Personality disorders in patients with eating disorders: a controlled study

A group of 24 eating-disordered female subjects (10 anorexia nervosa--AN--and 14 bulimia nervosa--BN--patients) were interviewed, using a semistructured interview for DSM-III-R Axis-II Personality Disorders (SCID-II). A group of 54 subjects without eating disorder acted as a control group. A high rate of personality disorder (PD) diagnoses occurred in eating disordered subjects (AN and BN patients), with a high prevalence of borderline, dependent, and self-defeating PD. Avoidant and obsessive-compulsive PD were more common in AN patients, whereas BN was associated with histrionic PD. Findings have implications for the assessment and diagnosis of eating-disordered patients and for treatment planning.     

Psychosomatic syndromes in clinical practice. A proposal of diagnostic criteria

The following is a translation of the proposed diagnostic criteria established by a European group for twelve common psychosomatic syndromes found in general clinical practice. Many of them have the potential to occur during different stages of a large variety of diseases and their detection could lead to better holistic provision of health care.     

Adolescents and sexuality in family practice. A pilot study

It is well established that teenagers are generally dissatisfied with the sexual education they receive from school and parents. While several alternative sources of sex counselling have been suggested (i.e. an anonymous and semi-official telephone hot-line), the role of the general practitioner in sexual guidance of youngsters is only poorly evaluated. One hundred and sixty-eight teenage callers of "The Adolescent Sexuality Hot-line" were asked about their experience with sexual counselling by their family doctor. One third had actually discussed such topics with their g.p., and a total of 44.6% (significantly more girls than boys) regarded their g.p. as a desirable interlocutor on these issues. The reasons for having approached a g.p. for counselling differed according to gender, as did the causes for not wanting to involve a g.p. in sexual matters: boys tended to state shyness and lack of anonymity as main causes, whereas girls more often pointed to personal aspects of the doctor.     

Cerebral blood flow study using SPECT in patients with memory disorders

INTRODUCTION: Global amnesia (AG) is a dysfunction of memory, in which there is a sudden incapacity to remember recent events and assimilate new information. The aetiology is currently under discussion. The main hypotheses under consideration are an ischemic mechanism and an epileptic mechanism. OBJECTIVE: To study the cerebral blood flow in patients with temporary global amnesia (AGT) or permanent global amnesia (AGP) using functional neuroimaging techniques. MATERIAL AND METHODS: Four patients were studied. Two had severe alterations of fixation memory which had been present for months. The other two had a sudden loss of recent memory, although space-person orientation and immediate memory remained normal. In all cases the cerebral blood flow (FSC), was assessed by single photon emission tomography (SPECT), using Tc-HMPAO as the radio tracer. RESULTS: We describe 4 patients, 2 men and 2 women aged between 42 and 64.2 with AGT and the others with AGP. On SPECT there was temporal hypoperfusion in all 4 patients. In 2 cases there was associated parietal hypoperfusion and in 1 case there was frontal hypoperfusion. CONCLUSIONS: These findings suggest that AGT and AGP are of vascular origin and that SPECT is a useful diagnostic technique in patients with AG.     

Pressure pain thresholds in patients with craniomandibular disorders before and after treatment with acupuncture and occlusal splint therapy: a controlled clinical study

Fifty-five patients (46 women and 9 men) with craniomandibular disorders and a history of pain of at least 6 months' duration participated in this trial. The patients were randomly assigned to three groups: one group to receive acupuncture; one group to receive occlusal splint therapy; and one group to act as controls. Pressure pain threshold, clinical dysfunction score, and visual analog scale measures were used to evaluate patients before, immediately after, and 6 months after treatment. A moderate, but statistically significant, correlation was found between pressure pain threshold and the number of tender spots in the masticatory muscles (tau = -.43; P < .001), degree of tenderness in the masticatory muscles (tau = -.43; P < .001), clinical dysfunction score (tau = .32; P < .001), and the visual analog scale (tau = -.25; P < .01). The short-term results showed a statistically significant improvement in all evaluations for both treatment groups. No significant differences were found in the control group. The improvements resulted in significant differences between the control and each treatment group immediately after treatment. At the 6-month follow-up, no significant differences in pressure pain threshold or clinical dysfunction score were found in the two treatment groups compared with the short-term results.     

