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Biomedical subjects

M Sigman

Publications and source records attributed to M Sigman.

At least 37 records · Page 2Linked to original sources
PubMed1998

Schizophrenia and severe affective illness alternating over time in some patients: a hypothesis.

There is a small portion of psychiatric patients whose symptom patterns at one point in their lives suggest a severe affective disorder and at another point a diagnosis of schizophrenia. Shifting symptom patterns such as this have heretofore been explained as misdiagnosis or dual diagnosis. An alternate hypothesis is offered--that in some patients, mental illness may be expressed in different and discrete ways at different points in their lives, depending upon intrapersonal, interpersonal, and biological processes. The rationale for the hypothesis derives from selected follow-up and family studies, treatment and drug effects, and the observed similarity of abnormal physiological measures in both diagnostic groups. Clinical implications are that one cannot always rely on family history to support a specific diagnosis on a patient's first presentation. Furthermore, if a patient subsequently presents with a significant change in symptom pattern, the therapist may wish to consider a modification of the original treatment regimen. The notion of shifting symptom patterns does not diminish the usefulness of descriptive diagnostic categories. Rather, it challenges the concept that these categories need be immutable within individuals. Compelling support for the hypothesis will necessitate prospective study of patient charts over time.

Adult↗
PubMed1998

Infant predictors of cognitive development in an undernourished Kenyan population.

Assessments of infant sociability, motoric capacities, and nutritional factors were performed to elucidate early influences on infant development in an undernourished Kenya population. In this longitudinal study, infant social skills were assessed using both the Bayley Behavior Record and home observations during the first 6 months of the infants' lives. Abilities were measured using an adapted version of the Bayley scales of infant development at 6 and 30 months, and a short battery of cognitive measures at 5 years. Infant size measurements were used as indicators of infant nutritional status. Shorter and lighter infants, and those infants showing growth faltering in weight attainment, were significantly less sociable at 6 months than infants who were taller and maintained heavier weights. Infants with smaller arm circumferences displayed lower motor scores at 6 months and lower Bayley mental scores at 30 months than infants with greater arm circumference. Furthermore, infants who were more motorically able and socially adept at 6 months had higher Bayley scores at 30 months and higher verbal comprehension scores at 5 years.

Anthropometry↗
PubMed1998

A longitudinal study of AIDS conversations between mothers and adolescents.

The current study examined the stability of mother-adolescent AIDS conversations. Twenty-four mother-adolescent dyads (9 boys, 15 girls) participated at Time 1 (adolescents aged 10-14 years), and again 2 years later. Mothers and adolescents engaged in a videotaped conversation about AIDS and completed AIDS questionnaires. Conversations were coded for content and the extent to which mothers dominated conversations. Conversational dominance remained stable over time. AIDS knowledge was greater for mothers than adolescents, but it improved over time for adolescents while remaining stable for mothers. Mothers who reported discussing AIDS-related topics with their adolescents had less discrepancy between their own and their children's AIDS knowledge. Conversational dominance at Time 1 predicted discrepancy in AIDS knowledge 2 years later, whereas discrepancy in AIDS knowledge at Time 1 did not predict conversational dominance two years later. These results suggest the importance of interactive conversations as a more effective way of teaching than didactic conversations.

Acquired Immunodeficiency Syndrome↗
PubMed1998

The Emanuel Miller Memorial Lecture 1997. Change and continuity in the development of children with autism.

The developmental approach to childhood psychopathology identifies deviations from typical patterns of development and stability of individual characteristics over time, and precursors in early life of later functions. The application of this approach to the social, communicative, and cognitive development of children with autism is discussed. Results from a longitudinal study of children with autism and other developmental disorders are described, indicating that children with autism have stable deficits in joint attention, representational play, and responsiveness to the emotions of others, and that early variations in these abilities are important for concurrent and subsequent language development and for peer engagement many years later.

Autistic Disorder↗
PubMed1998

Is affect aversive to young children with autism? Behavioral and cardiac responses to experimenter distress.

