Biomedical subjects

K Wilhelm

Publications and source records attributed to K Wilhelm.

At least 55 records · Page 3Linked to original sources

PubMed2000

Marital and family functioning: different measures and viewpoints.

BACKGROUND: Dysfunctional relationships have been considered to play an important part in the onset and maintenance of psychiatric disorders, particularly depression. Influential factors appear to be perception of low social support and emotional warmth and/or high levels of criticism and control by the recipient. The IBM was developed for use as a simple self-report measure to rate important components of the relationship between marital partners, described as the constructs of care and control. The aim of this study was to test the validity of the IBM. METHODS: The IBM was compared with data from a structured marital interview based on the Self-Evaluation of Social Support Schedule (SESS). Data were also obtained from a nominated adult offspring witness. Family functioning was assessed using the General Functioning component of the McMaster Family Assessment Device (FAD). The General Health Questionnaire (GHQ) was used to determine levels of psychological morbidity. The witness data for sons and daughters were analysed to gauge gender effects in reporting. RESULTS: The results show that 'care' and 'control' were identifiable constructs discerned by partners and witnesses with 'care' rated more consistently than 'control'. Care between parents was an indicator of the overall quality of the family environment. Care received by the wife from her husband seemed to set the emotional tone for the family. Daughters seemed to be more 'in tune' with perceived care by both parents. Sons were less so, overall, but were more 'in tune' with their fathers' perceived care than with their mothers'. CONCLUSION: Both the IBM, a self-report measure, and the structured marital interview provided consistent information about the quality of marital relationships, particularly perceptions of care. Perceptions of control were less consistently reported, which may suggest that 'control' is a less robust construct. This may suggest that 'control' is a more subjective experience, as the cues are more directed at the partner than other family members.

Adult↗

PubMed2000

The nature of bipolar depression: implications for the definition of melancholia.

AIM: To examine if melancholic depression is over-represented in those with 'bipolar depression' and, if confirmed, to use that phenomenon to assist the clinical definition of melancholia. METHODS: We contrast 83 bipolar and 904 unipolar depressed patients on three melancholic sub-typing systems (DSM, Clinical and CORE system) and compare representation of their clinical depressive features. RESULTS: By all three melancholic sub-typing systems, the bipolar patients were more likely to receive diagnoses of 'melancholia' and of psychotic depression. To the extent that this differential prevalence of depressive sub-types was reflected in varying patterns of clinical features, we so indirectly identified a set of items defining 'melancholia'. By such a strategy, melancholia was most clearly distinguished by behaviourally-rated psychomotor disturbance. While a number of 'endogeneity symptoms' were significantly over-represented, logistic regression analyses refined the set to psychomotor disturbance (both as a symptom and as a sign) and pathological guilt. We also established a distinctly higher prevalence of bipolar depression in those where a refined diagnosis of melancholia was made. CONCLUSIONS: Bipolar depression appears to be more likely to be 'melancholic' in type, thus providing an indirect strategy for the clinical definition of melancholia.

Adult↗

PubMed2000

Twelve-month outcome of nonmelancholic depressive subjects: refinement of subgroups by examination of trajectories.

We previously studied a sample of patients with nonmelancholic depression and attempted to subtype their depression on the basis of etiological factors and current clinical features, analyzed individually and together. We now examine the validity of the three contrasting analytic approaches by examining outcome trajectories in a prospective study. At follow-up we reinterviewed 67% of our initially assessed nonmelancholic subjects, with progress over the 12-month interval assessed across a range of outcome parameters. The "anxious depressed" groups identified across all three differing analytic strategies consistently had the poorest 12-month outcome. However, varying definitions of this group influenced quite differing trajectories, with the worst outcome being for those defined on the basis of clinical features. Study results strongly suggest that patients presenting with a nonmelancholic depressive disorder and who acknowledge a significant number of concurrent anxiety symptoms are likely to have a distinctly poor medium-term outcome. Thus, clinical definition does have predictive utility in such a group.

