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Biomedical subjects

D J Cohen

Publications and source records attributed to D J Cohen.

At least 109 records · Page 6Linked to original sources
PubMed1998

Sertraline in adults with pervasive developmental disorders: a prospective open-label investigation.

The short-term efficacy and tolerability of sertraline for adults with pervasive developmental disorders (PDDs) were assessed in this investigation. Forty-two adults with PDDs (autistic disorder, N = 22; Asperger's disorder, N = 6; and PDD not otherwise specified [NOS], N = 14) participated in a 12-week, open-label, systematic trial of sertraline. Behavioral ratings of repetitive symptoms, aggression, and social relatedness were obtained at baseline and after 4, 8, and 12 weeks of sertraline administration. Twenty-four (57%) of 42 patients showed significant improvement, primarily in repetitive and aggressive symptoms. Statistically significant changes in measures of social relatedness did not occur. Patients with autistic disorder and PDD NOS did significantly better than those with Asperger's disorder. Based on global improvement item criteria from the Clinical Global Impression Scale, 15 of 22 (68%) patients with autistic disorder, none of six (0%) patients with Asperger's disorder, and 9 of 14 (64%) patients with PDD NOS were categorized as treatment responders. Sertraline was well tolerated; no adverse cardiovascular effects, extrapyramidal symptoms, or seizures were identified. These findings suggested that sertraline may be an effective treatment for interfering repetitive and aggressive symptoms in adults with PDDs. Definitive statements about the efficacy and tolerability of sertraline for treating adults with PDDs must await results from double-blind, placebo-controlled trials. These preliminary results should not be generalized to include children and adolescents with PDDs.

1-Naphthylamine↗
PubMed1998

Mental rotation and temporal contingencies.

A task that requires subjects to determine whether two forms of the same shape, but in different orientations, are mirror images or identical except for orientation is called a handedness recognition task. Subjects' reaction times (RT) on this task are consistently related to the angular disparity (termed alpha) between the two presented forms. This pattern of data has been interpreted to indicate that subjects solve the task by imagining that one of the forms rotates into the orientation of the other (termed mental rotation). The speed with which one imagines one of the forms rotating has been widely considered a fixed capability of the individual, and thus immune to the effect of contingencies. We present an experiment that assesses the effects of temporal contingencies in a handedness recognition task on the slope of the function RT = f(alpha). The data indicate that the slope of this function can come under the control of temporal contingencies.

Adult↗
PubMed1998

The treatment of Tourette's syndrome: multimodal, developmental intervention.

The increasing clinical recognition of milder phenotypic variants of Tourette's syndrome and the keener appreciation of its phenomenological continuity with other transient and chronic tic syndromes have required a greater comprehensiveness and sophistication in the assessment and management of the disorder. Treatment must be individualized based on considerations of the source and degree of functional impairment associated with tics, the current and future impairment associated with comorbid illnesses, the available internal and external sources of support and capacities for coping, and the challenges that the tics and comorbidities present at varying stages of development. Specific therapeutic interventions must target not only tic symptoms, but also comorbid illnesses and coping strategies that can profoundly influence the unique impact that tic symptoms may have on an individual's well being during childhood and adolescence, and later into adulthood.

Adaptation, Psychological↗
PubMed1998

Police and mental health professionals. Collaborative responses to the impact of violence on children and families.

