Browsing by Author "Conroy, Susan K."

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    Chemotherapy-induced amenorrhea: a prospective study of brain activation changes and neurocognitive correlates
    (Springer US, 2013-12) Conroy, Susan K.; McDonald, Brenna C.; Ahles, Tim A.; West, John D.; Saykin, Andrew J.; Department of Radiology and Imaging Sciences, School of Medicine
    Chemotherapy-induced amenorrhea (CIA) often occurs in pre- and peri-menopausal BC patients, and while cancer/chemotherapy and abrupt estrogen loss have separately been shown to affect cognition and brain function, studies of the cognitive effects of CIA are equivocal, and its effects on brain function are unknown. Functional MRI (fMRI) during a working memory task was used to prospectively assess the pattern of brain activation and deactivation prior to and one month after chemotherapy in BC patients who experienced CIA (n=9), post-menopausal BC patients undergoing chemotherapy (n=9), and pre- and post-menopausal healthy controls (n=6 each). Neurocognitive testing was also performed at both time points. Repeated measures general linear models were used to assess statistical significance, and age was a covariate in all analyses. We observed a group-by-time interaction in the combined magnitudes of brain activation and deactivation (p = 0.006): the CIA group increased in magnitude from baseline to post-treatment while other groups maintained similar levels over time. Further, the change in brain activity magnitude in CIA was strongly correlated with change in processing speed neurocognitive testing score (r=0.837 p=0.005), suggesting this increase in brain activity reflects effective cognitive compensation. Our results demonstrate prospectively that the pattern of change in brain activity from pre- to post-chemotherapy varies according to pre-treatment menopausal status. Cognitive correlates add to the potential clinical significance of these findings. These findings have implications for risk appraisal and development of prevention or treatment strategies for cognitive changes in CIA.
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    Depression Comorbid With Stroke, Traumatic Brain Injury, Parkinson’s Disease, and Multiple Sclerosis: Diagnosis and Treatment
    (American Psychiatric Association, 2020-04) Conroy, Susan K.; Brownlowe, Katherine B.; McAllister, Thomas W.; Psychiatry, School of Medicine
    Depression is common among patients with neurologic disorders, and it has long been considered more difficult to treat than depression in the general population. In this review, the authors consider challenges in the diagnosis and treatment of depression among patients with stroke, traumatic brain injury, Parkinson’s disease, and multiple sclerosis. For each disorder, the authors discuss the epidemiology and time course of depression as well as review the physiologic and psychological etiologies of depression. In addition, for each disorder, they review screening tools and diagnostic considerations, including differential diagnosis; discuss etiological factors, both neurobiological and psychological; and assess evidence for various depression treatments, including pharmacologic, psychosocial, and neuromodulatory therapies. The evidence suggests that depression is common among patients with neurologic disorders and that it is crucial for general psychiatrists to provide treatment for this population.
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    Frontal Gray Matter Reduction After Breast Cancer Chemotherapy and Association With Executive Symptoms: A Replication and Extension Study
    (Office of the Vice Chancellor for Research, 2013-04-05) McDonald, Brenna C.; Conroy, Susan K.; Smith, Dori J.; West, John D.; Saykin, Andrew J.
    Cognitive changes related to cancer and its treatment have been intensely studied, and neuroimaging has begun to demonstrate brain correlates of these changes. We recently reported structural brain changes in a prospective longitudinal cohort of breast cancer patients. Decreased gray matter density, particularly in frontal regions, was detected one month after completion of chemotherapy and partially recovered over the next year. These findings helped confirm a neural basis for the cognitive symptoms reported by many prior studies, which most commonly involve executive and memory processes in which the frontal lobes are a critical component of underlying neural circuitry. Here we present data from an independent, larger and more demographically diverse cohort that is more generalizable to the breast cancer population. 3.0T MP-RAGE structural MRI scans were acquired on 27 breast cancer patients treated with chemotherapy, 28 breast cancer patients not treated with chemotherapy, and 24 matched healthy controls (all participants were female). Study measures were completed at baseline (after surgery but before radiation, chemotherapy, and/or anti-estrogen treatment) and one month following the completion of chemotherapy, or yoked intervals for the non-chemotherapy and control groups. Gray matter density was examined using optimized voxel-based morphometry (VBM) methods. Results showed decreased frontal gray matter after chemotherapy, as observed in our initial cohort, which was accompanied by self-reported difficulties in executive functioning. These findings provide confirmatory evidence of frontal morphometric changes that may be a pathophysiological basis for cancer and treatment-related cognitive dysfunction. Ongoing research into individual risk factors for such changes will be critical for development of treatment and prevention strategies.
