Browsing by Author "Carey P.D."
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- ItemBeauty and the beast: Psychobiologic and evolutionary perspectives on body dysmorphic disorder(2006) Stein D.J.; Carey P.D.; Warwick J.Body dysmorphic disorder (BDD) is characterized by preoccupation with a defect in appearance. Concepts of beauty play a particularly crucial role in humans' mental and social life, and may have specific psychobiologic and evolutionary underpinnings. In particular, there is a growing literature on the neurocircuitry underpinning the body schema, body image and facial expression processing, and aesthetic and symmetry judgments. Speculatively, disruptions in cognitive-affective processes relevant to judgments about physical beauty lead to BDD.
- ItemChanges in regional brain volumes in social anxiety disorder following 12 weeks of treatment with escitalopram(2010) Cassimjee N.; Fouche J.-P.; Burnett M.; Lochner C.; Warwick, James M.; Dupont P.; Stein D.J.; Cloete K.J.; Carey P.D.It has been suggested that antidepressants, including the selective serotonin reuptake inhibitors have neurotrophic effects. Nevertheless, the impact of treatment with a selective serotonin re-uptake inhibitor on regional brain volumes in social anxiety disorder has not been studied. 11 subjects with social anxiety disorder completed magnetic resonance imaging both before and after 12-weeks of treatment with 20 mg/day escitalopram. No increases in structural grey matter were found, but there were decreases in bilateral superior temporal cortex, vermis and the left cerebellum volumes following 12 weeks of treatment with escitalopram. These preliminary findings require replication to determine their reliability, and extension to determine whether or not they are disorder specific. © 2010 Springer Science+Business Media, LLC..
- ItemCharacterization of South African Adolescents With Alcohol Use Disorders but Without Psychiatric or Polysubstance Comorbidity(2011-05-25) Ferrett H.L.; Cuzen N.L.; Thomas K.G.F.; Carey P.D.; Stein D.J.; Finn P.R.; Tapert S.F.; Fein G.Background: Individuals who begin drinking during early adolescence and exhibit externalizing pathology and disinhibitory/dysregulatory tendencies are more vulnerable to developing alcohol use disorders (AUDs) in adulthood. Previous research has focused on in-treatment populations with substantial comorbid psychopathology and polysubstance use. Here, we characterize a unique sample of treatment-naïve adolescents without such comorbidity to help identify vulnerable youth who may benefit from early intervention. Methods: We compared externalizing propensity, disinhibitory characteristics, and school performance in adolescents with AUDs (but without comorbid psychopathology or other substance use; n=70) to those of demographically matched controls (n=70). Within the AUD group, we compared measures of substance use and the disinhibitory syndrome between boys and girls with differing severity of externalizing propensity. Results: Adolescents with AUDs demonstrated more externalizing propensity and disinhibitory personality traits (impulsivity, novelty seeking, and excitement seeking), poorer self-monitoring and response inhibition, more bullying and sexual risk-taking behavior, poorer first-language performance, and greater use of alcohol, cannabis, and nicotine (p<0.05). Within the AUD group, participants with higher externalizing propensity began drinking earlier, more frequently, and for a longer duration than those with lower externalizing symptoms (p<0.05). Disinhibitory features (personality, cognition, and behavior) were, however, not stronger in those with higher externalizing propensity. Conclusions: We suggest that the constructs of externalizing propensity and disinhibitory syndrome are useful in characterizing treatment-naïve adolescents with AUDs but without comorbid psychopathology or polysubstance use. These results support the importance of these constructs in understanding adolescent AUDs, even when the frank externalizing diagnoses of childhood (oppositional defiant disorder and conduct disorder) are excluded. Copyright © 2011 by the Research Society on Alcoholism.
