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PubMed1996

Modulation of NMDA and dopaminergic neurotransmissions by sigma ligands: possible implications for the treatment of psychiatric disorders.

Sigma (sigma) receptors, improperly classified as belonging to the opiate receptor family when discovered in 1976, were subsequently confused with phencyclidine binding sites for several years. It's only recently, with the emergence of new selective ligands that their functional significance could be meaningfully addressed. Several subtypes of sigma receptors are present in high densities in the limbic structures as well as in motor-related areas of the CNS. Different lines of evidence suggest that a major role for sigma receptors might be to regulate the activity of the glutamatergic system via the modulation one of its subtype of receptor, the NMDA receptor. This modulation of the glutamatergic system could in turn interfere with the dopaminergic neurotransmission with which, however, sigma ligands could also interact directly. The potential involvement of sigma receptors in schizophrenia has been considered ever since their discovery. The initial suggestion to this respect emerged from the observation that several of the earliest sigma ligands induced psychotomimetic symptoms such as delusions, hallucinations and depersonalization. This link was later reinforced with the demonstration that several neuroleptics, such as haloperidol, have a high affinity for sigma receptors, whereas, some new molecules with a high affinity for sigma receptors, but a low affinity for dopaminergic receptors demonstrated a "neuroleptic-like" pharmacological profile. However, the therapeutic efficacy of selective sigma ligands in schizophrenia has not yet been established and it has even been suggested that sigma receptors might be responsible for some side effects of the classical neuroleptics. The possible implication of sigma receptors in affective disorders has also been suggested by reports showing that some antidepressant drugs have a high affinity for sigma receptors and that long-term treatments with anti- depressant drugs, even with those devoid of affinity for sigma receptors, modify their binding characteristics. In conclusion, indirect evidence suggests possible etiological and/or therapeutic roles for sigma receptors in some psychiatric disorders. However, despite several attempts, no clear indications of a therapeutic efficacy of sigma ligands has yet emerged. More selective ligands and fundamental studies on the respective role of the different subtypes of sigma receptors are needed before clear concepts can be formulated. p3

Animals↗

PubMed1985

Maternal attitudes to fetal monitoring.

During a randomized clinical trial concerning alternative methods of intrapartum fetal surveillance (electronic fetal monitoring (EFM) and auscultation (AUS)) an investigatory interview was carried out. Out of 655 expecting mothers the antepartum preference of EFM was 39.5%, of AUS 32.3% and 28.1% were undecided (UD). EFM was especially preferred by obstetrical high-risk patients. Reasons for preference of AUS were a natural childbirth, a non-technological milieu, and the lack of supposed discomfort from sensors and belts. The pregnant women found as major advantages of EFM continuous observation and the possibility of quick intervention. Postpartum 385 patients were again interviewed. The majority upheld the original preference if that method was used. If the non-preferred method had been applied many would stick to the primary preference although a tendency to prefer the experienced method was seen. The patients who antepartum preferred AUS, but had EFM, became more positive toward the method, and a significantly increased number were positively influenced by the EFM signal/trace and found the method promoting their partner's involvement in labor. Enforced immobility, however, was a major disadvantage as well as the technical milieu. If EFM is to be accepted by a majority of women giving birth it is necessary to increase the pregnant women's knowledge of the method and to take milieu factors into consideration in order to reduce the intrinsic depersonalization of EFM.

Adult↗

PubMed1990

A qualitative analysis of adult incest survivors' responses to sexual involvement with therapists.

Six women who had histories of incest and had been sexually involved with therapists participated in qualitative research employing semi-structured, open-ended interviews. Transcribed interviews were content analyzed for recurrent regularities in topics, themes, events, and dynamics. Following content and cluster analyses of interviews, three overall themes emerged that appeared most salient in attempting to understand the development and maintenance of therapeutic relationships in which incest survivors experienced additional abuse. The themes were (1) early environment that prohibited the development of a sense of "personhood" in incest survivors, (2) repeated experiences of depersonalization inside and outside of therapy that reinforced a state of non-personhood, and (3) adoption of a "surrender pattern" to cope with violations, including therapist violations.

Adolescent↗

PubMed1995

The N-methyl-D-aspartate antagonists phencyclidine, ketamine and dizocilpine as both behavioral and anatomical models of the dementias.

