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Biomedical subjects

T Kakuma

Publications and source records attributed to T Kakuma.

70 records · Page 4Linked to original sources
PubMed1994

Suicidal children grow up: suicidal episodes and effects of treatment during follow-up.

OBJECTIVES: This paper describes risk for first recurrent suicidal episodes in follow-up of suicidal child psychiatric inpatients. It identifies relations between suicide attempts in follow-up and psychosocial and psychopharmacological treatments. METHODS: First suicidal episodes involving either suicidal ideation or a suicide attempt in a 6 to 8 year follow-up period were rated for 69 child psychiatric inpatients and 64 children selected from the community. Psychiatric treatments were determined from reports from multiple sources. RESULTS: Forty-five percent of 133 subjects reported a suicidal episode during follow-up. Children who reported suicidal ideation or a suicide attempt were greater than twice as likely to report a suicidal episode in follow-up than were children from the community. Children treated with antidepressants in follow-up were more likely to attempt suicide than were those not treated with antidepressants. CONCLUSIONS: Close follow-up of suicidal children is warranted to identity risk and to intervene to prevent suicidal episodes. Lack of efficacy of naturalistic treatments implies that controlled treatment studies are needed to determine effective intervention for suicidal children.

Adolescent↗
PubMed1994

Suicidal children grow up: suicidal behavior and psychiatric disorders among relatives.

OBJECTIVE: This paper reports comprehensive data on psychiatric symptoms and disorders and medical problems of first- and second-degree biological relatives of prepubertal children who have contemplated or attempted suicide. METHOD: Standard family study and family history interview techniques were used to obtain information about psychopathology and medical illness in 488 first- and 1,062 second-degree relatives of 25 child psychiatric inpatients who reported suicide attempts, 28 child psychiatric inpatients who contemplated suicide, 16 nonsuicidal child inpatients, and 54 normal children. RESULTS: Suicidal behavior in children was associated with suicidal behavior in their families, although no first-degree relatives committed suicide. More first-degree relatives of child suicide attempters, compared to first-degree relatives of normal children, had antisocial personality disorder, assaultive behavior, and substance abuse. Mood disorders in first-degree relatives were not associated with child suicidal behavior. No significant associations were identified for psychopathology of second-degree relatives and child suicidal behavior. CONCLUSIONS: The results suggest the importance of evaluating familial psychopathology during assessments of suicidal children. Self-directed and externally directed violence, antisocial personality disorder, and substance abuse of relatives of suicidal children should be studied to elucidate the etiology of youth suicidal behavior.

Adolescent↗
PubMed1994

Sleep spindle frequency changes during the menstrual cycle.

Five healthy adult women aged 20 to 28 had 12-15 polysomnographic recordings, as well as daily basal body temperature and multiple LH, FSH, estrogen and progesterone measurements taken during a single menstrual cycle. Sleep stages were scored both visually and with a spindle and delta-wave, real-time, automatic analysing system. A cubic growth-curve model showed that the frequency of sleep spindles changed markedly over the menstrual cycle: spindle frequency was lowest about 18 days before onset of menses and highest 3 days before onset of menses. Slow waves did not change. The percentages of Stage 1 and REM sleep showed small changes during the menstrual cycle, and other parameters of visually scored sleep showed no tendency to change. Spindle frequency may reflect the effects of sex hormones on the reticular thalamic nucleus and may be a quantitative marker of premenstrual sleep disturbances.

Journal Article↗
PubMed1994

Cardiac and respiratory activity in panic disorder: effects of sleep and sleep lactate infusions.

OBJECTIVE: This study examined cardiac and respiratory activity in panic disorder patients and healthy comparison subjects during sleep, when the effects of anxious cognition and expectancy set are minimized. METHOD: Heart rate, respiratory rate, end-tidal PCO2, and oxygen saturation were recorded for 11 panic disorder patients and 12 comparison subjects before and during sleep and before and after infusions of sodium lactate and a saline control. RESULTS: Panic disorder patients had higher oxygen saturations than comparison subjects before sleep onset and during sleep stages 0 and 2 before any infusions. The two groups did not differ on other respiratory variables and heart rate. Panic disorder patients responded to lactate infusions during stage 3-4 sleep with greater increases in heart rate and oxygen saturation, and possibly in respiratory rate and end-tidal PCO2, than comparison subjects. The saline control infusion had little effect. CONCLUSIONS: These findings suggest that panic disorder patients have greater cardiac and respiratory reactivity than healthy comparison subjects during sleep, when the influence of cognitive factors is minimal or absent.

Adolescent↗
PubMed1993

Cloning and expression of cDNA for a human enzyme that hydrolyzes 8-oxo-dGTP, a mutagenic substrate for DNA synthesis.