A clinical study of substance dependence patients combined with other psychiatric disorders

The present study was conducted for clarifying the comorbidity of substance dependence and other psychiatric disorders in outpatients of four psychiatric hospitals in May, 1995. The results were as follows; 7.4% (N = 234) of the total 3155 psychiatric outpatients were diagnosed as substance dependence. Among those substance dependence patients, alcohol dependence accounted for 82.5% and the percentage of the other substance dependence were very small, i.e., methamphetamine dependence 6.4%, solvent dependence 1.7%, multiple substance dependence 9.4%, respectively. The percentage of comorbidity of substance dependence and psychiatric disorders was 23.9% (N = 56) of 234 substance dependence patients. The percentage of co-morbid alcohol dependence patients with affective disorder in all affective disorder patients was 5.0%; the percentage of comorbidity of alcohol dependence in neurotic patients 4.1%; the percentage of alcohol dependence comorbidity in schizophrenic patients 0.7%. In many cases, onsets of substance dependence and psychiatric disorders were within 2 years, which suggests the common backgrounds for substance dependence and psychiatric disorders, such as disruption of family and occupational life, stress and individual vulnerability, and substance use for self-medication. The study indicates that the percentages of diagnosed comorbidity of substance dependence and psychiatric disorders are generally smaller in Japan than in the U.S., which may be based on the differences of diagnostic standards between the two countries. Further studies are needed on the comorbidity of substance dependence and psychiatric disorders in other general hospital and psychiatric clinic patients.     

Competitive memory training (COMET) for treating low self-esteem in patients with eating disorders: A randomized clinical trial.

This study evaluates a short stepwise cognitive–behavioral intervention for the treatment of low self-esteem in patients with eating disorders. Competitive memory training (COMET) for low self-esteem is based on insights and findings from experimental psychology. A total of 52 patients with eating disorders and low self-esteem were treated with COMET in a routine mental health center in addition to their regular treatment. These patients were randomized to receive 8 weeks of COMET + therapy as usual (TAU) or to receive TAU only. Differential effects in favor of COMET + TAU were found for 2 indexes of self-esteem and for 1 index of depressive mood. Shortcomings of this study and possible clinical implications are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A study of thyroid disease in family practice

Thyroid disease is relatively common in family practice, yet is often undiagnosed or poorly managed. This study examines several aspects of thyroid disease in a large, semirural family practice setting and exemplifies the type of practical clinical research that can be done in family medicine. An overall prevalence of approximately one percent was determined for thyroid disease in this practice. In a series of 85 patients, the ratio of hypothyroidism:hyperthyroidism:euthyroid goiter was 9:2:1 respectively. Initial signs and symptoms recorded for these patients conformed closely to the findings in other large series. Eighty percent of the patients with idiopathic hypothyroidism never had enlarged glands, whereas 100 percent of the patients with hypothyroidism associated with Hashimoto's thyroiditis had enlarged glands. Laboratory aids such as serum thyroid stimulating hormone (TSH), anti-thyroid antibodies, and radioactive iodine uptake (RAIU) and scans were inadequately utilized. Medical and/or surgical consultation was obtained in 17.5 percent of patients with hypothyroidism, 80 percent of patients with hyperthyroidism, and 63 percent of those with euthyroid goiter. Currently 95 percent of the hypothyroid patients and 100 percent of the hyperthyroid patients are euthyroid.     

