Search PubMed⌕ Search

Biomedical subjects

D J Stein

Publications and source records attributed to D J Stein.

At least 37 records · Page 2Linked to original sources
PubMed2004

The effects of repeated intra-amygdala CRF injections on rat behavior and HPA axis function after stress.

Patients diagnosed with certain anxiety disorders or depression show symptoms of a dysregulated HPA-axis secondary to increased release of corticotropin releasing factor (CRF). Male Wistar rats were injected with CRF (100 ng/microL) in the basolateral amygdala (BLA) for 5 days. Measurement of behavior was performed on the elevated plus maze and open field test. Behavioral and neuroendocrine response to restraint stress was also evaluated. Chronic treatment of CRF resulted in a significant increase in grooming after restraint stress in the Open Field test. Basal plasma corticosterone concentrations were significantly lower in the CRF-injected rats. These animals also showed greater and longer increase in corticosterone levels following the restraint stress than controls, but had comparable ACTH responses to restraint stress. Our results indicate that chronic administration of CRF into the basolateral amygdala may promote stress-induced grooming behavior in rats. In addition the data suggests that increased CRF in the amygdala may contribute to the dysregulation of corticosterone secretion. These findings may have important implications for patients suffering from psychiatric illnesses such as posttraumatic stress disorder and depression that are characterized by abnormalities in cortisol release.

Adrenocorticotropic Hormone↗
PubMed2004

Single photon emission computed tomography (SPECT) in obsessive-compulsive disorder before and after treatment with inositol.

Inositol, a glucose isomer and second messenger precursor, regulates numerous cellular functions and has demonstrated efficacy in obsessive-compulsive disorder (OCD) through mechanisms that remain unclear. The effect of inositol treatment on brain function in OCD has not been studied to date. Fourteen OCD subjects underwent single photon emission computed tomography (SPECT) with Tc-99m HMPAO before and after 12 weeks of treatment with inositol. Whole brain voxel-wise SPM was used to assess differences in perfusion between responders and nonresponders before and after treatment as well as the effect of treatment for the group as a whole. There was 1) deactivation in OCD responders relative to nonresponders following treatment with inositol in the left superior temporal gyrus, middle frontal gyrus and precuneus, and the right paramedian post-central gyrus; 2) no significant regions of deactivation for the group as a whole posttreatment; and 3) a single cluster of higher perfusion in the left medial prefrontal region in responders compared to nonresponders at baseline. Significant reductions in the YBOCS and CGI-severity scores followed treatment. These data are only partly consistent with previous functional imaging work on OCD. They may support the idea that inositol effects a clinical response through alternate neuronal circuitry to the SSRIs and may complement animal work proposing an overlapping but distinct mechanism of action.

Cerebrovascular Circulation↗
PubMed2004

Violence in male patients with schizophrenia: risk markers in a South African population.

OBJECTIVE: We investigate the role of functional variants in the catecholamine-O-methyl transferase gene (COMT) and the monoamine oxidase-A gene (MOA-A), as well as previously identified non-genetic risk factors in the manifestation of violent behaviour in South African male schizophrenia patients. METHOD: A cohort of 70 acutely relapsed male schizophrenia patients was stratified into violent and non-violent subsets, based on the presence or absence of previous or current violent behaviour. Standardized violence rating scales were also applied and the COMT/NlaIII and MAO-A promoter region variable number of tandem repeats (VNTR) polymorphisms were genotyped. RESULTS: A multiple logistic regression model based on the clinical, genetic and socio-demographic variables indicated that delusions of control (OR = 3.7, 95% CI = 1.21-11.61) and the combined use of cannabis and alcohol (OR = 6.89, 95% CI = 1.28-37.05) were two significant predictors of violent behaviour in this schizophrenia population. No association was found between the tested polymorphisms and violent behaviour. CONCLUSIONS: Although the sample size may have limited power to exclude a minor role for these specific gene variants, such a small contribution would have limited clinical relevance given the strong significance of the non-genetic markers. These findings suggest that currently proactive management of violent behaviour in this schizophrenia population should continue to be based on clinical predictors of violence.

Adult↗
PubMed2004

Predictors of major depression in recently diagnosed patients with HIV/AIDS in South Africa.