8-Oxoguanine (8-oxo-7, 8-dihydroguanine) is produced in DNA, as well as in nucleotide pools of cells, by active oxygen species normally formed during cellular metabolic processes. 8-Oxoguanine nucleotide can pair with cytosine and adenine nucleotides at almost equal efficiencies, and transversion mutation ensues. Human cells contain enzyme activity, which hydrolyzes 8-oxo-dGTP to 8-oxo-dGMP, and this enzyme is responsible for preventing misincorporation of 8-oxoguanine into DNA. We purified this particular human enzyme to physical homogeneity and determined a partial amino acid sequence. We then cloned the cDNA for human 8-oxo-dGTPase and examined its nucleotide sequence. The human protein comprises 156 amino acid residues and has some sequence homology with the Escherichia coli MutT protein, which has a distinct 8-oxo-dGTPase activity. When the human cDNA was expressed in E. coli mutT- mutant cells, there was a significant amount of 8-oxo-dGTPase activity. In such cells, the frequency of spontaneous mutation was greatly reduced. We propose that the human 8-oxo-dGTPase protects genetic information from the untoward effects of endogenous oxygen radicals.

Amino Acid Sequence↗
PubMed1993

Suicidal children grow up: rates and psychosocial risk factors for suicide attempts during follow-up.

OBJECTIVE: Rates and psychosocial risk factors for suicide attempts during a 6 to 8-year follow-up period were compared for 25 predominantly prepubertal inpatient suicide attempters, 28 inpatient suicidal ideators, 16 nonsuicidal inpatients, and 64 nonpatients. METHOD: Standard research instruments were used to interview subjects and parents. Cox proportional hazard regression analyses were used to identify risk factors for a suicide attempt in the follow-up. RESULTS: No deaths occurred during follow-up. Suicide attempters were six times and suicidal ideators were three times more likely than were nonpatients to attempt suicide during follow-up. Poor social adjustment and mood disorder close to a recurrent suicide attempt were the strongest risk factors. CONCLUSIONS: Risk assessment should focus on identifying symptoms of mood disorders and impaired social adjustment in children with histories of suicide attempts and psychiatric hospitalization.

Adolescent↗
PubMed1993

Treatment response of borderline inpatients. A growth curve analysis.

This study examined the course of 40 hospitalized female borderline personality disorder patients over 25 weeks of inpatient treatment. Course was measured through weekly administration of the SCL-90-R. Level of identity and interpersonal problems, hypothesized by Kernberg to be at the center of the borderline patient's pathology, were found to be powerful predictors of treatment course. Patients with the most severe identity and interpersonal problems reported more symptoms throughout treatment and increasing symptom levels over time. This was very different from patients with the lowest level of identity and interpersonal problems, who reported fewer symptoms overall and decreasing symptoms over time.

Adult↗
PubMed1993

The course of geriatric depression with "reversible dementia": a controlled study.

OBJECTIVE: The goals of this longitudinal investigation were 1) to study the rate of development of irreversible dementia in elderly depressed patients with a dementia syndrome that subsided after improvement of depression and 2) to compare it with that of depressed, never-demented patients. METHOD: The subjects were 57 elderly patients consecutively hospitalized for major depression. At entry into the study, 23 subjects also met criteria for "reversible dementia," while 34 were without dementia. After a systematic clinical evaluation, the subjects were followed up at approximately yearly intervals for an average of 33.8 months. RESULTS: Irreversible dementia developed significantly more frequently in the depressed group with reversible dementia (43%) than in the group with depression alone (12%). Survival analysis showed that the group with reversible dementia had a 4.69-times higher chance of having developed dementia at follow-up than the patients with depression alone. No clinical characteristics at entry into the study were found to discriminate the subjects who developed irreversible dementia during the follow-up period from those who remained nondemented. CONCLUSIONS: These findings suggest that geriatric depression with reversible dementia is a clinical entity that includes a group of patients with early-stage dementing disorders. Therefore, identification of a reversible dementia syndrome is an indication for a thorough diagnostic workup and frequent follow-ups in order to identify treatable neurological disorders.

Aged↗
PubMed1992

Pain perception in self-injurious patients with borderline personality disorder.

Pain ratings during the cold pressor test were significantly lower in female inpatients with borderline personality disorder who report that they do not experience pain during self-injury (BPD-NP group, n = 11), compared with similar patients who report that they do experience pain during self-injury (BPD-P group, n = 11), and normal female subjects (n = 6). Pain ratings were not significantly different in the BPD-P and normal control groups. Self-report ratings of depression, anger, anxiety, and confusion were significantly lower, and ratings of vigor significantly higher following the cold pressor test in the BPD-NP group, but not in the BPD-P group. Only anxiety was significantly lower in the normal control group following the cold pressor test. The implications and limitations of these preliminary findings are discussed.

Adolescent↗
PubMed1991

Effects of nortriptyline on memory self-assessment and performance in recovered elderly depressives.