Personality disorder in patients infected with HIV: a controlled study with implications for clinical care

A reversed-phase isocratic high-performance liquid chromatographic method is described for the simultaneous determination of EO9, 3-hydroxymethyl-5-aziridinyl-1-methyl-2-(1H-indole-4,7-dione)prop-beta- en-alpha-ol (I), and its ring-opened aziridine analogue EO5A (II), employing ultraviolet detection. Solid-phase sample extraction was used without addition of an internal standard. Plots of peak heights and areas of I and II were linear in the range 5-10,000 ng/ml. The lower limit of detection of both I and II in plasma was 2 ng/ml. The between-day variation of I was 13.9% at 5 ng/ml and lower than 6.2% for concentrations > or = 10 ng/ml. The between-day variation of II at 5 ng/ml was 13.8% and lower than 4.5% for concentrations > or = 10 ng/ml. The assay was developed to enable pharmacological guiding of a phase I study of I in solid tumour cancer patients.     

Epidemiological study of sleep disorders in patients in Swiss general practice

The aim of the study was to assess the prevalence, severity, associated factors and diagnosis of sleep disorders in general practice. Over 700 patients were investigated with a multiple choice questionnaire in 24 general practices in Switzerland. To assess sleep disorders, criterion A for insomnia according DSM-III-R was applied. The prevalence of sleep disorders was 44%, 64% of these were classified as mild, 31% as moderate and 5% as severe. 50% of the female patients complained about insomnia compared to 36% in males. Retrospectively, 74% of the patients stated having suffered from sleep disorders for more than one year (mild 76%, moderate 69%, severe 75%). 70% of patients with mild, 42% with moderate and 30% of patients with severe insomnia didn't inform their physicians about their sleep difficulties on the occasion of an earlier consultations. Patients with moderate or severe insomnia felt moderately or markedly disabled in their quality of life (71%) and work (58%). To estimate general anxiety and depressive state, self-rating scales were used (STAI, D-S). In comparison to reference values for healthy volunteers, insomniac patients had significantly higher scores on both scales, which were associated with the severity of sleep disorders, corroborating the association of sleep disorders with anxiety disorders and depressions. The physicians diagnosed in 18% of insomniacs a psychiatric disease, in 52% a psychoreactive disorder and in 26% a somatic etiology. The study shows that sleep disorders are a frequent syndrome in general practice and often not reported to the physician; therefore, the patients should routinely be questioned about sleep problems, and associated psychiatric diseases should be considered.     

External beam radiation in patients suffering from exudative age-related macular degeneration. A matched-pairs study and 1-year clinical follow-up

BACKGROUND: The aim of this prospective study was to ascertain whether external beam irradiation is effective in patients with subretinal neovascularization (SRN) due to age-related macular degeneration (AMD). METHODS: All patients had subfoveal SRN due to AMD as verified by fluoresceinangiography. Two hundred and eighty-seven patient-eyes were treated by external beam irradiation (total dose of 16 Gy in 2-Gy fractions, 5 times a week) from January 1996. The analysis was restricted to those 73 patients with a minimum follow-up of 11 months. Eighteen patients with subfoveal SRN who refused treatment served as control group (CG). 18 patients of the treatment group (TG) were matched for visual acuity, refraction and extent of SRN. The statistical analysis was performed with the unpaired t-test. RESULTS: The mean age of the CG was 73.9 years (range 66.9-81.3 years) and of the TG 75.6 years (range: 65.7-80.6 years). The median follow-up was 13.5 months (range 11.9-18.4 months) in the CG and 12.9 months (range 11-13.9 months) in the TG. The initial visual acuity (VA) was 20/80 in both groups. After 7 months the follow-up revealed median VA of 20/400 in the CG and 20/160 in the TG (P=0.0335). The final median VA was 20/400 in both groups, with a range from 20/40 to 20/1000 in the CG and from 20/63 to 20/500 in the TG (P=0.2433). The SRN doubled in size during this time in both groups. CONCLUSION: These results suggest that external beam irradiation applied in 2-Gy fractions 5 times a week slows down the visual loss in exudative AMD for a short time. Nevertheless, the patients' reading vision could not be saved in the long term.     

