Introduction: Dopamine agonists (DA) constitute primary treatment for prolactinomas.Recent international guidelines on prolactinoma management recommend use of cabergolineover other DAs and suggest attempting withdrawal after two years given certain criteria. Thelocal data on adherence to guidelines are scarce. Aim: This study aimed to compare local clinical practice to regional and internationalguidelines for prolactinomas and investigate management and outcome of patients with thisdiagnosis in a clinical setting in Örebro county. Methods: Medical records of patients with prolactinoma visiting the unit of endocrinology atÖrebro University Hospital between 2015-2019 were reviewed. Data on initial investigations,monitoring, treatment, and outcome were collected. Results: 91 patients with a median follow-up time of 69 months, were included. All patientshad initial investigations according to regional guidelines. 98.9% were ever treated with DA,and overall use of bromocriptine was higher than that of cabergoline. DA-withdrawal wasattempted in 40% of patients after a median treatment time of 6 years and was often successful.9.9% of patients had pituitary surgery. At last follow-up 37.4% of the patients were cured while20.9% had hypopituitarism. Treatment outcome differed significantly with adenoma size;microadenomas dominated among patients cured and macroadenomas among patients withremaining hypopituitarism (p<0.001). Conclusions:Local diagnostic prolactinoma care is in line with regional guidelines and patients are monitoredregularly. However, it is feasible that local practice concerning the choice of dopamine agonistand routines for its withdrawal could be revised and adjusted to international guidelines.

This repeated-measures study evaluated the relative sensitivity to change of the Child Behavior Checklist/6-18 (CBCL/6-18), the Behavior Assessment System for Children-2 (BASC-2), and the Youth Outcome Questionnaire-2.01 (Y-OQ-2.01). Participants were recruited from Valley Mental Health, a community outpatient clinic in Salt Lake City, UT. There were 178 participants for 136 cases, with 134 adults and 44 adolescents. Participants provided two through five data points for a total of 548 data points. Hierarchical Linear Modeling (HLM) was conducted for three major comparisons: adult informants, adult and adolescent dyads, and adolescents. Results indicated the Y-OQ-2.01 was the most change sensitive, while the BASC-2 and CBCL/6-18 were not statistically different from each other. Results also showed that the parent-report measures were more change-sensitive than the self-report measures completed by adolescent informants. Sensitivity to change was also evaluated through the reliable change index (RCI) and the use of cut-off scores. In comparisons using the RCI, the Y-OQ-2.01 identified the most cases for reliable change. The Y-OQ-2.01 also had the greatest corroboration of its findings with the other two measures. In comparisons using cut-off scores, results are offered for three variations, as different standards were used to establish cut-off scores for the three measures. The third variation, for which cut-off scores for all three measures were adjusted to one standard deviation above the mean, is suggested to be the most appropriate when comparing measures. Those results indicated there was no statistical difference in how the measures performed relative to each other. Thus, based on the HLM and RCI results of this study, it is recommended that clinicians select the Y-OQ-2.01 for outcome use and tracking changes in child and adolescent symptoms and behaviors.

Background: Several college students experience psychological distress and access college counseling center services every year. A subgroup of this population, collegiate student-athletes, experience unique stressors and protective factors but are less likely to engage in those same services. Mental health research on this subpopulation is still sparse and yields mixed findings, particularly treatment outcome research. Objective: This study aimed to compare the treatment outcomes of student-athletes and general population students. Method: Participants were 10,566 college students (ages 18-26) from 139 universities in the United States that obtained routine psychological treatment at their college counseling center. Approximately 55% of the sample identified as female, 44% as male, and less than 1% identified as transgender or self-specified. The ethnicity of the sample was approximately 76% White, 10% African American/Black, 5% Hispanic/Latino, 3% Asian/Asian American, 4% Multiracial, 1% Self-identified, < 1% American Indian/Alaska Native, and < 1% Native Hawaiian/Pacific Islander. The measures used for this study were the Standardized Data Set (SDS) and the Counseling Center Assessment of Psychological Symptoms (CCAPS-62). Differences in the number of sessions attended, initial distress at intake, and change in symptoms were calculated between the two groups along eight domains of distress. Results: 8% of the sample identified as student-athletes. There are no differences in the number of sessions attended. Student-athletes entered treatment self-reporting lower levels of distress on all eight domains of the CCAPS-62. Student-athletes reported greater symptom improvement in five of the eight domains of the CCAPS-62 and no differences in the other three. There were no differences between the two groups in the proportion of participants that recovered, reliably improved, did not change, or deteriorated across treatment. Conclusions: Although student-athletes are accessing psychological treatment less frequently, they may be able to experience the same or better outcomes than their general population peers tend to when they do.