There is increasing evidence that major depression impacts the course of HIV infection, yet few studies have explored demographic and clinical predictors of depression in people who with HIV/AIDS. This study investigated predictors of depression (e.g., demographic and clinical variables, negative life events, and coping response) among outpatients with recently diagnosed HIV/AIDS patients in South Africa. One hundred forty-nine recently diagnosed HIV/AIDS patients (44 males and 105 females; mean time since diagnosis = 5.8, standard deviation [SD] 4.1) were evaluated. Subjects were assessed using the Mini International Neuropsychiatric Interview (MINI), the Carver Brief COPE coping scale, and the Sheehan Disability Scale. In addition, previous exposures to trauma and past risk behaviors were assessed. Three variables: gender (odd ratio [OR] = 1.23; 95% confidence interval [CI] 1.56, 1.93), impact of negative life events (OR = 1.13; CI, 1.03, 1.23), and disability (OR = 1.51, CI, 1.28, 1.80) predicted current major depression. It is well known from non-HIV populations that female gender and increased negative life events predict depression. These data also emphasize the importance of these links in HIV.

Activities of Daily Living↗
PubMed2004

Trauma exposure and post-traumatic stress symptoms in urban African schools. Survey in CapeTown and Nairobi.

BACKGROUND: There is a lack of comparative data on the prevalence and effects of exposure to violence in African youth. AIMS: We assessed trauma exposure, post-traumatic stress symptoms and gender differences in adolescents from two African countries. METHOD: A sample of 2041 boys and girls from 18 schools in CapeTown and Nairobi completed anonymous self-report questionnaires. RESULTS: More than 80% reported exposure to severe trauma, either as victims or witnesses. Kenyan adolescents, compared with South African, had significantly higher rates of exposure to witnessing violence (69% v. 58%), physical assault by a family member (27% v. 14%) and sexual assault (18% v. 14%). But rates of current full-symptom post-traumatic stress disorder (PTSD) (22.2% v. 5%) and current partial-symptom PTSD (12% v. 8%) were significantly higher in the South African sample. Boys were as likely as girls to meet PTSD symptom criteria. CONCLUSIONS: Although the lifetime exposure to trauma was comparable across both settings, Kenyan adolescents had much lower rates of PTSD. This difference may be attributable to cultural and other trauma-related variables. High rates of sexual assault and PTSD, traditionally documented in girls, may also occur in boys and warrant further study.

Adolescent↗
PubMed2004

Suicide attempts in an African schizophrenia population: an assessment of demographic risk factors.

This study investigated demographic variables, including affected sibling pair status, as risk factors for suicidal behavior in schizophrenia patients of African (Xhosa) descent. Xhosa subjects with schizophrenia were interviewed with the Diagnostic Interview for Genetic Studies (DIGS) and then stratified into two groups: those with ( n = 90) and those without ( n = 364) a history of previous suicide attempts. Demographic parameters (including gender, age, and social circumstances, sib ship) were then compared across these groups. Demographic predictors of suicide included sib ship status ( p = 0.038; OR = 1.7) and age of onset of illness ( p = 0.008; OR = 2.5). On further analysis of suicide in siblings, only a minority of sib pairs was found to be concordant for a lifetime history of suicide attempts (3%). These findings raise the possibility that affected sib pair status may be protective in nature. Given the counter-intuitive nature of this finding, further work is needed to replicate it, and to explore possible underlying mechanisms.

Adolescent↗
PubMed2004

Self-disclosure of HIV serostatus in recently diagnosed patients with HIV in South Africa.

Failure of people living with HIV/AIDS to disclose their HIV serostatus can place their sexual partners at risk. The current study examined HIV serostatus disclosure and its relationship to risky sexual behaviours in 69 sexually active, heterosexual, married (62%) or cohabiting (38%) patients recently diagnosed as HIV positive. Results show that 78% had not disclosed their HIV serostatus to their sexual partners and 46% had no knowledge of their sexual partner's serostatus. Compared to those who disclosed their serostatus, those who did not disclose were more likely to be male (chi2 = 7.02, p = 0.00), to have not used a condom during their last sexual encounter (chi2 = 29.64, p = 0.000), to have used alcohol heavily before sex (chi2 = 6.79, p = 0.00), to have multiple sexual partners (t = 3.01, p = 0.05), and to have engaged more frequently in sexual intercourse in the six months preceding the study (t = 8.21, p = 0.00). Logistic regression analysis show that being in a married relationship (OR = 0.86, 95% CI = 0.65, 1.15), being male (OR = 1.48, 95% CI = 0.24, 1.99), having more than two multiple partners (OR = 2.03, 95% CI = 1.11, 3.68) and non-use of condom at last sex (OR = 1.53, 95% CI = 0.83, 1.88) were significantly associated with non-disclosure of HIV serostatus. Preventive strategies among HIV-positive patients should place emphasis on the management of self-disclosure and its importance in safe sexual behaviour.

