Isolated versus visible seclusion rooms: attitudes of psychiatric patients

This study compares the attitudes of nonsecluded patients hospitalized on psychiatric units with either isolated or visible seclusion rooms. It was found that there were minimal differences between units. Patients at the hospital with visible seclusion rooms more often indicate that patients are often cured in such rooms, in contrast to the patients on the other unit who endorsed more stereotypical perceptions of the quiet room.

Enzyme-linked immunosorbent assay for hyaluronate using cartilage proteoglycan and an antibody to keratan sulfate

An enzyme-linked immunosorbent assay has been developed to measure hyaluronate concentrations in biological samples. The assay is based on the aggregation of hyaluronate with cartilage proteoglycan monomer, followed by binding of a monoclonal antibody to the keratan sulfate on the proteoglycan. The sensitivity of the assay is 10 ng hyaluronate/ml of either serum or conditioned cell culture medium. The coefficient of variability was between 10 and 20%. Hyaluronate added to samples was recovered quantitatively and digestion of cell culture medium with protease did not affect the concentration of hyaluronate. Hyaluronate polysaccharides as small as a decasaccharide can be measured. This sensitive and convenient assay can be used for measuring large numbers of biological samples from a variety of animal and tissue sources.

Tourette syndrome

Tourette syndrome is not rare. At an early age, persons with this disorder show involuntary, rapid and purposeless movements of multiple muscle groups. They also develop vocal tics. Both motor and vocal tics vary in intensity and can worsen with stress. The syndrome may be confused with, or associated with, a variety of psychiatric disorders. Although some cases appear to be familial, the etiology of the syndrome is generally unknown. Haloperidol is effective in controlling symptoms in many patients. The Tourette Syndrome Association provides a valuable support system.

Borderline symptom inventory: assessing inpatient and outpatient borderline personality disorders

The Borderline Symptom Inventory (BSI), a 52-item self-report inventory, was administered to cohorts of patients diagnosed with borderline personality disorder (BPD), affective disorder and a normal control sample. The study failed to demonstrate that the inventory could effectively discriminate either ambulatory or hospitalized BPD patients from those with affective disorders, but that the inventory could correctly specify a control group without a psychiatric disorder. The results suggest that it is premature to utilize the BSI as a reliable screen to detect BPD.

Childhood reactions to illness and hospitalization

Emotional and cognitive developmental stages have a bearing on how children cope with illness and hospitalization. Within this framework, a general treatment strategy for helping children and parents deal with illness can be formulated. Parents and physicians who listen, educate, reassure and promote active mastery in the child help the child cope with serious illness and hospitalization.

Catabolin/interleukin-1 regulation of cartilage and chondrocyte metabolism

Catabolin/interleukin-1 effects on metabolism were studied in bovine nasal cartilage organ culture and articular chondrocyte cell culture. Keratan sulfate (KS) and hyaluronic acid (HA) were determined by an ELISA; prostaglandin E2 by RIA, sulfated glycosaminoglycan using dimethylmethylene blue and proliferation by incorporation of tritiated thymidine. Gel filtration of untreated 4-day organ culture media indicated that large sulfated and KS-containing proteoglycans were released and eluted in the void volume. Catabolin/interleukin-1 increased release of sulfated glycosaminoglycans and these were of lower molecular weight with an altered distribution of KS. Catabolin/interleukin-1 treatment of chondrocytes caused a decrease in KS production and proliferation but an increase in HA and in prostaglanding E2 production. Alterations of the chondrocyte metabolism by catabolin/interleukin-1 causing proteoglycan matrix degradation and modulation of chondrocyte glycosaminoglycan biosynthesis and proliferation may play a role in cartilage erosion and failure to repair in arthritic diseases.

Hyaluronate inhibition of cell proliferation

The proliferation of rabbit synovial cells, 3T3 cells, or simian virus-transformed 3T3 cells in cell culture was inhibited by the addition of hyaluronate to the culture medium. This effect was markedly dependent on the molecular weight and concentration of the hyaluronate. At the molecular weight and concentration of hyaluronate present in normal synovial fluid, proliferation was inhibited. At lower molecular weights or concentrations, as found in rheumatoid synovial fluid, hyaluronate was significantly less inhibitory. Thus, the changes in synovial fluid hyaluronate that are associated with arthropathies may contribute to a favorable environment for rheumatoid pannus expansion.

Guidelines for short-term inpatient psychotherapy

The authors propose guidelines for conducting psychotherapy in short-term general hospitals. They divide short-term psychiatric hospitalization into three phases, each of which presents different therapeutic tasks and calls for different therapeutic interventions and techniques. In phase one, when the patient is typically most distressed, the therapist and the patient must establish a therapeutic alliance and agree on the goals of therapy, a treatment contract, and limits on acting-out behavior. In phase two, the period of greatest comfort for the patient, the therapist must encourage the patient to focus on his goals while keeping the issue of discharge in the forefront of therapy. In phase three, the therapist helps the patient cope with separation issues that arise as he prepares for discharge.

