Shivering in patients recovering from CABG

Thirty-eight patients diagnosed as having continuous schizophrenia progrediens, 35 patients with shift-like schizophrenia and six patients with hypertoxic (feverish) schizophrenia were studied. The examinees displayed a marked increase in the blood content of lipid peroxidation products, such as malonic dialdehyde and conjugated dienes, together with an enhancement of the degree of erytrocytolysis, which events are particularly noticeable in hypertoxic- and continuous schizophrenia. Blood catalase activity gets higher, that of superoxide dismutase is on the decrease, which facts suggest to us some faults in the system of antioxidant defence.     

Thought suppression in patients with bipolar disorder.

Suppression of negative thoughts has been observed under experimental conditions among patients with major depressive disorder (MDD) but has never been examined among patients with bipolar disorder (BD). Patients with BD (n = 36), patients with MDD (n = 20), and healthy controls (n = 20) completed a task that required unscrambling 6-word strings into 5-word sentences, leaving out 1 word. The extra word allowed the sentences to be completed in a negative, neutral, or “hyperpositive” (manic/goal-oriented) way. Participants completed the sentences under conditions of cognitive load (rehearsing a 6-digit number), reward (a bell tone), load and reward, or neither load nor reward. We hypothesized that patients with BD would engage in more active suppression of negative and hyperpositive thoughts than would controls, as revealed by their unscrambling more word strings into negative or hyperpositive sentences. Under conditions of load or reward and in the absence of either load or reward, patients with BD unscrambled more negative sentences than did controls. Under conditions of reward, patients with BD unscrambled more negative sentences than did patients with MDD. Patients with BD also reported more use of negative thought suppression than did controls. These group differences in negative biases were no longer significant when current mood states were controlled. Finally, the groups did not differ in the proportion of hyperpositive sentence completions in any condition. Thought suppression may provide a critical locus for psychological interventions in BD. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Twelve-month outcome of patients with DSM-III-R schizoaffective disorder: comparisons to matched patients with bipolar disorder

We examined potential mechanisms by which angiotensin subtype-2 (AT2) receptor stimulation induces net fluid absorption and serosal guanosine cyclic 3',5'-monophosphate (cGMP) formation in the rat jejunum. L-arginine (L-ARG) given intravenously or interstitially enhanced net fluid absorption and cGMP formation, which were completely blocked by the nitric oxide (NO) synthase inhibitor, N-nitro-L-arginine methylester (L-NAME), but not by the specific AT2 receptor antagonist, PD-123319 (PD). Dietary sodium restriction also increased jejunal interstitial fluid cGMP and fluid absorption. Both could be blocked by PD or L-NAME, suggesting that the effects of sodium restriction occur via ANG II at the AT2 receptor. L-ARG-stimulated fluid absorption was blocked by the soluble guanylyl cyclase inhibitor 1-H-[1,2,4]oxadiazolo[4, 2-alpha]quinoxalin-1-one (ODQ). Cyclic GMP-specific phosphodiesterase in the interstitial space decreased extracellular cGMP content and prevented the absorptive effects of L-ARG. Angiotensin II (ANG II) caused an increase in net Na+ and Cl- ion absorption and 22Na+ unidirectional efflux (absorption) from the jejunal loop. In contrast, intraluminal heat-stable enterotoxin of Escherichia coli (STa) increased loop cGMP and fluid secretion that were not blocked by either L-NAME or ODQ. These findings suggest that ANG II acts at the serosal side via AT2 receptors to stimulate cGMP production via soluble guanylyl cyclase activation and absorption through the generation of NO, but that mucosal STa activation of particulate guanylyl cyclase causes secretion independently of NO, thus demonstrating the opposite effects of cGMP in the mucosal and serosal compartments of the jejunum.     

