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PubMed1976

Electrophysiologic properties of antidysrhythmic drugs as a rational basis for therapy.

The often emergent nature of life-threatening cardiac dysrhythmias, the frequent seeming "resistance" of the abnormal heart rhythm to therapy, and the commonly encountered toxicity of antidysrhythmic agents combine to make treatment of cardiac dysrhythmias one of the strictest challenges to the practicing physician. Although electrophysiologic studies have markedly increased out understanding of dysrhythmogenesis and the actions of anti-dysrhythmic drugs, these numerous investigations have provided but little assistance to the practicing physician either as an intellectual framework or as a guide to patient care. The electrophysiologic classification of the antidysrhythmic drugs presented in this paper should be acceptable both to the electrophysiologist and the clinician since it is based on alterations in basic membrane properties and correlates well with clinical realities. It serves as a guide to initial drug selection, anticipated bioelectric complications, the use of alternative drugs, and combination antidysrhythmic therapy.

Anti-Arrhythmia Agents↗
PubMed1999

[Alzheimer's disease: lesions and their progression].

Alzheimer disease appears to be a stereotyped mode of reaction of the central nervous system to various types of aggression such as different mutations involving various proteins, trisomy 21 or repeated head trauma as in dementia pugilistica. Rather than a disease, it appears to be a clinicopathological syndrome due to various causes. Lesions may be considered under 3 headings: neurofibrillary pathology, A beta peptide deposits and loss (neuronal and synaptic). Neurofibrillary pathology includes the neurofibrillary tangle, the crown of the senile plaque and the neuropil threads. All those lesions are characterized by the same ultrastructure--i.e. the accumulation of paired helical filaments--and the same immunohistochemistry: they are labelled by antibodies directed against the tau proteins. The amyloid deposits, present in the core of the senile plaque and in the vascular walls, are made of a 40 to 42 amino-acids long peptide, named A beta, derived from the amyloid precursor protein (APP). Antibodies directed against the A beta peptide also label diffuse deposits that are devoid of the tinctorial affinities and of the biochemical properties of amyloid substances. Those diffuse deposits are insufficient to cause dementia since they may be observed in high density in aged people without intellectual deterioration. Neuronal loss occurs after neurofibrillary pathology. The role of the synaptic pathology remains discussed. Besides tau proteins, A beta peptide and APP, several other proteins may play an important role: apolipoprotein E which could act as a chaperone protein, inducing or facilitating the formation of amyloid, presenilins 1 and 2, mutated in some cases of familial Alzheimer disease, alpha-synuclein which is present in the Lewy bodies found in Parkinson disease and in dementia with Lewy bodies. The A beta deposits are diffusely distributed in the cerebral cortex; the neurofibrillary changes have a hierarchical distribution. The progression of the neurofibrillary pathology in the various cortical areas follow a stereotyped sequence that may help to grade the severity of the disease. Progression may take decades. The relations between aging and Alzheimer disease are still poorly understood. Frequency of Alzheimer type lesions in old people could suggest that they are the inevitable burden of age, but this has been discussed.

Aged↗
PubMed1986

Assessing the employment-related interpersonal competence of mildly mentally retarded workers.

Interpersonal competence has been identified as a key variable in the vocational success of mentally retarded adolescents and adults. Unfortunately, few tests are available that address this critical skill area. The purpose of this article is to describe the Test of Interpersonal Competence for Employment (TICE), a measure designed to assess mildly retarded worker's knowledge of interpersonal skills in the employment setting. This test was developed using the Behavioral-Analytic Model of Test Development (Goldfried & D'Zurilla, 1969). This procedure called for the detailed analysis of the problems that mildly retarded workers experience in the vocational setting and the identification of correct responses to those problems by competitive employers. The TICE was standardized on both high school and workshop populations. Overall, the initial psychometric properties of the test are uniformly adequate and encouraging.

Adolescent↗
PubMed1994

The meaning of activities of daily living in a Thai elderly population: development of a new index.

Activities of daily living (ADL) of 703 Thai elderly people (aged 60+ years) living in a Bangkok slum community were studied with the aims of describing the prevalence of disability, considering the appropriateness of Western ADL scales and developing a new ADL index for Asian populations. The levels of disability found were higher than in industrial populations and the important areas of disability were in instrumental ADLs. The mean (SD) Barthel ADL Index (BAI) for the group was 19.5 (1.2) with a range of 10-20. The mean (SD) Office of Populations Censuses and Surveys (OPCS) disability score was 4.8 (1.9) with a range of 0-10 but was unsuitable for use in Thailand because of misinterpretation of behavioural and intellectual disability leading to 99% of subjects being scored as disabled. An analysis of the underlying dimensions making up ADL was conducted using factor analysis. Four dimensions of ADL were found: basic self-care ADLs, extended ADLs, mobility ADLs and continence. An extended ADL index suitable for use in developing countries was developed (the Chula ADL Index) which had strong hierarchical properties and high correlations with both the OPCS disability score and the Barthel ADL Index. Analysis of data derived from ADL instruments should consider each ADL dimension separately. The BAI is useful as an index of self-care ADL but the behaviour and intellectual disability sub-scales of the OPCS scale require further development for cross-cultural applications.