京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第19963号 / 医博第4153号 / 新制||医||1017(附属図書館) / 33059 / 京都大学大学院医学研究科医学専攻 / (主査)教授 村井 俊哉, 教授 森田 智視, 教授 佐藤 俊哉 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

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Background: Several college students experience psychological distress and access college counseling center services every year. A subgroup of this population, collegiate student-athletes, experience unique stressors and protective factors but are less likely to engage in those same services. Mental health research on this subpopulation is still sparse and yields mixed findings, particularly treatment outcome research. Objective: This study aimed to compare the treatment outcomes of student-athletes and general population students. Method: Participants were 10,566 college students (ages 18-26) from 139 universities in the United States that obtained routine psychological treatment at their college counseling center. Approximately 55% of the sample identified as female, 44% as male, and less than 1% identified as transgender or self-specified. The ethnicity of the sample was approximately 76% White, 10% African American/Black, 5% Hispanic/Latino, 3% Asian/Asian American, 4% Multiracial, 1% Self-identified, <1% American Indian/Alaska Native, and <1% Native Hawaiian/Pacific Islander. The measures used for this study were the Standardized Data Set (SDS) and the Counseling Center Assessment of Psychological Symptoms (CCAPS-62). Differences in the number of sessions attended, initial distress at intake, and change in symptoms were calculated between the two groups along eight domains of distress. Results: 8% of the sample identified as student-athletes. There are no differences in the number of sessions attended. Student-athletes entered treatment self-reporting lower levels of distress on all eight domains of the CCAPS-62. Student-athletes reported greater symptom improvement in five of the eight domains of the CCAPS-62 and no differences in the other three. There were no differences between the two groups in the proportion of participants that recovered, reliably improved, did not change, or deteriorated across treatment. Conclusions: Although student-athletes are accessing psychological treatment less frequently, they may be able to experience the same or better outcomes than their general population peers tend to when they do.

I provided an updated, comprehensive review of treatments for mothers diagnosed with postpartum depression. Studies included in this meta-analysis were single-group pre-posttest, non-randomized and randomized controlled studies published from 1986 to 2010 that included face-to-face psychotherapy and psychopharmacology as well as non-traditional methods such as exercise and nurse-assisted counseling. 53 published studies were analyzed. The randomized studies showed a moderate to large effects (d= 0.72 to 1.25, k= 9) when postpartum interventions were compared to a control condition, and smaller effects (d= 0.3 to 0.57, k = 13) to treatment as usual. When postpartum interventions were compared to each other there was small to no difference in effect sizes (k = 9). All of the non-randomized comparisons showed no significant difference, except when therapy was compared to treatment as usual (d= 0.55, k = 2). Pre-post studies showed large effect sizes for therapy (d= 0.95, k = 7) and medication treatments (d= 4.30, k = 5). Influence analyses suggest that two studies had a large effect on aggregate effect sizes and heterogeneity statistics. Moderator and multivariate analyses were largely underpowered. Publication bias was not significantly related to outcome. Clinical implications for postpartum depression treatments and directions for future research were identified.

Research suggests binge eating (BE) is equally prevalent across racial/ethnic groups. However, the majority of data concerning the assessment and treatment of BE come from clinical trials or specialty clinics where racial/ethnic minorities are underrepresented. Data regarding symptoms and treatment are needed from urban clinical settings where minorities are more likely to seek treatment. The current study assessed racial/ethnic group differences in BE prevalence, clinical and cognitive symptoms, and treatment retention in an ethnically-diverse weight loss treatment-seeking sample. Participants included 127 Hispanic, 204 African-American and 99 Caucasian adults who completed self-report measures of BE frequency, distress, eating-related cognitive symptoms including shape and weight concerns and dietary restraint, depression, stress, and treatment barriers. Data concerning number of treatment sessions attended and body mass index (BMI) were collected at 6-month follow up. The first study developed and validated the Dimensional Assessment of Loss of Control Eating (DALC) scale. The 2-factor DALC demonstrated good internal consistency and convergent, construct and incremental validity. The DALC contributed to variance in eating pathology and depression beyond existing BE measures. The second study examined racial/ethnic differences in BE prevalence, eating-related cognitive symptoms, and BMI. As hypothesized, no racial/ethnic differences in BE frequency were found and the rate of recurrent BE was 20% to 30%; participants with recurrent BE had higher BMIs, levels of depression, and global eating pathology than individuals without; African-American participants with BE had higher BMIs than other racial/ethnic groups, controlling for demographic variables. The hypotheses that Hispanic participants have higher weight and shape concerns, and that African-Americans have higher levels of restraint, were not supported. The third study examined the hypothesis that ethnicity is associated with obesity treatment retention and outcome. African-American participants had lower retention rates than Hispanics and Caucasians combined, and had lower levels of obesity-based stigma, which accounted for their lower retention rates. African-Americans lost less weight than Caucasians but this difference disappeared after accounting for age and income. The findings suggest high BE rates among racial/ethnic minorities at a common entry point for health services utilization. Stigma and African-American ethnicity should be considered when developing retention interventions.

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