Coordinating responses through the Child Development-Community Policing Program has led to multiple changes in the delivery of clinical and police services. Mental health clinicians and police officers have developed a common language for assessing and responding to the needs of children and families who have been exposed to or involved in violence. Learning from each other, these unlikely partners have established close working relationships that improve and expand the range of interventions they are able to provide while preserving the areas of expertise and responsibilities of each professional group. The immediate access to witnesses, victims, and perpetrators of violent crimes through the consultation service provides a unique opportunity to expand the understanding of clinical phenomena from the acute traumatic moment to longer-term adaptation, symptom formation, and recovery. In turn, the initiative introduces the systematic study of basic psychological and neurobiologic functions involved in traumatization as well as the investigation of psychotherapeutic and pharmacologic therapies. Similarly, program involvement with juvenile offenders has led to a coordinated response from the police, mental health, and juvenile justice systems. This project provides an opportunity to develop detailed psychological profiles and typologies of children engaged in different levels of antisocial behavior as well as to determine the characteristics that might predict with whom community-based interventions might be most successful. A recent survey of New Haven public school students has yielded promising evidence that community policing and the program are having a positive impact on the quality of life. In a survey of sixth-, eighth-, and tenth-grade students there were substantial improvements in students' sense of safety and experience of violence between 1992 and 1996. When asked if they felt safe in their neighborhood, there was an increase in the percentage of positive responses from 57% to 62% for sixth-grade students, 48% to 66% for eighth-grade students, and 53% to 73% for tenth-grade students, and when asked if they had seen someone shot or stabbed there was a decrease in positive responses from 43% to 28% for sixth-grade students, 46% to 31% for eighth-grade students, and 34% to 28% for tenth-grade students. Today, we are all too familiar with the developmental trajectory that leads children into violent crime. Newspaper articles and clinical case reports have taken on a dreary repetitiveness. These young criminals are often poor, minority, inner-city children who are known to many agencies to be at risk because of family disorganization, neglect, and abuse. They are failing in school or are already on the streets. One day they are victims and the very next they are assailants. We are all familiar with the inadequacies in the social response to these children, from their preschool years through the point at which they become assailants themselves. What is shocking is that the age at which children make the transition from being abused to being abusive seems to be getting earlier, and the number appears to be increasing. On the positive side, there is an increased awareness of the need and the ability of the various sectors of society to respond in concert. The institutions that function in the inner city--schools, police, mental health and child welfare agencies, churches--are all concerned about the same children and families. By working together, with a shared orientation to the best interests of the children, they can intervene earlier and more effectively: first, to disrupt the trajectory leading to violence; and, second, to help those children who are already caught in the web of exposure to violent crime and inner-city trauma. The experience with community-based policing and mental health in New Haven, now being replicated throughout the United States, can thus stand as a model of an active social response to an overwhel

Adolescent↗
PubMed1998

Multiplex developmental disorder.

BACKGROUND: Multiplex developmental disorder is a term that was suggested 20 years ago to describe the onset of developmental deficits in affective modulation, social behavior and social sensitivity combined with thinking disorder with bizarre ideas. With the recent validation of these diagnostic criteria, new interest in this disorder has emerged. METHODS AND RESULTS: We reviewed the background and the difficulties in classifying this subgroup of patients. We also describe a representative case of multiplex developmental disorder and discuss the diagnosis. CONCLUSION: This article emphasizes the importance of investigating this subgroup of patients and encourages reports of such cases in Israel.

Child↗
PubMed1997

Effect of continuous quality improvement analysis on the delivery of primary percutaneous transluminal coronary angioplasty for acute myocardial infarction.

A successful primary percutaneous transluminal coronary angioplasty (PTCA) program requires a learning process whereby the efficiency of the cardiac catheterization laboratory to deliver prompt intervention can be refined. The purpose of this study was to (1) quantify this learning process in terms of shortening the time to reperfusion, (2) examine the changes in strategy that allowed for this, and (3) determine if expedited reperfusion by primary PTCA improved patient outcomes. A database of all primary PTCA procedures was established in February 1, 1994. Continuous quality assurance analysis was performed, and program modifications introduced as needed. Patients were separated into early (group A = February 1, 1994 through January 31, 1995) and late (group B1 = February 1, 1995 through June 31, 1995, and group B2 = July 1, 1995 through December 31, 1995) cohorts. Time intervals to certain treatment landmarks were compared among groups. In-hospital outcomes were tabulated. Fifty-two consecutive patients were included (group A = 19, group B1 = 17, group B2 = 16). Time intervals shortened significantly (group A vs group B1 vs group B2) with the time from hospital presentation to first balloon inflation decreasing progressively (from 205 to 119 to 97 minutes; p <0.001). Most of this decrease was obtained by shortening the time from hospital presentation to xylocaine administration (158 to 85 to 72 minutes; p <0.005), although the time from xylocaine to first balloon inflation also decreased (from 47 to 33 to 24 minutes; p <0.005). Parallel decreases for in-hospital mortality (26% vs 0%; p = 0.004), adverse events (47% vs 18%; p = 0.05), and length of hospital stay (13.3 +/- 13.7 vs 8.4 +/- 4.4 days; p = NS) were demonstrated for groups A versus B1 and B2. A learning effect following initiation of a primary PTCA program is demonstrated in which reperfusion was more rapidly achieved as the result of procedural changes directed by quality improvement analysis with a concurrent improvement in in-hospital outcomes.

