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PubMed2001

Dysfunctional beliefs discriminate personality disorders.

This study examines whether specific sets of dysfunctional beliefs are differentially associated with five personality disorders (PDs) as predicted by cognitive theory. Seven hundred fifty-six psychiatric outpatients completed the Personality Belief Questionnaire (PBQ) at intake and were assessed for PDs using a standardized clinical interview conducted by assessors who were blind to patients' PBQ responses. Findings showed that patients with avoidant, dependent, obsessive-compulsive, narcissistic, and paranoid PDs preferentially endorsed PBQ beliefs theoretically linked to their specific disorders. The study results support the cognitive theory of personality disorders. Suggestions are made regarding the clinical utility of the PBQ with personality-disordered patients and future research on the PBQ.

Adolescent↗
PubMedDate not supplied

DSM-III-R personality disorders in seasonal affective disorder: change associated with depression.

Forty-five patients with winter Seasonal Affective Disorder (SAD) completed the Personality Diagnostic Questionnaire-Revised (PDQ-R) in a depressed state before starting therapy (light or medication), and again 14 weeks later when the scores on the Montgomery Asberg Depression Rating Scale (MADRS) had been reduced by an average of 74%. Prevalence and pattern of personality disorders (PDs) before treatment were similar to that found in patients with nonseasonal major depressive disorder (MDD) during a depressive episode. Number of categorical diagnoses were lower at follow-up for most PDs, but differences were not statistically significant. However, for dimensional scores (number of positive DSM-III-R criteria) significant changes were found for schizotypal, histrionic, narcissistic, and obsessive-compulsive PD, and for total dimensional score in cluster B and total score for all PDs. These changes differ from findings in similar studies of outpatients with nonseasonal MDD. Whether this indicates a specific pattern of change for patients with SAD is discussed. Multiple regression analysis showed a significant association between changes in positive PD criteria between the depressed and nondepressed state and change in depression score. No significant relationship was found between changes in PD criteria and Global Seasonality Score (GSS), a measure reflecting the sum of ratings of seasonal variation in sleep length, social activity, mood, weight, appetite, and energy level.

Adult↗
PubMedDate not supplied

Patterns of short-term course in patients treated in a day unit for personality disorders.

The objectives of the study were (1) to explore differences in the course for patients treated in a day unit specializing in personality disorders (PDs), and (2) to determine characteristics of patients with different courses and predictors of various courses. K-mean cluster analysis was applied to partition a sample of 128 patients, 101 with various PDs and 27 with axis I disorders only, into four groups representing different courses. The course was defined on the basis of global functioning (Health Sickness Rating Scale [HSRS]) at admission, discharge, and 3-years follow-up evaluation. The four courses were labeled good, fair, late improvement, and poor, demonstrating great variation in the short-term course among patients with PDs. Predictors were studied by means of polychotomous logistic regression using the patients with a fair course as the reference group. The dichotomy no PD/cluster C versus cluster A/B predicted a good versus a fair course. A poor work status the last year before admission and irregular discharge predicted a poor or late improvement course versus a fair course, also when controlling for PD clusters. None of the included variables discriminated between patients with a poor versus late improvement course.

Adult↗
PubMed1988

Electrical potential difference and ion transport across nasal epithelium of term neonates: correlation with mode of delivery, transient tachypnea of the newborn, and respiratory rate.

We studied the change in ion transport function by measuring the basal transepithelial potential difference (PD) across the ciliated epithelium of the nose in 85 term neonates during the first 72 hours of life. Differences in PD associated with the mode of delivery or the presence of respiratory disease and differences in the PD response to the superfusion of amiloride (10(-5) mol/L) were assessed. We also studied term neonates with transient tachypnea of the newborn (TTN) and acute respiratory insufficiency. Basal PDs during the first 24 hours of life were higher in neonates delivered by cesarean section without prior labor (-29.7 +/- 2.5 mV) and in those with TTN (-38.5 +/- 6.0 mV) than in neonates born during normal spontaneous vaginal delivery (-23.0 +/- 2.9 mV) or cesarean section with prior labor (-23.7 +/- 0.7 mV) or in those with respiratory insufficiency (-22.4 +/- 2.3 mV). The percentage inhibition of PD by amiloride superfusion (less than 24 hours) was significantly lower in infants with TTN (30.9 +/- 4.9%) and after cesarean section without prior labor (31.8 +/- 2.2%) than in other groups (37.6 +/- 1.6%). By 48 hours, nasal PDs after cesarean section without prior labor and in neonates with TTN had declined; and by 72 hours, values were similar to those in other groups; respiratory rate paralleled the decline in PD. The respiratory rate of neonates with respiratory insufficiency remained high and paralleled the persistence of respiratory distress. Amiloride sensitivity was similar for all groups by 72 hours. These findings indicate (1) that PDs vary with the mode of delivery and support a role for labor in the normal transition of respiratory epithelial ion transport and (2) that TTN is associated with abnormal epithelial ion transport.

