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PubMedDate not supplied

Use of carbamazepine in psychiatric disorders.

Use of carbamazepine for the treatment of psychiatric disorders is reviewed. Carbamazepine's mechanism of action may be related to inhibition of kindling (repeated subtherapeutic electrical stimulation) in the temporal lobe and limbic system. In most published studies, carbamazepine was useful in affective disorders, especially in patients with bipolar manic disorders. In controlled, double-blind studies in patients with primary affective or schizoaffective disorders, carbamazepine significantly decreased manic symptoms and showed some antidepressant effect. Synergistic effects have been observed when carbamazepine is used with lithium. Carbamazepine has been reported to decrease symptoms in patients with aggression, dyscontrol syndromes, schizophrenia, and alcohol withdrawal syndrome, but few of these studies have been controlled, comparative trials; carbamazepine may be useful in patients with these disorders who do not respond to conventional therapies. Beneficial effects of carbamazepine in psychiatric disorders are usually observed with doses of 400-1600 mg/day and serum concentrations of 8-12 micrograms/mL. Carbamazepine is useful alone or in combination with other agents for bipolar affective disorders, especially in patients who are intolerant of or unresponsive to lithium. Serum carbamazepine concentration, hematological profile, and serum electrolytes should be monitored carefully to minimize the risk of toxicity.

Antipsychotic Agents↗
PubMedDate not supplied

Caregiver strain and caregiver burden of primary caregivers of stroke survivors with and without aphasia.

Little is known about how the burden and strain of caring for stroke patients with or without aphasia affects primary caregivers. This article (a) critically examines the literature on the burden and strain of care experienced by caregivers of stroke patients and (b) examines the relationship between aphasia and caregiver burden and strain. Two literature reviews of three databases were conducted. Fourteen articles (12 quantitative articles, 1 mixed-design article, and 1 qualitative article) were found to comply with the study criteria for the first literature search. A second literature search focused on the effects of stroke survivors' aphasia on caregiving; none of the articles retrieved met the inclusion criteria. This article suggests that there is a lack of research in this area and that several key initiatives are needed, including the development of an instrument with psychometric properties appropriate for assessing the burden and strain on caregivers of stroke patients. Implications for future nursing practice and research are highlighted.

Adaptation, Psychological↗
PubMed1987

The association of supersensitive cholinergic REM-induction and affective illness within pedigrees.

Based on the Rieder and Gershon (1978) biological genetic study paradigm we compared the prevalence of a putative vulnerability factor (rapid cholinergic REM sleep induction) between 35 affectively ill and 31 well first-degree relatives of 34 probands chosen on the basis of presence of primary affective illness and positive marker status. A significantly higher percentage of ill relatives (63%, 22 out of 35 subjects) had a supersensitive REM-induction response as compared to well relatives (22%, 7 out of 31 subjects). Since the current study does not rule out the effects of prior depressive episodes or treatment on cholinergic sensitivity, caution must be exercised in the interpretation of our findings.

Acetylcholine↗
PubMed2005

The impact of donor factors on primary non-engraftment in recipients of reduced intensity conditioned transplants from unrelated donors.

