Neuroimaging in alcoholism: CT and MRI results and clinical correlates

The objectives of our work are to develop methodologies capable of identifying the potential environmental health hazards of chemicals. These techniques are particularly useful when it is necessary to evaluate molecules that have not been synthesized as yet, or for which there is little or no toxicological information known. With the help of MULTICASE, an artificial intelligence program capable of uncovering the relationship between the presence of specific substructures in a molecule and its toxicity, and TOX II, a program capable of identifying the existence of such substructures in a new molecule, it is now possible to predict with a reasonable degree of certainty whether a new molecule will be toxic. TOX II will uncover any functionality previously found to be related to toxicity in any organic molecule. The evaluation is extensive and may include its automatically generated metabolites. The scope of TOX II is vast as more than 70 toxicological endpoints can be evaluated.     

Behavioural problems in dementia and biochemistry: clinical aspects

OBJECTIVES: Vocal cord abductor paralysis (VCAP) is a life threatening complication which may cause nocturnal sudden death in patients with multiple system atrophy. However, the early diagnosis of VCAP is often difficult to make on routine laryngoscopy performed during wakefulness, as stridor, which is the sole symptom of VCAP in the early stage, develops only during sleep. The aim was to investigate laryngeal dysfunction in patients with multiple system atrophy while awake and asleep. METHODS: Seven patients with multiple system atrophy with nocturnal stridor and five control patients were studied. Vocal cord movement was analysed by laryngoscopy while the patients were awake and also during sleep induced by intravenous diazepam. RESULTS: When awake, for the seven patients with multiple system atrophy normal movement of the vocal cords occurred in three, mild abduction restriction in three, and paradoxical movement in one. When asleep, however, all showed obvious paradoxical movement with high pitched inspiratory stridor. In controls, there were no differences in the vocal cord movement between wakefulness and sleep. From these findings, VCAP could be divided into four stages: stage 0 (normal) with normal vocal cord movement during both wakefulness and sleep, stage 1 (mild VCAP) with normal movement during wakefulness and paradoxical movement during sleep, stage 2 (moderately severe VCAP) with abduction restriction during wakefulness and paradoxical movement during sleep, and stage 3 (severe VCAP) with an almost midline position for the vocal cords during both wakefulness and sleep. CONCLUSIONS: Laryngoscopy during sleep can disclose subclinical VCAP, making an early diagnosis of VCAP in patients with multiple system atrophy. Stage 2 of VCAP seems to be a suitable stage for tracheostomy in patients with multiple system atrophy.     

Depression in Parkinson's disease: clinical correlates and outcome

Depression has been shown to be more common in Parkinson's disease (PD) than in other chronic and disabling disorders. Neurochemical and functional disturbances are important etiopathogenic factors. The prevalence and clinical features associated with depression in PD remain controversial. The purpose of this study is to estimate the prevalence of depressive symptoms in our patients, as related to other clinical data, and to assess clinical outcomes of these symptoms. A series of PD patients were evaluated over a 9-year period, using the Unified Parkinson's Disease Rating Scale (UPDRS), Hoehn and Yahr stage (HY), Schwab and England Scale (SE), Mini-Mental State Examination (MMSE), and Yesavage Geriatric Depression Scale (GDS). Presence of depressive symptoms was considered if GDS score was higher than 10: mild-moderate (MD) for GDS scores between 11 and 20 and moderate-severe (SD) for GDS scores greater than 20. Three hundred and fifty-three patients were included in this study and additional follow up information was obtained for 184 patients. MD and SD were found in 40.2 and 16.7% of PD patients, respectively. Female gender, high HY, high UPDRS total and subtotal, and low MMSE and SE scores were significantly associated with depressive symptoms. According to changes in GDS score, 34% of patients remained stable, 35% showed an improvement, and 30.9% worsened in the follow up study. Gender, age, age of onset, HY, UPDRS, and PD duration are not related to depression outcome.     

