Psychotherapy - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

PSYCHOTHERAPY A M EDICAL D ICTIONARY , B IBLIOGRAPHY , AND A NNOTATED R ESEARCH G UIDE TO I NTERNET R E FERENCES

J AMES N. P ARKER , M.D. AND P HILIP M. P ARKER , P H .D., E DITORS

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ICON Health Publications ICON Group International, Inc. 4370 La Jolla Village Drive, 4th Floor San Diego, CA 92122 USA Copyright 2004 by ICON Group International, Inc. Copyright 2004 by ICON Group International, Inc. All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without written permission from the publisher. Printed in the United States of America. Last digit indicates print number: 10 9 8 7 6 4 5 3 2 1

Publisher, Health Care: Philip Parker, Ph.D. Editor(s): James Parker, M.D., Philip Parker, Ph.D. Publisher's note: The ideas, procedures, and suggestions contained in this book are not intended for the diagnosis or treatment of a health problem. As new medical or scientific information becomes available from academic and clinical research, recommended treatments and drug therapies may undergo changes. The authors, editors, and publisher have attempted to make the information in this book up to date and accurate in accord with accepted standards at the time of publication. The authors, editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in regard to the contents of this book. Any practice described in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation. The reader is advised to always check product information (package inserts) for changes and new information regarding dosage and contraindications before prescribing any drug or pharmacological product. Caution is especially urged when using new or infrequently ordered drugs, herbal remedies, vitamins and supplements, alternative therapies, complementary therapies and medicines, and integrative medical treatments. Cataloging-in-Publication Data Parker, James N., 1961Parker, Philip M., 1960Psychotherapy: A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References / James N. Parker and Philip M. Parker, editors p. cm. Includes bibliographical references, glossary, and index. ISBN: 0-597-84567-0 1. Psychotherapy-Popular works. I. Title.

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Disclaimer This publication is not intended to be used for the diagnosis or treatment of a health problem. It is sold with the understanding that the publisher, editors, and authors are not engaging in the rendering of medical, psychological, financial, legal, or other professional services. References to any entity, product, service, or source of information that may be contained in this publication should not be considered an endorsement, either direct or implied, by the publisher, editors, or authors. ICON Group International, Inc., the editors, and the authors are not responsible for the content of any Web pages or publications referenced in this publication.

Copyright Notice If a physician wishes to copy limited passages from this book for patient use, this right is automatically granted without written permission from ICON Group International, Inc. (ICON Group). However, all of ICON Group publications have copyrights. With exception to the above, copying our publications in whole or in part, for whatever reason, is a violation of copyright laws and can lead to penalties and fines. Should you want to copy tables, graphs, or other materials, please contact us to request permission (E-mail: [email protected]). ICON Group often grants permission for very limited reproduction of our publications for internal use, press releases, and academic research. Such reproduction requires confirmed permission from ICON Group International, Inc. The disclaimer above must accompany all reproductions, in whole or in part, of this book.

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Acknowledgements The collective knowledge generated from academic and applied research summarized in various references has been critical in the creation of this book which is best viewed as a comprehensive compilation and collection of information prepared by various official agencies which produce publications on psychotherapy. Books in this series draw from various agencies and institutions associated with the United States Department of Health and Human Services, and in particular, the Office of the Secretary of Health and Human Services (OS), the Administration for Children and Families (ACF), the Administration on Aging (AOA), the Agency for Healthcare Research and Quality (AHRQ), the Agency for Toxic Substances and Disease Registry (ATSDR), the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), the Healthcare Financing Administration (HCFA), the Health Resources and Services Administration (HRSA), the Indian Health Service (IHS), the institutions of the National Institutes of Health (NIH), the Program Support Center (PSC), and the Substance Abuse and Mental Health Services Administration (SAMHSA). In addition to these sources, information gathered from the National Library of Medicine, the United States Patent Office, the European Union, and their related organizations has been invaluable in the creation of this book. Some of the work represented was financially supported by the Research and Development Committee at INSEAD. This support is gratefully acknowledged. Finally, special thanks are owed to Tiffany Freeman for her excellent editorial support.

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About the Editors James N. Parker, M.D. Dr. James N. Parker received his Bachelor of Science degree in Psychobiology from the University of California, Riverside and his M.D. from the University of California, San Diego. In addition to authoring numerous research publications, he has lectured at various academic institutions. Dr. Parker is the medical editor for health books by ICON Health Publications. Philip M. Parker, Ph.D. Philip M. Parker is the Eli Lilly Chair Professor of Innovation, Business and Society at INSEAD (Fontainebleau, France and Singapore). Dr. Parker has also been Professor at the University of California, San Diego and has taught courses at Harvard University, the Hong Kong University of Science and Technology, the Massachusetts Institute of Technology, Stanford University, and UCLA. Dr. Parker is the associate editor for ICON Health Publications.

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About ICON Health Publications To discover more about ICON Health Publications, simply check with your preferred online booksellers, including Barnes&Noble.com and Amazon.com which currently carry all of our titles. Or, feel free to contact us directly for bulk purchases or institutional discounts: ICON Group International, Inc. 4370 La Jolla Village Drive, Fourth Floor San Diego, CA 92122 USA Fax: 858-546-4341 Web site: www.icongrouponline.com/health

