Recent Publications From BIRCWH Scholars

Examining the Prevalence, Bidirectionality, and Co-Occurrence of Sexual Intimate Partner Violence among Women During Pregnancy and Postpartum. Partner Abuse. 2014 Oct;5(4):407 to 419. PubMed PMID: 25664145; PubMed Central PMCID: PMC4319552.
Hellmuth JC, Jaquier V, Gordon KC, Moore TM, Stuart GL.

Objectives: This longitudinal study examined the prevalence of women's sexual intimate partner violence (IPV) perpetration, the extent to which women experienced both sexual IPV victimization and perpetration, and the overlap between women's experiences of sexual IPV with psychological and physical IPV victimization and perpetration.

Methods: Data were collected via self-report survey from 180 women during the first 18 weeks of pregnancy and 122 participants completed follow-up assessments at six weeks postpartum.

Results: At both time points, the prevalence of sexual IPV victimization and perpetration were similar in this sample. Bidirectional sexual IPV was more common than sexual IPV victimization or perpetration only. The majority of participants who experienced sexual IPV victimization at baseline and follow-up also experienced psychological or physical IPV victimization. No participants at either time point reported sexual IPV perpetration only, those participants who perpetrated sexual IPV also perpetrated psychological or physical IPV.

Conclusions: Future research should investigate women's sexual IPV victimization and perpetration as they relate to other areas of mental and physical health during this time period.

Discontinuation of buprenorphine maintenance therapy: perspectives and outcomes.
J Subst Abuse Treat. 2015 May;52:48 to 57. doi: 10.1016/j.jsat.2014.12.011. Epub 2014 Dec 30.
Bentzley BS, Barth KS, Back SE, Book SW.

Buprenorphine maintenance therapy (BMT) is increasingly the preferred opioid maintenance agent due to its reduced toxicity and availability in an office-based setting in the United States. Although BMT has been shown to be highly efficacious, it is often discontinued soon after initiation. No current systematic review has yet investigated providers' or patients' reasons for BMT discontinuation or the outcomes that follow. Hence, provider and patient perspectives associated with BMT discontinuation after a period of stable buprenorphine maintenance and the resultant outcomes were systematically reviewed with specific emphasis on pre-buprenorphine-taper parameters predictive of relapse following BMT discontinuation. Few identified studies address provider or patient perspectives associated with buprenorphine discontinuation. Within the studies reviewed providers with residency training in BMT were more likely to favor long term BMT instead of detoxification, and providers were likely to consider BMT discontinuation in the face of medication misuse. Patients often desired to remain on BMT because of fear of relapse to illicit opioid use if they were to discontinue BMT. The majority of patients who discontinued BMT did so involuntarily, often due to failure to follow strict program requirements, and 1 month following discontinuation, rates of relapse to illicit opioid use exceeded 50 percent in every study reviewed. Only lower buprenorphine maintenance dose, which may be a marker for attenuated addiction severity, predicted better outcomes across studies. Relaxed BMT program requirements and frequent counsel on the high probability of relapse if BMT is discontinued may improve retention in treatment and prevent the relapse to illicit opioid use that is likely to follow BMT discontinuation.

Laboratory-induced cue reactivity among individuals with prescription opiod dependence.
Addict Behav. 2014 Aug;39(8):1217 to 23.
Back SE, Gros DF, McCauley JL, Flanagan JC, Cox E, Barth KS, Brady KT.

Prescription opioid (PO) dependence is a critical health problem. Although examination of drug cue reactivity paradigms has advanced the understanding of risk factors for relapse for a variety of substances (e.g., cocaine, alcohol, nicotine), no PO specific drug cue paradigm has been developed. The current study addressed this gap in the literature and evaluated the ability of a newly developed PO drug cue paradigm to elicit subjective, physiological, and neuroendocrine changes among PO-dependent participants (n equal to 20) as compared to controls (n equal to 17). The drug cue paradigm included an induction script, viewing and handling paraphernalia (e.g., bottle of oxycontin pills, pill crusher) and watching a video depicting people using POs as well as places related to POs (e.g., pharmacies). Consistent with hypotheses, the PO group demonstrated significant pre- to post-cue increases on subjective ratings of craving, difficulty resisting POs, stress, and anger. The control group did not demonstrate significant changes on any of the subjective measures. Both the PO group and the control group evidenced significant pre- to post-cue increases in physiological responses (e.g., blood pressure, skin conductance), as expected given the arousing nature of the drug cue stimuli. The PO group, but not the control group, evidenced a significant pre- to post-cue increase in heart rate and salivary cortisol levels. The development and validation of a drug cue paradigm for POs may help inform future research and treatment development efforts for patients with PO dependence.

