[The observation unit and patients with chest pain--an efficient organizational model?]

BACKGROUND

Patients with chest pain make up 5-8% of all acute admissions to a department of internal medicine. Many of these patients could be discharged safely after a limited period of observation. Aker University Hospital opened an observation unit in the autumn of 2000, but for organizational reasons closed the ward on weekends for 4 months in the autumn of 2001.

METHOD

This study assessed the effect of this observation unit on the average admission time (in days) for patients who presented with chest pain. This was a retrospective cohort study which compared the average admission time for patients admitted on Fridays and Saturdays in the autumn of 2001 (n = 75), compared with those admitted in the autumn of 2000 and 2002 (n = 100).

RESULTS

The two groups are directly comparable with regards to age, gender, general risk factors, pre-morbid hospitalization and co-morbidity. The average hospital stay was 3.84 days when the unit was closed, as opposed to 2.59 days when it was in operation. Corrected for age and previous cardiac illness, the closing of the observation ward led to an increase in hospital stay by 1.11 days, p = 0,001. This corresponded to an increase in average admission time of 43%. Most of this difference was accounted for by a higher discharge rate within 24 hours when the unit was in operation. There was no increase in the number of readmissions within 30 days.

CONCLUSION

The observation unit leads to a meaningful shortening of admission time for patients with chest pain. This has not previously been shown in a Norwegian hospital.

A prospective evaluation of adherence to medication in first episode schizophrenia

The aim of this study was to identify the features of first episode schizophrenia that predict adherence antipsychotic medication at six-month follow-up. We used validated instruments to assess clinical and socio-demographic variables in all patients with first episode schizophrenia from a defined geographical area admitted to a Dublin psychiatric hospital over a four-year period (N=100). At six-month follow-up (N=60) we assessed adherence to medication using the Compliance Interview. One third of patients with schizophrenia were non-adherent with medication within six months of their first episode of illness. High levels of positive symptoms at baseline, lack of insight at baseline, alcohol misuse at baseline and previous drug misuse predict non-adherence. These results indicate that an identifiable subgroup of patients with first episode schizophrenia is at high risk of early non-adherence to medication. While high positive symptom scores pre-date and predict non-adherence in most patients, reduced insight is the best predictor of non-adherence in patients who do not misuse alcohol or other drugs.

Team-referent attributions among sport performers

The aim of this study was to develop and validate a team-referent attribution scale. Conducted over three studies, Study 1 modified items from McAuley, Duncan, and Russell's (1992) Causal Dimension Scale II by rewording items to reflect team attributions and adding one item per factor. This led to the development of a 16-item scale (Causal Dimension Scale-T, CDS-T). Study 2 tested competing models of attribution theory among a sample of 433 team sport players. Confirmatory factor analysis indicated strongest support for a four-factor model (robust comparative fit index = .961; root mean squared error of approximation = .054). Study 3 tested the predictive validity of the scale among a sample of 201 team players. Results indicated that winners reported more internal and stable attributions than losers. Further, performances perceived as successful were associated with stable attributions. The results of the study, therefore, suggest that the CDS-T provides a valid measure of team-referent attributions in sport.

Early insight predicts depression and attempted suicide after 4 years in first-episode schizophrenia and schizophreniform disorder

OBJECTIVE

To map the development of insight in the 4 years after presentation with first-episode schizophrenia and schizophreniform disorder and to determine the effects of evolving insight on depression and the likelihood of attempted suicide.

METHOD

We assessed 101 individuals at presentation, 6 months and 4 years. We measured insight, including recognition of mental illness, recognition of need for treatment and ability to relabel psychotic symptoms. We measured depression and recorded all suicide attempts.

RESULTS

Insight improved with time. Recognition of mental illness at 6 months predicted depression and attempted suicide at 4 years.

CONCLUSION

Six months after presentation, the greater the acknowledgement by people that they had a mental illness, the more depressed they were at 4 years and the greater the likelihood that they would attempt suicide by 4 years. This may have implications for disclosure of diagnosis.

Benchmarking outcome in ICU

There are as yet few well developed systems for comparing the quality of care in Irish hospitals with other hospitals either nationally or internationally. The best known are the perinatal mortality rates of the Dublin maternity hospitals. Other examples include mortality rates after cardiac surgery and survival rates after cancer surgery. We describe a comparison of outcomes in an Irish ICU with internationally validated mortality rates for a given severity of illness. The method of stratifying for severity of illness is by use of the APACHE II scoring system. In 2003 the standardised mortality ratio for Beaumont Hospital ICU was 0.87 with a mean APACHE II admission score of 17.5 which compares favourably with similar data produced from UK units.