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Table of Contents FORWARD .......................................................................................................................................... 1 CHAPTER 1. STUDIES ON PSYCHOTHERAPY ...................................................................................... 3 Overview........................................................................................................................................ 3 The Combined Health Information Database................................................................................. 3 Federally Funded Research on Psychotherapy ............................................................................... 4 E-Journals: PubMed Central ....................................................................................................... 63 The National Library of Medicine: PubMed ................................................................................ 64 CHAPTER 2. NUTRITION AND PSYCHOTHERAPY ............................................................................ 77 Overview...................................................................................................................................... 77 Finding Nutrition Studies on Psychotherapy.............................................................................. 77 Federal Resources on Nutrition ................................................................................................... 78 Additional Web Resources ........................................................................................................... 79 CHAPTER 3. ALTERNATIVE MEDICINE AND PSYCHOTHERAPY ...................................................... 81 Overview...................................................................................................................................... 81 The Combined Health Information Database............................................................................... 81 National Center for Complementary and Alternative Medicine.................................................. 82 Additional Web Resources ........................................................................................................... 83 General References ....................................................................................................................... 92 CHAPTER 4. DISSERTATIONS ON PSYCHOTHERAPY ........................................................................ 93 Overview...................................................................................................................................... 93 Dissertations on Psychotherapy................................................................................................... 93 Keeping Current ........................................................................................................................ 124 CHAPTER 5. CLINICAL TRIALS AND PSYCHOTHERAPY ................................................................ 125 Overview.................................................................................................................................... 125 Recent Trials on Psychotherapy................................................................................................. 125 Keeping Current on Clinical Trials ........................................................................................... 127 CHAPTER 6. PATENTS ON PSYCHOTHERAPY ................................................................................ 129 Overview.................................................................................................................................... 129 Patents on Psychotherapy .......................................................................................................... 129 Patent Applications on Psychotherapy ...................................................................................... 136 Keeping Current ........................................................................................................................ 138 CHAPTER 7. BOOKS ON PSYCHOTHERAPY .................................................................................... 139 Overview.................................................................................................................................... 139 Book Summaries: Federal Agencies............................................................................................ 139 Book Summaries: Online Booksellers......................................................................................... 141 Chapters on Psychotherapy........................................................................................................ 145 CHAPTER 8. MULTIMEDIA ON PSYCHOTHERAPY ......................................................................... 147 Overview.................................................................................................................................... 147 Video Recordings ....................................................................................................................... 147 Audio Recordings....................................................................................................................... 148 CHAPTER 9. PERIODICALS AND NEWS ON PSYCHOTHERAPY ...................................................... 151 Overview.................................................................................................................................... 151 News Services and Press Releases.............................................................................................. 151 Newsletters on Psychotherapy ................................................................................................... 153 Newsletter Articles .................................................................................................................... 154 Academic Periodicals covering Psychotherapy .......................................................................... 157 APPENDIX A. PHYSICIAN RESOURCES .......................................................................................... 161 Overview.................................................................................................................................... 161 NIH Guidelines.......................................................................................................................... 161 NIH Databases........................................................................................................................... 163 Other Commercial Databases..................................................................................................... 165

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APPENDIX B. PATIENT RESOURCES ............................................................................................... 167 Overview.................................................................................................................................... 167 Patient Guideline Sources.......................................................................................................... 167 Finding Associations.................................................................................................................. 186 APPENDIX C. FINDING MEDICAL LIBRARIES ................................................................................ 189 Overview.................................................................................................................................... 189 Preparation................................................................................................................................. 189 Finding a Local Medical Library................................................................................................ 189 Medical Libraries in the U.S. and Canada ................................................................................. 189 ONLINE GLOSSARIES................................................................................................................ 195 Online Dictionary Directories ................................................................................................... 195 PSYCHOTHERAPY DICTIONARY ........................................................................................... 197 INDEX .............................................................................................................................................. 241

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FORWARD In March 2001, the National Institutes of Health issued the following warning: "The number of Web sites offering health-related resources grows every day. Many sites provide valuable information, while others may have information that is unreliable or misleading."1 Furthermore, because of the rapid increase in Internet-based information, many hours can be wasted searching, selecting, and printing. Since only the smallest fraction of information dealing with psychotherapy is indexed in search engines, such as www.google.com or others, a non-systematic approach to Internet research can be not only time consuming, but also incomplete. This book was created for medical professionals, students, and members of the general public who want to know as much as possible about psychotherapy, using the most advanced research tools available and spending the least amount of time doing so. In addition to offering a structured and comprehensive bibliography, the pages that follow will tell you where and how to find reliable information covering virtually all topics related to psychotherapy, from the essentials to the most advanced areas of research. Public, academic, government, and peer-reviewed research studies are emphasized. Various abstracts are reproduced to give you some of the latest official information available to date on psychotherapy. Abundant guidance is given on how to obtain free-of-charge primary research results via the Internet. While this book focuses on the field of medicine, when some sources provide access to non-medical information relating to psychotherapy, these are noted in the text. E-book and electronic versions of this book are fully interactive with each of the Internet sites mentioned (clicking on a hyperlink automatically opens your browser to the site indicated). If you are using the hard copy version of this book, you can access a cited Web site by typing the provided Web address directly into your Internet browser. You may find it useful to refer to synonyms or related terms when accessing these Internet databases. NOTE: At the time of publication, the Web addresses were functional. However, some links may fail due to URL address changes, which is a common occurrence on the Internet. For readers unfamiliar with the Internet, detailed instructions are offered on how to access electronic resources. For readers unfamiliar with medical terminology, a comprehensive glossary is provided. For readers without access to Internet resources, a directory of medical libraries, that have or can locate references cited here, is given. We hope these resources will prove useful to the widest possible audience seeking information on psychotherapy. The Editors

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From the NIH, National Cancer Institute (NCI): http://www.cancer.gov/cancerinfo/ten-things-to-know.

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CHAPTER 1. STUDIES ON PSYCHOTHERAPY Overview In this chapter, we will show you how to locate peer-reviewed references and studies on psychotherapy.

The Combined Health Information Database The Combined Health Information Database summarizes studies across numerous federal agencies. To limit your investigation to research studies and psychotherapy, you will need to use the advanced search options. First, go to http://chid.nih.gov/index.html. From there, select the “Detailed Search” option (or go directly to that page with the following hyperlink: http://chid.nih.gov/detail/detail.html). The trick in extracting studies is found in the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Journal Article.” At the top of the search form, select the number of records you would like to see (we recommend 100) and check the box to display “whole records.” We recommend that you type “psychotherapy” (or synonyms) into the “For these words:” box. Consider using the option “anywhere in record” to make your search as broad as possible. If you want to limit the search to only a particular field, such as the title of the journal, then select this option in the “Search in these fields” drop box. The following is what you can expect from this type of search: •

Sign-Language Interpretation in Psychotherapy with Deaf Patients Source: American Journal of Psychotherapy. 53(2): 163-176. Spring 1999. Contact: Available from American Journal of Psychotherapy. Belfer Center, Room 405, 1300 Morris Park Avenue, Bronx, NY 10461. (718) 430-3503. Fax (718) 430-8907. Website: www.ajp.org. Summary: Sporadic encounters with deaf patients seeking psychotherapy present a challenge to general clinicians outside of specialized services for the deaf. Skills for working with people who do not share one's own language mode and culture are not routinely taught in most training programs, so clinicians may be unprepared when they first encounter a deaf patient. This article arose from one psychiatric resident's first experience of psychotherapy working with a sign language interpreter. The author

