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Biomedical subjects

J de Leon

Publications and source records attributed to J de Leon.

At least 37 records · Page 2Linked to original sources
PubMed1998

Menstrual cycle and profiles of suicidal behaviour.

The first (or menstrual) and fourth (or premenstrual) week of the menstrual cycle may be associated with many suicide attempts in women. The study sample included 113 Spanish women who attempted suicide and contacted an emergency service. Inclusion criteria were as follows: fertility; regular menstrual cycles; lack of oral contraceptives; and willingness to see a psychiatrist. The incidence of suicide attempts in the first week (36%) was significantly higher than that in the remaining weeks (second week, 19%; third week 16%; fourth week, 29%). A correspondence analysis suggested that suicide attempts were associated with differences in demographics and clinical profiles. In particular, suicide attempts in the third week were correlated with a severe history of psychiatric problems and a lower level of education. The limitations of this study are its exclusiveness to hospitalized cases and its use of patient reports to date menstruation.

Adult↗
PubMed1998

A factor analysis of the Mini-Mental State Examination in schizophrenic disorders.

The Mini-Mental State Examination (MMSE) is frequently used in schizophrenia studies. Therefore, it is surprising that no factor analysis of MMSE has been carried out in schizophrenic patients. The MMSE ratings of 80 long-term in-patients with DSM-III-R schizophrenia or schizoaffective disorder were introduced into a principal-component analysis with varimax rotation which generated three MMSE factors or subscales (frontal, memory and spatial). The limitations of this pilot study are the small sample size and the inclusion of only hospitalized patients.

Adult↗
PubMed1998

Pilot study of the cytochrome P450-2D6 genotype in a psychiatric state hospital.

OBJECTIVE: The authors conducted a pilot study to develop preliminary data on the frequency of cytochrome P450-2D6 (CYP2D6) genotypes in state psychiatric hospital patients and to establish population sizes needed to determine potential clinical relevance in therapeutic outcome. METHOD: One hundred consecutive inpatients at Eastern State Hospital in Kentucky who provided informed consent were genotyped at the CYP2D6 locus during their hospital stay. RESULTS: Twelve of the patients were CYP2D6 deficient, and four carried the *1Xn or *2Xn allele associated with ultrarapid metabolism; all of these patients were Caucasian (N=87). The rate of deficiency in CYP2D6 expression in these Caucasian state psychiatric hospital patients (14%) was twice that of the U.S. population (7%). The patients with CYP2D6 deficiency also appeared more likely to experience side effects in response to CYP2D6 medications. CONCLUSIONS: This study, limited by a small number of subjects, suggests that one-fifth of Caucasians admitted to a state hospital in Kentucky had genotypes associated with extremes in CYP2D6 activity that may have affected their response to CYP2D6 medications.

Adult↗
PubMed1998

Tobacco smoking and bipolar disorder.

BACKGROUND: We sought to determine whether tobacco smoking is associated with bipolar disorder. METHOD: This case-control study carried out in Alava, in the north of Spain, included patients with a DSM-III-R diagnosis of bipolar disorder type I (N = 51) and a representative sample of the normal population (N = 517). Smoking history of bipolar patients was assessed with the Fagerstrom Test for Nicotine Dependence and was verified by family members of the patients. RESULTS: The frequencies of ever smoking and current daily smoking were, respectively, 63% (32/51) and 51% (26/51) for the bipolar patients and 45% (235/517) and 33% (169/517) for the control group (respective odds ratios [ORs] and 95% confidence intervals [CIs] were OR = 2.0, 95% CI = 1.1 to 3.8 and OR = 2.1, 95% CI = 1.2 to 4.0). The differences were significant (p = .03 and p = .042, respectively) for bipolar versus control males. Bipolar disorder (in both genders) was also significantly associated (OR = 4.4, 95% CI = 1.7 to 11.9, p = .0015) with heavy smoking (more than 1 pack per day). CONCLUSION: Despite its small sample size, this study suggests that smoking may be more prevalent in bipolar patients than in the normal population. Since most patients started to smoke before the onset of illness, vulnerability to bipolar illness may make subjects vulnerable to become tobacco smokers.

Adolescent↗
PubMed1998

Absence of changes in antidiuretic hormone, angiotensin II, and atrial natriuretic peptide with clozapine treatment of polydipsia-hyponatremia: 2 case reports.