Affect↗

PubMed2000

The Influence of Hyperbaric Oxygenation (HBO) on Proliferation and Differentiation of Human Keratinocyte Cultures In Vitro.

A drop in tissue oxygen partial pressure below 30 mm Hg as a result of reduced perfusion in an extensive area of acute skin damage, or where a large number of chronic skin defects occur, inhibits collagen synthesis and neoangiogenesis in the various phases of wound healing. Subsequent granulation and epithelialisation are correspondingly impaired.Hyperbaric oxygenation is now recognised as a valuable supplementary method of treatment for problematic wounds. Stimulation of fibroblast and endothelial cell proliferation through Hyperbaric oxygenation has been demonstrated in numerous studies.The aim of this study was to investigate the effect of hyperbaric oxygen treatment on the proliferation and differentiation of human keratinocyte cultures.The influence of hyperbaric oxygenation on the proliferation of human keratinocyte cultures was demonstrated using flow-through cytometry and a fluorescence activated cell sorter, which detects fluorescence intensity following incorporation of 5-bromo-2'-deoxyuridine in cell DNA.The degree of cell differentiation was deduced from the expression of various components of the cytoskeleton, such as cytokeratin 10 and involukrin, the production of which was quantified through the determination of monoclonal antibodies against cytokeratin 10 and involukrin from measurements of fluorescence activity in a flow-through cytometer.Hyperbaric oxygenation of cell cultures in vitro did not produce a significantly higher rate of cell proliferation, so that no increase in vitality was observed.An interesting observation following exposure to hyperbaric oxygen was the marked increase in expression of both cytokeratin 10 and involukrin, as an indication of accelerated cell differentiation.

Journal Article↗

PubMed2000

Subtyping depression by clinical features: the Australasian database.

OBJECTIVE: To distinguish psychotic, melancholic and a residual non-melancholic class on the basis of clinical features alone. Previous studies at our Mood Disorders Unit (MDU) favour a hierarchical model, with the classes able to be distinguished by two specific clinical features, but any such intramural study risks rater bias and requires external replication. METHOD: This replication study involved 27 Australasian psychiatrist raters, thus extending the sample and raters beyond the MDU facility. They collected clinical feature data using a standardized assessment with precoded rating options. A psychotic depression (PD) class was derived by respecting DSM-IV decision rules while a cluster analysis distinguished melancholic (MEL) and non-melancholic classes. RESULTS: The MELs were distinguished virtually entirely by the presence of significant psychomotor disturbance (PMD), as rated by the observationally based CORE measure, with over-representation on only three of an extensive set of 'endogeneity symptoms'. CONCLUSION: In comparison to PMD, endogeneity symptoms appear to be poor indicators of 'melancholic' type, confounding typology with severity. Results again support the hierarchical model.

Adult↗

PubMed2000

Predictors of 1-year outcome in depression.

OBJECTIVE: We compared several different methods for assessing depression 'recovery' over a 1-year review interval, to determine the utility of the contrasting approaches. Second, we assessed baseline predictors of 1-year outcome and recovery status. Third, we examined the extent to which predictors showed consistency across the variable definitions of outcome and recovery. METHODS: Twelve-month outcome was assessed in a sample of 182 subjects who at baseline assessment met DSM criteria for a major depressive episode. The contrasting methods involved a defined percentage reduction in Beck Depression Inventory self-rating scores, formalised change point definitions, no longer meeting DSM-IV major depression criteria, and clinical global improvement (CGI) ratings. RESULTS: Sixty-one per cent reached formalised change point criteria for full remission or recovery when trajectories across the 12-month interval were examined. Other measures quantified recovery rates ranging from 43% to 70%. Those with a psychotic or melancholic depression were more likely to have achieved recovery status in some analyses. Non-recovery at 12 months was predicted most consistently by higher baseline levels of anxiety and depression; high trait anxiety and a lifetime anxiety disorder; disordered personality function; and having reported exposure to acute and enduring stressors at baseline assessment. CONCLUSIONS: While the CGI was the superior system in terms of number of significant discriminating predictors of outcome, the change point definitional approach provides much greater information across the follow-up interval, arguing for their complementary utility. As several currently identified baseline predictors of outcome (i.e. anxiety, disordered personality function) also predicted onset of depression, their relevance as both depression-inducing and depression-propagating variables is suggested.

