Sertraline for premenstrual dysphoric disorder

Symptomatic cryoglobulinaemia is infrequent in HIV-1-infected patients, but a few cases have been described [1-3], occasionally associated with hepatitis C virus (HCV) infection [1, 3]. These cases showed rheumatologic [1] or neurologic manifestations [2, 3], but until now no cutaneous symptoms associated with cryoglobulinaemia in HIV-infected patients have been described. We report what we believe to be the first case of cutaneous, symptomatic cryoglobulinaemia in an HIV-1-positive patient, who, in addition, was HCV-negative.     

Premenstrual syndrome: diagnosis and intervention

Premenstrual syndrome (PMS) is a recurrent disorder that occurs in the luteal phase of the menstrual cycle. It is characterized by intense physical, psychologic, and behavioral changes that interrupt interpersonal relationships and disrupt the lives of affected women. Up to 40% of women of childbearing age have some form of PMS, and up to 10% have severe signs and symptoms. There are at least four types of PMS, each with its own constellation of signs and symptoms. Related illnesses or illnesses that need to be ruled out include diabetes mellitus, thyroid dysfunction, hypoglycemia, and primary and secondary dysmenorrhea. Difficulty in identifying the exact etiology of the disorder is documented. Diagnostic issues include confusion over exact signs and symptoms, differential diagnoses, pertinent laboratory data, careful history taking, and the importance of women recording a menstrual cycle history on a calendar. Recommended first-line treatments include a diet low in salt, fat, caffeine, and sugar; an aerobic exercise regimen; and stress reduction via changes in lifestyle.     

Premenstrual syndrome: diagnosis and treatment experiences

We sought to examine the diagnosis and treatment experiences of women in the United States who reported having been diagnosed with premenstrual syndrome (PMS) by a physician. A survey of 220 women, randomly selected, ages 26-56, who subscribed to a woman's health newsletter and reported being given a diagnosis of PMS by a physician was conducted. Subjects reported (1) they sought medical help for 5.33 +/- 6.23 years before receiving a diagnosis, (2) they sought help from 3.75 +/- 3.22 physicians for PMS symptoms, (3) they thought the majority (71%) of physicians they used were not adequately informed to diagnose and treat them, (4) only a minority (23%) of physicians used a symptom chart, currently the only way to confirm a PMS diagnosis, when determining their diagnosis, and (5) only approximately 1 in 4 (26%) physicians provided them with a helpful treatment. Seventy-six percent of subjects reported that a PMS diagnosis resulted from their own suggestion, with an agreement by the physician. Eighty-one percent reported that the initial suggestion of PMS came from a non-medical source. The most commonly recommended and used treatments were vitamins, exercise, and diet modification. Current treatment satisfaction was 15.6% not very satisfied, 48.8% somewhat satisfied, and 35% very satisfied. Satisfaction was higher if natural progesterone or hysterectomy with oophorectomy was included as a treatment, although a high percentage of satisfaction was seen with several treatments. Data indicate that physicians from whom most of the women sought care between 1974 and 1994 failed to recognize, diagnose, or treat their PMS using the standards and protocols published in the medical literature.     

Methodological controversies in the treatment of panic disorder.

Although the National Institutes of Health Consensus Development Conference on the Treatment of Panic Disorder endorsed the effectiveness of cognitive–behavior therapy (CBT), D. E. Klein (see record 1996-02770-008) argues that fatal flaws in all but one (negative) CBT study undermine claims about the effectiveness of CBT for panic disorder. He holds that methodologically sound CBT trials must include a drug condition and a pill placebo condition and must demonstrate the superiority of drug versus placebo; otherwise researchers are debarred from making comparative statements about the effectiveness of CBT versus drug (or placebo). The purpose of the present article is to provide a critique of Klein's arguments and to provide suggestions for resolving methodological disputes in the panic disorder field. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Mood and performance changes in women with premenstrual dysphoric disorder: acute effects of alprazolam

