Mental disorders and disability among patients in a primary care group practice

OBJECTIVE: This article examines social and occupational disability associated with several DSM-IV mental disorders in a group of adult primary care outpatients. METHOD: The subjects were 1,001 primary care patients (aged 18-70 years) in a large health maintenance organization. Data on each patient's sociodemographic characteristics and functional disability, including scores on the Sheehan Disability Scale, were collected at the time of a medical visit. A structured diagnostic interview for current DSM-IV disorders was then completed by a mental health professional over the telephone within 4 days of the visit. RESULTS: The most prevalent disorders were phobias (7.7%), major depressive disorder (7.3%), alcohol use disorders (5.2%), generalized anxiety disorder (3.7%), and panic disorder (3.0%). A total of 8.3% of the patients met the criteria for more than one mental disorder. The proportion of patients with co-occurring mental disorders varied by index disorder from 50.0% (alcohol use disorder) to 89.2% (generalized anxiety disorder). Compared with patients who had a single mental disorder, patients with co-occurring disorders reported significantly more disability in social and occupational functioning. After adjustment for other mental disorders and demographic and general health factors, compared with patients with no mental disorder, only patients with major depressive disorder, bipolar disorder, phobias, and substance use disorders had significantly increased disability, as measured by the Sheehan Disability Scale. CONCLUSIONS: Primary care patients with more than one mental disorder are common and highly disabled. Individual mental disorders have distinct patterns of psychiatric comorbidity and disability.     

Cumulative vs. acute dose-response procedures produce differential BAC and behavioral functions for ethanol

The discriminative stimulus attributes of ethanol (ETOH) were characterized in rats trained to discriminate between 1.25 g/kg ETOH and saline. The ETOH generalization functions were assessed using both acute and cumulative dosing procedures. The cumulative procedures differed in the individual incremented doses used to generate the functions. Acute dosing procedures produced discriminative functions that were significantly different from cumulative dose-response curves (DRCs). Similar cumulative DRC's were generated within each cumulative dosing procedure, whereas significant differences were produced between the two dosing incremented procedures. When blood alcohol concentrations (BACs) were quantified, a cumulative testing procedure produced significantly lower BACs than acute testing procedures at every dose above the initial or starting dose. Interestingly, response rate functions did not differ within or between cumulative and acute procedures. These data may suggest that differential ETOH dosing procedures may differentially influence the behavioral choice and BAC functions in rats, and cautions against the use of cumulative procedures to assess shifts in DRCs during chronic treatments without a concomitant assessment of BACs.     

The content of electrolytes (Na, K, Ca, Mg) in vertebrate otoliths and otoconia

IVOX (intravenous oxygenator and CO2 removal device) augments venous gas exchange in patients with severe respiratory failure. Controlled hypoventilation with permissive hypercapnia reduces airway pressures during mechanical ventilation and augments CO2 exchange through the IVOX. To quantify the additive effects of gradual permissive hypercapnia and IVOX on gas exchange and reduction of airway pressures, 13 adult sheep underwent tracheostomy and severe smoke inhalation injury. Seven were mechanically ventilated alone (control), and six had mechanical ventilation, systemic anticoagulation, and implantation of IVOX (size 7 with 0.21-m2 surface area) (IVOX group). Both groups were anesthetized and paralyzed for 24 hr. In the IVOX group, minute ventilation was decreased in a stepwise fashion to produce a gradual increase in PaCO2, from 30 to 95 mm Hg, over 12 hr, and then sustained for an additional 12 hr. Sodium bicarbonate was given intravenously as necessary to keep arterial pH above 7.25. There were no significant differences in mean arterial pressure, cardiac output, or pulmonary artery pressure between the two groups. In the IVOX/permissive hypercapnia group, IVOX CO2 removal increased as a linear function of PaCO2 (y = 0.87x + 8.99, R2 = 0.80). IVOX CO2 removal was only 40 ml/min at normocapnia (40 mm Hg) but increased to 91 ml/min when PaCO2 was 95 mm Hg. Both peak inspiratory pressure and minute ventilation of the IVOX/permissive hypercapnia group were significantly lower than the control group, 30 +/- 4 mm Hg vs 51 +/- 3 mm Hg and 3.9 +/- 0.3 liters vs 8.4 +/- 0.5 liters (P < 0.05) respectively.(ABSTRACT TRUNCATED AT 250 WORDS)     

Effects of ethanol consumption on brown adipose tissue thermogenic capacity in mice

The objective of this work was to evaluate the effects of ethanol consumption on brown adipose tissue (BAT) thermogenic capacity in mice. Mice offered only ethanol (10%; v/v) for 10 days as drinking fluid had significant reductions in total energy and fluid intakes relative to mice given water, but net weight gains were similar. BAT thermogenic capacity was reduced in mice drinking ethanol, as shown by decreases in tissue protein and succinate dehydrogenase (SDH) activity and in the uncoupling protein content of isolated mitochondria. Ethanol consumption differed greatly between mice offered a choice between ethanol and water for 25 days after a 10-day habituation period, with only ethanol as the drinking solution. Total energy intake of mice that continue to consume the most ethanol voluntarily (up to 25% of total fluid intake) was significantly reduced but carcass fat was increased, relative to mice consuming less or no ethanol. Brown fat thermogenic capacity was not significantly affected by the degree of ethanol consumption. Basal and norepinephrine-stimulated rates of oxygen uptake of isolated brown adipocytes were not affected by ethanol. Thus, changes in the animal capacity for energy expenditure in brown adipose tissue does not appear an important factor to explain the effects of ethanol consumption on fat deposition in mice.     

A novel MspI PCR-RFLP in the human cytosine 5-methyltransferase gene: lack of relevance for malignant lymphoproliferative disease and breast cancer

A 72 year-old man underwent a Bentall procedure for aortic regurgitation secondary to annulo-aortic ectasia and ascending aortic aneurysm. On the 11th postoperative day, the C-reactive protein (CRP) level and white blood cell (WBC) count rose. Echocardiography and a computed tomographic scan showed the appearance of pericardial effusion. A diagnosis of mediastinitis and composite graft infection was made, and mediastinal drainage and irrigation were performed. Methicillin-resistant coagulase negative staphylococcus (MRCNS) was identified as the causative organism. Vancomycin, arbekacin and minocycline were used intravenously. Additionally, a continuous mediastinal irrigation was performed through the chest tubes. CRP level and WBC count were gradually reduced to normal range. He has now been free from signs of infection for more than 3 years. Because MRCNS is considered less virulent than methicillin-resistant Staphylococcus aureus, mediastinitis and composite graft infection due to MRCNS might be treatable by such conservative therapy even in patients with prosthetic implants. Since MRCNS often becomes ubiquitous, preventing infections by strict attention to asepsis is important.