Patrice Cobb - Academia.edu (original) (raw)

Papers by Patrice Cobb

Multivariate Behavioral Research, 2015

Innovations in Clinical Neuroscience

Objective: When treating acute bipolar mania, the speed of onset of anti-manic effects is crucial... more Objective: When treating acute bipolar mania, the speed of onset of anti-manic effects is crucial. Quetiapine and divalproex ER are widely used agents to treat acute mania. Rapid dose administration regimens for divalproex ER and for quetiapine have been described. We conducted a naturalistic, head-to-head, pilot study comparing the efficacy and safety of rapidly titrated divalproex ER and quetiapine in acutely manic inpatients, with the primary outcome being improvement within the first seven days.Method: Thirty consenting bipolar patients with acute mania (Young Mania Rating Scale >17 ) needing hospitalization due to acute mania were randomized to receive rapidly loaded divalproex ER (30mg/kg/day) or rapidly titrated quetiapine (200mg Day 1, raised by 200mg/day up to 800mg as tolerated). Assessments were made on Day 1 (baseline), Day 3, Day 7, Day 14, and Day 21 and included Young Mania Rating Scale, Clinical Global Impressions-Severity, Clinical Global Impressions-Improvement,...

Innovations in clinical neuroscience, 2011

When treating acute bipolar mania, the speed of onset of anti-manic effects is crucial. Quetiapin... more When treating acute bipolar mania, the speed of onset of anti-manic effects is crucial. Quetiapine and divalproex ER are widely used agents to treat acute mania. Rapid dose administration regimens for divalproex ER and for quetiapine have been described. We conducted a naturalistic, head-to-head, pilot study comparing the efficacy and safety of rapidly titrated divalproex ER and quetiapine in acutely manic inpatients, with the primary outcome being improvement within the first seven days. Thirty consenting bipolar patients with acute mania (Young Mania Rating Scale >17 ) needing hospitalization due to acute mania were randomized to receive rapidly loaded divalproex ER (30mg/kg/day) or rapidly titrated quetiapine (200mg Day 1, raised by 200mg/day up to 800mg as tolerated). Assessments were made on Day 1 (baseline), Day 3, Day 7, Day 14, and Day 21 and included Young Mania Rating Scale, Clinical Global Impressions-Severity, Clinical Global Impressions-Improvement, and Montgomery-As...

Schizophrenia Research, 2012

Cognitive deficits are a prominent, disabling component of schizophrenia and current pharmacologi... more Cognitive deficits are a prominent, disabling component of schizophrenia and current pharmacological treatments have demonstrated limited efficacy in their amelioration. Oxytocin - though it has shown promise as a novel antipsychotic in multiple clinical trials - has as-yet poorly characterized effects on cognition, with some evidence indicating an amnestic profile. As part of a previously reported trial of chronic adjunctive oxytocin in schizophrenia, we measured its effect on two cognitive tests: the CVLT (California Verbal Learning Test) and the LNS (Letter Number Sequence). Tests were performed at baseline and after 3 weeks of treatment. We found no evidence for an amnestic effect and, in fact, significantly better performance with oxytocin on several subtests of the CVLT; namely total Recall trials 1-5 (p=0.027), short delayed free recall (p=0.032) and total recall discrimination (p=0.020). In contrast we found no difference between placebo and oxytocin on LNS performance. This is the first report we are aware of documenting a beneficial effect of oxytocin on cognition in schizophrenia. Though from a small sample (n=15), these data both offset past concerns about oxytocin's amnestic effects, and may auger another potential benefit in addition to the already-demonstrated salutary effects on other components of the illness.

Journal of Clinical Psychopharmacology, 2012

Published research on agitation is limited by the difficulty in generalizing findings from trials... more Published research on agitation is limited by the difficulty in generalizing findings from trials using moderately agitated, carefully selected patients treated with single agents. More specifically, there are few comparative studies examining common intramuscular (IM) regimens (ie, haloperidol with or without benzodiazepines) with IM atypical antipsychotics. Therefore, we conducted a retrospective chart review to compare IM olanzapine and haloperidol in a "real-world" population with agitation. We performed a retrospective evaluation of charts from 146 consecutive emergency department patients who received either IM haloperidol or IM olanzapine for agitation. We used a clinically oriented proxy marker of efficacy--the necessity for additional medication intervention for agitation (AMI)--as our primary outcome measure. Additional medication intervention for agitation was required by 43% (13/30) patients when haloperidol was given alone and by 18% (13/72) when haloperidol was given with a benzodiazepine. In the case of olanzapine, AMI was required by 29% (6/21) of patients receiving olanzapine alone and by 18% (2/11) of patients given olanzapine plus a benzodiazepine. A significant percentage of patients had clinical characteristics (nonpsychiatric triage complaint, drug/alcohol use, severe agitation) that differ from more selective samples. Overall, these finding suggest that in a naturalistic emergency department setting, haloperidol monotherapy is less effective--at least in requiring AMI--than olanzapine with or without a benzodiazepine or haloperidol plus a benzodiazepine. Moreover, these later 3 regimens seemed comparable. Prospective studies examining the treatment of real-world agitation, including head-to-head comparisons of the haloperidol-benzodiazepine combination with newer IM antipsychotics, are needed.