Adrenergic beta-Antagonists↗
PubMed1997

The impact of optimal stenting techniques on cardiac catheterization laboratory resource utilization and costs.

Coronary stenting has been shown to reduce angiographic restenosis and improve clinical outcomes compared with conventional balloon angioplasty, but at greater in-lab cost. Recent studies have suggested that "optimal" stent deployment can eliminate the need for intensive oral anticoagulation after stenting, with the potential to reduce vascular complications, length of stay, and hospital cost. Between January and June 1995, we performed elective 1-vessel coronary stenting in 78 patients with a single, discrete (< 15 mm) coronary stenosis (optimal single-lesion group) and in 30 patients with either a single, long stenosis or serial discrete lesions (optimal multilesion group). Compared with stent patients from the Stent Restenosis Study (STRESS) economic substudy, optimal single-lesion stenting required more stents (1.3 +/- 0.6 vs 1.1 +/- 0.4, p <0.01) and more adjunctive angioplasty balloons per patient (2.5 +/- 1.0 vs 2.0 +/- 0.9, p <0.01). As a result, catheterization laboratory costs for single-lesion stenting increased by nearly $600 between 1993 and 1995 ($4,619 +/- $1,120 [median $4,435] to $5,209 +/- $1,697 [median $4,6731, p <0.01). Compared with the STRESS angioplasty group, optimal coronary stenting increased catheterization laboratory costs by nearly $2,200 ($3,012 +/- $1,382 [median $2,548] vs $5,209 +/- $1,697 [median $4,673], p <0.01). Optimal stenting of long lesions or multiple discrete stenoses increased catheterization laboratory costs by an additional $2,000 compared with optimal single-lesion stenting ($7,201 +/- $2,428 [median $6,887] vs $5,209 +/- $1,697 [median $4,673], p <0.01). These findings demonstrate that optimal coronary stenting increases in-lab procedural resource utilization and costs compared with historical stenting techniques. Based on the downstream cost savings seen in the STRESS trial ($1,400/patient), it is unlikely that current optimal stenting techniques will result in an overall cost savings compared with balloon angioplasty.

Aged↗
PubMed1997

Health after coronary stenting or balloon angioplasty: results from the Stent Restenosis Study.

This study was designed to compare health-related quality of life (HRQOL) in patients undergoing coronary stenting or balloon angioplasty in the randomized Stent Restenosis Study. The study sample was drawn from patients at nine U.S. clinical sites of the Stent Restenosis Study, a randomized trial comparing Palmaz-Schatz coronary stent implantation with conventional balloon angioplasty. One hundred ninety-nine consecutive patients were sent surveys 6 to 18 months after enrollment and 160 (80%) were returned. The survey sent to the patients included the Medical Outcomes Study 36-Item Short-Form Health Survey, the Canadian Cardiovascular Society Classification, and the Duke Activity Status Index. Although patients who underwent stenting had less angiographic restenosis and a tendency for fewer ischemic events, there were few differences in HRQOL after a mean of 456 days after randomization. The group that underwent stenting reported significantly less bodily pain than the group that underwent angioplasty (p = 0.02). Otherwise, there were no significant differences in generic or disease-specific measures. In a rating of their overall health, 47% of the group that underwent stenting and 45% of the group that underwent percutaneous transluminal coronary angioplasty reported very good or excellent health. In each group, 60% of the patients reported being symptom free from a cardiovascular perspective. This survey revealed no marked differences in long-term HRQOL between patients who underwent Palmaz-Schatz coronary stenting compared with those who underwent conventional angioplasty.

