Awareness of illness in schizophrenia and outpatient treatment adherence

We present a brief measure of awareness of illness in schizophrenia and test whether awareness is related to perceived need for and adherence to outpatient psychiatric treatment. A prospective design assessed treatment adherence, awareness of the signs and symptoms of schizophrenia, symptoms, neurocognitive status, and substance abuse at baseline and 6-month follow-up in 89 persons with schizophrenia. Results indicate that persons with greater awareness perceived greater need for outpatient treatment and evidenced better adherence to outpatient treatment when adherence and awareness were measured concurrently. Awareness was not related to adherence at 6-month follow-up. In addition, neurocognitive impairment was associated with lower overall adherence to treatment when reported by collaterals at baseline and 6-month follow-up. Neurocognitive impairment was, however, associated with higher self-reported adherence to medication, which suggests that neurocognitive status may bias adherence reporting in persons with schizophrenia.     

Toxicity of ornidazole and its analogues to rat spermatozoa as reflected in motility parameters

Ornidazole, a 5-nitro-imidazole derivative, has contraceptive properties in rats. As some ornidazole passes through the body unmetabolized after administration, the aim of this study was to investigate if ornidazole itself has a direct effect on sperm motility and whether these effects are limited or potentiated by the epididymal epithelium or structural changes to the molecule. Cauda epididymal spermatozoa or cauda epididymal tubules were incubated with ornidazole or ornidazole analogues, and motility parameters were subsequently measured by means of a computer-assisted sperm analysis (CASA) system. Incubation of spermatozoa in 2.5 mmol/L ornidazole for 4 h reduced their motility significantly, whereas incubation of epididymal tubules for 8 h in 10 mmol/L ornidazole was required to alter the velocity parameters of the enclosed spermatozoa upon release, suggesting that extratubular non-metabolized ornidazole can participate in inhibiting the motility in vivo. The in vitro toxicity of ornidazole derivatives depends on the halogen present and on the position of the nitro-group. The putatively inactive (R)- and the active (S)-ornidazole exhibited equivalent depression of sperm motility by direct incubation. This observation, and the differences between the in vitro and the in vivo efficacies of various ornidazole analogues, indicates distinct mechanisms of motility inhibition in the two experimental systems.     

Beyond lithium in the treatment of bipolar illness

Primary non-Hodgkin lymphoma of the stomach is a rare disorder for which clinical management has not yet been settled completely. Faced with the many uncertainties associated with the selection of a treatment for a patient with this disorder, it is difficult to determine the treatment that is optimal for the patient, as well as the prognosis to be expected. The development of a decision-theoretic model of non-Hodgkin lymphoma of the stomach is described. The model aims to assist the clinician in exploring various clinical questions, among others questions concerning prognosis and optimal treatment. Central to the model is a probabilistic network that offers an explicit representation of the uncertainties underlying the decision-making process. The model has been incorporated in a decision-support system. Preliminary evaluation results indicate that the performance of the model in its present form matches the performance of experienced clinicians.     

Communication in general practice: recognition and treatment of mental illness

The scope of the present review is to describe epidemiology, classification, symptomatology and treatment of diabetic peripheral somatic neuropathy and autonomic neuropathy. Special attention is paid to the use of local anaesthetic agents in painful diabetic neuropathy. Denervation hypersensitivity is a characteristic of autonomic neuropathy in diabetic patients. The pathophysiology behind this phenomenon is elucidated in this review and most recent studies related to diabetic encephalopathy are reviewed. References for this review were acquired via a MedLine and MedLars literature search.     

From private attitude to public opinion: A dynamic theory of social impact.

A computer simulation modeled the change of attitudes in a population resulting from the interactive, reciprocal, and recursive operation of B. Latané's (see record 1982-01296-001) theory of social impact, which specifies principles underlying how individuals are affected by their social environment. Surprisingly, several macrolevel phenomena emerged from the simple operation of this microlevel theory, including an incomplete polarization of opinions reaching a stable equilibrium, with coherent minority subgroups managing to exist near the margins of the whole population. Computer simulations, neglected in group dynamics for 20 years, may, as in modern physics, help determine the extent to which group-level phenomena result from individual-level processes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Distancing after group success and failure: Basking in reflected glory and cutting off reflected failure.