BACKGROUND: Polydipsia-hyponatremia is a poorly understood disorder that causes considerable mortality and morbidity. Hyponatremia in polydipsia-hyponatremia has been attributed to disturbances in antidiuretic hormone (ADH) function. Improvements in polydipsia-hyponatremia during clozapine treatment offered the chance to see if levels of ADH and other hormones associated with osmoregulation changed with improvement in biochemical and clinical measures of polydipsia-hyponatremia. METHOD: In this preliminary, longitudinal study, we studied 2 male schizophrenic patients (DSM-III-R) who had polydipsia-hyponatremia. Measures were (1) biochemical and clinical: serum sodium and osmolality, urine osmolality and specific gravity, normalized diurnal weight gain, and estimated urine volume and (2) endocrine: ADH, angiotensin II, atrial natriuretic peptide, and prolactin. Measures were collected during 2 months of baseline (typical neuroleptic) and 6 months of clozapine treatment. RESULTS: Single-case statistical procedures showed significant changes in sodium levels (a.m. and p.m.), estimated urine volume, and a.m. urine specific gravity in both patients and significantly decreased diurnal weight gain in 1 patient. Both serum and urine osmolality showed improvement, but values did not reach statistical significance. Low baseline ADH levels persisted through 6 months of clozapine treatment and showed no changes in the context of improvements in serum sodium and osmolality. No significant changes were seen in levels of angiotensin II and atrial natriuretic peptide. CONCLUSION: Given the limitations of this study, there is some evidence to suggest that the improvements in serum sodium and osmolality during clozapine treatment of polydipsia-hyponatremia may not be related to serum levels of ADH, although altered ADH receptor function cannot be ruled out. These data need to be extended in larger samples.

Adult↗
PubMed1997

A comparison of polydipsia prevalence among chronic psychiatric patients using three measurement approaches.

Many previous prevalence studies of polydipsia (PD) have utilized single and often non-biologic measures. In this study we estimated prevalence using specific gravity of urine (SPGU), normalized diurnal weight gain (NDWG), and staff identification (staff ID). Agreement between these two biologic and one behavioral measure was assessed. A total of 572 psychiatric inpatients were assessed for SPGU and NDWG. Unit staff were asked to identify PD patients. Positive and negative PD groups were formed separately based on the SPGU, NDWG, and staff ID data. All three measures were collected on the same day. Prevalence data for the biologic measures varied. The estimate for PD by SPGU (< 1.009 cutoff) was higher (43.4% of sample) than that of NDWG (> 2.5%; 25.4%) or staff ID (21.4%). These prevalence rates did not change substantially after exclusion of medical causes of polyuria. Agreement, assessed by the kappa statistic, was uniformly low among the measures. Weak association between the measures reflects their multidetermined, nonspecific nature, and highlights the lack of a diagnostic standard in the field. The observed prevalence rates must be considered rough approximations. Associations between the measures and certain subject characteristics suggest the measures may identify different types of potential PD patients. These different types of patients are discussed, as are other issues in the measurement of PD. The data suggest estimates of PD are a function of the type of measure used as even biologic measures vary greatly.

Adult↗
PubMed1997

Clozapine withdrawal resulting in delirium with psychosis: a report of three cases.

BACKGROUND: Withdrawal symptoms for typical antipsychotics are generally mild, self-limited and do not include development of psychotic symptoms. In contrast, withdrawal symptoms for clozapine can be severe with rapid onset of agitation, abnormal movements, and psychotic symptoms. Different pathophysiologic etiologies have been suggested for these severe symptoms, including dopaminergic supersensitivity and rebound. METHOD: Three case reports of clozapine withdrawal symptoms are presented. A review of previous case reports and discussion of the etiology of withdrawal symptoms of typical antipsychotics and clozapine are provided. RESULTS: These three patients developed delirium with psychotic symptoms that resolved rapidly and completely upon resumption of low doses of clozapine. CONCLUSION: The severe agitation and psychotic symptoms after clozapine withdrawal in these three patients were due to delirium, perhaps the result of central cholinergic rebound. The withdrawal symptoms and delirium resolved rapidly with resumption of low doses of clozapine. Severe withdrawal symptoms can probably be avoided by slowly tapering clozapine and/or simultaneously substituting another psychotropic with high anticholinergic activity, such as thioridazine.

Adult↗
PubMed1996

Polydipsia and water intoxication in a long-term psychiatric hospital.

This cross-sectional survey attempts to establish the prevalence of polydipsia and water intoxication at a state hospital (N = 360) using staff diagnosis, specific gravity of the urine (SPGU), weight changes, and chart review. There were 150 [42%, 95% confidence interval (CI) 37-47%] patients diagnosed as polydipsic by the staff or by SPGU. At least 93 (26%, CI 21-30%) had primary polydipsia not explained by other causes. Chart review identified 17 (5%, CI 3-7%) patients with a history of water intoxication. Using a case-control study design, schizophrenia, extended duration of hospitalization, and heavy smoking were associated with primary polydipsia in a logistic regression analysis (respective odds ratios were 1.6, 1.8, and 3.6). All patients with a history of water intoxication were Caucasian (versus 83% in those without a history) and had significantly more extended hospitalizations (94 vs. 49%). Future case-control studies should combine longitudinal identification of true cases and controls and exhaustive collections of clinical information in a standardized way.

Adolescent↗
PubMed1996

Diurnal and weekly variation of tardive dyskinesia measured by digital image processing.

The diurnal and weekly variability of tardive dyskinesia (TD) was assessed instrumentally by digital image processing. Weekly assessments were obtained in ten patients over a 6-week period. In six of the ten patients, assessments were obtained four times over a single 12-h period. Results indicate that TD movements measured by instrumental assessment vary from week to week and throughout the day. Factors that appear to have affected the variability were changes in medications and the time of day when the assessments were conducted.

