A proposal to standardize terminology for weak D antigen.
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Reference Standards↗
Biomedical subjects
P J Schmidt
Publications and source records attributed to P J Schmidt.
Lack of effect of induced menses on symptoms in women with premenstrual syndrome.
BACKGROUND: No physiologic abnormality of the luteal phase has been consistently demonstrated in women with premenstrual syndrome (PMS). Using the progesterone antagonist mifepristone, we truncated the late luteal phase of the menstrual cycle in a blinded fashion to evaluate the relation of the events of the late luteal phase to the symptoms of PMS. METHODS: Fourteen women with PMS were given mifepristone (12.5 or 25 mg per kilogram of body weight) by mouth on the seventh day after the surge of luteinizing hormone. On the sixth through the eighth days after the surge, they also received injections of either placebo or human chorionic gonadotropin (2000 IU). Seven women with PMS received placebo instead of both mifepristone and human chorionic gonadotropin. All the women completed daily questionnaires measuring a variety of mood-related and somatic symptoms. RESULTS: Mifepristone consistently induced menses. The women receiving only mifepristone had plasma progesterone levels like those of the follicular phase (less than 3 nmol per liter) within four days, whereas all the other women had plasma progesterone levels characteristic of the luteal phase (greater than 8 nmol per liter) for at least seven days after treatment. In all three groups, the severity of symptoms was significantly higher after treatment than before, according to an analysis of variance with repeated measures. The level and pattern of the ratings of symptom severity were similar in all treatment groups. CONCLUSIONS: Neither the timing nor the severity of PMS symptoms was altered by mifepristone-induced menses or luteolysis. The temporal association of typical PMS symptoms with an artificially induced follicular phase suggests that endocrine events during the late luteal phase do not directly generate the symptoms of PMS.
Adult↗
Blood donation by the healthy elderly.
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Aged↗
Menopause-related affective disorders: a justification for further study.
Despite descriptions dating back to the nineteenth century of menopause-related affective syndromes, recent investigations have been unable to characterize a specific disturbance of mood or behavior related to this period of life. In this article the authors identify a number of methodologic problems in earlier studies and suggest that further study is warranted and that it is premature to conclude that menopause-related affective syndromes do not exist. They then provide guidelines for examining mood and behavioral changes that take place during the climacteric and menopause, with the hope of stimulating further research which may determine whether menopause-related affective disorders exist and, if so, their characteristics.
Adult↗
Suicidal ideation in Darier's disease.
We investigated the psychiatric history of patients with severe Darier's disease and a control group, which consisted of patients with comparably severe dermatologic disorders of keratinization. Three patients with Darier's disease reported either a suicide attempt (one patient) or a specific suicide plan (two), compared with one patient in the control group. Of 11 patients with Darier's disease, 7 had a history of suicidal thoughts, compared with 3 of 11 patients in the control group. Thus suicidal ideation is a potential problem in patients with cutaneous illnesses, particularly those with chronic disfiguring disorders such as severe Darier's disease.
Adolescent↗
Models for research in consultation psychiatry.
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Adrenal Cortex Hormones↗
State-dependent alterations in the perception of life events in menstrual-related mood disorders.
The authors examined the reporting of daily life events by women with prospectively confirmed menstrual-related mood disorder (N = 40) and asymptomatic control subjects (N = 20). During the follicular and late luteal phases of the menstrual cycle, subjects completed a schedule of life events that monitors an individual's perception of 1) the frequency of occurrence of life events and 2) the degree of associated distress or pleasure. The patient group reported significantly more negative life events than the control group. Further, the patients with menstrual-related mood disorder showed significantly more distress associated with the same event when it occurred in the premenstrual phase than when it occurred in the post-menstrual phase.
Adult↗
Hypothalamic-pituitary-adrenal function in patients with the premenstrual syndrome.
