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Biomedical subjects

L Dixon

Publications and source records attributed to L Dixon.

At least 73 records · Page 4Linked to original sources
PubMed1995

Effects of homelessness on the quality of life of persons with severe mental illness.

OBJECTIVE: This study assessed the relationship between homelessness and specific quality-of-life problems for persons with severe and persistent mental illness. METHODS: The objective and subjective quality of life of 106 homeless persons with severe mental illness who lived on the streets or in shelters in Baltimore was compared with that of 146 domiciled persons with severe mental illness who lived in the community. RESULTS: Objective and subjective quality of life of the homeless subjects was clearly worse than that of the domiciled group in the areas of living situation, family and social relations, employment, daily activities, and legal and safety problems. Homeless subjects were also less likely to have federal disability entitlements. CONCLUSIONS: Poorer quality of life is associated with homelessness among persons with severe mental illness. Their quality of life may be improved by efforts to increase their access to disability entitlements and treatment services and to help them develop supportive social networks.

Adult↗
PubMed1995

The evolving practice of nurse-midwifery.

Increasingly, nurses nationwide are assuming expanded roles in the provision of health care. Certified nurse-midwives (CNMs) are one example. These practitioners function in varied settings from the home to the level three hospital. As with any change, the transition to this present role has been a long and, very often, a difficult one. Their efficacy, safety, and cost-effectiveness is today unquestioned; however, impediments to practice still exist. Whether the impediment be in securing hospital privileges or prescriptive capability, the CNM continues to strive to overcome these obstacles in order to ensure the accessibility of nurse-midwifery care to all women.

Female↗
PubMed1994

Consumers as service providers: the promise and challenge.

The importance of consumers in planning, providing and evaluating mental health services has received increasing recognition. Consumer participation as staff members on professional multidisciplinary teams describes one model of consumer involvement in providing services. This report gives the perspective of the professional leadership of such a team which employs two full-time "consumer advocates" (CAs). CAs have made significant and valuable contributions to the clinical work of the team by virtue of their street smarts, engagement skills, peer support, positive role modeling, fighting stigma, and education of co-workers. However, the CA/professional collaboration presented a number of challenging questions for ongoing discussion, including: 1) What is the role of the CA? 2) What are the boundaries between CAs and patients and the implications of these boundaries for the potential effectiveness of CAs? 3) What supervision should the CA have and with whom? 4) What is the impact of the CA's individual experience with mental illness on their work? Examples are presented of both the clinical contribution of CAs and how the importance of addressing the above questions became evident in the work of the team. We found that CAs were extremely important team members; however, an ongoing dialogue between consumers and professionals is essential to operationalize this important collaboration.

Baltimore↗
PubMed1994

Human in vivo phosphorus 31 magnetic resonance spectroscopy of psoriasis. A noninvasive tool to monitor response to treatment and to study pathophysiology of the disease.

BACKGROUND: There is no objective laboratory technique to measure and to monitor disease activity in psoriasis. OBJECTIVE: We assessed the effectiveness of using phosphorus 31 (31P) magnetic resonance spectroscopy (MRS) to noninvasively monitor metabolism in psoriasis and to compare these spectroscopic data with chromatographic analysis. METHODS: Fourteen persons were enrolled in the study. 31P magnetic resonance spectra were obtained from skin of persons without skin disease, uninvolved psoriatic skin, nonpsoriatic erythroderma, and from skin of patients with psoriasis. In three patients with psoriasis 31P magnetic resonance spectra were repeated after treatment with methotrexate, UVB, etretinate, and topical steroids. Finally, shave biopsy specimens were obtained from two patients with psoriasis and submitted for chromatographic evaluation. RESULTS: In patients with severe psoriasis, in comparison with the control group, elevations in phosphomonoester concentrations and in the phosphomonoester/phosphodiester ratio were observed. These appear to be useful markers to monitor treatment response in patients with psoriasis. Finally, 31P MRS data in conjunction with chromatographic analysis indicated a defect in phosphometabolism in psoriatic skin. However, it is unclear whether this defect is a cause or an epiphenomenon of the disease. CONCLUSION: 31P MRS appears to be a sensitive, noninvasive technique to monitor disease activity in psoriasis. Further studies to characterize the defect in phosphometabolism in psoriatic skin are warranted.

Adenosine Triphosphate↗
PubMed1994

Clinical and treatment correlates of access to Section 8 certificates for homeless mentally ill persons.

OBJECTIVE: The study assessed how clients' housing preference and other variables were related to the acquisition of Section 8 certificates, facilitating independent living, for homeless persons with severe mental illness who were being served by an experimental assertive community treatment team. METHODS: For 77 clients, demographic and clinical differences between receivers and nonreceivers of certificates were examined, and correlates of time from referral to the team to completion of the Section 8 application were analyzed. Reasons clients did not receive certificates and housing outcomes were summarized in relation to client preference. RESULTS: The 34 clients who received certificates (44 percent) had significantly less psychopathology after three months than did nonreceivers and tended to have affective disorders rather than schizophrenia. Of the 43 nonreceivers, the two largest groups were 19 clients who did not want certificates and ten clients who wanted certificates but whom staff considered unable to live safely in an unsupervised apartment. The mean +/- SD length of time for application for a certificate was 5.7 +/- 5.8 months. Longer time to apply was significantly associated with having schizophrenia, having the team as a representative payee, and showing increased psychotic symptoms at referral and at three months. CONCLUSIONS: The study suggests that it is possible to honor the housing preferences of the majority of homeless persons with severe mental illness if adequate resources are provided. However, staff may view persons who have schizophrenia and more symptoms as needing more supervision than those clients prefer. Homeless mentally ill persons may also take longer than more symptomatic persons to pursue independent living through a Section 8 certificate.

