Cannabis use has been associated with various psychosis outcomes, including psychotic disorders, the clinical high risk period of psychosis, and subthreshold measures of psychotic symptoms in non-clinical samples, such as attenuated positive psychotic symptoms (APPS). The present study examined whether individual- and contextual-level factors account for the relationship between cannabis use and psychosis. Specifically, we hypothesized that the relationship between cannabis and psychosis would be mediated by social functioning; negative, depression, anxiety, and aggression symptoms; context of cannabis use; and motivations for cannabis use. Nine hundred and forty-five young adults ages 18-35 years (M = 20.1 years, 24.4% male) completed self-report questionnaires: the Prodromal Questionnaire, Marijuana Use Form, Social Functioning Scale, Center for Epidemiologic Studies Depression Scale, State-Trait Anxiety Inventory-Trait Form-Anxiety Subscale, Social Phobia Scale, Life History of Aggression Scale, Reasons for Use scale, and Drug Use Frequency questionnaire. Psychosis outcomes included a dimensional measure of APPS and a dichotomous measure indicating potential higher/lower risk for psychosis, based on number of distressing symptoms endorsed (i.e., D-APPS status). A multiple mediation framework was used, and significance of mediators was evaluated through estimating the significance of indirect effects using bootstrapped confidence intervals. Increases in negative and aggression symptoms mediated the relationship between higher cannabis use and increases in APPS. Negative and aggression symptoms, context of cannabis use, and using cannabis to cope with unpleasant affect mediated the relationship between cannabis use and high-D-APPS status. Results indicate that individual and contextual-level characteristics may contribute to the relationship between cannabis use and psychosis. / Psychology

A sizeable proportion of adults suffer from an anxiety disorder and many of those adults are parents. Parental anxiety, as well as dysfunctional family environment, contributes to both internalizing and externalizing problems in children. Specifically, family control, conflict, and cohesion have been shown to predict child internalizing and externalizing symptoms to varying degrees. However, few studies have examined the association between all three components in the same study: parental psychopathology, family environment, and child outcomes. The current study tested the relationships among these variables in a sample of 189 children (66% male, 93% Caucasian, mean age = 10.34 years). Family conflict predicted child externalizing symptoms for both mothers and fathers, and mediated the relationship between maternal anxiety and child externalizing symptoms. Family cohesion predicted child externalizing problems based on maternal report and mediated the relationship between maternal anxiety and child externalizing symptoms. Furthermore, family cohesion moderated the relationship between maternal anxiety and child internalizing symptoms. These findings provide preliminary support for the role of the family environment in the relationship between parental anxiety and child psychopathology, and these environmental variables may be important targets of intervention in families with elevated parental anxiety. / Master of Science

Reward-based learning is the ability to alter our future behavior following a novel reward. Dysregulation in this system has been linked to different forms of adult and pediatric psychopathologies such as mood disorders, for which it has proved to be an important treatment target given its link to broader health outcomes for these disorders. However, more research is needed to better understand its underlying mechanisms in the pediatric population. The current study examined how probabilistic reward learning, feedback-related negativity (FRN; an event-related potential from EEG), and dimensional ADHD symptom severity relate in adolescents with prominent mood symptoms. The final sample included 36 adolescents (72.2% female; aged 13 to 17) who completed a Probabilistic Reward Task (PRT) during EEG recording. Results revealed an inverse relationship between FRN mean amplitude and the reward learning score, independent of mood and ADHD symptoms. We also found that teens with increased overall ADHD symptom severity showed a larger (i.e., more negative voltage) FRN amplitude and a lower reward learning score. Exploratory analyses also showed that as ADHD inattentive symptom severity increased, FRN mean amplitude became more negative and reward learning score decreased. No significant relationship was found with ADHD hyperactive/impulsive symptom severity. In conclusion, our results showed that a poor modulation of behavior based on prior reward contingencies was related to an increase in dimensional ADHD symptom severity in a sample of adolescents with prominent mood difficulties. This behavioral dysfunction was also reflected by a blunted neural habituation to reward feedback as evidenced by a larger FRN mean amplitude. Additionally, exploratory analyses highlighted how the relationship between overall ADHD symptom severity and FRN may be driven especially by symptoms of inattention vs. hyperactivity/impulsivity. Results suggest deficits in reward learning that could impact response to behavioral therapies in youth with mood disorders and comorbid inattentive ADHD.

No description available.