Biological Transport↗
PubMed2000

Effects of valproate derivatives I. Antiepileptic efficacy of amides, structural analogs and esters.

Derivatives of the antiepileptic drug valproate (VPA, 2-propylpentanoic acid) have been synthesized and tested in order to improve the intracellular availability of VPA. The buccal ganglia of Helix pomatia were used as a test nervous system and antiepileptic efficacies were reconfirmed using rat cortex in vivo. Epileptiform activities consisted of typical paroxysmal depolarization shifts (PDS) which appeared in the identified neuron B3 with application of pentylenetetrazol. Epileptiform activities were found to be accelerated, unaffected or blocked. (i) The Amide-derivatives 2-propylpentanamide and N,N-dipropyl-2-propylpentanamide, and short chain ester derivatives 1-O-(2-propylpentanoyl)-2,3-propandiol, 2,2-di(hydroxymethyl)-1-O-(2-propylpentanoyl)-1,3-propanediol and 2,2-di(hydroxymethyl)-1,3-di-O-(2-propylpentanoyl)-1,3-propanediol accelerated epileptiform activities. Membrane potential often shifted to a permanent depolarization which corresponded to the PDS-inactivation level. (ii) The structural analogs 1-cycloheptene-1-carboxylic acid and cyclooctanecarboxylic acid accelerated epileptiform activities only slightly or were without effects. (iii) The small VPA-ester, 2-propylpentanoic acid ethyl ester, decreased the epileptiform activities in a way that is comparable to the effects of VPA well known from previous studies. It thus could be thought as a VPA-pro-drug. (iv) The mannitol-esters 1-O-(2-propylpentanoyl)-D-mannitol and 3,4;5,6-Di-O-isopropylidene-1-O-(2-propylpentanoyl)-D-mannitol blocked the PDS in a way which is different from the known effects of VPA. These substances are interpreted not to exert their effects after being metabolized to VPA and thus they are thought to be new antiepileptic substances.

Amides↗
PubMed2001

Personality disorders in bipolar and depressive disorders.

The association of mood disorders with personality disorders (PDs) is relevant from a clinical, therapeutic and prognostic point of view. To examine this issue, we compared the prevalence of DSM-III-R personality disorders assessed with SCID-II in patients with depressive (n = 117) and bipolar (n = 71) disorders both recovered from a major depressive index episode that needed hospital admission. PDs prevalence and comorbidity with axis I were calculated. Avoidant PD (31.6%) (O.R. = 1.7, C.I. = 1.06-2.9. P < 0.01), borderline PD (30.8%) and obsessive-compulsive PD (30.8%) were the most prevalent axis II diagnoses among patients with depressive disorder. In bipolar disorder group, patients showed more frequently obsessive-compulsive PD (32.4%), followed by borderline PD (29.6%) and avoidant PD (19.7%). Avoidant PD showed a trend toward being significantly more prevalent among depressives (P < 0.07). A different pattern of PDs emerges between depressive and bipolar patients.

Adult↗
PubMed2000

Ankyloglossia: controversies in management.