Phencyclidine (PCP) and ketamine can induce a model psychosis in drug addicts and exacerbate the symptoms of chronic schizophrenics. The model psychoses these drugs induce mimic a variety of schizophrenic symptoms, including flattened affect, dissociative thought disorder, depersonalization and catatonic states. These symptoms can persist for prolonged periods and chronic PCP and ketamine addicts have persisting memory deficits. Dizocilpine (MK-801) is a simpler drug than PCP or ketamine in its actions, but it shares with both the property of blocking in a non-competitive manner the N-methyl-D-aspartate (NMDA) ion-channel. Behavioral observations and drug-discrimination studies in animals indicate that PCP and dizocilpine are similar in their effects and they both have a neurotoxic effect on neurons in posterior cingulate cortex. Recent studies have indicated that both of these drugs, when given continuously for several days, further induce neuronal degeneration in other limbic structures. These include brain regions of rats related to olfaction, associated limbic structures such as piriform cortex and posterior regions of entorhinal cortex and in it's projections, through the perforant pathway, to dentate gyrus and other cells in ventral hippocampus. These degenerative consequences may be excitatory neurotoxic effects, for these compounds also induce an elevation in glucose metabolism maximal in just those structures where degeneration is observed and the degeneration involves entire cells, with all of their processes. It has been suggested these non-competitive NMDA antagonists induce an increase in firing rate in a limbic circuit which includes the perforant pathway. At least some competitive NMDA antagonists induce the same pattern of degeneration and altered glucose utilization. There is anatomical and functional evidence that alterations in these same limbic structures are present in the dementia syndrome manifested by some schizophrenics and most Alzheimer's patients. This suggests that these non-competitive NMDA antagonists may provide a more complete model of psychoses and memory disturbances than previously recognized, in that they can mimic both persisting symptomatology and neuroanatomical abnormalities. While the neurochemical underpinnings of this effect remain elusive, it appears to be both age and sex dependent. Further studies of the mechanisms by which NMDA antagonists induce increased glucose utilization and neurotoxicity in these limbic structures may clarify these alterations in this simplified Papez-like circuit.

Animals↗

PubMed1983

Distal colon motility and clinical parameters in depression.

Eighty-six patients suffering from nonpsychotic unipolar major depressive disorder, according to Research Diagnostic Criteria, were rated on a modified Hamilton Rating Scale for Depression (HRS). All completed the self-rating Beck Depression Inventory (BDI). Distal colon motility (dcm) studies, performed in all the patients, differentiated two types: low intestinal tone (low-IT) = 40 subjects, and high intestinal tone (high-IT) = 46 subjects. Low-IT depressed patients showed a statistically significant preponderance in the HRS items 'retardation', 'somatization', 'fatigability', 'hypochondriasis' and 'obsessional symptoms'. The high-IT depressed patients, on the other hand, showed preponderance in the items 'guilt', 'suicide', 'insomnia', 'agitation', 'anxiety psychic', 'loss of insight', 'depersonalization' and 'paranoid symptoms'. A positive correlation (r) was found between HRS- and BDI-mean total scores. In addition, a positive correlation (r) was found between HRS scores and distal colon tone in high-IT patients, although the same was not true for low-IT patients. Our results suggest the existence of two subtypes of depressive syndromes, distinguishable on the basis of distal colon motility profiles.

Adolescent↗

PubMed1980

A comparison of psychiatric patients and normal controls on the integration of auditory stimuli.

Temporal processing of sensory auditory information was investigated in 27 psychiatric patients and 29 normal controls by measuring forced choice thresholds for the right ear to bursts of noise stimuli of three different durations-4, 32, and 128 msec. Psychiatric patients were found to be 5 dB less sensitive than normal controls. A subsequent analysis compared the normal controls with three subgroups of psychiatric patients differentiated according to symptom profile. Those psychiatric patients whose main symptoms were affective showed a shallower threshold duration integration function than did normal controls. Patients whose major symptoms were delusions of persecution and depersonalization showed a slightly steeper slope than normal controls, whereas patients whose major symptom were hallucinations and lack of insight showed the steepest slope.

Adolescent↗

PubMed1983

Depressive symptoms associated with dexamethasone resistance.

Using split sample discriminant function analysis on a series of 63 consecutive depressed outpatients, the authors identified several items on the Hamilton Depression Rating Scale that were associated with dexamethasone resistance (late and middle insomnia, retardation, somatic and psychic anxiety, and obsessive-compulsive symptoms), and several items that were associated with dexamethasone suppression (genital symptoms, somatic-general symptoms, hypochondriasis, early insomnia, and depersonalization). The accuracy of the classification function was 100% for the index split sample, 84% for the overall sample, and 72% for the other split sample. The implications of these findings are discussed.