Aged↗
PubMed1997

Tic disorders.

The picture that emerges is one of complex behavioral phenotypes that alter over the course of CNS development. While many cases are mild and may not come to medical attention, others are chronic and disabling. The aim of this article is to provide an overview of recent progress in understanding phenomenology, epidemiology, genetics, neurobiology, and treatment of tic disorders.

Basal Ganglia↗
PubMed1997

Percutaneous treatment of protected and unprotected left main coronary stenoses with new devices: immediate angiographic results and intermediate-term follow-up.

OBJECTIVES: We sought to evaluate the immediate angiographic results and intermediate-term follow-up after percutaneous treatment of left main coronary stenoses in the new device era. BACKGROUND: Historically, balloon angioplasty of left main coronary stenoses has been associated with high procedural morbidity and poor long-term results. It is not clear whether new devices are more effective in this anatomic setting. METHODS: Between July 1993 and July 1995, we performed initial left main coronary interventions on 46 patients (mean age 67 +/- 12 years, 26% women). Quantitative angiography was available for 42 of 46 interventions, and clinical follow-up was obtained for all patients at 1 month, 6 months and 1 year after initial revascularization. RESULTS: Most interventions (42 of 46) were performed in patients with "protected" coronary stenoses to the left coronary system owing to the presence of one or more patent left main coronary grafts. Seventy-seven percent of screened patients were deemed unsuitable for repeat coronary artery bypass surgery. Procedures performed included stenting in 73% of patients (alone in 30% and after rotational atherectomy in 43%), rotational atherectomy in 58% (alone in 15% and before stenting in 43%), directional atherectomy in 4% and angioplasty alone in 7%. Initial procedural success was achieved in all interventions, with no deaths, myocardial infarctions (creatine kinase, MB fraction > 50 IU/liter) or emergent bypass surgery. Follow-up data to date (median duration 9 months, range 6 to 19) demonstrate a 98% overall survival rate and a 6-month event-free survival rate of 78% (six target vessel revascularizations [TVRs], four non-TVRs). CONCLUSIONS: Treatment of protected left main coronary artery stenoses can be accomplished safely and effectively with new device technology. Intermediate-term follow-up demonstrates an acceptably low rate of death, myocardial infarction or repeat revascularization at 6 months and 1 year.

Aged↗
PubMed1997

Multivessel Palmaz-Schatz stenting: early results and one-year outcome.

OBJECTIVES: To determine whether the benefits outlined in Background might extend to patients with multivessel disease, we examined the short- and long-term outcome of multivessel Palmaz-Schatz stenting. BACKGROUND: Percutaneous transluminal coronary angioplasty (PTCA) has become the dominant treatment for most patients with single-vessel coronary artery disease and has emerged as an alternative treatment for selected patients with multivessel coronary artery disease. Although multivessel angioplasty has excellent early results and low procedural complication rates, long-term outcome is tempered by the frequent need for repeat revascularization. In patients with single-vessel coronary artery disease, Palmaz-Schatz stenting has been shown to have a higher success rate and a lower restenosis rate than conventional PTCA. METHODS: A total of 103 patients (mean age 64 +/- 11 years, 78 men and 25 women) underwent stenting of 212 vessels (saphenous vein graft [53%], left anterior descending coronary artery [20%], left circumflex artery [12%] and right coronary artery [15%]). In 88 patients (85%), multivessel stenting was performed during the same procedure, whereas the remaining 15 patients (15%) had staged multivessel stenting within 1 week of the index stent. Stenting involved only native coronary arteries in 33 patients and only vein grafts in 51 patients. RESULTS: Angiographic success was achieved in 102 patients (99%). Major complications developed in three patients: one patient died, and two patients had Q wave myocardial infarction, with no emergency coronary artery bypass graft surgery or stent thrombosis. Eleven additional patients (11%) developed non-Q wave myocardial infarction, and nine patients (9%) had local vascular complications requiring surgical repair. Clinical follow-up was available in all patients at a mean of 13 +/- 8 months. At 1 year, survival was 98%, with an event-free survival rate of 80%, reflecting predominantly repeat revascularization (17% overall, with 9% target site revascularization). Multivessel native coronary stenting resulted in a higher event-free survival rate and a lower probability of repeat revascularization than did multivessel saphenous vein graft stenting. CONCLUSIONS: In selected patients, multivessel Palmaz-Schatz stenting is technically feasible and carries both excellent early results and favorable 1-year clinical outcome.