The aim of this study was to determine whether displays of negative emotions are more aversive to young children with autism than displays of neutral emotions. The attention, behavioral reactions, facial affect, and cardiac responses of 22 autistic and 22 mentally retarded 3-5-year-old children were compared when an experimenter pretended to hurt herself and showed strong distress in contrast to when the experimenter pretended to hurt herself but showed only neutral affect. The children in both diagnostic groups looked more at the experimenter and appeared more interested and concerned when she displayed strong distress than when she showed neutral affect. The heart rate of the mentally retarded children decreased during the distress condition relative to a baseline condition, but the heart rate of the children with autism did not change across conditions. In summary, the children with autism gave no evidence of being overly aroused by or avoiding the distressed experimenter.

Affect↗
PubMed1997

Endocrine evaluation of infertile men.

OBJECTIVES: To determine the incidence and type of endocrinologic abnormalities in men undergoing infertility evaluations and the most appropriate testing to detect them. METHODS: A retrospective review of consecutive patients attending two infertility centers was performed. Results of endocrine testing were compared to medical history and physical and laboratory findings to determine whether endocrinologic screening could be limited to a specific subpopulation. RESULTS: Only 99 of the 1035 patients (9.6%) had abnormal endocrine studies upon repetitive testing. The majority of these patients had an isolated elevation of serum follicle stimulating hormone (FSH) levels. Only 1.7% had a clinically significant endocrinopathy that would have had an effect upon disease management. Screening with serum testosterone and FSH levels alone was just as effective as a complete hormonal panel of testosterone, FSH, luteinizing hormone, and prolactin for the detection of clinically significant endocrinopathy. Only 1 patient with a clinically significant endocrinopathy would not have been identified if hormonal screening was limited to only those patients with a sperm density of less than 10 x 10(6)/mL. CONCLUSIONS: Endocrinopathies are a rare cause of male infertility. Endocrine screening of men with sperm counts of less than 10 million/mL with serum testosterone and FSH levels alone will detect the vast majority of clinically significant endocrinopathies.

Adult↗
PubMed1997

Effect of level of anastomosis and quality of intraepididymal sperm on the outcome of end-to-side epididymovasostomy.

OBJECTIVES: Epididymovasostomy is commonly performed at the most distal site of the epididymis where whole sperm are present within the lumen, regardless of their motility status. Although more fresh and motile sperm can be found more proximally within the epididymis, it is believed that the outcome of epididymovasostomy is better more distally. Because the current results of epididymovasostomy are far from perfect, it would be ideal to be able to harvest motile sperm for cryopreservation at the time of surgery in case the patient remains azoospermic postoperatively. The objective of this study was to determine the effect of the level of epididymal anastomosis and quality of sperm on the outcome of surgery. METHODS: An end-to-side epididymovasostomy was performed on 131 azoospermic men with a mean age of 39 years and a mean obstructive interval of 18 years. The etiology of obstruction was vasectomy in 48%, infectious in 19%, congenital in 20%, and unknown in 13%. The average duration of follow-up was 32 months. The overall patency rate was 67% and pregnancy rate was 27%. Subgroups of patients with an anastomosis to the same level of the epididymis on all functional sides were identified as follows: caput (56), corpus (28), and cauda (13). These groups were compared in regard to the presence of motile sperm within the epididymal lumen at the time of surgery, patency rates, postoperative semen quality, and pregnancy rates. RESULTS: Motile sperm were present more often in both the caput (54%) and corpus (61%) than in the cauda epididymis (25%) (P < 0.05). The patency rates for the three subgroups were not significantly different. The postoperative total motile sperm count and pregnancy rate for the corpus epididymis (13 x 10(6) and 45%) was significantly (P < 0.05) better than for the caput (4.4 x 10(6) and 22%) but no different than that of the cauda (10 x 10(6) and 23%). The patency and pregnancy rates for anastomoses performed at levels demonstrating motile sperm were not significantly better than at sites with nonmotile sperm, but the postoperative total motile sperm count was better (P < 0.05). CONCLUSIONS: The results of this study suggest that the outcomes of epididymovasostomy to the corpus and cauda epididymis are roughly equivalent and superior to the caput. Therefore, it may be reasonable to move more proximally from the cauda to corpus in the search for motile sperm for cryopreservation during an end-to-side epididymovasostomy. In contrast, moving from the corpus to the caput epididymis has a significant adverse effect upon outcome; it is, therefore, not worthwhile to search for viable sperm for cryopreservation in this clinical setting.

