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Biomedical subjects

R Mollica

Publications and source records attributed to R Mollica.

15 recordsLinked to original sources
PubMed2001

Neuropsychological issues in the assessment of refugees and victims of mass violence.

Brain injury, stressor severity, depression, premorbid vulnerabilities, and PTSD are frequently intertwined in trauma populations. This interaction is further complicated when the neuropsychologist evaluates refugees from other cultures. In addition, the observed psychiatric symptoms reported in refugees and victims of mass violence may in fact not be the primary features of PTSD and depression but psychiatric symptoms secondary to the effects of traumatic brain injury. This paper reviews the occurrence of starvation, torture, beatings, imprisonment, and other head injury experiences in refugee and POW populations to alert treators to the presence of chronic and persistent neuropsychiatric morbidity, with implications for psychosocial adjustment. The concept of fixed neural loss may also interact with environmental and emotional stresses, and a model of neuropsychological abnormalities triggered by traumatic events and influenced by subsequent stress will also be considered. Neuropsychologists working with refugees play an important role in assessing the possibility of traumatic brain injury with tools that are relatively culture-fair.

Adaptation, Psychological↗
PubMed2001

The evolution of assisted living. A view from the states.

Use of nursing homes has declined significantly with the expansion of home care services and the explosion of assisted living facilities. To give consumers more choices, many states allow assisted living facilities to provide higher levels of service that enable residents to continue to live as independently as possible as their needs change.

Aged↗
PubMed2001

[Reconstruction of mental health services in Bosnia and Herzegovina].

Psychiatric services in Bosnia-Herzegovina before the war disaster was fairly developed and one of the best organized services amongst the republics of the former Yugoslavia. The psychiatric care system was based on psychiatric hospitals and small neuropsychiatric wards within general hospitals, accompanied by psychiatric services in health centers. The onset of war in B&H brought devastation and destruction in all domains of life, including the demolition and closing of numerous traditional psychiatric institutions, together with massive psychological suffering of the whole civilian population. Already during the war, and even more so after the war, the reconstruction and reorganization of the mental health services was undertaken. The basis of mental health care for the future is designed as a system where majority of services is located in the community, as close as possible to the habitat of the patients. The key aspect of the system of the comprehensive health care is primary health care and the main role is assigned to family practitioners and mental health professionals working in the community. Large psychiatric institutions were either closed or devastated, or have their capacities extensively reduced. There will be no reconstructions or reopening of the old psychiatric facilities, nor the new ones will be built. The most integrated part of the psychiatric system are the Community based mental health centers. Each of these centers will serve a particular geographic area. The centers will be responsible for prevention and treatment of psychiatric disorders, as well as for the mental health well being. Chronic mental health patients without families and are not able to independently live in the community will be accommodated in designated homes and other forms of protected accommodation within their communities. The principal change in mental health policy in B&H was a decision to transfer psychiatric services from traditional facilities into community, much closer to the patients. Basic elements of the mental health policy in B&H are: Decentralization and sectorization of mental health services; Intersectorial activity; Comprehensiveness of services; Equality in access and utilization of psychiatric service resources; Nationwide accessibility of mental health services; Continuity of services and care, together with the active participation of the community. This overview discusses the primary health care as the basic component of the comprehensive mental health care in greater detail, including tasks for family medicine teams and each individual member. 1. Comprehensive psychiatric care is implemented by primary health care physicians, specialized Centers for community-based mental health care, psychiatric wards of general hospitals and clinical centers in charge of brief, "acute" inpatient care; 2. Primary mental health care is implemented by family practitioners (primary care physicians) and their teams; 3. Specialized psychiatric care in community is performed professional teams specialized mental health issues' within Mental health centers in corresponding sectors; 4. A great deal of relevance is given to development of confidence and utilization of links between primary health care teams and specialized teams in Mental health centers and psychiatric in patient institutions; 5. Psychiatric wards within general cantonal hospitals, departments of psychiatric clinics in Sarajevo, Tuzla, and Mostar, and Cantonal Psychiatric hospital in Sarajevo (Jagomir) shall admit acute patients as well as chronic (with each new relapse). Treatment in these facilities is brief an patients are discharged to return to their homes, with further treatment referral to their family practitioner or designated Mental health center; 6. Chronic mental patients with severe residual impairment in social, psychological, and somatic functioning, shall live in the community with their families or independently. Those chronic patients without families and economic and other resources to live independently shall be placed in supervised Homes in the communities where they live. The above delineated strategy of mental health care program in B&H has several fundamental and specific objectives, among which the most important are: Reduction of incidence and prevalence of some mental disorders, particularly war stress-related disorders and suicide; Reduction of level of functional disability caused by mental disorders through improvement of treatment and care of individuals with mental health problems; Improvement of psychosocial well being of people with mental health problems, through implementation of comprehensive and accessible service for community mental health care; and Respect of basic human rights of individuals with mental health disabilities. The program has been updated since 1996, after the two-year pilot program. The main goals for current two- and five-year period are: Implement the mental health care reform program by launching all 38 Mental health centers in the Federation of BiH by 2002; Complete the 10-day education and re-education of at least 50% of all professionals employed in mental health services in FB&H by 2002; and Achieve that 80 percent of all mental health problems are treated by family medicine teams (primary care practitioners) and specialized mental health services (Community mental health care centers) by 2005.