Craniofacial dysmorphology in Swedish schizophrenia patients

OBJECTIVE

To perform detailed assessments of craniofacial dysmorphology in individuals with schizophrenia and controls in Sweden, in order to further elucidate the neurodevelopmental origins of schizophrenia.

METHOD

We performed detailed, anthropometric assessments of craniofacial dysmorphology in male patients with schizophrenia (n=24), healthy controls (n=16), and patients' siblings with schizophrenia (n=2) in Sweden, while remaining as blind as possible to schizophrenia/control status.

RESULTS

Individuals with schizophrenia evidenced significantly more craniofacial dysmorphology than controls, especially in the ears and mouth. At a group level, there was a dose-response type relationship between total dysmorphology score and patient/control status.

CONCLUSION

The consistency of results across multiple studies supports the hypothesis that individuals with schizophrenia have increased rates of prenatal developmental disturbances. The presence of a dose-response type relationship between total dysmorphology score and patient/control status supports the importance of neurodevelopmental disturbance as a contributory cause of schizophrenia.

Clinical predictors of admission status in first episode schizophrenia

Having a diagnosis of schizophrenia is a risk factor for involuntary admission to psychiatric inpatient care, but we have a limited understanding of why some patients and not others require involuntary admission. We aimed to identify the predictors of involuntary admission in first episode schizophrenia. We used validated instruments to assess clinical and socio-demographic variables in all patients (n = 78) with first episode schizophrenia from a defined geographical area admitted to a Dublin psychiatric hospital over a 4-year period. Involuntary patients (n = 17) could not be distinguished from voluntary patients (n = 61) on the basis of age, gender, living status, marital status, drug abuse or duration of untreated psychosis. Neither positive nor negative symptoms were useful predictors of admission status. Lack of insight was a strong predictor of involuntary status.

Prospective evaluation of neurological soft signs in first-episode schizophrenia in relation to psychopathology: state versus trait phenomena

BACKGROUND

Although patients with schizophrenia have increased rates of neurological soft signs, few studies have examined prospectively their trait or state characteristics in relation to psychopathology.

METHOD

In a prospective study of 97 patients with first-episode schizophrenia (DSM-IV criteria) we assessed neurological soft signs and psychopathology at presentation and at 6 month follow-up for 73 cases. To establish whether soft signs were associated with variations in clinical state, neurological soft signs were measured using two validated examinations (Neurological Evaluation Scale and Condensed Neurological Examination); psychopathology was assessed using the Positive and Negative Syndrome Scale.

RESULTS

There was significant improvement in overall neurological function, primarily in motor-related and cortical signs, which were associated with improvement in psychopathology. Conversely, 'harder' signs were unrelated to improvement in psychopathology.

CONCLUSIONS

Neurological soft signs in schizophrenia are heterogenous. Motor and cortical signs evidence state-like characteristics and vary with clinical course, while 'harder' signs evidence more static, trait-like characteristics in accordance with a neurodevelopmental basis.

Relationships between attitudes towards eating disorders and mood

The purpose of the present study was to examine whether gender moderates the relationship between mood and attitudes toward eating disorders in athletes. 165 athletes (Male = 99; Female = 66) completed the Eating Attitudes Test (EAT), the Profile of Mood States-A (POMS-A), and the Hospital Anxiety Depression Scale (HADS). To test the proposed moderating effect, multisample structural equation modelling was used with equality constraints placed on relationships between mood and EAT scores. Results indicated that relationships between mood and EAT scores did not differ significantly between males and females (CFI = .988), thereby demonstrating that gender did not have a moderating effect. Mood significantly accounted for 38% of the variance in EAT scores in males and 29% of the variance in females, with depressed mood scores showing the strongest relationship with EAT scores. Findings support the use of mood profiling in applied work, and suggest negative mood, particular depressed mood, might be masking a disordered eating attitude. It is suggested that follow-up interviews should be conducted with athletes who report symptoms of depressed mood to ascertain its cause and that further research is needed to investigate the nature of disordered eating attitudes in athletes.

