A Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine. / Background. Rates of childhood obesity in the United States have risen dramatically in recent decades, with more than 31% of children currently classified as overweight or obese. This raises concerns about the effects of weight on outcomes for pediatric illness, including cancer. There is some evidence of poorer outcomes for pediatric leukemia patients who are overweight or obese, and studies in adults have suggested negative impacts of obesity in numerous cancer types. To date, there are no studies investigating outcomes in overweight and obese children with Hodgkin lymphoma (HL). Our hypothesis was that higher body mass index (BMI) at diagnosis is associated with increased risk for HL relapse. Methods. We conducted a retrospective cohort study of 101 pediatric HL patients treated between 1980 and 2010 at Phoenix Children’s Hospital, a large pediatric oncology referral center in the Southwestern United States. Data was abstracted from electronic and paper medical charts as well as survival clinic follow‐up records. We performed logistic regression and conducted a survival analysis to test whether body mass index (BMI) at diagnosis was associated with time to disease relapse. For this pilot study, we conducted a primary analysis as well as several exploratory secondary analyses with the goal of generating hypotheses to be tested in future large studies of this population. Results. In the primary analysis comparing underweight and normal children to overweight and obese children, none of the patient characteristics – sex, race, age, clinical risk level, or radiation status – were significantly associated with BMI group. In the univariate analysis of HL relapse, children in the overweight/obese group had an increased unadjusted odds ratio of 1.58 (95% CI: 0.50‐5.28), but this was not statistically significant. Exploratory analyses categorizing BMI groups in various ways also suggested an association between increased BMI and risk for HL relapse, though this failed to reach statistical significance. No potential confounders were associated with HL relapse except radiation status (p=0.004), although we were unable to calculate an odds ratio due to a lack of patients in some subgroups. In the survival analysis, radiation was the only variable significantly associated with time to HL relapse. Kaplan‐Meier curves of relapse‐free survival time did not show a significant difference between BMI groups in the primary analysis, but secondary analyses suggested a nonsignificant trend toward decreased long‐term disease‐free survival in patients with higher BMI. Discussion. The relatively small sample size for this pilot study precluded demonstration of statistically significant differences in HL relapse risk or time to relapse between BMI groups. However, exploratory analyses suggested a trend toward increased risk for relapse and shorter disease‐free survival in patients with higher BMI, and these results merit further investigation in larger studies. Multi‐center collaborative studies will be required to attain sufficient sample sizes to accurately assess clinical prognosis in this patient population. Improving our understanding of how BMI affects pediatric cancer outcomes is an important step toward identifying patients at increased risk and determining how best to individualize treatment and monitoring plans for overweight and obese children.

Introduction: This study explored the subjective experience of relapse of psychosis from the patients’ perspective and the meanings they attach to the relapse, their prevention and their perception of risk of relapse. Method: A qualitative methodology was used based on a semi-structure interview. Audio tapes were transcribed verbatim and two researchers participated in a content analysis that identified five major themes: meaning of relapse, perceived risk of relapse in the future, views on antipsychotic medication, subjective risk and protective factors of relapse and the cost of having psychosis. Results: Patients’ view of relapse was similar to those held by psychiatrists, however, patients had a broader definition of the criteria of relapse, extending from family support to medication discontinuation. Their major concerns were the side effects and the independence of antipsychotic medication. Conclusion: Ideas about what constitutes relapse need to take into account the patients’ views and experiences in order to further improve and develop relevant intervention of relapse prevention in early psychosis. / published_or_final_version / Psychological Medicine / Master / Master of Psychological Medicine

Indiana University-Purdue University Indianapolis (IUPUI) / Despite data suggesting that current substance use disorder treatments are largely effective in reducing substance use, most adolescents in SUD treatment experience relapse after finishing treatment. Understanding the factors proximal to relapse is crucial to understanding the course of substance use disorder and how best to improve recovery among adolescents. The current study represents part of a novel line of research using qualitative data analysis to examine these factors. Data for the present study were 200 de-identified node-maps, completed by high school students at Hope Academy, a recovery high school in Indianapolis, Indiana. The reported age in this sample ranged from 14-20 years (64.1% male, 89.1% White), with a mean age of 16.8 years (SD = 1.9 years). After a four-phase process of qualitative data sorting, primary people, places, and things most frequently described included using with others (n=153, 76.5%), away from home (n=156, 78.0%), and in response to negative affect (n=93, 48.4%). Eleven relapse pathways emerged: escaping (n=16), self-medicating (n=3), coping with tragedy (n=5), critical mass (n=6), unexpected activation (n=8), unexpected offer (n=22), planned use (n=19), resistant to recovery (n=5), not in recovery (n=22), passive agency (n=30), and acting out (n=15). Recovery is a system made up of many interrelated parts, including those related to the individual person in recovery, their thoughts, beliefs, feelings, and emotions; and those related to external factors, their environment, adverse life events, and the actions of other people. By considering the pathways together for their common features, they can each be said to represent one of three critical failures related to those three overarching facets of the system: failure to cope, failure to guard against temptation, and failure of belief. Identifying these overarching failures in the system is helpful because the failures contain in themselves the seeds of their solution, so by examining them as critical components to a relapse event, it may be possible to gain insight into how to prevent the same type of relapses from occurring in the future.