Two image-maintenance processes by which people manipulate their association with others were tested: the tendency to bask in reflected glory as a means of increasing one's association with successful others and the tendency to cut off reflected failure as a means of decreasing one's association with unsuccessful others. 102 undergraduates were initially involved in a group task and were then assigned to 1 of 3 group-performance feedback conditions: failure, no information, or success. Self-report and behavioral (taking and wearing of team badges) dependent measures of distancing showed that Ss in the failure group manifested less association with their group than did Ss in the no-information feedback and success groups; there was a tendency on behavioral but not self-report measures for Ss in the success group to manifest more association with their group than for Ss in the no-information feedback group. Therefore, more support was found for the cutting-off-reflected-failure process than for the basking-in-reflected-glory process as an image-maintenance tactic. Because Ss truly identified with their group's relative sense of failure or success, it is suggested that it was this identification process that appeared to have driven Ss' distancing behaviors in relation to their groups. (31 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Advances in the diagnosis and treatment of children with serious mental illness

As a nation, we are becoming aware that a significant number of children develop severe neuropsychiatric disorders. Unfortunately, knowledge of DSM-IV criteria does not always help the child and family social worker identify children with these disorders. Early onset schizophrenia, bipolar disorders, and severe depression can cause child behaviors that differ markedly from symptoms manifested by adults with serious mental illness. This article provides specific information for screening and treating children who develop long-term neuropsychiatric disorders.     

Older persons'' preferences for site of treatment in acute illness

OBJECTIVES: The objective of this pooled analysis was to examine whether exposure to DDT was associated with the risk of non-Hodgkin's lymphoma among male farmers. METHODS: Data from three case-control studies from four midwestern states in the United States (Nebraska, Iowa, Minnesota, Kansas) were pooled to carry out analyses of 993 cases and 2918 controls. Information on use of agricultural pesticides and other risk factors was based on interviews. Non-farmers (people who had never lived or worked on a farm) were used as a reference category. RESULTS: There were 161 cases and 340 controls who reported use of DDT on animals or crops, or on both, yielding an odds ratio (OR) of 1.2 (95% confidence intervals (95% CI) 1.0 to 1.6). Farmers who had used DDT for > or = 15 years had an OR of 1.5 (95% CI 1.0 to 2.3). Adjustment for respondent status and use of other pesticides resulted in slightly reduced ORs. Analyses by the number of days of use a year was limited to the Nebraska data. The most notable increase was found among farmers who used DDT for > or = 5 days a year (OR 2.6, 95% CI 1.1 to 5.9); however, additional adjustment for use of organophosphates, phenoxyacetic acids, and the individual pesticides lindane, malathion, and atrazine reduced the ORs to 1.0, 0.9, 1.1, 1.6, and 1.9 respectively. CONCLUSIONS: No strong consistent evidence was found for an association between exposure to DDT and risk of non-Hodgkin's lymphoma. It seems that the excess risk initially found may be explained by use of other pesticides.     

Failure of a moral enterprise: Attitude of the public toward mental illness.

Presents a critical analysis of published reports on the public's attitudes toward mental illness and toward deviant conduct. The mental health movement fits the defining criteria for a moral crusade, motivated and supported by moral entrepreneurs. The reported data indicate that the mental illness paradigm, as a formula for understanding and controlling deviant conduct, has not been widely accepted by the public. The central objective of the mental health movement has been to influence the general public to regard mental illness with the same nonrejecting valuations as somatic illness. Social survey reports and other data point to the conclusion that the public tends to declare negative (rejecting) valuations on persons diagnosed as mentally ill. However, the public tends to be more tolerant of deviant conduct when it is not described with mental illness labels. (37 ref.) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Facing chronic illness: the family support model and its benefits

With the aging of the population and the evolving health care system, it is more important than ever before that individuals be actively involved in selfcare activities and that individuals and families receive education and support to help them cope with chronic illness. This article describes a model family support program which operates within a hospital setting to provide information, education, support, and respite services. This model is based on an extensive research base which underscores the value of this model both for the individuals and families involved and for the health care system.     

The Israeli-Palestinian peace process and its vicissitudes: Insights from attitude theory.