Delusions in Alzheimer''s disease: a review

To understand the developing processes of gamma-aminobutyric acid (GABA)-containing chromaffin cells and nerve fibers in the mouse adrenal gland, we examined the tissues in various postnatal stages by immunohistochemistry using a GABA antibody. From birth until postnatal week 1, GABA-immunoreactivity was seen in very few nerve fibers, and in none of the chromaffin cells. At postnatal week 2, GABA-immunoreactivity appeared weakly in clusters of chromaffin cells and strongly in relatively numerous varicose nerve fibers. The immunoreactive nerve fibers were densely distributed in the small immunonegative chromaffin cells and large ganglion cells, but only sparsely so in the weak immunoreactive chromaffin cells. At postnatal week 3, the number of the immunoreactive chromaffin cells and nerve fibers further increased compared to that at postnatal week 2. The staining pattern of GABA-immunoreactive nerve fibers in the medullas was similar to that at postnatal week 2. From postnatal week 4 until postnatal week 8, the distribution and frequency of the immunoreactive chromaffin cells and nerve fibers were also similar to those at postnatal week 3. These results suggest that the expression of GABA in the chromaffin cells and in the nerve fibers of the mouse adrenal gland may be completed by postnatal week 3.     

Delusions and delusional reasoning.

In 2 studies, delusional participants assigned higher probabilities to narratives of actual delusions than participants with no history of delusions; previously delusional participants did not differ significantly from delusional participants or participants with no history of delusions. In Study 2, the authors found that this reasoning bias was specific to delusions and did not generalize to "neutral" text. Familiarity with the content of the delusional narratives played a mediating role in the estimation of their probability, but delusional status also had a significant, independent effect. These findings are consistent with the Bayesian model of delusion formation proposed by D. R. Hemsley and P. A. Garety (1986), and with R. P. Bentall, P. Kinderman, and S. Kaney's (1994) concept of "emotional saliency." A productive area of future research might be to further determine the elements of "emotional saliency" and their impact on the individual steps of the Bayesian model. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Glucocorticoid therapy for immune-mediated diseases: basic and clinical correlates

Glucocorticoids are pleiotropic hormones that at pharmacologic doses prevent or suppress inflammation and other immunologically mediated processes. At the molecular level, glucocorticoids form complexes with specific receptors that migrate to the nucleus where they interact with selective regulatory sites within DNA; this results in positive and negative modulation of several genes involved in inflammatory and immune responses. At the cellular level, glucocorticoids inhibit the access of leukocytes to inflammatory sites; interfere with the functions of leukocytes, endothelial cells, and fibroblasts; and suppress the production and the effects of humoral factors involved in the inflammatory response. Clinically, several modes of glucocorticoid administration are used, depending on the disease process, the organ involved, and the extent of involvement. High doses of daily glucocorticoids are usually required in patients with severe diseases involving major organs, whereas alternate-day regimens may be used in patients with less aggressive diseases. Intravenous glucocorticoids (pulse therapy) are frequently used to initiate therapy in patients with rapidly progressive, immunologically mediated diseases. The benefits of glucocorticoid therapy can easily be offset by severe side effects; even with the greatest care, side effects may occur. Moreover, for certain complications (for example, infection diathesis, peptic ulcer, osteoporosis, avascular necrosis, and atherosclerosis), other drug toxicities and pathogenic factors overlap with glucocorticoid effects. Minimizing the incidence and severity of glucocorticoid-related side effects requires carefully decreasing the dose; using adjunctive disease-modifying immunosuppressive and anti-inflammatory agents; and taking general preventive measures.     

MMPI clinical scale correlates.