Activities of Daily Living↗
PubMedDate not supplied

A history of antipsychotic drug development.

The history of antipsychotic drug development has had a long and torturous course, often based on chance findings that bear little relationship to the intellectual background driving observations. In 1891, Paul Ehrlich observed the antimalarial effects of methylene blue, a phenothiazine derivative. Later, the phenothiazines were developed for their antihistaminergic properties. In 1951, Laborit and Huguenard administered the aliphatic phenothiazine, chlorpromazine, to patients for its potential anesthetic effects during surgery. Shortly thereafter, Hamon et al. and Delay et al. extended the use of this treatment in psychiatric patients and serendipitously uncovered its antipsychotic activity. Between 1954 and 1975, about 15 antipsychotic drugs were introduced in the United States and about 40 throughout the world. Thereafter, there was a hiatus in the development of antipsychotics until the introduction of clozapine treatment in the United States in 1990 opened the era of "atypical" antipsychotic drugs, which show a reduced potential to induce extrapyramidal symptoms (EPS), an increased efficacy for the negative symptoms of schizophrenia, no elevation of prolactin after chronic use (except risperidone), and, at least for clozapine, effectiveness in some patients previously regarded as treatment-refractory. This review describes the available atypical antipsychotic drugs and their characteristics, and concludes by highlighting those in the pharmaceutical "pipeline."

Antipsychotic Agents↗
PubMed1995

On the calibration of knowledge and perception.

This study examined confidence judgements (i.e., calibration, resolution, and over/underconfidence) and response times in an intellectual knowledge task and a perceptual task requiring location comparisons. At each of four levels of judgement difficulty (i.e., Easy, Hard, Impossible and Misleading/Illusory), very similar properties were evident in the two tasks. The results are inconsistent with theories that assume a fundamentally different basis for confidence in human knowledge and perception.

Attention↗
PubMed1992

Perceptual strategies of isolation in obsessive-compulsive personality disorder.

Recent findings have shown that the Defense Mechanism Test, a serial tachistoscopic technique developed inside the percept-genetic frame of reference, discriminates neurotics from normals, neurotics from schizophrenic outpatients, and subjects with histrionic personality disorder from controls. The present research addresses another major class of Axis II pathology, comparing on the Defense Mechanism Test a group with a psychometric diagnosis of obsessive-compulsive personality disorder (n = 26) with a matched sample of noncompulsive controls. As predicted, several variants of isolation were significantly more characteristic of the compulsive group. Intellectualization, disappearance of the whole structure, whitening of the hero, and lack of recognition of the threat were the variants of isolation with the best discriminative properties. Codings of reaction formation were not linked with compulsive personality, which is congruent with the recent observation of their correspondence to the histrionic personality disorder. The findings are presented in the context of the percept-genetic literature on obsessive-compulsive defensive strategies.

Adult↗
PubMed1994

A survey of aggressive behaviour among a population of persons with intellectual disability in Queensland.

A survey was conducted on aggressive behaviour within a population of 2412 persons with intellectual disability in Queensland, Australia. Two hundred and sixty-one individuals were identified who engaged in at least one form of aggressive behaviour, yielding an overall prevalence of 11%. The relative prevalence of aggressive behaviour was higher among institutionalized persons (35%) when compared to those living in group homes (17%) or other community-based facilities (3%). The aggressive behaviour sample included a higher percentage of males (64%). Most were described as functioning in the severe/profound (54%) or moderate (31%) range of intellectual disability with one-third having no intelligible speech. Two-thirds of the sample received medication for their challenging behaviour, while only one-third had behavioural programmes. Eighty per cent engaged in three or more forms of aggression. Many also displayed self-injury (34%) or property destruction (30%). Surveys of aggressive behaviour may prove useful for coordinating services.

Adolescent↗
PubMed2004

The Resident Choice Scale: a measure to assess opportunities for self-determination in residential settings.

BACKGROUND: A 26-item Resident Choice Scale was designed to assess service practices for promoting resident choice. METHOD: The staff working with 560 UK/Irish adults with intellectual disability were interviewed. Specific examples of practices promoting resident choice were requested and independently rated by the interviewer. RESULTS: The interrater reliability of Resident Choice items was found to be acceptable (subsample n = 50). The psychometric properties of the Resident Choice Scale total score and scores on eight subscales were also acceptable. Consistently strong associations were found between greater resident choice and greater resident ability and, to a lesser extent, fewer resident challenging behaviours. Few associations were found between resident choice and autism or mental health problems. Even when controlling for resident ability and challenging behaviour, consistent associations were found between greater resident choice and the concurrent variables of greater community presence, fewer institutional practices, and greater user self-reported satisfaction (subsample n = 50). CONCLUSIONS: Taken together, this pattern of results indicates that the Resident Choice Scale shows promise as a measure of the environmental opportunities available for adults with intellectual disability to exercise self-determination. Areas for future research testing the reliability and validity of the Resident Choice Scale are outlined.