Patients with primary affective disorders, such as melancholic depression and anorexia nervosa, frequently have a hyperactive hypothalamic-pituitary-adrenal (HPA) axis, characterized by hypersecretion of CRH and a blunted ACTH response to exogenous CRH. Premenstrual syndrome (PMS) is a luteal phase dysphoric disorder characterized by primarily affective and behavioral disturbances. HPA axis function was compared in PMS patients and control women, respectively, diagnosed by DSM3-R criteria or found to have no current psychiatric disorders, determined by the Schedule for Affective Disorders and Schizophrenia-Lifetime Interview. Urinary free cortisol excretion was the same in PMS and normal women, and no differences in urinary free cortisol excretion between the follicular and luteal phases occurred in either group. Two HPA axis abnormalities, however, were noted when PMS patients were compared to normal women. First, basal evening cortisol concentrations in plasma were significantly decreased, while the time-integrated response of plasma cortisol to ovine (o) CRH was significantly increased. Second, the negative correlation between time-integrated plasma ACTH and cortisol responses to oCRH and basal luteal progesterone concentrations present in normal control women was not seen in the PMS patients. These changes in basal and oCRH-stimulated plasma cortisol levels in association with normal urinary free cortisol excretion suggest that women with PMS might have transient or episodic disturbances of their HPA axis, which appear adequately corrected by this system's servomechanisms. This probably explains the maintenance of regular menstrual cycles in PMS patients, which contrasts with the irregular menses observed in patients with depression, anorexia nervosa, or women who participate in chronic strenuous exercise.
Adrenocorticotropic Hormone↗
A case of autoimmune thyroiditis presenting as menstrual related mood disorder.
A case of autoimmune thyroiditis presenting as menstrual related mood disorder (MRMD) is described. The symptoms of the patient's prospectively confirmed MRMD remitted following thyroid hormone supplementation. Although most patients with prospectively confirmed MRMD are not clinically hypothyroid or hyperthyroid, the importance of routine thyroid function tests in the initial evaluation of MRMD is underscored by the successful treatment of this patient with thyroid hormone replacement.
Adult↗
The 1988 comprehensive blood bank survey of the College of American Pathologists.
An average of 2211 laboratories reported results in this comprehensive blood bank survey. In general, the participant performance remains strong in ABO and D typing, unexpected antibody detection and identification, crossmatching, and antigen identification. However, certain samples achieved less than the usual performance levels. In one sample, anti-C, which was not present, was reported by many participants. In a third sample, only 90% of the participants correctly recorded that no antibody was detectable. Two cross-match challenges did not reach the required participant consensus for grading purposes. The ungraded samples and the supplementary questions provide mock clinical situations and are used to determine current practices and procedures in transfusion medicine. The results of these studies and the participant responses are included.
Blood Banks↗
The algorithm and the crossmatch.
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ABO Blood-Group System↗
Impact of explicit questions about high-risk activities on donor attitudes and donor deferral patterns. Results in two community blood centers.
Concern about the ineffectiveness of indirect questioning of donors about participation in activities with a high-risk of exposure to human immunodeficiency virus (HIV) led our two community blood centers independently to begin direct and explicit questioning of donors about such activities. The impact of direct questioning was assessed via a donor attitude survey and by comparing the number of donors deferred for a positive response to a direct verbal question with the number previously deferred for a positive response to indirect questions. Our donor attitude survey indicated 90% donor approval of direct questioning, and analysis of donor deferral patterns indicated almost a five-fold increase in the number of donors deferred for participation in high-risk activities. Our experience documents the acceptability of direct questioning of donors and indicates that such questioning may well have a positive impact on blood safety.
Acquired Immunodeficiency Syndrome↗
Panic disorder and the menstrual cycle: panic disorder patients, healthy control subjects, and patients with premenstrual syndrome.
The authors prospectively evaluated 20 normally menstruating women with panic disorder across a minimum of two drug-free menstrual cycles. There were no significant effects of menstrual cycle phase on anxiety ratings in the panic disorder patients or in 20 healthy control subjects; this contrasted with a robust increase in premenstrual anxiety in 20 subjects with premenstrual syndrome. These findings suggest that the symptoms of panic disorder are not commonly exacerbated by the premenstrual phase of the menstrual cycle and highlight the need for prospective evaluation in the attempt to document an association between psychiatric symptoms and the menstrual cycle.