General Hospital Psychiatry, 2010

Objective: The treatment of agitation in drug-and alcohol-using emergency patients is understudie... more Objective: The treatment of agitation in drug-and alcohol-using emergency patients is understudied. Method: We performed a retrospective chart review of 105 agitated emergency department patients who received either intramuscular (IM) haloperidol or IM olanzapine, comparing prescribing patterns, level of agitation, response to treatment and side effects in patients positive for drugs or alcohol [D/A(+)] and patients negative for drugs or alcohol [(D/A(−)]. Results: The haloperidol-benzodiazepine combination was the most frequently prescribed treatment in both groups, although alcohol(+) status biased clinicians toward using haloperidol alone. Overall, D/A(+) and D/A(−) patients responded to the initial intervention at similar rates, although D/A(+) patients were rated as more agitated and had more posttreatment sedation than D/A(−) patients. In D/A(+) patients, haloperidol+benzodiazepine and IM olanzapine performed better than haloperidol alone. There were no serious adverse events with any treatment. Conclusion: Findings support the generalization of efficacy data from more rarified agitated samples to populations with high rates of substance use and highlight the need for prospective, inclusive, randomized trials comparing the commonly used haloperidol-benzodiazepine combination with newer injectable antipsychotics.

Biological Psychiatry, 2010

Background: Both human and animal studies suggest oxytocin may have antipsychotic properties. The... more Background: Both human and animal studies suggest oxytocin may have antipsychotic properties. Therefore, we conducted a clinical trial to directly test this notion.

A review of the software Just Another Gibbs Sampler (JAGS) is provided. We cover aspects related ... more A review of the software Just Another Gibbs Sampler (JAGS) is provided. We cover aspects related to history and development and the elements a user needs to know to get started with the program, including (a) definition of the data, (b) definition of the model, (c) compilation of the model, and (d) initialization of the model. An example using a latent class model with large-scale education data is provided to illustrate how easily JAGS can be implemented in R. We also cover details surrounding the many programs implementing JAGS. We conclude with a discussion of the newest features and upcoming developments. JAGS is constantly evolving and is developing into a flexible, user-friendly program with many benefits for Bayesian inference.

Multivariate Behavioral Research, 2015

Innovations in Clinical Neuroscience

Objective: When treating acute bipolar mania, the speed of onset of anti-manic effects is crucial... more Objective: When treating acute bipolar mania, the speed of onset of anti-manic effects is crucial. Quetiapine and divalproex ER are widely used agents to treat acute mania. Rapid dose administration regimens for divalproex ER and for quetiapine have been described. We conducted a naturalistic, head-to-head, pilot study comparing the efficacy and safety of rapidly titrated divalproex ER and quetiapine in acutely manic inpatients, with the primary outcome being improvement within the first seven days.Method: Thirty consenting bipolar patients with acute mania (Young Mania Rating Scale >17 ) needing hospitalization due to acute mania were randomized to receive rapidly loaded divalproex ER (30mg/kg/day) or rapidly titrated quetiapine (200mg Day 1, raised by 200mg/day up to 800mg as tolerated). Assessments were made on Day 1 (baseline), Day 3, Day 7, Day 14, and Day 21 and included Young Mania Rating Scale, Clinical Global Impressions-Severity, Clinical Global Impressions-Improvement,...

Innovations in clinical neuroscience, 2011

When treating acute bipolar mania, the speed of onset of anti-manic effects is crucial. Quetiapin... more When treating acute bipolar mania, the speed of onset of anti-manic effects is crucial. Quetiapine and divalproex ER are widely used agents to treat acute mania. Rapid dose administration regimens for divalproex ER and for quetiapine have been described. We conducted a naturalistic, head-to-head, pilot study comparing the efficacy and safety of rapidly titrated divalproex ER and quetiapine in acutely manic inpatients, with the primary outcome being improvement within the first seven days. Thirty consenting bipolar patients with acute mania (Young Mania Rating Scale >17 ) needing hospitalization due to acute mania were randomized to receive rapidly loaded divalproex ER (30mg/kg/day) or rapidly titrated quetiapine (200mg Day 1, raised by 200mg/day up to 800mg as tolerated). Assessments were made on Day 1 (baseline), Day 3, Day 7, Day 14, and Day 21 and included Young Mania Rating Scale, Clinical Global Impressions-Severity, Clinical Global Impressions-Improvement, and Montgomery-As...