PURPOSE: To determine current beliefs regarding ankyloglossia and its treatment. DESIGN: Anonymous written survey. PARTICIPANTS: Otolaryngologists (OTO, n=423), pediatricians (PD, n=425), speech pathologists (SP, n=400), and lactation consultants (LC, n=350) were randomly selected from professional membership lists, with a response rate of 209 (49%), 235 (55%), 150 (37.5%), and 203 (58%), respectively. CLINICAL FINDINGS: Sixty-nine percent of LCs, but a minority of physician respondents, believe tongue-tie is frequently associated with feeding problems. Sixty percent of OTOs, 50% of SPs, but only 23% of PDs believe tongue-tie is at least sometimes associated with speech difficulties. Sixty-seven percent of OTOs versus 21% of PDs believe tongue-tie is at least sometimes associated with social/mechanical issues. Surgery is recommended at least sometimes for feeding, speech, and social/mechanical issues by 53, 74, and 69% of OTOs, respectively, but by only 21%, 29%, and 19% of PDs. CONCLUSION: The significance of ankyloglossia in children remains controversial, both within, and between, specialty groups.

Adult↗
PubMed1997

Pharmacological profiles of generalized absence seizures in lethargic, stargazer and gamma-hydroxybutyrate-treated model mice.

We examined the pharmacological profiles of generalized absence seizures in three mouse models: two mutant strains with spontaneous absence seizures, lethargic and stargazer, and ddY mice (GHB model) in which absence seizures were induced by administering gamma-butyrolactone (GBL), a prodrug of gamma-hydroxybutyric acid (GHB). A typical antiabsence drug, ethosuximide (200 mg/kg), attenuated absence seizure behavior, spike and wave and paroxysmal discharges (SWDs and PDs) in each model. P-[3-Aminopropyl]-P-diethoxymethylphosphinic acid (CGP 35348), a selective gamma-aminobutyric acid (GABA)B antagonist (200 mg/kg), suppressed absence seizure behavior, SWDs and PDs at least as effectively as ethosuximide (200 mg/kg) in lethargic and GHB model mice. P-[3-Aminopropyl]-P-cyclohexylmethylphosphinic acid (CGP 46381) was more effective than CGP 35348 and ethosuximide in these models. Although the antiabsence effect of CGP 46381 was as strong as that of ethosuximide (200 mg/kg) in stargazer mice, CGP 35348 (200-400 mg/kg) was weaker than ethosuximide. (+)-5-Methyl-10,11-dihydro-5H-dibenzo[a,b]cyclohepten-5,10-imine hydrogen maleate (MK-801), a non-competitive N-methyl-D-aspartate (NMDA) antagonist (0.5 mg/kg), had no effects on SWDs and PDs in lethargic or GHB model mice. Although MK-801 (0.5 mg/kg) suppressed SWDs significantly in stargazer mice, irregular electroencephalographic patterns were observed. These results suggest that GABAB receptors play a significant role in the pathogenesis of generalized absence seizures in these models, although the mechanism involved in stargazer mice differ from that in the other two.

Animals↗
PubMed2003

Telephone call contact for post-discharge surveillance of surgical site infections. A pilot, methodological study.

Accurate determination of superficial surgical-site infection (SSI) requires post-discharge surveillance (PDS) for up to 30 days. To be useful for regional or national audit the method must be effective, inexpensive, and acceptable to patients. We assessed the role of telephone calls to patients in PDS of SSI in 3150 patients in 32 Scottish hospitals undergoing groin hernia repair during one year. Overall, 104 (3.3%) patients opted out of the audit by declining to give a contact telephone number, 96 (3.0%) could not provide a personal telephone contact number, and 12 could not be contacted, a compliance rate of 93.3%. Two thousand, nine hundred and thirty-eight patients were contacted at one or all of the call points, i.e. 10, 20, or 30 days postoperatively, from a single call centre by medical records clerks, working to a piloted protocol. Contact data, including contact at all three time points are available on 2665 (84.6%) patients. All patients who believed their wound to be infected were seen by a healthcare worker (HCW) to confirm or refute the diagnosis. Of the 2665 patients in whom complete data are available, 140 (5.3%) patients developed confirmed wound infection and a further 57 (2.1%) thought their wound was infected, but this was not confirmed by the HCW. Patients appeared to welcome the concept of telephone contact. Methods for identifying all patients eligible for surveillance need to be improved. However, we believe this method of patient contact could be appropriate for PDS in regional or national audit.

Data Collection↗
PubMed1981

Incidence of tempero-mandibular joint pain dysfunction syndrome in rural population.