Discusses and compares the results of 7 independent studies that have attempted empirically to identify the behavioral or symptom correlates of individual MMPI clinical scales for psychiatric patients. Symptom correlates, in general, tend to provide construct validity for the "traditional" interpretation of individual scales. The correlations are uniformly quite low, however, and individual scales evidence relatively few instances of unique discrimination. Major symptom correlates for individual scales also tend to be significantly related to 2-point profile codes that include the individual scales, although there are obvious differences that may be associated with scale profiles. Some possible interactions of scale correlates with race, sex, and clinical setting are noted. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Serotonergic functioning in depressed abused children: clinical and familial correlates

BACKGROUND: The goal of this study was to examine serotonergic functioning and concomitant clinical and familial correlates in depressed abused children. METHODS: L-5-Hydroxytryptophan (L-5-HTP) (0.8 mg/kg) was administered intravenously to 10 depressed abused (MDD-AB), 10 depressed nonabused (MDD-NA), and 10 normal control nonabused (NC-NA) children. The children in the two nonabused cohorts represent a small matched subset of children from a larger interlocking study of the psychobiology of depression. Blood samples for prolactin and cortisol were collected from 30 min before to 2.5 hours after L-5-HTP infusion. RESULTS: The MDD-AB children secreted significantly more prolactin post-L-5-HTP than the children in the other two groups. There were no differences in baseline prolactin or any of the cortisol measures. Total prolactin post-L-5-HTP was significantly correlated with clinical ratings of aggressive behavior (rho = .48). In addition, children with a family history positive for suicide attempt (MDD-AB: n = 7; MDD-NA: n = 5; NC-NA: n = 2) secreted significantly more prolactin post-L-5-HTP than children with no family history of suicide. CONCLUSIONS: Dysregulation in the serotonergic system in abused children appears to be related to both familial and experiential factors.     

Renal deterioration in myelodysplastic children: urodynamic evaluation and clinical correlates

PURPOSE: We determined which factors portend a higher risk of renal deterioration in the myelodysplastic child, and evaluated the sensitivity and predictive value. MATERIALS AND METHODS: We retrospectively reviewed the medical history, imaging studies and urodynamics of 90 children with spinal dysraphism. Median patient age at initial evaluation was 3 months and average followup ranged between 2 and 25 years (average 11). We evaluated the relation of urodynamic parameters and sex to upper tract changes and the resolution of these changes. RESULTS: Statistically significant relationships were identified between the urodynamic parameters of leak point pressure, compliance and detrusor-sphincter dyssynergia, and renal deterioration but not with resolution of deterioration. Boys and girls did not demonstrate a significant difference among urodynamic parameters. Female patients had a higher incidence of reflux and parenchymal loss. CONCLUSIONS: With knowledge of the inherent sensitivity, specificity and predictive value of urodynamic parameters, selective use of urodynamics will assist in identifying patients at risk of renal deterioration. Female patients with reflux are at greatest risk of parenchymal loss. We advocate early institution of intermittent catheterization in patients identified as high risk for deterioration by urodynamics.     

Psychosis proneness and clinical psychopathology: Examination of the correlates of schizotypy.

The present report examined the associations between the Perceptual Aberration Scale (PAS), a prominent psychometric index of hypothetical psychosis proneness, and several measures of clinical psychopathology in a nonpsychotic psychiatric sample (N?=?101). Patients were examined by experienced clinicians using structured psychiatric interviews to assess Diagnostic and Statistical Manual of Mental Disorders-III—Revised (DSM-III—R) Axis I and II conditions and rated for anxiety, depression, severity of illness, and current adult social competence. Elevated scores on the PAS were most closely associated with anxiety and depression as well as schizotypal, schizoid, avoidant, and obsessive–compulsive personality disorder symptomatology. Hierarchical regression analysis identified schizotypal symptoms and anxiety as the two underlying psychopathological processes most useful in explaining variance in PAS scores. Results are interpreted as supporting both the clinical relevance and research utility of the PAS and enhancing the construct validity of Meehl's model of schizotypy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Dexamethasone suppression and self-reinforcement correlates of clinical depression.