Aged↗
PubMed1997

Why can't most people draw what they see?

The study presented a theoretical and empirical approach to the adult drawing process. Four possible sources of drawing inaccuracies were described: misperception of the object, inability to make good representational decisions, deficient motor skills, and misperception of the drawing. In four studies the degree to which the latter three sources contributed to drawing inaccuracies was assessed. The results suggest that (a) motor coordination is a very minimal source of drawing inaccuracies, (b) the artist's decision-making process is a relatively minor source of drawing inaccuracies, and (c) the artist's misperception of his or her work is not a source of drawing inaccuracies. These results suggest that the artist's misperception of the object is the major source of drawing errors.

Art↗
PubMed1997

Clomipramine in adults with pervasive developmental disorders: a prospective open-label investigation.

The purpose of this investigation was to determine the short-term efficacy and tolerability of clomipramine in a consecutive series of adults with pervasive developmental disorders (PDDs). Thirty-five adults with PDDs (DSM-IV), 16 of whom were nonverbal, entered a 12-week prospective open-label trial of clomipramine. The initial sample included 18 patients with autistic disorder, 6 patients with Asperger's disorder, and 11 patients with pervasive developmental disorder not otherwise specified (PDDNOS). Behavioral ratings were obtained at baseline and after 4, 8, and 12 weeks of clomipramine. Eighteen (55%) of the 33 patients who completed the trial were categorized as treatment responders based on scores of "much improved" or "very much improved" on the Clinical Global Impression (CGI) global improvement item (p < 0.001). Ten (63%) of 16 patients with autistic disorder, 2 (33%) of 6 patients with Asperger's disorder, and 6 (55%) of 11 patients with PDDNOS were considered responders to clomipramine treatment. In those 18 patients, clomipramine significantly reduced total repetitive thoughts and behavior (p < 0.001) and also aggression (p < 0.001), and improved some aspects of social relatedness, such as eye contact and verbal responsiveness (p < 0.001). Change in these specific symptom clusters over time was not related to DSM-IV subtype of PDD. The level of autistic behavior, as measured by the Autism Behavior Checklist (ABC) score, and full-scale intelligence quotient (IQ) were not significantly associated with global treatment response. Whereas clomipramine was well tolerated by most patients, 13 had clinically significant adverse effects. Three patients had seizures during clomipramine treatment, including 2 who had prior seizure disorders and were taking anticonvulsants. Of the 32 patients who had no history of prior seizures, only 1 had a seizure during clomipramine treatment. There were no adverse cardiovascular or extrapyramidal effects. All responders continued on clomipramine after completion of the study. The results of this open-label trial suggest that clomipramine may be an effective drug for reducing repetitive thoughts and actions and aggressive behavior and for improving some elements of social behavior, such as eye contact and verbal responsivity in adults with PDDs. Careful monitoring of adverse effects, particularly seizures, is warranted. Although an electroencephalogram (EEG) is not mandatory in patients with PDD prior to clomipramine treatment, we recommend that patients with PDD and a history of seizures be treated initially with a selective serotonin uptake inhibitor rather than with clomipramine. The findings of this study require replication in a double-blind placebo-controlled investigation before definitive statements of efficacy and tolerability can be made.

