistic and may have differentially influenced hospital course and illness characteristics. Factors related to suicide attempts (rare in this cohort) or completions (not a focus of this study) may differ from those related only to suicidal ideation. Conclusions: Caucasian dysphoric manic patients with past suicide attempts and substance abuse may have a significantly elevated risk for suicidality, even when full major depression does not accompany mania. Suicidality is a clinically important consideration in a majority of dysphoric manic patients.

European Neuropsychopharmacology, 2001

Comprehensive Psychiatry, 2003

Although suicidality remains highly prevalent among patients with bipolar disorder, little resear... more Although suicidality remains highly prevalent among patients with bipolar disorder, little research exists examining the characteristics of successive attempts among individuals who make and survive a first suicide attempt. We compared bipolar subjects with a history of one suicide attempt to those with multiple attempts and assessed demographic characteristics, family histories, psychopathology, and clinical dimensions of suicidal behavior. Fifty-two DSM-IV bipolar patients (age 21 to 74 years) with a history of at least one suicide attempt were consecutively evaluated in the Bipolar Disorders Research Clinic of the New York Presbyterian Hospital. Circumstances surrounding each lifetime suicide attempt were assessed by direct interviews, questionnaires, and chart reviews along with family psychiatric histories, substance abuse histories, current psychopathology, and features of impulsivity and aggression. Multiple suicide attempts occurred in approximately two thirds of the study group. Single attempters were significantly more likely than multiple attempters to show high seriousness of intent at their first attempt (OR ‫؍‬ 0.65, 95% CI ‫؍‬ 0.43 to 0.99), and tended to be less likely than multiple attempters to exhibit mixed states at their first attempt (OR ‫؍‬ 0.54, 95% CI ‫؍‬ 0.28 to 1.01). Seriousness of intent was consistent across the first and second attempts (r ‫؍‬ .48, P < .01) and second and third attempts (r ‫؍‬ .74, P < .05). Single and multiple attempters differed in no other clinical or demographic characteristics studied. We conclude that multiple suicide attempts are common among bipolar patients. Those who survive an initial suicide attempt involving high seriousness of intent appear less likely than those with low intent to make subsequent attempts. Consequently, single attempters may represent a group more closely resembling those who complete suicide on a first attempt, in terms of the risk for death associated with their first attempt. However, multiple suicide attempts among bipolar patients are not necessarily associated with a higher risk for lethality in first suicide attempt survivors.

Comprehensive Psychiatry, 2000

Previous studies have compared demographic and clinical-outcome features of bipolar patients with... more Previous studies have compared demographic and clinical-outcome features of bipolar patients with mixed or pure mania. However, little is known about the potential differences in the nature and extent of manic symptoms in mania either with or without an accompanying depression. This study examined DSM-III-R manic symptoms in a cohort of 183 bipolar I inpatients hospitalized for mixed mania (diagnosed by broad or narrow criteria) or pure manic episodes. Inpatient charts were reviewed to determine the presence of individual affective symptoms. The results indicate that clinicians were more likely to diagnose a pure mania from the beginning to end of an episode than to diagnose a mixed mania from its beginning to end. Mixed-manic patients had significantly fewer manic symptoms than pure manic patients. Grandiosity, euphoria, pressured speech, and a decreased need for sleep were more prevalent during pure versus mixed mania. Grandiosity and a diminished need for sleep were especially notable during pure mania compared with mixed mania as defined by narrow criteria for mixed states. The observed differences in manic symptom profiles between mixed and pure mania may aid in the clinical assessment of dysphoric states among bipolar patients. The data also lend support to the use of broad diagnostic criteria for defining mixed mania as an entity phenomenologically distinct from pure mania.