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summarizes the literature search that resulted from a quest for understanding of deaf culture and experience, of the unique characteristics of sign language, and of the effects on the therapeutic relationship made by the interpreter's presence. The author notes that while it would be ideal to be able to match deaf patients with therapists fluent in their preferred language mode, this is often not feasible in smaller centers. Working with a trained, professional sign language interpreter can be a productive alternative, as long as patient, therapist, and interpreter understand and are comfortable with the process. Peer reviewed literature on sign language interpretation in psychotherapy is sparse, but some practical guidelines can be gleaned from it and supplemented by information provided by the deaf community through the Internet. 27 references. •

Psychotherapy for Individuals With Alzheimer Disease Source: Alzheimer Disease and Associated Disorders: An International Journal. 8(Supplement 3): 75-81. 1994. Summary: This article discusses the emotional difficulties of patients with Alzheimer's disease (AD) as the disease progresses and the early- and late-stage use of psychotherapy as an intervention. The author states that individuals with AD often experience depression, anger, and other psychological symptoms. Various forms of psychotherapy have been attempted with these people, including insight-oriented therapy and less verbal therapies such as music therapy and art therapy. Although few data- based outcome studies support the effectiveness of these interventions, case studies and descriptive information suggest they may help alleviate negative emotions and minimize problematic behaviors. 25 references. (AA-M).

Federally Funded Research on Psychotherapy The U.S. Government supports a variety of research studies relating to psychotherapy. These studies are tracked by the Office of Extramural Research at the National Institutes of Health.2 CRISP (Computerized Retrieval of Information on Scientific Projects) is a searchable database of federally funded biomedical research projects conducted at universities, hospitals, and other institutions. Search the CRISP Web site at http://crisp.cit.nih.gov/crisp/crisp_query.generate_screen. You will have the option to perform targeted searches by various criteria, including geography, date, and topics related to psychotherapy. For most of the studies, the agencies reporting into CRISP provide summaries or abstracts. As opposed to clinical trial research using patients, many federally funded studies use animals or simulated models to explore psychotherapy. The following is typical of the type of information found when searching the CRISP database for psychotherapy: •

Project Title: A CONTROLLED TRIAL OF PSYCHODYNAMIC TREATMENT FOR PANIC Principal Investigator & Institution: Milrod, Barbara L.; Psychiatry; Weill Medical College of Cornell Univ New York, Ny 10021

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Healthcare projects are funded by the National Institutes of Health (NIH), Substance Abuse and Mental Health Services (SAMHSA), Health Resources and Services Administration (HRSA), Food and Drug Administration (FDA), Centers for Disease Control and Prevention (CDCP), Agency for Healthcare Research and Quality (AHRQ), and Office of Assistant Secretary of Health (OASH).

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Timing: Fiscal Year 2002; Project Start 15-FEB-2000; Project End 31-JAN-2005 Summary: This mentored patient-oriented treatment development award is designed to assist Barbara Milrod, M.D. to become an independent physician investigator. It will also further the development of the psychotherapy research program at Cornell by expanding it into the area of panic disorder. The award will free Dr. Milrod from much of her present clinical responsibility and enable her to obtain the training and experience necessary to become a well-rounded investigator. The training plan is built on specific educational experiences dedicated to achieve specific educational aims, with close tutoring by expert clinical research faculty. The specific aims of the research plan are to: 1) Conduct a randomized controlled trial of PFPP in comparison with relaxation treatment (ART) for patients with panic disorder. 2) Building upon previous research, to test a set of instruments that can reliably distinguish between the already-manualized Panic-Focused Psychodynamic Psychotherapy (PFPP) and applied relaxation training (ART). The plan develops a method of testing the efficacy of an accessible and commonly practiced treatment, psychodynamic psychotherapy, for a specific DSM Axis I disorder, panic disorder. Psychodynamic psychotherapy is a widely-practiced, understudied treatment that deserves careful assessment in clinical populations. Panic disorder is a significant public health problem, from which some treatment responders may relapse after receiving therapies that have been researched to date. Academic and research activities will take place throughout the award period. Upon completion of the award, Dr. Millrod will serve as principle investigator in psychotherapy research studies, and as mentor to residents, child and adolescent psychiatry fellows, medical students and colleagues. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: BEHAVIORAL INTERVENTION FOR DEPRESSION IN NURSING HOMES Principal Investigator & Institution: Meeks, Suzanne; Associate Professor; Psychology; University of Louisville University of Louisville Louisville, Ky 40292 Timing: Fiscal Year 2002; Project Start 01-APR-2002; Project End 31-MAR-2005 Summary: (provided by applicant): The risk for depression is nearly twice as great among nursing home residents as it is for community-residing elders, with up to 50 percent of nursing home residents affected by significant depressive symptoms. Although we now have a good understanding of the epidemiology and manifestations of depression in late life, and are beginning to apply effective treatments to some groups of elders, the benefits of the past decade of research have yet to reach the frailest elders living in nursing homes. Depression in long-term care is a significant public health issue. The health and cognitive multiple comorbidity of this population makes treatment, and treatment research, extremely challenging. The broad goal of this proposal is to adapt an efficacious psychosocial intervention for depression to the nursing home setting, using the public health model of intervention research and the exploratory/development mechanism provided by NIMH for implementing such work. There are 3 specific aims: (1) To use a collaborative treatment development process involving nursing home staff to adapt a behavioral intervention for treating depression in elders with cognitive impairment to nursing home residents with a range of physical and cognitive abilities; (2) to conduct a pilot effectiveness study on the adapted intervention, using a replicated, single-subject design, in 2-3 nursing homes other than the one in which the initial treatment development process took place, and (3) as a part of the effectiveness study, to collect data on staff outcomes and cost effectiveness. The treatment has a behavioral theoretical basis, and focuses on increasing opportunity for