The effects of nortriptyline (NTL) on memory were compared with those of placebo (PBO), in elderly subjects after recovery from a major depression. Subjective and objective memory was assessed using a repeated-measures discontinuation design. Average immediate, but not delayed, free recall, on a 20-item selective reminding test was adversely affected by medication. Free recall on placebo was stable over four learning trials and at delay. A different pattern of responses occurred on nortriptyline: Performance dropped off significantly on learning Trial 2, remained worse than placebo through Trial 4, but improved after a 15-min delay. Performance on measures of immediate and delayed recognition memory were comparable on nortriptyline and placebo. Discontinuation of nortriptyline resulted in significant improvement on a subset of nine memory self-assessment items. On questions addressing ability to retrieve recently learned information, subjects reported the greatest improvement while on placebo compared with nortriptyline.

Aged↗
PubMedDate not supplied

State specificity of DST abnormalities in geriatric depression.

Pre-treatment and posttreatment dexamethasone suppression test (DST) results in physically healthy elderly major depressives without dementia demonstrated an association between treatment and DST normalization. Sixty percent of subjects were nonsuppressors at baseline compared to 17% after intensive treatment. DST results normalized in 75% of initial nonsuppressors; none of the initial suppressors converted to nonsuppression. A strong correlation between clinical improvement and decreases in afternoon cortisol levels was identified. Initial suppression status did not influence this association. There was a nonsignificant trend for very high (> 15 micrograms/dl) afternoon cortisol levels to be associated with delusional depression. The advantage of using continuous rather than categorical measures to assess the relationship between reversal of depression and DST results is discussed.

Aged↗
PubMedDate not supplied

Exploratory eye movement dysfunctions in patients with schizophrenia: possibility as a discriminator for schizophrenia.

In our previous studies patients with schizophrenia and their parents had less frequent eye fixations and a more limited area of inspection than normal controls while freely viewing stationary S-shaped figures. The present study attempted to discriminate schizophrenics from non-schizophrenics using exploratory eye movements. Two groups (A and B) were formed, each comprising 30 schizophrenic and 70 non-schizophrenic subjects (10 each of patients with depression, methamphetamine psychosis, alcohol psychosis, anxiety disorder, temporal lobe epilepsy, frontal lobe lesions and healthy normal controls). Discriminant analysis was performed on group A to obtain a discriminant. The validity of applying this discriminant to group B was investigated. By focussing on exploratory eye movements, schizophrenics could be discriminated from non-schizophrenics with a sensitivity of 76.7% and a specificity of 81.4%. These results show that exploratory eye movements are a useful discriminator for schizophrenia.

Adult↗
PubMedDate not supplied

A prospective 5-year follow-up study on the behavioral disturbances of community-dwelling elderly people with Alzheimer disease.

The aim of the present study was to determine the longitudinal course of behavioral disturbances and to examine whether these disturbances are stage dependent during the course of Alzheimer disease (AD). One hundred seven community-dwelling patients with probable AD were assessed up to six times annually by using a validated and reliable rating scale, the Troublesome Behavior Scale, for assessing the frequencies of behavioral disturbances. The subjects were divided into three groups according to their baseline global function as assessed by the Clinical Dementia Rating (CDR; 1 = mild, 2 = moderate, 3 = severe). At the end of the 5-year observation period, 31 subjects were still active participants, 52 had died, 20 lived in institutions, and 4 had stopped participating. The patterns of their behavioral disturbance changes depended to a considerable extent on the baseline severity of the illness. The behavioral disturbance frequencies generally peaked at the CDR 2 stage and followed a downward trend thereafter. Considerable individual variations in the disturbance frequencies during the course of the illness were observed. Knowing the behavioral course of AD will enable clinicians to better counsel families and appraise the results of treatments for behavioral symptoms.

Aged↗
PubMedDate not supplied

Analysis of behavioral disturbances among community-dwelling elderly with Alzheimer disease.

One hundred seven community-dwelling elderly patients with Alzheimer disease were enrolled in a study to evaluate the characteristics specific to the patients' and caregivers' situations that are associated with behavioral disturbances and to examine how these disturbances are related to caregiving stress. The frequencies of the disturbance were assessed by using the Troublesome Behavior Scale according to its three categories, agitation, hyperactivity, and miscellaneous. The patients' characteristics found to contribute most to their own behavioral disturbances were visual and speech function, activities of daily living, years of education, cognitive function, and sex, whereas the caregivers' characteristics contributing to these disturbances were duration of caregiving, age of caregiver, and relationship to the patient. In addition, a mutual relation among the three categories was found. Among the three categories, agitation was most strongly related to the caregivers' psychologic health status rated by use of the General Health Questionnaire. Behavioral disturbance as a whole was the only predictor of the patient's institutionalization within 2 years after baseline examination. Thus, behavioral disturbances were found to be influenced by the personal characteristics and situational circumstances of both the patient and caregiver, influencing, in turn, the caregivers' psychologic health status.

Activities of Daily Living↗