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PubMed2002

The general public's perceptions and use of antimicrobials in Trinidad and Tobago.

OBJECTIVE: To determine the general public's perceptions and use of antibiotics in Trinidad and Tobago, a two-island republic in the Caribbean. METHODS: This prospective study surveyed 824 randomly selected households listed in the telephone directory, from November 1998 to January 1999. Through telephone interviews we determined knowledge about antibiotics and beliefs concerning their safety and efficacy. We studied the influence of age, gender, education, and having private health insurance on knowledge, self-medication, storing medication at home for emergency use ("hoarding"), and asking a private doctor to prescribe antibiotics ("demand prescribing"). RESULTS: For the 824 telephone calls that the interviewers completed, 753 of the households agreed to participate (91.4% response rate). Of those 753 participants, 699 of them (93%) knew the term "antibiotic," 29% (206/699) said it was a drug for bacterial infections, and 25% (170/690) had asked a doctor for an antibiotic prescription. Penicillin was correctly identified as an antibiotic across age, gender, and education categories, but 36% of respondents incorrectly said Benadryl (diphenhydramine), a common over-the-counter cough and cold formulation, was an antibiotic. Gender was not significantly associated with knowledge of antibiotic safety, with self-medication, or with hoarding antibiotics. On the other hand, completion of tertiary (university) education was significantly associated with correct knowledge of the safety of antibiotics and whether or not they could cure all infections. Of the various antimicrobials, beta-lactams were the ones that survey respondents had used most frequently in the preceding year, and 20% of antibiotics users had used multiple antibiotics in that period. In comparison to persons with private health insurance, more individuals without private health insurance said that antibiotics are safe and do not have side effects, and more of them also incorrectly called aspirin and Benadryl antibiotics. CONCLUSIONS: In Trinidad and Tobago, inappropriate use of antimicrobials results from self-medication, over-the-counter availability at the community pharmacy, prescribing on demand, and lack of regulatory control. In order to contain antibiotic abuse, both the Drug Inspectorate of the Ministry of Health and the Pharmacy Board should exert stricter control on the dispensing of antibiotics at private pharmacies. Further, education of the general public and of health care professionals on antibiotic misuse and appropriate use must be instituted, along with community-based surveillance of antimicrobial resistance trends.

Adolescent↗
PubMed1982

The family medicine cabinet.

Medicine selection and storage was examined in 130 families. Over 50 per cent were found to be less than adequate. Health education advice helped half the inadequate group to change to adequate. Age and social class were not related to hoarding of prescribed drugs, to initial standards of storage or selection, nor to the likelihood of a response to advice. Those who hoarded medicines but stored them well were highly likely to change. Those who stored and selected poorly were unlikely to make any changes. The 130 families had an average of 8.6 prescribed drugs per house, over half of which were completely out of date and were not being kept for emergency usage. There were also an average of 14.2 non-prescribed items per house, giving a total of 22.8 per house.

Drug Storage↗
PubMed1994

Self-injurious behavior and serotonin in Prader-Willi syndrome.

Low central nervous system (CNS) serotonin levels have been associated with impulsive, aggressive and self-injurious behavior (SIB). Persons with Prader-Willi Syndrome (PWS) often engage in self-injury by severe compulsive skin picking and gouging and often manifest compulsive eating, hoarding, and explosive outbursts. Some of the compulsive behaviors seen in patients with obsessive-compulsive disorder (OCD) bear similarity to behaviors associated with PWS: Skin picking, trichotillomania, and onychophagia (nail biting). There is abundant evidence that selective serotonin reuptake inhibitors (SSRIs) are effective in treating OCD. Three cases are described in which persons with PWS responded favorably to SSRI treatment. Two persons showed a significant decrease in skin picking. The third case showed a significant decrease in hoarding and explosive outbursts. Strategies are discussed for investigating the possibility of a shared neurochemical basis for the self-injurious, aggressive, and compulsive behaviors in persons with PWS. PWS may provide a relatively homogenous model for the study of skin picking and explosive outbursts among other populations.

Adult↗
PubMed1988

Perianal cellulitis. Cutaneous group A streptococcal disease.

Five case reports of perianal cellulitis caused by group A beta-hemolytic streptococci are presented. These reports illustrate delays in diagnosis and therapy of this condition that may present as chronic diaper dermatitis, perirectal fissures, painful defecation, fecal hoarding behavior, or proctocolitis. One patient had associated guttate psoriasis. In children especially, guttate psoriasis should alert physicians to culture perirectal as well as pharyngeal sites for group A streptococci.

