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Biomedical subjects

D J Cohen

Publications and source records attributed to D J Cohen.

At least 145 records · Page 8Linked to original sources
PubMed1996

Anna Freud and developmental psychoanalytic psychology.

When reviewed in its entirety, Anna Freud's legacy represents her efforts to address the deepest of metapsychological dilemmas: What moves development along, and is it inherently progressive and linear? She created a developmental psychoanalytic psychology that is remarkably current and draws upon principles of neurobiology, genetics, pediatrics, and social psychology. Her general developmental psychology builds upon three fundamental notions: (1) development proceeds not predominantly stage-based but more continuous and cumulative, with progressions and regressions; (2) progression along developmental lines involves the maturational push of innate or biologic givens as well as the interaction between biology and environmental conditions; and (3) understanding the complexities of normal development is a means of understanding the presence or absence of psychopathology in any given symptomatic presentation. These contributions and the notion of a developmental psychoanalytic psychology are reviewed through the contemporary lens of the field of developmental psychopathology. The enduring contributions of Anna Freud's developmental psychoanalytic psychology to child psychiatry and child development are in asking how mind and body are brought together, and in asserting that the interaction between the biologic and the mental remains the common ground of all disciplines concerned with children.

Austria↗
PubMed1996

Mammalian sperm-egg fusion: the development of rat oolemma fusibility during oogenesis involves the appearance of binding sites for sperm protein "DE".

Rat epididymal protein DE mediates gamete fusion through complementary sites localized on the egg surface. To investigate whether these egg components are involved in the development of rat oolemma fusibility, both the presence of DE-binding components and the ability of the oolemma to fuse with sperm during oogenesis were examined. Localization of DE-complementary sites by indirect immunofluorescence revealed the absence of fluorescent labeling on growing oocytes with a diameter < 50 microns, and the presence of a uniform staining over the entire surface of germinal vesicle oocytes with a diameter > 50 microns. This localization of oolemma components changed progressively to a patchy distribution during maturation. Whereas sperm incorporation was observed only in maturing oocytes, the development of the Hoechst transfer technique to evaluate membrane fusion revealed that germinal vesicle oocytes with a diameter > 50 microns were already competent to fuse with sperm. The involvement of the DE-complementary sites in the oolemma fusibility of these oocytes was confirmed by the fact that the presence of DE during gamete coincubation significantly (p < 0.001) reduced the percentage of oocytes with fused sperm. Together, these observations indicate that the acquisition of fusibility by the rat oolemma occurs during the growth period and involves the appearance of DE-binding components on the oocyte surface. This study provides novel information on the molecular mechanism by which the mammalian egg plasma membrane becomes competent to fuse with sperm during oogenesis.

Animals↗
PubMed1996

Asperger's syndrome.

This Grand Rounds is concerned with the classification of Asperger's syndrome and its continuity/discontinuity with autism. Information on a 15-year-old with the condition is presented as are data on other family members. The proband exhibited a longstanding pattern of marked deficits in social interaction, motor awkwardness, and unusual, circumscribed interest consistent with a diagnosis of Asperger's syndrome. Both the proband and his father exhibited unusual discrepancies between verbal and performance (nonverbal) cognitive abilities favoring the former. Deficits were observed in the social use of language. Father and son had similar abnormalities on magnetic resonance imaging examination. Potential differences between higher-functioning autism and Asperger's syndrome are important areas for future research.

Adolescent↗
PubMed1996

Effects of Special Olympics International on social competence in persons with mental retardation.

OBJECTIVE: To evaluate the social and emotional goals of Special Olympics International, specifically whether Special Olympics facilitates social competence and self-esteem in persons with mental retardation. METHOD: Findings were "triangulated" across three studies on the social competence, adaptation, and self-perceptions of 104 athletes from 1993 Team USA (mean age = 22 years; mean IQ = 59). Study 1 related behavior to athletes' length of time in Special Olympics. Study 2 compared Team USA to an appropriately matched group of non-Special Olympians. Study 3 assessed Team USA before and 4 months after their participation in the World Games held in Salzburg, Austria. RESULTS: Relative to age and IQ, length of time in Special Olympics was the most powerful predictor of social competence. Special Olympics athletes had higher social competence scores and more positive self-perceptions than the comparison group. Team USA's behavioral data remained stable over time, suggesting that high pre-Game scores were not simply a function of parental or athlete pre-Game excitement. CONCLUSIONS: Based on the most conservative meaning of triangulation, more support was found linking Special Olympics to social competence than to remaining behavioral domains.

Adolescent↗
PubMed1996

Obsessive-compulsive characteristics: from symptoms to syndrome.

