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Biomedical subjects

J Levine

Publications and source records attributed to J Levine.

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

Utilization of depot neuroleptic medication in psychiatric inpatients.

This report describes the extent and pattern of use of depot neuroleptics within the 21 adult civil psychiatric hospitals operated by the New York State Office of Mental Health (OMH). All inpatients receiving depot or oral neuroleptics in calendar year 1994 were identified. In addition to descriptive data on admission and drug orders, a logistic regression was fit using gender, age, race, and facility for the probability of receiving depot. Depot utilization ranged from 12 percent to 39 percent of all patients receiving neuroleptics (N = 18,543). Differences among facilities were statistically significant (p < .05). Gender was not found to be a statistically significant factor, but blacks and Hispanic/others were found to be more likely than whites to receive depot (p < .05), and those 65 years or older were found to be less likely to receive depot (p < .05). For patients admitted in 1994, depot neuroleptics were typically started within a month or two of admission and continued for 2 to 3 months, with 86 percent of these patients discharged by December 31, 1995. Except for milligram dose and frequency of injection, haloperidol decanoate and fluphenazine decanoate did not differ in terms of extent and pattern of use.

Adult↗
PubMed1996

Just do it!

Explore the source record for details and available documents.

Exercise Therapy↗
PubMed1995

Colonic medication bezoar from extended-release nifedipine and procainamide.

We report an unusual case of a primary colonic bezoar composed of extended-release formulations of nifedipine and procainamide. Although these bezoars are rare, the increasingly frequent application of extended-release delivery systems to other commonly prescribed medications may increase the incidence of such bezoars in vulnerable patients. Clinicians should be aware of this potential problem when prescribing these medications, and have a high index of suspicion when painful or refractory constipation occurs.

Aged↗
PubMed1995

Recombinant protein sequences can trigger methylation of N-terminal amino acids in Escherichia coli.

Recombinant human hemoglobin rHb1.1 has been genetically engineered with the replacement of the wild-type valine residues at all N-termini with methionine, an Asn 108 Lys substitution on the beta globins, and a fusion of the two alpha globins with a glycine linker. When rHb1.1 was expressed in Escherichia coli, methylation of the N-terminal methionine of the alpha globin was discovered. Another mutant has been engineered with the alpha globin gene coding for N-terminal methionine followed by an insertion of alanine. Characterization of expressed hemoglobin from this variant revealed a methylated N-terminal alanine that occurred through two posttranslational events: initial excision of the N-terminal methionine, followed by methylation of alanine as the newly generated N-terminus. No methylation was observed for variants expressed with wild-type valine at the N-terminus of the alpha globin. The methylation of N-terminal amino acids was attributed to a specific protein sequence that can trigger methylation of proteins expressed in E. coli. Here we demonstrate that proline at position 4 in the protein sequence of alpha globin seems an essential part of that signaling. Although N-terminal methylation has been observed previously for native E. coli proteins with similar N-terminal sequences, methylation of the recombinant globins has allowed further delineation of the recognition sequence, and indicates that methylation of heterologous proteins can occur in E. coli.

Alanine↗
PubMed1995

Prevalence of pervasive developmental disorder in a sample of psychiatrically hospitalized children and adolescents.

Pervasive developmental disorder (PDD) is underrecognized because of lack of awareness of the wide range of severity and differing manifestations of the disorder. A survey of psychiatrically hospitalized children and adolescents was conducted. 3.2% of the sample of boys was found to have PDD. Underappreciation of the presence of PDD characterized the patients. Family members experienced a wide array of psychiatric symptoms and showed evidence for the presence of familial Tourette syndrome.

Adolescent↗
PubMed1995

Evaluating and improving the cost-effectiveness of the implantable cardioverter-defibrillator.