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pleasant events to increase levels of activity and positive affect. Treatment is implemented primarily by existing nursing facility staff, with supervision from a licensed psychologist, making ultimate dissemination of this treatment practical and affordable. Standardizing the treatment collaboratively with staff insures a high level of staff acceptance and maximizes feasibility in the nursing home setting. The treatment evaluation design employs a replicated, multiple-baselines-within-subjects design and Hierarchical Linear Modeling, optimizing features from single-case and group research. Each participant will be observed for a minimum of a two-week baseline, followed by six weeks of active intervention, four weeks of maintenance, and a three-month followup. Measures include comprehensive psychiatric evaluation and diagnosis, depression and mood rating scales, observed affect and activity participation, behavior problems, and staff burden. The end-product of the work will be a standardized treatment protocol ready for formal multi-site intervention trials. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: BIOBEHAVIORAL EFFECTS OF EMOTIONAL EXPRESSION IN CANCER Principal Investigator & Institution: Cohen, Lorenzo; Associate Professor; Behavioral Science; University of Texas Md Anderson Can Ctr Cancer Center Houston, Tx 77030 Timing: Fiscal Year 2002; Project Start 11-FEB-2002; Project End 31-JAN-2007 Summary: Models of cognitive processing suggest that once a traumatic event is appropriately understood and integrated the stress associated with the event will diminish. Thoughts and feelings surrounding a traumatic experience are often disorganized, yet when disclosed verbally or through writing, they can assume the form of an organized, coherent narrative resulting in improved health outcomes. This is illustrated by recent findings that indicated that a brief written emotional expression exercise was associated with improved physical health, psychological well-being, physiological functioning, and general functioning. This writing exercise was also associated with beneficial changes in immune function. The brief writing intervention is hypothesized to increase cognitive processing and foster adaptation to traumatic events. To date, however, most research examining this intervention has been conducted in healthy populations. The diagnosis and treatment of cancer are traumatic experiences associated with distress and the fear of cancer recurrence, progression, and death. The impact of stress on the immune system may be particularly detrimental to patients with renal cell cancer, as this cancer is immunogenic, meaning that the immune system regulates progression of the disease. Because emotional expression writing interventions have been shown to facilitate adaptation, reduce stress, improve psychological adjustment and QOL, and positively impact immune function, this type of intervention may be beneficial in patients with renal cancer. Pilot data from our laboratory suggest that it is feasible to conduct the emotional expression writing intervention in patients with renal cancer. Results from this study also provide initial evidence that the intervention increases cognitive processing and improves psychological well- being. The proposed study will assess the benefits of this written emotional expression exercise in patients with renal cell carcinoma. Patients in this study will be randomly assigned either to an emotional expression writing group or to a neutral writing group. This research will also evaluate the extent to which psychosocial factors mediate or moderate the effects of the intervention program and predict recovery and adjustment. The effects of the intervention should be evident throughout recovery and across indices of quality of life, mental health, subjective symptoms of stress, and immune function. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: BIOBEHAVIORAL MECHANISMS OF DEPRESSION IN WOMEN Principal Investigator & Institution: Cyranowski, Jill M.; Psychiatry; University of Pittsburgh at Pittsburgh 350 Thackeray Hall Pittsburgh, Pa 15260 Timing: Fiscal Year 2002; Project Start 20-AUG-2001; Project End 31-JUL-2006 Summary: (provided by applicant): This Mentored Research Scientist Development Award (MRSDA) is designed to promote the Candidate's long-term goal of becoming a women's health researcher with expertise in the etiology and treatment of depression in women. The training and research activities described in this MRSDA will facilitate the Candidate's training in the methods of acute stress research and neurohormonal assessment techniques, and the integration of these techniques within her own background in depression intervention research. This interdisciplinary training will provide the Candidate with the skills and experience needed to pursue an independent program of research testing biobehavioral mechanisms of stress sensitivity, depression vulnerability, and ultimately, depression treatment outcomes in women. Post-pubertal females are twice as likely as males to experience a lifetime episode of major depression, and are particularly likely to become depressed when faced with stressful life events. This gender-linked health disparity persists throughout women's reproductive lives, carrying deleterious consequences for both the woman herself and the children under her care. We (Cyranowski et al., 2000) have theorized that women's sensitivity to interpersonal life stress is mediated, in part, by the hypothalamic neurohormone, oxytocin. Oxytocin is known to play a key role in female reproductive processes. A growing body of animal research indicates that oxytocin is critically regulated by female reproductive hormones, and that oxytocin serves to facilitate female affiliative behaviors and down-regulate the hypothalamic-pituitary-adrenal (HPA) stress axis. The proposed pilot study was designed to provide a preliminary examination of the role of oxytocin in women's stress sensitivity and depression vulnerability. Twenty-two normal cycling, depressed females aged 21-40 and 22 age-matched never-depressed controls will be recruited to participate in a 3-hour laboratory experiment designed to stimulate, measure and compare peripheral oxytocin release and basal oxytocin concentrations within and between groups, and to examine whether peripheral oxytocin release is associated with a down-regulation of the HPA stress axis following an acute stress task. Subjects will also complete self-report measures of depression, anxiety, interpersonal function, trauma history, and recent life stress. Subjects will then be retested with the laboratory paradigm at 18 weeks follow-up, or for depressed subjects, following a course of interpersonal psychotherapy (IPT). The skills, training, and pilot data obtained from this MRSDA will subsequently be used to support the Candidate's development of an R0l application in Years 03-05 of the award period. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: BRIEF ALCOHOL INTERVENTION WITH DEPRESSED PATIENTS Principal Investigator & Institution: Ramsey, Susan E.; Rhode Island Hospital (Providence, Ri) Providence, Ri 029034923 Timing: Fiscal Year 2003; Project Start 05-SEP-2003; Project End 31-MAY-2008 Summary: (provided by applicant): Heavy alcohol consumption is common among patients seeking treatment for depression. Heavy drinking is associated with a variety of medical and psychosocial problems. Heavy drinking is particularly problematic among depressed patients, increasing the likelihood of poor depression treatment outcomes. While methods for reducing alcohol use in this population have been unexplored to date, brief interventions to reduce heavy alcohol use have been well-validated in