OBJECTIVE: To assess the distribution and severity of obsessions and compulsions in a nonclinical adolescent population. METHOD: During preinduction military screening, 861 sixteen-year-old Israelis completed a questionnaire regarding the lifetime presence of eight obsessive-compulsive (OC) symptoms and three severity measures. The presence or absence of obsessive-compulsive disorder (OCD) or subclinical OCD was ascertained by an independent interview. RESULTS: Although only 8.0% and 6.3% of respondents reported disturbing and intrusive thoughts, respectively, 27% to 72% of subjects endorsed the six remaining OCD symptoms. Twenty percent of subjects regarded the symptoms they endorsed as senseless and 3.5% found them disturbing; 8% reported spending more than an hour daily on symptoms. OCD and subclinical OCD cases differed significantly from non-OCD cases, but not from each other, in distress and mean number of symptoms. Although the distribution of nine of the items differed for noncases, compared with OCD and subclinical OCD cases, the distributions for all items overlapped markedly across the three groups. CONCLUSIONS: OC phenomena appear to be on a continuum with few symptoms and minimal severity at one end and many symptoms and severe impairment on the other. Defining optimal cutoff points for distinguishing between psychiatric disorder and OC phenomena that are common in the general population remains an open question.

Adolescent↗
PubMed1996

Test-retest reliability for false-belief tasks.

Despite notable variations in children's rate of success on theory of mind tasks and the presumed theoretical implications drawn from a child's success or failure on such tasks, there have been no studies of the test-retest reliability of children's performance on these tasks. Twenty-three children (mean age 49.6 months, SD 8.6) watched three videotaped stories illustrating a false-belief situation: the standard experimenter narrated false-belief task, a minor variant replacing the narration of the story with a dialogue among the characters, and a third version involving a humorous situation. The time elapsed between test and retest was 2-3 weeks and the order of presentation was counterbalanced. Results corroborated previous findings of a developmental trend in the understanding of false-belief questions but, despite a general improvement in children's comprehension of the stories, the test-retest reliability for the false belief questions was poor. Although changes recorded between test-retest sessions frequently occurred in the direction of children answering correctly questions they had previously failed, a subset of children incorrectly answered questions they had initially passed. These findings underscore the need for validation assessments of techniques for studying children's developing theories of mind.

Child↗
PubMed1996

Pericardial effusion in patients with cancer: outcome with contemporary management strategies.

OBJECTIVE: To investigate the clinical presentation and current management strategies of pericardial effusion in patients with malignancy. DESIGN: Retrospective single centre, consecutive observational study. SETTING: University hospital. PATIENTS: 93 consecutive patients with a past or present diagnosis of cancer and a pericardial effusion, including 50 with a pericardial effusion > 1 cm. RESULTS: Of the 50 patients with pericardial effusions > 1 cm, most had stage 4 cancer (64%), were symptomatic at the time of presentation (74%), and had right atrial collapse (74%). Twenty patients were treated conservatively (without pericardiocentesis) and were less symptomatic (55% v 87%, P = 0.012), had smaller pericardial effusions (1.5 (0.4) v 1.8 (0.5), P = 0.02), and less frequent clinical (10% v 40%, P = 0.02) and echocardiographic evidence of tamponade (40% v 97%, P < 0.001) than the 30 patients treated invasively with initial pericardiocentesis (n = 29) or pericardial window placement (n = 1). Pericardial tamponade requiring repeat pericardiocentesis occurred in 18 (62%) of 29 patients after a median of 7 days. In contrast, only four (20%) of 20 patients in the conservative group progressed to frank clinical tamponade and required pericardiocentesis (P = 0.005 v invasive group). The overall median survival was 2 months with a survival rate at 48 months of 26%. Survival, duration of hospital stay, and hospital charges were similar with both strategies. By multivariable analysis, the absence of symptoms was the only independent predictor of long-term survival (relative hazards ratio = 3.2, P = 0.05). Survival was similar in the 43 patients with cancer and pericardial effusions of < or = 1 cm. CONCLUSION: Asymptomatic patients with cancer and pericardial effusion can be managed conservatively with close follow up. In patients with symptoms or clinical cardiac tamponade, pericardiocentesis provides relief of symptoms but does not improve survival and has a high recurrence rate. Surgical pericardial windows or possibly percutaneous balloon pericardiotomy should be used for recurrences and should be considered for initial treatment.

Cardiac Tamponade↗
PubMed1996

Children's developing theory of mind.

