The Chinese version of the Davidson Trauma Scale: a practice test for validation

The Chinese version of the Davidson Trauma Scale (DTS-C) was developed to respond to the need of Chinese-speaking individuals. The DTS is a validated self-rating scale used in the diagnosis of posttraumatic stress disorder (PTSD). The DTS-C is translated from DTS through a two-stage translation. Subjects were drawn from a sample of 210 survivors of the 21 September 1999, Chi-Chi Earthquake. The scale showed good internal consistency (Cronbach's alpha = 0.97) and test-retest reliability (r = 0.88). Concurrent validity was obtained against the clinical diagnostic interview, with a diagnostic accuracy of 0.85 at DTS-C score of 44. It showed that the sensitivity was 0.9, specificity 0.81, positive likelihood ratio 4.74, and negative likelihood ratio 0.12. The recommended stratum-specific likelihood ratios were 0.10 (95% CI: 0.05-0.20) for the score range 0-39, 4 (2.22-7.23) for the score range of 40-59, and 6.14 (3.42-11.02) for the scores above 60. In PTSD diagnosed subjects, the factor structures closely resembled the DSM-IV grouping of PTSD symptoms. The psychometric strength of DTS-C is reliable for its future use, particularly for screening for subjects with possible diagnosis of PTSD.

Omega-3 fatty acids as a psychotherapeutic agent for a pregnant schizophrenic patient

Because of the potential adverse events and teratogenesis of antipsychotic drugs, it is important to find a safe and effective treatment for pregnant women with severe mental illness. The membrane hypothesis of schizophrenia provides a rationale to treat symptoms of schizophrenia with omega-3 PUFAs. We report a 30-year-old married woman with chronic schizophrenia, who experienced an episode of acute exacerbation of psychotic symptoms during pregnancy. After entering into an open trial of omega-3 PUFAs monotherapy, she showed a dramatic improvement in both positive and negative symptoms of schizophrenia and a significant increase of omega-3 PUFA composition in erythrocyte membrane. There were no adverse effects in this treatment. Thus, omega-3 PUFAs could be both beneficial and therapeutic to pregnant schizophrenic women.

Magnetic resonance imaging findings in patients with delusional disorder due to diffuse cerebrovascular disease: a report of seven cases

Delusions associated with cerebrovascular diseases have been sporadically reported. Although both psychiatrists and neurologists attempted to link delusions with anatomical locations of the brain lesion, comorbid psychiatric and neurological disorders make the interpretation of delusions difficult. The purpose of the present paper is to report the clinical features and magnetic resonance imaging (MRI) characteristics in patients with delusional disorder due to diffuse cerebrovascular diseases, and to redefine the concept of 'vascular delusion'. The clinical features and MRI findings were reviewed retrospectively in a series of seven patients with 'delusional disorder due to cerebrovascular disease' as defined in Diagnostic and Statistical Manual of Mental Disorders (DSMIV). The average age of onset is 64. No patient had a prior personal or family history of major psychiatric illness. The illness is presented as acute, subacute or stepwise course. Hypertension was present in all patients. Two had diabetes mellitus, and one had atrial fibrillation. Three had clinical evidence of previous cerebrovascular attacks, only one showed minor neurological deficits. Three had diffuse cortical slow wave in electroencephalogram. No patient had significant cognitive impairment but had multiple cortical and subcortical cerebrovascular lesions in MRI, with white-matter lesions (WML) in bilateral frontal areas. Delusional disorder due to diffuse cerebrovascular change is characterized by late-onset, stepwise course, and comorbid medical and neurological diseases. The results of vascular changes in the present study did not establish a cause-effect relationship and should be considered as multifactorial in pathogenesis. The findings suggested the hypothesis of neural circuit theory. Further studies in larger numbers of patients and newer neuroimaging techniques are needed to expand the knowledge learned from these findings.

Soy isoflavone supplementation in postmenopausal women. Effects on plasma lipids, antioxidant enzyme activities and bone density

OBJECTIVE

To investigate isoflavone supplementation on plasma lipids, erythrocyte antioxidant enzyme activities and bone mineral density in postmenopausal women.

STUDY DESIGN

Thirty-seven postmenopausal women were given 150 mg/d of isoflavone supplements twice daily for six months. Blood was sampled before and after supplementation, at three and six months.

RESULTS

There were no significant differences in plasma total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triglyceride concentrations or erythrocyte antioxidant enzyme activities after three and six months of supplementation when compared with the baseline. No significant changes were noted in calcaneus bone mineral density after supplementing isoflavones for six months.

CONCLUSION

The antioxidant effect of isoflavones in normal postmenopausal women is not obvious, and supplementation with isoflavone alone may not have a hypocholesterolemic effect. Since the duration of this study was too short with respect to bone density, longer studies are needed to clarify the bone-sparing effect of isoflavone supplementation.

