Practices and attitudes among Swedish psychiatrists regarding the ethics of compulsory treatment.
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Adult↗
Biomedical subjects
R Kohn
Publications and source records attributed to R Kohn.
[Mushroom poisoning--classification, symptoms and therapy].
The most serious poisonings are the hepatotoxic ones which are caused above all by Amanita phalloides, virosa, verna, Lepiota helveola, Galerina marginata, Gyromitra esculenta, Hypholoma fasciculare, and nephroptoxic intoxications which are caused above all by Cortinarius orrelanus and Paxillus involutus. Neurotoxic and psychotropic intoxications develop after ingestion of Inocybe, Clitocybe, Amanita-panterina, muscaria and Psilocybe. Most frequently the gastroenteric type of mushroom poisoning is encountered which is caused by many species e.g. Boletus satanas, Entoloma sinuatum and others. In the diagnosis anamnestic data are used, the clinical picture, mycological and toxicological examinations of residues of mushrooms, their spores and toxins. Therapeutic strategy comprises elimination methods gastric lavage, intestinal lavage and administration of large amounts of animal charcoal, forced diuresis, haemoperfusion, haemodialysis or peritoneal dialysis, administration of antidotes and symptomatic treatment, i.e. mainly rehydration and restoration of the mineral balance. Early and comprehensive treatment are important.
Humans↗
[Fibrillary glomerulopathy].
The authors present an account on contemporary knowledge of the diagnosis and differential diagnosis of fibrillar glomerulopathies. The latter are characterized by extracellular localized microfibrils and microtubules resp. in the glomeruli of the kidneys, their diameter being 8-60 nm. They are divided into amyloid and non-amyloid types. The others are classified according to the immunofluorescent finding into immunoglobulin positive and negative ones. The differential diagnosis is important in particular in immunoglobulin positive ones as they are present in serious diseases such as cryoglobulinaemia, monoclonal gammapathy, systemic lupus erythematosus and immunotactoid glomerulopathy.
Adult↗
The seroepidemiology of human herpesvirus 8 (Kaposi's sarcoma-associated herpesvirus): distribution of infection in KS risk groups and evidence for sexual transmission.
Striking differences in Kaposi's sarcoma (KS) risk for AIDS patients who acquire HIV via homosexual activity and those whose HIV infections derive from blood product exposure suggest the presence of a sexually transmitted agent other than HIV in the development of KS. Using an immunofluorescence assay, we examined serum samples from 913 patients for the presence of antibody specific for infection by human herpesvirus 8 (HHV8), an agent whose genome is regularly found in KS tissue. The distribution of HHV8 seropositivity conforms to that expected for a sexually transmitted pathogen and tracks closely with the risk for KS development. Our data support the inference that this virus is the etiologic cofactor predicted by the epidemiology of KS.
Adolescent↗
Practices and attitudes among Swedish psychiatrists regarding the ethics of compulsory treatment.
Few empirical studies have examined the attitudes and ethical beliefs of psychiatrists. In this study, 328 members of the Swedish Psychiatric Association were randomly selected to respond to a questionnaire containing three clinical vignettes examining involuntary hospitalization, other compulsory interventions, and restraint. The questionnaire also contained 16 controversial statements and items on the abuse of psychiatry. A 60% response rate was obtained. Psychiatrists' responses were influenced not only by the severity of and risks associated with the patient's disorder, but also by family pressure which affected the decision-making process. Female psychiatrists less often suggested the use of physical restraints and the compulsory use of ECT. Sexual misconduct, and also the inadequate treatment of refugees, were the most frequently reported forms of abuse of psychiatry.
Adult↗
Subcortical hyperintensities on MRI and activities of daily living in geriatric depression.
Data from 30 elderly inpatients with major depression were analyzed to explore the relationship between subcortical hyperintensities (SH) on MRI and activities of daily living (ADLs). A comparison of subjects based on a median split of the severity of SH revealed that subjects with greater SH performed worse on both instrumental and physical ADLs. A hierarchical multiple regression revealed that age, depression severity, neuropsychological test performance, and SH variables accounted for a total of 53% of the variance in ADL functioning. Severity of SH accounted for an additional 18% of the variance over and above the other three variables. Results suggest that severity of subcortical disease measured by MRI improves prediction of functional impairment in elderly individuals.
Activities of Daily Living↗
MRI and neuropsychological differences in early- and late-life-onset geriatric depression.