Studies from the developmental research perspective inform analytic understanding of the neuropsychological preconditions necessary for children's increasing awareness of their own and others' mental lives. Conversely, psychoanalytically informed observations of children's early development demonstrate how the child's emerging understanding of other minds is contextualized in the earliest interactions between parent and child. The notion of a gradually developing understanding of mind that becomes most evident in observational studies between 4 and 6 years of age provides a developmental context for considering children's capacity for internalization, their creation of an inner, psychic reality, and their response to therapeutic interventions during an analytic hour. Significant for psychoanalytic work with children is the suggestion that only after children are able to understand how their own and other's mental states are constructed and how such states are behind all actions and language can they then reflect upon their own thoughts and mental life. Developing a theory of the mind of the other integrates psychoanalytic notions of self-other differentiation, of the development of internalized representations of others, and ultimately of the capacity for self-reflection.

Child, Preschool↗
PubMed1996

Biology of the mesangial cell in glomerulonephritis--role of cytokines.

The mesangial cell occupies a central position in the genesis of the pertubations occurring during the pathogenesis of glomerulonephritis. In vitro studies have shown that this cell is a metabolically active cell producing a variety of cytokines which act as autocoids; such cytokines are also liberated by the monocytes/macrophages which infiltrate the glomerulus in nephritis. This review summarizes the evidence for the participation of these cytokines in animal models of nephritis and in human renal disease, focusing on the roles of basic fibroblast growth factor, platelet-derived growth factor, transforming growth factor-beta, colony-stimulating factor-beta, tumor necrosis factor, interleukin-1, and interleukin-6.

Animals↗
PubMed1996

Linkage disequilibrium between an allele at the dopamine D4 receptor locus and Tourette syndrome, by the transmission-disequilibrium test.

Dopaminergic abnormalities are implicated in the pathogenesis of Tourette syndrome (TS) and chronic multiple tics. We used the transmission-disequilibrium test (TDT) method to test for linkage disequilibrium between a specific allele (the seven-repeat allele (DRD4*7R) of the exon 3 VNTR polymorphic site) at the D4 dopamine receptor locus (DRD4) and expression of chronic multiple tics and TS. This particular allele had been shown in functional studies to have different binding properties compared with the other common alleles in this DRD4 polymorphic system. We studied 64 family trios (consisting of an affected person and two parents, at least one heterozygous for DRD4*7R), including 12 nuclear family trios and 52 trios from four large TS kindreds. The DRD4*7R allele was transmitted significantly more frequently than expected (chi 2 TDT ranging from 8.47 [P < .004] to 10.80 [P = .001], depending on breadth of disease definition and inclusion or exclusion of inferred genotypes). Confirmation of this finding will depend on either replication in other samples or the identification of a transmitted functional mutation within this sample.

Alleles↗
PubMed1995

In-hospital and one-year economic outcomes after coronary stenting or balloon angioplasty. Results from a randomized clinical trial. Stent Restenosis Study Investigators.

BACKGROUND: Coronary stenting has been shown to improve initial success, reduce angiographic restenosis, and reduce the need for repeat revascularization compared with conventional balloon angioplasty (PTCA). Although previous studies have demonstrated that initial hospital costs for stenting are considerably higher than those for conventional PTCA, the impact of coronary stenting on long-term medical care costs remains unknown. METHODS AND RESULTS: Between January 1991 and June 1993, 207 consecutive patients with symptomatic coronary disease requiring revascularization of a single coronary lesion were randomized to receive initial treatment by either PTCA (n = 105) or Palmaz-Schatz coronary stent implantation (n = 102) in the multicenter STRESS trial. Detailed resource utilization and cost data were collected for each patient's initial hospitalization and for any subsequent hospital visits for 1 year after randomization. Compared with conventional angioplasty, coronary stenting resulted in additional catheterization laboratory costs, increased vascular complications, and longer length of stay. Initial hospital costs were thus approximately $2200 higher for stenting than for PTCA ($9738 +/- 3248 versus $7505 +/- 5015; P < .001). Over the first year of follow-up, however, patients assigned to initial stenting were less likely to require rehospitalization for a cardiac condition and underwent fewer subsequent revascularization procedures. Follow-up medical care costs thus tended to be lower for stenting than for conventional angioplasty ($1918 +/- 4841 versus $3359 +/- 7100, P = .21). Nonetheless, cumulative 1-year medical care costs remained higher for patients undergoing initial stenting ($11,656 +/- 5674 versus $10,865 +/- 9073, P < .001). Even after adjustment for the higher incidence of vascular complications in the stent group, total 1-year costs were $300 higher for stenting than for balloon angioplasty. CONCLUSIONS: Elective coronary stenting, as performed in the randomized STRESS trial, increased total 1-year medical care costs by approximately $800 per patient compared with conventional angioplasty. Future studies will be necessary to determine whether ongoing refinements in stent design, implantation techniques, and anticoagulation regimens can narrow this cost difference further by reducing stent-related vascular complications or length of stay.