Management of postpartum depression.
J Midwifery Womens Health. 2013 Nov-Dec;58(6):643 to 53.
Guille C, Newman R, Fryml LD, Lifton CK, Epperson CN.

The mainstays of treatment for peripartum depression are psychotherapy and antidepressant medications. More research is needed to understand which treatments are safe, preferable, and effective. Postpartum depression, now termed peripartum depression by the DSM-V, is one of the most common complications in the postpartum period and has potentially significant negative consequences for mothers and their families. This article highlights common clinical challenges in the treatment of peripartum depression and reviews the evidence for currently available treatment options. Psychotherapy is the first-line treatment option for women with mild to moderate peripartum depression. Antidepressant medication in combination with therapy is recommended for women with moderate to severe depression. Although pooled case reports and small controlled studies have demonstrated undetectable infant serum levels and no short-term adverse events in infants of mothers breastfeeding while taking sertraline (Zoloft) and paroxetine (Paxil), further research is needed including larger samples and long-term follow-up of infants exposed to antidepressants via breastfeeding controlling for maternal depression. Pharmacologic treatment recommendations for women who are lactating must include discussion with the patient regarding the benefits of breastfeeding, risks of antidepressant use during lactation, and risks of untreated illness. There is a growing evidence base for nonpharmacologic interventions including repetitive transcranial magnetic stimulation, which may offer an attractive option for women who wish to continue to breastfeed and are concerned about their infants being exposed to medication. Among severe cases of peripartum depression with psychosis, referral to a psychiatrist or psychiatric advanced practice registered nurse is warranted. Suicidal or homicidal ideation with a desire, intent, or plan to harm oneself or anyone else, including the infant, is a psychiatric emergency, and an evaluation by a mental health professional should be conducted immediately. Peripartum depression treatment research is limited by small sample sizes and few controlled studies. Much work is still needed to better understand which treatments women prefer and are the most effective in ameliorating the symptoms and disease burden associated with peripartum depression.

Yohimbine administration and cocaine cue-reactivity in cocaine-dependent individuals.
MoranSanta Maria MM, McRae-Clark A, Baker NL, Ramakrishnan, Brady KT. (2014. In press).
Psychopharmacology. NIHMSID: NIHMS583711

Rationale: Preclinical studies suggest that stress potentiates cue-induced cocaine seeking and that this effect is more pronounced in females. These findings have not been characterized in clinical populations. Objectives: The objectives of this study were to examine the impact a pharmacological stressor, alpha-2 adrenergic receptor antagonist yohimbine, on the subjective, endocrine, and physiologic responses to drug-paired cues cocaine-dependent men and women.

Methods: In a double-blind placebo-controlled cross-over study, cocaine-dependent men (n equal to 32), cocaine-dependent women (n equal to 30), control men (n equal to 32), and control women (n equal to 25) received either yohimbine or placebo prior to two cocaine cue exposure sessions.

Results: Yohimbine increased ratings of anxiety both before (p less than 0.001) and after (p equal to 0.035) cues, and the post-cue increase in anxiety was more pronounced in women (p equal to 0.001). Yohimbine also significantly increased craving, compared with placebo (p less than 0.05), following the cue presentation, and this effect was greater in women than men (gender by treatment interaction; p equal to 0.006). Yohimbine also increased salivary cortisol (p less than 0.001) and dehydroepiandrosterone (p equal to 0.003) levels, regardless of diagnostic group. Women had a significantly greater heart rate response following yohimbine as compared with men (p less than 0.001).

Conclusions: Stress may increase the salience of cocaine cues for cocaine-dependent women as compared with men. This suggests gender differences in vulnerability to craving and relapse under stressful conditions.