Detection of polymorphic triplet repeats in the genomes of patients suffering from bipolar affective disorder

P2X receptors are a family of ion channels gated by extracellular ATP. Each member of the family can form functional homomeric channels, but only P2X2 and P2X3 have been shown to combine to form a unique heteromeric channel. Data from in situ hybridization studies suggest that P2X1 and P2X5 may also co-assemble. In this study, we tested this hypothesis by expressing recombinant P2X1 and P2X5 receptor subunits either individually or together in human embryonic kidney 293 cells. In cells expressing the homomeric P2X1 receptor, 30 microM alpha,beta-methylene ATP (alpha,beta-me-ATP) evoked robust currents that completely desensitized in less than 1 sec, whereas alpha,beta-me-ATP failed to evoke current in cells expressing the homomeric P2X5 receptor. By contrast, alpha, beta-me-ATP evoked biphasic currents with a pronounced nondesensitizing plateau phase in cells that co-expressed both subunits. Further, the EC50 for alpha,beta-me-ATP was greater in cells expressing both P2X1 and P2X5 than in cells expressing P2X1 alone (5 and 1.6 microM, respectively). Heteromeric assembly was confirmed using a co-immunoprecipitation assay of epitope-tagged P2X1 and P2X5 subunits. In summary, this study provides biochemical and functional evidence of a novel channel formed by P2X subunit heteropolymerization. This finding suggests that heteromeric subunit assembly constitutes an important mechanism for generating functional diversity of ATP-mediated responses.     

A pilot study of lithium carbonate plus divalproex sodium for the continuation and maintenance treatment of patients with bipolar I disorder

PURPOSE OF STUDY: To assess whether selected periapical radiographs, taken according to High Yield Criteria, can reveal as much intra-osseous pathology as universal panoramic screening. POPULATION STUDIED: The records of 1101 RAF recruits enlisted in 1988-89, average age 19 years (range 16-26). METHODS: The clinical records and bitewing radiographs of the recruits were examined and the requirement for periapical radiographs determined according to high yield criteria. A template, cut out to simulate the area covered by a periapical bitewing radiograph, was placed over the suspect region on the panoramic film and any findings found within the template recorded. The entire dental panoramic tomograph was then examined on a masked screen under 2X magnification and any further findings recorded. FINDINGS: There was a considerable number of findings reported, including three large isolated radiolucent areas, 75 periradicular radiolucent areas, four probable cysts and 1187 unerupted mandibular third molars. However, when the clinical significance of these 'lesions' was assessed only those related to dental causes appeared to have significant clinical implications and the results indicated that these could have been detected by selective radiology. CONCLUSION: This study showed that the only pathology which occurs frequently enough to justify radiographic screening of the jaws in young adults is related to teeth. It seems probable that this type of pathology can be at least as well detected by selective periapical screening, using high yield criteria, as is possible by universal panoramic screening.     

Tryptophan depletion in stable lithium-treated patients with bipolar disorder in remission

Cleft sternum is a rare malformation due to partial or total failure of sternal fusion at an early stage of embryonic development. Sternal clefts can be classified as superior, inferior, or complete. Here we report on a 2-year-old boy with inferior sternal cleft and complex cardiac malformation. We review a series of 9 children with sternal clefts, referred to us over a 10-year period. Hypothetical mechanisms for this developmental anomaly are discussed.     

Life events and bipolar disorder: Implications from biological theories.

Although a number of studies suggest that stressful life events play a role in bipolar disorder, methodological flaws impose serious limitations on this literature. Nonetheless, better designed studies indicate that life events influence the course of bipolar disorder. Little is known, however, about the nature of events that are of particular importance to this disorder. Given the strong biological vulnerability and the unique clinical aspects of bipolar disorder, certain forms of stress may have stronger interactions with vulnerability characteristics. Three major biological theories of bipolar disorder are discussed, with particular attention to their implications for investigations of life events. Although tenuous, these models suggest that greater attention needs to be paid to particular dimensions of life events and the course of disorder. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Modal attention asymmetry in patients with schizophrenia and bipolar disorder.

This cross-sectional study examined modal attention asymmetries in patients with schizophrenia (n?=?47) and bipolar disorder (n?=?42), as contrasted to a matched-sample comparison group of normal participants (n?=?89). A test of continuous auditory and visual attention was the primary measure. The data were analyzed from 2 experimental conditions: simple modal responses (auditory and visual) and modal switching responses (ipsimodal and cross-modal switching). In the simple modal condition, patients with schizophrenia demonstrated a visual over auditory asymmetry; patients with bipolar disorder showed no differences. In modal switching conditions, however, patients with bipolar disorder displayed a significant auditory over visual asymmetry. No main effect was detected between medications and attention functioning. Results are discussed in light of differentiating these 2 populations on the basis of modal specificity of attention functioning. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Temporal discounting of rewards in patients with bipolar disorder and schizophrenia.