Monoamine oxidase inhibitor-induced speech blockage

Speech blockage has been identified by recent case reports as a side effect of tricyclics in the treatment of depression. The first report of speech blockage associated with a monoamine oxidase inhibitor is presented and the possible mechanisms are discussed. All reports, including this one, associate this phenomenon with clinical improvement.

Management of acute grief

Family physicians must often help patients through the grief process. Acute grief may occur with the loss of a loved one or with the loss of physical health. Normal grief has well-defined stages, which help distinguish it from pathologic grief reactions. Familiarity with the grief process allows the physician to intervene when necessary and to facilitate the normal sequence of grieving which, if thwarted, has serious ramifications.

A learning-theory perspective of brief psychodynamic psychotherapy

The authors discuss the role of repeated exposure, a universal aspect of learning theory, in implosive therapy and brief psychodynamic psychotherapy. After demonstrating that it is one common denominator of these distinctive treatment modalities, they offer hypotheses concerning the workings of brief psychodynamic psychotherapy based on observations of the role of repeated exposure in behaviorally oriented therapies.

Corticosteroid abuse revisited

Corticosteroids are potent but hazardous medications which can be abused. This article reviews existing literature on corticosteroid abuse and provides three new case reports. A profile of the corticosteroid patient is described and some treatment guidelines are offered. Hopefully, this article will sensitize physicians to the abuse potential of this class of drugs.

Medical psychotherapy

Medical psychotherapy is often practiced by family physicians unknowingly. It shares certain features with all other forms of psychotherapy, but it also possesses its own unique qualities. Medical psychotherapy represents combinations of techniques, learned largely by experience, that are useful in treating the patient in crisis, as well as the patient with chronic psychiatric or physical illness. It contributes to higher quality medical care.

Pericellular coat of chick embryo chondrocytes: structural role of hyaluronate

Chondrocytes produce large pericellular coats in vitro that can be visualized by the exclusion of particles, e.g., fixed erythrocytes, and that are removed by treatment with Streptomyces hyaluronidase, which is specific for hyaluronate. In this study, we examined the kinetics of formation of these coats and the relationship of hyaluronate and proteoglycan to coat structure. Chondrocytes were isolated from chick tibia cartilage by collagenase-trypsin digestion and were characterized by their morphology and by their synthesis of both type II collagen and high molecular weight proteoglycans. The degree of spreading of the chondrocytes and the size of the coats were quantitated at various times subsequent to seeding by tracing phase-contrast photomicrographs of the cultures. After seeding, the chondrocytes attached themselves to the tissue culture dish and exhibited coats within 4 h. The coats reached a maximum size after 3-4 d and subsequently decreased over the next 2-3 d. Subcultured chondrocytes produced a large coat only if passaged before 4 d. Both primary and first passage cells, with or without coats, produced type II collagen but not type I collagen as determined by enzyme-linked immunosorbent assay. Treatment with Streptomyces hyaluronidase (1.0 mU/ml, 15 min), which completely removed the coat, released 58% of the chondroitin sulfate but only 9% of the proteins associated with the cell surface. The proteins released by hyaluronidase were not digestible by bacterial collagenase. Monensin and cycloheximide (0.01-10 microM, 48 h) caused a dose-dependent decrease in coat size that was linearly correlated to synthesis of cell surface hyaluronate (r = 0.98) but not chondroitin sulfate (r = 0.2). We conclude that the coat surrounding chondrocytes is dependent on hyaluronate for its structure and that hyaluronate retains a large proportion of the proteoglycan in the coat.

Endogenous hyaluronate-cell surface interactions in 3T3 and simian virus-transformed 3T3 cells

3T3 cells have a large, pericellular coat which contains 30 times more hyaluronate than the amount of cell surface hyaluronate associated with simian virus 40-transformed 3T3 (SV-3T3) cells. On the other hand, SV-3T3 cells have high affinity binding sites for exogenously added hyaluronate, whereas 3T3 cells have much lower affinity sites. Removal of cell surface hyaluronate from SV-3T3 cells by treatment with hyaluronidase caused a reproducible increase in their maximum binding capacity for exogenous hyaluronate but no significant change in binding affinity or specificity. For 3T3 cells, however, the maximum amount of binding decreased and the affinity of binding increased after hyaluronidase treatment. When endogenous cell surface hyaluronate was labeled metabolically and then the cells incubated in the presence of exogenous unlabeled hyaluronate, the labeled cell surface hyaluronate was quantitatively displaced from the SV-3T3 cells but was not displaced from the 3T3 cells. Chondroitin sulfate and heparin did not displace cell surface hyaluronate from either cell type. Membranes isolated from SV-3T3 cells bound hyaluronate specifically and with high affinity, whereas membranes from 3T3 cells did not consistently bind a significant amount of hyaluronate. We conclude from these studies that the retention of endogenous hyaluronate on the surface of SV-3T3 cells is mediated by binding sites similar to those detected by the addition of exogenous hyaluronate, and the mechanism of retention of endogenous hyaluronate on the surface of 3T3 cells differs from SV-3T3 cells.

