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Biomedical subjects

R E Drake

Publications and source records attributed to R E Drake.

At least 109 records · Page 6Linked to original sources
PubMed1994

Correlates and outcomes of alcohol use disorder among rural outpatients with schizophrenia.

BACKGROUND: The use of alcohol by persons with schizophrenia is common and has been associated with increased severity of psychiatric symptoms, multiple psychosocial problems, abuse of other drugs, and poor treatment outcomes. Most of the previous research in this area has been with urban patients. METHOD: The authors examined the correlates and outcomes of alcohol use in a rural sample of 75 DSM-III-R outpatients with schizophrenia. Based on multiple measures, 25% (N = 19) of 75 rural patients with schizophrenia were diagnosed with current co-occurring alcohol use disorders. Clinicians' ratings and self-reported symptoms were used to examine correlates of alcohol use, and the study group was followed prospectively for 1 year to identify all episodes of rehospitalization, incarceration, or literal homelessness. RESULTS: Alcohol use disorder was statistically significantly associated with unstable housing, conceptual disorganization, denial of mental illness, and rehospitalization during 1-year follow-up. Several trends suggested that alcohol use was also related to positive symptoms of psychosis. CONCLUSION: Among rural patients with schizophrenia, alcohol use appears to play a significant role in destabilizing psychosocial adjustment. These results replicate similar findings in urban settings.

Adult↗
PubMed1993

Detection of substance use disorders in severely mentally ill patients.

Severe mental illness is frequently complicated by substance use disorder. Approximately half of the severely mentally ill patients treated in acute care psychiatric settings have abused one or more of these substances. Despite the high rate of comorbidity, substance use disorders are generally not detected in acute care psychiatric settings, leading to incorrect diagnoses and ineffective treatments. The reasons for nondetection are complex, and research is needed to refine instruments and procedures for the detection of substance abuse in the severely mentally ill population. Nevertheless, clinicians can make better use of existing techniques of multimodal assessment to increase significantly the rate of accurate detection.

Age Factors↗
PubMed1993

Substance abuse in schizophrenia: service utilization and costs.

Utilization and cost of institutional and outpatient services were prospectively measured over 1 year for three groups of schizophrenic patients: current substance abusers, past substance abusers, and those without a history of substance abuse. Current abusers had significantly greater utilization and cost of institutional (hospital and jail) services. Current abusers also had greater utilization of emergency services. There were no significant differences between the groups in utilization and cost of other services, including psychosocial rehabilitation, outpatient treatment (case management, psychotherapy, and psychiatric visits), and housing supports. The implications for developing cost-effective treatments for dually diagnosed individuals are discussed.

Adult↗
PubMed1993

Treatment of substance abuse in severely mentally ill patients.

Substance abuse is the most common comorbid complication of severe mental illness. Current clinical research converges on several emerging principles of treatment that address the scope, pace, intensity, and structure of dual-diagnosis programs. They include a) assertive outreach to facilitate engagement and participation in substance abuse treatment, b) close monitoring to provide structure and social reinforcement, c) integrating substance abuse and mental health interventions in the same program, d) comprehensive, broad-based services to address other problems of adjustment, e) safe and protective living environments, f) flexibility of clinicians and programs, g) stage-wise treatment to ensure the appropriate timing of interventions, h) a longitudinal perspective that is congruent with the chronicity of dual disorders, and i) optimism.

Activities of Daily Living↗
PubMed1993

Detection of alcoholism in schizophrenia using the MAST.

The classification accuracy of the Michigan Alcoholism Screening Test (MAST) for detecting alcoholism in a community sample of 75 schizophrenic outpatients was assessed, as a replication and extension of Searles et al. (1990). The criterion diagnosis of alcohol use disorder was based on the convergence of ratings from multiple sources. The MAST classified 85% of the sample correctly, and item-based analyses showed that various subsets were equally effective, indicating a high degree of redundancy among MAST items. Differences between our sample and that of Searles et al. influenced the choice of MAST items for optimal detection and classification, and males were consistently classified more correctly than females. These results suggest that the construction of a brief and accurate detection instrument for alcohol use among schizophrenic patients may be possible, although attention to subpopulation differences will be required.