AIDS Serodiagnosis↗
PubMed2003

Treatment utilisation and trauma characteristics of child and adolescent inpatients with posttraumatic stress disorder.

OBJECTIVE: Few empirical studies have addressed the impact of trauma exposure and posttraumatic stress disorder (PTSD) on treatment utilisation and outcome in South African youth. This study was undertaken to document demographic, clinical, and treatment characteristics of child and adolescent inpatients with PTSD. DESIGN: A retrospective chart study of all patients presenting to a child and adolescent inpatient unit was conducted between 1994-1996. For children and adolescents diagnosed with PTSD; demographic, diagnostic and treatment variables, including trauma type, family history, and delays in treatment seeking, were documented. SETTING: Child and Adolescent Psychiatric Inpatient Unit, Tygerberg Hospital, Cape Town. SUBJECTS: Children and adolescents (2 to 18 years) presenting to an inpatient unit (n = 737). RESULTS: 10.3% (n = 76) met diagnostic criteria for PTSD. Gender differences were clearly evident: PTSD was six times more prevalent in girls (65 with PTSD were female and 11 were male); girls were most likely to have experienced rape or sexual abuse while boys were most likely to have witnessed a killing. Psychotherapy was the most common intervention for PTSD, followed by treatment with a tricyclic antidepressant. 97.4% of children and adolescents who were treated were improved at treatment endpoint. Delays in seeking treatment and problems with the primary support group were highly prevalent. CONCLUSION: PTSD is a common disorder that is responsive to treatment with psychotherapy and/or tricyclic antidepressants in child and adolescent inpatients. These findings underscore the importance of early identification and treatment of childhood PTSD in mental health settings, in particular tertiary service institutions.

Adolescent↗
PubMed2002

Barriers to treatment among members of a mental health advocacy group in South Africa.

BACKGROUND: As part of an international survey of mental health advocacy groups, information pertinent to patients' concerns regarding their diagnosis and treatment was gathered from South African members of a depression and anxiety support group (n = 404). METHODS: Questionnaires developed by GAMIAN, an international consortium of advocacy groups, were mailed along with explanatory letters and self-addressed envelopes to South African members and members in nine other countries, for completion. Of 1,000 questionnaires mailed in South Africa, 40.4 % were returned. RESULTS: The sample comprised patient members with anxiety-only (39 %), depression-only (8 %), mixed anxiety-depression (26 %), and other diagnoses (27 %). While one-third of respondents reported onset of symptoms before the age of 20, most waited 3-5 years before seeking help. After making contact with the health system, respondents experienced further delays in obtaining a correct diagnosis. In many instances, respondents were poorly informed of diagnosis and treatment (25 %), and nearly half of all respondents discontinued treatment on account of side-effects. CONCLUSIONS: Attempts to improve awareness of mental illness, and better communication between physicians and their patients, might help to break down some of the barriers patients encounter when seeking help.

Adolescent↗
PubMed2002

The effects of co-morbidity on the onset and persistence of generalized anxiety disorder in the ICPE surveys. International Consortium in Psychiatric Epidemiology.

BACKGROUND: Although it is well known that generalized anxiety disorder (GAD) is highly co-morbid with other mental disorders, little is known about the extent to which earlier disorders predict the subsequent first onset and persistence of GAD. These associations are examined in the current report using data from four community surveys in the World Health Organization (WHO) International Consortium in Psychiatric Epidemiology (ICPE). METHOD: The surveys come from Brazil, Canada, the Netherlands and the United States. The Composite International Diagnostic Interview (CIDI) was used to assess DSM-III-R anxiety, mood and substance use disorders in these surveys. Discrete-time survival analysis was used to examine the associations of retrospectively reported earlier disorders with first onset of GAD. Logistic regression analysis was used to examine the associations of the disorders with persistence of GAD. RESULTS: Six disorders predict first onset of GAD in all four surveys: agoraphobia, panic disorder, simple phobia, dysthymia, major depression and mania. With the exception of simple phobia, only respondents with active disorders have elevated risk of GAD. In the case of simple phobia, in comparison, respondents with a history of remitted disorder also have consistently elevated risk of GAD. Simple phobia is also the only disorder that predicts the persistence of GAD. CONCLUSIONS: The causal processes linking temporally primary disorders to onset of GAD are likely to be state-dependent. History of simple phobia might be a GAD risk marker. Further research is needed to explore the mechanisms involved in the relationship between simple phobia and subsequent GAD.