Adolescent↗
PubMed1997

Israeli preschool children under Scuds: a 30-month follow-up.

OBJECTIVE: Longitudinal studies of children exposed to traumatic events show contrasting findings regarding their symptomatic change over time. The present study reports on a 30-month follow-up of preschool children and their mothers who had been exposed to Scud missile attacks. METHOD: Families displaced during the Gulf War after their homes had been damaged by the missile attack and a control group whose homes remained intact were interviewed about posttraumatic and general symptomatology, the mothers' capacity to control images, and the children's adaptive behavior. RESULTS: Stress symptoms decreased in the displaced children but not in their mothers. Both reported more posttraumatic symptoms than did the control group. No differences in the children's adaptive behavior were observed. Posttraumatic symptoms of the displaced children correlated with the mothers' avoidant symptoms. The mothers' avoidant symptoms at follow-up were statistically explained by the mothers' symptoms during the war and their capacity for image control, the duration of displacement, and the cohesion of the family. CONCLUSIONS: The maternal stress-buffering capacity constitutes a central element in children's protective matrix and is crucial in minimizing long-term internal suffering of traumatized preschool children.

Adaptation, Psychological↗
PubMed1997

Risperidone treatment of children and adolescents with pervasive developmental disorders: a prospective open-label study.

OBJECTIVE: To investigate the short-term safety and efficacy of risperidone in the treatment of children and adolescents with pervasive developmental disorders. METHOD: This was a 12-week, prospective, systematic, open-label trial that included 18 subjects (15 boys and 3 girls) with a mean age of 10.2 +/- 3.7 years. The sample included 11 subjects with autistic disorder, 3 with Asperger's disorder, 1 with childhood disintegrative disorder, and 3 with pervasive developmental disorder not otherwise specified. Fourteen subjects had comorbid mental retardation. Behavioral ratings were obtained during two baseline visits and again after 12 weeks of risperidone treatment. RESULTS: The optimal dose of risperidone for the 18 subjects was 1.8 +/- 1.0 mg/day. On the basis of the global improvement item of the Clinical Global Impression Scale, 12 of 18 subjects were considered responders. Significant improvement was seen in measures of interfering repetitive behavior, aggression and impulsivity, and some elements of impaired social relatedness. The most common side effect was weight gain (range 10 to 35 lb). CONCLUSIONS: These preliminary results suggest that risperidone may be effective for improving interfering behavioral symptoms in some children and adolescents with pervasive developmental disorders. Double-blind, placebo-controlled studies are needed before definitive statements of safety and efficacy can be made.

Adolescent↗
PubMed1997

Pathogenesis of Tourette's syndrome.

This review presents a models of disease pathogenesis in the context of CNS development. It begins with an exploration of the clinical features and natural history of Tourette's syndrome. This is followed by a consideration of the role of genetic and nongenetic factors. An effort is then made to review the anatomical organization of the basal ganglia and related cortical sites. These circuits are intimately involved in the normal processing of sensorimotor, cognitive, and emotionally laden information. Evidence implicating these circuits in the pathobiology of Tourette's syndrome is then considered. The review closes with the prospects for advances in interdisciplinary research and therapeutics using this model as a guide.

Basal Ganglia↗
PubMed1997

Plasma beta-endorphin, adrenocorticotropin hormone, and cortisol in autism.

Plasma levels of the hypothalamo-pituitary-adrenal axis hormones beta-endorphin (BE), adrenocorticotropin hormone (ACTH), and cortisol were measured in autistic (N = 48), mentally retarded/cognitively impaired (MR/CI, N = 16), and normal control (N = 26) individuals. Comparison of log transformed data from the three groups revealed that levels of BE and ACTH were significantly higher (p < .05) in the autistic individuals than in normal controls. The higher means in the autistic group were due to significantly higher plasma levels of BE and ACTH, indices of acute stress response, in the more severely affected individuals. The data support the idea that individuals with severe autism have a heightened response to acute stressors rather than chronic hyperarousal or elevated basal stress response system functioning.

Adolescent↗