MOOD CHANGES FOLLOWING MODERN-DANCE CLASSES

Full-time dancers typically spend a large proportion of time participating in dance classes. The present study examined mood state changes following two contrasting modern-dance styles on a sample of full-time dancers. Twenty-three dancers completed the Brunel University Mood Scale (Terry, Lane, Lane, & Keohane, 1999) to assess anger, confusion, depression, fatigue, tension, and vigor before and after two different dance classes. One class taught was the Jose Limon technique style, characterized by light flowing movement, and the other class taught was the Martha Graham technique style, characterized by bound movements. Results showed that participants reported a positive mood profile before and after both dance classes. Repeated Measures Multivariate Analysis of Variance results indicated a significant interaction effect (Pillai's Trace 6, 15 = .32, p < .01), whereby Vigor increased following the Limon class but remained stable after the Graham class. Future research is also needed to investigate mood changes over a sustained period to evaluate more fully mood states responses to the demands of dance classes.

Schizophrenia: solving the puzzle

BACKGROUND

Schizophrenia is a common mental illness with an incidence of 15 new cases per 100,000 population per year.

AIM

To review evidence for current neurodevelopmental models of the aetiology of schizophrenia.

METHODS

We performed a literature search using Medline and PsychINFO. We evaluated the relevance of each article and tracked other relevant articles through references.

RESULTS

There is considerable evidence to support neurodevelopmental models of the aetiology of schizophrenia. One or more aetiological events occur between conception and birth that disturb central nervous system (CNS) development, leading to persisting alterations in brain structure and function. These early events, acting in concert with genetic loading and later influences or insults, predispose to the development of schizophrenia in early adulthood.

CONCLUSIONS

There have been considerable advances in schizophrenia research over the past 20 years. Future study of Indices of neural development will help advance our understanding of this common, disabling mental illness.

Interaction trial between artemether-lumefantrine (Riamet) and quinine in healthy subjects

Forty-two healthy Caucasian subjects were randomized in a double-blind, parallel three-group study (14 subjects per group) to investigate potential electrocardiographic and pharmacokinetic interactions between the antimalarials artemether-lumefantrine (six-dose regimen of Riamet over 3 days) and quinine (2-h intravenous infusion of 10 mg/kg body weight, not exceeding 600 mg in total, 2 h after the last dose of Riamet). The study medications were all safe and well tolerated after all treatments. Neither the pharmacokinetics of lumefantrine nor the pharmacokinetics of quinine was influenced by the presence of the other drug. Plasma levels of artemether and dihydroartemisinin appeared to be lower following the combined treatment Riamet + quinine, but this was not considered to be clinically relevant. Riamet alone had no effect on QTc interval. Infusion of quinine alone caused a transient prolongation of QTc interval, which was consistent with the known cardiotoxicity of quinine, with this effect being slightly but significantly greater when quinine was infused after Riamet. It would thus appear that the inherent risk of QTc prolongation of IV quinine was enhanced by prior administration of Riamet. However, these occasional QTc prolongations, which were small in magnitude and not correlated with plasma concentrations of any of the compounds, were not considered to be of clinical importance. In conclusion, overlapping therapy with artemether-lumefantrine and IV quinine in the treatment of patients with complicated or multidrug-resistant Plasmodium falciparum malaria may result in a modest increased risk of QTc prolongation, but this is far outweighed by the potential therapeutic benefit.

Long-term headache following epidural analgesia

Epidural analgesia is widely used in modern obstetric practice. Complications are uncommon but if they occur may result in significant morbidity. Post dural puncture headache (PDPH), in particular, may be particularly incapacitating especially if left untreated. In this report we describe the management of a case of unrecognised and undiagnosed PDPH.

Is reduced dermatoglyphic a-b ridge count a reliable marker of developmental impairment in schizophrenia?

BACKGROUND

Finger and hand prints are formed during the late first and second trimester of foetal development, after which they remain unchanged. Their expression may be influenced by both genetic and environmental factors. Some studies have suggested that a reduced total finger ridge count (TFRC) and, in particular, a reduce total a-b ridge count (TABRC), may be associated with schizophrenia.

AIM

To study these two variables in a large, ethnically homogenous sample and to compare our findings with those of other recent studies.

METHOD

Finger and hand prints of 150 people with DSM-III-R schizophrenia were compared with those of 92 healthy controls.