Neuroendocrine dysfunction and self-reinforcement deficits were evaluated in 45 individuals exhibiting symptoms of major depression. The dexamethasone suppression test (DST), Beck Depression Inventory (BDI), and Frequency of Self-Reinforcement Questionnaire (FSRQ) were administered to subjects who also were participating in a comparative antidepressant drug study. Subjects with low rates of self-reinforcement tended to exhibit normal DST responses, whereas high self-reinforcement could not be characterized as being significantly more or less dysfunctional on the DST. Only one third of this sample of depressives evidenced abnormal DSTs, which suggests that in these cases of depression with normal neuroendocrine functioning, a deficit in self-reinforcement could be related to depression. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Some clinical correlates of operant behavior.

"22 chronic psychotic patients, Ss in an operant conditioning study, were given psychological tests and rated as to their ward behavior. Ratings of ward behavior and rates of operant response were directly related. Those patients who were testable by at least one clinical test were those who were high operant responders. These findings were discussed in terms of a notion of adaptability to the demands of the hospital environment. Clinical and operant data on 6 normal Ss were also presented." (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Costs of dementia and dementia care: a review

Costs of dementia care constitute a great part of the total costs of care for elderly. Because the prevalence of dementia is linked to increasing age, and the number of the oldest old is rising, the costs of dementia care will increase considerably in the forthcoming decades. In this review, research describing costs of dementia care has been analysed and classified. The available database in this field is small, though expanding, and the methodological problems are obvious. Differences between countries, and between different periods of time, are difficult to analyse due to different methods of financing and organizing care. The main result of the present study is that the costs of dementia care differ considerably in the literature. One important reason for this variability is that the number of included cost categories vary, leading to a wide range of costs. Unpaid informal care forms a major part of the total costs, but the theory of costing informal care is complicated.     

Three-dimensional CT angiography of the thorax: clinical applications

Spiral CT with three-dimensional (3D) display can provide a rapid noninvasive examination of the vascular system and has been shown to have a wide range of clinical applications in the thorax, including imaging of the aorta, pulmonary vasculature, and venous abnormalities. Three-dimensional images can provide views of the imaging volume from innumerable viewing angles for both the radiologist and referring clinician, and potentially obviate invasive procedures such as angiography. In this article, we will review many of these applications of spiral CT angiography with 3D displays. Emphasis is placed on study design, protocol selection, and display of pathology.     

Image quality in dynamic CT: a clinical discussion

Modern state-of-the-art computed tomographic (CT) scanners emphasize three capabilities: image quality, dynamic scan capability, and a high-resolution thin-section technique. Image quality is fundamental and dependent on optimum performance and the interrelationship of all system components. Variables that affect the performance of the scanner include x-ray tube output and rate of heat dissipation; quantum detection efficiency; electronic noise in the acquisition system; speed, accuracy, and integration of mechanical motion in the gantry and table; and the algorithm used for image reconstruction. System design must allow for dynamic scan operation, either in the single-scan or cluster mode, with short interscan or intergroup delays or, as more recently developed, with helical acquisition. Dynamic scanning is frequently used for nonneurologic applications, including diagnosis of vascular and perivascular diseases and multifocal organ disease, particularly hepatic disease. Efficient operation depends on rapid reconstruction and display capability. Modern systems have been engineered to provide flexible modes of operation, particularly in dynamic scanning, and rapid on-line review and analysis, all of which serve to improve the quality of images produced with dynamic CT scanning.     