Adult↗
PubMed1997

Linking parental perceptions to interactions in young children with autism.

This study examines the relation of parental perceptions and observed parent-child interactive behaviors. Samples observed included normally developing children, children with autism, and children with mental retardation who were equivalent on mental age. Parental perceptions of children's temperament and parental feelings of parenting stress were examined. Results indicated that parental perceptions of autistic children's behavior were more often linked to actual child and parental behaviors than in the comparison samples. Parents who reported their autistic children as more difficult in temperamental style had children who were less engaged during a social game with the parent and less responsive in interaction with an experimenter. Parents who reported greater stress had autistic children who were less responsive in social interactions with others.

Autistic Disorder↗
PubMed1997

Ipsilateral testicular hypotrophy is associated with decreased sperm counts in infertile men with varicoceles.

PURPOSE: The presence of ipsilateral testicular growth retardation (hypotrophy) is the most common indication for prophylactic varicocele repair in adolescents in an effort to prevent future infertility. We examined the relationship between semen parameters and ipsilateral versus contralateral testicular size in men with unilateral varicoceles to determine whether testicular size is an appropriate parameter for predicting future fertility. MATERIALS AND METHODS: We studied the records of consecutive patients with palpable unilateral left varicoceles for whom a history, physical examination and semen analysis were available. Total motile sperm counts of men with and without ipsilateral testicular hypotrophy were compared. RESULTS: We identified 611 patients with unilateral clinical left varicoceles, including 305 (50%) with ipsilateral testicular hypotrophy. Mean total motile sperm counts plus or minus standard error of mean were significantly less in the patients with than without testicular hypotrophy (80 +/- 5.2 versus 126 +/- 7.8 x 10(6) sperm, p = 0.0018). Hypotrophy was more common in patients with large varicoceles (73%) than in those with medium (53%) or small (43%) varicoceles. CONCLUSIONS: Infertile patients with testicular hypotrophy associated with unilateral varicoceles have worse semen parameters than those without hypotrophy. These data support the practice of varicocele repair in adolescents with varicocele associated testicular growth retardation.

Adult↗
PubMed1996

Incidence of varicoceles in men with primary and secondary infertility.

OBJECTIVES: To determine whether varicoceles are more prevalent in men with secondary infertility than in men with primary infertility. METHODS: The records of 2188 consecutive men attending three infertility centers were reviewed to determine the incidence of varicoceles in men with primary and secondary infertility. In addition, other factors affecting both male and female infertility were assessed in these patients. RESULTS: The incidence of varicoceles was not significantly different between the 1447 men with primary infertility versus the 741 men with secondary infertility: 44% and 45%, respectively. The incidence of vasal agenesis was significantly greater in men with primary infertility (P < 0.001). In addition, the female partner was significantly older in couples with secondary infertility (P < 0.001). CONCLUSIONS: These findings do not support the conclusion that varicoceles have a progressive adverse effect on fertility over time and suggest that further study is needed to determine whether varicocele repair is indicated in patients with normal semen parameters.

Adult↗
PubMed1996

Fear, anxiety and perceived control in children of agoraphobic parents.

Sixteen children (M = 11 years) of agoraphobic parents were compared with 16 children of parents with no history of psychopathology, matched on age, gender and socioeconomic status. The majority (68%) of children of agoraphobic parents met DSM-III-R diagnostic criteria, anxiety disorders being most common. They reported more fear and anxiety and less control over various risks than did comparison children. Group's perceptions of the prevalence and their vulnerability to these risks did not differ. Agoraphobic mothers reported more separation anxiety than did comparison mothers, and maternal separation anxiety was negatively correlated with children's perceived control. Results are related to models of anxiety transmission.