BACKGROUND AND OBJECTIVES: Primary graft failure is a serious complication following hematopoietic cell transplants, particularly when using unrelated donors. We analyzed factors affecting primary graft failure in recipients of hematopoietic cell transplants from unrelated donors, which were performed using reduced intensity conditioning. DESIGN AND METHODS: This was a retrospective analysis of 144 patients whose transplants took place between March 1998 and October 2004. The data were analyzed in January 2005. RESULTS: The median age of the patients was 51 years. The diagnoses were varied. Conditioning regimens were fludarabine, melphalan, campath (n=80), fludarabine, busulphan, campath (n=38), fludarabine, BEAM, campath (n=9) and other (n=17). The donor was 10/10 allele matched in 95/144 (66%) cases; 94 donated bone marrow and 50 peripheral blood stem cells. The 3-year probability of overall survival was 43%. The median follow-up was 724 days (range: 91-1651 days). Of evaluable patients, 7/140 (5%) failed to achieve myeloid engraftment. Primary graft failure was significantly associated with the use of a mismatched donor (6/47,13% versus 1/93, 1%, p=0.006), as well as: bone marrow as the source of stem cells (p=0.046), chronic myeloid leukemia compared to other diagnoses (p=0.022), and a female rather than a male donor (p=0.019). In multivariate analysis chronic myeloid leukemia, HLA mismatched and/or female donors remained significantly associated with primary graft failure. Single HLA mismatches were tolerated, however in multiply mismatched grafts, overall survival was worse (p=0.005); transplanted-related mortality (p=0.005) and chronic graft-versus-host disease (p=0.025) were increased. INTERPRETATION AND CONCLUSIONS: These data have implications for the choice of donor and stem cell source in transplants performed using reduced intensity conditioning regimens, suggesting that the use of bone marrow, female donors and HLA-mismatched grafts increase the risk of primary graft failure, and should be avoided in certain situations.

Adolescent↗
PubMed1977

Pituitary thyrotropin response to thyrotropin-releasing hormone in affective illness: relationship to spinal fluid amine metabolites.

The authors studied pituitary thyrotropin, i.e., thyroid-stimulating hormone (TSH), response to thyrotropin-releasing hormone (TRH) in patients with primary affective disorder. There were no overall differences between either depressed or manic patients and normal controls; however, the TSH response was significantly lower in the unipolar depressed patients than in either bipolar depressed patients or normal subjects. Bipolar patients in the manic phase tended to have a lower response than bipolar depressed patients. In the unipolar group, the TSH response showed a significant negative correlation with the serotonin metabolite 5-hydroxyindoleacetic acid (5-HIAA) in the CSF. These neuroendocrine responses may constitute markers of specific monoamine dysfunction in subgroups of patients with affective illness.

Age Factors↗
PubMed1990

Identification of T-helper cells as the target of stearic acid-inhibition in primary antibody responses in vitro.

We have previously shown that albumin-complexed stearic acid (18:0) inhibited in vitro primary anti-TNP plaque-forming cell (PFC) responses to trinitrophenyl keyhole limpet hemocyanin (TNP-KLH), but did not affect primary PFC responses to trinitrophenyl lipopolysaccharide (TNP-LPS). The present studies were done to identify the cellular target of fatty acid inhibition. The addition of 18:0 at the initiation of antibody cultures exerted a dose-dependent inhibitory effect on subsequent PFC responses to TNP-KLH, and removal of the fatty acid after 20 h did not reverse its inhibitory effect. Preincubation of isolated T-cells with TNP-KLH and 18:0 resulted in a similar inhibition of subsequent PFC responses, but a preincubation of isolated B-cells had no effect. The addition of 18:0 to the culture system in vitro led to a marked reduction in the level of IL-2 detectable in culture supernatants, and PFC responses could be restored by providing exogenous mouse recombinant IL-2. The addition of antigen-primed T-helper cells to antibody cultures partially abrogated the inhibition by 150 microM 18:0, apparently due to their greater production of IL-2. Lastly, following overnight incubation of unfractionated splenic lymphocytes in the presence of TNP-KLH and [1-14C]-18:0, B-cells were shown to contain nearly 5-fold more radiolabeled oleic acid (18:1) than T-cells. Collectively, these findings implicate T-helper cells as the principle target of 18:0-inhibition of primary antibody responses in vitro, possibly as a result of the inability of T-helper cells to avoid an over accumulation of stearic acid in their membrane phospholipids.

Animals↗
PubMed1989

Unsaturated fatty acids inhibit IL-2 production in thymus-dependent antibody responses in vitro.

