Pharmacogenetics and antipsychotic drugs.
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Biomedical subjects
Publications and source records attributed to L Sher.
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Case-control association studies investigating polymorphisms of candidate genes in behavioral disorders have produced a lot of positive and negative findings with few consistent replications. The inconsistent results of association studies in behavioral genetics are usually explained by the fact that significant-appearing relationships may be found as an artifact of genetic differences between the cases and controls because population stratification (or admixture) due to ethnic variation or other confounding factors can generate considerable population differences in marker allele frequencies. The author suggests that a major problem of association studies in psychiatric genetics is that psychiatric diagnoses are not biologically real disease entities: syndromal psychiatric diagnostic categories such as depression or schizophrenia include etiologically, pathologically, and prognostically heterogenous disorders. The author further suggests that extensive clinical research and observations are necessary to classify heterogeneous diagnostic categories into more scientific and more homogenous disease entities.
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Synthetic and semisynthetic fabrics generate electrostatic potentials on the surface of the skin. The author suggests that the effects of electrostatic potentials on physical and psychological condition are mediated by acupuncture points. The author further suggests that electrostatic charges on the surface of the skin may affect virtually all physiological functions, mood, and behavior.
False-memory syndrome describes the 'recovery' of memories of traumatic events which did not take place. 'Recovered' memories are created as a result of suggestion or other psychological maneuvers. This means that memories can be implanted. The author suggests that the possibility of use of implantation of 'good' memories for the treatment of certain psychiatric disorders should be explored and that implantation of 'good' memories may be called 'positive memory creation therapy'. The author also suggests that memory creation treatment should be used under strict ethical and legal control.
Natural and man-made electromagnetic fields influence the mood and behavior of healthy and sick people. Considerable evidence suggests that electromagnetic fields affect sleep. The author suggests that electromagnetic field-induced changes in sleep may mediate the effects of electromagnetic fields on mood, behavior, and cognitive abilities. The author further suggests that the development of sleep abnormalities in persons exposed to artificial electromagnetic fields may predict the onset of a psychiatric disorder at a later time and that early intervention may prevent the onset of a psychiatric disease.
The incidence of acute myocardial infarction is increased in the winter months. Seasonality of mood and behavior is common throughout the general population. Increased cardiovascular morbidity and mortality in patients with depressive disorders have been well documented. The author suggests that seasonal mood changes may contribute to the increased incidence of acute myocardial infarction in the winter. The author further suggests that patients with cardiovascular disorders who suffer from seasonal mood changes should be identified and receive the appropriate treatment for seasonal depressive symptoms that may improve the quality of life for these individuals and reduce their incidence of acute myocardial infarction.
The degree to which seasonal changes affect mood, energy, sleep, appetite, food preference, or the wish to socialize with other people has been called seasonality. Seasonal affective disorder (SAD), a condition where depressions in fall and winter alternate with non-depressed periods in spring and summer, is the most marked form of seasonality. Several lines of evidence suggest that genetic factors play an important role in the etiology of seasonality and SAD. Millions of years of evolution and adaptation have optimized human biochemical and physiological systems for function and survival under equatorial environmental conditions. Modern humans began their migration out of Africa only about 150 000 years ago. Little change in our 'equatorial' systems might have been expected over this relatively short evolutionary time-span. The author suggests that a genetic susceptibility to seasonal changes in mood and behavior is a genetic predisposition to an insufficient adaptation to temperate and high latitudes.
Many individuals experience seasonal changes in mood and behavior. Various theories have been suggested to explain the mechanisms of these changes. However, the mechanisms of seasonal mood and behavioral changes remain unclear. The author suggests that brain thyroid hormones may play an important role in seasonal changes in mood and behavior. This suggestion is based on the facts that seasonal changes in light and temperature may affect the metabolism of brain thyroid hormones and that small alterations of the brain thyroid economy, independent of peripheral changes in thyroid status, may produce significant behavioral effects. The author further suggests that there may be a fault in the thyroid metabolism in the brain in seasonal affective disorder patients, and that fault cannot be identified by studying the peripheral thyroid hormone metabolism. Seasonal mood and behavioral changes may also be related to the interaction between thyroid hormones and different neurotransmitter systems in the brain.
The influence of culture on patients with psychiatric disorders has been well documented in the psychiatric literature. The unique emphasis of this paper is the influence of current social and political events on psychotic patients. Current events can be classified into two groups: (1) Communal stressful events that affect everyone (shared stressors), such as earthquakes, wars, etc.; and (2) Public events, highly reported by mass media, but not personally stressful, e.g., elections. This article is devoted to the discussion about the effect of sociopolitical non-traumatic events on persons with psychotic disorders. The author reviewed evidence that sociopolitical events and technical innovations affect patients with psychotic disorders. The author suggests that social events and scientific innovations may change the content of delusions and affect the course of psychotic disorders. The author also suggests that physicians should be sensitive to the clinical impact of sociopolitical events.
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Pleiotropy refers to the ability of a single gene to influence multiple traits. A polymorphism in the regulatory region of the serotonin transporter gene (5-HTTLPR) has previously been found to be associated both with the personality trait of neuroticism and with seasonal changes in mood and behavior, or seasonality. Hypothesizing that the contribution of the serotonin transporter gene to seasonality is specific, i.e. independent of neuroticism, we measured 5-HTTLPR genotypes and both psychological traits in 236 healthy volunteers. The results indicated that the 5-HTTLPR contributions to variation in the two traits are largely independent; approximately three-quarters of the effect of the gene on seasonality are not related to its effects on neuroticism. Moreover, the gene has a larger effect on the covariation between neuroticism and seasonality than it does on either trait alone. Sibling-pair analysis confirmed that the effects of the 5-HTTLPR are due to genetic pleiotropy rather than population stratification.
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Acute sinusitis is commonly encountered in clinical practice and treated in the primary care setting. The clinician should recognize the subtle clinical presentation of acute bacterial sinusitis and initiate appropriate, aggressive treatment. Other upper respiratory tract disorders can confound the accurate diagnosis and appropriate treatment of sinusitis. Variable patterns of microbial resistance and antibiotic susceptibility and the dissociation between in vitro findings and clinical efficacy are a treatment challenge. This report is a comprehensive review of the pathophysiology and diagnosis of acute sinusitis, infectious agents, treatment methods, antibiotic resistance patterns, and costs associated with the management of sinusitis. Treatment algorithms are presented for adult and pediatric sinusitis.