Adult↗
PubMed1996

Repetitive behaviors in schizophrenia: a single disturbance or discrete symptoms?

Schizophrenia patients often display multiple repetitive behaviors. We investigated relations among nine repetitive behaviors and evaluated the hypothesis that these behaviors are varied manifestations of a single underlying biobehavioral disturbance. Nine repetitive behaviors from the Elgin Behavioral Rating Scale were assessed in 400 schizophrenia patients residing at a state hospital. A majority of patients were smokers (76.3%) and very few had pica (3%). Several other repetitive behaviors showed substantial frequency. A principal components analysis revealed eight of nine behaviors shared at least 10% of their variance with a single, common component. However, a principal factor analysis suggested a five-factor model best represented the data. The five factors and items identifying them were: (1) 'oral consumption' behaviors-polydipsia and smoking; (2) 'Kluver-Bucy' behaviors-bulimia and hypersexuality; (3) 'movement' behaviors-mannerisms/postures and pacing; (4) 'bizarre use of objects'-bizarre grooming and hoarding; (5) 'Pica'. Associations among repetitive behaviors varied. Symptoms such as smoking and polydipsia appeared reliably related, and others such as pica appeared discrete and independent. Overall, the data did not support the 'single disturbance' hypothesis and suggested a multifactorial model is needed to characterize repetitive behavior disturbances in schizophrenia.

Adult↗
PubMed1996

Neurological frontal signs and neuropsychological deficits in schizophrenic patients.

A higher prevalence of neurological signs (NS) has been described in schizophrenic patients when compared with controls or patients with other mental illnesses. This study, which includes a sample of 66 DSM-IIIR schizophrenics, was designed to assess the relationship between 7 frontal neurologic signs described by Luria and cognitive disturbances measured by an exhaustive neuropsychological battery. There was a statistically significant relationships between the frontal signs and the cognitive deficits (mean shared variance was 22%) which persisted after correcting for the influence of age, education, and duration of illness.

Adolescent↗
PubMed1996

Smoking and vulnerability for schizophrenia.

In several countries, the prevalence of smoking among schizophrenia patients is extraordinarily high (70% or greater). A State hospital survey demonstrated that after correcting for other factors, inpatients who have schizophrenia are more likely to be smokers than are persons in the normal population or even other chronic psychiatric inpatients. These findings suggest that neuroleptic treatment and the hospital environment cannot completely explain the high prevalence of smoking. The relationship between smoking and schizophrenia may be explained by a combination of three factors. One factor is the great difficulty for schizophrenia patients to quit smoking. Another is late onset: some schizophrenia patients start to smoke after the onset of psychosis. A third is increased early onset: schizophrenia patients may start daily smoking in greater numbers during adolescence (before the onset of their psychosis) than do persons in the normal U.S. population. Daily smoking is usually considered a sign of nicotine addiction and is used by epidemiological surveys to define the prevalence of smokers (most smokers smoke daily and very few smokers do not smoke every day). The increased early onset suggests that familial factors may increase the prevalence of smoking even among patients who have not yet shown psychotic symptoms. It is hypothesized that smoking among family members in families with genetic loading for schizophrenia may be a marker for those at risk of developing schizophrenia.

Humans↗
PubMed1996

Problems and progress in the diagnosis and treatment of polydipsia and hyponatremia.

Fluid-electrolyte balance is regulated within a narrow range and disturbances in this system are unusual in animals and humans. Studies from the preneuroleptic era to date suggest that up to 25 percent of patients with schizophrenia have polydipsia, suggesting that it is related to the pathophysiology of the psychoses. Polydipsia and the related phenomenon of hyponatremia cause considerable mortality and morbidity. Prevalence studies are limited by imprecise measures available at present. The treatment was limiting water intake when patients reached critical levels of water retention, which however did not improve polydipsia. Recent case reports and open studies have shown that clozapine improves both polydipsia and water retention. The response occurs at low doses and is not related to improvement in psychosis. This may not be applicable to all patients and better understanding of the pathophysiology of polydipsia-hyponatremia would lead to more empirically derived treatments.

Behavior Therapy↗
PubMed1995

Schizophrenic syndrome and Wisconsin Card Sorting Test dimensions.

A principal component analysis of Wisconsin Card Sorting Test (WCST) scores has recently shown three factors. Only the Perseveration factor may measure the activity of the dorsolateral prefrontal cortex in schizophrenic patients. Liddle has hypothesized that a dysfunction in this area is specifically related to the negative syndrome and not to other schizophrenic syndromes (positive and disorganization). The factor analysis of the WCST was replicated with similar results in 38 schizophrenic or schizoaffective patients. In the total group, the correlation between the negative syndrome and the Perseveration factor did not reach significant levels. In the patients with a DSM-III-R diagnosis of schizophrenia (n = 30), the correlations did reach significant levels.

Adult↗