RESULTS

Patients had a reduced mean TABRC (P = 0.03) compared with controls. There was a significant (P=0.02) linear trend for lower TABRC and increasing incidence of schizophrenia (ORlineartrend = 1.3; 95%CI1.1-1.7), implying a continuous increase in the risk for schizophrenia with reduction in TABRC. No significant difference between groups was observed for TFRC.

CONCLUSION

These results provide further evidence that dermatoglyphic abnormalities exist in at least some patients with schizophrenia and that the a-b ridge count may be a marker of disruption, probably environmental, that occurs when the developing brain may also be particularly vulnerable to such insult. These findings support the concept that some cases of schizophrenia may be due to adverse intrauterine events.

Dermatoglyphic fluctuating asymmetry and atypical handedness in schizophrenia

Atypical handedness and dermatoglyphic abnormalities are hypothesized to reflect a neurodevelopmental disturbance in schizophrenia. Developmental instability, indexed by dermatoglyphic fluctuating asymmetry (FA), reflects the degree to which an individual's ontogenetic program is maintained and provides a useful framework in which to consider atypical handedness in schizophrenia. Thirty patients diagnosed with schizophrenia were compared with 37 matched healthy controls on levels of dermatoglyphic FA, a demonstration task determining hand preference and a test of relative hand skill. Multivariate analyses established that patients demonstrated greater FA and more atypical hand skill compared with controls. In patients, but not in controls, there was a strong positive association between a measure of FA and a measure of atypical hand skill, suggesting that these markers of neurodevelopmental disturbance are related in schizophrenia. On a measure of hand preference, patients were more likely than controls to be classified as mixed handed than either right or left handed. Results from the present study support the conjecture of greater developmental instability in schizophrenia affecting neurodevelopmental processes, including those conferring manual dominance.

Relationships between perceptions of performance expectations and mood among distance runners: the moderating effect of depressed mood

Recent research has proposed that depressed mood is the most important mood dimension due to its de-motivating nature. Lane and Terry (2000a) proposed that depressed mood influences the intensity of other mood dimensions, and moderates the nature of anger and tension. Distance runners (N = 188) completed the 24-item Profile of Mood States-A (POMS-A: Terry, Lane, Lane, & Keohane, 1999) and a 7-item Pre-race Questionnaire to assess Perceived Readiness and Course Suitability 1 hr. before competition. On the basis of scores on the POMS-A Depression subscale, participants were dichotomized into a No-depression group (n = 137) or a Depressed mood group (n = 51). MANOVA results indicated that the Depressed mood group reported significantly higher scores on Anger, Confusion, Fatigue, Tension with lower Vigor and Perceived Readiness. In the No-depression group, Vigor correlated with Perceived Readiness, whereas in the Depressed mood group, Vigor was associated more closely with Course Suitability than Perceived Readiness. Anger showed a positive relationship with Perceived Readiness in the No-depression group, and an inverse relationship with Perceived Readiness in the Depressed mood group. Collectively, findings lend support to the notion that mood and thoughts about performance are significantly associated. Further, findings show that depressed mood fosters a negative psychological state and moderates the nature of anger but not tension.

SELF-EFFICACY AND ACADEMIC PERFORMANCE

The aim of the present study was to examine the predictive effectiveness of self-efficacy in an academic setting. Seventy-six postgraduate students completed a questionnaire to assess efficacy expectations toward competencies perceived to underpin performance on the course. As there was a 13-week difference in time between completing the self-efficacy questionnaire and completing the performance criterion, it was considered important to assess the stability of self-efficacy measures. To this end, participants completed the same items one week later. Test-retest reliability results indicated that efficacy to cope with “intellectual demands”, “pass first time”, and “achieve a specific grade” were relatively stable. Performance was assessed using end of the semester grades. Regression results showed that “self-efficacy to cope with the intellectual demands of the program” predicted 11.5% of performance variance. Given that there was a 13- week time gap between self-efficacy and performance and that the complexity of the task was high, findings from the present study suggest that self-efficacy has some utility in an academic setting.

Determinants of neurological dysfunction in first episode schizophrenia

BACKGROUND

Although it is well recognized that individuals with schizophrenia display evidence of subtle neurological impairment, its aetiopathological and clinical significance continues to be unclear.

METHODS

Patients presenting with a first episode of schizophrenia or schizophreniform psychosis (DSM-IV criteria) were examined using two previously validated neurological examinations. The majority (N = 35) were examined prior to their 'first ever' dose of neuroleptic while the remaining patients (N = 21) had been medicated for less than one month. The manner in which neurological functioning is influenced by symptomatology and handedness was ascertained.