Adult↗

PubMed1990

Contradictions in the social production of clinical knowledge: the case of schizophrenia.

This paper is divided into two parts. In Part I, I contend that the current thrust to synthesize clinical and critical medical anthropology is misdirected and may serve to further fragment, rather than unify their concerns. I then suggest that instead of focusing on their differences, either in levels of analysis ('micro-' versus 'macro-') or in objects for analysis, we should emphasize instead the perspective that they share--one drawn from the common task their work assumes as a critical, emancipatory science of mankind. In Part II, keeping in mind this short prolegomenon, I utilize data regarding the National Alliance for the Mentally Ill (NAMI) to illustrate that medical knowledge is reducible to neither natural nor social forces; it is instead produced by living actors who are constrained by their social and historical conditions and the exigencies of the mode of production in which these actors produce. I show how NAMI members have succeeded in changing 'blame-the-family' ideologies about schizophrenia etiology and treatment, but I also explain how the medicalized alternative they produced in redefining schizophrenia as a disease of the brain is itself limited and fraught with contradictions (e.g. reinforcing a depersonalizing mind/body separation that inhibits healing). These contradictions highlight the difficulty of transcending the assumptions implicit in medical categories since they are tied to the dominant epistemology of the mode of production in which they are produced--one that binds our world views and limits the options we can generate. Anthropologists must draw attention to these constraints as an initial step to transcending them.

Anthropology↗

PubMed1984

Benzodiazepine dependence.

Dependence to benzodiazepines is difficult to induce in animals but has been induced by high doses in man. Case reports of benzodiazepine dependence are rare compared with the usage of these drugs, but provide no proper epidemiological framework for the estimation of risk. Patients taking these drugs for four months or more may develop symptoms on withdrawal, characterized by anxiety, dysphoria, malaise, depersonalization, and by perceptual changes such as hyperacusis and unsteadiness. In our first study we compared four patients withdrawing from high doses of benzodiazepines with six patients withdrawing from therapeutic doses. In all patients the typical withdrawal syndrome was noted and was equal in intensity in both groups. In the second study, long-term, normal-dose benzodiazepine treatment was discontinued in 24 patients believed to be dependent on their medication. The withdrawal was gradual, placebo-controlled and double-blind. All experienced some form of withdrawal reaction, which ranged from anxiety and dysphoria to moderate affective and perceptual changes. Symptom ratings rose as the drugs were discontinued, but usually subsided to pre-withdrawal levels over the next two to four weeks. Electroencephalograhic (EEG) changes comprised marked reduction in fast-wave activity as the drugs were withdrawn, and an improvement in psychological performance was noted. It is concluded that a risk of dependencies present in all patients taking benzodiazepines even in therapeutic doses for more than a few months. Caution is urged in the prescribing of these drugs.

Animals↗

PubMed1993

Sleep deprivation accelerates the response to nortriptyline.

1. The authors examined the effect of total sleep deprivation (SD) in combination with nortriptyline in 20 patients with major depressive disorder (MDD). Patients underwent a 36-hour SD procedure followed by nortriptyline started on the evening after SD, with ratings for two weeks. 2. Eleven (55%) patients were responders; they showed a rapid and sustained remission after SD, whereas non-responders demonstrated the delayed results expected with nortriptyline. 3. High initial depression scores and absence of depersonalization were associated with response to SD, while being female and middle insomnia were associated with response to the combined regimen. 4. The combination of SD with antidepressants proves to be an effective and safe treatment modality.

Adult↗

PubMed1991

Quantitative increases in temporal lobe symptoms in human males are proportional to postnatal geomagnetic activity: verification by canonical correlation.

Enhanced geomagnetic activity during episodes of biochemical stress has been correlated with inferences of increased liability within deep temporal lobe structures. Because adult limbic epilepsy is frequently associated with perinatal hypoxia or metabolic disruption within this region, a weak positive correlation was expected between possible signs of mesiobasal temporal lobe lability in normal adults and perinatal geomagnetic activity. Canonical correlation demonstrated that young adult males (n = 243) displayed a positive (r = 0.31) relationship between the intensity of geomagnetic disturbance the day after birth only and a history of subjective depersonalization, anomalous visual and olfactory experiences. The effects was very clear when aa values exceeded 30 nT (gamma). Temporal lobe signs for these males were similar to those reported by normal young adult females (n = 313) who did not display any consistent correlation between these measures and perinatal geomagnetic disturbance. The results suggest that interactions between perinatal neurochemistry and the correlates of geomagnetic activity might permanently alter portions of the male limbic system.