Adolescent↗
PubMed2002

Quetiapine augmentation of serotonin reuptake inhibitors in obsessive-compulsive disorder.

The augmentation of serotonin reuptake inhibitors (SRIs) with atypical antipsychotics for the management of treatment-resistant obsessive-compulsive disorder (OCD) is gaining increasing acceptance. Quetiapine is a novel antipsychotic which is well tolerated, and which may therefore be particularly useful in this context. Charts of all patients treated in our OCD clinic with the combination of an SRI and quetiapine were reviewed. Demographic details and clinical symptoms on the Yale-Brown Obsessive-Compulsive Scale and the Clinical Global Impressions Scale (CGI) were tabulated before and after augmentation. Eight OCD patients who had proven resistance to treatment with SRIs had received quetiapine augmentation. Four of these eight patients were responders (CGI of 1 or 2) within 4 weeks. In the treatment-responders, the medication was well tolerated. Although limited by the retrospective design and lack of controls, these data are consistent with the growing literature suggesting that approximately one-half of OCD patients resistant to treatment with SRIs may respond to augmentation with an atypical antipsychotic. Quetiapine, a relatively well tolerated agent, deserves further controlled study in this context.

Adolescent↗
PubMed2002

Moclobemide is effective and well tolerated in the long-term pharmacotherapy of social anxiety disorder with or without comorbid anxiety disorder.

Social phobia (social anxiety disorder) is a highly prevalent and chronic disorder that is associated with significant comorbidity and disability. Despite recent advances in the pharmacotherapy of the disorder, there is a paucity of randomized controlled trials on patients with comorbid disorders and on maintenance treatment. A randomized placebo-controlled, double-blind multi-site trial of moclobemide, a reversible inhibitor of monoamine oxidase A, was undertaken with 390 subjects. After an initial 12 weeks, there was the option of continuing for an additional 6 months of treatment. The primary efficacy parameter chosen was responder status as defined by the Clinical Global Impression scale change item. From week 4 onwards, there was a significantly higher response rate on moclobemide than on placebo. Superiority of medication over placebo was similar in patients with comorbid anxiety disorders (33% of subjects) and without, as well as in patients with different subtypes of social anxiety disorder; indeed, treatment with moclobemide rather than placebo was the strongest predictor of response. Adverse events were similar across treatment groups, and were typically mild and transient. In the extension phase, response rates remained higher in the moclobemide group, and ratings of tolerability were equally high in both groups. Thus, in a large sample of social anxiety disorder patients with and without comorbid anxiety disorders, moclobemide was both effective and well-tolerated in the short as well as long-term. These data confirm and extend previous findings on the value of moclobemide in the treatment of social anxiety disorder, and strengthen the range of therapeutic options for managing this important disorder.

Adolescent↗
PubMed2002

Attitudes towards and beliefs about schizophrenia in Xhosa families with affected probands.

OBJECTIVE: The development of effective psychoeducational programs for the management of schizophrenia requires an understanding of attitudes towards and beliefs about the disorder in families of affected probands. In order to establish the need for adaptation of Western psychoeducational programs, these variables were investigated in Xhosa speaking families in South Africa. DESIGN: Xhosa speaking family members of patients with DSM-IV schizophrenia were recruited on a voluntary basis, and interviewed with a structured belief and attitudes questionnaire adapted from previous studies in the West. SETTING: The study population was drawn from both urban and rural Xhosa communities in South Africa. SUBJECTS: 100 Xhosa speaking family members participated in the study. RESULTS: Family members most often recommended treatment with psychotropic medications (88%) and traditional healers (32%), and least often recommended psychotherapy (4%) and meditation (1%). Of the respondents who recommended traditional healing methods, 92% also recommended simultaneous use of allopathic treatment. CONCLUSION: Attitudes towards and beliefs about schizophrenia in family members of patients with schizophrenia may differ substantially from those described in previous work in the West. An understanding of local attitudes and beliefs is crucial for the successful development of local psychoeducational programs.