Albumin-complexed unsaturated fatty acids such as oleic acid (18:1) exerted a dose-dependent inhibitory effect on in vitro primary anti-TNP plaque-forming cell (PFC) responses to trinitrophenyl keyhole limpet haemocyanin (TNP-KLH), but did not affect primary PFC responses to trinitrophenyl lipopolysaccharide (TNP-LPS). The addition of 150 microM 18:1 at the initiation of thymus-dependent (T-D) antibody cultures inhibited the subsequent PFC response by 85%, and removal of the fatty acid after 24 hr did not reverse its inhibitory effect. By contrast, delaying the addition of 18:1 until 3 or 4 days after culture initiation abrogated its inhibitory effects. T-D antibody cultures displayed maximum production of interleukin-2 (IL-2) on the third day after culture initiation and a 24-hr exposure to 18:1 resulted in a dose-dependent inhibition of IL-2 production. Lastly, the addition of exogenous IL-2 reversed the inhibition of PFC responses in cultures transiently exposed to 18:1. These findings suggest that unsaturated fatty acids inhibit in vitro T-D PFC responses by selectively interfering with early stages of the antibody response, particularly those events leading to IL-2 production by T-helper cells.

Animals↗
PubMedDate not supplied

[The current objective criteria for the adequacy of general anesthesia in children].

Auditory evoked potentials (AEP) were recorded and analyzed in 12 children during general halothane and ketamine anesthesia. Ketamine suppressed the amplitude of primary negative component and eliminated secondary AEP components with latencies more than 60 ms, including N-200 and P-300 waves. By contrast, halothane did not affect primary components with less than 95 ms latencies and suppressed the latest components. Hence, ketamine suppresses the nonspecific afferent pathways and the brain structures responsible for memory and emotional functions, while halothane does not affect the afferent pulsation and partially suppresses emotional and mnemonic functions.

Acoustic Stimulation↗
PubMed2003

Iliac artery stenting in patients with poor distal runoff: Influence of concomitant infrainguinal arterial reconstruction.

OBJECTIVE: Inadequate infrainguinal runoff is considered an important risk factor for iliac stent failure. However, the influence of concomitant infrainguinal arterial reconstruction (CIAR) on iliac stent patency is unknown. This study evaluated the influence of CIAR on outcome of iliac angioplasty and stenting (IAS) in patients with poor distal runoff. METHODS: Over 5 years (1996 to 2001), 68 IAS procedures (78 stents) were performed in 62 patients with poor distal runoff (angiographic runoff score >or=5). The SVS/AAVS reporting standards were followed to define outcome variables and risk factors. Data were analyzed with both univariate analysis (Kaplan-Meier method [K-M]) and regression analysis (Cox proportional hazards model). RESULTS: Indications for iliac artery stenting were disabling claudication (59%) and limb salvage (41%). Of the 68 procedures, IAS with CIAR was performed in 31 patients (46%), and IAS alone was performed in 37 patients (54%). Patients undergoing IAS with CIAR were older (P =.03) and had more extensive and multifocal iliac artery occlusive disease, with more TASC (TransAtlantic Inter-Society Consensus) type C lesions (P =.03), compared with patients undergoing IAS alone. No other significant differences in risk factors were noted. Runoff scores between patients undergoing IAS with CIAR and those undergoing IAS alone were not significantly different (median runoff scores, 6 [range, 5-8] and 7 [range, 5-9], respectively; P =.77). Primary stent patency rate at 1, 3, and 5 years was 87%, 54%, and 42%, respectively, for patients undergoing IAS with CIAR, and was 76%, 66%, and 55%, respectively, for patients undergoing IAS. Univariate analysis revealed that primary stent patency rate was not significantly different between the 2 groups (K-M, log-rank test, P =.81). Primary graft patency rate for CIAR was 81%, 52%, and 46% at 1, 3, and 5 years, respectively. Performing CIAR did not affect primary iliac stent patency (relative risk, 1.1; 95% confidence interval, 0.49-2.47; P =.81). Overall, there was a trend toward improved limb salvage in patients undergoing IAS with CIAR, compared with those undergoing IAS alone (K-M, log rank test, P =.07). CONCLUSION: In patients undergoing IAS with poor distal runoff, CIAR does not improve iliac artery stent patency. Infrainguinal bypass procedures should therefore be reserved for patients who do not demonstrate clinical improvement and possibly for those with limb-threatening ischemia.