Adult↗
PubMed1993

Intestinal lymphatic pressure increases during intravenous infusions in awake sheep.

Intravenous fluid infusions cause increased venous pressure and increased lymph flow throughout the body. Together the increased lymph flow and increased venous pressure (the outflow pressure to the lymphatic system) should increase the pressure within the postnodal intestinal lymphatics. To test this, we measured the pressure in postnodal intestinal lymphatics and the neck vein pressure in five awake sheep. At baseline, the neck vein pressure was 1.2 +/- 1.5 (SD) cmH2O and the lymphatic pressure was 12.5 +/- 1.7 cmH2O. When we infused Ringer solution intravenously (10% body weight in approximately 50 min), the neck vein pressure increased to 17.3 +/- 0.9 cmH2O and the lymphatic pressure increased to 24.6 +/- 3.8 cmH2O (both P < 0.05). In two additional sheep, the thoracic duct lymph flow rate increased from 0.8 +/- 0.4 ml/min at baseline to 5.5 +/- 2.0 ml/min during the infusions. Our results show that postnodal intestinal lymphatic pressure may increase substantially during intravenous fluid infusions. This is important because increases in postnodal lymphatic pressure may slow lymph flow from the intestine.

Animals↗
PubMed1993

Washout of protein in dog lung lymph.

After an increase in microvascular filtration rate, lung lymph may contain protein washed from the tissue spaces plus protein from the filtrate. If so, then the lymphatic protein concentration may be significantly higher than the filtrate protein concentration (Cf). To test this hypothesis, we decreased the plasma protein concentration from 5.1 +/- 0.6 to 0.54 +/- 0.15 g/dl and increased the pulmonary microvascular filtration rate in four dogs. We estimated Cf to be 0.16 +/- 0.05 g/dl after we reduced the plasma protein concentration, and the lymphatic protein concentration (0.43 +/- 0.04 g/dl) was significantly greater than Cf. Our results indicate that lung microvascular membrane reflection coefficients estimated from lung lymph data may be too low. However, the amount of error caused by tissue protein washout is probably small. To account for the protein washout error, we estimated the lung microvascular membrane reflection coefficient to be approximately 0.74-0.76 instead of the approximately 0.70 previously reported for dogs (J. C. Gabel et al. J. Appl. Physiol. 55: 866-869, 1983).

Animals↗
PubMed1993

Estimation of lymph flow by relating lymphatic pump function to passive flow curves.

Active pumping in postnodal lymphatic vessels is an important factor influencing lymph flow. However, the output of the lymphatic pump also depends on the rate of flow into the pump. This arrangement is similar to the blood circulation where cardiac output depends on the rate of blood flow through the veins into the heart (venous return) and on the pumping characteristics of the heart itself (cardiac function curves). One common way to analyze the blood circulation rate is to interrelate venous return and cardiac function curves. In this study, we used a similar technique to analyze lymph flow. We used lymphatic flow vs. outflow pressure (passive flow) relationships for nonpumping lymphatics to represent the inflow of lymph to the lymphatic pump. We used data on the pumping characteristics of postnodal lymphatic vessels to generate relationships between lymphatic pump outflow and pump inflow pressure (pump function curves), and then interrelated these curves. The results were not only similar to previously measured lymph flow data obtained from experimental animals, but also support the observation that under normal circumstances lymph flow is periodic and in surges (active pumping) but in edematogenic states lymph flows more continuously (i.e., passively).

Animals↗
PubMed1992

Mental patients' attraction to the hospital: correlates of living preference.

Mental patients often show attraction to the hospital as a living alternative. In this study, 187 aftercare patients of an urban state hospital were examined for correlates of hospital attraction. Several variables, including background characteristics, psychosocial problems, psychiatric symptoms, substance abuse, and medication noncompliance, characterized the approximately 25% of the sample who showed hospital attraction. A logistic regression model for hospital attraction indicated that past hospital tenure, problems obtaining regular meals, positive symptoms of psychosis, and severe drug abuse contributed separately to the variance. The authors discuss the implications of these findings for treatment and public policy.

