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Biomedical subjects

J P Kahn

Publications and source records attributed to J P Kahn.

At least 19 recordsLinked to original sources
PubMed1998

The importance of expanding current training in the responsible conduct of research.

Despite the growing need to teach principles of the responsible conduct of research (RCR) to those training to be biomedical researchers, no descriptive, easily compared information about the nation's RCR programs exists. To draw some preliminary conclusions about the state of RCR education and training and to gain insight into what kinds of future initiatives are needed, the authors reviewed materials describing U.S. training programs in RCR that had been collected by the Department of Health and Human Services in June-August 1996. In direct response to a 1990 federal policy, formal RCR training programs have been established at many institutions that carry out research. This policy requires that recipients of National Research Service Award Institutional Research Training Grants from the National Institutes of Health provide RCR training to the predoctoral and postdoctoral trainees supported by these grants. The authors found that two thirds of the 45 institutions represented in the materials provided RCR training only to those trainees whom they were required to train, although among the rest of the institutions, a few required that all trainees receive such training. The training programs studied were quite diverse regarding who was responsible for the program (the principal investigator, the ethics faculty, etc.), what kinds of instruction were given (lectures, seminars, small-group discussions, etc.), course content, and how discipline-specific the focus was. The authors review the obstacles to effective RCR training (e.g., the needs for culture change and for sizable faculty, financial, course time, and administrative resources; the need for proper evaluation of programs) and discuss ways to foster such programs (e.g., sharing of resources; identifying competencies; tailoring teaching to the individual institution's and department's characteristics; public-private partnerships). They conclude that the institutional efforts needed to establish widespread and effective RCR training are more than justified by the result that such training will help foster: the integrity of the research process and a solid future for the research enterprise.

Biomedical Research↗
PubMed1997

[Atypical pharmacologic characteristics of an antipsychotic drug: clozapine].

The discovery of clozapine in the mid-sixties and the demonstration of its clinical efficacy vis-à-vis recalcitrant schizophrenia contributed to the development of specific psychopharmacological research addressing the concept of atypical antipsychotics. The research has a dual aim. First, identifying the action sites, in the brain, specific to clozapine and to conventional neuroleptics, in order to classify those drugs on the basis of the observed differences in pharmacoclinical profile (low incidence of neurological side effects, activity on schizophrenic deficiency symptoms, activity vis-à-vis certain forms of recalcitrant schizophrenia). Recent studies have used tools derived from molecular biology to determine the action sites. The results of those studies suggest that there are at least four classes of antipsychotics (reverse neuroleptics, conventional neuroleptics, atypical neuroleptics and atypical antipsychotics). The second aim of the research is to determine the behavioral effects of each of the recognized classes of medication in order to determine the neurobiological substrates specific to the elementary cognitive operations impaired in schizophrenia. There is preclinical evidence to suggest that, in each area investigated (low incidence of neurological side effects, negative symptoms, cognitive symptoms), clozapine, a "dirty" drug, acts on different neurotransmission systems. The research thus aims to determine the pharmacological profile of the drugs of the future, designed to treat the cognitive deficiencies specific to the various types of schizophrenia.

Antipsychotic Agents↗
PubMed1996

[Tolerance of neuroleptics, deficit syndrome and cognitive functions].

Neuroleptics have been held responsible for cognitive impairments and negative symptoms in the course of schizophrenia. On the other hand, recent data suggest that alterations in information processing, cognitive and neuro-psychological functions are present at early stages in the developmental course of the illness. Two recent reviews, by D. King and G. Cassens suggest that, although acute administration of neuroleptics may alter performances in some neuro-psychological functions, there is no convincing evidence so far, to support a significant role of chronic neuroleptic treatment in the development of negative symptoms and cognitive dysfunction in schizophrenia. Despite several methodological limitations, which preclude any definitive statement, experimental and clinical data suggest that chronic neuroleptic treatment might improve neuropsychological functioning and the deficit syndrome, in some groups of schizophrenic patients. These results are examined in the framework of recent theoretical developments, which emphasize the role of cognitive dysfunction in the pathophysiology of schizophrenia.

Antipsychotic Agents↗
PubMed1996

[New antipsychotic agents: new paths of research on the notion of atypical agents].

