Individual cognitive-behavioural interventions in early psychosis

BACKGROUND: Cognitive-behavioural treatments have previously been explored in the treatment of chronic psychotic problems, but recently, the effectiveness of these treatments has been investigated with regard to recent onset and acute psychosis. METHOD: The literature relating to cognitive-behavioural treatments in psychosis is explored and the application of the approach to recent onset psychosis is described in detail. RESULTS: There appears to be a growing body of evidence that the advances made in the treatment of people with chronic treatment resistant psychosis can be similarly applied to people with recent onset and acute psychosis. CONCLUSIONS: Cognitive-behavioural treatments are feasible with recent onset psychotic patients although further evaluation of their effectiveness is necessary.     

The CD4+ T lymphocyte is a site of steroid resistance in asthma

Phytohaemagglutinin (PHA)-induced T-cell proliferation is suppressed completely in steroid-sensitive asthma (SSA) by fluticasone propionate (FP). By contrast, in patients with steroid-resistant asthma (SRA), this proliferative response is only partially attenuated by steroids, which suggests that the T lymphocyte may harbour a key molecular defect in these patients. Both CD4+ and CD8+ T cells may be involved in orchestrating the inflammation underlying asthma. We examined whether CD4+ or CD8+ T cells isolated from SRA and SSA patients are equally susceptible to steroid suppression of PHA-induced proliferation. Complete suppression of CD4+ T-lymphocyte proliferation was seen in both SSA and control subjects at concentrations of 10(-9) M FP. In contrast, proliferation of CD4+ T cells from SRA patients was only partially inhibited, even at 10(-6) M FP. CD8+ responses from SRA, SSA and controls were all similar, with only a partial suppression of proliferation at 10(-6) M FP. Differential suppression by FP of CD4+ T cells has thus been demonstrated between SRA and SSA patients.     

Fetal assessment based on fetal biophysical profile scoring. VIII. The incidence of cerebral palsy in tested and untested perinates

OBJECTIVE: The intent of this comparative clinical study was fourfold: (1) to determine the incidence of cerebral palsy in a large obstetric population, (2) to compare the incidence of cerebral palsy in patients at high risk referred for and managed according to the fetal biophysical profile score result with the incidence among unreferred and untested patients, (3) to determine the relationship, if any, between the last fetal biophysical profile score and the incidence of cerebral palsy, and (4) to categorize cases of cerebral palsy according to the clinical parameters and the probable time and nature of the damaging insult. STUDY DESIGN: In this retrospective 5-year comparative study (1987 to 1991) the incidence of cerebral palsy was determined by analysis of International Classification of Diseases, Ninth Revision, -coded related medical services. The clinical records were then sought and reviewed in index cases and obstetric, neonatal, and postnatal clinical data were abstracted. Cross-correlation with partial registries was done to confirm completeness of capture of index cases. The population of referred high-risk patients who received serial fetal biophysical profile scoring and were managed according to test results was determined by review of a prospective computer-stored database and by review of patient log books. The population of untested patients was calculated as the residual of total cases minus tested cases. The rate of cerebral palsy for all patients and for the tested and untested population was calculated and compared. The tested and untested perinates were compared for birth age, weight, and assigned timing or etiology of cerebral palsy. In the tested population the distribution of test results by last recorded biophysical profile score was determined and the relationship between the last test result and cerebral palsy and predictive accuracy parameters of the fetal biophysical profile score were calculated. RESULTS: The incidence of cerebral palsy among the 84,947 live births was 3.68 per 1000 live births (313 cases). The rate of cerebral palsy in the 26,290 referred high-risk tested patients was 1.33 per 1000 (35 cases) compared with a rate of 4.74 per 1000 live births in the 58,657 untested mixed low-risk/high-risk patients (278 cases). These differences were highly significant. A significant declining trend in the annual incidence of cerebral palsy was observed in the total population and the untested population, whereas the rate in the tested population remained relatively constant over the 5-year study interval. The differences in the cerebral palsy rate between the tested and untested population were not related to differences in gestational age, birth weight, or assigned timing or etiology category. In the tested population the relationship between the incidence of cerebral palsy and the last test fetal biophysical profile score was inverse, exponential, and highly significant. CONCLUSIONS: Antepartum assessment by fetal biophysical profile scoring is associated with a significant reduction in the incidence of cerebral palsy compared with untested patients. The relationship between the last test score and the incidence of cerebral palsy is inverse and exponential, suggesting that antenatal asphyxia is an important and potentially avoidable cause of cerebral palsy.     