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numerous patient populations and offer the promise to reduce heavy drinking among depressed patients and to improve depression treatment outcomes. We hypothesize that adding a brief alcohol intervention to standard psychiatric care, relative to standard psychiatric care alone, will reduce overall drinking volume and heavy drinking days among heavy-drinking depressed patients. Furthermore, we expect patients who receive the brief alcohol intervention to have better depression outcomes than patients receiving standard psychiatric care alone. We also expect that reduced alcohol consumption will mediate the effect of the brief alcohol intervention on depression outcomes. In addition, we will examine individual difference variables as predictors of change in alcohol use. The proposed study is a randomized, two-group design with repeated measures over time, comparing a brief, motivationally-focused alcohol intervention plus standard psychiatric care to standard psychiatric care alone. For this study, we will recruit a sample of 240 psychiatry clinic outpatients meeting structured diagnostic criteria for major depressive disorder who drink heavily but are not alcohol dependent. We expect that the results of this study will improve depression treatment outcomes for the significant sub-population of depressed patients who drink heavily and are likely to do poorly in depression treatment in the absence of a change in their drinking behavior. The intervention proposed in this study represents a novel approach to reducing heavy drinking among depressed patients that, if effective, can be readily integrated into depression treatment in a variety of treatment settings. In addition, this study will provide valuable information on the association between alcohol use and depression outcomes and on the mechanisms of change in alcohol use among heavy-drinking depressed patients. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: CHILD PSYCHIATRY INTERVENTION RESEARCH CENTER Principal Investigator & Institution: Shaffer, David S.; Irving Phillips Professor; New York State Psychiatric Institute 1051 Riverside Dr New York, Ny 10032 Timing: Fiscal Year 2002; Project Start 24-SEP-1999; Project End 31-MAY-2004 Summary: This is an application for a Child Psychiatry Intervention Research Center (CPIRC) at New York State Psychiatric Institute. The CPIRC comprises: 1) The Central (Administrative) Core (Director: David Shaffer, M.D.) will perform administrative functions for all Cores, distribute small grants, oversee protocols to insure consumersensitive practice, insure coordination between the locally based NIMH Research Unit for Pediatric Psychopharmacology (RUPP), the Ruane Early-Diagnosis Center, and if funded the Anxiety Disorders IRC, will maintain a local Area Network (LAN) to serve all CPIRC users; 2) a Clinical Core (PI: Rachel Klein, Ph.D.) will recruit and screen subjects for treatment studies and will provide post-protocol care; 3) a Psycho-therapy Core (PI: Myrna Weissman, Ph.D.) will provide training and archival materials for manualized psychotherapies; 4) a Biostatistics, Measurement, Effectiveness Evaluation Core (PI: Andrew Leon, Ph.D.) will provide consultation on biostatistics, and research design, that will advise investigators on planning and conducting of effectiveness studies that will advise and train research staff on measurement choice and will manage and customize entry into a uniform database; and 5) a Psychopharmacology Core (PI: Laurence Greenhill, M.D.) that will monitor safety parameters, provide manuals to standardize psychopharmacology studies, will provide training and will facilitate pharmacological and basic science studies related to treatment response. Over the past four years, there has been a Child Psychiatry CRC that performed some but not all the treatment related functions that will be carried out by the CPIC that CRC screened over 1,698 individuals and referred over 718 to treatment protocols, provided consultation on

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75 research projects, provided over 200 consultations related to publications and research-grant applications, and given courses whose combined audiences numbered in the hundreds. CRC users were productive: over a 4 year period wrote 367 publications that related to Center activities. This flourishing research environment, will be maintained by the CPIRC. The CPIRC will start life with a large number of experienced researchers and 28 funded treatment protocols. It will provide the infrastructure necessary for successful recruitment, sophisticated design badly needed in a field characterized by the widespread use of medical and psychotherapies of unproven value and safety for children and teens. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: CHILD/ADOLESCENT ANXIETY MULTIMODAL TREATMENT STUDY Principal Investigator & Institution: Piacentini, John C.; Associate Professor; None; University of California Los Angeles 10920 Wilshire Blvd., Suite 1200 Los Angeles, Ca 90024 Timing: Fiscal Year 2002; Project Start 01-SEP-2002; Project End 31-MAY-2006 Summary: (provided by applicant): With point prevalence estimates ranging from 12 percent to 20 percent, anxiety disorders are among the most common conditions affecting children and adolescents. The three most commonly impairing childhoodonset anxiety disorders are separation anxiety disorder, social phobia and generalized anxiety disorder. As a group, these disorders routinely co-occur and cause clinically significant distress and impairment affecting school, social, and family functioning. Left untreated, these disorders leave children at risk for anxiety disorders, major depression and, in some cases, substance abuse extending into late adolescence and adulthood. Hence, effective treatments for childhood-onset anxiety disorders promise to alleviate and perhaps to prevent long-term morbidity and even mortality. In randomized controlled trials, we have shown that two monotherapies, cognitive-behavioral therapy (CBT) and the selective serotonin reuptake inhibitor (SSRI), fluvoxamine (FLV), are effective treatments for separation anxiety, social phobia, and generalized anxiety disorders in children and adolescents. Even though the monotherapies are effective a substantial number of patients remain symptomatic following treatment and, might have benefited from combined treatment. There are as yet no systematic, controlled studies comparing CBT and an SSRI, alone or in combination, against a control condition in the same patient population. This revised application proposes a four-year, six site, randomized controlled efficacy trial comparing cognitive-behavioral (CBT) and pharmacological treatment for youth ages 7 to 16 years with anxiety disorders. Phase 1 is a 12-week, random assignment acute efficacy study comparing CBT, FLV, their combination (n=90, each condition), and pill placebo control (n=48) in 318 (53/site) youth with DSM-IV primary diagnoses of separation anxiety, social phobia, and/or generalized anxiety disorder. Phase II involves a 6-month treatment maintenance period for Phase I responders. All subjects regardless of response status will be evaluated at all scheduled assessment points. In addition to comprehensive parent, child, clinician, and teacher reports, the primary outcome variables will be assessed by blind independent evaluators. Manualized intervention and assessment protocols plus state-of-the-art quality assurance and adverse event monitoring procedures insure uniform cross-site administration of the study protocol. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: COGNITIVE THERAPY FOR PERSONALITY DISORDERS Principal Investigator & Institution: Hayes, Adele M.; Associate Professor; Psychology; University of Miami Coral Gables Box 248293 Coral Gables, Fl 33134 Timing: Fiscal Year 2002; Project Start 01-JUN-2002; Project End 31-MAY-2005 Summary: (provided by applicant): The Cluster C personality disorders (obsessivecompulsive, avoidant, and dependent) are the most prevalent personality disorders (PDs) in outpatient samples. These PDs are highly comorbid with mood and anxiety disorders. Patients with comorbid PD and Axis I disorders present with more severe and chronic symptom profiles, and they do not respond well to psychotherapy or pharmacotherapy. It is particularly difficult to establish a therapeutic alliance, a welldocumented predictor of treatment outcome, and treatment retention and compliance are often compromised. Given the prevalence of Cluster C PDs and their significant impact on psychosocial functioning, treatment response, and health care utilization, it is surprising that little attention has been paid to treatment development for this population. Cognitive therapy has been demonstrated to be an effective treatment across a number of Axis I disorders and recently has been extended to PDs. In a sample of patients with obsessive-compulsive (OCPD) and avoidant (AVPD) PDs, the first open trial of cognitive therapy for PDs (CT-PD) demonstrated significant improvements in personality symptoms, as well as in symptoms of depression and anxiety. Because the therapy is in early stages of development, general principles and guidelines for treatment of PDs are provided, but there are few specific details on how to treat OCPD and AVPD. This lack of specificity limits the extent to which the manual can be used to conduct larger scale clinical trials outside of the Center for Cognitive Therapy, where the manual was developed. The goal of this R-21 treatment development research is to identify active ingredients of the therapy and to use this process research to improve the specificity of the manual. CT-PD is thought to have its effects by exposing patients to corrective information challenging existing personality patterns, identifying the historical roots of these patterns, and providing exercises to facilitate generalization. The proposed study will examine these interventions as predictors of three hypothesized precursors of change: turbulence in defensiveness and avoidance (protection), the therapeutic alliance, and in-session affect. Growth curve modeling will be used to examine sequencing and timing of therapist interventions and relations between these interventions and the hypothesized precursors of change, which will then be examined as predictors of symptom reduction. Quality of therapeutic alliance in early sessions will be examined as a predictor of treatment retention. With this information, sections of the treatment manual on OCPD and AVPD can be refined, strategies to facilitate therapeutic alliance and symptom change can be specified, and the refined manual can be used in future proposals examining treatment efficacy. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: COGNITIVE THERAPY VIA CD ROM FOR BINGE EATING DISORDER Principal Investigator & Institution: Bulik, Cynthia M.; Professor; Psychiatry; Virginia Commonwealth University Richmond, Va 232980568 Timing: Fiscal Year 2002; Project Start 01-APR-2001; Project End 31-MAR-2004 Summary: Although eating and weight-related disorders are treatable, most afflicted individuals never receive proper treatment. Despite the existence of excellent prototype cognitive-behavioral programs for the treatment of binge-eating disorder (BED) and other eating disorders, we face a crisis of dissemination. The goal of this project is to join