- ItemDopamine transporter binding in social anxiety disorder: The effect of treatment with escitalopram(2012) Warwick, James M.; Carey P.D.; Cassimjee N.; Lochner C.; Hemmings, Sian M. J.; Moolman-Smook H.; Beetge E.; Dupont P.; Stein D.J.Social anxiety disorder (SAD) is characterised by fear of social or performance situations where the individual is exposed to unfamiliar people or to possible scrutiny by others. The literature on dopamine ligands and dopamine genotypes in SAD is however inconsistent. In this study we measured the effects of SSRI pharmacotherapy on dopamine transporter (DAT) binding in patients with SAD, also addressing variability in DAT genotype. Adult subjects meeting DSM-IV criteria for generalised SAD were studied before and after 12 weeks of pharmacotherapy with the selective serotonin reuptake inhibitor (SSRI) escitalopram. DAT single photon emission computed tomography (SPECT) using 123I-FP-CIT was performed at baseline, and repeated at 12 weeks. Striatal DAT binding was analysed for changes following therapy, and for correlations with clinical efficacy, in the whole group as well as for a subgroup with the A10/A10 DAT genotype. The study included 14 subjects (9 male, 5 female) with a mean (SD) age of 41 (±13) years. The subjects' Liebowitz Social Anxiety Scale (LSAS) score was significantly decreased following pharmacotherapy. In the combined group the left caudate and left putamen showed clusters of increased DAT binding after therapy. The left caudate changes were also observed in the subgroup of 9 A10/A10 homozygotes. However no correlation was found between improved symptoms and DAT binding. The changes found in DAT binding in the caudate and putamen may be due to serotonergic activation of dopamine function by SSRI therapy. This is consistent with previous work indicating decreased DAT binding in SAD, and increased DAT binding after SSRI administration. © Springer Science+Business Media, LLC 2012.
- ItemEscitalopram in obsessive-compulsive disorder: Response of symptom dimensions to pharmacotherapy(2008) Stein D.J.; Carey P.D.; Lochner C.; Seedat Soraya; Fineberg N.; Andersen E.W.Introduction: There is a substantial body of evidence that obsessive-compulsive disorder (OCD) symptoms can be grouped into a series of discrete dimensions, and some evidence that not all OCD symptom dimensions respond equally well to pharmacologic or psychotherapeutic intervention. The response of OCD symptom dimensions to 12 weeks of treatment with escitalopram or placebo was investigated. Methods: Data from a randomized, double-blind, placebo-controlled study of escitalopram in 466 adults with OCD were analyzed. Exploratory factor analysis of individual items of the Yale-Brown Obsessive-Compulsive Scale checklist was performed and subscale scores based on the extracted factors were determined. Analyses of covariance were undertaken to determine whether inclusion of each subscale score in these models impacted on the efficacy of escitalopram versus placebo. Results: Exploratory factor analysis of individual Yale-Brown Obsessive-Compulsive Scale items yielded 5 factors (contamination/cleaning, harm/checking, hoarding/symmetry, religious/ sexual, and somatic/hypochondriacal). Analyses of covariance including all the subscales demonstrated that escitalopram was more effective than placebo. There was a significant interaction for the hoarding/symmetry factor, which was associated with a poor treatment response. Conclusion: Escitalopram shows good efficacy across the range of OCD symptom dimensions. Nevertheless, hoarding/symmetry was associated with a poorer treatment response. Hoarding/symmetry may be particularly characteristic of an early-onset group of OCD patients, with the involvement of neurotransmitters other than serotonin. Further work is needed to delineate fully the subtypes of OCD, and their correlates with underlying psychobiology and treatment responsivity.