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    Functional network connectivity in early-stage schizophrenia
    (Elsevier, 2020-04) Hummer, Tom A.; Yung, Matthew G.; Goñi, Joaquín; Conroy, Susan K.; Francis, Michael M.; Mehdiyoun, Nicole F.; Breier, M. A. Alan; Psychiatry, School of Medicine
    Schizophrenia is a disorder of altered neural connections resulting in impaired information integration. Whole brain assessment of within- and between-network connections may determine how information processing is disrupted in schizophrenia. Patients with early-stage schizophrenia (n = 56) and a matched control sample (n = 32) underwent resting-state fMRI scans. Gray matter regions were organized into nine distinct functional networks. Functional connectivity was calculated between 278 gray matter regions for each subject. Network connectivity properties were defined by the mean and variance of correlations of all regions. Whole-brain network measures of global efficiency (reflecting overall interconnectedness) and locations of hubs (key regions for communication) were also determined. The control sample had greater connectivity between the following network pairs: somatomotor-limbic, somatomotor-default mode, dorsal attention-default mode, ventral attention-limbic, and ventral attention-default mode. The patient sample had greater variance in interactions between ventral attention network and other functional networks. Illness duration was associated with overall increases in the variability of network connections. The control group had higher global efficiency and more hubs in the cerebellum network, while patient group hubs were more common in visual, frontoparietal, or subcortical networks. Thus, reduced functional connectivity in patients was largely present between distinct networks, rather than within-networks. The implications of these findings for the pathophysiology of schizophrenia are discussed.
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    Left versus right subcallosal cingulate deep brain stimulation for treatment-resistant depression
    (Elsevier, 2021-03) Conroy, Susan K.; Malloy, Shannon; Kelley, Mary E.; Filkowski, Megan M.; Trimble, Ryan M.; Pirtle, Megan E.; Maher, Ashley; Dreyer-Oren, Sarah; Doucette, Wilder; Roth, Robert M.; Aronson, Joshua P.; Roberts, David W.; Choi, Ki Sueng; Mayberg, Helen S.; Holtzheimer, Paul E.; Psychiatry, School of Medicine
    Deep brain stimulation (DBS) of the subcallosal cingulate has emerged as a promising therapy for treatment-resistant depression (TRD). To date, all studies have employed bilateral stimulation; however, the physiology of affect and pathophysiology of depression are known to be asymmetric across hemispheres. Unilateral stimulation may provide efficacy while decreasing risk. Five patients were exposed to unilateral open-label DBS to the subcallosal cingulate for 12 weeks each to the left and then right hemispheres in a double-blind, crossover fashion. After 12 weeks of stimulation to each hemisphere, bilateral stimulation was initiated, and patients were followed for 12 additional weeks. Additionally, nine months of long-term follow up data were collected. Left, but not right, unilateral stimulation was associated with significant decrease in depression scores; with bilateral stimulation, all patients improved and one patient remitted. No serious adverse events were associated with surgery or acute or chronic stimulation. This small study suggests that unilateral DBS to the subcallosal cingulate may be an effective treatment for TRD. All patients improved with bilateral stimulation, though antidepressant effects following 12 weeks were modest. These findings contrast somewhat with prior open-label trials, though duration of bilateral stimulation was shorter in this trial. The current study continues to confirm safety of implantation and use of DBS to the subcallosal cingulate for patients with TRD and highlights the importance of personalization of therapy, for example by hemisphere, in future trials.
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    National Network of Depression Centers' Recommendations on Harmonizing Clinical Documentation of Electroconvulsive Therapy
    (Wolters Kluwer, 2022) Zandi, Peter P.; Morreale, Michael; Reti, Irving M.; Maixner, Daniel F.; McDonald, William M.; Patel, Paresh D.; Achtyes, Eric; Bhati, Mahendra T.; Carr, Brent R.; Conroy, Susan K.; Cristancho, Mario; Dubin, Marc J.; Francis, Andrew; Glazer, Kara; Ingram, Wendy; Khurshid, Khurshid; McClintock, Shawn M.; Pinjari, Omar F.; Reeves, Kevin; Rodriguez, Nelson F.; Sampson, Shirlene; Seiner, Stephen J.; Selek, Salih; Sheline, Yvette; Smetana, Roy W.; Soda, Takahiro; Trapp, Nicholas T.; Wright, Jesse H.; Husain, Mustafa; Weiner, Richard D.; Psychiatry, School of Medicine
    Electroconvulsive therapy (ECT) is a highly therapeutic and cost-effective treatment for severe and/or treatment-resistant major depression. However, because of the varied clinical practices, there is a great deal of heterogeneity in how ECT is delivered and documented. This represents both an opportunity to study how differences in implementation influence clinical outcomes and a challenge for carrying out coordinated quality improvement and research efforts across multiple ECT centers. The National Network of Depression Centers, a consortium of 26+ US academic medical centers of excellence providing care for patients with mood disorders, formed a task group with the goals of promoting best clinical practices for the delivery of ECT and to facilitate large-scale, multisite quality improvement and research to advance more effective and safe use of this treatment modality. The National Network of Depression Centers Task Group on ECT set out to define best practices for harmonizing the clinical documentation of ECT across treatment centers to promote clinical interoperability and facilitate a nationwide collaboration that would enable multisite quality improvement and longitudinal research in real-world settings. This article reports on the work of this effort. It focuses on the use of ECT for major depressive disorder, which accounts for the majority of ECT referrals in most countries. However, most of the recommendations on clinical documentation proposed herein will be applicable to the use of ECT for any of its indications.