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cognitive-behavioral therapy (CBT) with novel information technology to develop an interactive CBT program that will allow individuals to experience the basics of CBT in the privacy of their own homes. This Exploratory/Development Grant for Mental Health Intervention (R21) proposes a four stage project to develop a CD-ROM-based program for the effective delivery of cognitive-behavioral therapy (CBT) to obese individuals with binge-eating disorder (OBED) and other unhealthy eating behaviors. In Phase 1 of the project, we will continue development of a CD-ROM program that we began in 1998. The program will be a rich, vivid, and interactive approach to CBT that provides helpful psychoeducation on unhealthy eating and weight-related practices; clearly introduces the basic concepts and techniques of CBT; provides rich and vivid examples of techniques; provides individualized and interactive exercises for practicing CBT principles; and enables users to contact the central web site and staff with questions. This program will be applicable to a broad range of adult women and men of all races and backgrounds. In Phase 2, we will implement a rigorous four-stage betatesting procedure that includes: group testing sessions followed by individual and focus group debriefing for feedback; peer review by experts in the field of CBT for eating disorders; and in-home beta testing prior to final production. Phase III of the project will be a small feasibility and pilot study comparing the efficacy of the CD-ROM-based delivery of CBT to traditional manual-based group therapy for individuals with OBED and a wait list control. Data from this pilot study will be used to support Phase IV, which will develop a proposal for a large-scale clinical trial comparing CD-ROM-based intervention with traditional group therapy. We anticipate that a CD-ROM-based program will be an efficacious and cost-effective intervention. For some, this program may suffice for treating their eating and weight-related problems. For others, it may be a useful adjunct to traditional psychotherapy or an introductory step to treatment which will familiarize them with the principles and techniques of CBT and increase their comfort and motivation to seek additional professional care. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: COGNITIVE TRAINING FOR SOCIAL ANXIETY Principal Investigator & Institution: Huppert, Jonathan D.; Assistant Professor of Psychology in Psy; Psychiatry; University of Pennsylvania 3451 Walnut Street Philadelphia, Pa 19104 Timing: Fiscal Year 2003; Project Start 11-JUN-2003; Project End 31-MAY-2007 Summary: (provided by applicant): This application proposes Jonathan D. Huppert, Ph.D. for a K23 Mentored Patient Oriented Research Career Development Award at the University of Pennsylvania. The overarching goal of this award is for the applicant to acquire expertise in information processing/cognitive science of anxiety disorders and to translate this knowledge to the treatment of anxiety disorders through an independent program of research funded by NIH. The four-year program discussed in this proposal is designed to accomplish this goal by through five aims: 1) to solidify his foundation in cognitive science and advanced research methods; 2) to establish a research program on cognitive training of social anxiety that will integrate cognitive science and clinical outcome research; 3) to write and publish empirical and theoretical papers about such an integration; 4) to create collaborative relationships with clinical and cognitive science faculty at the University of Pennsylvania as well as other experts in the field; and 5) to prepare for further funding for this programmatic line of research. These aims will be accomplished through a structured four-part plan: 1) to receive further formal instruction in cognitive science, advanced research design, and bioethics; 2) to obtain training and mentoring by a senior scientist experienced in this area (Edna