Bosnia and Herzegovina↗
PubMed1991

Cold-induced changes in plasma norepinephrine, epinephrine and dopamine concentrations in patients with Raynaud's phenomenon.

To investigate the role of the sympathetic system in Raynaud's phenomenon, which has not yet been elucidated, we measured the levels of norepinephrine, epinephrine and dopamine before, immediately and 30 min after the cold pressor test in plasma from 17 patients with primary, 6 with secondary Raynaud's phenomenon and 19 volunteers, matched for age and sex. Patients had significantly low baseline epinephrine (0.13 +/- 0.02 vs 0.37 +/- 0.04, nmol/l, p less than 0.001, mean +/- S.E.), but normal norepinephrine and dopamine (norepinephrine: 1.77 +/- 0.16 and 2.06 +/- 0.18; dopamine: 0.10 +/- 0.01 and 0.11 +/- 0.02, patients and controls). Immediately after the cold test norepinephrine significantly increased (p less than 0.001) in patients (2.42 +/- 0.22) and controls (3.24 +/- 0.28); epinephrine increased in patients (0.18 +/- 0.02, p less than 0.02); dopamine did not show any significant change (0.13 +/- 0.01 and 0.13 +/- 0.02, patients and controls). In the recovery period, while norepinephrine and epinephrine returned to baseline in both groups, dopamine increased in controls (0.21 +/- 0.04, p less than 0.005) but remained unchanged in patients (0.11 +/- 0.01). We conclude that there is no sympathetic overactivity in Raynaud's phenomenon and propose a role for circulating dopamine in post-ischaemic vasodilatation as an explanation for the particular behaviour of dopamine.

Adult↗
PubMed1990

Effect of chronic ketanserin treatment on serotonin-induced platelet aggregation in patients with Raynaud's phenomenon.

To investigate whether the variable efficacy in Raynaud's phenomenon of long-term oral ketanserin treatment might be related to variation in the sensitivity of 5-HT2 receptors to ketanserin, serotonin-induced platelet aggregation was measured in ten patients with Raynaud's phenomenon at various times after treatment with ketanserin. Platelet aggregation was completely inhibited 90 min after 40 mg ketanserin, but not 12-14 h after the last dose of 40 mg on the 31st day of continuous twice daily administration. However, 90 min after an additional dose of 40 mg, platelet aggregation was again completely inhibited. The present results indicate that ketanserin 40 mg b.d. does not continuously inhibit platelet 5-HT2 receptors in patients with Raynaud's phenomenon and suggest that more frequent intake might be more effective.

Administration, Oral↗
PubMed1975

Serum, renal, and urinary lysozyme levels after hypohysectomy.

Hypophysectomy is known to cause a rise in the renal lysozyme levels and atrophy of the proximal tubules of the kidney. The present study describes the relationship of serum, urinary, and renal lysozyme levels in hypophysectiomized animals. The renal lysozyme level continued to rise during the first 4 weeks after hypophysectomy and then remained constant while the serum level increased immediately after hypophysectomy and plateaued. Hypophysectomy did not produce lysozymuria for the time periods used in these experiments despite obvious tubular atrophy by the end of the 1st week after hypophysectomy. These data suggest that tubular atrophy must progress to a severe stage before a lysozymuria is produced. Thus the absence of urinary lysozyme activity does not exclude the possibility of proximal tubule injury.

Animals↗