Adult↗

PubMed1990

Symptom profiles of biological markers in depression: a multivariate study.

The dexamethasone suppression test (DST), the thyrotropin releasing hormone (TRH) test, and the ratio of plasma L-tryptophan to competing amino acids (L-TRP/CAA) were studied in relation to the 21 items of the Hamilton Depression Rating Scale (HDRS) in 123 depressed patients categorized according to DSM-III. The relationships between the biological data and the items or item clusters of the HDRS were assessed by multivariate analyses. The psychopathological correlates of increased post-dexamethasone cortisol and decreased thyroid stimulating hormone (TSH) responsivity to TRH were middle and delayed insomnia and weight loss. The symptom correlates of decreased availability of L-TRP to the brain were psychic anxiety, depersonalization, obsessions and paranoid symptoms. Core depressive symptoms, i.e. depression, loss of interest, feelings of guilt and suicidal thoughts, were not related to the biological markers.

Adult↗

PubMed1994

Development of the emergency physician job satisfaction measurement instrument.

The objective of this study was to develop a valid and reliable instrument to measure the job satisfaction of physicians practicing emergency medicine. A prospective survey involving four separate stages (an item evaluation and reduction stage, a factor analysis stage, a construct validity stage, and a reliability stage) was distributed in Canada to full-time emergency physicians. Three separate survey instruments were administered (an initial draft instrument with 228 items, a pilot instrument with 142 items, and the final instrument with 79 items). Construct validity of the final instrument was tested by evaluating the correlation between physician scores on the instrument, and scores on two instruments measuring the same construct, and three measuring different but related constructs. A draft instrument with 228 items and six hypothetical domains was tested on 61 physicians. Evaluation for frequency endorsement, redundancy, and homogeneity reduced the item pool to 157. The remaining 157 items were used as a pilot instrument and tested on 223 physicians. Factor analysis eliminated 66 items from the pilot instrument, creating a final instrument with 79 items, 11 factors, and six domains. Cronbach's coefficient alpha for the final instrument domains is 0.81, and all domain-total correlations are greater than 0.4. All correlations between the final instrument and the construct validity instruments were statistically significant (P < .001), but not so high that they appeared to be measuring the same thing. Correlations between instruments measuring the same construct were higher than those measuring related but different constructs. Correlations between the final instrument and the CES-D scale, emotional exhaustion, and depersonalization subscales of the Maslach Burnout Inventory were negative. A test-retest reliability study on 42 physicians showed Pearson's correlation coefficients for individual domains were all greater than 0.7 and greater than 0.8 for the final instrument. This study has produced a valid and reliable instrument for measuring emergency physician job satisfaction, which is both internally consistent and stable.

Canada↗

PubMed2006

Burnout of caregivers: a comparison between partners of psychiatric patients and nurses.

Care of a person with mental illness involves multiple burdens, possibly leading to burnout. This study compares partners of persons with schizophrenia and depression with nursing staff based on dimensions of burnout. Nursing staff and partners of patients with schizophrenia or depression were consecutively recruited from psychiatric hospitals and interviewed with the Maslach Burnout Inventory. No significant differences were found in the three dimensions of burnout (emotional exhaustion, depersonalization, and personal accomplishment) for the two groups of caregivers. About one fourth of the respondents in both groups showed a high degree of burnout. Professional and nonprofessional caregivers face a similar degree of burden and need support to perform their caretaking tasks.

Adolescent↗

PubMed2006

The effects of the ARC organizational intervention on caseworker turnover, climate, and culture in children's service systems.

OBJECTIVE: This study examines the effects of the Availability, Responsiveness, and Continuity (ARC) organizational intervention strategy on caseworker turnover, climate, and culture in a child welfare and juvenile justice system. METHOD: Using a pre-post, randomized blocks, true experimental design, 10 urban and 16 rural case management teams were randomly assigned to either the ARC organizational intervention condition or to a control condition. The culture and climate of each case management team were assessed at baseline and again after the one-year organizational intervention was completed. In addition, caseworker turnover was assessed by identifying caseworkers on the sampled teams who quit their jobs during the year. RESULTS: Hierarchical Linear Models (HLM) analyses indicate that the ARC organizational intervention reduced the probability of caseworker turnover by two-thirds and improved organizational climate by reducing role conflict, role overload, emotional exhaustion, and depersonalization in both urban and rural case management teams. CONCLUSIONS: Organizational intervention strategies can be used to reduce staff turnover and improve organizational climates in urban and rural child welfare and juvenile justice systems. This is important because child welfare and juvenile justice systems in the U.S.A. are plagued by high turnover rates, and there is evidence that high staff turnover and poor organizational climates negatively affect service quality and outcomes in these systems.