Adult↗
PubMed2002

Treatment utilisation and trauma characteristics of child and adolescent inpatients with posttraumatic stress disorder.

OBJECTIVE: Few empirical studies have addressed the impact of trauma exposure and posttraumatic stress disorder (PTSD) on treatment utilisation and outcome in South African youth. This study was undertaken to document demographic, clinical, and treatment characteristics of child and adolescent inpatients with PTSD. DESIGN: A retrospective chart study of all patients presenting to a child and adolescent inpatient unit was conducted between 1994-1996. For children and adolescents diagnosed with PTSD; demographic, diagnostic and treatment variables, including trauma type, family history, and delays in treatment seeking, were documented. SETTING: Child and Adolescent Psychiatric Inpatient Unit, Tygerberg Hospital, Cape Town. SUBJECTS: Children and adolescents (2 to 18 years) presenting to an inpatient unit (n = 737). RESULTS: 10.3% (n = 76) met diagnostic criteria for PTSD. Gender differences were clearly evident: PTSD was six times more prevalent in girls (65 with PTSD were female and 11 were male); girls were most likely to have experienced rape or sexual abuse while boys were most likely to have witnessed a killing. Psychotherapy was the most common intervention for PTSD, followed by treatment with a tricyclic antidepressant. 97.4% of children and adolescents who were treated demonstrated significant improvement. Delays in seeking treatment and problems with the primary support group were highly prevalent. CONCLUSION: PTSD is a common disorder that is responsive to treatment with psychotherapy and/or tricyclic antidepressants in child and adolescent inpatients. These findings underscore the importance of early identification and treatment of childhood PTSD in mental health settings, in particular tertiary service institutions.

Acute Disease↗
PubMed2001

A comparative study of clinical features between pure checkers and pure washers categorized using a lifetime symptom rating method.

The current study assessed lifetime obsessive-compulsive disorder (OCD) symptoms in 156 Japanese patients with OCD in order to investigate clinical differences between pure lifetime checkers and pure lifetime washers. Fifty subjects (32%), who had no lifetime history of washing or checking compulsions, or who had a principal symptom other than washing or checking compulsions, were initially excluded. The remaining 106 subjects were divided into three groups: 43 pure lifetime washers (W), 33 pure lifetime checkers (C) and 30 subjects who had experienced both checking and washing compulsions over their lifetime (WC). No differences in clinical characteristics were observed between the W and C groups, suggesting that the lifetime washer-checker distinction may not be useful in subtyping OCD. However, subjects in the WC group differed from other subjects in a number of respects including poorer level of insight, more severe psychopathology and global dysfunction. Thus, they can be generally distinguished by more pervasive and severe psychopathological features, and may constitute a valid subgroup of OCD. Further work from a multidimensional perspective is required to verify the clinical significance of a typology based on lifetime symptoms.

Adolescent↗
PubMed2001

The factor structure for positive and negative symptoms in South African Xhosa patients with schizophrenia.

Most studies investigating the symptom dimensions of schizophrenia utilising the Scale for the Assessment of Negative Symptoms (SANS) and the Scale for the Assessment of Positive Symptoms (SAPS) favour a three factor model. This study sought to investigate the factor structure of both the global and individual items of the SANS and SAPS in a large sample of South African Xhosa patients with schizophrenia. A total of 422 subjects participated. Both principal components and factor analytical procedures were applied. For the global items, a two-factor solution representing positive and negative symptoms accounted for 59.9% of the variance. Alternatively, the three-dimensional model of negative, psychotic and disorganisation factors was supported by a five-factor solution if the more heterogeneous items of attention and alogia were ignored. Analysis of the individual items yielded a five-factor solution with the negative symptoms splitting into diminished expression and disordered relating, and the positive symptoms separating into factors for psychosis, thought disorder and bizarre behaviour. Our findings are very similar to those from other parts of the world, providing evidence that the factor structure for the symptoms of schizophrenia is relatively resistant to cultural influences. This is particularly true for negative symptoms.

Adult↗