Quality of Life in Youth with Bipolar Disorder and Trauma

Background:Epidemiological work suggests that youth with histories of trauma or bipolar disorder have lower quality of life (QoL) than generally healthy youth without a history of bipolar disorder or trauma. Aim: To evaluate whether trauma and bipolar disorder have a negative effect in youth seeking services for emotional and behavioral difficulties. Method & Sample: Participants were 596 youths and caregiver dyads from an urban community mental health center and an academic medical center in Cleveland, OH. Diagnoses were based on semi-structured interviews of the parent and youth. The KINDL-R measured Total, Emotional, Self-esteem, Family, Friend, School, and Physical QoL. Results: Trauma history was not associated with changes in QoL. Youth with bipolar disorder had significantly lower QoL than youth without bipolar disorder. There was no interaction between trauma history and bipolar disorder. Conclusion: Among youth seeking mental health services, trauma history was common. A history of trauma does not alter QoL compared to youth without a history of QoL in a service seeking sample. Youth with bipolar disorder had significantly lower QoL than youth without bipolar disorder suggesting that youth with bipolar disorder might require more intensive services than youth without bipolar disorder

Revealing Choice Bracketing

In a decision problem comprised of multiple choices, a person may fail to take into account the interdependencies between her choices. To understand how people make decisions in such problems we design a novel experiment and revealed preference tests that determine how each subject brackets her choices. In separate portfolio allocation under risk, social allocation, and induced-utility shopping experiments, we find that 40-43\% of our subjects are consistent with narrow bracketing while only 0-15\% are consistent with broad bracketing. Classifying subjects while adjusting for models' predictive precision, 73\% of subjects are best described by narrow bracketing, 14\% by broad bracketing, and 5\% by intermediate cases

Molecular signatures distinguish human central memory from effector memory CD8 T cell subsets

Abstract Memory T cells are heterogeneous in terms of their phenotype and functional properties. We investigated the molecular profiles of human CD8 naive central memory (TCM), effector memory (TEM), and effector memory RA (TEMRA) T cells using gene expression microarrays and phospho-protein-specific intracellular flow cytometry. We demonstrate that TCM have a gene expression and cytokine signaling signature that lies between that of naive and TEM or TEMRA cells, whereas TEM and TEMRA are closely related. Our data define the molecular basis for the different functional properties of central and effector memory subsets. We show that TEM and TEMRA cells strongly express genes with known importance in CD8 T cell effector function. In contrast, TCM are characterized by high basal and cytokine-induced STAT5 phosphorylation, reflecting their capacity for self-renewal. Altogether, our results distinguish TCM and TEM/TEMRA at the molecular level and are consistent with the concept that TCM represent memory stem cells.</jats:p

Patterns of Treatment for Psychiatric Disorders Among Children and Adolesecents in Mississippi Medicaid

The nature of services for psychiatric disorders in public health systems has been understudied, particularly with regard to frequency, duration, and costs. The current study examines patterns of service reception and costs among Medicaid-covered youth newly diagnosed with anxiety, depression, or behavioral disturbance in a large data set of provider billing claims submitted between 2015–2016. Eligibility criteria included: 1) identification of an initial diagnosis of a single anxiety, unipolar mood, or specific behavioral disorder; 2) continuous Medicaid eligibility over the duration of the time period studied; and 3) under 18 years of age on the date of initial psychiatric diagnosis. The final cohort included 7,627 cases with a mean age of 10.65 (±4.36), of which 58.04% were male, 57.09% were Black, 38.97% were White, and 3.95% were of other ethnicities. Data indicated that 65.94% of the cohort received at least some follow-up services within a median 18 days of diagnosis. Of those, 54.27% received a combination of medical and psychosocial services, 32.01% received medical services only, and 13.72% received psychosocial services only. Overall median costs for direct treatment were $576.69, with wide discrepancies between the lowest (anxiety =$308.41) and highest (behavioral disturbance = $653.59) diagnostic categories. Across all categories the frequency and duration of psychosocial services were much lower than would be expected in comparison to data from a well-known effectiveness trial. Overall, follow-up to psychiatric diagnosis could be characterized as highly variable, underutilized, and emphasizing biomedical treatment. Understanding more about these patterns may facilitate systematic improvements and greater cost efficiency in the future