Delusions and hallucinations in patients with borderline personality disorder

OBJECTIVE: Heat exposure has been shown to stimulate GH release, but the specificity and the reproducibility have not been determined, and the test has not been compared with validated GH stimulation tests in adulthood. We therefore tested the specificity and the reproducibility of the heat exposure test in healthy subjects and compared the results with those obtained with the insulin-tolerance test (ITT). DESIGN: Ten healthy non-obese men, aged 31.3+/-4.80 years, underwent four GH stimulation tests in random order: two ITTs and two heat exposure tests. In the heat test, subjects were placed in a hot bath with water temperature at 40.3+/-0.11 degrees C for 45 min, resulting in an identical (P = 0.477) significant increase in tympanic temperature of 1.26+/-0.05 and 1.41+/-0.07 degrees C in the two tests. RESULTS: Peak GH response to the heat exposure test was less than the peak GH response to ITT (5.25+/-1.72 vs 15.5+/-3.17 microg/l, P = 0.006). Furthermore the specificity (arbitrary cut-off level = 3 microg/l) of the heat test was lower than of the ITT (8/17 vs 18/20, P = 0.006). The coefficient of variation did not differ between the two tests (heat test 0.31, ITT 0.36, P = 0.77). Peak GH values in the individual tests were highly correlated (heat, r = 0.908, P = 0.002; ITT, r = 0.815, P = 0.004). Reproducible increments in the circulating levels of stress hormones were observed during ITT. but these hormones remained largely unchanged during heat exposure. CONCLUSIONS: The heat exposure test is not a reliable GH stimulation test compared with the ITT in adults. This study documents that the ITT has a high specificity and reproducibility in the diagnosis of GH deficiency in adulthood. We propose that the heat exposure test is not used in the diagnosis of this condition in adulthood.     

Overview of clinical trials of hydergine in dementia

OBJECTIVE: To assess the overall effect of Hydergine (a combination drug called ergoloid mesylates) on patients with possible dementia and to investigate potential moderators of an effect. DATA SOURCES: MEDLINE, EMBASE, and two proprietary databases were searched for reports of clinical trials. STUDY SELECTION: Included were randomized, placebo-controlled, double-blind, parallel-group trials in subjects with symptoms consistent with dementia performed with specified outcome instruments and sufficient statistical information to calculate effect sizes. Forty-seven (31%) of 151 trials reviewed met selection criteria. DATA EXTRACTION: Potential moderating variables were extracted from each trial: sample size, inpatient-outpatient status, trial duration, age, gender, medication dose, publication year, and diagnostic grouping. Outcome measures were extracted with their associated statistics. DATA SYNTHESIS: The overall combined treatment effects ("adjusted d") for three types of outcome measures were calculated. Overall, Hydergine was more effective than placebo as assessed by comprehensive ratings (d = 0.47; 95% confidence interval [CI], 0.38 to 0.56; P = .0001), clinical global ratings (d = 0.56; 95% CI, 0.44 to 0.68; P = .0001), and combined neuropsychological measures (d = 0.27; 95% CI, 0.22 to 0.32; P = .0001). Inpatient status, daily doses of 4 mg or more, and vascular dementia were generally associated with larger effects. The effect in patients with possible Alzheimer's dementia was significant only for combined neuropsychological measures in five trials (d = 0.30; 95% CI, 0.16 to 0.44; P = .0001; and with a dose-response, P = .001). CONCLUSIONS: Overall, ergoloid mesylates were more effective than placebo. However, the effect in patients with possible Alzheimer's dementia was very modest at best. The dose-response relation suggests that potentially effective doses may be higher than the currently approved. The circumstances of the efficacy of Hydergine remain inadequately defined.     

Prevalence and clinical correlates of psychotic symptoms in Alzheimer''s disease

The Canadian Heart Health Initiative-Ontario Project (CHHIOP) investigates predisposition and capacity in Ontario public health departments to implement community-based heart health promotion activities. The research draws upon diffusion of innovations theory and recent work on ecological approaches to health promotion within which public health agencies are seen to play a central role. Mail-back surveys were completed by heart health staff in all 42 health departments in 1994 and 1996. Predisposition and capacity were measured as the importance and effectiveness ascribed to 18 organizational practices supportive of community heart health activities. Level of implementation was reported for 74 activities spanning a range of risk factors and settings. Predisposition, capacity and implementation scores increased between 1994 and 1996. The findings confirm positive correlations between predisposition and capacity and between capacity and implementation.