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. / Neuroleptic medications are commonly administered in the emergency department but are known to induce extrapyramidal symptoms (EPS) in some patients; typically dystonia and akathisia. This systematic review will examine if adjunctive medications are efficacious when given in conjunction with neuroleptic medications to prevent these extrapyramidal symptoms. The Central, DARE, LILACS, PubMed, CINAHL, and OVID databases were searched for relevant articles between January 2014 and February 2016. Inclusion criteria required the article to be a randomized controlled trial; administer an anticholinergic medication given concurrently or just prior to treatment with medications with known extrapyramidal side effects; and be published in English. The initial search strategy yielded 1222 prospective articles of which 1208 were excluded by title and/or abstract. Fourteen articles were retrieved in full text and independently reviewed by each author. Seven 7 RCTs representing 645 patients were determined to be appropriate for analysis. Meta‐analysis of 5 studies found a significant effect (OR 0.4 with 95% CI 0.23‐0.71) for utilizing anticholinergic adjunct medications in the prevention of EPS for 60 minutes after administration. No reduction was found (OR 1.14 with 95% CI 0.01‐164) in EPS after 60 minutes in meta‐analysis of 2 studies with opposing results. Adjunctive anticholinergic medication was effective in reducing symptoms of dystonia (OR 0.13 with 95% CI 0.04‐0.43) but not in reducing symptoms of akathisia (OR 0.74 with 95% CI 0.27‐1.98). This systematic review found that anticholinergic adjuvant anticholinergic treatment reduced EPS induced by antipsychotic medications during 60 minutes after administration, with the greatest reduction in dystonic symptoms.

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. / The aim of this study is to conduct a systematic review of the existing evidence on marijuana use and its association, or the absence of an association, with an increased risk of developing chronic obstructive pulmonary disease (COPD), lung cancer, and/or chronic respiratory symptoms. We hypothesize that a systematic review will not demonstrate sufficient evidence to determine that marijuana use increases the risk of developing COPD, lung cancer, and/or chronic respiratory symptoms. The term “chronic respiratory symptoms” encompasses the following: cough, sputum production, wheeze, shortness of breath, acute bronchitis, and chest tightness. The following databases were searched for the topics of marijuana smoking, COPD, lung cancer, and chronic respiratory symptoms: MEDLINE (PubMed/OvidSP), the Cochrane Controlled Trials Register, the Cochrane Database of Systematic Reviews, PsycINFO, the Database of Abstracts of Reviews of Effects, and Google Scholar. The search ended September 7th, 2016. Studies were initially limited only by the requirement that they were based upon human research and published in English. Studies were included if they were systematic reviews, randomized controlled trials (RCTs), prospective or retrospective cohort studies, case control studies, or cross‐sectional studies. A total of 739 articles were screened for eligibility, 17 unique studies met the inclusion criteria and underwent qualitative analysis1‐17. The quality of systematic reviews was evaluated using the AMSTAR criteria18; cohort, case‐control, and cross sectional studies were evaluated based upon the Newcastle‐Ottawa Quality Assessment Scale (NOS) 19. No RCTs were identified. The overall quality of the evidence for each outcome was determined by utilizing the GRADE methodology20‐21. Studies were primarily assessed by a single reviewer, with random validation of assessments on a limited number of studies by a second reviewer. Overall, there is very low quality evidence that assesses for an association between marijuana smoking and an increased risk of developing lung cancer, COPD, and/or chronic respiratory symptoms. There was no conclusive finding for lung cancer and COPD. However, seven of eight studies concluded that there was an association between marijuana use and chronic respiratory symptoms. The totality of evidence describing any associations between marijuana smoking and the risk of developing lung cancer, COPD, and/or chronic respiratory symptoms is not strong enough to confidently state that marijuana use is associated with any of these chronic pulmonary conditions. Of all the evidence examined in this systematic review, the most convincing appears to be that relating to a potential positive association between marijuana smoking and the risk of developing chronic respiratory symptoms. Unfortunately, the overall quality of evidence was very low due to significant methodological weaknesses within the studies. Thus, there is insufficient evidence in the current literature to make a definitive statement regarding this possible association.