Schizophrenia Research, 2012

Cognitive deficits are a prominent, disabling component of schizophrenia and current pharmacologi... more Cognitive deficits are a prominent, disabling component of schizophrenia and current pharmacological treatments have demonstrated limited efficacy in their amelioration. Oxytocin - though it has shown promise as a novel antipsychotic in multiple clinical trials - has as-yet poorly characterized effects on cognition, with some evidence indicating an amnestic profile. As part of a previously reported trial of chronic adjunctive oxytocin in schizophrenia, we measured its effect on two cognitive tests: the CVLT (California Verbal Learning Test) and the LNS (Letter Number Sequence). Tests were performed at baseline and after 3 weeks of treatment. We found no evidence for an amnestic effect and, in fact, significantly better performance with oxytocin on several subtests of the CVLT; namely total Recall trials 1-5 (p=0.027), short delayed free recall (p=0.032) and total recall discrimination (p=0.020). In contrast we found no difference between placebo and oxytocin on LNS performance. This is the first report we are aware of documenting a beneficial effect of oxytocin on cognition in schizophrenia. Though from a small sample (n=15), these data both offset past concerns about oxytocin's amnestic effects, and may auger another potential benefit in addition to the already-demonstrated salutary effects on other components of the illness.

Journal of Clinical Psychopharmacology, 2012

Published research on agitation is limited by the difficulty in generalizing findings from trials... more Published research on agitation is limited by the difficulty in generalizing findings from trials using moderately agitated, carefully selected patients treated with single agents. More specifically, there are few comparative studies examining common intramuscular (IM) regimens (ie, haloperidol with or without benzodiazepines) with IM atypical antipsychotics. Therefore, we conducted a retrospective chart review to compare IM olanzapine and haloperidol in a "real-world" population with agitation. We performed a retrospective evaluation of charts from 146 consecutive emergency department patients who received either IM haloperidol or IM olanzapine for agitation. We used a clinically oriented proxy marker of efficacy--the necessity for additional medication intervention for agitation (AMI)--as our primary outcome measure. Additional medication intervention for agitation was required by 43% (13/30) patients when haloperidol was given alone and by 18% (13/72) when haloperidol was given with a benzodiazepine. In the case of olanzapine, AMI was required by 29% (6/21) of patients receiving olanzapine alone and by 18% (2/11) of patients given olanzapine plus a benzodiazepine. A significant percentage of patients had clinical characteristics (nonpsychiatric triage complaint, drug/alcohol use, severe agitation) that differ from more selective samples. Overall, these finding suggest that in a naturalistic emergency department setting, haloperidol monotherapy is less effective--at least in requiring AMI--than olanzapine with or without a benzodiazepine or haloperidol plus a benzodiazepine. Moreover, these later 3 regimens seemed comparable. Prospective studies examining the treatment of real-world agitation, including head-to-head comparisons of the haloperidol-benzodiazepine combination with newer IM antipsychotics, are needed.

General Hospital Psychiatry, 2010

Objective: The treatment of agitation in drug-and alcohol-using emergency patients is understudie... more Objective: The treatment of agitation in drug-and alcohol-using emergency patients is understudied. Method: We performed a retrospective chart review of 105 agitated emergency department patients who received either intramuscular (IM) haloperidol or IM olanzapine, comparing prescribing patterns, level of agitation, response to treatment and side effects in patients positive for drugs or alcohol [D/A(+)] and patients negative for drugs or alcohol [(D/A(−)]. Results: The haloperidol-benzodiazepine combination was the most frequently prescribed treatment in both groups, although alcohol(+) status biased clinicians toward using haloperidol alone. Overall, D/A(+) and D/A(−) patients responded to the initial intervention at similar rates, although D/A(+) patients were rated as more agitated and had more posttreatment sedation than D/A(−) patients. In D/A(+) patients, haloperidol+benzodiazepine and IM olanzapine performed better than haloperidol alone. There were no serious adverse events with any treatment. Conclusion: Findings support the generalization of efficacy data from more rarified agitated samples to populations with high rates of substance use and highlight the need for prospective, inclusive, randomized trials comparing the commonly used haloperidol-benzodiazepine combination with newer injectable antipsychotics.

Biological Psychiatry, 2010

Background: Both human and animal studies suggest oxytocin may have antipsychotic properties. The... more Background: Both human and animal studies suggest oxytocin may have antipsychotic properties. Therefore, we conducted a clinical trial to directly test this notion.

A review of the software Just Another Gibbs Sampler (JAGS) is provided. We cover aspects related ... more A review of the software Just Another Gibbs Sampler (JAGS) is provided. We cover aspects related to history and development and the elements a user needs to know to get started with the program, including (a) definition of the data, (b) definition of the model, (c) compilation of the model, and (d) initialization of the model. An example using a latent class model with large-scale education data is provided to illustrate how easily JAGS can be implemented in R. We also cover details surrounding the many programs implementing JAGS. We conclude with a discussion of the newest features and upcoming developments. JAGS is constantly evolving and is developing into a flexible, user-friendly program with many benefits for Bayesian inference.