Adult↗
Models for the development and expression of symptoms in premenstrual syndrome.
Models for the development and expression of symptoms in premenstrual syndrome (PMS) must integrate a variety of reported characteristics of the syndrome, such as the symptomatic profile, the menstrual cycle phase-specific timing of the symptoms, treatment response characteristics, and the absence of consistently observed biochemical or psychological markers. In this article, the authors review the available evidence supporting three proposed models for PMS. They also discuss a fourth model that may serve to explain and integrate many of the ostensibly conflicting observations of PMS and direct research toward the further characterization of this syndrome. These models are (1) biochemical or endocrine models; (2) symptom exaggeration or "special sensitivity" models; (3) premenstrual syndrome as a variant of affective disorder; and (4) premenstrual syndrome as a disorder of state regulation.
Female↗
Evaluation and treatment of sleep disorders in the medical setting.
Sleep disturbances may complicate the clinical presentation of medically ill patients. The assessment and management of sleep disorders in this population requires direct attention to the nature of the relationships between medical illness and sleep disorder. In this paper we present a systematic description of these relationships, which include sleep disturbances secondary to symptoms of a medical illness, sleep disturbances secondary to medical treatment, sleep disorders sharing a similar pathophysiology with medical symptoms, and sleep disturbances and medical symptoms secondary to a psychiatric disorder.
Combined Modality Therapy↗
Psychiatric consultations in rheumatology: a review of 100 cases.
Consultation-liaison psychiatry has contributed much to our understanding of the psychological complications of physical illness, both in general responses to illness and in particular problems related to specific diseases. We reviewed 100 psychiatric consultations from a specialized rheumatology unit. Eighty percent of the consultations consisted of patients with systemic lupus erythematosus (36%), rheumatoid arthritis (29%), and fibrositis (15%). The majority of S.L.E. patients had organic brain syndromes related to central nervous system involvement or corticosteroids, while the majority of rheumatoid arthritis patients had a depressive diagnosis. Fibrositis patients showed no specific psychiatric diagnosis. Some future areas of research for consultation-liaison psychiatry in this area are suggested.
Adaptation, Psychological↗
Use of Rh positive blood in emergency situations.
The emergency blood needs of 449 patients were met by supplying 1,717 uncrossmatched units of either red blood cells (RBC) type specific Whole Blood or group O RBC. The RBC were all Rh positive, and 601 units were transfused to 262 untyped patients. None of the patients presented with anti-Rh antibodies. Only 20 patients who were Rh negative received group O Rh positive RBC, and most of these patients were male. There were no acute hemolytic reactions or sensitizations of young females. Group O Rh positive RBC is our first choice to support patients with trauma who cannot wait for type specific or crossmatched blood. Those who do survive the emergency conditions can be reverted to blood of their own type without problem. Acceptance of Rh positive emergency transfusions by physicians giving emergency care can prevent unbalanced shortages in a regional blood supply system.
Acute Disease↗
The 1986 Comprehensive Blood Bank Survey of the College of American Pathologists.
In 1986, a total of 2781 laboratories subscribed to the Comprehensive Blood Bank Survey of the College of American Pathologists (CAP) (Skokie, Ill). Performance of these laboratories on the ABO and Rh challenges was good, with 99.7% to 99.9% of the participants reporting the correct response. Antibody identification showed less consistency (45.4% to 97.5%). These challenges consisted of two serum samples with multiple antibodies, one serum sample with antibody to a high-incidence antigen, and one serum sample with anti-M. Performance on the cross match ranged from 95.0% to 99.8% correct, with one exception. This exception was an intended incompatible cross match with the serum containing anti-M, which was reported as incompatible by 56.2% of participants. The antigen-typing challenges ranged from 98.3% to 100% correct, but three typings proved to be a problem. Two samples, when typed for the c antigen, were correctly typed 70.4% of the time and 50.1% of the time. One of these samples, when typed for the E antigen, was correctly typed only 30% of the time. This discrepancy proved to be the result of inadvertent pooling of units of different phenotypes in the sample preparation process.
ABO Blood-Group System↗