The implantable cardioverter defibrillator (ICD) is an expensive, widely used device for severe ventricular arrhythmias. Marginal cost-effectiveness analysis is a technique to examine the incremental cost of treatment strategy in relation to its effectiveness. In this study, we used this technique to analyze the cost-effectiveness of the ICD compared with that of electrophysiology (EP)-guided drug therapy and examined ways in which it may be improved. We analyzed Michigan Medicare discharge abstracts (1989 to 1992) and local physician visit, test, and ICD charges. Effectiveness was from 218 previously described patients with ICDs in whom the time of first event (first appropriate shock or death) was determined and presumed to represent "control" (EP-guided drug therapy) mortality. We assumed a 4-year life cycle for the ICD generator and 3.4% operative mortality and used a 5% discount to prevent value. Data were analyzed in a 1-month cycle Markov decision model over a 6-year horizon, and results were updated to 1993 dollars. ICD effectiveness was an increase in discounted mean life expectancy of 1.72 years. Cost-effectiveness was $31,100/year of life saved (YLS). Results were minimally or modestly sensitive to variations in preoperative mortality; resource use; consideration only of patients with ICDs who were receiving any antiarrhythmic drug or specifically amiodarone; and to a decrease in the percentage of first shocks that would equal death without the ICD until the assumed percentage decreased to < 38%. At ejection fraction of < 0.25 and > or = 0.25, cost-effectiveness was $44,000/YLS and $27,200/YLS, respectively, and without preimplant EP study was $18,100/ YLS.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

Candida-associated diarrhea: a syndrome in search of credibility.

Candida species have been often considered but infrequently documented as a credible cause of diarrhea. Evaluations of the colon in patients who have diarrhea and for whom Candida organisms have been isolated from stool have not shown invasive fungal lesions, and the mechanisms by which Candida species may induce diarrhea remain undefined. However, symptoms ascribed to Candida-associated diarrhea in the literature include prolonged secretory diarrhea with abdominal pain and cramping but without blood, mucus, fever, nausea, or vomiting. A critical review literature review showed a strong between the abatement of diarrheal symptoms in patients for whom a significant growth of Candida was found in their stools and treatment with specific topical antifungal agents. Most of the patients had received antibacterial therapy before the onset of symptoms. On the basis of these data, we conclude that Candida species may cause diarrhea in selective clinical settings.

Candidiasis↗
PubMed1995

Conventional antipsychotic medications for schizophrenia.

This article reviews the existing evidence for the efficacy and effectiveness of conventional antipsychotic medications in the treatment of schizophrenia. Among the issues reviewed are their efficacy for acute symptom episodes and for long-term maintenance therapy, differential efficacy among medications, the gap between research-based efficacy rates and effectiveness rates in practice, dosing strategies, and the treatment of first-episode cases. Evidence for efficacy is overwhelming for reduction of positive symptoms but quite limited for other outcomes. Effectiveness in practice may be substantially less than efficacy in clinical trials, perhaps owing to patient heterogeneity, prescribing practices, and noncompliance. First-episode patients should be treated with antipsychotic medication, but perhaps at lower dosages, with consideration of a gradual decrease or discontinuation at 6 months to 1 year.

Antipsychotic Agents↗
PubMed1995

Double-blind, controlled trial of inositol treatment of depression.

OBJECTIVE: CSF levels of inositol have been reported to be lower than normal in depressed subjects. The authors administered inositol to depressed patients in a double-blind, controlled trial. METHOD: Under double-blind conditions, 12 g/day of inositol (N = 13) or placebo (N = 15) was administered to depressed patients for 4 weeks. RESULTS: The overall improvement in scores on the Hamilton Depression Rating Scale was significantly greater for inositol than for placebo at week 4. No changes were noted in hematology or in kidney or liver function. CONCLUSIONS: This may be the first use of the precursor strategy for a second messenger rather than a neurotransmitter in treating depression. Although inositol had a significant antidepressant effect in this study, replication is crucial.

Adult↗
PubMed1995

Double-blind, placebo-controlled, crossover trial of inositol treatment for panic disorder.

