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Biomedical subjects

T Shapiro

Publications and source records attributed to T Shapiro.

At least 19 recordsLinked to original sources
PubMed1998

Effects of diagnosis, race, and puberty on platelet serotonin levels in autism and mental retardation.

OBJECTIVE: To reevaluate platelet serotonin (5-HT) levels in autism, measuring and controlling for effects of race and puberty. The specificity of hyperserotonemia for autism versus cognitive impairment is also assessed. METHOD: Platelet 5-HT levels were measured in 77 individuals, aged 2 through 37 years, with autistic disorder; 65 normal controls; and 22 mentally retarded or otherwise cognitively impaired (MR/CI) prepubertal children. Effects of diagnosis, race, and pubertal status were evaluated by analysis of variance in separate pre- and postpubertal groups. 5-HT levels were expressed as ng/mL blood and ng/microL platelet volume. RESULTS: Among prepubertal children, significant effects of diagnosis (ng/mL; F2,109 = 5.9, p = .004) and race (F2,109 = 14.7, p < .0005) were found. Autistic youngsters had significantly higher 5-HT concentrations than controls, although the elevation (25%) was less than typically reported; MR/CI children had levels very similar to those of controls. White children had significantly lower 5-HT levels than black or Latino youngsters, regardless of diagnosis. Diagnosis and race effects were nonsignificant in the postpubertal group. Postpubertal subjects had lower 5-HT concentrations than prepubertal subjects (ng/mL; F1,114 = 28.5, p < .0005). CONCLUSIONS: The data underscore the importance of matching for race and pubertal status in neuropsychiatric research and suggest that the prevalence of hyperserotonemia in autistic individuals may have been overestimated because of a failure to control for both variables. Hyperserotonemia was not found in MR/CI youngsters without autistic features.

Adolescent↗
PubMed1997

Evolution and revolution in child psychiatry: ADHD as a disorder of adaptation.

Current knowledge about early plasticity and children's responsiveness to environmental modifications as well as the atheoretical nature of current nosological systems necessitate alternative models to explain the phenomena of childhood behavioral and emotional disturbances. Evolutionary biology provides one such framework. It organizes data from the behavioral and cognitive sciences and parallels similar efforts in other areas of medicine and biology. Through an evolutionary biological lens, some mental disorders are better viewed as an adaptive response to early pathogenic environments and/or reflect the optimization of brain function to some environments at the cost of poorer response to the demands of other environments. As an example, the authors examine attention-deficit/hyperactivity disorder (ADHD) in relation to evolutionary theories of psychology and biology and clarify the potentially adaptive nature of characteristics of inattention, impulsivity, and motoric hyperactivity, depending on the nature of child's environments. Reframing ADHD characteristics according to evolutionary theory has important treatment implications for clinicians and offers researchers opportunities for novel scientific discoveries.

Adaptation, Psychological↗
PubMed1996

Exploration of failure on the subspecialty examination for child and adolescent psychiatry.

OBJECTIVE: The purposes of this study were to compare first-time performance on the oral examination for certification in child and adolescent psychiatry with first-time performance on the written and oral examinations for certification in general psychiatry and to identify factors that contribute to failure on the child and adolescent psychiatry oral examination. METHOD: To address the first question, two successive cohorts of first-time child and adolescent psychiatry candidates were identified, and chi-square analyses were used to explore the relationship between first-time performance on the different examinations. For the second question, a special checklist was developed and completed for all candidates who failed any section of the oral examination for child and adolescent psychiatry three successive times. RESULTS: There was no relationship between passing or failing the written and oral examinations for general psychiatry on the first attempt and passing or failing the child and adolescent psychiatry oral examination on the first attempt. The checklist results suggested that the failing candidates had difficulty in organizing and integrating case material. Other weaknesses were related to the specific sections of the oral examination. CONCLUSIONS: The results suggest that the knowledge and skills that are required to pass the child and adolescent psychiatry oral examination are different from those of the general psychiatry examination. The information about weaknesses should be of interest to general and child and adolescent psychiatric educators, candidates, and service delivery agencies.

Adolescent Psychiatry↗
PubMed1995

Developmental issues in psychotherapy research.

Research on psychosocial interventions with children requires attention to developmental principles such as age-specific competence, maturational shifts, increasing cone of relevant contacts, and socioeconomic context of biological stages. Research strategies that include such variables should lead to ecologically sound investigations and the correct selection of outcome variables. A consideration of the specificity of treatment and controlled design alone are not sufficient to guide the study of the psychological treatment of developing organisms and persons.