Patients with bipolar disorder (BD) and schizophrenia (SZ) often show decision-making deficits in everyday circumstances. A failure to appropriately weigh immediate versus future consequences of choices may contribute to these deficits. We used the delay discounting task in individuals with BD or SZ to investigate their temporal decision making. Twenty-two individuals with BD, 21 individuals with SZ, and 30 healthy individuals completed the delay discounting task along with neuropsychological measures of working memory and cognitive function. Both BD and SZ groups discounted delayed rewards more steeply than did the healthy group even after controlling for current substance use, age, gender, and employment. Hierarchical multiple regression analyses showed that discounting rate was associated with both diagnostic group and working memory or intelligence scores. In each group, working memory or intelligence scores negatively correlated with discounting rate. The results suggest that (a) both BD and SZ groups value smaller, immediate rewards more than larger, delayed rewards compared with the healthy group and (b) working memory or intelligence is related to temporal decision making in individuals with BD or SZ as well as in healthy individuals. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

After the menopause: tamoxifen and other new prevention maintenance therapies

INTRODUCTION: Parvovirus B19 infection is frequent. Primary infection leads to diverse skin manifestations including the recently described gloves-and-socks papulopurpura. CASE REPORT: A patient presented with a papulopurpuric eruption on the nose, hands, feet and perineum with cheilitis and high-grade fever. Parvovirus B19 serology showed characteristic IgG on the 15th day after the initial eruption demonstrating the seroconversion. Cold agglutinins were positive during the eruption and negative after regression. DISCUSSION: The gloves-and-socks papulopurpura syndrome was initially described in 1990. Since that time 20 cases have been reported. In 7 cases, primary parvovirus B19 infection was proven and viral infections were suspected in the others (measles, coxsackie B6, hepatitis B, Epstein-Barr virus). Our case evidenced here to undescribed skin manifestations and the development of cold agglutinins. The presence of cold agglutinins at eruption could explain the acral localizations observed in this syndrome.     

Causes of chronic persistent cough in adult patients: the results of a systematic management protocol

BACKGROUND AND METHODS: In Japan, 26 children who vertically acquired human immunodeficiency virus (HIV) infection had been reported as at February 1997. Little information was published about their epidemiological backgrounds and the rate of perinatal HIV transmission in Japan remains unknown. To learn the epidemiological features of perinatal HIV infection in Japan, we examined the medical records of five perinatally infected children. RESULTS: Three of five mothers were Japanese and two others were South East Asian. Four of them acquired HIV infection abroad and one became infected through her spouse who had acquired infection abroad. Therefore, HIV infection in these five cases can be regarded as an imported infectious disease. None of the five mothers noticed their HIV infection before their pregnancy. One mother was found to be HIV seropositive during her pregnancy, but the others did not notice their HIV infection until their delivery. CONCLUSIONS: To reduce the incidence of perinatally HIV-infected children it is necessary to lower the incidence of mother-to-infant HIV transmission. In Western countries they have succeeded in reducing the risk for perinatal HIV transmission with perinatal zidovudine therapy. To prescribe the preventive therapy against perinatal HIV transmission, it is essential to know if pregnant women are infected with HIV or not. Therefore, women of childbearing age should accept voluntary prenatal HIV testing. At the same time, they should be offered such programs that can enable them to receive timely counseling, besides medical treatment, if they are found to be HIV infected.     

Family functioning and mood disorders: A comparison between patients with major depressive disorder and bipolar I disorder.