Functional tethered lipid bilayers

Our strategy to provide the structural basis for the build-up of functional tethered membranes focuses on three approaches: the first one is based on the pre-organization of a monomolecular layer of a lipopolymer at the water/air interface which is then transferred to a solid support. Prior to deposition, the substrate is coated with a layer of benzophenone-derivatized silane molecules that allow for a stable covalent attachment by photo-cross-linking of some of the monomer units of the lipopolymer to the support. An alternative concept realizes a layer-by-layer deposition of the various structural elements: (1) the attachment layer with the reactive sites for the chemical stabilization; (2) a polymer 'cushion' prepared by adsorption and simultaneous or subsequent partial covalent binding to the reactive sites; and (3) a lipid monolayer transferred from the water/air interface, that contains a certain amount of lipids with reactive headgroups which, upon binding to the polymer tether, act as anchor lipids stabilizing the whole monolayer/cushion-composite. And finally, we build peptide-supported monolayers by first (self-) assembling amino acid sequences of various lengths via a SH-group near their N-terminus onto Au substances and use then their COO(-)-terminus to chemically attach phosphatidyl-ethanolamine lipids to form a stable monolayer of lipid-peptide conjugates. All the individual preparation steps and the various resulting (multi-) layers are characterized by surface plasmon spectroscopy, X-ray and neutron-reflectometry, contact angle measurements, IR spectroscopy, fluorescence microscopy, scanning probe microscopies, as well as, electrochemical techniques. For all tethering systems, the final membranes' architecture is obtained by fusing lipid vesicles onto the lipid monolayer. Proteins can be incorporated by either fusing vesicles that are loaded with the respective receptors, pores, or ion pumps via a reconstitution procedure, or via a transfer directly from a micellar solution to the pre-formed lipid bilayer at the solid support by a dialysis step. Two structural/dynamical features of tethered membranes which are considered to be of particular functional relevance, i.e. the degree of water uptake and, hence, the degree of swelling of the polymer support, as well as the lateral mobility of the lipid molecules in the membrane, are tested by surface plasmon optics and by measurements of the fluorescence recovery after photobleaching (FRAP), respectively. The results confirm that the presented preparation protocols yield fluid bilayers that mimic certain relevant properties of biological membranes. The functional characterization of tethered membranes, which is briefly summarized, is based on various electrochemical techniques, in particular, impedance spectroscopy, cyclic voltammetry, and chronoamperometric studies. The results obtained for reconstituted H(+)-ATPase from chloroplasts and E. coli and for cytochrome oxidase (with and without cytochrome c) confirm the incorporation of the proteins in an active form, thus, opening opportunities for novel sensor formats or offering a completely new model membrane system.

Is episodic obsessive compulsive disorder bipolar? A report of four cases

Several reports have noted cases of OCD which were unusual in showing an abrupt remission. We report longitudinal clinical observation of four cases of acute onset OCD without major depression through a variety of treatments. These patients had prominent feelings of shamefulness; compared to patients with typical OCD they were ill for months rather than years and were older. Two had previous episodes of psychiatric illness with full recovery. Full and persistent recovery occurred in response to lithium or an acute course of ECT but not to tricyclic or SSRI antidepressants. The generalizability of these observations is limited by its uncontrolled nature and the small numbers. The courses observed were consistent with episodic OCD as a possible expression of bipolar disorder and consideration of corresponding treatments. This perspective offers a new rationale for reported observations of remissions of acute onset OCD in response to lithium without lithium effectiveness for typical OCD.

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."

The metabolism of atypical antipsychotic drugs: an update

This paper reviews the current literature describing the metabolism of both multi-receptor clozapine analogue atypical antipsychotic drugs (clozapine, olanzapine, and quetiapine) and serotonin-dopamine antagonist atypical antipsychotic drugs (risperidone, sertindole and ziprasidone), to highlight the significance of those data in the context of clinical practice. The former group of atypical antipsychotic drugs shares a similar tricyclic structural nucleus and are metabolized through three major categorical metabolic pathways--N+-oxidation, N-glucuronidation, and phases 1 and 2 biotransformation with final glucuronidation before renal excretion. Differing in clozapine and olanzapine, quetiapine has incomplete data describing its metabolism. The latter group of atypical antipsychotic drugs has diversified chemical structures and absence of data on N+-oxidation and N-glucuronidation in the literature. But their metabolic routes in phase 1 biotransformation are versatile although current data are far from completion. No apparent significant drug interactions in clinical practice are reported, although QT prolongation is implicated in all those three drugs. None of all six atypical antipsychotic drugs are identified as significant inhibitors or inducers to any co-administered medication. The author suggests the need for more research to address some pertinent clinical issues in the metabolism of those drugs.