Child↗
PubMed1995

In vitro activity of beta-lactamase inhibitors against clinical isolates of Acinetobacter species.

Acinetobacter is an important cause of nosocomial infections, and it is often resistant to many antibiotics. In a search for alternative agents, three beta-lactamase inhibitors (sulbactam, clavulanate, and tazobactam) and five beta-lactam antibiotics (imipenem, ceftazidime, ceftriaxone, cefotaxime, and piperacillin) were tested against 68 unique clinical isolates of Acinetobacter species. Minimum inhibitory concentrations were determined by a broth microdilution method. Using temperature sensitivity testing, we identified 59 strains as Acinetobacter baumannii, one as Acinetobacter haemolyticus, and eight as indeterminate biotype species. We demonstrated 41 of 59 (70%) strains of A. baumannii to be multiply resistant (susceptible only to amikacin and imipenem), whereas all the nonbaumannii strains were not. Imipenem was the most active agent among the compounds investigated. All three beta-lactamase inhibitors had strong intrinsic activity, with sulbactam being the most active agent among the beta-lactamase inhibitors studied.

Acinetobacter↗
PubMed1995

An empirical study of defense mechanisms in panic disorder.

Psychodynamic factors have rarely been systematically studied in panic disorder, despite indications that these factors may be important in the understanding and treatment of panic. This is a report of a study using the Defense Mechanism Rating Scale to test the hypothesis that patients with panic disorder utilize particular defense mechanisms: reaction formation, undoing, and displacement. The use of defense mechanisms in 22 patients with primary panic disorder was compared with that of 22 patients with primary dysthymic disorder, based on Defense Mechanism Rating Scale ratings of psychodynamic interviews of these patients. Panic subjects scored significantly higher than dysthymics on the defenses of reaction formation and undoing, but not on the defense of displacement. The defense mechanisms found are consistent with a proposed psychodynamic formulation for panic disorder that emphasizes the panic patient's difficulty in tolerating angry feelings toward significant others. Knowledge of these defense mechanisms can be useful for various treatment approaches in panic disorder.

Adult↗
PubMed1994

Psychoanalytic facts: from the editor's desk.

The editor's vantage-point adds additional requirements to our concept of a psychoanalytic fact. The data of the psychoanalytic experience must pass peer review and enlist the conviction of the editors that what is asserted holds up to the general conceptions of truth within the context of the profession. Issues that converge on this process are reviewed, including how analysts report data, the context of discovery, and the adequacy of the written report as a convincing new contribution. Recent developments in the United States that bear on these matters are reviewed.

Authorship↗
PubMed1994

Reliability of the KIDIES for diagnosing pervasive developmental disorder in children.

The Kiddie-Infant Descriptive Instrument for Emotional States (KIDIES), a new instrument that uses affective and behavioral dimensions for categorization, was compared with DSM-III-R criteria to assess diagnostic reliability in childhood pervasive developmental disorder (PDD). Forty-two children with PDD and other developmental disorders were evaluated. Their diagnoses were based on DSM-III-R criteria. Subjects were videotaped during interviews with three different partners and rated using the KIDIES. Cluster analysis of KIDIES ratings revealed a significant correlation with DSM-III-R diagnostic categories, demonstrating the potential reliability of the KIDIES dimensional approach for diagnosing PDD in preschoolers.

Child Development Disorders, Pervasive↗
PubMed1993

Assessing the relationship between affective responsivity and social interaction in children with pervasive developmental disorder.

An investigation of children with pervasive developmental disorder (PDD) was conducted using a new instrument, the Kiddie-Infant Descriptive Instrument for Emotional States (KIDIES). The KIDIES rates several affective and behavioral dimensions based on facial, vocal, gestural, and postural cues. The study's goals were to determine whether the KIDIES could detect individual differences in responsivity among the PDD subjects; to ascertain the KIDIES' sensitivity in identifying group differences between PDD subjects and control children with other developmental disorders. Children were videotaped during episodes with three partners: the mother, a familiar female teacher, an unfamiliar male doctor. Episodes were scored using the KIDIES. PDD subjects were most severely impaired during the Mother episode in comparison to the controls. Equally as striking was the within-episode heterogeneity among PDD subjects. During the Teacher episode, PDD subjects were twice as variable in interpersonal response as the controls.

Affective Symptoms↗
PubMed1993

A psychodynamic model of panic disorder.

