Quantitative Documentation of the Therapeutic Efficacy of Adolescent Telepsychiatry

The following is a case report of a 15-year-old adolescent who was evaluated and treated via telepsychiatry as part of an ongoing project at the University of Michigan Health System and the Hiawatha Community Mental Health Center in Michigan. In addition to clinical information, prospective quantitative data was collected at baseline, 6 weeks, and 3 months. Measures included the Youth Self Report (YSR), Child Behavior Checklist (CBCL), Suicide Probability Scale (SPS), Reynold's Adolescent Depression Scale (RADS), Connor's Global Index—Parent Version (CGI-P), and the Children's Global Assessment Scale (CGAS). Prior to the telepsychiatry intervention, the patient was diagnosed as having bipolar disorder with psychosis. During the telepsychiatry intervention, the diagnosis was altered to a posttraumatic stress disorder; medications were discontinued and the patient improved. All scales showed reductions in severity of symptoms after the telepsychiatry interventions. This case represents the first application of adolescent telepsychiatry for the diagnosis, treatment, and tracking of clinical symptoms.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/63270/1/153056203322502678.pd

Is There a Future for Depression Digital Motion Constructs in Psychiatry?

Psychomotor retardation has been recognized as a principal component of depression for centuries. Amongst symptoms and signs associated with depression, it is seen as having high predictive validity, correlating with severity of illness and the outcome of numerous therapeutic interventions. Of the two components—"psycho" and "motor"—the psychological component has received the most thorough investigation and has been given the greatest consideration. The "motor" (or motion) component has been given little consideration. A review of the literature suggests few studies have attempted to quantitatively characterize this phenomenon or use it as anything more than one indice among other signs and symptoms of depression. Unlike other phenomena associated with depression, the use of motion alterations has lagged in significance due to limited technology that would allow its study; depression has been seen predominantly as a "mood" disorder, with principal interest being in the "feelings" associated with the disorder. Recent advances in motion capture technologies allow motion alterations to be used for many purposes, both quantitative and qualitative. These sources of information appear to have direct and indirect impact. There is a fertile future for motion capture constructs in the study of depression, and recent technological advances will allow progress to occur in this area.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/63233/1/109493101750527015.pd

Evolution of the Virtual Human: From Term to Potential Application in Psychiatry

Virtual reality applications in mental health have traditionally involved the creation of virtual environments that acted as provocative agents either for the purposes of the identification of disorders or their treatment. There is infrequent mention of the utilization of "virtual humans" despite the obvious significance of humans within our lives. More broadly, the term Virtual Human is frequently used in a number of contexts extending from its use as a term, modifying anything that needs to be modernized, to the application of 3D animated figures that exist in virtual realities. These applications refer to quite different phenomena in very different contexts leading to a high level of ambiguity and uncertainty when referring to virtual humans. In the following, the various applications of the term virtual human will be reviewed and critiqued through its most frequent applications, in various fields. They will be reviewed in an ascending manner from the least human of application to the most. Finally, a definition will be offered reflecting the potential complexity of the term as it reflects the expression of our most human factors, and how these are needed in the development of a model of a virtual human in psychiatry.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/63235/1/10949310050078751.pd

Vivid Visualization in the Experience of Phobia in Virtual Environments: Preliminary Results

We explored the effect of being able to form vivid mental images on the experience of phobia during exposure treatment in virtual environments. Taking subjects with acrophobia, we randomized them to two treatment groups: in vivo exposure treatment in a real building versus virtual exposure in a model of the same building, projected in a CAVE™ Virtual Environment. Using Marks' Vividness of Visual Imagery Questionnaire (VVIQ-2) as a measure of vividness of visual imagery, we performed Pearson correlations of vividness with amount of fear experienced as measured by Pekala's Phenomenology of Consciousness Inventory (PCI). Contrary to expectation, we found a negative correlation between vividness of visualization and amount of fear experienced during exposure (R =- 0.77728, p = 0.0137). There was a positive correlation between fear and vividness of visualization during the exposure experience as measured by the PCI (R = 0.94083, p = 0.0171). These results are discussed in terms of possible differences between the VVIQ and PCI vividness measures as well as possible effects from the subject's experience.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/63186/1/10949310050078742.pd