Adult↗

PubMed2000

[CT angiography hemodynamically relevant to renal artery stenosis. Evaluation of AXIAL, MPR, MIP and SSD reconstruction procedures under standard investigation conditions].

PURPOSE: To evaluate the various reconstruction methods of helical-CT angiography for the assessment of hemodynamically relevant renal artery stenoses in comparison to i.a. DSA. METHODS: In 76 renal arteries the reconstruction modalities AXIAL, MRP, MIP and SSD of helical-CT angiography were compared with the results of i.a. DSA for the determination of the grade and location of the stenosis. RESULTS: The highest accuracy of stenosis grading was 76% with AXIAL reconstruction. In 8% of the cases grading of the stenosis was not evaluable by the AXIAL reconstruction. In these cases, a higher sensitivity in the detection of hemodynamically relevant stenoses (> grade II, > 50%) was achieved with the reconstruction mode MPR (96%) than with MIP (92%). In 51% of the cases the reconstruction mode SSD was not suitable for any diagnosis of renal artery stenosis because of overlying calcified plaques. CONCLUSIONS: The evidence of hemodynamically relevant stenosis in helical-CT angiography in comparison to i.a. DSA succeeds most reliable by using the reconstruction modality AXIAL in combination with MPR. The MIP reconstruction provides information about the anatomy of the renal arteries within one image.

Angiography↗

PubMed2000

[Locoregional chemoperfusion with mitoxantrone for palliative therapy in bleeding bladder cancer compared with embolization].

PURPOSE: To assess the efficacy of intraarterial chemoperfusion (CP) with mitoxantrone in patients with bleeding bladder cancer; comparison with the results of intraarterial embolization therapy (ET). MATERIALS AND METHODS: Thirty patients with urinary bladder cancer and intractable bladder hemorrhage were treated with intraarterial (i.a.) CP (15 patients) using Mitoxantron 820 mg/m2/1-2 h) and i.a. ET (15 patients) using Histoacryl or Ethibloc. Bleeding control rate, recurrence of hemorrhage, survival rate and complications were evaluated. RESULTS: Complete control of the hemorrhage was achieved in 14/15 and 12/15 of the patients with CP and ET, respectively. Hemorrhage stopped in CP patients after an interval of (4 to 15) 10 days, and within 24 hours in ET patients. Recurrence of hemorrhage was observed in 3/14 of CP and 4/13 of ET patients. The survival rate was 4-5 months in both groups. Complications were observed in ET patients only (7/22). Posttherapeutic pain occurred significantly more often in ET patients (20/22) than in CP patients (6/31 versus 20/22). CONCLUSION: Intra-arterial chemoperfusion using Mitoxantron is an effective therapy in patients with intractable urinary bladder hemorrhage. Due to the delayed effect in CP, ET should be used in patients with life-threatening bleeding.

Adult↗

PubMed2000

Costing depression and its management: an Australian study.

OBJECTIVE: To examine the cost impact of referral to a Mood Disorders Unit (MDU), by comparing pre-service and post-service costs, and MDU and control samples. METHOD: We studied tertiary referral MDU patients and a control group of consultants' depressed patients, with the principal comparison intervals being: (i) 12 months prior to and (ii) 6 months following baseline assessment, with costs annualised to allow the impact of assessment and treatment recommendation to be determined. In addition, we assessed any 'personal cost' of depression. RESULTS: Following baseline assessment, MDU referrals showed a reduction in costs, while controls' costs increased, largely driven by contrasting directions in hospitalisation and social welfare costs. We identify variables associated with high and increased costs, including features of the earlier stages of the disorder, whether social welfare was received, diagnostic subtype and personality dysfunction, with multivariate analyses refining the variable sets. Self-report data indicated that patients judged the 'personal cost' of depression to exceed more formal cost parameters, so that to experience depression is itself depressogenic. CONCLUSIONS: This first Australian attempt to cost depression and its management in the clinical setting more provides a methodology for wider application in service evaluation studies rather than delivers an unequivocal answer to whether a specialist Mood Disorders Unit is cost efficient or not.

