Biomedical subjects
Publications and source records attributed to L Mullen.
This pilot study evaluated neuropsychological dysfunction in obsessive-compulsive disorder (OCD) and Parkinson's disease (PD). Both OCD and PD patients had impairment on visuoconstructional tasks but not on tasks of immediate memory and focused attention, suggesting common selective deficits in these two disorders with basal ganglia involvement.
BACKGROUND: Fluoxetine, a selective serotonin reuptake blocker, is an antidepressant medication that has also been shown in open clinical trials and one controlled trial to be effective in the treatment of obsessive compulsive disorder (OCD). OCD is often complicated by depression, and depressive symptoms may interfere with response to both pharmacologic and behavioral treatments. METHOD: We describe pilot data from 10 outpatients who met DSM-III-R criteria for OCD in whom the possibility of a depressive reaction or lack of antidepressant response occurred during an open trial of fluoxetine. RESULTS: Rapid increase in fluoxetine dose to high doses was associated with depressive symptoms in 6 patients. In 8 patients, improvement in depression was associated with addition of a tricyclic antidepressant to fluoxetine treatment. In 5 patients, both OCD and depressive symptoms improved when the patient was switched to the partially selective serotonin reuptake blocker clomipramine. CONCLUSION: This paper serves to alert clinicians to the possibility of a depressive reaction, or lack of antidepressant response, to fluoxetine in OCD patients. This possibility can only be resolved scientifically by adequately controlled experimental trials. If depression occurs, combined fluoxetine and tricyclic treatment, or a switch to a partially selective serotonin reuptake inhibitor, may be helpful. Special considerations and side effects of combined fluoxetine-tricyclic treatment are described.
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This study provides data on changes in the functional status of older patients that are associated with acute hospitalization. Seventy-one patients over the age of 74 admitted to the medical service of Stanford University Hospital between February and May 1987 received functional assessments covering seven domains: mobility, transfer, toileting, incontinence, feeding, grooming, and mental status. Assessments were obtained by report from the patient's caregiver (or the patient when he or she lived alone) for 2 weeks before admission; from the patient's nurse on day 2 of hospitalization and on the day before discharge; and again from the caregiver (or patient) 1 week after discharge. The sample had a mean age of 84, covered 37 Diagnostic Related Groups, and had a median length of stay of 8 days. Between baseline and day 2, statistically significant deteriorations occurred for the overall functional score and for the individual scores for mobility, transfer, toileting, feeding, and grooming. None of these scores improved significantly by discharge. In the case of mobility, 65% of the patients experienced a decline in score between baseline and day 2. Between day 2 and discharge, 67% showed no improvement, and another 10% deteriorated further. These data suggest that older patients may experience a burden of new and worsened functional impairment during hospitalization that improves at a much slower rate than the acute illness. An awareness of delayed functional recovery should influence discharge planning for older patients. Greater efforts to prevent functional decline in the hospitalized older patient may be warranted.
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Absorption of stable 65Cu incorporated intrinsically or extrinsically into foods was studied in women fed a diet marginal in Cu content. Isotopic enrichment was 73.1 +/- 1.0 atom percent 65Cu in goose breast meat, 74.9 +/- 0.5 atom percent in goose liver, and 55-69.5 atom percent in two crops of peanuts. Seven women were fed a basal diet containing 1.25 mg Cu/d. At 4-wk intervals, they were fed test meals over a 3-d period; each set of meals contained one of the labeled test foods in amounts with similar copper content. Absorption of 65Cu from intrinsically labeled liver was (mean +/- SD) 65 +/- 4%; extrinsic liver, 65 +/- 10%; E/I = 1.00 +/- 0.16. 65Cu absorption from intrinsically labeled goose breast meat was 54 +/- 6%; extrinsic meat, 52 +/- 10%; E/I = 0.97 +/- 0.18. 65Cu absorption from intrinsically labeled peanut butter was 58 +/- 15%; extrinsic peanut butter, 54 +/- 10%; E/I = 0.93 +/- 0.11. 65Cu absorption from extrinsically labeled sunflower butter was 50 +/- 2%. There were no differences in absorption of intrinsic and extrinsic Cu from these foods. Absorption of Cu was significantly higher from goose liver than from goose meat or sunflower butter (P less than 0.05). With a dietary intake of 1.25 +/- 0.20 mg Cu/d, Cu balance, exclusive of surface losses, was essentially zero (0.01 +/- 0.13 mg/d) in the seven subjects.
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Schedule induced polydipsia, urination and defecation were examined in rats that received training on a fixed interval 2 min schedule of food reinforcement. In Phase I of the experiment, animals received peripheral injections of captopril (an angiotensin conversion enzyme blocker, 0.5 or 50 mg/kg), or equivalent volumes of 0.9% saline. The results showed that low doses of captopril (0.5 mg/kg) significantly increased both operant responding and the adjunctive behaviors. High peripheral doses of captopril significantly reduced responding and schedule induced behavior. In Phase II of the experiment, animals received either low peripheral doses of captopril (sc 0.5 mg/kg), or low doses that were coupled with central injections (i.e., 0.12 mg icv + 0.5 mg/kg sc). As observed in Phase I, low peripheral doses of captopril enhanced behavior, but the enhancement effect was eliminated with low (0.12 mg) central administration. The overall results are consistent with past research examining captopril effects on non-operant, meal-induced drinking. Yet since captopril affected operant responding and adjunctive behaviors similarly, the findings suggest that angiotensin plays a common role in the motivational processes that precede and follow the arrival of food.
The influence of laminin-1 (LN) and tenascin-C (TN), extracellular matrix molecules expressed spatially and temporally along the neural growth route from spiral ganglion (SG) neurons to the cochlear sensory cells, was evaluated in cultured SG explants from postnatal day 4 rats. Increasing concentrations of LN resulted in a strong, dose-dependent increase in the length of neurites and in a higher number of neural processes, while varying TN concentrations had relatively minor effects on both parameters. The results suggest differential receptor activation by LN and TN. When explants grown on LN were treated with Kistrin, an inhibitor of the alphavbeta3 integrin, the LN-induced increase in neurite length was reduced in a dose-dependent manner. However, the number of extending neurites was not affected, indicating that different receptors mediate this response, perhaps by increasing neuronal survival.
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A 5-day patient education program, taught on an outpatient basis, was evaluated to determine its effect on metabolic control as reflected by glycosylated hemoglobin test values. A quasi-experimental design was used, consisting of a pretest, a posttest, and a follow-up assessment made approximately 6 months after the posttest. The 72 experimental and 324 comparison subjects all had insulin-dependent diabetes mellitus (IDDM), were between 14 and 78 years of age, and had a duration of diabetes ranging from 1 to 20 years. The experimental group demonstrated a statistically significant improvement in Hb A1 values from pre- to posttest and sustained these posttest levels upon follow-up, although not at statistically significant levels. The comparison group showed no pre- to posttest difference, but demonstrated an improvement from posttest to follow-up assessment.
The results of a psychometric study of the Test of Patient Knowledge are reported. The 50-item, multiple-choice test, developed by Etzwiler and associates at the International Diabetes Center, consists of a total score and seven subscores based on seven nonoverlapping content categories: nutrition, insulin, general knowledge, methods of control, pattern control, exercise, and complications. The results described herein provide evidence for the validity of the test (content, concurrent, and discriminant validity), a high level of reliability (Cronbach's alpha = .88), readability for the layperson at the 7th- to 8th-grade level, and sensitivity to instructional gains. The literature on psychometric research with other tests of patient knowledge of diabetes is reviewed and compared with the results of this study.