Adult↗
PubMed1999

Predicting variability in biological control of a plant-pathogen system using stochastic models.

A stochastic model for the dynamics of a plant-pathogen interaction is developed and fitted to observations of the fungal pathogen Rhizoctonia solani (Kühn) in radish (Raphanus sativus L.), in both the presence and absence of the antagonistic fungus Trichoderma viride (Pers ex Gray). The model incorporates parameters for primary and secondary infection mechanisms and for characterizing the time-varying susceptibility of the host population. A parameter likelihood is developed and used to fit the model to data from microcosm experiments. It is shown that the stochastic model accounts well for observed variability both within and between treatments. Moreover, it enables us to describe the time evolution of the probability distribution for the variability among replicate epidemics in terms of the underlying epidemiological parameters for primary and secondary infection and decay in susceptibility. Consideration of profile likelihoods for each parameter provides strong evidence that T. viride mainly affects primary infection. By using the stochastic model to study the dependence of the probability distribution of disease levels on the primary infection rate we are therefore able to predict the effectiveness of a widely used biological control agent.

Models, Biological↗
PubMed1995

Unusual distribution of enamel hypoplasia in an 11-year-old child with Proteus syndrome.

An 11-year-old girl with Proteus syndrome attended our dental department because her teeth were sensitive to cold stimuli and because of the poor appearance of her anterior teeth. Extraoral examination revealed several of the previously reported craniofacial features of Proteus syndrome: facial and skull asymmetry, exostoses of the nasal bridge, and mandibular prognathism. Intraoral examination revealed enamel hypoplasia of primary and permanent teeth. The distribution of hypoplasia was unusual in that only teeth on the right side of the mouth were affected, and also in that only the distal half of the crown of the maxillary right permanent central incisor was affected. Behavioural problems necessitated treatment under general anaesthesia; the affected primary teeth were extracted and the hypoplastic permanent teeth were restored, relieving the patient's symptoms and greatly improving aesthetics.

Child↗
PubMed1981

Familial and developmental factors in characterological depressions.

Patients with chronic low-grade depressions (screened to exclude primary affective illness and those secondary to rigorously defined nonaffective disorders) were divided into subaffective dysthymic versus character-spectrum groups and compared to 40 primary unipolar controls. A prior report found the 30 character-spectrums different from the 20 dysthymics (and usually from the unipolars) on pharmacological, phenomenological, REM sleep, social and outcome criteria. The present study parsed family history and developmental differences: The character-spectrum group had significantly lower incidence of familial depressions, but higher frequencies of loss of a parent in childhood, familial alcoholism, and parental assortative mating than both other groups--which did not differ. Just 10% of our 90 patients had bipolar family histories; 7 were dysthymics and 6 of these had earlier shown brief, tricyclic-induced hypomania. The results support, at the subsyndromal level, Winokur's separation of disorders with +FH for alcoholism from those with +FH for affective illness. Furthermore, data suggest the DSM-III concept of 'dysthymia' is too broad and needs further distinctions among several subaffective and nonaffective chronic depressions.

Adult↗
PubMed1975

Affective disorder: studies with amine precursors.

The authors assessed the clinical antidepressant effects of L-tryptophan given alone and in combination with L-dopa in 12 patients with a diagnosis of primary affective disorder; Preliminary results did not demonstrate an antidepressant response when L-dopa was combined with L-tryptophan. Also, the results did not support the catecholamine or biogenic amine hypotheses of affective disorder.

Adult↗
PubMed1995

Computerized knowledge bases in primary health care: a curse or a blessing for health promotion, prevention and patient quality?.