Usefulness of tomography in the evaluation of patients with temporomandibular disorders: a retrospective clinical study

OBJECTIVES: To evaluate the effect of temporomandibular joint tomography on the diagnosis and management of temporomandibular disorders and to determine whether there were any clinical predictors of usefulness of tomography in providing new information helpful in the treatment of these patients. STUDY DESIGN: The charts of 116 patients with temporomandibular joint tomograms were reviewed retrospectively for presenting signs and symptoms, initial clinical diagnosis, and alterations in diagnosis and management as a result of tomography. RESULTS: Common clinical diagnoses included osteoarthrosis (54%) and internal derangement (42%). Tomography changed the diagnosis in 24%, mainly adding or subtracting osteoarthrosis, and altered the management in 17%. Most of the latter were minor changes in treatment recommendations. There were few clinical variables that were related to whether tomography changed diagnosis or management. CONCLUSIONS: Tomography seems to have a minimal effect on the diagnosis or management of temporomandibular disorders based on the results of this retrospective study.     

A study of deliberate self-poisoning in patients with adjustment disorders

A sample of 140 patients (34 men and 106 women), hospitalized for deliberate self-poisoning in a toxicological clinic, was evaluated clinically and by P?ldinger's risk list for assessment of suicidality. All subjects met the criteria of DSM-IV adjustment disorder with no additional Axis I and Axis II comorbidity. 18% of the patients had a chronic adjustment disorder. The most common problems on Axis IV were those with the primary support group (especially in women). Occupational and economic problems were more frequent in men than in women. Most of the studied subjects undertook the suicidal attempt impulsively. Suicidal thoughts after deliberate self-poisoning persist in only 11% of the patients. The suicidal risk measured by P?ldinger's risk list for assessment of suicidality was negligible in 4/5 of the cases. The suicidal risk was higher in patients with chronic adjustment disorder and in patients with previous suicide attempts. The most represented age group - from 15 to 19 years old showed the highest suicidal risk. In women the suicidal risk increased with age. Women with impulsive suicide attempt showed a lower suicidal risk than women with a non-impulsive suicide attempt. A cathartic and abreactive effect of the suicide attempt was detected, but this effect only partially accounts for the relatively low percentage of suicidal thoughts after the suicidal act and the insignificant suicidal risk in 4/5 of the studied subjects.     

The use of isoxsuprine in essential dysmenorrhea. A controlled clinical study

The "uterus-specific" beta-adrenoceptor stimulator isoxsuprine was used for the treatment of primary dysmenorrhea in a double-blind controlled clinical study. No significant beneficial effect of the drug was evident.     

Behavioral treatment of problem drinkers: A comparative outcome study of three controlled drinking therapies.

Evaluated and compared 3 therapies designed to reduce the alcohol consumption of problem drinkers. 29 self-referred and 89 court-referred clients were randomly assigned to 1 of 3 treatment groups: (a) aversive counterconditioning (AC) using self-administered electrical stimulation; (b) behavioral self-control training (BT) including self-monitoring and instruction in functional analysis; or (c) a controlled drinking composite (CD) including blood alcohol awareness training, discriminated aversive counterconditioning, self-monitoring, and rate-control training. Prior to treatment, all Ss completed the MMPI, Michigan Alcoholism Screening Test, Rotter's Internal-External Locus of Control Scale, and Profile of Mood States. All therapies were conducted by trained paraprofessionals and consisted of 10 weekly sessions. Results show that all 3 therapies produced significant reduction in weekly alcohol consumption and peak blood alcohol concentration. These gains were largely maintained over 1 yr of follow-up. No significant differences among treatments were found, although AC was initially least effective. CD proved least cost effective, requiring 4 times more therapist contact than either AC or BT. A self-control manual was helpful in maintaining controlled drinking. (29 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Self-reported parental abuse relates to autobiographical memory style in patients with eating disorders.