Within a sample of patients with major depressive disorder (MDD; n = 121) and bipolar affective disorder (BPAD; n = 69), the authors examined (a) diagnostic differences in family functioning at acute episode, (b) diagnostic differences in family functioning at episode recovery, (c) within-group changes in family functioning from acute episode to recovery, and (d) whether within-group changes from acute episode to recovery varied by diagnosis. Using a multidimensional model, the authors evaluated interviewer, patient, and family ratings. Overall, patients with MDD and BPAD evidenced similar levels of family impairment at acute episode and recovery. Generally, patients in both groups experienced improvement in family functioning over time, yet mean scores at recovery continued to range from fair to poor. Although certain specific differences emerged, diagnostic groups appeared to be more similar than different in level and pattern of family functioning. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychoeducation and expressed emotion in bipolar disorder: preliminary findings

A multifamily psychoeducational intervention was carried out in patients with bipolar disorder. The study explored (1) the effects of the intervention on the level of expressed emotion (EE) of key relatives; (2) the validity of EE defined by a 5-min speech sample as a predictor of relapse; and (3) the evaluations of the intervention program by patients and key relatives. Four key relatives in the treatment group, compared with none in a waiting list control group, changed from high to low EE levels. The change was clinically but not statistically significant, perhaps because of the small sample size. Patients whose key relatives had low EE levels had a significantly lower number of relapses and hospital admissions compared with those whose key relatives had high EE levels. The psychoeducational program was well received by all participants, and there were no dropouts.     

Observed emotional involvement and overinvolvement in families of patients with bipolar disorder.

Many studies have examined the construct validity of the criticism component of expressed emotion, but little work has been done on clarifying the emotional overinvolvement (EOI) construct. In a sample of 115 recently episodic patients with bipolar disorder, the authors of the present study examined the construct validity of an observational coding system for both appropriate and inappropriate emotional involvement that permitted separate ratings for relatives' intrusiveness, self-sacrificing behaviors, and distress related to the patient's well-being. Findings support the measure's reliability and convergent validity and are moderately supportive of the measure's discriminant validity. Results also suggest that Camberwell Family Interview (C. E. Vaughn & J. P. Leff, 1976) EOI ratings do not discriminate among the different dimensions of the emotional involvement construct (or their appropriateness or inappropriateness) as revealed in laboratory-based interactions. The findings suggest that clinicians working with such families might consider differentiating among the various ways in which family members are involved with the patient and helping them learn to judge under what circumstances such involvement is appropriate and inappropriate. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A prospective study of bipolar disorder in children and adolescents from India

In the light of new opportunities for structural arrangements in Germany calling for higher co-operation between physicians in private practice, determinants for diagnostic and therapeutic co-operation need to be examined. In the present study, 130 general practitioners were asked in regard to four typical primary care indication groups whether they prefer to diagnose and treat the patients on their own or in co-operation with colleagues. This self-assessment was validated using the data from 2,069 physician-patient contacts: physicians preferring therapy in co-operation actually referred patients three times more often. Concerning both gastro-intestinal and rheumatic disorders, physicians' preferences for diagnostic and therapeutic co-operation are highly correlated (phi = 0.491 and 0.528 respectively); preferences for diagnostic and therapeutic co-operation across indications are not as strongly correlated (phi = 0.334 and 0.397 respectively). However, there is no general indication-independent attitude towards co-operation for individual physicians: Indication and type of services are two factors which--probably in addition to others--affect co-operation independently. We confirm earlier conclusions that the detailed analysis of provider and patient characteristics together with the actual patient management on a case by case basis is a powerful tool for health services research.     

Information processing in schizophrenia and bipolar disorder: a discriminant analysis

Schizophrenia and bipolar disorder are two distinct categories of mental disorders in the DSM-IV. However, it is often difficult to make a differential diagnosis because of the overlapping symptoms. A potential adjunct in the classification of schizophrenia and bipolar disorder is the application of information processing models, as patients with schizophrenia and possibly those with bipolar disorder have information processing deficits. A study was conducted in which a computerized battery of information processing tasks (called COGLAB) was administered to three participant groups: patients with schizophrenia, patients with bipolar disorder, and normal controls. The tasks included the Mueller-Lyer illusion, reaction time, size estimation, a variant of the Wisconsin Card Sorting Test, backward masking, and Asarnow continuous performance. Discriminant analyses were used to investigate the differences among the three groups. Results indicated that COGLAB correctly classified 75.5% of the cases of schizophrenia and bipolar disorder. The Mueller-Lyer illusion and the number of perseverative errors on the card sort most powerfully discriminated the two groups.     