This paper presents a future scenario analysis of how the introduction of computerized knowledge bases (KBs) can come to affect primary care practice. For the collection and analysis of data, a two-level video method was applied. First, four consultations where a computerized KB was used were video-recorded. A search workshop was then carried out by letting a multi-disciplinary panel comment on the video recordings. The comments were categorized with regard to content and perspective. Analyses of the comments showed a concern for a disregard of patients' health beliefs and for difficulties in portioning out the acquired medical knowledge to the patient during the consultation. Furthermore, the computerized KB was found to easily break the natural flow of the consultation and be perceived as a third party. The conclusion is that the most critical aspects for using computerized KBs in a reformed primary health care concern the integration of the systems into the consultation process. Health promotion, prevention, and patient quality are central here, and the introduction of KB technology must not lead the consultation away from these issues.

Artificial Intelligence↗
PubMed1994

Lithium response and genetics of affective disorders.

The authors have carried out an investigation of psychiatric morbidity in families of patients who responded and failed to respond to long-term lithium treatment. The study included 121 probands with RDC primary affective disorders and 903 first-degree relatives and spouses. Seventy-one probands were responders and 50 were nonresponders to long-term lithium treatment. Extended to 20 years, the follow-up of patients and their families provided substantial information relevant for the diagnosis and reliable assessment of lithium response. The diagnoses were based on all available information, SADS-L interviews and RDC criteria. The principal statistical methods were survival analysis and Cox regression analysis. The results revealed a significantly higher frequency of bipolar disorder in the relatives of lithium responders (3.8% vs. 0%). Schizophrenia was more common in the families of nonresponders (2.4% vs. 0.3%). There were no significant differences in the rates of other psychiatric disorders. Both family history and the proband's diagnosis contribute independently to predicting response to long-term lithium.

Adult↗
PubMed1991

Neuroleptic malignant syndrome: life-threatening complication of neuroleptic treatment in adolescents with affective disorder.

Neuroleptic malignant syndrome (NMS) is an uncommon, potentially fatal side effect of neuroleptic treatment characterized by hyperthermia, rigidity, rhabdomyolysis, and delirium. In recent clinical studies of adults it was suggested that affective disorder is a risk factor for the development of neuroleptic malignant syndrome. The cases of two adolescents with neuroleptic malignant syndrome who were treated with neuroleptic therapy because of psychotic symptoms in association with primary affective disorders are reported. The occurrence of these cases, as well as the observations in adults, suggests that attention to the primary psychiatric diagnosis is important in neuroleptic usage and that physicians should be vigilant to the occurrence of neuroleptic malignant syndrome in the pediatric population.

Adolescent↗
PubMed1997

The effect of linomide, an immunoregulator in experimental autoimmune diseases, on humoral antibody responses in mice.

Linomide (quinoline-3-carboxamide), a well tolerated, orally administered compound was recently shown to be effective in the prevention and treatment of several autoimmune diseases in experimental animal models. We have investigated its effect on specific humoral immune responses directed to T-cell-dependent soluble or particulate antigens and to a T cell-independent antigen in several mouse strains. Linomide administered after antigen priming did not affect primary and secondary antibody responses directed to T-cell particulate antigens (SRBC) or soluble antigens given with or without complete Freund's Adjuvant (CFA). Linomide treatment given prior to antigen priming did not affect the antibody response to a soluble antigen (TNP-KLH) given with an adjuvant. In contrast, dose-dependent down regulation of primary antibody responses was observed when T cell-dependent (BSA-dextran) or T-cell-independent (TNP-Ficoll) antigens were administered in an immunogenic form without adjuvant after starting Linomide treatment. The primary anti-SRBC antibody response was also suppressed by high dose Linomide given prior to immunization although normal secondary responses were retained. It is worth noting that no immunosuppressive effects on antibody responses were found at low dose ranges which effectively reversed T cell dependent autoimmune manifestation.

Animals↗