RESULTS

The majority of patients who were examined neuroleptic-naive displayed evidence of neurodysfunction. A combination of relative hand preference and symptomatology explained a significant proportion of the variance in neurological functioning. Mixed handedness among adults at the time of first presentation with schizophrenia was associated with more severe neurological impairment and a history of poorer scholastic attainment and pre-morbid social adjustment.

CONCLUSIONS

Neurological soft signs are an intrinsic part of schizophrenia rather than a direct consequence of treatment. Early developmental processes are associated with the level of subsequent neurological impairment in first episode schizophrenia. However, symptomatology appears to have an influence on the apparent severity of neurological impairment.

Long-term adaptive life functioning in relation to initiation of treatment with antipsychotics over the lifetime trajectory of schizophrenia

BACKGROUND

There is evidence that the stage of illness at which antipsychotic treatment is initiated in schizophrenia may have consequences for its subsequent course. How this might relate to impaired adaptive life functioning in the long-term is poorly understood.

METHODS

Thirty-eight inpatients, many of whom had been admitted in the preneuroleptic era, were assessed using the Social-Adaptive Functioning Evaluation (SAFE); constituent clinical and medication phases of the lifetime trajectory of their illnesses were then analyzed to identify predictors of SAFE score using multiple regression modeling.

RESULTS

The primary, independent predictor of SAFE score was duration of initially unmedicated psychosis, which accounted for 22% of variance (p<.001) therein. Conversely, duration of subsequently treated illness, although decades longer, failed to predict SAFE score.

CONCLUSIONS

These findings are consistent with some form of "progressive" process, particularly over the first several years following the emergence of psychosis, which is associated with accrual of deficits in adaptive life functioning.

Early cerebro-craniofacial dysmorphogenesis in schizophrenia: a lifetime trajectory model from neurodevelopmental basis to 'neuroprogressive' process

Understanding the temporal origin(s) of schizophrenia, through specifying the earliest identifiable pathology, might indicate when to look for etiological factor(s), what their nature might be, and how course of illness might evolve from these origins. From this premise, earlier formulations are elaborated to offer a rigorously data-driven model that roots schizophrenia in cerebro-craniofacial dysmorphogenesis, particularly along the mid-line but involving other structures, over weeks 9/10 through 14/15 of gestation. However, a brain that has been compromised very early in fetal life is still subject to the normal endogenous programme of developmental, maturational and involutional processes on which a variety of exogenous biological insults and psychosocial stressors can impact adversely over later pregnancy, through infancy and childhood, to maturation and into old age, to sculpt brain structure and function; it should be emphasised that the effects of such endogenous programmes and exogenous insults on such an already developmentally-compromised brain may be different from their effects on a brain whose early fetal origins were unremarkable. From these early origins, a lifetime trajectory model for schizophrenia from developmental basis to 'neuroprogressive' process is constructed. Thereafter, consideration is given to what the model can explain, including cerebral asymmetry and homogeneity, what it cannot explain, what empirical findings would challenge or disprove the model, what cellular and molecular mechanisms might underpin the model, and what are its implications.

Interactions of c-Raf-1 with phosphatidylserine and 14-3-3

Activation of Raf-1 occurs at the plasma membrane. We recently showed that 14-3-3 must be complexed with Raf-1 for efficient recruitment to the plasma membrane and activation by Ras, but that 14-3-3 is completely displaced from Raf-1 following plasma membrane binding. We show here that the Raf-1 zinc finger is not absolutely required for 14-3-3 binding but is required to stabilize the interaction between Raf-1 and 14-3-3. Incubation of Raf-1 with phosphatidylserine, an inner plasma membrane phospholipid, results in removal of 14-3-3 and an increase in Raf-1 kinase activity, whereas removal of 14-3-3 from Raf-1 using specific phosphopeptides substantially reduces Raf-1 basal kinase activity. Displacement of 14-3-3 from activated Raf-1 by phosphopeptides has no effect on kinase activity if Raf-1 is first removed from solution, but completely eradicates kinase activity of soluble activated Raf-1. These results suggest a mechanism for the removal of 14-3-3 from Raf-1 at the plasma membrane and show that removal of 14-3-3 from Raf-1 has markedly different effects depending on experimental conditions.

