Biomedical subjects
Publications and source records attributed to J Reich.
Two patients with chronic panic disorder with no difficulties with socialization before their illness or family history of schizophrenia are shown by standardized personality testing to have developed schizoid, paranoid, and schizotypal traits after years of illness.
The authors examined the effect of state anxiety on the personality test scores of 56 patients receiving treatment for panic disorder and agoraphobia. The tests were administered before treatment and again 6 weeks later. For the 40 patients who improved by 5 or more points on the Hamilton Anxiety Rating Scale, significant changes in personality measures were observed at week 6, including increased emotional strength and extraversion and decreased interpersonal dependency. The authors conclude that state anxiety, like depression, is a possible confounding factor in personality measurement, and adjustment for it should be made in future studies.
Short-term psychotherapy is a technique with a long history of development and a some solid data supporting its effectiveness. There is also some evidence for cost effectiveness in terms of medical utilization. Certain broad principles involving patient selection, relative contraindications, and treatment appear common across different therapeutic styles.
Hypochondriasis was assessed in 60 patients with panic disorder and agoraphobia using the Illness Behavior Questionnaire. Before treatment, IBQ hypochondriasis scores were similar to those of a group of hypochondriacal psychiatric patients. In patients who improved with treatment, significant reductions in somatic preoccupation, disease phobia, and disease conviction occurred. Hypochondriasis appears to be a prominent feature of panic disorder and agoraphobia, and responds to treatment of the primary conditions. Our findings underscore the importance of providing adequate treatment and thereby avoiding wasteful use of medical resources and alienation of patients from doctors.
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The relationship between early childhood events and DSM III personality disorders was examined in 82 non-psychotic psychiatric outpatients. Early loss of a parent or living in a family where there was overt marital discord was associated with having a greater chance of developing DSM III Cluster B personality disorders (narcissistic, antisocial, borderline, histrionic) as adults. It was also related to an increased number suicide attempts as adults. Those patients who suffered an early loss of a parent through death had a significantly higher percentage of antisocial personality and suicide attempts as adults. Patients who as adults had a DSM III Cluster B personality disorder were significantly less likely than comparison patients to have had an early loss of a parent. This finding of a lower chance of a personality disorder if there were a loss of a parent was also significant for histrionic personality disorder when it was analyzed separately. Some theoretical implications of these findings are discussed.
Demographic data and DSM-III diagnoses are presented for 55 applicants for Social Security disability benefits who were referred for psychiatric evaluations of psychiatric disability. Some of the applicants had apparently experienced difficulties in functioning secondary to severe psychiatric disorders (schizophrenic and schizoaffective disorders, 27%; anxiety disorders, 15%; and affective disorders, 33%), and others had psychiatric problems that may have been secondary to adverse life circumstances (adjustment disorders, 6%; phase-of-life problems, 6%; and bereavement, 2%); some of the affective disorders may also have been precipitated by environmental events. Many of the psychiatric disorders were potentially treatable (affective, anxiety, and substance abuse disorders).
In order to clarify the nature of those defendants referred multiple times for competency-to-stand-trial evaluations, 390 consecutive admissions to the Yale-New Haven Psychiatric Court Clinic were reviewed. Fifty-four of these had had more than one evaluation in the 2.5-year period under study and will be referred to as repeaters. Repeaters were significantly different from nonrepeaters in terms of diagnosis (p less than .01), tending to be more likely to be schizophrenic or affectively disordered. Repeaters also tended to have less education (p less than .01) and to be found competent less often (p less than .01) than nonrepeaters. No repeater-nonrepeater differences were found in age, race, or legal charge. Implications for future research on and management of this population are discussed.
A study was conducted to establish whether the EcoK-specific restriction, which is alleviated in E. coli cells after UV induction of the SOS response (Day 1977), is also alleviated under the influence of an increased level of recA protein without induction of other SOS functions. The host cells used were E. coli K-12, strain AB2497, and its derivatives; the nonmodified phage lambda was a mutant b2b5(vir). An increase of the recA protein level was induced using the plasmid pX02, which is a recombinant of pBR322 carrying the recA gene of E. coli. AB2497(pX02) cells were found to exhibit a lower level of restriction than those without plasmid. The results indicate that the recA protein protects phage DNA during the process of restriction. A further factor affecting restriction is the growth phase of the culture of the restricting host: cells in the late stationary phase exhibit lower restriction than those in the exponential phase of growth. By a combination of these two factors (presence of plasmid pX02 and stationary growth phase) one can reduce the restriction of nonmodified phage about 300 times.