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B. Foa, Ph.D.) as well by a collaborator (Andrew M. Mathews, Ph.D.) and consultants (Colin M. MacLeod, Ph.D., Richard G. Heimberg, Ph.D., David M. Clark, Ph.D., and Xin Tu, Ph.D.); 3) to coordinate ongoing clinical research trials at the Center for the Treatment and Study of Anxiety; 4) to design and execute an original program of research. A series of studies examining the factors involved in the modification of interpretation and attentional biases in social anxiety will be conducted. The goal of these investigations is to create a cognitive training program that directly addresses the core biases involved in causing and maintaining social anxiety. First, a new measure of interpretation bias will be developed using contextual priming in order to have a measure that is less likely to be confounded by repeated administration. Simultaneously, the nature of attentional bias in social anxiety will be clarified in order to bring some resolution to conflicting findings in the literature. Then, potential for modifying interpretation bias will be examined. In parallel, parameters related to modifying attentional bias in social anxiety will be examined. In addition, the relationship between cognitive biases and cognitive-behavioral therapy outcome in patients diagnosed with social phobia will be evaluated. Based on these findings, a cognitive training program for social phobia will be developed and will be further evaluated in future research. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: COMBINED PHARMACOTHERAPIES FOR ALCOHOLISM Principal Investigator & Institution: Johnson, Bankole A.; Wurzbach Distinguished Professor and Dep; Psychiatry; University of Texas Hlth Sci Ctr San Ant 7703 Floyd Curl Dr San Antonio, Tx 78229 Timing: Fiscal Year 2002; Project Start 10-SEP-2001; Project End 31-JUL-2006 Summary: Recent scientific and clinical interest in combining therapeutic agents for the treatment of alcoholism are based on the fact that derangement of multipleneurotransmitter systems are likely to underlie biological predisposition to the disease. Thus, combining effective medications working at different neurotransmitters should produce a synergistic or at least an added clinical response. In animals, the combination of the 5-HT3 antagonist, ondansetron, and the mu receptor antagonist, naltrexone show synergism of action at reducing ethanol consumption. Alcoholics with an early onset of disease are effectively treated by ondansetron, and those with a family history of alcoholism in first degree relatives may have the best clinical outcome to treatment with naltrexone. Given that family history of alcoholism is associated with an early onset of disease, it reasonable for us to predict that the combination of ondansetron and naltrexone should be more optimal than either alone for the treatment of Early Onset Alcoholics (EOA). Indeed, preliminary clinical data from our group provide strong support that the medication combination is an effective treatment for EOA. We will test this hypothesis by comparing the effectiveness of ondansetron (4 mg/kg) and naltrexone(50 mg/day), both alone and in combination, in treating EOA vs. Late Onset Alcoholics (LOA) (total N of 45 subjects/cell x 8 cells = 360) in a randomized, doubleblind, placebo-controlled, 12-week (1 week of single-blind placebo followed by 11 weeks of the double-blind condition) outpatient clinical trial. All subjects will receive standardized Cognitive Behavioral Therapy, and follow-up at 1, 3, 6, and 9 months posttreatment. Specifically, we predict that: 1) EOA, compared with LOA, will be more responsive to treatment with either ondansetron or naltrexone alone, and 2) that the combination of ondansetron and naltrexone will be superior to either medication alone in the treatment of EOA. We will have the unique opportunity to test with adequate power the secondary hypothesis that the combination of ondansetron and naltrexone

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will be better tolerated than naltrexone alone, thereby improving compliance. This is because nausea is an important side-effect of naltrexone which can limit compliance, and as shown in our preliminary study, ondansetron by having anti-nausea and antiemetic properties counteracts this naltrexone side-effect. We support NIAAA's mission to develop effective pharmacotherapies as adjuncts to psychotherapy for the treatment of alcoholism. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: COST EFFECTIVENESS OF ALCOHOL TREATMENT Principal Investigator & Institution: Zarkin, Gary A.; Director; Research Triangle Institute Box 12194, 3040 Cornwallis Rd Research Triangle Park, Nc 27709 Timing: Fiscal Year 2002; Project Start 02-AUG-2000; Project End 31-JUL-2005 Summary: Alcohol and drug abuse impose significant costs on society. In 1992, the economic cost of alcohol and drug abuse was estimated to be 246 billion dollars. The majority of these costs arise from alcohol abuse (148 billion dollars). Partly in response to these costs, new pharmacotherapies have recently been developed to treat alcohol abuse and alcoholism. Likewise, important advances have been made in the development of behavioral interventions designed to treat alcohol abuse. While new alcohol abuse therapies have been developed over the last several years, pressures have been developing to identify therapies that are not only efficacious but also cost-effective. Much of this pressure has been driven by managed care, which has placed a premium on economic studies that assess whether the clinical and economic outcomes of new pharmaceutical and behavioral therapies justify their costs. To increase the understanding of the efficacy of two pharmacotherapies (naltrexone and acamprosate) and psychotherapy, the National Institute on Alcohol Abuse and Alcoholism (NIAAA) recently funded Project COMBINE, a multi-site, randomized control trial (RCT). This trial is one of the most ambitious clinical trials ever undertaken for the treatment of alcoholism. However, in spite of the importance of economic analysis of clinical trials, the Project COMBINE protocol does not include cost or cost-effectiveness studies. The purpose of this study is to examine the costs and cost-effectiveness of behavioral and pharmacotherapies for alcoholism (and their combination) included in Project COMBINE. Our proposed project builds on Project COMBINE's RCT design, which will provide great credibility of our results in the scientific community. Because of the number of therapies studied, the strength of the study design, and the limited existing literature on the cost and cost-effectiveness of alcohol treatments, the proposed study represents a major advance in the cost and cost-effectiveness analysis of alcohol treatment; our results should have a profound effect on the choice of alcohol treatment in the United States. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: DEPRESSION

CULTURALLY

RELEVANT

PSYCHOTHERAPY--PERINATAL

Principal Investigator & Institution: Grote, Nancy K.; None; University of Pittsburgh at Pittsburgh 350 Thackeray Hall Pittsburgh, Pa 15260 Timing: Fiscal Year 2003; Project Start 01-APR-2003; Project End 31-JAN-2008 Summary: (provided by applicant): Depression during the perinatal period has adverse effects on the mother, on the development of her newborn infant, and on her family relationships. The purpose of this proposed mentored Patient-Oriented Research Career Development (K23) Award is to promote the Candidate's long-term goal of conducting