Adult↗
PubMed1998

Contending paradigms for the interpretation of data on patient compliance with therapeutic drug regimens.

Electronic and chemical marker methods provide the first reliable measurements of drug exposure in ambulatory trials. These data contradict the usual claim in published drug trials of > 90% of patients having been satisfactorily compliant with the protocol-specified dosing regimen. Such exaggerated claims are based, usually, on count of returned dosing forms, which afford patients easy ability to manipulate by discarding or hoarding untaken doses. Electronic monitoring provides, for the first time, data on intervals between doses, revealing the 'drug holiday'--3 or more consecutive days without dosing--as a basis not only for lapsed therapeutic action, but as a pharmacodynamic trigger for hazardous rebound effects on recurrent first dose effects. Another new findings is the evident non-specificity of poor or partial compliance, the range and distributions of which appear to be hardly affected by drug, disease, prognosis, or symptoms. This finding contradicts often repeated but unsupported claims that noncompliance is a specific response to drug action, disease, prognosis or other treatment-related factors. New statistical methods are needed for trial design and analysis, to use drug exposure data as covariate information, to incorporate into drug labelling estimates of dose-related efficacy, holiday-related hazard, the limits of safe variation in dose-timing, and what one should best do when those limits are exceeded. Oral contraceptive labelling in the U.K. and U.S. is exemplar for this next step toward full-disclosure labelling.

Clinical Trials as Topic↗
PubMed1997

Behavioural disturbances in psychiatric inpatients with dementia of the Alzheimer's type in Taiwan.

This report studied behavioural disturbances in psychiatric inpatients with dementia of the Alzheimer's type (DAT) in Taiwan. The sample consisted of 75 inpatients with DAT who were consecutively admitted to the geropsychiatric ward. Their behavioural disturbances were obtained from semistructured interviews with families and ward observation. There were eight main behavioural disturbances: getting lost, repetitive phenomena, sleep disturbance, aggression, wandering, hyperphagia, hoarding behaviour, and inappropriate sexual behaviour. Number of behavioural disturbances, wandering, hyperphagia and sleep disturbance were significantly associated with the severity of cognitive impairment.

Aged↗
PubMed1999

Punding on L-dopa.

"Punding" is a stereotypical motor behavior in which there is an intense fascination with repetitive handling and examining of mechanical objects, such as picking at oneself or taking apart watches and radios or sorting and arranging of common objects, such as lining up pebbles, rocks, or other small objects. It is thought to be dopamine-related although only a single report of punding in a patient with Parkinson's disease (PD) resulting from L-dopa has been reported. We describe three additional cases. All were women aged 65-72 years with a PD duration between 10 and 20 years, on 500-1900 mg L-dopa per day. One spent hours in the market fascinated by cans. At home she endlessly examined and catalogued her jewelry. Another picked threads in rugs indoors and weeded her garden compulsively to the point of wetting herself rather than stopping. The third hoarded flashlights taking them apart and reassembling them. All improved with reduction of their anti-PD medications. We think punding is an uncommon but overlooked complication of dopaminergic drugs.

Aged↗
PubMed2004

Obsessive-compulsive disorder in patients with velocardiofacial (22q11 deletion) syndrome.

The study of neurogenetic microdeletion syndromes provides an insight into the developmental psychopathology of psychiatric disorders. The aim of the study was to evaluate the prevalence of psychiatric disorders, especially obsessive-compulsive disorder (OCD), in patients with velocardiofacial syndrome (VCFS), a 22q11 microdeletion syndrome. Forty-three subjects with VCFS of mean age 18.3 +/- 10.6 years were comprehensively assessed using semi-structured psychiatric interview and the Yale-Brown obsessive compulsive scale (Y-BOCS). Best estimate diagnoses were made on the basis of information gathered from subjects, parents, teachers, and social workers. Fourteen VCFS subjects (32.6%) met the DSM-IV criteria for OCD. OCD had an early age of onset and generally responded to fluoxetine treatment. It was not related to mental retardation. The most common obsessive-compulsive symptoms were contamination, aggression, somatic worries, hoarding, repetitive questions, and cleaning. Sixteen of the 43 patients (37.2%) had attention-deficit/hyperactivity disorder (ADHD), and 7 (16.2%) had psychotic disorder. The results of our study suggest that there is a strong association between VCFS and early-onset OCD. This finding may be significant in the understanding of the underlying genetic basis of OCD.