Hyaluronate coat formation and cell spreading in rat fibrosarcoma cells

Hyaluronate-containing pericellular coats have been demonstrated around rat fibrosarcoma cells by exclusion of particles (fixed red blood cells). The cell coats normally form during spreading of the rat fibrosarcoma cells subsequent to subculturing. Monensin, a drug which disrupts the Golgi and which also inhibits hyaluronate synthesis in these cells, inhibits the regeneration of these coats after hyaluronidase or trypsin treatment but does not inhibit cell spreading. Cycloheximide, a drug which inhibits protein but not hyaluronate synthesis does not prevent coat regeneration but partially inhibits cell spreading. Thus by exploiting the opposing effects of cycloheximide and monensin on coat regeneration and cell spreading, we have been able to dissociate these two phenomena.

Effect of heavy metals on human rheumatoid synovial cell proliferation and collagen synthesis

The dose-dependent effects of heavy metals on cell proliferation, collagen synthesis, and non-collagen protein synthesis were studied in early passage cultures of human synovial cells exposed to 1-100 microM concentration of gold, silver, mercury, cadmium or lead for 5 days. The incorporation of [3H]thymidine into trichloroacetic acid insoluble material was inhibited 50% by each of the heavy metals at concentrations between 1 and 10 microM. Gold, lead and mercury (10 microM) decreased the DNA content of the cultures by less than 15%; silver (10 microM) and cadmium (10 microM) resulted in decreased DNA content, which was attributed to cytotoxicity. A dose-dependent inhibition of [3H]proline incorporation into bacterial collagenase resistant (non-collagen) protein was observed after incubation with 10 microM mercury, lead and silver. During incubations with 10 microM gold and cadmium, collagenase resistant protein accumulation increased. All the heavy metals except for gold inhibited collagen accumulation to a greater extent than non-collagen protein accumulation. Gold (10 microM) stimulated the amount of collagen produced per cell, and the percentage of collagen to total protein was increased 50%. The rate of collagen accumulation in medium decreased during incubation with 10 microM silver, mercury, cadmium and lead. The stimulation of collagen synthesis may be a unique property of gold related to the therapeutic indices of gold, compared to other heavy metals, in rheumatoid arthritis.

Monensin inhibition of hyaluronate synthesis in rat fibrosarcoma cells

Evidence is presented that monensin-sensitive membranes, presumably the Golgi apparatus, are involved in the synthesis of hyaluronate in rat fibrosarcoma cells. Monensin caused the inhibition of incorporation of metabolic precursors into hyaluronate produced by rat fibrosarcoma cells in a concentration- and time-dependent manner. Maximum inhibition (70-80%) was obtained on treatment with 10(-7) M monensin for 24 h. Incorporation of label into secreted hyaluronate and into that associated with the cell surface was inhibited, but incorporation into intracellular hyaluronate was not inhibited. In 3T3 cells, treatment for 24 h with 10(-7) M monensin inhibited incorporation of label only into secreted hyaluronate. The hyaluronate-rich pericellular coat, revealed by exclusion of fixed red blood cells, was depleted on treatment with monensin under the same conditions which caused inhibition of hyaluronate synthesis in the fibrosarcoma cells. Cell proliferation, as measured by DNA content/culture and [3H]thymidine incorporation, was also inhibited in a dose-dependent manner by monensin (10(-8)-10(-6) M). Protein synthesis was not inhibited at these doses, nor was monensin cytotoxic as judged by a 51Cr release assay. The inhibition of hyaluronate synthesis was independent of the antiproliferative effect of monensin because it was obtained during log phase growth or confluency and in the presence or in the absence of serum.

Sustained yawning as a side of imipramine

The occurrence of sustained yawning, uncoupled from sedation but caused by psychotropic medication, has been noted infrequently in the literature. This case report suggests the possibility of an association between imipramine and sustained yawning. Mechanisms of action for this yawning are proposed and a treatment strategy is offered.