The vicissitudes of the Israeli-Palestinian peace process since 1967 are analyzed using attitudes and related concepts where relevant. The 1967 war returned the two peoples' zero-sum conflict around national identity to its origin as a conflict within the land both peoples claim. Gradually, new attitudes evolved regarding the necessity and possibility of negotiations toward a two-state solution based on mutual recognition, which became the building stones of the 1993 Oslo agreement. Lacking a commitment to a final outcome, the Oslo-based peace process was hampered by reserve options, which increased avoidance at the expense of approach tendencies as the parties moved toward a final agreement. The resulting breakdown of the process in 2000 produced clashing narratives, reflecting different anchors for judgment and classical mirror images. Public support for violence increased, even as public opinion continued to favor a negotiated two-state solution. Reviving the peace process requires mutual reassurance about the availability of a partner for negotiating a principled peace based on a historic compromise that meets the basic needs and validates the identities of both peoples. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Reasoning about moral aspects of illness and treatment by preschoolers who are healthy or who have a chronic illness

Obesity, a common nutritional disorder in childhood, is a complex problem that is poorly understood. The purpose of this study was to identify the prevalence of obesity in preschool children, and to examine the relationships between obesity and gender, race, socioeconomic status, and health problems. Data were collected from 309 charts of children enrolled in a Head Start program. Ninety-nine (32%) of the children were obese. Obese children had significantly higher blood pressure readings than those who were not obese. This study represents a beginning effort to learn more about the prevalence of, and factors associated with, obesity in preschoolers.     

Cognitive-behavioral treatment of panic complicated by medical illness.

Notes that cognitive-behavior therapy combined with medication can be an effective treatment combination for individuals suffering from panic attacks. Certain cases may prove difficult however, particularly when an individual is recovering from a serious medical illness in which many of the symptoms of the medical illness overlap with the symptoms of panic. This article reviews some of the complicating factors that may occur with such cases as well as techniques for helping individuals differentiate between symptoms that denote a recurrence of the medical illness and those that involve panic disorder and anxiety. Two case vignettes, one of a 54-yr-old steel worker and one of a 19 yr-old gymnast, are included that portray how cognitive-behavioral techniques can be used to help individuals reduce their anxiety and panic and also effectively differentiate symptoms of a recurring medical illness. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Hypertension and its treatment in pregnancy

Hypertensive disorders complicate approximately 10% of all pregnancies, about half due to transient and essential hypertension and the rest due to preeclampsia that continues to be a major contributor to maternal and perinatal mortality. However, when hypertensive pregnancies are carefully monitored, the neonatal mortality is low. Therefore, identification of women destined to have preeclampsia is essential, and it is the major purpose of the new classification proposed by M. A. Brown and M. L. Buddle to better stratify those hypertensive pregnant women who are at high risk and need intensive inpatient management. Prophylactic low-dose aspirin appeared to prevent preeclampsia in some studies and to be reasonably safe; however, the effectiveness in reducing the incidence of severe preeclampsia and improving pregnancy outcome remains uncertain. The basic therapy for hypertension during pregnancy is now hydralazine, labetalol and methyldopa; for preeclampsia the cornerstone for treatment is magnesium sulphate and hydralazine intravenously, and small doses of diazoxide, if necessary. Diuretics have a dubious place in treatment of hypertension during pregnancy, and ACE-inhibitors are contraindicated. In severe preeclampsia and eclampsia, the only solution is delivery; better knowledge of etiology and pathogenetics is needed for effective and safe treatment of gestational hypertension, as well as careful blood pressure monitoring and adequate laboratory control.     

The relationship of public support payments to substance abuse among homeless veterans with mental illness

OBJECTIVE: A suspicion that disability payments may exacerbate substance use among persons with chemical addictions recently led Congress to limit federal disability entitlements of applicants whose disability status is related to substance abuse, even if they have another serious mental disorder. This study empirically explored the relationship between receipt of disability payments and substance use among homeless mentally ill veterans. METHODS: The study sample included 2,474 homeless veterans with a current diagnosis of schizophrenia and a substance abuse or dependence disorder who were assessed in a community outreach program sponsored by the Department of Veterans Affairs. RESULTS: After adjustment for other relevant factors, receipt of disability payments showed no significant relationship to the number of days of substance use a month, even among frequent users of alcohol and drugs. CONCLUSIONS: Findings about substance use among the homeless veterans with serious mental disorders in this study provide no support for the assertion that disability payments exacerbate substance use.