Adolescent↗
PubMed2006

Factor analysis of obsessive-compulsive disorder YBOCS-SC symptoms and association with 5-HTTLPR SERT polymorphism.

Symptoms defining obsessive-compulsive disorder (OCD) are diverse. Factor analyses of OCD symptoms have been used to evaluate obsessive-compulsive phenotypes that are thought to be more homogenous than the macro phenotype. There is evidence that three factors (symmetry/ordering, obsessions/checking, and hoarding) are familial and preliminary evidence that repetitive rituals are associated with a functional polymorphism in the promotor region of the serotonin transporter gene (5-HTTLPR). The goal of this study was to examine relationships between OCD symptom dimensions and 5-HTTLPR. We genotyped 153 subjects who met DSM-IV criteria for OCD. We used the Yale-Brown obsessive-compulsive scale symptom checklist (YBOCS-SC) to assess OCD symptoms. Using principle components analysis, we derived four factors from the 13 symptom categories of the YBOCS-SC in this patient sample, which replicated previous factor analyses of this scale. The frequencies of the S allele and the SS genotype were associated with the second factor including obsessions regarding symmetry and compulsions involving repeating, counting, and ordering/arranging. This study may contribute to understanding of molecular genetic features underlying the appearance of symptom clusters in OCD.

Adult↗
PubMed2002

Obsessive-compulsive disorder with and without tics in a clinical sample of children and adolescents.

The purpose of this study was to discriminate subtypes of obsessive-compulsive disorder (OCD) in a clinical sample of children and adolescents. Sixty OCD patients were assessed in two outpatient psychiatric clinics; 15 patients had a lifetime history of tics and 45 patients had no tic history. Interviews were conducted with the patients and their parents by a child psychiatrist using the Children's Yale-Brown Obsessive Compulsive Scale (CY-BOCS). The symptom checklist of the CY-BOCS was used to categorize obsessions and compulsions. Discriminant function analysis was used to compare the two groups in their symptomatology. There was no difference between the two groups in seven obsession categories. However, there was a significant difference between the two groups in seven compulsion categories. Ordering, hoarding, and washing compulsions were more common in those with no tic history. The results indicate that tic-related OCD may be differentiated from non-tic-related OCD early in life by the presence or absence of certain compulsive symptoms.

Adolescent↗
PubMed2002

Social vole parents force their mates to baby-sit.

Parental care has been categorized into direct and indirect investment. The former includes direct contact with the offspring, as in lactation or huddling with the pups, and the latter includes activities such as nest building or hoarding food for the guarding mate. We report here an unfamiliar type of parental behavior in which one parent aggressively forces its mate to stay in the nest with the pups. In this "forced baby-sitting," one parent grasps the fur of its mate and drags it toward the nest. The behavior was observed in 6 of 10 pairs of the social vole (Microtus socilalis guentheri) and was typically executed by the male. Dragging the mate to the nest was not correlated with other parental behaviors; neither could we explain why/when it occurred. However, this behavioral pattern was eye catching, and its goal was obviously to enforce the mate to stay in the nest with the pups.

Animals↗
PubMed2003

Obsessions and compulsions in anorexia nervosa subtypes.

OBJECTIVE: Obsession and compulsions in anorexia nervosa (AN) patients are often confused with the preoccupations and rituals that are characteristic of obsessive-compulsive disorder (OCD). We examined the type and frequency of characteristic OCD obsessions and compulsions in a large sample of AN patients. METHOD: In personal interviews with 324 AN patients, we assessed lifetime histories of eating disorder symptomatology and obsessive-compulsive behaviors with valid semistructured interviews. Checklist category sums on the Yale-Brown Obsessive Compulsive Scale were compared between AN and OCD subjects using generalized estimating equations. RESULTS: Lifetime obsessions and compulsions occurred in 68% of the AN restricting type and in 79.1% of the AN binge/purge type. The AN subgroups did not differ from OCD controls in frequency of obsessions in the symmetry and somatic categories or in the compulsion categories of ordering and hoarding. In all other categories, the AN subgroups had a significantly lower frequency compared with the OCD controls. DISCUSSION: Some common phenotype characteristics shared by most AN and OCD patients suggest these disorders may share common brain behavioral pathways. However, the lack of complete overlap indicates they most likely have different loci of pathology within those pathways.