This study determined if women with premenstrual dysphoric disorder (PMS) showed impaired mood and performance when they were experiencing their premenstrual symptoms, and if the effects of alprazolam varied as a function of menstrual cycle phase. Under double-blind conditions, the acute effects of placebo and alprazolam (0.25, 0.50, 0.75 mg) were tested during both luteal and follicular phases. Women with confirmed PMS experienced substantial changes in mood as a function of menstrual cycle phase. However, under controlled laboratory conditions, acute doses of alprazolam did not improve negative premenstrual mood, but rather increased negative mood in the follicular phase. Alprazolam impaired task performance, although this impairment was generally similar in both phases when baseline phase differences were taken into consideration. Consistent with the failure of alprazolam to improve mood premenstrually, subjective measures indicative of abuse liability were not increased following alprazolam. Taken together, these data suggest that acute administration of alprazolam doses are not clinically useful for the treatment of PMS.     

Dysregulation of cardiovascular and neuroendocrine responses to stress in premenstrual dysphoric disorder

A reporter gene system that allows in situ detection of cells that have suffered a specific frameshift mutation was developed. To construct the reporter gene, the open reading frame of a human placental alkaline phosphatase (PLAP) gene was disrupted by insertion of either 5 or 7 G:C basepairs, which formed mutant alleles carrying 9 and 11 consecutive G residues, respectively. The mutant PLAP genes did not produce alkaline phosphatase activity in cultured mouse cells in transient transfection assays. Several cell lines that contained integrated copies of the mutant PLAP genes were made. Histochemical staining of fixed cells showed that these cell lines contained a small number of cells that expressed PLAP activity and bound antibodies directed against PLAP. Cells carrying the allele with 11 consecutive G residues (G11 allele) acquired PLAP activity at a rate between 2 x 10(-3) and 2 x 10(-4) events per cell per generation, depending on the cell line. Cells carrying the allele with 9 consecutive G residues (G09 allele) acquired PLAP activity at a rate between 2 x 10(-5) and 2 x 10(-6) events per cell per generation, depending on the cell line. Cultures of PLAP+ cells were derived from cell lines carrying PLAP mutant genes. All the cells in these cultures had PLAP activity and bound anti-PLAP antibody. PLAP mRNA levels were the same in cultures where all cells were PLAP+ and in cultures where less than 1% of the cells expressed PLAP activity. DNA sequence analysis of PLAP+ cells showed that the G11 allele reverted by losing one basepair, and the G09 allele reverted by gaining one basepair.     

Menstrual cycle, beta-endorphins, and pain sensitivity in premenstrual dysphoric disorder.

This study examined pain sensitivity and pain modularity mechanisms (e.g., beta-endorphin levels, blood pressure) in women with premenstrual dysphoric disorder (PMDD; n=27) and healthy controls (n=27) during the follicular and luteal phases of the menstrual cycle. Physiological measures were taken during rest and ischemic pain testing. In both cycle phases, PMDD women (a) displayed lower resting cortisol and beta-endorphin levels and (b) exhibited shorter pain threshold and tolerance times and greater pain unpleasantness ratings during pain. PMDD women also reported greater pain unpleasantness and intensity and had lower beta-endorphin levels in their luteal phase and tended to display higher blood pressure levels at rest and during pain testing. Results suggest that endogenous opioids may be pathophysiologically relevant to PMDD and that the hypothalamic-pituitary-gonadal axis may modulate pain sensitivity in PMDD. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Gender differences in the diagnosis of mental disorders: conclusions and controversies of the DSM-IV

One of the more controversial issues in terms of mental disorder diagnoses has been their differential sex prevalence. The conclusions provided in the 4th edition of the American Psychiatric Association's (1994) Diagnostic and Statistical Manual of Mental Disorders were derived from systematic reviews of the research literature. However, this research is perhaps complicated by common sources of error. Two sources, in particular, are emphasized here: biases in sampling and biases within the diagnostic criteria themselves. The potential for such biases is illustrated for a wide variety of mental disorder diagnoses, and suggestions for research to address them are provided.     

Persistent alterations in biological profiles in women with abuse histories: Influence of premenstrual dysphoric disorder.