The neurodevelopmental basis of schizophrenia: clinical clues from cerebro-craniofacial dysmorphogenesis, and the roots of a lifetime trajectory of disease

A "read-back" analysis of schizophrenia, from chronic illness, through the first psychotic episode, to psychosocial and neurointegrative abnormalities of childhood and infancy, leads to the intrauterine period as a primary focus for etiological events. Evidence for a characteristic topography of cerebro-craniofacial dysmorphology in schizophrenia is reviewed, and interpreted to estimate: (i) the timing of dysmorphic event(s); (ii) the nature of early cellular and molecular mechanisms which might determine that topography of dysmorphogenesis; and (iii) the population homogeneity of these processes. It is argued that early cerebro-craniofacial dysmorphogenesis in schizophrenia should be conceptualized as a first stage not in a static but rather in a dynamic, lifetime trajectory of disease.

Neonatal skin care: the scientific basis for practice

OBJECTIVE

To review the literature addressing the care of neonatal skin.

DATA SOURCES

Computerized searches in MEDLINE and CINAHL, as well as references cited in articles reviewed. Key concepts in the searches included neonatal skin differences; neonatal skin and care practices for skin integrity; neonatal skin and toxicity; permeability; and contact irritant sensitization.

STUDY SELECTION

Articles and comprehensive works relevant to key concepts and published after 1963, with an emphasis on new findings from 1993 to 1999. One hundred two citations were identified as useful to this review.

DATA EXTRACTION

Data were extracted and organized under the following headings: anatomy and physiology of the skin; physiologic and anatomic differences in neonatal skin; nutritional deficiencies; skin care practices; and care of skin breakdown.

DATA SYNTHESIS

Newborns' skin is at risk for disruption of normal barrier function because of trauma. In light of available evidence about differences in neonatal skin development, clinical practice guidelines are suggested for baths, lubrication, antimicrobial skin disinfection, and adhesive removal. In addition, basic care practices are suggested for maintaining skin integrity, reducing exposure to potentially toxic substances, and promoting skin health beyond the neonatal period. Preventive care recommendations are made for reducing trauma, protecting the skin's immature barrier function, and promoting skin integrity.

CONCLUSIONS

This review generated evidence with which to create a new and comprehensive practice guideline for clinicians. Evaluation of the guideline is under way at 58 U.S. sites.

Neonatal skin care: the scientific basis for practice

OBJECTIVE

To review the literature addressing the care of neonatal skin.

DATA SOURCES

Computerized searches in MEDLINE and CINAHL, as well as references cited in articles reviewed. Key concepts in the searches included neonatal skin differences; neonatal skin and care practices for skin integrity; neonatal skin and toxicity; permeability; and contact irritant sensitization.

STUDY SELECTION

Articles and comprehensive works relevant to key concepts and published after 1963, with an emphasis on new findings from 1993 to 1999. One hundred two citations were identified as useful to this review.

DATA EXTRACTION

Data were extracted and organized under the following headings: anatomy and physiology of the skin; physiologic and anatomic differences in neonatal skin; nutritional deficiencies; skin care practices; and care of skin breakdown.

DATA SYNTHESIS

Newborns' skin is at risk for disruption of normal barrier function because of trauma. In light of available evidence about differences in neonatal skin development, clinical practice guidelines are suggested for baths, lubrication, antimicrobial skin disinfection, and adhesive removal. In addition, basic care practices are suggested for maintaining skin integrity, reducing exposure to potentially toxic substances, and promoting skin health beyond the neonatal period. Preventive care recommendations are made for reducing trauma, protecting the skin's immature barrier function, and promoting skin integrity.

CONCLUSIONS

This review generated evidence with which to create a new and comprehensive practice guideline for clinicians. Evaluation of the guideline is under way at 58 U.S. sites.