The use of illicit drugs continues to be a problem around the world, particularly in the United States. Many individuals relapse following treatment for substance abuse; however, the role that drug attitude plays in the amount of time between treatment and relapse is not known. Research regarding the relationship between attitude and behavior change, drug use and relapse, gender differences in relapse, ways to measure drug attitude, and the relationship between drug attitude and drug use are discussed. The present study utilized a data set that consisted of one hundred subjects who participated in residential treatment for addiction. All subjects were dually diagnosed with major mental illness and a substance use or abuse disorder. The overall purpose of the present study was to examine the relationship between drug attitude at intake and time to relapse following completion of residential treatment. Results indicated that there was no significant relationship between drug attitude and time to relapse following treatment. Results further indicated that there were no differences in scores on Campbell's Drug Attitude Scale for males and females and no difference in time to relapse for males and females. Finally, results demonstrated that scores on the Attitude subscale and the Clinical subscale of Campbell's Drug Attitude Scale did not significantly predict time to relapse.

published_or_final_version / Psychiatry / Doctoral / Doctor of Philosophy

No description available.

ABSTRACT AIM: The aim of this study was to determine, if any, the factors associated with relapse with a view to provide guidelines for prevention, early identification and management of relapse in a community setting. METHOD: The study is a retrospective record review of the patients attending seven randomly selected Community Mental Health Clinics in Southern Gauteng during the period January 1995 to June 2005. Two hundred and seventeen (217) patients aged 18 years with a diagnosis of schizophrenia were included in the study. Patients were excluded if the diagnosis of schizophrenia was made in the preceding six months of the study. Demographic and clinical variables including age, gender, marital status, source of income, highest level of education, non compliance, presence of substance abuse, co-morbid psychiatric condition, the presence and number of relapses and stressful life events were recorded on a data schedule. RESULTS: Two hundred and seventeen patients records were analysed: 61.8% have had at least one relapse. The only factors that provided a significant predictive factor for relapse included non compliance due side-effects, non compliance due to lack of insight, and the presence of depressive symptoms. 64.2% of the study population were non compliers and 27.1% have had depressive features. Demographic variables were not associated with relapse. CONCLUSION: These findings imply that interventions aimed at reducing relapse in schizophrenia should include improving medication compliance and early detection and treatment of depression.

The present study used a Microsoft Visual Basic computer program to examine the effects of changing reinforcement schedule components on response allocation following previously extinguished responding. In Experiment 1, participants allocated responses to three different colored buttons that moved around the screen after each successive click. Components were arranged such that clicking on one button resulted in reinforcer delivery on a programmed variable-interval (VI) 10 s schedule while clicking either of the other two buttons did not result in programmed reinforcer deliveries. Results of Experiment 1 may have been confounded by an unintended signaling of component changes, so an identical experiment was repeated without a point counter visible to the participants. The results of Experiment 2 indicated an induced responding on the button most recently associated with reinforcement when the reinforcement schedule changed. This induction effect is discussed in relation to current conceptions of relapse effects in the scientific literature and implications for treatment of challenging behavior.

Background. The majority of childhood acute myeloid leukemia (AML) patients lack a matched-related bone marrow transplant (BMT) donor in first remission. Procedure. Disease-free survival (DFS), overall survival (OS), relapse-free survival (RFS), and post-relapse outcome were evaluated for children with de novo AML on CCG 213 and the standard timing (ST) and intensive timing (IT) induction arms of CCG 2891 who were randomized to (intent-to-treat, ITT) or who received (as-treated, AT) only chemotherapy intensification. Results. Outcomes at 8 years post-induction in ITT analysis of chemotherapy intensification were as follows: 31% DFS, 43% OS on CCG 213; 34% DFS, 51% OS on CCG 2891 ST; 48% DFS, 56% OS on CCG 2891 IT. All toxic deaths during and following Capizzi II chemotherapy intensification on both protocols were in patients >3 years of age (P ≤ 0.001). Black race was a significant poor prognostic factor for OS (P = 0.008, hazard ratio: 1.74, 95% CI: 1.15-2.61). Overall 48% of patients on both trials relapsed and 19.1% of patients who relapsed on these trials survived. CR1 >12 months portends a much better OS for patients who relapse. Post-relapse treatment included BMT in 47% of patients. Conclusions. OS on CCG 2891 was superior to CCG 213 but equivalent between ST and IT arms due to better salvage rates post-relapse in ST patients. Overall survival for childhood AML in the absence of BMT in CR1 is influenced by duration of CR1 and by race.

This study explored reasons for relapse among a sample of 938 self-identified problematic pornography users. A combination of numeric content analysis and qualitative coding of responses to an open-ended question about pornography relapse revealed six main categories of reasons for relapse. The mental, emotional, and relational categories were then analyzed in detail, and this analysis revealed significant overlap of responses from the emotional and relational categories. Hence, a new category of relational-emotional reasons for relapse was created and analyzed. The findings from this study highlight the complex interactions of different types of factors driving relapse in self-perceived problematic pornography users and future research and clinical applications are discussed.