Adult↗

PubMed2006

Compassion fatigue, burnout, and compassion satisfaction among Colorado child protection workers.

OBJECTIVE: The goal of this study was to understand better the risk of compassion fatigue (the trauma suffered by the helping professional) and burnout (emotional exhaustion, depersonalization, and reduced sense of personal accomplishment), and the potential for compassion satisfaction (the fulfillment from helping others and positive collegial relationships) among Colorado county child protection staff using the Compassion Satisfaction/Fatigue Self-Test [Figley, C. R., & Stamm, B. H. (1996). Psychometric review of Compassion Fatigue Self-Test. In B. H. Stamm (Ed.), Measurement of stress, trauma, and adaptation (pp. 127-130). Lutherville, MD: Sidran Press]. An additional goal was to test the relationship of these three constructs to each other. METHOD: A self-report instrument developed by Stamm and Figley was used to measure the risk of compassion fatigue and burnout and the potential for compassion satisfaction among 363 child protection staff participating in a secondary trauma training seminar. RESULTS: Participants were significantly more likely to have high risk of compassion fatigue, extremely low risk of burnout, and good potential for compassion satisfaction. Participants with high compassion satisfaction had lower levels of compassion fatigue (p=.000; mean=35.73 high compassion satisfaction group, mean=43.56 low group) and lower levels of burnout (p=.000; mean=32.99 high compassion satisfaction group, mean=41.69 low group). CONCLUSION: Approximately 50% of Colorado county child protection staff suffered from "high" or "very high" levels of compassion fatigue. The risk of burnout was considerably lower. More than 70% of staff expressed a "high" or "good" potential for compassion satisfaction. We believe compassion satisfaction may help mitigate the effects of burnout.

Adult↗

PubMed2004

Can memories kindle nonconvulsive behavioral seizures in humans? Case report exemplifying the "limbic psychotic trigger reaction".

We present three hypotheses-(1) the limbic psychotic trigger reaction (LPTR) is a form of nonconvulsive behavioral seizures (NCBS), (2) kindling may occur in the LPTR, and (3) kindling may occur with memory stimuli-and report a case that may exemplify a LPTR kindled by memory and triggered by light and smell. The LPTR has a primate model, in which NCBS are kindled by intermittent exposure to actual subthreshold stimuli. In humans, we propose that such triggering stimuli can be revived by memory alone. Thus, individualized stimuli can trigger partial limbic seizures or seizure-like bizarre episodes with a transient loss of frontal control functions. We present a case of paroxysmal episodes of out-of-character, bizarre, unplanned nonvoluntary acts that occurred with flat affect and without drive motivation (e.g., "fire setting"). Implicated is a transient state of limbic "paleo-consciousness" with preserved memory, autonomic arousal, and first-time brief psychosis (e.g., olfactory, visual hallucinations and depersonalization with olfactory attributes). As in kindled primates, LPTR patients do not show a consistent pattern of morphological brain abnormality; half have had an abnormal electroencephalogram, computed tomography scan, or magnetic resonance image at some time during their lives, and half (including the new patient) have had closed head injuries.

Adult↗

PubMed2004

Job satisfaction, stress, and burnout among Canadian gynecologic oncologists.

OBJECTIVES: (1). To provide a job description of Canadian gynecologic oncologists. (2). To assess job satisfaction and job stress, and measure the prevalence of burnout and psychological morbidity. METHODS: A cross-sectional survey was mailed to all Canadian gynecologic oncologists in September 2002. RESULTS: The job profile on Canadian gynecologic oncologists is predominantly clinical with a minor component of administration and to a less extent education or research. Clinically, 80% of the activity is focused on gynecologic cancer care. The majority of physicians (92%) are satisfied with their job, but there are clear concerns raised concerning systems issues in health care delivery. Approximately 26% of physicians are experiencing high stress, and this is strongly associated with emotional exhaustion and high depersonalization. Fourteen percent of Canadian gynecologic oncologists are actively looking for alternative jobs and 45% are trying to decrease the number of hours worked per week. When considering an alternate job, the most important factors are location, colleagues, and potential for personal growth. CONCLUSION: High stress and low personal accomplishment were seen in Canadian gynecologic oncologists. Organizations (i.e., hospitals) and health care funders have the opportunity to incorporate preventative strategies to keep this physician resource healthy.

Adult↗