Accuracy of a portable International Normalization Ratio monitor in outpatients receiving long-term oral anticoagulant therapy: comparison with a laboratory reference standard using clinically relevant criteria for agreement

The accuracy of a new, portable INR monitor (CoaguChek, Boehringer-Mannheim, Indianapolis, IN) was evaluated by comparing INR results from the portable monitor with results obtained by a laboratory-based method. Dual INR measurements (portable monitor, laboratory) were performed in 163 consecutive outpatients receiving warfarin. Agreement in dual INR measurements was defined based on clinically-relevant expanded and narrow criteria and statistical criteria. Agreement in dual INR measurements also was evaluated as a function of increasing INR. The proportion of dual INR measurements that satisfied the clinically-relevant expanded, and narrow agreement criteria was 90%, and 86%, respectively. Seventy-nine percent of all dual measurements were within 0.5 INR units. The accuracy of the portable monitor was greatest for INR values less than 3.0; above this INR level, the portable monitor underestimated laboratory INR values. The proportion of dual INR measurements within 0.5 INR units for laboratory INR ranges of <2.0, 2.0-3.0, 3.1-4.0, and >4.0 was 98%, 87%, 57%, and 21%, respectively. We conclude that the portable INR monitor achieved a clinically acceptable level of accuracy when compared to the traditional laboratory method and provides a suitable alternative method of monitoring the INR in patients receiving warfarin.

Ras isoforms vary in their ability to activate Raf-1 and phosphoinositide 3-kinase

Ha-, N-, and Ki-Ras are ubiquitously expressed in mammalian cells and can all interact with the same set of effector proteins. We show here, however, that in vivo there are marked quantitative differences in the ability of Ki- and Ha-Ras to activate Raf-1 and phosphoinositide 3-kinase. Thus, Ki-Ras both recruits Raf-1 to the plasma membrane more efficiently than Ha-Ras and is a more potent activator of membrane-recruited Raf-1 than Ha-Ras. In contrast, Ha-Ras is a more potent activator of phosphoinositide 3-kinase than Ki-Ras. Interestingly, the ability of Ha-Ras to recruit Raf-1 to the plasma membrane is significantly increased when the Ha-Ras hypervariable region is shortened so that the spacing of the Ha-Ras GTPase domains from the inner surface of the plasma membrane mimicks that of Ki-Ras. Importantly, these data show for the first time that the activation of different Ras isoforms can have distinct biochemical consequences for the cell. The mutation of specific Ras isoforms in different human tumors can, therefore, also be rationalized.

Spontaneous abnormal involuntary movements in first-episode schizophrenia and schizophreniform disorder: baseline rate in a group of patients from an Irish catchment area

OBJECTIVE

This study investigated the rate of spontaneous abnormal involuntary movements in a group of patients presenting with a first episode of schizophrenia or schizophreniform psychosis.

METHOD

Seventy-nine patients with a first episode of schizophrenia or schizophreniform psychosis who presented to a catchment area psychiatric service over a 3-year period, and who were neuroleptic-naive or had been medicated for less than 1 month, were examined for the presence of involuntary movements with use of the Abnormal Involuntary Movement Scale.

RESULTS

Six patients (7.6%) had spontaneous dyskinesia as defined by the criteria of Schooler and Kane, and nine other patients had mild orofacial involuntary movements. The patients with spontaneous dyskinesia had completed significantly fewer years of education than the patients without dyskinesia. Spontaneous involuntary movements were unrelated to age at presentation for treatment.

CONCLUSIONS

Spontaneous abnormal involuntary movements were evident among a proportion of patients with first-episode schizophrenia or schizophreniform psychosis at baseline presentation and were associated with reduced educational attainment. This finding supports previous suggestions that abnormal involuntary movements in schizophrenia may be related to the pathophysiology of the illness and therefore cannot be attributed entirely to the adverse effects of neuroleptic medication.

Murine immune responses to Schistosoma haematobium and the vaccine candidate rSh28GST

Longitudinal studies of Schistosoma haematobium infection in CBA mice revealed a progressive down-regulation of cellular immune responses, as measured by mitogenic and antigenic stimulation of in vitro lymphocyte cultures. Antigen-stimulated production of the Th1 cytokine IFN-gamma by splenocytes increased progressively up to 14 weeks post infection, (four weeks after the onset of parasite egg production), before declining swiftly. Levels of the Th2 cytokine IL-4 in the same cultures remained low until 14 weeks, after which they rose rapidly as IFN-gamma declined. High levels of IL-10 coincided with the peak in IFN-gamma production, suggesting a non Th2-restricted role for this cytokine. Both total and antigen-specific immunoglobulin production confirmed parasite egg deposition as being a major stimulus for host humoral responses. The S. haematobium infection failed to elicit detectable T cell responses to the antifecundity vaccine candidate rSh28GST. However, low levels of antibody were detectable in infected mouse serum and strong IgG and IgA production was induced by vaccination with rSh28GST plus adjuvant.