The effect of lymphokines on proliferation and collagen synthesis of cultured human synovial cells

Human mononuclear cell supernatants were obtained by incubating 3 X 10(6) cells per ml of Dulbecco's modified Eagles medium at 37 degrees C for 24 h or 48 h, either in presence or absence of phytohaemagglutinin. After removal of intact cells, the supernatants were dialysed and diluted (1:1, 1:2, 1:5, 1:10) again using the above medium. The diluted supernatants, containing a final concentration of 10% (v/v) human platelet-factor poor serum, were found to stimulate the proliferation of human synovial cells in culture and to increase both the total amount of collagen and the percentage of Type III collagen synthesized by these cells. Incubation of the mononuclear cells in presence of phytohaemagglutinin appeared to further enhance the stimulatory effects of the supernatants upon the synovial cells. Since activated mononuclear leucocytes such as lymphocytes and macrophages are present in rheumatoid synovia, this study suggests that factors released from activated mononuclear leucocytes may play an important role in the proliferation of rheumatoid synovial tissue and development of the pannus.

Psychologic sequelae of myocardial infarction

Myocardial infarction should be understood not only in relation to its biologic impact but also in terms of its psychologic effect. Patients with myocardial infarction pass through identifiable dynamic phases associated with psychologic recovery and adaptation to myocardial damage. These phases consist of denial, anxiety, depression and convalescence. Some therapeutic strategies help the patient to cope with this life-threatening event. Delirium is a special problem after myocardial infarction.

Psychogenic seizures and loss

A review of the diagnostic and treatment approaches to psychogenic seizures has been offered. Two case reports of psychogenic seizures precipitated by loss and associated with depressive symptomatology have been presented. A literature review of cases seems to substantiate the frequency for the association between the development of psychogenic seizures and loss/depressive symptomatology. Symptom relief can be achieved with the utilization of a crisis intervention style psychotherapy. Antidepressant medication may also have a useful role in the treatment of some psychogenic seizures.

The use of carbamazepine for the treatment of paraphilias in a brain damaged patient

The authors evaluated a thirty-four year-old man who had an organic personality disorder, partial complex seizure disorder, and several paraphilias. After unsuccessful treatment with dilantin and phenobarbital, therapy with carbamazepine ameliorated the patient's psychosexual disorder.

Recognizing and treating organic mental disorders

Patients with organic mental disorders are frequently encountered by the family physician. Diagnosis is based on the recognition of cardinal signs and symptoms, an appreciation of the current classification for organic mental disorders and thorough physical and laboratory examination. While treatment should be aimed at correcting the underlying etiology of an organic mental disorder, useful guidelines for psychologic and psychopharmacologic intervention are available.

A mechanism of action of gold sodium thiomalate in diseases characterized by a proliferative synovitis: reversible changes in collagen production in cultured human synovial cells

These studies, conducted on early passage synovial cell mono-layers (derived from explant cultures of tissue obtained from patients with rheumatoid arthritis), have established that gold sodium thiomalate (GST) exposure results in dose-dependent changes in cell proliferation and protein synthesis as a consequence of the cellular accumulation of gold. The amount of gold found in the cell layer is correlated with the degree of inhibition of [3H]thymidine incorporation. Gold remains in the cell layer of treated cells after they have been subcultured twice in the absence of GST. Exposure of cells to a concentration of GST of 100 muM for 4 days results in 50% inhibition of [3H]thymidine incorporation. This antiproliferative effect is reversible at concentrations of 10 muM GST or less. Only partial recovery is observed after exposure to higher concentrations of GST which may be related to retained gold. The amount of collagen and noncollagen protein synthesized per cell increases at concentrations of GST of 10 muM and below but decreases with concentrations above 10 muM. A dose-dependent decrease in protein synthesized per flask and a decrease in the commitment to synthesize collagen relative to total protein synthesis follows exposure to GST in excess of 10 muM for 20 days which recovers partially after synovial cells are grown in GST-free medium for 10 days. An observed decrease in the percentage of type III collagen synthesized by synovial cells after GST exposure was not observed in cells grown in GST-free medium for 5 days after exposure, indicating that this effect of collagen synthesis is reversible. The reversible biochemical changes resulting from the exposure of cultured human synovial cells to GST are discussed as a mechanism of action of this drug on the proliferative synovitis that characterizes diseases such as rheumatoid arthritis.

Psychiatry and the primary care physician

Psychiatry makes an important contribution to the training and practice of primary care physicians by emphasizing a holistic approach to patient care, by teaching psychiatric skills and by providing knowledge that enables primary care physicians to give basic psychological care to the large numbers of their patients who need it. Consultation-liaison psychiatry and psychiatry education programs for medical students, both of which are given high priority for support by the Psychiatry Education Branch of National Institute of Mental Health (NIMH), are model settings in which to teach the psychiatric aspects of primary care.