Sildenafil in the treatment of female sexual dysfunction induced by selective serotonin reuptake inhibitors

OBJECTIVE

To review the literature describing female orgasmic disorder and impaired sexual desire disorder by selective serotonin reuptake inhibitors (SSRIs) and their treatment, including the use of sildenafil.

STUDY DESIGN

Literature reviews of all available published articles on this topic from 1989 to 1996 were done. This paper also includes a sample case of a 38-year old woman who suffers from fluoxetine-induced arousal and orgasmic disturbance.

RESULTS

Treatment approaches include the use of "antidotes," such as cyproheptadine, yohimbine, amantadine, granisetron and ginkgo biloba. This article also reports a case of successful female use of sildenafil, which was released by the Food and Drug Administration in March 1998 for erectile dysfunction in men.

CONCLUSION

Sildenafil is beneficial in reversing female sexual dysfunction induced by SSRIs. This paper also discusses sildenafil's action in the background of nitric oxide and cyclic guaninosine monophosphate in penile/clitoral erection.

Psychotropic drug-induced sexual function disorders: diagnosis, incidence and management

The human sexual response can be divided into 3 phases: desire (libido), excitement (arousal) and orgasm. The fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) classifies sexual disorders into 4 categories: (i) primary; (ii) general medical condition-related; (iii) substance-induced; and (iv) 'not otherwise specified' sexual dysfunctions. Each of the 4 DSM-IV categories has disorders in all 3 sexual phases. Substance-induced sexual dysfunctions are caused by the use of either substances of abuse [alcohol (ethanol), amphetamines, cocaine, opioids or sedatives/hypnotics/anxiolytics], or prescription medications which include psychotropic drugs. Patients with psychiatric difficulties tend to experience more frequent sexual function disturbances. The literature provides more than anecdotal evidence that psychotropic drugs can induce sexual function disorders in the epidemiologically vulnerable population of psychiatric patients. Sexual dysfunctions caused by psychotropic drugs can be divided into 2 groups: sexual inhibition (inhibited desire, inhibited arousal and inhibited orgasm) and increased sexual function disorders (increased sexual desire, priapism and premature ejaculation). The diagnosis of psychotropic drug-induced sexual function disorders is easy if the psychiatrist is sensitive to the existence of these adverse effects. This mostly involves careful history taking, although several questionnaires have been developed for reliable and valid quantification of sexual functioning. Diagnosis is usually established if the sexual function disorders develop when the patient is receiving a psychotropic drug and then disappear when the offending drug is discontinued. The management of psychotropic-drug induced sexual inhibition can be divided into 6 steps: inform the patient about the possibility of sexual inhibition occurring before prescribing a psychotropic agent; wait for remission or tolerance of sexual inhibition; reduce the dosage of the psychotropic drug; switch the medication to one less likely to cause sexual inhibition; if possible, adjust the concomitant nonpsychotropic drugs; and add various pharmacological agents to the existing psychotropic drug to treat the sexual inhibition. Physicians should take sexual histories as a routine practice when prescribing psychotropic drugs. Through careful management and patience on the part of both the patient and the physician, psychotropic drug-induced sexual function disorders can be improved so that the patient's compliance with medication and quality of life can be optimised.

[A primary study on the relationship between the weight of newborn and sucking pressure]

OBJECTIVE:In this study, the main aim is to investigate the relationship between the weight of newborn and sucking pressure.the relationship between the weight of 26 cases health newborn and sucking pressure was analyzed with "oral air manometers computer analysis system".The result showed that the relationship of both corelated positively.It showed that sucking pressure is one of the indication which reflects the condition of growth and development of newborn.

Activation of the tumor necrosis factor-alpha system in the liver in chronic hepatitis B virus infection

To determine the status of the tumor necrosis factor-alpha (TNFalpha) system in the liver in chronic hepatitis B virus (HBV) infection, hepatic expression of TNFalpha, its two receptors (TNFR-A, TNFR-B), HLA class I antigens (HLA-I), and HBV core antigen (HBcAg) were studied by immunohistochemistry in 24 patients with chronic HBV infection. TNFalpha was detected exclusively in the infiltrating mononuclear cells (MNC) in 19 of 24 patients. The expression of TNFalpha in infiltrating MNC correlated with serum markers of HBV replication and liver histology. TNFR were detected in hepatocytes, sinusoidal cells, and infiltrating MNC. The expression of TNFR correlated with liver histology (p < 0.01) but had no bearing on viral replication. There was a parallel expression of TNFalpha and TNFR (p < 0.01). Hepatocytic expression of HLA-I was increased, and this was related to liver histology but not with TNF alpha nor TNFR. These data indicate that the TNFalpha system is activated in the liver in chronic HBV infection.