Previous reports from treated psychiatric populations have reported a higher risk of mental illness among married females; however, community surveys often do not show this prevalence. Three referral groups, consisting of 488 subjects who were mentally ill but not seeking psychiatric treatment, provided a third type of population. For both sexes, combined drug and alcohol abusers were more likely to be divorced than to be married when compared to the rest of the study population (p less than .05). Both schizophrenia and drug and alcohol abuse showed differential findings by marital status and by sex, with the likelihood of more mentally ill females than males being married in these treatment populations.
A seven-item rating scale reported by researchers from the Mayo Clinic to have high validity in identifying chronic pain patients who would benefit from inpatient treatment was administered to an outpatient sample. Initial results did not replicate the previous findings; inclusion of four additional variables (disruption of a close relationship, altered body image, history of childhood illness, and history of abuse in childhood) produced results comparable to the Mayo study. This expanded screening test appears to be a useful method for selecting patients in a pain-management program and warrants further investigation.
The authors discuss difficulties in the assumptions that underlie Kernberg's Structural Interview method for diagnosing borderline personality organization and demonstrate methodological limitations in the studies that have reported results from its use. Further data analysis leads to the conclusion that, in the population studied, the Structural Interview diagnosis of borderline personality disorders is essentially equivalent to the clinical diagnosis of the presence of any personality disorder. A predictive formula to determine the presence or absence of clinically diagnosed personality disorder is derived using logistic regression.
The freeze-microwave thaw technique has important advantages compared with conventional piggyback delivery systems. A requirement for the implementation of this technique, however, is the documentation of antibiotic stability following freezing and microwave thawing. The purpose of this study was to assess the stability of a commonly used cephalosporin, cephapirin sodium, following freezing and conventional or microwave thawing. This data was not previously available. Cephapirin sodium was admixed with either 5% dextrose injection or 0.9% sodium chloride injection in polyvinylchloride minibags at concentrations of 10 and 40 mg/ml and then frozen for 14 days. Admixtures were then thawed conventionally or by microwave heating. Cephapirin concentrations were determined spectrophotometrically after reconstitution, immediately after thawing, and 6, 12, and 24 hours after thawing. No significant differences in admixture potency after reconstitution, immediately after thawing, or at 6, 12, and 24 hours after thawing were observed when thaw techniques were compared. All admixtures retained at least 90% of labeled content regardless of thaw technique, type of diluent, or initial concentration. In addition, all admixtures retained at least 90% potency 24 hours after thawing when compared with the actual concentration determined immediately after reconstitution. The rate of cephapirin degradation was not influenced by thaw technique, type of diluent, or initial admixture concentration. The results of this study suggest that cephapirin sodium may be added to the list of drugs capable of withstanding freeze-microwave thaw treatment.
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Education in aesthetic plastic surgery involves the dissemination of information at different levels, as to the aims and ideals of this special field of plastic surgical practice. This is particularly important in our time, characterized as it is by increasing government interference in medical practice, social pressures on our patients, and constant professional pressures on us to abandon established methods and adopt new, unproven and sometimes potentially hazardous ways, all this in the face of a growing litigation problem.
This method of mammaplasty is based on the use of a lower central segment of breast tissue and thus differs from the inferior dermal pedicle techniques both in philosophy and execution. It uses breast tissue rather than skin tension to determine form and retains the anatomical integrity of gland-duct units and their connection with the nipple surface, as well as the essential innervation and blood supply of a normal breast. The method is applicable to both reduction and/or repositioning of the breasts.
Dermis grafts were used by themselves or in conjunction with a more rigid material such as cartilage or bone in a series of 220 patients during a period of 18 years. Of these, 182 patients were seen between 6 months and 2 years after operation. The significant problem during the earlier postoperative period was a transient swelling of the recipient site, which was seen in 150 of the 182 patients (82 percent) and which lasted for up to 6 months. It resolved spontaneously in all cases without active treatment in between 3 and 6 months. In the late postoperative period a significant permanent decrease in graft volume with a return to the previous deformity occurred in 9 of 182 patients (5 percent). This paper illustrates the versatility of dermis grafts in dealing with a variety of iatrogenic and accidental traumatic deformities of the nose.