Objective: To examine dysregulation in biological measures associated with histories of abuse in women and whether women with premenstrual dysphoric disorder (PMDD) differ in their dysregulation. Design: Twenty-five women meeting prospective criteria for PMDD and 42 non-PMDD controls underwent structured interview to determine abuse histories and lifetime Axis I diagnoses, excluding those with current Axis I disorders or using medications. Major Outcome Measures: Plasma cortisol and norepinephrine (NE), heart rate (HR), blood pressure (BP), and vascular resistance index (VRI) were assessed at rest and in response to mental stress. Results: A greater proportion of PMDD women had prior abuse compared with non-PMDD women. Regardless of PMDD status, all abused women had lower plasma NE and higher HRs and tended to have lower plasma cortisol at rest and during stress. Abused women also reported more severe daily emotional and physical symptoms. Greater VRI and BP at rest and during stress were seen only in PMDD women with abuse. Conclusion: There is persistent dysregulation in stress-responsive systems in all abused women that cannot be accounted for by current psychiatric illness or medications, and PMDD women may be differentially more vulnerable to the impact of abuse on measures reflecting α-adrenergic receptor function. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Advances and controversies in the diagnosis and management of medullary thyroid carcinoma

In tasks requiring sustained attention, human alertness varies on a minute time scale. This can have serious consequences in occupations ranging from air traffic control to monitoring of nuclear power plants. Changes in the electroencephalographic (EEG) power spectrum accompany these fluctuations in the level of alertness, as assessed by measuring simultaneous changes in EEG and performance on an auditory monitoring task. By combining power spectrum estimation, principal component analysis and artificial neural networks, we show that continuous, accurate, noninvasive, and near real-time estimation of an operator's global level of alertness is feasible using EEG measures recorded from as few as two central scalp sites. This demonstration could lead to a practical system for noninvasive monitoring of the cognitive state of human operators in attention-critical settings.     

Intussusception. Issues and controversies related to diagnosis and reduction

Co-operative oxygen binding by the vertebrate haemoglobins arises from an equilibrium between a quaternary structure with low affinity (T), favoured in the absence of ligand, and a high affinity form (R) adopted by the fully ligated protein. While R state haemoglobin has an oxygen affinity close to that of isolated subunits, the affinity of the T state is roughly 300-fold lower. The mechanism by which the T state restrains ligand binding, and the pathway of the quaternary transition, have been largely revealed by detailed crystallographic analyses of a number of haemoglobin molecules in the equilibrium states, as well as intermediate forms of the T state including partially ligated species. The ligation intermediates of the R state, however, have not been as well characterized structurally. We report here the crystal structure of one such intermediate species, namely, horse deoxyhaemoglobin in the R state, at 1.8 A resolution. While ligand binding in the T state may result in unfavourable stereochemistry in and around the haem-ligand complex, the more plastic R structure appears to accommodate equally well both liganded and ligand-free haem. Loss of ligand at the R state haem results in movements of the haem and shifts of the FG corners, which form characteristic intersubunit contacts that distinguish the quaternary states. The shifts are comparable in magnitude to the corresponding movements associated with de-ligation in the T state, although they differ in direction. These and other differences illustrate how the structural changes in the haem pocket are communicated to the subunit interfaces and how the movements that can occur in the R state may be impeded in the T state.     

Premenstrual depression: A distinct entity.

Premenstrual symptom report of 30- to 45-year-old normal women was assessed retrospectively with the Premenstrual Assessment Form (Halbreich, Endicott, Schacht, & Nee, 1982). Women reporting premenstrual depression (PMD) or no psychological changes (controls) premenstrually completed daily symptom ratings during one menstrual cycle and were assessed pre- and postmenstrually with self-report depression inventories and a test of selective attention. Inspection of daily ratings revealed two distinct subgroups within the PMD group: 39% were confirmed as experiencing PMD and 36% reported intermittent depression throughout the cycle. Both self-report and selective attention data yielded distinctly different response patterns for the three groups, with only the PMD group reporting the classic premenstrual increase in depression. Implications of these findings for the validity and nature of the premenstrual depressive experience are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Obsessive-compulsive disorder: diagnosis and treatment in the primary care setting