Adult↗
PubMed2000

What is a moment? "Cortical" sensory integration over a brief interval.

Recognition of complex temporal sequences is a general sensory problem that requires integration of information over time. We describe a very simple "organism" that performs this task, exemplified here by recognition of spoken monosyllables. The network's computation can be understood through the application of simple but generally unexploited principles describing neural activity. The organism is a network of very simple neurons and synapses; the experiments are simulations. The network's recognition capabilities are robust to variations across speakers, simple masking noises, and large variations in system parameters. The network principles underlying recognition of short temporal sequences are applied here to speech, but similar ideas can be applied to aspects of vision, touch, and olfaction. In this article, we describe only properties of the system that could be measured if it were a real biological organism. We delay publication of the principles behind the network's operation as an intellectual challenge: the essential principles of operation can be deduced based on the experimental results presented here alone. An interactive web site (http://neuron.princeton.edu/ approximately moment) is available to allow readers to design and carry out their own experiments on the organism.

Cerebral Cortex↗
PubMed1977

Toxicological properties of lead.

The pathological effects of lead on the renal, nervous, reproductive, endocrine, and immune systems have been reviewed. Emphasis is placed on reported subclinical effects due to chronic, low-level lead exposure. The crucial issue of whether subtle behavioral, intellectual, and developmental impairment occurs in young children, as a result of lead-induced CNS damage is discussed in detail. This issue remains unresolved. Further studies are needed in order to determine the long-term health effects of continuous, low-level lead exposure.

Adult↗
PubMed2003

Content validity and clinical applicability of the Irena Daily Activity assessment measuring occupational performance in adults with developmental disability.

The purpose of this study was to investigate the validity of the Irena Daily Activity (IDA) assessment which measures occupational performance in adults with developmental disabilities. The instrument's content validity was investigated by elucidating its general appropriateness, its clinical applicability and the feasibility of the measurement procedure. Data were collected from a multidisciplinary panel of clinical experts working in day activity centres. Each expert independently judged and reviewed the IDA instrument's content validity. The results show that the content validity index (CVI) values ranged from 0.8 to 1.0 for the instrument's general appropriateness and clinical applicability, and from 0.7 to 1.0 with respect to the significance of the IDA domains' clinical applicability. The applicability of the IDA items were judged as satisfactory (CVI > 80) with respect to their importance for planning treatment and intervention. The feasibility of the measurement procedure was estimated as satisfactory in relation to the items (CVI > 0.70) and satisfactory with respect to the time needed and material used, with CVI values ranging from 0.8 to 1.0. The results of this study support the use of the IDA as a feasible and time-efficient assessment that provides insights regarding the occupational performance of adults with developmental disabilities. A limitation of this study was that it could not illuminate all-important aspects of validity. In conclusion, the IDA has the potential to become a reliable and valid clinical assessment, but additional research on psychometric properties is still needed.

Activities of Daily Living↗
PubMed1968

Chlorpromazine: direct measurement of differential behavioral effect.

A retarded child with a high stereotyped rocking rate was conditioned to pull a ball on a reinforcement schedule in which the fixed ratio aof rewarded to nonrewarded responses was 100. Results show no rocking movements during ball-pulling; but when ball-pulling was on extinction, rocking returned to its original rate. Chlorpromazine blocked rocking movements during extinction, but had no effect on ball-pulling. Delivery of one free reinforcer was sufficient to reinstate ball-pulling after extinction, but the stimulus properties of the free reinforcer were not affected by the drug.

Adolescent↗
PubMed1993

Mental retardation and parental occupation: a study on the applicability of job exposure matrices.

In a case-referent study on mental retardation and parental occupation, the applicability of job exposure matrices for the identification of risk factors was evaluated. The parents of 306 mentally retarded children (cases) and 322 referents were interviewed about their occupational activities in the pregnancy period. Detailed occupational histories were obtained that were compared with exposures generated by two different job exposure matrices. The agreement between interview and matrices was low: the sensitivity ranged from 17.9% to 32.4% and the percentages of false positive exposures from 66.7% to 96.0%. By means of the interview, significantly increased odds ratios (ORs) were found for exposure of the mother in late pregnancy to radiation (OR = 9.3), mercury (OR = 8.7), organic solvents (OR = 1.7), hair cosmetics and dyes (OR = 3.7), paint (OR = 2.7), hexachlorophene/phenylphenol (OR = 3.1), antibiotics (OR = 2.9), and dust (OR = 2.2) and for working with copying machines (OR = 3.0) or in occupations with poor climatological circumstances and permanent contact with people. The last was confirmed by the British matrix (OR = 1.7). Otherwise, most of the mentioned associations were missed by the job exposure matrices. Therefore, these matrices were not considered to be applicable in this particular study, nor in most other reproductive epidemiological studies in view of their general properties and limitations.

Case-Control Studies↗