Aged↗
PubMed1995

Modulation of macrophage proliferation by hyperglycemia.

Macrophages have been show to be of importance in three areas of pathology in the diabetic state: (a) in the destruction of the beta cells of the pancreas; (b) in the pathogenesis of the microvascular lesions; and (c) in the atherosclerotic lesion which is a common complication of diabetes. However, there is only scanty information on the behavior of the macrophage in the hyperglycemic environment. The present study investigates the growth of WEHI-3 monocytes/macrophages and the proliferative response of splenic macrophages to colony stimulating factor-1 when cultured in media containing high glucose concentrations. The results of the study show that hyperglycemia increases the proliferation of these macrophages; this effect is not mediated by the effect of osmolality since mannitol and L-glucose failed to produce a similar result. These findings suggest that alterations of macrophage physiology may be an important component of the diabetic state; such alterations may have a role in the production of some of the lesions found in diabetes mellitus.

Animals↗
PubMed1995

Psychosocial therapies for children and adolescents: overview and future directions.

The assessment and psychosocial treatment of children must consider developmental phase and stage, developmental tasks, the nature of the disorder (does it affect a narrow sector or one developmental line or is there a broad disruption of development?) and biological contributions (including constitution, maturational rate, and factors such as the onset of puberty). Treatments can be distinguished along dimensions, including theoretical emphases, degrees of definition of the treatment, scope, the "patient" (child, family), duration, frequency of contacts, combination with other modalities, etc. Similarly, choice of treatment is based on many factors, including the clinician's expertise, availability of resources, wishes of parents, cost, etc. Future research should be grounded in a theory of child development as well as a theory of therapeutic action. Treatments should be well defined and currently practiced, provided by experts, and arise from realistic situations. The study of therapies bridges basic and applied research and provides data of profound relevance for theories of child development.

Adolescent↗
PubMed1995

Plasma androgens in autism.

Plasma levels of testosterone and the adrenal androgen dehydroepiandrosterone sulfate (DHEA-S) were measured in male autistic subjects (31 prepubertal, 8 postpubertal), mentally retarded/cognitively impaired subjects (MR, 12 prepubertal), and normal control subjects (NC, 10 prepubertal, 11 postpubertal). Mean levels of plasma testosterone were similar in the postpubertal autistic (4.54 +/- 1.12 ng/ml) and postpubertal NC (5.02 +/- 1.87 ng/ml) groups. Plasma DHEA-S levels in postpubertal autistic (2170 +/- 1020 ng/ml) and postpubertal NC (1850 +/- 777 ng/ml) groups also were not significantly different. Similarly, no significant group differences were seen for testosterone or DHEA-S in the prepubertal autistic, MR, or NC individuals, although prepubertal MR individuals with cerebral palsy did have increased plasma DHEA-S levels compared to age-matched MR or NC individuals. Significant negative correlations were found between testosterone and whole blood serotonin (5-HT) levels in the combined (all subjects, all ages) groups and in the autistic group, suggesting that the effect of puberty on whole blood 5-HT may deserve further study. Data indicate that altered secretion of the androgens is not a common feature of autism. However, abnormalities of adrenal androgen secretion may be present in individuals with cerebral palsy.

Adolescent↗
PubMed1995

Acute and chronic effects of fluoxetine and haloperidol on mouse brain serotonin and norepinephrine turnover.

Evidence from clinical studies suggests that the noradrenergic system may play a role in the pathophysiology of antidepressant- and neuroleptic-induced akathisia. In limited previous neurochemical research, acute treatment with selective serotonin reuptake inhibitors (SSRIs) has been reported to increase rat brain norepinephrine (NE) turnover or release. We have examined the neurochemical effects of 2 hr, 4 day, and 20 day treatment with the SSRI fluoxetine, and the neuroleptic haloperidol, on regional brain monoamine metabolism. Short and long-term fluoxetine treatment produced substantial decreases (to 65-79% of control) in serotonin (5HT) turnover. However no effects of fluoxetine on mouse brain NE turnover--as assessed by forebrain, hypothalamus, and hindbrain 3-methoxy-4-hydroxyphenylglycol (MHPG) levels or MHPG/NE ratios--were observed. Acute (2 hr) fluoxetine also did not alter regional NE turnover in rat brain. In contrast, haloperidol tended to increase MHPG levels and MHPG/NE ratios in the mouse brain regions studied. The persistence of decreased 5HT turnover during fluoxetine treatment, the lack of an effect of fluoxetine on NE turnover, and the increased NE turnover seen after haloperidol may have important implications regarding drug responsivity and the mechanism of akathisia induction.

Animals↗