Human naive CD8 T cells down-regulate expression of the WNT pathway transcription factors lymphoid enhancer binding factor 1 and transcription factor 7 (T cell factor-1) following antigen encounter in vitro and in vivo

Abstract The transcription factors lymphoid enhancer binding factor 1 (LEF1) and transcription factor 7 (TCF7) (T cell factor-1 (TCF-1)) are downstream effectors of the WNT signaling pathway, which is a critical regulator of T cell development in the thymus. In this study, we show that LEF1 and TCF7 (TCF-1) are not only expressed in thymocytes, but also in mature T cells. Our data demonstrate that Ag encounter in vivo and engagement of the TCR or IL-15 receptor in vitro leads to the down-regulation of LEF1 and TCF7 (TCF-1) expression in human naive CD8 T cells. We further show that resting T cells preferentially express inhibitory LEF1 and TCF7 (TCF-1) isoforms and that T cell activation changes the isoform balance in favor of stimulatory TCF7 (TCF-1) isoforms. Altogether, our study suggests that proteins involved in the WNT signaling pathway not only regulate T cell development, but also peripheral T cell differentiation.</jats:p

Portability of a screener for pediatric bipolar disorder to a diverse setting

The purpose of the study is to examine differential item functioning when moving from an Academic setting to a community setting, differential item functioning when extracting ten items in a community setting, and comparative diagnostic efficiency of the extracted items to the embedded items. Differential item functioning using Samejima's Graded Response Model indicated that across samples, total observed scores were similar across levels of mania. ROC indicated that the ten extracted items discriminated well. Sum scores less than 18 substantially decreased the probability of bipolar disorder, while sum scores greater than 18 substantially increased the probability of bipolar disorder in youth. Findings suggest that the extracted items perform similarly to the embedded items in the community setting

Age Effects in Manic Symptoms in Pediatric Bipolar Disorder

Pediatric bipolar disorder (PBD) remains a controversial diagnosis due in part to questions about the developmental appropriateness of manic symptoms. Three phenotypes have been proposed that differentially place importance on episodes, irritability, and elated mood/grandiosity. Participants were 1,395 outpatients (845 males) ages 5-17 years presenting from a mood disorders clinic or a community mental health clinic. Factor mixture modeling did not support developmentally distinct phenotypes. Confirmatory factor analysis with age as a covariate indicated small differences in ages. Regression analyses predicting comorbid diagnoses and CBCL subscales also displayed age differences. Limitations include that the sample is non-representative of outpatient clinics or epidemiological settings and symptom ratings were completed by the same caregiver. These findings affirm similar clinical presentations of manic symptoms across childhood and adolescence with different patterns of comorbidity.Doctor of Philosoph

Disruptive Mood Dysregulation Disorder in a Community Mental Health Clinic: Prevalence, Comorbidity and Correlates

Objective: The revision of the Diagnostic and Statistical Manual of Mental Disorders, 5th ed. (DSM-5) added a new diagnosis of disruptive mood dysregulation disorder (DMDD) to depressive disorders. This study examines the prevalence, comorbidity, and correlates of the new disorder, with a particular focus on its overlap with oppositional defiant disorder (ODD), with which DMDD shares core symptoms

High Fidelity Single Qubit Operations using Pulsed EPR

Systematic errors in spin rotation operations using simple RF pulses place severe limitations on the usefulness of the pulsed magnetic resonance methods in quantum computing applications. In particular, the fidelity of quantum logic operations performed on electron spin qubits falls well below the threshold for the application of quantum algorithms. Using three independent techniques, we demonstrate the use of composite pulses to improve this fidelity by several orders of magnitude. The observed high-fidelity operations are limited by pulse phase errors, but nevertheless fall within the limits required for the application of quantum error correction.Comment: 4 pages, 3 figures To appear in Phys. Rev. Let