OBJECTIVE: Because they found in an earlier study that inositol, an important intracellular second-messenger precursor, was effective against depression in open and double-blind trials, the authors studied its effectiveness against panic disorder. METHOD: Twenty-one patients with panic disorder with or without agoraphobia completed a double-blind, placebo-controlled, 4-week, random-assignment crossover treatment trial of 12 g/day of inositol. RESULTS: The frequency and severity of panic attacks and the severity of agoraphobia declined significantly more after inositol than after placebo administration. Side effects were minimal. CONCLUSIONS: The authors conclude that inositol's efficacy, the absence of significant side effects, and the fact that inositol is a natural component of the human diet make it a potentially attractive therapeutic for panic disorder.

Adult↗
PubMed1995

Changes in interleukin-1 beta and soluble interleukin-2 receptor levels in CSF and serum of schizophrenic patients.

Some evidence points towards a possible autoimmune role in the aetiology of schizophrenia. Experimental findings provide contradictory results regarding abnormalities in cytokine production in this disorder. In the present study we tested the production of cytokines in CSF and serum in 16 schizophrenic patients and 10 healthy controls (tumor necrosis factor alpha - TNF alpha; interleukins IL-1 beta, IL-2, IL-6, soluble IL-2 receptor). Cytokine levels were evaluated by radioactively-labeled antibodies (IL-1 beta, IL-2, IL-6), by enzyme-linked immunoassay (TNF) and by a sandwich enzyme immunoassay (soluble IL-2 receptor). No significant differences were found in either CSF fluid or serum levels of TNF and IL-2 or IL-6. Interleukin-1 beta was significantly decreased in patients' CSF and serum as compared to controls. Soluble interleukin-2 receptor levels were decreased in CSF of patients, but highly increased in their serum in comparison with controls. Changes in various cytokine levels in CSF fluid and serum of schizophrenic patients probably reflect interrelated process of growth, degeneration or neuroimmunological abnormalities, which may all play a role in the pathophysiology of schizophrenia. The present study supports evidence for change in immune activation, probably of peripheral origin, in schizophrenic patients.

Adult↗
PubMed1995

Follow-up and relapse analysis of an inositol study of depression.

A recent controlled double-blind study of 28 patients treated with 12 gm daily of inositol or placebo revealed significant antidepressant effect for this second messenger precursor. Patients were followed-up by interview and Hamilton Depression Scale 10-12 months after the end of the study. Half of the patients who had responded well to inositol relapsed rapidly after inositol discontinuation whereas none of those who responded to placebo relapsed rapidly after placebo cessation. Klein suggested that true drug responders to tricyclic antidepressants respond slowly and gradually whereas placebo responders improve early in an abrupt fashion. However, in the recent study both inositol and placebo responders improved at similar rates. Hamilton Depression Scale Scores 10-12 months after completion of the study were not significantly different between those who had responded and those who had not responded to inositol or to placebo.

Adult↗
PubMed1995

Inositol treatment in psychiatry.

Inositol, a naturally occurring isomer of glucose, is a key intermediate of the phosphatidyl-inositol (PI) cycle, a second-messenger system used by several noradrenergic, serotonergic and cholinergic receptors. The suggestion that lithium might treat mania via its reduction of inositol levels led to experiments showing that pharmacological doses of peripheral inositol reverse behavioral effects of lithium in animals and side effects of lithium in man. Cerebrospinal fluid (CSF) levels of inositol are low in depression. An open-label, add-on trial of inositol in depression suggested a beneficial effect. In a subsequent 1-month, parallel-groups, double-blind, placebo-controlled study of 28 patients, inositol was effective as sole therapy for depression (p = .043). Inositol was also effective for panic disorder in a double-blind, random-assignment, placebo-controlled crossover study of 21 patients, with 4 weeks in each phase (p = .02); the effect was comparable to that of imipramine in recent studies.

Clinical Trials as Topic↗