Even before the 1990 war the populations of some areas of Kuwait was subject to severe atmospheric pollution. However, little was known about the effect of this pollution on health and on the use of health care. Three areas in Kuwait were chosen for study which were demographically similar and lay at a different distances to the north (i.e. usually downwind) of the industrial area. Plant in this area emits hydrogen sulphide, sulphur dioxide, hydrocarbons, nitrogen oxides, ammonia and carbon monoxide among other pollutants. A special survey was carried out to gather information on demographic, health and lifestyle factors including age, sex, place of residence, smoking, physical symptoms, psychological effects, life satisfaction, environmental problems, experience of air pollution and use of health care. A random sample of 136 households (1140 persons) was chosen from the three areas and studied over the period from lst February 1988 to 31st January 1989. Data on levels of pollution concentrations and meteorological conditions were also collected over the same period for each area studied. Data on use of health care were available from the health centres in the three areas studied and also from the population survey. The demographic similarity of the three areas studied was generally confirmed by the data from population survey. The relationships involved were examined for different age groups using cross tabulation, time series analysis and regression analysis. There were clear gradients with increased distance from the industrial area in levels of pollution, levels of selfreported physical and psychological symptoms and in the use of health care. Of the individual pollutants it appeared that carbon monoxide levels were most closely correlated with levels of symptoms. For those aged less than 18, the link to CO was closest for respiratory symptoms, while for those aged 18 to 64 the link was with headache. The use of primary care is more closely linked to H2S although this relationship is relatively weak. Consider the relationship between levels of pollution in the three areas studied and Kuwait City and the levels of pollution in Shuaiba area taking meteorological conditions into account. The purpose of this was to allow for estimates of the effect of pollution reduction in Shuaiba on the health of population elsewhere in the country. However, no way was and of making such estimates with sufficient prison. This analysis confirmed a number of recommendations that have been made by others.

Community treatment of insanity acquittees is a highly controversial matter among legislators, mental health professionals and the public. At issue is the balancing of public safety concerns with least restrictive, non-punitive rehabilitation alternatives for insanity acquittees. Attempts to determine predictors of dangerousness in mentally ill offenders have produced mixed results with questionable practical value. In view of this, many mental health professionals are instead recommending that research on insanity acquittees be focused on evaluating the effectiveness of mandated community treatment programs for insanity acquittees. One area being designated for such research is the monitoring and management of psychopathology in conditionally released insanity acquittees, as mental deterioration in this population is a primary concern in assuring public safety. This thesis examined the monitoring and management of psychiatric symptomatology in a subsample of conditionally released insanity acquittees.

This study addressed gaps in the literature regarding the lack of information about the degree and extent of the relationships among symptom burden, specific symptoms, and health-related quality of life (HRQL). The sample included 89 adults receiving care for colorectal cancer in an outpatient setting. Data for this cross-sectional study were collected over a four month period using the Modified Ambulatory Care Flow Sheet (MACFS), the Rotterdam Symptom Checklist- Modified, numerical rating scales for pain and coping, and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Cancer 30. Results showed that the MACFS was reasonably valid and internally consistent and that symptom burden and number of symptoms were significantly abut weakly correlated with HRQL. Specific symptoms most significantly correlated with HRQL were insomnia, fatigue, pain, nausea and vomiting. Findings support the use of the MACFS to assess symptoms and HRQL in the study population.

The main aims of this thesis were to investigate the effect of distraction, midazolam and morphine on fear, distress, and pain during needle procedures, and to longitudinally describe parents’ perceptions of their children’s symptom burden during and after cancer treatment. The design in Study I-III was that of a randomized controlled trial (RCT) conducted in a medical setting; Studies II-III were placebo controlled. Study IV has a longitudinal design, and data were collected at three times during treatment and three times after the end of successful treatment. Participants in Study I were children aged 1 to 7 (n=28), in Study II children aged 1 to 19 (n=50), in Study III children aged 1 to 19 (n=50), and in Study IV parents (n=160) of children aged 1 to 19. Blowing soap bubbles or having a heated pillow reduces children’s fear and distress in connection with needle procedures. Low-dose oral midazolam 0.3mg/kg body weight is effective in reducing fear and distress, especially in younger children. Interestingly, oral morphine at a dose of 0.25mg/kg body weight does not reduce fear, distress or pain. These studies have evaluated interventions that may be of help for the most frightened children during needle procedures. We suggest that the first-line intervention against procedural fear, distress, and/or pain should be standard care (i.e. EMLA) in addition to distraction interventions when needed, and only when this is insufficient to add pharmacological interventions. According to parents, feeling drowsy, pain, and lack of energy are initially the most prevalent symptoms in their children, whereas less hair than usual is the most prevalent symptom during treatment. Pain, feeling sad, and nausea are initially the most distressing symptoms. Pain is both prevalent and distressing throughout treatment. The child’s symptom burden, as reported by parents, decreases over time. Information about distressing symptoms and when they can be expected may increase acceptance and adaptation in children and parents during and after cancer treatment.