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Biomedical subjects

R G Klein

Publications and source records attributed to R G Klein.

At least 55 records · Page 3Linked to original sources
PubMed1993

Attention-deficit hyperactivity disorder and comorbid psychosis: a review and two clinical presentations.

BACKGROUND: A review of literature relating attention-deficit hyperactivity disorder (ADHD) to adult-onset psychosis suggests that cases of comorbid ADHD and atypical neuroleptic-refractory psychosis may respond to psychostimulants. METHOD: Two patients are described who presented to the authors for clinical care. Data were gathered by reviewing hospital charts from previous admissions and by conducting serial mental status examinations over many weeks. Subjects chosen for presentation herein met DSM-III-R criteria for ADHD and atypical psychosis characterized by delusions or hallucinations. RESULTS: After each subject had suffered multiple neuroleptic-refractory psychotic episodes, both had been treated by adding psychostimulants to ongoing neuroleptic therapy. The patients were then observed by the authors to be free of psychosis for many weeks, both while taking neuroleptics and psychostimulants concurrently, as well as while taking only psychostimulants after neuroleptics had been withdrawn. CONCLUSION: When integrated with reports of five similar cases and a review of the literature, the above results suggest that further attention be given to the evaluation, treatment, and eventual classification of a potentially distinct patient group with ADHD and atypical psychotic episodes.

Adult↗
PubMed1993

A randomized double-blind trial of dextrose-glycerine-phenol injections for chronic, low back pain.

This randomized clinical trial evaluated the efficacy of injections of a dextrose-glycerine-phenol connective tissue proliferant into the posterior ligaments, fascia, and joint capsules to treat chronic low back pain. Seventy-nine patients with chronic low back pain that had failed to respond to previous conservative care were randomly assigned to receive a double-blind series of six injections at weekly intervals of either Xylocaine/saline solution or Xylocaine/proliferant into the posterior sacroiliac and interspinous ligaments, fascia, and joint capsules of the low back from L4 to the sacrum. Patients were observed with a visual analog, disability, and pain grid scores, and with objective computerized triaxial tests of lumbar function for 6 months following conclusion of injections. Pretreatment imaging tests with either magnetic resonance imaging (MRI) or computed tomography (CT) scans were performed in all patients. Thirty of the 39 patients randomly assigned to the proliferant group achieved a 50% or greater diminution in pain or disability scores at 6 months compared to 21 of 40 in the group receiving lidocaine (p = 0.042). Subjective parameters measured at 6 months posttreatment improved (p < 0.001) overall in both the treatment and control group compared to baseline. Improvements in visual analog (p = 0.056), disability (p = 0.068), and pain grid scores (p = 0.025) were greater in the proliferant group. Objective testing of range of motion, isometric strength, and velocity of movement showed significant improvements in both groups following treatment but did not favor either group. The MRI and CT scans showed significant abnormalities in both groups, but these did not correlate with subjective complaints and were not predictive of response to treatment.

Adult↗
PubMed1992

Attention-deficit hyperactivity and conduct disorder: comorbidity and implications for treatment.

The distinguishing and overlapping features of attention-deficit hyperactivity disorder (ADHD) and conduct disorder (CD) are discussed. Conclusions regarding comorbidity, treatment efficacy, and long-term outcome can be influenced by several factors, including diagnostic procedures and sample characteristics. The need to distinguish between referred and non-referred samples is particularly crucial when considering treatment and comorbidity issues. The efficacy of psychosocial and pharmacological treatments in ADHD and CD children is reviewed as are the few studies of psychostimulant medication in co-morbid youngsters. Suggestions regarding treatment planning and recommendations for treatment and research are described.

Adolescent↗
PubMed1992

Imipramine treatment of children with separation anxiety disorder.

The efficacy of imipramine was investigated in 20 children (ages 6 to 15) with separation anxiety disorder. Children were treated for a month with vigorous behavioral treatment. If they did not respond, they entered a double-blind, randomized, 6-week trial of imipramine or placebo. Of 45 children accepted, 21 (47%) entered the trial. About half the children improved with either treatment, and no superiority for imipramine was obtained. There was no instance of clinically significant EKG changes. This small study failed to replicate previous findings of imipramine efficacy in a similar, but larger, clinical population.

Adolescent↗
PubMed1992

The pharmacotherapy of anxiety disorders in children and adolescents.