We sought to determine whether geriatric patients with late-life-onset major depression have more subcortical hyperintensities on MRI and greater cognitive impairment than age-matched geriatric patients with early-life-onset major depression, suggesting that subcortical disease may be etiologic in late-life depression. Most negative studies of the clinical significance of subcortical hyperintensities on MRI in geriatric patients have sampled from a restricted range of subjects, have employed limited batteries of neuropsychological tests, or have not quantified MRI changes; the present study attempted to address these limitations. Thirty subjects from a geriatric psychiatry inpatient service who were over 60 years of age and presented with major depression were divided into groups with onset of first depression after age 60 (mean = 72.4 years, 15 women, 0 men), and onset of first depression before age 60 (mean = 35.8 years, 12 women, 3 men). Quantitative analysis of MRI yielded the volume of: periventricular hyperintensities (PVH) and deep white-matter hyperintensities (DWMH). Subjects were administered a neuropsychological battery and measures of depression by raters blind to age of onset. The late-onset group had significantly more PVH and DWMH. They were also more impaired on executive and verbal and nonverbal memory tasks. Discriminant analysis using the severity or subcortical signal hyperintensities on MRI, cognitive index, and depression scores correctly predicted late versus early onset of depression in 87% of the early-onset group and 80% of the late-onset group. These findings suggest that late-life-onset depression may be associated with an increased severity of subcortical vascular disease and greater impairment of cognitive performance.
Adult↗
[Chronic renal insufficiency].
The authors submit a review on the etiopathogenesis, clinical picture and treatment of chronic renal insufficiency. They emphasize the fact that based on pathogenetic ideas it proved possible to influence the majority of pathological processes: retention and deficiency of substances as well as impaired regulation. After introduction of treatment, using erythropoietin, calcitriol as well as due to advances in the technique and quality of dialysis treatment, the patients' quality of life improved substantially. The authors draw attention also to the danger of accumulation of some drugs in renal insufficiency and its development.
Humans↗
[Heart failure in acute myocardial infarct and the importance of hemodynamic monitoring].
In his study the author deals with etiopathogenesis, diagnosis and therapy of heart failure in acute infarction of myocardium (AMI) with special attention paid to haemodynamic monitoring. The therapy of AMI is based especially on thrombolysis, or urgent revascularisation. In therapy of left ventricular failure we prefer nitrates, diuretics, and ACE-inhibitors. A severe heart failure requires haemodynamic monitoring and administration of positive inotropic substances (dopamine, dobutamine, amrinone) and sodium nitroprusside. Digoxin is indicated only in atrial fibrillation and flutter with fast response of ventricles. In cardiogenic shock it is necessary to introduce an intraaortic balloon contrapulsation and urgent revascularisation (coronary angioplasty, or aortocoronary bypass). Special attention has to be paid to the diagnosis and therapy of AMI of the right ventricle. We avoid the administration of diuretics, nitrates, or morphine which cause hypotension. The therapy is based on thrombolysis, hypotension requires volume expansion, sustained hypotension needs administration of dobutamine, and haemodynamic monitoring. In case of complete AV block, sequence atrioventricular cardiostimulation is recommended. (Ref. 11.).
Cardiac Output, Low↗
Lack of long-term ventricular arrhythmia reduction by enalapril in heart failure. SOLVD Investigators.
Previous studies have indicated that angiotensin-converting enzyme inhibitors may reduce the frequency of ventricular arrhythmias in patients with heart failure. These reports were mostly small and of short duration. We prospectively studied 734 patients recruited in 11 universities for 1 year who were enrolled in the Studies of Left Ventricular Dysfunction (SOLVD) to determine the long-term effects of enalapril and placebo on the frequency and complexity of ventricular arrhythmias in patients with symptomatic (treatment trial) or asymptomatic (prevention trial) heart failure and depressed left ventricular function (ejection fraction < or = 35%). Five hundred fifty-three patients from the prevention trial and 181 from the treatment trial of SOLVD underwent ambulatory electrocardiographic monitoring at baseline, and then at 4 and 12 months of double-blind therapy with either placebo or enalapril (2.5 to 10 mg twice daily). The prospectively defined primary analysis was by intent-to-treat and revealed no significant differences in ventricular premature complexes between the placebo and enalapril groups at baseline (87 +/- 13 vs 84 +/- 13/hour), 4 months (100 +/- 15 vs 85 +/- 12/hour), or 12 months (80 +/- 12 vs 90 +/- 14/hour). Likewise, there was no difference between the placebo and enalapril groups in runs of nonsustained ventricular tachycardia: baseline (8.3 +/- 4.1 vs 1.9 +/- 0.4 runs/day), 4 months (16 +/- 12 vs 7.2 +/- 4.1 runs/day), or after 12 months of blinded therapy (11 +/- 7.0 vs 6.1 +/- 4.4 runs/day).(ABSTRACT TRUNCATED AT 250 WORDS)
Arrhythmias, Cardiac↗
Role of the family in recovery and major depression.