- ItemGrey matter abnormalities in social anxiety disorder: A pilot study(2012) Syal S.; Hattingh C.J.; Fouche J.-P.; Spottiswoode B.; Carey P.D.; Lochner C.; Stein D.J.While a number of studies have explored the functional neuroanatomy of social anxiety disorder (SAD), data on grey matter integrity are lacking. We conducted structural MRI scans to examine the cortical thickness of grey matter in individuals with SAD. 13 unmedicated adult patients with a primary diagnosis of generalized social anxiety disorder and 13 demographically (age, gender and education) matched healthy controls underwent 3T structural magnetic resonance imaging. Cortical thickness and subcortical volumes were estimated using an automated algorithm (Freesurfer Version 4.5). Compared to controls, social anxiety disorder patients showed significant bilateral cortical thinning in the fusiform and post central regions. Additionally, right hemisphere specific thinning was found in the frontal, temporal, parietal and insular cortices of individuals with social anxiety disorder. Although uncorrected cortical grey matter volumes were significantly lower in individuals with SAD, we did not detect volumetric differences in corrected amygdala, hippocampal or cortical grey matter volumes across study groups. Structural differences in grey matter thickness between SAD patients and controls highlight the diffuse neuroanatomical networks involved in both social anxiety and social behavior. Additional work is needed to investigate the causal mechanisms involved in such structural abnormalities in SAD. © Springer Science+Business Media, LLC 2012.
- ItemLymphocyte measures in treatment-naïve 13-15-year old adolescents with alcohol use disorders(2011) Naude C.E.; Bouic P.; Senekal M.; Kidd M.; Ferrett H.L.; Fein G.; Carey P.D.Many adolescents have chronic exposure to hazardous levels of alcohol. This is likely to be a significant predictor of health outcomes, including those related to immunity. We assessed substance use and biochemical immunological parameters in heavy drinking adolescents (meeting DSM-IV criteria for alcohol dependence) and light/nondrinking control adolescents in Cape Town. Lifetime alcohol dose, measured in standard units of alcohol, was orders of magnitude higher in alcohol-dependent (AD) participants than controls. All adolescent AD had a "weekends-only" style of alcohol consumption. The AD group was chosen to represent relatively "pure" AD, with minimal other drug use and no psychiatric diagnoses. With these narrow parameters in place, we found that AD adolescents were lymphopenic compared with controls, with significantly lower mean numbers of absolute circulating CD3+, CD4+, and CD8+ T-lymphocytes. On conclusion, we found that adolescent AD individuals with excessive alcohol intake, in a weekend binge-drinking style but without comorbid drug or psychiatric disorders, may be at increased risk of lymphopenia. This alcohol misuse may increase infectious disease susceptibility (including TB and HIV) by reducing immune system capabilities. Complex interactions of alcohol with other documented high-risk activities may further compound health risks. © 2011 Elsevier Ltd.
- ItemSingle Photon Emission Computed Tomography (SPECT) in obsessive-compulsive disorder before and after treatment with inositol(2004) Carey P.D.; Warwick, James M.; Harvey B.H.; Stein D.J.; Seedat S.Inositol, a glucose isomer and second messenger precursor, regulates numerous cellular functions and has demonstrated efficacy in obsessive-compulsive disorder (OCD) through mechanisms that remain unclear. The effect of inositol treatment on brain function in OCD has not been studied to date. Fourteen OCD subjects underwent single photon emission computed tomography (SPECT) with Tc-99m HMPAO before and after 12 weeks of treatment with inositol. Whole brain voxel-wise SPM was used to assess differences in perfusion between responders and nonresponders before and after treatment as well as the effect of treatment for the group as a whole. There was 1) deactivation in OCD responders relative to nonresponders following treatment with inositol in the left superior temporal gyrus, middle frontal gyrus and precuneus, and the right paramedian post-central gyrus; 2) no significant regions of deactivation for the group as a whole posttreatment; and 3) a single cluster of higher perfusion in the left medial prefrontal region in responders compared to nonresponders at baseline. Significant reductions in the YBOCS and CGI - severity scores followed treatment. These data are only partly consistent with previous functional imaging work on OCD. They may support the idea that inositol effects a clinical response through alternate neuronal circuitry to the SSRIs and may complement animal work proposing an overlapping but distinct mechanism of action.