Time of origin of opioid peptide-containing neurons in the rat hypothalamus

By using a combined technique of immunocytochemistry and [ 3 H]thymidine autoradiography, we have determined the “birth date” of opioid pep-tide-containing neurons in several hypothalamic nuclei and regions. These include proopiomelanocortin (POMC) neurons (represented by ACTH immunoreactivity) in the arcuate nucleus; dynorphin A neurons in the supraoptic and paraventricular nuclei and the lateral hypothalamic area; and leuenkephalin neurons in the periventricular, ventromedial, and medial mammillary nuclei, as well as in preoptic and perifornical areas. Arcuate POMC neurons were born very early in embryonic development, with peak heavy [ 3 H]thymidine nuclear labelling occurring on embryonic day E12. Supraoptic and paraventricular dynorphin A neurons were also labelled relatively early (peak at E13). The lateral hypothalamic dynorphin A neurons showed peak heavy labelling also on day E12, By contrast, leu-enkephalin neurons in the periventricular nucleus and medial preoptic area exhibited peak heavy nuclear labelling on day E14. Furthermore, perifornical and ventromedial leu-enkephalin neurons were also born relatively early (peak on days E12 and E13, respectively). However, the leu-enkephalin neurons in the medial mammillary nucleus were born the latest of all cell groups studied (i.e., peak at E15). The results indicate a differential genesis of these opioid peptide-containing neuronal groups in different hypothalamic nuclei and regions.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/50027/1/902360409_ftp.pd

Chronic inescapable footshock produces cholinergic system supersensitivity

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/26670/1/0000214.pd

Suicide and the dexamethasone suppression test in adolescence

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/25837/1/0000400.pd

Postnatal Development of ACTH and a-MSH in the Medulla Oblongata of Rat: c -MSH Is the Predominant Peptide

development of ACTH and a-MSH in the medulla oblongata of rat: a-MSH i.s the predominant peptide. PE PTIDES 6: Suppl. 2, 137-141, 1985.-ACTH and a-MSH levels were measured by radioimmunoassays in extracts of the caudal medulla oblongata of developing rats on postnatal (P) days 1-42 at 7 day intervals, and in adult rats. From PI to adulthood, ACTH increased > ! 1-fold from 7.2_ + 1.9 fmol to 82.4_+ 12.6 fmol per medulla section (mean_+ S.E.M.). In comparison, a-MSH increased >7-fold from 68.75_+ 11.0 fmol to 491 _+97.8 fmol during this time period. ACTH/p.g of soluble protein decreased during postnatal development from 0.006_+0.01 to 0.005_+0.001 fmol//zg of protein and a-MSH increased from 0.06_+0.01 fmol//zg of protein to 0.11 -+0.009 fmol//xg of protein between P1 and P7, decreased to 0.015_+0.003 fmol/#g of protein by P42 and increased to 0.03-+0.006 fmol/protein per unit protein by adulthood. These data indicate a significant shift in the levels of a-MSH detected during development with a decrease in the concentration of material occurring from early postnatal development (P1-P7) to adulthood, which does not appear to be solely related to a regional increase in protein. These studies, as well as radioimmunoassays for ACTH and a-MSH in combination with sizing chromatography of pooled extracts at P1. P7 and the adult, demonstrated the predominance of a-MSH at all ages

MSG effects on beta-endorphin and alpha-MSH in the hypothalamus and caudal medulla

Monosodium glutamate (MSG) was given to neonatal male rats to determine its effects on neurons containing beta-endorphin ([beta]-END) and alpha-melanocyte stimulating hormone ([alpha]-MSH) within the basal hypothalamus (arcuate nucleus) and caudal medulla [nucleus tractus solitarius (NTS)] and on the levels of [beta]-END and [alpha]-MSH within these areas. Immunocytochemical studies demonstrated a reduction in the number of cells within the medial hypothalamic area (arcuate nucleus) amon MSG-treated animals versus saline controls. MSG did not reduce the number of cell bodies within the caudal medulla (NTS). MSG significantly reduced [beta]-END and [alpha]-MSH immunoreactive levels in the basal hypothalamus as determined by radioimmunoassay. Whereas a significant reduction in the level of [beta]-END occurred in the ventral caudal medulla (VCM), none occurred in the dorsal caudal medulla (DCM). In contrast, levels of [alpha]-MSH increased significantly in the DCM among animals receiving MSG compared to control animals. This study documents the contribution of beta-endorphin containing neurons of the basal hypothalamus to areas of the caudal medulla. The effect of MSG on beta-endorphin and [alpha]-MSH neurons in these areas and their differential effects on levels in the caudal medulla areas raises questions about the sites of origin of these peptides.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/27254/1/0000263.pd

Peptide F (pro-enkephalin fragment) : Radioimmunoassay, and stress-induced changes in adrenal

Utilizing a nine amino-acid (Asp-Glu-Leu-Tyr-Pro-Leu-Glu-Val-Glu) non-enkephalin containing fragment of Peptide F from the pro-enkephalin molecule, a radioimmunoassay was developed. Extraction of bovine, rat, and guinea pig adrenomedullary preparations demonstrated this fragment to be present and apparently partially conserved across species. In rats, acute inescapable foot-shock stress led to a significant decrease of the immunoreactive material in the adrenal medulla. Chronic daily stress for two weeks resulted in an inability of the adrenals to alter F levels upon subsequent stress. The existence of F-like immunoreactivity and its alteration by environmental manipulation, suggest that it may play a unique physiological role.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/23838/1/0000077.pd