BACKGROUND: Obsessive-compulsive disorder is a common anxiety disorder found in 1 to 2 percent of the population. Obsessions are recurrent and persistent thoughts that cause marked anxiety or distress. Compulsions are repetitive behaviors or mental acts done to prevent or reduce anxiety. Patients might underreport symptoms or complain of coexisting depression or anxiety instead. The primary care physician is often the first to encounter this disorder in patients. METHODS: The authors cared for and observed a patient with obsessive-compulsive disorder at a family practice office and used her case to illustrate a literature review gathered by means of a MEDLINE search. RESULTS AND CONCLUSIONS: A combination of patient education, selective serotonin reuptake inhibitors, and behavioral techniques allow the family physician to maximize patient recovery and play a major role in the diagnosis and treatment of obsessive-compulsive disorder.     

Gender differences in the diagnosis of mental disorders: Conclusions and controversies of the DSM–IV.

One of the more controversial issues in terms of mental disorder diagnoses has been their differential sex prevalence. The conclusions provided in the 4th edition of the American Psychiatric Association' s (1994 ) Diagnostic and Statistical Manual of Mental Disorders were derived from systematic reviews of the research literature. However, this research is perhaps complicated by common sources of error. Two sources, in particular, are emphasized here: biases in sampling and biases within the diagnostic criteria themselves. The potential for such biases is illustrated for a wide variety of mental disorder diagnoses, and suggestions for research to address them are provided. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychiatric consultation: concepts and controversies

There are two major models of consultation in the field of psychiatry, differing in their goals, participants, settings, and methods. The psychiatric-therapeutic model entails provision of optimal care for the individual patient; the community mental health model involves provision of assistance to mental health caregivers. The author believes that to enhance the value of consultation the consultation should restrict his or her role to that for which he or she has been trained. Current social needs, coupled with a limited supply of consultants, suggest that psychiatric consultation should be provided within comprehensive health care systems. There is a pressing need to clarify the concepts of formulations concerning the criteria of outcome of psychiatric consultation so that evaluation of its effectiveness can be advanced.     

Proinsulin: recent observations and controversies

INTRODUCTION: Defibrillation thresholds (DFTs) usually are determined with the patient in the supine position. However, patients may be in the upright position when a shock is delivered during follow-up, which may explain some first shock failures observed clinically. This study investigated whether body posture affects defibrillation energy requirements of nonthoracotomy implantable cardioverter defibrillators with biphasic shocks. METHODS AND RESULTS: Using a step up-down protocol, DFTs were compared intraindividually in 52 patients ("active-can" sytems in 41 patients, two-lead systems in 11 patients) for the supine and upright positions as achieved by a tilt table. The mean DFT was 7.3 +/- 4.2 J in the supine versus 9.2 +/- 4.8 J in the upright position (P = 0.002). Repeated comparison in reversed order 3 months after implantation in 22 patients revealed thresholds of 6.2 +/- 2.5 J (supine) versus 8.4 +/- 3.7 J (upright; P < 0.03) 1 week and 4.4 +/- 2.4 J (supine) versus 6.2 +/- 4.1 J (upright; P < 0.04) 3 months after implantation. DFTs decreased significantly for both body positions from 1 week to 3 months after implantation (P < 0.04). CONCLUSION: (1) DFTs for biphasic shocks delivered by nonthoracotomy defibrillators are higher in the upright compared to the supine body position. (2) Differences remain significant 3 months after implantation. For both body positions, DFT decreases significantly from 1 week to 3 months after implantation. These findings have important implications for programming first shock energy to lower than maximal values or for development of devices with lower maximal stored energy.     

Weighting criteria in the diagnosis of a personality disorder: A demonstration.

Focused on how clinicians combine symptom information about narcissistic personality disorder (NPD) to make a diagnosis. A sample of 59 psychiatrists and clinical psychologists were asked to read and diagnose 20 case histories of which 6 cases had criteria for NPD embedded as sentences. The number of criteria and the face validity of the criteria were varied across case histories. Three models of how criteria might be combined to form a diagnosis were compared: the polythetic model, the additive model, and the weighting model. The results were most consistent with the weighting model. (PsycINFO Database Record (c) 2010 APA, all rights reserved)