The synthesis of new compounds called atypical neuroleptics such as amisulpride, clozapine, risperidone and now olanzapine has roused interest in the psychopharmacology of atypical antipsychotics. Since the synthesis of chlorpromazine in the early 1950s, subsequent therapeutic research has had two main goals: to define the mechanism of action of atypical neuroleptics and to search new compounds with both clinical efficacy and fewer side effects. The first one has widely been achieved, as it is clear that classical neuroleptics exert their effects by blockade of dopamine D2 receptors located in the ventral striatum. As a matter of fact, non specific blockade of dopaminergic receptors in the dorsal striatum also predicts extrapyramidal side effects. Moreover, classical neuroleptics have poor effects on negative and cognitive symptoms. That is why the search for new compounds has focused on two main goals: first, understanding the interactions of the neurotransmitters involved by the new drugs, second, characterizing their brain site of action. Achieving these two goals might enable us to precise the notion of atypicity as well as the classification of these new drugs.

Antipsychotic Agents↗
PubMed1994

Workplace mental health consultation. A primer of organizational and occupational psychiatry.

Though there are only a few hundred psychiatrists who identify themselves as specialists in organizational and occupational issues, the need for psychiatric skills in the workplace has increased dramatically in recent years. Crucial issues include distressed employees, the effects of organizational structure and change, job stress, psychiatric disability, substance abuse, and violence in the workplace. It is important for general psychiatrists to become more conversant in work and workplace-related mental health issues. Use of an occupational history with all patients, and knowledge of organizational structures and function, are just two ways to become more aware of these matters. With business and government increasingly attentive to mental health benefits and systems, appropriate psychiatric focus on organizational and occupational concerns becomes ever more important.

Adult↗
PubMed1994

[Corticotropin-releasing factor and anorexia nervosa: reactions of the hypothalamus-pituitary-adrenal axis to neurotropic stress].

The aim of this study is to obtain CRF (Corticotropin Releasing Factor) stimulation at a suprahypothalamic level with a psychological stressor and to evaluate its response in anorexia nervosa. CRF plays a major role in the mechanisms underlying the hypothalamo-pituitary-adrenal (HPA) system's response to stress. Animal studies clearly showed that CRF is involved both in the adaptation to a novel environment and the regulation of eating behaviour. CRF's staietogenic effect is mediated via the paraventricular nucleus. Three groups of age matched young women were studied: 8 patients meeting the DSM III-R criteria for anorexia nervosa, 8 underweight healthy volunteers and 10 normal weight volunteers. All subjects were submitted to an auditory stimulation test ("psychosocial stress test") consisting of an intellectual task in which maximal performance is impossible to achieve, the subjects being permanently disturbed by various meaningful noises. Subjects were asked to answer self-rating scales for anxiety and tension prior to and after the test. CRF reactivity was measured by salivary cortisol (RIA). After the test, anorexia nervosa patients exhibit a significantly higher salivary cortisol response compared to the normal weight volunteers. In most of cases, salivary cortisol response was not correlated with the psychological variables. The range of the response is very explosive in two anorectic patients. Our data are consistent with the hyperactivity of the corticotropic axis stress response in anorexia nervosa, but request further investigations to prove that.

Acoustic Stimulation↗
PubMed1990

Cardiac left ventricular hypertrophy and chamber dilatation in panic disorder patients: implications for idiopathic dilated cardiomyopathy.

Echocardiographic comparison of 35 panic disorder patients to 35 normal control subjects found subclinical increases of cardiac left ventricular chamber size in eight panic patients (and one control subject), and of left ventricular mass (corrected for body surface area) in seven panic patients. There was a significantly greater variance of left heart chamber size and corrected mass in panic patients compared with control subjects, without significant group mean differences. Consistent with a previously reported association of panic anxiety and idiopathic dilated cardiomyopathy, this study suggests that some healthy panic patients may have subclinical myocardial changes.

Adult↗
PubMed1990

Tolerability and pharmacokinetics of remoxipride after intramuscular administration.