Adult↗

PubMed2000

Extracorporeal perfusion of the human uterus as an experimental model in gynaecology and reproductive medicine.

Experimental perfusion of various organs has primarily been used in transplantation medicine to study the physiology, pathophysiology and metabolism of tissues and cells. The purpose of this study was to establish an experimental model for the extracorporeal perfusion of the human uterus with recirculation of a modified, oxygenated Krebs-Henselait solution, in comparison with a non-recirculating perfusion system. With consent of the patients we obtained 25 uteri after standard hysterectomy. We performed an isovolumetric exchange of the perfusion medium at different intervals from 1 to 6 h and examined pH, pO(2), pCO(2), lactate, lactate dehydrogenase and creatine kinase by taking arterial and venous samples every hour for 24 h. We found the perfusions to be adequate when maintaining flow rates at 15-35 ml/min and at pressures ranging from 70 to 130 mmHg. Isovolumetric exchange of the perfusate every 3-4 h was the maximum interval to keep pH, the arterio-venous gradients of pO(2) and pCO(2), and the other biochemical parameters in physiological ranges. Examination by light and electron microscopy showed well-preserved features of myometrial and endometrial tissue. However, a 6 h exchanging interval led to increasing hypoxic and cytolytic parameters during the whole perfusion period. X-ray studies using digital subtraction angiography and perfusion studies with methylene blue demonstrated the homogeneous distribution of the perfusion fluid throughout the entire organ.

Adult↗

PubMed2000

Modeling and measuring the personality disorders.

Livesley, Jang, and Vernon (1998. Archives of General Psychiatry, 55, 941-948) reported that personality disorders (PDs) are quantitatively extreme expressions of normal personality functioning. A similarly designed study attempts to replicate those findings for both self- and observer-rated reports of patients judged clinically to have a PD. Analyses of data sets generated by 758 self-reports (SRs) and 515 reports from corroborative witnesses (CWs) refined the set of 266 descriptors to 142 items assessing 30 constructs. Intercorrelation of the constructs revealed considerable interdependence. Principal components analyses identified four factors, consistent across the SR and CW databases, and consistent with the Livesley et al. (1998) analyses where they were labeled Emotional Dysregulation. Dissocial, Inhibition, and Compulsivity. Replication and extension of findings to CW-rated data offer additional support for the argument that higher-order PD traits strongly resemble normal personality dimensions.

Adult↗

PubMed1999

Solar wind outflow and the chromospheric magnetic network

Observations of outflow velocities in coronal holes (regions of open coronal magnetic field) have recently been obtained with the Solar and Heliospheric Observatory (SOHO) spacecraft. Velocity maps of Ne7+ from its bright resonance line at 770 angstroms, formed at the base of the corona, show a relationship between outflow velocity and chromospheric magnetic network structure, suggesting that the solar wind is rooted at its base to this structure, emanating from localized regions along boundaries and boundary intersections of magnetic network cells. This apparent relation to the chromospheric magnetic network and the relatively large outflow velocity signatures will improve understanding of the complex structure and dynamics at the base of the corona and the source region of the solar wind.

Journal Article↗

PubMed1999

The carpal ligaments in MR arthrography of the wrist: correlation with standard MRI and wrist arthroscopy.