OBJECTIVE: Major depression is significantly influenced by the family environment of the depressed patient. In order to explore how family functioning relates to this illness, the authors examined changes in family functioning over a 1-year course of major depression. METHOD: Subjective (Family Assessment Device) and objective (McMaster Clinical Rating Scale) assessments of family functioning were collected at hospitalization and 6 and 12 months after discharge for 45 inpatients diagnosed with major depression and their family members. Patterns of family functioning were examined by subjective and objective perspectives, initial levels of functioning, and reports of patients and other family members. RESULTS: Approximately 50% of families with a depressed member perceived their own family functioning as unhealthy; clinicians rated 70% of the families as unhealthy. While family functioning improved significantly from hospitalization through 12 months after discharge, the improvement was not uniform across all areas of functioning. Further, patients with good family functioning at hospitalization generally maintained their healthy functioning and were more likely to recover by 12 months than patients with poor family functioning. Although steady improvement in family functioning characterized the subjective ratings, objective assessments of family functioning suggested initial improvement followed by a decline from month 6 to month 12. CONCLUSIONS: Results show a clear association between family functioning and recovery from major depression. Different aspects of family life respond differently to the depressive illness; no one family dimension was uniquely related to outcome.
Adolescent↗
[Personal experience with determination of endogenous, digoxin-like substances in patients with myocardial infarct and other cardiopathies].
A group of 65 patients with acute infarction of myocardium (IM) who were not treated with digitalis preparations were subdued to examination to the presence of digitalis-like substances in their urine by means of radioimmuno-analytic method with use of anti-digoxin antibodies. The control group was constituted of 69 healthy subjects. Patients afflicted with IM had significantly increased concentrations of DLS in serum in comparison with health subjects. No significant relations of DLS to the activity of creatinkinase, IM localisation, occurrence of dysrhythmias, heart insufficiency and IM mortality were discovered. An increase in DLS in the blood of patients with acute IM probably coincides with a decreased cardiac output, with the activation of the stress axis and retention of sodium and fluids. The second examined group of patients was constituted of 20 subjects with other severe cardiopathies (inborn and acquired heart defects, chronic ischemic heart disease, inflammatory and degenerative diseases of the heart, and hypertension), who were subdued to catheter examinations. The authors discovered no significant differences of DLS concentrations in the blood during catheterization of individual compartments of inferior vena cava, superior vena cava, and the right ventricle. They were not successful in defining the particular site of DLS secretion on the basis of this examination. The authors pay attention to interaction of DLS during the radioimmuno-analytic examination of the digoxin serum concentration.
Adult↗
[Endomyocardial biopsy in cardiopathy of unknown origin].
The authors described their experiences with endomyocardial biopsy (EMB) in 21 adult patients aged from 18 to 59 years with the preliminary diagnosis of cardiopathy of uncertain origin (CPUO). Their definition of CPUO is as symptoms and/or findings of cardiac disease, which cannot be exactly identify using even complex clinical and noninvasive cardiological diagnostic procedures. Diagnostic value of EMB was substantial in two of their patients (in one hypereosinophilia of myocardium, and in another amyloidosis), non specific results were found in 18 patients, and 1 patient had normal pattern of the biopsy. EMB is useful and safe clinical diagnostic procedure in exactly defined groups of patients.
Adolescent↗
[Endogenous digoxin-like and ouabain-like substances].
Despite the fact that cardioglycosides have been used in the treatment of cardiac failure for more than 2000 years, endogenous digoxin and ouabain-like substances were identified from the chemical aspect only in 1990. They are steroids, their main site of origin being the adrenals. It is assumed that they play a part in the regulation of the body fluids and sodium in the organism and participate in the regulation of cardiac activity. The stimulus which leads to their release into the blood stream are above all conditions associated with sodium and fluid retention with expansion of the intravascular volume. It is assumed that these substances participate in the pathogenesis of some types of hypertension. The authors present a general review of contemporary knowledge of endogenous digoxin and ouabain-like substances.
Digoxin↗
[Hypercirculatory heart failure in a patient with plasmacytic leukemia].