Analyzing amenorrhea

When menarche has failed to occur or menstrual cycles have stopped, the problem can be traced back to a functional or structural defect in the hypothalamus, pituitary, ovaries, or uterus. In most cases, the history is the principal source of diagnostic information. Necessary laboratory studies include one for the most common cause of amenorrhea: pregnancy.     

Yes. No. Maybe. That's about as firm as the guidance gets over launching a provider-sponsored health plan. Strategy roundtable

Few participants in our roundtable on provider-sponsored health plans see them the same way. Some are gearing up new products, others are scaling back or getting out. Yet they agreed on one thing: The financial risks are tremendous.     

Reproducibility of fluorine-18-6-fluorodopa positron emission tomography in normal human subjects

We calculated the mean energy required to produce an ion pair (W) in methane-, propane- and butane-based tissue-equivalent (TE) gas mixtures from W values in pure constituent gases according to various models for energy partition among gas components. We found an agreement between the experimental and calculated W values in the methane-based TE gas regardless of the model concept. In contrast, only those models which take into account differences in the stopping powers, total ionization cross sections and model constants of gas components give acceptable results for the propane-based TE gas. The calculated W value for high-energy electrons in the isobutane-based TE gas mixture is 25.2 eV for high-energy electrons and 28.0 eV for approximately 5 MeV alpha particles.     

Resolution depths for some transmitter-receiver configurations

Equivalent dipole polarizability matrices and equivalent dipole location are a convenient way to interpret magnetic field data due to currents induced in isolated conductive objects. The uncertainties in polarizability estimates and in the equivalent dipole location provide a quantitative measure of the performance of different configurations of transmitters and receivers. In another paper, we estimate these uncertainties using a linearized inversion. For many systems, consisting of one or more rectangular loop transmitters and a number of dipole receivers, sited on a horizontal grid, equivalent dipole depth is determined to 10% accuracy to depths approximately 20% deeper than the depths at which polarizability matrix elements can be determined to the same precision. Systems that have a lower product of rms polarizability uncertainty and square root of their number of transmitter-receiver pairs are considered more effective for the number of transmitter-receiver pairs. Among the systems studied, a system with three orthogonal transmitter loops and a three-component receiver is the most effective, for objects shallower than 0.6 times the instrument siting grid spacing, yielding an rms polarizability uncertainty 0.04 times that of a single-transmitter single-receiver system. At intermediate depths, a system with two vertical component receivers on the diagonal of a square horizontal transmitter loop is most effective for its number of transmitter-receiver pairs, yielding an rms polarizability uncertainty 0.07 times that of a single receiver system. At depths greater than 2.5 times, the siting grid spacing a three-orthogonal loop transmitter with a single vertical component receiver is about the most effective for its number of transmitter-receiver pairs, yielding an rms polarizability uncertainty 0.08 times that of a single-transmitter system.     

Stimulus-elicited behavior in rapid eye movement sleep without atonia.

Alert wakefulness (W) and rapid eye movement sleep (REM) are remarkably similar on several measures of brain activity, but 2 differences in REM are reduced sensory responsiveness and atonia in postural muscles. Pontine tegmental lesions create REM without atonia (REM-A), releasing motor behavior. In 9 cats, we studied the acoustic startle reflex (ASR), orienting (OR), and ponto-geniculo-occipital waves (PGOE) elicited by tones during W, REM, REM-A, and non-REM (NREM). OR occurred in W and REM-A, being most complete in cats with the most elaborate spontaneous behavior. ASR occurred in W, NREM, and REM-A in lesioned cats. In normal cats, ASR rarely appeared in NREM and REM. PGOE had similar characteristics in both groups. The similarity of REM to W is particularly obvious when cats lack motoneuronal inhibition. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Childhood depression and conduct disorder: II. An analysis of family interaction patterns in the home.

Directly sampled the interaction patterns of families with depressed (DEP), conduct-disordered (CD), mixed DEP-CD, and comparison children (aged 7–14 yrs) in the homes during the evening meal. Observational measures were taken of positive and aversive behaviors and affect expression for both parents, the referred children, and their siblings. Results replicated previous research showing that CD children express high levels of aversive behavior and anger and are part of a family system marked by conflict and aggression. The DEP children were exposed to maternal aversiveness but did not show any evidence of elevated levels of anger or aversiveness. Surprisingly, this was also true for the mixed-disorder children. High levels of depression in both groups of DEP children were associated with low levels of conflict and anger in family members. Overall, siblings showed very similar patterns of behavior and were exposed to similar patterns of parental behavior as the referred children. Results are discussed in terms of family models that emphasize the function of aggression and depression in the maintenance of child psychopathology. (PsycINFO Database Record (c) 2010 APA, all rights reserved)