We assessed the value of three-compartment magnetic resonance (MR) wrist arthrography in comparison with non-enhanced magnetic resonance imaging (MRI) for the evaluation of 13 individual wrist ligaments in 35 patients with refractory wrist pain. In 20 of these patients MR findings were correlated with the findings from multiportal wrist arthroscopy. For MR imaging (1.5-T magnet) a three-dimensional volume acquisition with a gradient-recalled echo sequence and 0.6-1.0 mm effective slice thickness was used. The delineation of individual wrist ligaments was rated as "good" in 10% of non-enhanced MR and 90% of MR arthrography images. Ligament evaluation was possible with high diagnostic confidence in 11% by non-enhanced MR imaging and 90% by MR arthrography. With wrist arthroscopy as the standard of reference, average sensitivities/specificities/accuracies for the diagnosis of full-thickness ligamentous defects were 0.81/0.75/0.77 for non-enhanced MR imaging and 0.97/0.96/0.96 for MR arthrography. Our findings suggest that MR arthrography is more accurate than standard MRI in delineating and evaluating the ligaments of the wrist.

Adolescent↗

PubMed1999

Sub-grouping non-melancholic depression from manifest clinical features.

AIM: To determine whether clinical symptoms manifested during an episode of major depression are sufficient to allow meaningful sub-groups of non-melancholic depression to be identified. METHODS: A sample of 178 non-melancholic patients with a major depressive episode was studied. The initial set of clinical variables was refined to 38 (21 depression, 17 anxiety) items and a cluster analysis undertaken. RESULTS: A four-cluster solution identified 'anxiety', 'irritability', 'depressed mood' and 'residual' clusters, with these labels clarified by reference to a large data bank of non-symptomatic variables. These analyses suggested that members of the first two clusters could be viewed as having spectrum conditions (whereby Axis I symptom states are able to be linked with precursor or prodromal states and personality). CONCLUSIONS: We confirm the long-standing suggestion that the non-melancholic depressive class contains sub-groups of those with manifest states of anxious depression and of an irritable or 'hostile' depression, and that such manifest symptoms are likely to be rooted in and fed by temperament and personality characteristics. The delineation of such sub-groups should assist studies designed to identify underlying neurobiological underpinnings and clinical management of the non-melancholic depressive disorders.

Adult↗

PubMed1999

Psychological predictors of single and recurrent major depressive episodes.

AIM: To examine for differential psychological risk factors in a nonclinical sample having single or recurrent episodes of major depression. METHODS: A cohort of 164 subjects was assessed initially in 1978 in their last year of teacher training, and at five-yearly intervals in 1983, 1988 and 1993. Experience of episodes of DSM major depression and anxiety disorders from each wave were summed and three groups (nil, one, and two or more episodes of major depression) were derived. The cohort also completed a series of self-report measures including neuroticism, state and trait depression, self-esteem, dependency, childhood parental environment and social support. RESULTS: The group with two or more episodes were distinctly more likely to have met lifetime criteria for an anxiety disorder and to have had multiple anxiety disorder diagnoses over their lifetime. Groups with one or more episodes reported higher mean scores for trait depression, neuroticism and maternal overprotection and lower mean scores for paternal care and self esteem at baseline in 1978, but these variables did not predict differences between groups with single and recurrent episodes. At 1993, those with two or more episodes differed from those with none and single episodes in reporting lower trait depression scores and decreased perception of satisfactory social support over time, suggesting a psychological scarring effect for those with repeated episodes.

Anxiety Disorders↗

PubMed1999

Cognitive function in depression: a distinct pattern of frontal impairment in melancholia?