High cardiac output failure/state (HCOF) is regular feature of some illnesses e.g. thiamine deficiency, hyperthyroidism, severe anemia, Paget's disease or arteriovenous fistulae. HCOF in multiple myeloma is reported quite rarely. 31-year-old man was admitted because of fatigue, dyspnea and subfebrilities. Heart rate was 116/min, sinus rythm blood pressure 110/60 mmHg. Chest film showed cardiomegaly with sings of interstitial pulmonary edema, echocardiography mild dilatation of the left ventricle with hyperkinetic wall motion and small pericardial effusion. Hemoglobin was 104 g/l, leukocyte count 13.5 x 10(9)/l with 30% of plasmatic cells. Serum protein electrophoresis demonstrated a monoclonal gammapathy, X ray studies of the skelet multiple osteolytic lesions. Diagnosis of plasmocytic leukemia-form of multiple myeloma was established and chemotherapy (vincristine + adriamycine + dexamethason) was started. Patient cardiac status deteriorated. Cardiac catheterisation demonstrated mean righ atrial pressure of 25 mmHg, mean pulmonary artery pressure of 28 mmHg and pulmonary artery wedge pressure of 24 mmHg. Co was 20.0 l/min (C.I. 11.5 l/min/m2). In continuing of chemotherapy and symptomatic therapy for heart failure patients status gradually improved and complete remission of the myeloma and normalisation of cardiac parameters was achieved. Heart failure in multiple myeloma patients has been attributed to amyloidosis of myocardium, hyperviscosity syndrome, co-existing CAD or anthracycline toxicity. HCOF should be considered in patients with clinical evidence of heart failure and normal left ventricular function.
Adult↗
Occupational asthma following kapok exposure.
Whether a distinct kapok allergen exists or whether the fiber's allergenicity is due to contamination by other allergens has never been resolved. Several years ago, we evaluated a patient who appeared to develop occupational asthma to kapok. We performed an environmental assessment, cross-shift spirometric testing of the patient's co-workers, and the first reported bronchoprovocation challenge with kapok. The disappearance of the patient's asthma following cessation of kapok exposure, with now 7 years of follow-up, our inability to incriminate any other agent, and the patient's positive specific bronchoprovocation challenge strengthen the evidence, but do not prove definitively, that kapok fiber itself is allergenic.
Adult↗
Jews and their intraethnic differential vulnerability to affective disorders, fact or artifact? I: An overview of the literature.
The observation that Ashkenazim have higher rates of affective disorders than either Sephardi or Oriental Jews was reanalyzed from the available literature. Statistical reanalysis of these studies was consistent with rates being elevated for Ashkenazim. The results of these treatment-based studies, however, suffer from biases due to differential help-seeking patterns, lack of accounting for readmission rates, diagnostic unreliability, misuse of frequency ratios relative to other disorders and failure to control for confounding variables. As a result of these causes for biases and in the absence of a true incidence or prevalence study serving as a basis for these observations, the assumption that Ashkenazim are at an increased risk for affective disorders is questionable and may be a mere result of methodological artifacts.
Bipolar Disorder↗
Comparison of voluntary and blinded human immunodeficiency virus type 1 (HIV-1) seroprevalence surveys in a high prevalence sexually transmitted disease clinic population.
To compare the seroprevalence of and risk factors for human immunodeficiency virus infection (HIV) among patients attending a public sexually transmitted disease clinic, the authors conducted both voluntary and blinded seroprevalence surveys between June 1989 and August 1990. For the voluntary survey, every twenty-fifth patient attending the clinic for a new problem was invited to receive anonymous testing for HIV antibody. For the blinded survey, sera obtained for syphilis serologies from 2,297 (86%) of the 2,682 patients attending the clinic for a new problem were tested for HIV antibody after all personal identifiers were removed. Of the 946 eligible patients, 631 (66.7%) agreed to participate in the voluntary survey. Black men were significantly less likely to participate than other men and women (p < 0.0001). The prevalence of HIV antibody was 25% greater in the blinded survey than in the voluntary survey (15.2% and 11.4%, respectively, p < 0.05). This difference was due primarily to black homosexual/bisexual men, who had a 12.7-fold greater risk of HIV infection in the blinded survey than in the voluntary survey. These results suggest that blinded seroprevalence surveys may provide a better prevalence estimate of HIV infection than voluntary surveys. The greater risk for HIV infection observed among homosexual and bisexual black men, who were tested only in the blinded serosurvey, suggests that efforts to increase voluntary testing for HIV infection in this group should be developed.
Adolescent↗