A study was undertaken in seven schizophrenic patients to evaluate the tolerability and examine the pharmacokinetics of intramuscularly administered remoxipride after a single 200 mg dose and at steady state following repeated doses of 200 mg twice daily for one week. Comparisons of AUC, t1/2 and tmax using the Wilcoxon's signed rank test showed no significant difference between single dose and steady state indicating that the pharmacokinetics of intramuscular remoxipride were linear. The steady-state Cmax was found to be significantly larger than that after single dose and the increase was accounted for by the predicted accumulation factor, assuming linear kinetics. Although the inter-individual variability in plasma concentrations was large, the intra-individual variability was low as shown by the reproducibility of the single-dose and steady-state plasma curves. Remoxipride, administered intramuscularly, was well tolerated.

Adolescent↗
PubMed1990

Panic disorder and cardiovascular/cerebrovascular problems: results from a community survey.

Follow-up studies of psychiatric patients with panic disorder have shown an abnormally high mortality rate in men due to cardiovascular and cerebrovascular events. The authors report that in the New Haven portion of the Epidemiologic Catchment Area program the risk for stroke in persons with lifetime diagnoses of panic disorder was over twice that in persons with other psychiatric disorders or no psychiatric disorder. After adjustments for demographic differences between groups, the risk was even higher. While the results should be interpreted cautiously because of the small sample and absence of medical examinations, these findings are consistent with clinical studies showing an association between panic disorder and cardiovascular/cerebrovascular events.

Adolescent↗
PubMed1989

A comparison of sodium bicarbonate and sodium lactate infusion in the induction of panic attacks.

Infusion of sodium lactate has been shown by a number of investigators to induce panic in patients with panic disorder, but the pathophysiology underlying this phenomenon is unknown. One theory to explain lactate's anxiety-producing effects involves its ability to induce alkalosis because of metabolic conversion to bicarbonate. To test this hypothesis, we administered both sodium lactate and sodium bicarbonate infusions in counterbalanced order to patients with panic disorder. Thirteen of 22 subjects panicked in response to lactate and nine of 20 subjects panicked in response to bicarbonate. Although the rate of panic between the two infusion responses was not significantly different, several aspects of response to the two infusions indicated that lactate may be a more potent producer of anxiety than bicarbonate. An unexpected finding was that bicarbonate panickers had a reduction in arterial carbon dioxide pressure during the infusion, while bicarbonate nonpanickers had an increase in arterial carbon dioxide pressure during the infusion. Induction of hyperventilation and subsequent hypocapnia appears to be a common denominator between lactate- and bicarbonate-induced panic.

Adult↗
PubMed1989

[Is it possible to have a medical definition of family crisis?].

In our contemporary society, the traditional multi-generational family has to adapt and to organize itself around a smaller nucleus: "The nuclear family". Nowadays, the management of the crises which accompany significant Life Events (such as birth, marriage, retirement, death...) within this new family-system, is refrained by the lack of "relays" which were previously provided by the "enlarged family". In the absence of available relatives (that is, grandparents, cousins, etc...), it is now the Medical System which is addressed with the demand for help. Using worthy contributions of the systemic theories, the authors analyze the ambiguity of such a request and the paradox underlying it, namely, to take care of a "normal" family crisis. They emphasize two major dangers consisting of the "designation" of an identified patient and the risk of "phagocytosis" of the therapeutic system by the family system.

Adaptation, Psychological↗
PubMed1989

[Nutrition behavior in adolescent students (15-19 years of age) in the Nancy metropolitan area. A comparison with the recommended nutritional intake of the French population].

This paper describes the food behavior of 495 adolescents (15-19 years old) sample living in Nancy (France). The results are compared with the Recommended Dietary Allowances (RDA) for French adolescent population. The RDA are not satisfied for important percentages of girls for the daily energy intake (26.3% of girls have allowances less than 30% RDA), for the calcium intake (28.7% of girls have allowances less than 40% RDA), and for the protein intake (17.6% of girls have allowances less than 20% RDA). Lipids consumption is excessive (19.9% of boys and 23.4% of girls have allowances greater than 20% RDA) and energy intake from breakfast are low (25% of adolescents provide less 10% of daily energy intake by breakfast) for all these teen-agers. These results confirm the data observed in two others studies concerning the food behavior of French adolescents.

Adolescent↗