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clinical trials of culturally relevant, psychosocial interventions for perinatal depression in low-income, African American and White Ob/Gyn patients to ameliorate their depression during pregnancy and prevent postpartum depression. The training and research activities described in this application will take place in the cross-disciplinary environment of the School of Social Work and the Department of Psychiatry, University of Pittsburgh. Training will enable the Candidate to assess perinatal mood disorders, develop culturally relevant strategies to effectively engage and retain Ob/Gyn patients in multi-session psychosocial interventions, conduct randomized clinical trials of psychosocial treatments, and collaborate with health services researchers to enhance the public health value of the intervention. Interpersonal psychotherapy (IPT) addresses both depressive symptoms and problematic interpersonal relationships and is an efficacious treatment for depression in general (Weissman, Markowitz, & Klerman, 2000), as well as for depressed African American and White primary care patients (Brown et al, 1999). The first phase of this research plan consists of employing an 8session form of IPT 0PT-B; Swartz, Frank, & Shear, 2002) and modifying it to be more culturally relevant to poor, African American and White Ob/Gyn patients by incorporating a number of engagement strategies to minimize practical and psychological practical barriers to care. The second phase of the research plan consists of a small, randomized pilot trial comparing treatment as usual to culturally relevant IPT-B (followed by monthly maintenance IPT up to 6 months postpartum) in a sample of depressed, pregnant, low-income African American and White patients in a public care Ob/Gyn clinic. Participants will be assessed at baseline, posttreatment, and 2 months and 6 months postpartum. The skills, training, and pilot data obtained from this award will support the development of an RO1 application in Years 03-05 of the award period. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: DAILY PROCESS DESIGN APPLIED TO COGNITIVE THERAPY Principal Investigator & Institution: Cohen, Lawrence H.; Psychology; University of Delaware Newark, De 19716 Timing: Fiscal Year 2003; Project Start 01-APR-2003; Project End 31-MAR-2005 Summary: (provided by applicant): The proposed project represents the first application of daily process measures of stress and coping, and idiographic indices of affect regulation, to research on cognitive therapy (CT) for depression. The daily stress and coping measures will be administered by an interactive voice response (IVR) procedure, and the idiographic indices will be computed using hierarchical linear modeling (HLM). Specifically, idiographic indices of affect regulation will be computed at the beginning of CT (Time 1), and again six sessions later (Time 2). We will evaluate the utility of the Time 1 indices as predictors of CT outcome (depression-reduction), and the utility of the Time 2 indices as measures of the effects of CT. It is hypothesized that depressed individuals with better initial ability to regulate daily negative affect will show more symptom reduction in CT than individuals with worse initial ability to regulate daily negative affect. It is also predicted that patients' ability to regulate daily negative affect will-improve during the course of CT. If successful, our project will demonstrate the value of an IVR-based daily process methodology, and HLM-based idiographic indices of daily affect regulation, for research on psychotherapy outcome. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: DEPRESSION AND HEALTH OUTCOMES IN REFRACTORY EPILEPSY Principal Investigator & Institution: Gilliam, Frank G.; Neurology; Washington University Lindell and Skinker Blvd St. Louis, Mo 63130 Timing: Fiscal Year 2002; Project Start 24-AUG-2001; Project End 31-JUL-2006 Summary: (provided by applicant): Epilepsy is the most prevalent disabling neurologic illness, and depression is the most frequent comorbid condition associated with epilepsy. The prevalence of depression is 20-50 percent in patients with uncontrolled seizures. This combination affects between 250,000 and 450,000 people in the United States. Our recent clinical studies have shown that depression is a strong predictor of function and health outcomes in epilepsy. Despite the marked adverse effects and high prevalence of depression in epilepsy, most affected patients are not treated. This complacency toward treatment may result from insufficient use of diagnostic screening, the widespread belief that antidepressants lower the seizure threshold, or lack of demonstrated efficacy in the only controlled trial of antidepressant medications in epilepsy. The broad aims of this study are to define the benefits of antidepressant treatment on mood, compliance, and health outcomes in epilepsy patients with comorbid major depression. Based on our prior clinical and research experience, we hypothesize that 1) pharmacotherapy or psychotherapy will reduce depression and improve health-related quality of life in patients with refractory epilepsy, 2) antiepileptic medication compliance will improve after reduction of depression, 3) seizure frequency will not significantly increase during treatment with a selective seratonin reuptake inhibitor compared to psychotherapy, and 4) depression and antiepileptic medication toxicity are stronger predictors of health-related quality of life than seizure frequency or severity in patients with refractory epilepsy. The hypotheses will be tested through a randomized trial comparing the efficacy of sertraline (n=127) to cognitive behavior therapy (n=127) for mood and health outcomes in patients with refractory epilepsy and depression. Reliable and valid measures will be used to assess depression and healthrelated quality of life. Electronic, computer-assisted monitoring will determine compliance. Multivariate repeated-measures analyses will be used to determine the interrelationships of treatment, mood, antiepileptic medication toxicity, seizure frequency and severity, compliance and health-related quality of life. We anticipate that dissemination of the results of a positive study will support the modification of the current model of intervention for epilepsy from predominantly seizure reduction to a more comprehensive approach that includes assessment and treatment of depression Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: DEPRESSION AND INSULIN RESISTANCE IN TYPE 2 DIABETES Principal Investigator & Institution: Lustman, Patrick J.; Professor of Psychiatry; Psychiatry; Washington University Lindell and Skinker Blvd St. Louis, Mo 63130 Timing: Fiscal Year 2002; Project Start 30-SEP-2002; Project End 31-JUL-2007 Summary: (provided by applicant): The overall purpose of this study is to determine the impact of depression on insulin resistance (IR) in diabetes. IR characterizes type 2 diabetes (T2DM) and is a predictor of diabetes complications, particularly coronary heart disease (CHD). CHD, in turn, accounts for more than 50% of deaths and 75% of hospitalizations among diabetic patients. Because of this, potentially modifiable factors contributing to IR are being sought. There is evidence linking IR to depression in nondiabetic subjects, and IR may improve with depression treatment in these subjects. Depression is present in approximately 20% of patients with type 2 diabetes (T2DM),

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precedes the onset of diabetes diagnosis by more than 5 years on average, and may be responsible for some of the IR typifying T2DM and its CHD risk. In a 10-year prospective study of diabetic women with and without depression, we found that depression accelerated the development of (p