The incidence and clinical course of the tempero-mandibular joint dysfunction syndrome was studied among 1187 subjects over the age of 16, who attended the rural dental consultations held at various places in the State of Karnataka, India. The study revealed an incidence of 20.3%. Contracy to earlier reports, the incidence was higher in males than in females and more married females were affected than unmarried. Clicking appeared to be the predominant symptom in all age groups. The incidence of pain increased with age. Of all patients 43.75% were not aware of a clicking joint; 53.7% persons with clicking and 14% with pain were not disturbed by their symptoms. The findings of the study failed to establish any relationship between unilateral missing teeth and the occurrence of the pain dysfunction syndrome (PDS). The chewing habits (betel leaf, tobacco, betel nut) which are prevalent in India appeared to have no effect on the incidence of PDS. It is suggested that more epidemiological studies should be carried out in different parts of the world with varying social, political and economic systems to enable better understanding of the global incidence of PDS.

Adolescent↗
PubMed2001

Calculation of the uncertainty in complication probability for various dose-response models, applied to the parotid gland.

PURPOSE: Usually, models that predict normal tissue complication probability (NTCP) are fitted to clinical data with the maximum likelihood (ML) method. This method inevitably causes a loss of information contained in the data. In this study, an alternative method is investigated that calculates the parameter probability distribution (PD), and, thus, conserves all information. The PD method also allows the calculation of the uncertainty in the NTCP, which is an (often-neglected) prerequisite for the intercomparison of both treatment plans and NTCP models. The PD and ML methods are applied to parotid gland data, and the results are compared. METHODS AND MATERIALS: The drop in salivary flow due to radiotherapy was measured in 25 parotid glands of 15 patients. Together with the parotid gland dose-volume histograms (DVH), this enabled the calculation of the parameter PDs for three different NTCP models (Lyman, relative seriality, and critical volume). From these PDs, the NTCP and its uncertainty could be calculated for arbitrary parotid gland DVHs. ML parameters and resulting NTCP values were calculated also. RESULTS: All models fitted equally well. The parameter PDs turned out to have nonnormal shapes and long tails. The NTCP predictions of the ML and PD method usually differed considerably, depending on the NTCP model and the nature of irradiation. NTCP curves and ML parameters suggested a highly parallel organization of the parotid gland. CONCLUSIONS: Considering the substantial differences between the NTCP predictions of the ML and PD method, the use of the PD method is preferred, because this is the only method that takes all information contained in the clinical data into account. Furthermore, PD method gives a true measure of the uncertainty in the NTCP.

Confidence Intervals↗
PubMed1999

A reduction in the AAPM TG-36 reported peripheral dose distributions with tertiary multileaf collimation. American Association of Physicists in Medicine Task Group 36.

PURPOSE: The American Association of Physicists in Medicine Task Group 36 (AAPM TG-36) data can be used to estimate peripheral dose (PD) distributions outside the primary radiation field. However, the report data apply to linear accelerators not equipped with tertiary multileaf collimators (MLCs). Peripheral dose distributions consist of internal scatter, collimation scatter, transmission through collimation, head leakage, and room scatter. Tertiary MLCs may significantly reduce the PD due to a reduction in collimation scatter, transmission through collimation, and head leakage. Measurements were performed on a multimodality linear accelerator, equipped with a tertiary MLC, to determine PD distributions as a function of energy, field size, distance from the primary radiation field edge, MLC position, and collimator orientation. METHODS AND MATERIALS: Measurements were made using an ionization chamber embedded in a 20 x 40 x 120-cm3 water-equivalent plastic phantom with the secondary collimator and MLC settings of 10 x 10, 15 x 15, 20 x 20, 25 x 25 cm2, and with the MLC fully retracted. Data were taken along the longitudinal axis of the machine for 6 and 18 MV photons. Peripheral dose distributions were evaluated with the collimator set to 180 and 90 degrees. Rotation of the collimator allowed measurements parallel and orthogonal to the direction of motion of the MLC. RESULTS: For both photon energies, peripheral doses measured on a MLC machine were lower than the TG-36 data. When the collimator is rotated by 90 degrees, placing the lower jaws and the MLC leaves along the plane of interest, PD was reduced by as much as a factor of three compared with PDs measured with the MLC fully retracted and the collimator rotated to 180 degrees. PDs measured with the MLC fully retracted and collimator rotated to 180 degrees were comparable to the TG-36 data. Measured PDs were lower when the MLC was used to shape the field than when the MLC was fully retracted. CONCLUSION: A strategic orientation of the collimator with a tertiary MLC can reduce PD distributions by more than a factor of two. This decrease significantly lessens or eliminates the need for external lead shielding to reduce the critical organ dose. This method can be used even when Lipowitz metal blocking (such as for mantle fields) is used, with the MLC leaves oriented along the longitudinal plane.