Psychopharmacologic agents may offer potentially effective treatment of child and adolescent anxiety disorders. Much further research, however, remains to be done to determine medication specificity, dosages, duration of treatment, and the optimal relationship between pharmacologic and nonpharmacologic therapies.

Adolescent↗
PubMed1991

Hyperactive boys almost grown up. V. Replication of psychiatric status.

We previously reported a prospective follow-up study of 101 young adult males whose conditions had been diagnosed as hyperactivity in childhood. Compared with controls, probands had significantly higher rates of attention-deficit, antisocial, and drug use disorders at follow-up (mean age, 18 years). The present study was an attempt to replicate these findings on an independent sample of 94 hyperactive boys who were seen at the same clinic, compared with 78 normal controls. Assessments were made by clinicians who were blind to group membership. Information was obtained for 90% of the original cohort. As in the previous study, significantly more probands than controls were given ongoing diagnoses of attention-deficit disorder (43% vs 4%), antisocial disorders (32% vs 8%), and drug use disorders (10% vs 1%). Furthermore, the absolute rates of these disorders were comparable for corresponding groups across studies, and the adjusted odds ratios did not differ significantly. As previously, there was no increased risk for affective disorders in the grown hyperactive children. The present study provides a powerful replication of the nature of the young adult outcome of childhood hyperactivity.

Adolescent↗
PubMed1991

Long-term outcome of hyperactive children: a review.

Reports of adolescent outcome in attention deficit hyperactivity disorder have uniformly indicated high rates of behavioral problems including cognitive impairment. Dysfunction is markedly reduced in adulthood, but the pattern of outcome remains unchanged except for failure to document cognitive deficits. In adulthood, dysfunction is characterized by antisocial personality and substance (nonalcohol) use disorders. These are in turn associated with criminality. The little existing information on girls with attention deficit hyperactivity disorder does not suggest a worse outcome than for boys. Attempts to identify the children most likely to have a poor outcome have been largely unsuccessful.

Adolescent↗
PubMed1991

Effects of high methylphenidate doses on the cognitive performance of hyperactive children.

It has been reported that high doses of methylphenidate, required for optimal clinical efficacy in the treatment of hyperactive children impair cognitive performance. This study examines the effects of a four week placebo trial of high doses of methylphenidate on cognitive performance in hyperactive 81 children. In addition, effects of medication over more extended time (12 weeks) are examined. Dosage after 4 weeks averaged 1.78 mg/kg, and after 12 weeks 1.66 mg/kg. No significant decrements in cognitive performance were obtained on any measure which included tests of: IQ, reading, spelling, arithmetic, non-verbal reasoning, graphomotor performance, visual memory, and sustained attention. The results argue for titrating medication to obtain maximum behavioral improvement. (Tab. 2, Ref. 15.)

Attention Deficit Disorder with Hyperactivity↗
PubMed1991

Effects of long-term inhalation of N-nitrosodimethylamine in rats.

The toxicological evaluation and histopathological findings of a long-term inhalation study in progress with N-nitrosodimethylamine (NDMA) are presented. Exposure was to three concentrations of NDMA: 0.04, 0.2 and 1.0 ppm (corresponding to 120, 600 and 3000 micrograms/m3). A significant reduction in median survival time (nine months) was seen in animals treated with the highest concentration of NDMA. Tumours occurred mainly in the nasal cavity, with the highest incidences in the groups receiving 1.0 and 0.2 ppm NDMA (19/36 and 31/36 tumour-bearing animals); in the lowest exposure group, 13/36 nasal tumours have been observed. The survival time of this treatment group, however, was about two months longer than that of the controls.

Administration, Inhalation↗
PubMed1991

Young adult mental status of hyperactive boys and their brothers: a prospective follow-up study.

This study reports on the psychiatric outcome as young adults (ages 16-23) of 50 hyperactive boys compared with their nonhyperactive brothers and to unrelated controls. Siblings provide a built-in control for potentially important factors, such as social class and parental psychopathology. Blind assessments at follow-up showed that significantly more probands (30%) than siblings (6%) and controls (10%) had multiple DSM-III diagnoses. Moreover, probands had a more severe form of antisocial disorder than siblings. In conclusion, the increased risk for multiple and more pervasive mental disorder in the young adulthood of hyperactive boys cannot be attributed to childhood factors shared with siblings.

Adolescent↗
PubMed1990

In vitro and ex vivo effects of the air pollutants SO2 and NOx on benzo(a)pyrene activating enzymes of the rat liver.