BACKGROUND: Although depressed patients demonstrate impaired performance on a range of neuropsychological tests, there is little research that examines either frontal cognitive deficits or possible differences in test performance between melancholic and non-melancholic subtypes. METHODS: Depressed subjects were administered a broad neuropsychological battery. In an overall analysis, 77 depressed subjects were compared with 28 controls. In a second set of analyses, the depressed sample was divided into melancholic and non-melancholic subsets according to DSM-III-R, the CORE system and the Newcastle scale. These depressed subsets were contrasted to controls and with each other using ANCOVA controlling for age, IQ, simple reaction time and Hamilton Depression scores where appropriate. RESULTS: The total depressed sample was impaired on most mnemonic tasks, simple reaction time and Trails B. Similar findings applied to DSM-III-R melancholic and non-melancholic subjects. When defined by the CORE and Newcastle (narrower definitions of melancholia), melancholic patients were additionally impaired on WCST (perseverative response) and (for Newcastle) digit symbol substitution. In contrast, the cognitive performance of the CORE and Newcastle-defined non-melancholic patients was largely unimpaired. CONCLUSIONS: Using narrower definitions of melancholia, i.e. CORE and (in particular) Newcastle, melancholic patients were impaired on mnemonic tasks and tasks of selective attention, and set-shifting while non-melancholic subjects were largely unimpaired in their cognitive performance. These differences may be due to impairment of specific neuroanatomical regions in narrowly defined melancholic patients, in particular the anterior cingulate.

Adult↗

PubMed1999

Sub-grouping non-melancholic major depression using both clinical and aetiological features.

OBJECTIVE: In previous papers we have considered the extent to which two contrasting analytic approaches, examining reported clinical symptom variables alone and aetiological variables alone, assist definition of subgroups of non-melancholic major depression. Here, we address the same objective but combine both sets of variables, and contrast the combined solution with each of the contributing ones. METHOD: We study a sample of 185 subjects with a putative non-melancholic major depressive disorder, with analyses involving 13 aetiological and 38 symptom variables. RESULTS: A four-class subgrouping was derived by use of a cluster analytic technique, with 'neurotic depression', non-anxious 'depressed', 'situational' and 'residual' groups. The largest group comprised 'neurotic depression' subjects, with characteristics compatible with a spectrum disorder encompassing both clinical features as well as an underlying temperament and personality style marked by anxiety. CONCLUSIONS: Comparative advantages and properties of the three differing analytic approaches to defining 'meaningful' non-melancholic major depressive subgroupings are considered. As a 'neurotic depressive' class has been consistently identified across those three approaches, but with quite varying numbers of subjects circumscribed, it is clearly a 'fuzzy' entity which may benefit from a dimensional approach to its measurement. As many of the non-melancholic groupings appear secondary to a substantive predisposing factor such as anxiety or disordered personality functioning, the clinical importance and treatment utility in identifying and circumscribing such classes are clearly supported.

Adult↗

PubMed1999

Are the newer antidepressant drugs as effective as established physical treatments? Results from an Australasian clinical panel review.

OBJECTIVE: The aim of this study was to determine, in a clinical panel sample, the extent to which patients with depression (and melancholic and non-melancholic subtypes) judged the effectiveness of previously received antidepressant treatments, particularly the comparative effectiveness of the older and newer antidepressant drugs. METHOD: Twenty-seven Australasian psychiatrists assessed 341 non-psychotic depressed patients and rated the extent to which previous antidepressant treatments had been effective. Patients were assigned to 'melancholic' and residual 'non-melancholic' categories by two processes (DSM-IV decision rules, and a cluster analysis-derived allocation) and treatment effectiveness examined within each category. RESULTS: Electroconvulsive therapy (both bilateral and unilateral) was judged as highly effective by both melancholic and non-melancholic patients. Antipsychotic medication similarly rated highly (but was judged as more effective by the non-melancholic than melancholic patients). The tricyclics and irreversible monoamine oxidase inhibitors (MAOIs) were rated as more effective by the whole sample than several newer antidepressant classes (including the selective serotonin re-uptake inhibitors [SSRIs], venlafaxine, mianserin and moclobemide), whether effectiveness was examined dimensionally or categorically. Comparison of the overall tricyclic and SSRI classes indicated that any superior tricyclic effectiveness was specific to the melancholic subjects. CONCLUSIONS: Despite methodological limitations intrinsic to such clinical panel data, the judged greater effectiveness of the older antidepressants (tricyclics and irreversible MAOIs) for melancholic depression is of importance. If valid, such data are of intrinsic clinical relevance but also have the potential to inform us about the neurobiological determinants of 'melancholia' and pharmacological actions which contribute to its effective treatment.

Antidepressive Agents↗