Particle Accelerators↗
PubMed1998

Methods to reduce the variability of EMG power spectrum estimates.

Three methods that can significantly reduce the variability of the EMG power density spectrum (PDS) variable by eliminating artifactual components are described. Two methods, one that allows the subtraction of power line noise in the time domain and one which allows the subtraction of system noise in the frequency domain from the EMG, were shown to be effective in helping to accurately estimate the median frequency (MF) of the PDS, and especially during low level contractions (0-25% maximal voluntary contraction, MVC) when the signal-to-noise ratio is unfavorable. The techniques eliminate the artifactual effects of system and power line noises from the EMG recordings throughout the force range (0-100% MVC) while preserving the native EMG power at all frequencies. It was also shown that if a technique to train subjects to produce their true MVC is employed, the absolute force/torque produced could be as much as 30% higher than in untrained MVC. The effect of true MVC production was also shown to be significant when interpretation of PDS variables are correlated to the processes which produce contraction.

Algorithms↗
PubMed2003

Evidence for compensation for stuttering by the right frontal operculum.

There is recent evidence of focal alteration in fibre tracts underlying the left sensorimotor cortex in persistent developmental stuttering (PDS) [Lancet 360 (2002) 380]. If, as proposed, this anatomical abnormality is the cause of PDS, then overactivation in the right hemisphere seen with functional neuroimaging in stutterers may reflect a compensatory mechanism. To investigate this hypothesis, we performed two functional magnetic resonance imaging (fMRI) experiments. The first showed systematic activation of a single focus in the right frontal operculum (RFO) in PDS subjects during reading, which was not observed in controls. Responses in this region were negatively correlated with the severity of stuttering, suggesting compensation rather than primary dysfunction. Negative correlation was also observed during the baseline task that consisted in passive viewing of meaningless signs, indicating that RFO compensation acts independently of specific demands on motor speech output. The second experiment, that involved a covert semantic decision task, confirmed that RFO activation does not require overt utterances or motor output. In combination these findings suggest that the RFO serves a nonspecific compensatory role rather than one restricted to the final stages of speech production.

Adult↗
PubMed1995

Microvascular function in the peripheral vascular bed during ischaemia and oxygen-free perfusion.

OBJECTIVES: To determine the influence of acute ischaemia and absence of leukocytes on the microvascular function and capillary permeability in skeletal muscle. DESIGN: Prospective, open study. SETTING: University Department of Vascular Surgery and Institute of Medical Physiology. MATERIALS AND METHODS: Ten isolated cat gastrocnemius muscles were perfused with oxygen-free Ringer-albumin solution through the femoral artery. At 5 microliters bolus with 14.8 MBq 51Cr-EDTA was injected through a side branch into the femoral artery, and the response function was detected over the muscle by a scintillation detector connected to a spectrometer and a computer. The perfusion coefficient was measured directly at the venous outlet. The response function was analysed in accordance with non-compartmental black box kinetic principles to give perfusion rate, capillary extraction fraction and capillary diffusional permeability-surface area product (PdS). In separate experiments the molecular size and the free diffusion coefficient of 51Cr-EDTA in water at 37 degrees C were determined by a modified true transient diffusion method. MAIN RESULTS: During perfusion the PdS-product increased as a function of flow rate, f, in accordance with the linear regression line PdS = 1.78 + 0.15 f between 5 to 60 ml/100 g/min. This permeative conductance was identical to that found previously in a similar experimental set up with oxygenated whole blood perfusion. During oxygen free perfusion the perfusion rate was a linear function of arterial perfusion pressure, and autoregulation of blood flow did not occur in response to variations of arterial perfusion pressures. The free diffusion coefficient in water at 37 degrees C for 51Cr-EDTA was 7.4 x 10(-6) cm2/s (n = 36), which corresponds to a Stokes-Einstein molecular radius, rSE, of 0.439 nm. CONCLUSIONS: In spite of complete anoxia and absence of normal microcirculatory flow regulating mechanisms there is no sign of changes in capillary diffusional permeability for smaller hydrophilic molecules and functional membrane damage is not elicited in the absence of oxygen under these conditions.