Adult↗
PubMed2006

Comparative efficacy of risperidone versus haloperidol on behavioural and psychological symptoms of dementia.

BACKGROUND: Behavioural and psychological symptoms of dementia (BPSD) cannot be regarded as a single clinical syndrome, but rather as a heterogeneous group of symptoms, each of which can be considered as possible targets for therapy. OBJECTIVE: To compare the efficacy of risperidone and haloperidol on specific manifestations of BPSD. METHODS: A post-hoc analysis was conducted using data from an 18-week, randomized, double-blind, crossover head-to-head trial of risperidone vs haloperidol in treating 114 nursing-home residents with BPSD. Dependent variables were item scores of the Korean versions of the Behavioural Pathology in Alzheimer's Disease Rating Scale (BEHAVE-AD-K) and Cohen-Mansfield Agitation Inventory (CMAI-K). RESULTS: On the BEHAVE-AD-K, risperidone was significantly more effective than haloperidol in treating wandering (p = 0.0496), agitation (p = 0.0091), diurnal rhythm disturbances (p = 0.0137), anxiety regarding upcoming events (p = 0.0002), and other anxieties (p = 0.0088). On the CMAI-K, risperidone was significantly more effective in treating physical sexual advances (p = 0.0202), pacing and aimless wandering (p = 0.0123), intentional falling (p = 0.0398), hoarding things (p = 0.0499), performing repetitious mannerisms (p = 0.0048), repetitive sentence or questions (p = 0.0025), complaining (p = 0.0101), and negativism (p = 0.0027). Haloperidol was not significantly superior to risperidone on any individual item in either scale. CONCLUSIONS: When comparing treatment effects on individual symptoms frequently occurring in patients with dementia, risperidone significantly improved symptoms of agitation, wandering, diurnal rhythm disturbance and anxieties, among other symptoms, compared with haloperidol.

Aged↗
PubMed1995

Comparative studies of food-storing, memory, and the hippocampal formation in parids.

Birds which scatter-hoard large numbers of food items such as marsh tits, Parus palustris, use memory to retrieve their caches and have an enlarged hippocampal formation relative to the rest of the telencephalon compared with species that store little or no food. Preliminary observations suggested that captive blue tits, P. caeruleus, may store small quantities of food albeit in limited amounts. This experiment compared food-storing intensity, memory for cache sites, and relative hippocampal formation in marsh tits and blue tits. Comparisons were made both within species, by comparing wild-caught adults and hand-raised juvenile blue tits that store and those that do not, and between closely related species, by comparing food-storing adult wild-caught blue tits and juvenile hand-raised blue tits with adult wild-caught marsh tits. Food-storing blue tits stored fewer seeds than did marsh tits, and they had a less accurate memory for cache sites and a smaller absolute and relative hippocampal formation than did marsh tits. For further analysis, the hippocampal volume was divided into a rostral (front) portion and a caudal (rear) portion, separated by the first appearance of the anterior commissure. Marsh tits had both larger rostral and caudal portions than did blue tits, but the species difference in hippocampal volume was greater for the rostral than for the caudal portion. In blue tits, wild-caught adults had significantly larger absolute and relative hippocampal volumes than did hand-raised juveniles, but there was no difference in the proportion of rostral to caudal portions, irrespective of whether they had stored and retrieved food. Although food-storing blue tits did not differ from non-storing blue tits in total absolute or relative hippocampal volume, they had larger rostral portions of the hippocampal formation and small caudal portions. Possible reasons for this are discussed.

Animals↗
PubMed2004

Challenges in treating obsessive-compulsive disorder: introduction.

This issue of In Session is devoted to challenges in the treatment of obsessive-compulsive disorder (OCD). The remarkable diversity of symptoms and the comorbidity in OCD pose substantial challenges to practitioners seeking to treat this disorder. After briefly reviewing the clinical features of OCD and its typical treatment, we provide brief descriptions of the six articles this issue comprises. Articles focus on the treatment of OCD with comorbid depression, compulsive hoarding, incompleteness, and repugnant obsessions, and on treatment of children who have OCD. The final article describes pharmacotherapy for OCD. All articles feature case vignettes and provide practitioners with clinical recommendations.

Adult↗
PubMed1989

Relationships between spleen and respiration in the newt.