Previous research has shown a relationship between levels of self-reported childhood abuse and overgeneral memory style. This relationship was further clarified in patients with an eating disorder (ED). Patients and healthy controls completed a task in which they had to generate specific autobiographical memories to emotional cue words. The results showed that first, the ED group, relative to the controls, produced more first memories that were "overgeneral" and fewer first memories that were specific. Second, in the ED group, the level of self-reported parental abuse was positively correlated with the tendency to produce overgeneral memories to negative cues. This effect remained significant even after levels of depressed mood were controlled for. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Nail changes in patients infected with human immunodeficiency virus. A prospective controlled study

OBJECTIVES: To study the frequency of nail changes in a population of human immunodeficiency virus (HIV)-infected patients and to evaluate the specificity of these findings by comparison with HIV-negative control subjects. DESIGN: Prospective controlled study. Nail changes were recorded by a standardized clinical examination (curvature, nail plate, color, onychomycosis). In case of clinical diagnosis of onychomycosis, mycological culture was performed. SETTING: Primary care university hospital. PATIENTS: A total of 155 HIV-1-positive patients and 103 healthy HIV-negative control subjects of comparable age and sex ratio. INTERVENTION: None. MAIN OUTCOME MEASURE: Clinical examination findings. RESULTS: Nail symptoms were present in 67.7% of HIV-positive patients vs 34.0% of controls (P < .001). The following symptoms were significantly more frequent in the HIV group: clubbing (5.8%) (P < .05), transverse lines (7.1%) (P < .01), onychoschizia (7.1%) (P < .05), leukonychia (14.3%) (P < .001), and longitudinal melanonychia (14.8%) (P < .01). The main finding was onychomycosis in 30.3% of patients vs 12.6% of controls (P < .001). Trichophyton rubrum was present in 48% of onychomycoses and unusual Candida species were also recorded. Multiple fungi were frequently cultured in a single patient. The mean CD4+ cell count was lower in patients with onychomycosis and the frequency of onychomycosis increased in advanced stages of HIV disease. Acquired total leukonychia of the 20 nails was present in 4% of patients. CONCLUSION: Nail symptoms are much more frequent in patients with HIV than in healthy controls, and some of them could be linked to the level of immunosuppression.     

Representativeness of clinical samples of youths with mental disorders: A preliminary population-based study.

In a household community sample of 1,285, 9–17 year-olds with mental disorders who had received outpatient specialty mental health services in the past year were compared with youths with mental disorders who had not received those services to determine if samples drawn from clinical settings are representative of youths with mental disorders in the general population. Those who had used services were more impaired, less competent, more likely to have comorbid disorders, more likely to belong to non-Hispanic White relative to other ethnic groups, and less likely to be prepubertal girls. Their parents were more educated, but less satisfied with family life, engaged in less monitoring of their children, and more likely to have used mental health services themselves. These findings suggest the hypothesis that samples of youths with mental disorders drawn from outpatient clinical settings are not representative of all youths with mental disorders. If confirmed, this would indicate the importance of population-based samples for the study of psychopathology in youths. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Neuroanatomical and cognitive mediators of age-related differences in episodic memory.

Aging is associated with declines in episodic memory. In this study, the authors used a path analysis framework to explore the mediating role of differences in brain structure, executive functions, and processing speed in age-related differences in episodic memory. Measures of regional brain volume (prefrontal gray and white matter, caudate, hippocampus, visual cortex), executive functions (working memory, inhibitory control, task switching, temporal processing), processing speed, and episodic memory were obtained in a sample of young and older adults. As expected, age was linked to reduction in regional brain volumes and cognitive performance. Moreover, neural and cognitive factors completely mediated age differences in episodic memory. Whereas hippocampal shrinkage directly affected episodic memory, prefrontal volumetric reductions influenced episodic memory via limitations in working memory and inhibitory control. Age-related slowing predicted reduced efficiency in temporal processing, working memory, and inhibitory control. Lastly, poorer temporal processing directly affected episodic memory. No direct effects of age on episodic memory remained once these factors were taken into account. These analyses highlight the value of a multivariate approach with the understanding of complex relationships in cognitive and brain aging. (PsycINFO Database Record (c) 2010 APA, all rights reserved)