Adolescent↗
PubMed1996

Long-term stability of individual differences in the emotional responsiveness of children with autism.

The results of two studies designed to investigate the short- and long-term stability of autistic children's responsiveness to displays of negative emotions in others are reported here. In the first study we measured the attention and behavioural responses of 22 autistic children to another's distress about a year and a half after initial assessments in a similar situation. In the second study, the children were re-assessed in two affective contexts over 5 years after initial testing. Individual differences in early responses to affect predicted affective responsiveness at each follow-up. Emotional responsiveness was positively associated with concurrent cognitive skills at each point of assessment. Furthermore, autistic children discriminated between affective and non-affective contexts when this discrimination was tested at the second follow-up.

Affective Symptoms↗
PubMed1996

Resistances in a hospital setting: issues in resolution.

This article describes multiple forms of resistances--patients toward reality, staff toward patients, staff toward staff, and my own counterresistances--in a hospital setting. Examples derive from within the psychiatric system itself, group work with a chronically ill population, a multiple family therapy group, and a case conference setting.

Adult↗
PubMed1995

Nonverbal communication and early language acquisition in children with Down syndrome and in normally developing children.

Many children with Down syndrome display asynchrony in development with the acquisition of language preceding at a slower pace than the acquisition of other cognitive skills. Recent research suggests that the expressive language delays that are displayed by these children may be associated with an earlier disturbance in the development of nonverbal requesting skills (Mundy, Sigman, Kasari, & Yirmiya, 1988; Smith & von Tetzchner, 1986). To test this hypothesis, a longitudinal study of 37 children with Down syndrome and 25 children with normal development was conducted. The results of the study indicated that this sample of children with Down syndrome exhibited a disturbance in nonverbal requesting. Furthermore, individual differences in nonverbal requesting were associated with the subsequent development of expressive language in these children. This association was observed even after taking into account initial variance in developmental level and language status. These data suggested that some of the processes involved in the expressive language delay of children with Down syndrome were not unique to linguistic development. Instead, some aspects of this delay appeared to be associated with problems in an earlier nonverbal phase of communication development. Additionally, the results suggested that measures of nonverbal communication skills also made a unique contribution to the prediction of language development among children with normal development. These data supported the hypothesis that the acquisition of nonverbal communication skills provides an important foundation for the emergence of language in atypical as well as typical development.

Child Development↗
PubMed1995

Current research findings on childhood autism.

OBJECTIVE: To review the main areas of current research findings regarding the core deficits in autism and the implications of these findings for the practicing clinician. METHOD: Behavioural, cognitive, emotional and neurophysiological aspects are covered with an emphasis on the importance of methodology. RESULTS: The implication of these findings for the treatment of autism is discussed. CONCLUSION: Autism can teach us how we learn about emotions and the possibility of sensitive periods of development.

Adolescent↗
PubMed1995

Towards the development of a fluorescent in situ hybridization based genotoxicologic assay for aneuploidy detection in sperm.

Fluorescent in situ hybridization (FISH) is a molecular cytogenetic technique which allows an analysis of chromosome copy number in interphase cells. The cytological examination of spermatozoa is routinely performed as part of semen analysis. While this analysis is only a component of the evaluation of an infertile male, the aetiology of many cases of infertility remains unknown. FISH on semen smears can yield information on chromosome-specific aneuploidy due to constitutional and acquired chromosomal abnormalities as found with cancer or exposure to genotoxic substances. The ability to analyse germ cells directly is a useful adjunct to GTG-banding analysis of meiotic chromosomes, an invasive and extremely labour-intensive procedure. The work of 2 years in developing and optimizing a FISH-based assay in routinely processed semen smears is described.

Aneuploidy↗