Special care units need all pharmacy services.
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Biomedical subjects
Publications and source records attributed to M R Cohen.
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Inclusion body myositis has been described as an inflammatory myopathy with distinctive clinical and pathologic features that is refractory to treatment. Ten cases of inclusion body myositis, as defined by histopathologic findings, were reviewed to determine whether the clinical characteristics are different in patients whose disease has been defined by light and electron microscopic studies compared with those whose disease has been defined by light microscopic studies alone. The clinical characteristics of both groups of patients were similar, and 2 patients have had excellent responses to treatment. Although inclusion body myositis represents a histologic subset of polymyositis, from a clinical perspective, it must be considered a nonspecific designation. Despite a generally poor prognosis, therapeutic intervention is still warranted.
Thyrotropin releasing hormone (TRH) was administered intravenously to ten patients with Alzheimer's Disease (AD) in a high-dose paradigm, thought to maximize central nervous system effects and potentially produce facilitation of cholinergic function, a known property of the neuropeptide. Acute effects of TRH on behavioral, cognitive and physiologic measures were assessed after patients received 0.1 mg/kg TRH, 0.3 mg/kg TRH and placebo, the higher TRH dose and placebo being given in a randomized, double-blind fashion. Patients showed statistically significant increases in arousal and improvement in affect, as well as a modest improvement in semantic memory, all after receiving the higher TRH dose. Both TRH doses produced transient rises in systolic blood pressure, with no effect on diastolic blood pressure, heart rate or temperature. This study suggests that high-dose TRH can be safely administered to AD patients and is neurobehaviorally active; further studies are needed to determine the extent and mechanism of the cognitive and psychobiological properties of this peptide in AD and other neuropsychiatric disorders.
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The knowledge base with respect to helping persons with long-term mental illness is expanding dramatically. Specific skills can be identified as critical for those who work with the long-term mentally ill. In contrast to in-service training, preservice (university-based) programs have been slow in offering relevant skills-based curricula. A model is proposed for describing current and future pre-service curricula. Curricula can be categorized as to whether it provides exposure, experience, or expertise in working with the long-term mentally ill. More than ever before the pre-service training programs seem ripe for the introduction of skill-based curricula relevant to helping persons who are psychiatrically disabled.
Mental health settings serving the severely psychiatrically disabled or the long-term chronic client have begun developing a rehabilitation orientation in an attempt to increase their effectiveness with this group. The authors have, in an earlier work, described basic elements of a rehabilitation program. These elements have been refined. Forty rehabilitation-oriented community and hospital agencies were assessed in terms of the presence or absence of these elements of a rehabilitation approach. Results indicate that the programs in the agencies clearly value client involvement and a program focus on improving skill and resource utilization. These concepts, however, are only beginning to be systematically implemented in practice.
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Separate lines of investigation implicate excitotoxins or disruption of cytoskeletal architecture in the pathogenesis of human neurodegenerative disease. To assess the hypothesis that these neurotoxic mechanisms may have a synergistic effect, albino rats were given intrastriatal administrations of either the excitotoxin, kainic acid, or the microtubule inhibitor, colchicine, or both. Assessment of neuronal damage, either by loss of neurotransmitter metabolic enzyme activities or by histologic analysis, demonstrated synergism between the agents. Further, the synergism was still apparent with substitution of quinolinic acid, but not dimethyl kainate, for kainic acid, and Vinca alkaloids, but not lumicolchicine, for colchicine.
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The behavioral and cognitive effects of naloxone HCl, in doses of 5 micrograms/kg, 0.1 mg/kg, and 2.0 mg/kg administered as an IV bolus, were assessed in a double-blind, placebo-controlled, randomized study of eight normal subjects ranging in age from 44 to 74 years (mean 63). Naloxone produced mild behavioral effects with slight cognitive impairment after the 2.0 mg/kg dose only. The threshold, dose dependency, characteristics, and magnitude of these behavioral effects were similar to what has previously been reported in young normal subjects, but markedly different from those observed in patients with dementia of the Alzheimer type (DAT) matched in age to the current study sample. These data suggest that the metabolic fate of naloxone is not substantially affected by age within the range studied. The findings of this study provide further support for a role for endogenous opiate systems in the modulation of behavior and cognition, and suggest that the unusual behavioral sensitivity of patients with DAT to naloxone cannot be accounted for by the effect of age.
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A complete explanation of the neurotoxicity that follows kainic acid (KA) injection into the rat striatum is lacking. An assessment of the chronological course after intrastriatal KA injection of the activities of enzymes preferentially concentrated in glia or involved in the detoxification of oxygen metabolites is accomplished. An enhancement of the specific activities of glutathione peroxidase (GP) and catalase is found without an alteration in the specific activity of superoxide dismutase (SOD). There is no increase in the in vivo striatal levels of malondialdehyde, a putative indicator of lipid peroxidation, the expected result of cell membrane damage from oxygen metabolites. Understanding the mechanism and importance of the preferential induction of the activities of the detoxification enzymes will require further study.