In the course of a larger project aimed at studying possible combination effects between common air pollutants and carcinogens, previous studies of our laboratory had shown that the genotoxic activity of benzo(a)pyrene (B(a)p) in fetal lung cells of the Syrian hamster is decreased by NOx and SO2. This particular study was performed to assess whether the gases may cause this depression by affecting the net yield of active B(a)p metabolites. Using the S. typhimurium assay as a model-system the gaseous exposure of subcellular activation systems to SO2 and NOx did not affect the yield of B(a)p induced mutants of S. typhimurium. Also the pretreatment of animals with SO2 or NOx in vitro did not result in a measurable induction or inhibition of B(a)p metabolizing enzymes, as was assessed also with S. typhimurium. Accordingly, neither direct enzymic interactions nor complex systemic pathways reflected possible mechanisms of combination effects between B(a)p and the air pollutants.

Air↗
PubMed1990

Inhalation carcinogenesis of N-nitrosomorpholine (NMOR) in rats and hamsters.

N-Nitrosomorpholine (NMOR) is a potent liver carcinogen in rats when administered orally. NMOR was found in the atmosphere at working places in the rubber industry in concentrations up to several hundred micrograms/m3. It can be assumed that NMOR inhalation may play a role in human carcinogenesis. Therefore an inhalation study was carried out to evaluate the carcinogenic potency of NMOR vapors in rats and hamsters. The concentration of volatile NMOR in the inhalation chamber was continuously determined with a Thermal Energy Analyzer. The rats received 29 administrations (4th/day, 5 days/week; mean inhaled daily dose: 130 micrograms/animal; total dose: 15 mg/kg bodyweight). The hamsters inhaled a total of 38 mg/kg of NMOR (21 applications, daily dose 260 micrograms/animal). In rats 4 carcinomas and 5 neoplastic nodules of the liver, 1 neuroblastoma and 1 mucoepidermoidal carcinoma of the nose, and 1 carcinoma of the thyroid gland were induced. In treated hamsters 4 carcinomas of the liver, 2 neurogenic sarcomas of the nasal region, and 5 papillomas of the trachea were found. None of these tumors were observed in control rats and control hamsters.

Administration, Inhalation↗
PubMed1990

Low-energy laser treatment and exercise for chronic low back pain: double-blind controlled trial.

Twenty patients with chronic low back pain were enrolled in a randomized double-blind trial to test the efficacy of low-energy laser biostimulation combined with exercise. Ten patients received low-energy gallium-arsenide laser treatment, and ten received placebo laser treatment. Both groups were also placed on an active exercise program. Visual analogue and disability pain scores were assessed pretreatment and one month posttreatment and showed significant (p less than .02) improvements in both groups, but no relative advantage was found for either group. Objective parameters using computerized triaxial measurements of range of motion, isometric torque, and isodynamic velocity were also performed before and after treatment. There were significant improvements in objective parameters in both the laser and placebo groups, but no relative advantage accrued to either group. Under the conditions of this study, low-energy laser stimulation plus exercise did not provide a significant advantage over exercise alone.

Adult↗
PubMed1989

Hyperactive boys almost grown up. IV. Criminality and its relationship to psychiatric status.

Attention-deficit disorder with hyperactivity is believed, by some, to be a developmental antecedent (predisposing factor) to antisocial personality disorder and criminality. However, evidence supporting this association has not been consistent. We report on a prospective follow-up study of 103 males (ages 16 to 23 years), who were diagnosed as hyperactive (attention-deficit disorder with hyperactivity) between ages 6 and 12 years, and 100 normal controls. The official arrest records of all subjects who resided in New York State during the follow-up interval were obtained. Blind diagnoses (based on structured interviews with subjects and their parents) were made on 98% of the initial cohort at follow-up. Although other investigators have reported on the delinquent behavior of hyperactive children in a prospective design, to our knowledge, follow-up mental status has not been studied previously in relation to official arrest records. Significantly more probands than controls had been arrested (39% vs 20%), convicted (28% vs 11%), and incarcerated (9% vs 1%). The presence of an antisocial/conduct disorder in young adulthood almost completely accounted for the increased risk for criminal activities in the former hyperactive children whether or not it was accompanied by a substance use disorder. Continuing attention-deficit disorder with hyperactivity at follow-up, by itself, was not associated with arrest history. The findings support the view that childhood attention-deficit disorder with hyperactivity is a risk factor for later criminality, but that this relationship is almost exclusively mediated by the development of an antisocial disorder in early adulthood.

Adolescent↗