Animals↗
PubMed1988

A prospective randomized trial of suture material in aural wound closure.

The aim of the study was to compare synthetic monofilament suture materials with chromic catgut and silk in aural wound closure. Forty patients undergoing mastoidectomy or tympanoplasty were randomized to closure with either 3o PDS (Polydioxanone) to fascia plus 3o Prolene to skin, or 2o chromic catgut to fascia plus 3o silk to skin. Known or suspected factors affecting wound healing were recorded. Nine patients had post-operative wound infections. The infection rate was significantly lower in wounds closed with PDS and Prolene (chi 2 = 6.05, p less than .05), and in tympanoplasty operations (chi 2 = 4.42, p less than .05). Four patients suffered wound dehiscence, all four had been closed with catgut and silk. No other complication of wound healing was noted in the trial. In conclusion, PDS and Prolene are superior suture materials to catgut and silk in the closure of aural wounds.

Adult↗
PubMed2005

Stability of functional impairment in patients with schizotypal, borderline, avoidant, or obsessive-compulsive personality disorder over two years.

BACKGROUND: A defining feature of personality disorder (PD) is an enduring pattern of inner experience and behavior that is stable over time. Follow-up and follow-along studies have shown considerable diagnostic instability of PDs, however, even over short intervals. What, then, about personality disorder is stable? The purpose of this study was to determine the stability of impairment in psychosocial functioning in patients with four different PDs, in contrast to patients with major depressive disorder (MDD) and no PD, prospectively over a 2-year period. METHOD: Six hundred treatment-seeking or treated patients were recruited primarily from clinical services in four metropolitan areas of the Northeastern USA. Patients were assigned to one of five diagnostic groups: schizotypal (STPD) (n=81), borderline (BPD) (n=155), avoidant (AVPD) (n=137), or obsessive-compulsive (OCPD) (n=142) personality disorders or MDD and no PD (n=85), based on the results of semi-structured interview assessments and self-report measures. Impairment in psychosocial functioning was measured using the Longitudinal Interval Follow-up Evaluation (LIFE) at baseline and at three follow-up assessments. RESULTS: Significant improvement in psychosocial functioning occurred in only three of seven domains of functioning and was largely the result of improvements in the MDD and no PD group. Patients with BPD or OCPD showed no improvement in functioning overall, but patients with BPD who experienced change in personality psychopathology showed some improvement in functioning. Impairment in social relationships appeared most stable in patients with PDs. CONCLUSION: Impairment in functioning, especially social functioning, may be an enduring component of personality disorder.

Activities of Daily Living↗
PubMed2007

The heritability of cluster A personality disorders assessed by both personal interview and questionnaire.

BACKGROUND: Personality disorders (PDs) as assessed by questionnaires and personal interviews are heritable. However, we know neither how much unreliability of measurement impacts on heritability estimates nor whether the genetic and environmental risk factors assessed by these two methods are the same. We wish to know whether the same set of PD vulnerability factors are assessed by these two methods. METHOD: A total of 3334 young adult twin pairs from the Norwegian Institute of Public Health Twin Panel (NIPHTP) completed a questionnaire containing 91 PD items. One to 6 years later, 1386 of these pairs were interviewed with the Structured Interview for DSM-IV Personality (SIDP-IV). Self-report items predicting interview results were selected by regression. Measurement models were fitted using Mx. RESULTS: In the best-fit models, the latent liabilities to paranoid personality disorder (PPD), schizoid personality disorder (SPD) and schizotypal personality disorder (STPD) were all highly heritable with no evidence of shared environmental effects. For PPD and STPD, only unique environmental effects were specific to the interview measure whereas both environmental and genetic effects were found to be specific to the questionnaire assessment. For SPD, the best-fit model contained genetic and environmental effects specific to both forms of assessment. CONCLUSIONS: The latent liabilities to the cluster A PDs are highly heritable but are assessed by current methods with only moderate reliability. The personal interviews assessed the genetic risk for the latent trait with excellent specificity for PPD and STPD and good specificity for SPD. However, for all three PDs, the questionnaires were less specific, also indexing an independent set of genetic risk factors.

Adult↗