Current psychiatric research on panic disorder and its treatment are heavily influenced by neurobiological and cognitive-behavioral models rather than psychodynamic propositions, and psychodynamic treatment is generally considered to be of little benefit in amelioration of symptoms. However, because neither of the current models fully explains the clinical psychopathology, etiology, or pathogenesis of panic disorder, there is a need for further model building. The authors suggest that a psychodynamic approach may add to the understanding of patients with panic disorder. They base their psychodynamic formulation on pilot interviews with nine patients with panic disorder, published reports of psychological characteristics of patients with panic disorder, and data from infant and animal research on temperament. Interview results included the following: 1) all of the patients described themselves as fearful, nervous, or shy as children, 2) they remembered their parents as angry, frightening, critical, or controlling, 3) they frequently indicated discomfort with aggression, 4) most described chronic feelings of low self-esteem, 5) their spouses were characterized as passive, kind, and nonaggressive, and 6) stressors associated with frustration and resentment preceded the onset of panic. The authors propose a model in which inborn neurophysiological irritability predisposes to early fearfulness. Exposure to parental behaviors that augment fearfulness results in disturbances in object relations and persistence of conflicts between dependence and independence, which predispose to fears of feeling trapped, suffocated, and unable to escape and/or feeling alone and unable to get help. Catastrophic fears of helplessness in the face of suffocation or abandonment are easily accessible.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

On reminiscences.

Recently, psychoanalysts have focused on narrative truth and hermeneutics with diminished attention to the role of remembering in symptom formation and treatment. This shift has tended to remove us from prior status as a motivational and cognitive science with potential for causal inferences. At the same time, psychiatry and cognitive science have moved toward a vigorous study of reminiscences and their role in pathology. Arguments for a revival of Freud's position on the central role of memory are cited. A case example is offered to show that Freud and his psychoanalytic progeny have never taken a simplistic view of archeological truth, but were among the original group to bring to light the distorting effect of mind on remembering, and actually led the way for other scientific approaches.

Fantasy↗
PubMed1993

On psychoanalytic listening: language and unconscious communication.

The authors review past and recent perspectives on psychoanalytic listening, then present a synthetic model founded on psycholinguistics and semiotics. They argue that the analytic listening process can be broken down into nonlinguistic communications and--most important--linguistic categories pertaining to narrativity, symbolic reference, form, and interactive conventions. In each of these areas of signification, the authors present the ways in which the technique of psychoanalytic listening attends to unconscious meanings, thereby differing from ordinary listening which "hears," at best, only denotative and connotative meanings.

Attention↗
PubMed1993

Epidural anesthesia for labor in an ambulatory patient.

The effectiveness of two epidural analgesic regimens on the ability to ambulate was compared in women in labor by a prospective, randomized, double-blind design. One group of patients received epidural fentanyl, a 75-micrograms bolus and an infusion of fentanyl 2.5 micrograms/mL at 15 mL/h (FENT, n = 53). A second group received ultra low-dose bupivacaine (0.04%), epinephrine (1.7 micrograms/mL), and fentanyl (1.7 micrograms/mL) (BEF, n = 77), a 15-mL bolus followed by an infusion at 15 mL/h. Adequate analgesia was rapidly obtained in 90.6% of patients in the FENT group and 92.2% of patients in the BEF group (P = 0.89). Seventy percent of patients in the FENT group ambulated versus 68% in the other group. The BEF mixture provided analgesia of longer duration (287 +/- 171 min versus 156 +/- 72 min, P = 0.0001). The number of patients delivering during administration of only their study drug (without needing higher doses of local anesthetics) was 52% for BEF and 21% for FENT (P = 0.0005). Hip flexion weakness precluding ambulation occurred in 17% (P = 0.002) of BEF patients and orthostatic hypotension in 9% (P = 0.08). Neither problem occurred in FENT patients. Neonatal outcome was similar in both groups. Approximately 70% of women receiving epidural analgesia with fentanyl or ultra low-dose bupivacaine, epinephrine, and fentanyl may ambulate safely during labor.

Adolescent↗
PubMed1992

Postpartum paravaginal hematoma and lower-extremity infection.

We report a case of infection of the lower extremity after a normal vaginal delivery. The infection originated in an occult obturator internus muscle hematoma, and diagnosis was based on a clinical suspicion and characteristic findings on computerized tomography scan. These findings permitted prompt surgical drainage, debridement, and antibiotic therapy and resulted in a successful outcome.

Adult↗