Adult↗
PubMed1993

Changes in psychopathology and dyskinesia after neuroleptic withdrawal in a double-blind design.

The goal of this study was to assess the time course of change in psychopathology and dyskinesia after neuroleptic withdrawal. Fifteen DSM-III schizophrenic patients were abruptly withdrawn in a double-blind fashion from stable haloperidol treatment. Weekly ratings of dyskinesia and psychopathology were performed for 4 weeks post-withdrawal. There was an overall increase in dyskinesia ratings over the 4-week period (p < 0.05) beginning in week 2, with dyskinetic movements of the fingers showing the most significant increase (p < 0.001). There were no overall changes in psychopathology, though the group appeared to be bimodal with 6 of the 15 patients showing a significant relapse in psychotic symptoms. Neither baseline TD nor psychotic relapse significantly interacted with change in TD over time. These schizophrenic patients showed an increase in global dyskinesia rating early within four weeks of neuroleptic withdrawal. This time course did not appear to be associated with reemergence of psychopathology which occurred later. A significant minority of patients relapsed within this time period. This suggests the relative safety of brief periods of neuroleptic withdrawal for carefully selected patients in a controlled setting with specific goals (e.g., for evaluation or in preparation for clozapine) and the need to further understand who is at risk for rapid relapse.

Adolescent↗
PubMed1993

Comparison of DSM-III-R diagnoses and a brief interview for substance use among state hospital patients.

OBJECTIVE: Identifying substance use disorders in persons with mental illness is often difficult. In this study prevalence rates of substance use disorders among state psychiatric hospital patients were obtained by six different methods: DSM-III-R substance use diagnoses and five additional strategies based on frequency of use and past substance abuse treatment. Overlaps and differences between patients identified by the six methods were examined. METHODS: Chart review and a structured substance use screening interview were used with a random sample of 20 percent (N = 474) of the population of the Maryland state hospital system. Comparisons focused on cohorts identified by two of the methods: DSM-III-R substance use diagnoses and recent regular use (any past period of daily or weekly use plus any use during the 30 days before hospitalization). RESULTS: The prevalence rates of substance use identified by the six strategies ranged from 23 percent to 55 percent. The recent-regular-use criteria identified 176 patients, and DSM-III-R diagnoses identified 111. The recent-regular-use criteria also identified a greater number of patients as likely to benefit from substance use treatment. Patients identified by both methods were significantly younger and more likely to be male and nonschizophrenic than patients without substance use disorders. CONCLUSIONS: The need for substance use treatment may be underestimated if discharge planners consider only DSM-III-R diagnoses. A brief screen for recent regular use may be a better way to assess treatment needs in a state hospital population.

Adolescent↗
PubMed1992

Magnetic resonance imaging evaluation helps to delineate a recurrent skin cancer present under the skin flap.

A case of recurrent squamous cell carcinoma under a skin flap as confirmed and delineated by magnetic resonance imaging (MRI) is described. This report illustrates a potentially new indication for MRI in clinical dermatology, namely, to define skin cancer recurrences under skin flaps and grafts and to determine the extent of underlying tissue involvement. The cost-effectiveness of MRI and the use of gadolinium, an MRI contrast agent, in the evaluation of skin tumors are also addressed.

Aged↗
PubMed1991

The sequences of the ribonucleotide reductase genes from African swine fever virus show considerable homology with those of the orthopoxvirus, vaccinia virus.

Two African swine fever virus (ASFV) recombinant plasmids containing large inserts of DNA have been sequenced at random, and translations of the DNA sequence have been compared to libraries of vaccinia virus protein sequences. Among other genes identified by their extensive homology with vaccinia virus genes were the large and small subunits of ribonucleotide reductase. A 5.5-kb fragment from the Malawi (LIL20/1) strain of ASFV was identified as containing the genes for both these subunits. The fragment has been sequenced and the two genes have been found to be in a head-to-head orientation. The sequences are compared to other sequenced ribonucleotide reductase genes, and the evolutionary implications discussed.

African Swine Fever Virus↗
PubMed1991

Drug abuse in schizophrenic patients: clinical correlates and reasons for use.

OBJECTIVE: This study aimed to 1) determine substance abuse prevalence and preference in a diverse sample of schizophrenic, schizoaffective, and schizophreniform inpatients, 2) compare drug-abusing and non-drug-abusing patients on demographic and clinical variables during the acute and stabilization phases of their hospital course, and 3) obtain data from patients on reasons for drug abuse and on acute state-related changes during periods of intoxication. METHOD: Eighty-three psychotic inpatients consecutively admitted to a New York City teaching hospital were evaluated. Sixty-eight had schizophrenia, 12 had schizoaffective disorder, and three had schizophreniform disorder diagnosed according to the Structured Clinical Interview for DSM-III-R. Each patient received ratings on the Brief Psychiatric Rating Scale, the Global Assessment Scale, and the Scale for the Assessment of Negative Symptoms at admission and at discharge, an evaluation of premorbid adjustment, and an extensive interview on drug and alcohol use. RESULTS: Forty (48%) of the patients received diagnoses of drug or alcohol abuse or dependence. The drug-abusing patients primarily used cannabis (N = 26), alcohol (N = 21), and cocaine (N = 14) and reported that they abused drugs to get "high," to relieve depression, and to relax. They had significantly fewer positive and negative symptoms at discharge, better sexual adjustment and worse school performance during adolescence, and more family histories of drug abuse than the non-drug-abusing patients. CONCLUSIONS: Schizophrenic patients who abuse drugs may represent a subgroup of patients with better prognoses and less severe clinical characteristics of schizophrenia, but their drug abuse may adversely affect global outcome.

Adolescent↗