Male sexual side effects associated with antidepressants: a descriptive clinical study of 32 patients

OBJECTIVE

This is a retrospective study to add to the existing body of clinical information regarding male sexual side effects associated with antidepressants. From the chart review, thirty-four out of eighty male patients were identified to have reported loss of libido, erectile difficulty, anorgasmia, and delayed ejaculation while receiving pharmacotherapy of selective serotonin reuptake blockers (fluoxetine, paroxetine, and sertraline); tricyclic antidepressants (nortriptyline, imipramine, amitriptyline, desipramine, and clomipramine); and a monoamine oxidase inhibitor (phenelzine).

METHOD

The authors also discussed the management of these sexual side effects by waiting for spontaneous remission, reducing the dosage level, and substituting the offending drug with other antidepressants.

RESULTS

This article underscores the underreported nature of antidepressant-associated sexual dysfunction, the high incidence of SSRI-associated sexual side effects, equal potentials in causing sexual side effects among the three SSRI's, the low incidence rate of sexual adverse effects from bupropion, and the minimal need to add an antidote if the side effects are to be managed systematically.

CONCLUSIONS

Finally, male sexual side effects can occur randomly and involve any sexual phase randomly, and the treatment approaches are similar, regardless of the types of sexual dysfunction associated with antidepressants.

Female sexual side effects associated with selective serotonin reuptake inhibitors: a descriptive clinical study of 33 patients

OBJECTIVE

After the advent of selective serotonin reuptake inhibitors on the U.S. market in 1988, American psychiatrists have been faced with more choices of antidepressants for the treatment of depression. The prescribing of SSRIs has been increasing in popularity because they are easily titrated by the physicians and tolerated by patients. However, the SSRI use is frequently associated with female sexual dysfunction. The aim of this study was to describe these SSRI-associated female sexual side effects.

METHODS

In a retrospective series, clinic records of 110 female SSRI-treated outpatients were reviewed for loss of or decreased libido, orgasmic disturbances (anorgasmia or delayed orgasm), as well as clinical management patterns to alleviate sexual side effects.

RESULTS

Twenty-one fluoxetine-, nine paroxetine-, and five sertraline-treated cases with female sexual inhibition were identified. The fates of SSRI-associated sexual adverse effects and clinical managements of restoring these side effects were described.

CONCLUSIONS

With some limitations in interpreting the data, the findings of this study suggest that SSRI-associated female sexual dysfunction occurs at a higher rate than we previously thought, equal potentials in implicating female sexual side effects among three SSRIs, and the absence or the low incidence of female sexual adverse effects from bupropion, and that these side effects can be managed by waiting for a spontaneous remission, dosage reduction of SSRIs, substitution with bupropion and other antidepressants, or the use of an antidote.

Cytochrome P450 monooxygenases and interactions of psychotropic drugs: a five-year update

OBJECTIVE

This article is a five-year update on a previous review article (International Journal of Psychiatry in Medicine, 21:47-56, 1991) on cytochrome P450 monooxygenases and interactions of psychotropic drugs.

METHOD

In the literature review, the recent committee work on nomenclature of the P450 superfamily are highlighted. Then, the author reviewed gene clusters of three human cytochrome P450s--CYP1A2, CYP2D6, and CYP3A4 with the focus on the changes of serum levels of the coadministered psychotropic drugs in the context of enzymatic induction and inhibition of these three hepatic enzymes.

RESULTS

As indicated in one table, the author stratified probes, inducers, inhibitors, chemical reactions, and substrates under these three gene clusters. As shown in another simple table, the author compared the hepatic enzymatic inhibitions of four selective serotonin reuptake inhibitors and pointed out the inhibition potentials of fluvoxamine at CYP1A2, fluoxetine and paroxetine at CYP2D6, and fluoxetine and fluvoxamine at CYP3A4 if these two SSRIs have higher serum concentrations.

CONCLUSION

The author suggests that with these systematic approaches, this rapidly adding knowledge can help psychiatrists better understand psychotropic drug interactions and maximize the benefits of patients' psychopharmacotherapy.

Pharmacotherapy of schizophrenia: the American current status

This is a review paper covering the American current status of pharmacotherapy of schizophrenia. The author lists all available antipsychotic agents on the market in the United States and describes the American prescribing pattern of antipsychotic agents. This includes a brief history of antipsychotic use in America, acute treatment and chronic maintenance with antipsychotic drugs, the recent advent of atypical antipsychotic agents, and management of antipsychotic-induced side-effects. The characteristics of prescribing American antipsychotics in America are described, and they are then compared with Japanese prescribing practices. The author also makes brief remarks about the uncovered issues in antipsychotic pharmacotherapy and about atypical antipsychotic agents in the context of the future pharmaceutical development.