Treatment of depression in bipolar disorder: new directions for research

The objective of the study was to review the clinical literature on the acute, somatic treatment of the depressed phase of bipolar disorder. We reviewed all available published studies of "standard" somatic treatments (lithium, antidepressant and anticonvulsant agents, and electroconvulsive therapy [ECT]) reporting three or more depressed bipolar patients who were not psychotic, rapid cycling, or previously treatment refractory. We also reviewed all studies of "nonstandard" pharmacologic treatments involving even a single case of a depressed bipolar patient. Data sources included the MEDLINE database and relevant references from articles obtained in this search and in major reviews. Five of seven studies comparing ECT with antidepressant agents find ECT more efficacious. Eight of nine controlled comparisons find lithium superior to placebo in depressed bipolar patients. Three controlled comparisons of lithium to tricyclic antidepressants suggest that lithium is equivalent to tricyclic drugs in such patients. Three double-blind, controlled studies indicate that carbamazepine is more effective than placebo. Limited data on other antidepressant classes suggest that monoamine oxidase inhibitors, bupropion, and serotonergic agents may offer some advantages over tricyclic antidepressants in this population. Some "nonstandard" treatments also show some potential in bipolar patients. The possibility of switching into a manic episode is an important consideration with many of the agents studied, although little remains known about spontaneous versus treatment-associated mood shifts. In contrast to the extensive literature on the acute treatment of the manic phase of bipolar disorder and on the prophylaxis of manic and depressive episodes, there are few studies of treatment of the depressed phase of bipolar disorder, and their results generally are limited or inconclusive. Lithium generated a revolution in psychiatric treatment, but the treatment of the depressed phase of bipolar disorder remains a relatively neglected corner of the field. Several study designs may help to augment knowledge in the treatment of bipolar depression.     

Agreement between face-to-face and telephone-administered mood ratings in patients with rapid cycling bipolar disorder

BACKGROUND AND PURPOSE: Clinical trials have demonstrated that high dose radiation therapy and daily cisplatin (CDDP) could increase local control and survival in carcinoma from various sites. The present phase I-II study has combined high dose radiation therapy and daily CDDP at escalating dosages. METHODS: From August 1994 to December 1995, 23 patients with non-resectable carcinoma of the pancreas were enrolled in a phase I-II multicentric, pilot study to test the toxicity and the effectiveness of high dose radiotherapy and daily cisplatin (CDDP) at escalating dosages. A dose of 6 mg/sqm/day of CDDP was selected for the phase II step since no grade IV toxicity occurred in any patient in the phase I step. RESULTS: Toxicity was considered fairly acceptable. At the time of analysis, the 23 patients who entered the study had clear evidence of evolutive disease either locally or distantly in the liver. It is suggested that high dose radiotherapy (60 Gy continuously) and daily CDDP have little effect on local control of the tumor and survival, and only a moderate effect on pain. CONCLUSIONS: In unresectable, apparently non-metastatic cancers of the pancreas, there is an urgent need for new agents or new combinations of agents to be tested.     

Benzodiazepines and exposure-based cognitive behavior therapies for panic disorder: conclusions from combined treatment trials

OBJECTIVE: Concurrent use of benzodiazepines and psychotherapy for panic disorder is a prevalent but highly controversial practice. Although there are many rationales for that approach, critics contend that benzodiazepines foster drug abuse and dependence and undermine psychosocial treatments in various ways. The authors examine that controversy in the light of recent empirical findings and offer some tentative conclusions and recommendations. METHOD: Data from studies combining benzodiazepines and the leading psychosocial treatment for panic disorder, exposure-based cognitive behavior therapy, are reviewed, and their application to clinical practice is discussed. RESULTS: The strongest support for combined treatment is for the addition of cognitive behavior therapy to pharmacotherapy for patients with agoraphobia and for those whose benzodiazepine treatment is being discontinued. The greatest problem with combined treatment is relapse after drug discontinuance. CONCLUSIONS: Combined treatment may be advantageous for some patients, but it must be carefully designed to avoid potential problems. Suggestions for that are given.