Specimens of newt, Triturus cristatus carnifex (Laurenti), anesthetized by submersion in 0.2% chlorbutol in tap water for 15 min, and then placed out of water in a damp terrarium, show hypertrophy of the spleen that in 2 hr gradually increases from 0.31 +/- 0.12%with respect to body weight to 1.56 +/- 0.26% (means and standard deviation calculated for groups of six animals). Other anesthetics either do not produce hypnosis (Veronal), do not have a prolonged enough effect (ethyl ether, chloroform), or induce vasodilatation, which prevents hypertrophy (MS-222, urethane). The spleen hypertrophy, seen histologically to be due exclusively to blood congestion, is not caused by either a pharmacological effect of the chlorbutol or by the hypnotic state, as it does not appear in submerged anesthetized animals, unless the water is constantly stirred by a magnetic agitator, and can be reversed depending on the ventilation of the animal's skin. The spleen hoards blood when oxygenation is good (in air or stirred water) and releases this supply in the bloodstream when oxygenation is insufficient (in still water). The hypoxic "diffusion boundary layer," which, in still water, forms around the immobile newts, hampers respiratory exchange and stimulates the spleen contraction. This mechanism and its relationship to oxygenation has been demonstrated statistically in unanesthetized newts as well, in both air and water, despite the interference of two contrasting factors--lung respiration and spontaneous motor activity--absent in anesthesized animals. Congestion and decongestion of the spleen are the physiological mechanisms compensating for variations in the level of oxygenation, an alternative to the "capillary recruitment" described by Poczopko and Burggren and Moalli in may amphibians that appears to be absent in newts. The newt spleen, known to play a lesser role in erythropoiesis and destruction of aged erythrocytes than that traditionally assigned to it is thus of primary importance in respiration.

Anesthesia↗
PubMed1998

Vigilance as a benefit of intermittent locomotion in small mammals

In many animal species, locomotion is frequently interrupted by brief pauses. This intermittent locomotion is usually considered a mode of prey search, but other possible functions include reduced detection or attack by predators and improved endurance. We tested the hypothesis that pauses also serve to improve vigilance for predators in two species of sciurid rodent. Videotaping animals travelling between food-collecting and food-hoarding sites revealed that numerous short pauses comprise 5-38% of the time spent 'moving' in grey squirrels, Sciurus carolinensis, and 0-41% in eastern chipmunks, Tamias striatus. In this situation, search for food items did not occur, and pausing did not reduce the total time spent as a moving stimulus for predators. It also appeared that speed while running was too slow and the pauses too brief to provide an endurance advantage. As predicted by the vigilance hypothesis, both species spent more time pausing when moving away from forest cover (presumably towards areas of higher risk) than when travelling back towards forest cover. In control trials within forest cover, squirrels did not differ in time pausing when approaching and leaving patches, but chipmunks paused more when approaching patches than when leaving them. We conclude that one function of pausing in squirrels is to improve anti-predator vigilance. The occurrence of pausing by chipmunks did not match a priori predictions of the vigilance hypothesis. Because it also failed to match predictions of previous alternative hypotheses, we suggest that studies are needed to examine whether the risk of attacks by conspecifics and predators is higher for chipmunks approaching than leaving food patches in forest habitat. Copyright 1998 The Association for the Study of Animal Behaviour.

Journal Article↗
PubMed1998

Influence of competitors on caching behaviour in the common raven, Corvus corax.

Both territorial breeding common ravens and nonbreeding vagrants scatter-hoard carcass meat extensively. We show experimentally with four captive nonbreeders in a large semi-natural enclosure that common ravens alter their caching behaviour in the presence of conspecifics. When four birds were simultaneously given a small amount of food, which any one bird by itself could easily remove in several trips, all four birds decreased the latency to begin caching and increased caching speed. In contrast, when the four birds were given only enough food for a single individual to control, caching was greatly delayed. If, as these results suggest, competition between conspecifics over food sources induces caching behaviour, then individuals should cache close to the food source to reduce travelling time and increase the time available to effectively compete for food in the presence of conspecifics. Here we show, that in the presence of competitors, common ravens instead cached further from the food source, provided they had space into which they could escape from the sight of the competitors. When escape from competitor vigilance was not possible, common ravens delayed caching and/or hid food when the competitor was preoccupied. A second factor that influenced caching behaviour was cache robbing; ravens not only recovered their own caches, but also routinely recovered the caches they saw others make. Copyright 1998 The Association for the Study of Animal Behaviour.

Journal Article↗