Activities of Daily Living↗
PubMed1992

Effect of increased neck vein pressure on intestinal lymphatic pressure in awake sheep.

Lymphatic vessels from the intestines drain into the thoracic duct, and the thoracic duct empties into veins in the neck. Thus increases in neck vein pressure (PNV) might slow intestinal lymph flow, provided the increased pressure is reflected upstream through the lymphatic vessels. To test the effect of increases in PNV on lymphatic pressure, we cannulated intestinal lymphatics in the direction of flow in six sheep. After the sheep recovered from surgery, we measured the pressure in the lymphatics (Px) as we increased PNV in steps. Px increased only slightly (but significantly) from 7.4 +/- 2.0 to 11.4 +/- 5.2 (SD) cmH2O when we increased PNV from baseline (0.8 +/- 2.4 cmH2O) to 37.4 +/- 4.1 cmH2O. However, when we simulated an increased lymph flow by infusing Ringer solution into the lymphatics at 1,000 microliters/min, Px increased to 24.6 +/- 7.0 cmH2O at PNV equal to 37.1 +/- 5.3 cmH2O. These results indicate that, at normal lymph flow rates, increases in neck vein pressure cause only small increases in intestinal lymphatic pressure. On the other hand, when lymph flow is elevated, increases in neck vein pressure may substantially increase lymphatic pressure and thus slow intestinal lymph flow.

Animals↗
PubMed1992

Increased venous pressure causes increased thoracic duct pressure in awake sheep.

The lymph from most organs drains through the thoracic duct and into veins in the neck. We hypothesized that increases in neck vein pressure (Pnv) are reflected through the thoracic duct to the lung lymphatic-thoracic duct junction. To test this, we cannulated the lung lymphatics in the direction of flow in four sheep. We advanced each cannula until it entered the thoracic duct. Thus the pressure at the tip of the lymphatic cannula (Px) was the pressure at the outflow of the lung lymphatics. We also placed a balloon into the superior vena cava. One to two days later, we measured Px in the awake sheep as we inflated the balloon and increased Pnv in steps to 25-45 cmH2O. We found no significant differences in Px and Pnv. Furthermore, Px closely followed Pnv after each step increase in Pnv. These results support our hypothesis that increases in Pnv cause increases in the outflow pressure to lung lymphatics.

Animals↗
PubMed1992

Diaphragmatic lymph vessel drainage of the peritoneal cavity.

We have studied the drainage of peritoneal fluid through the diaphragmatic lymph vessels in sheep. To measure the lymphatic flow rate, we cannulated the lymphatic vessels and timed the flow from the cannula. After we infused Escherichia coli endotoxin into awake sheep, the diaphragmatic lymph flow rate increased substantially. However, we found no increase in lymph flow in anesthetized acutely operated sheep. This indicates that studies in anesthetized animals may yield underestimates of diaphragmatic lymph flow. In sheep, many of the diaphragmatic lymph vessels drain to the caudal mediastinal lymph node. We cannulated an efferent vessel from that node in 5 sheep. Several days later we infused 100 ml/kg of Ringer's solution into the abdominal space of each awake sheep. In response, the lymph flow rate increased from 0.15 +/- 0.16 ml/min (mean +/- SD) to 0.50 +/- 0.17 ml/min. Our results are important because they demonstrate that diaphragmatic lymph flow increases substantially after fluid infusions into the abdominal space.

Animals↗
PubMed1992

Alcohol abuse, depression, and suicidal behavior in schizophrenia.

Alcohol use was correlated with depression and suicidal behavior in two independent studies of schizophrenic outpatients. Depression alone accounted for over 80% of the explained variance in suicidal behavior in both studies; alcohol use alone and the correlation between depression and alcohol use accounted for only small amounts of variance.

Adult↗