14-3-3 facilitates Ras-dependent Raf-1 activation in vitro and in vivo

14-3-3 proteins complex with many signaling molecules, including the Raf-1 kinase. However, the role of 14-3-3 in regulating Raf-1 activity is unclear. We show here that 14-3-3 is bound to Raf-1 in the cytosol but is totally displaced when Raf-1 is recruited to the plasma membrane by oncogenic mutant Ras, in vitro and in vivo. 14-3-3 is also displaced when Raf-1 is targeted to the plasma membrane. When serum-starved cells are stimulated with epidermal growth factor, some recruitment of 14-3-3 to the plasma membrane is evident, but 14-3-3 recruitment correlates with Raf-1 dissociation and inactivation, not with Raf-1 recruitment. In vivo, overexpression of 14-3-3 potentiates the specific activity of membrane-recruited Raf-1 without stably associating with the plasma membrane. In vitro, Raf-1 must be complexed with 14-3-3 for efficient recruitment and activation by oncogenic Ras. Recombinant 14-3-3 facilitates Raf-1 activation by membranes containing oncogenic Ras but reduces the amount of Raf-1 that associates with the membranes. These data demonstrate that the interaction of 14-3-3 with Raf-1 is permissive for recruitment and activation by Ras, that 14-3-3 is displaced upon membrane recruitment, and that 14-3-3 may recycle Raf-1 to the cytosol. A model that rationalizes many of the apparently discrepant observations on the role of 14-3-3 in Raf-1 activation is proposed.

Compliance with neuroleptic medication in outpatients with schizophrenia; relationship to subjective response to neuroleptics; attitudes to medication and insight

The relationship between compliance, subjective response to neuroleptics, attitudes to medication, and insight was assessed in a selected group of individuals with schizophrenia who were attending a catchment area outpatient psychiatric service. Regular compliers with medication reported a significantly better subjective response to neuroleptics and were more frequently prescribed depot medication compared with individuals who were irregularly compliant. There was no difference between regular and irregular compliers in terms of attitudes to medication or level of insight. There was a significant correlation between the measures of insight obtained using a self-report questionnaire (the Insight Scale [IS]) and a semistructured interview (the Scale for Assessment of Insight [SAI]).

Course of psychopathology, cognition and neurobiological abnormality in schizophrenia: developmental origins and amelioration by antipsychotics?

It is argued that schizophrenia has origins in events occurring during the first or early second trimester that are reflected in minor physical anomalies and which may at least in part predispose to later obstetric complications. This neurodevelopmental basis underlies certain neuromotor and psychosocial abnormalities of infancy and childhood, which are the early manifestations of what will be reconceptualised later as negative symptoms and (particularly frontal) cognitive dysfunction, but gives rise to positive symptoms only on the maturation of other systems necessary for their expression. This later emergence of psychosis may reflect an active morbid process that is associated with increased accrual of negative symptoms and of general (but not frontal) cognitive impairment that may be ameliorated by effective antipsychotic treatment. The psychological or biological basis of this heuristic process is poorly understood. Contemporary re-appraisal of any impact of antipsychotics on the long-term course of schizophrenia must take into account what is known of the origins of the disease process with which such drugs might interact. Much recent work continues to indicate that very early events, during the embryonic/fetal period, are important in, if not fundamental to, the genesis of schizophrenia; i.e. that there is a neurodevelopmental basis to the disorder. The present article seeks to establish a time-line relating early intrauterine adversity and dysmorphogenesis, through the onset of psychosis, to the chronic phase of the illness over adulthood; from this time-line, a schema is elaborated for a beneficial impact of antipsychotics on the course of psychopathology, cognition and, less clearly, neurobiological abnormality.

Neurodevelopmental and neuroprogressive processes in schizophrenia. Antithetical or complementary, over a lifetime trajectory of disease?

The neurodevelopmental model of schizophrenia maintains ascendancy among current etiopathologic perspectives on schizophrenia. However, inconsistencies across studies and the absence thus far of pathognomic brain changes suggest the need for complex conceptualization of neurodevelopmental arrest, including some reconciliation with the competing neurodegenerative model of schizophrenia. This article critically reviews the preponderance of evidence for each model and provides an account of how these may interact or synergize to produce the characteristic clinical expression of schizophrenia.

Evaluation of the analytical performance of the Boehringer Mannheim Elecsys 2010 immunoanalyzer

OBJECTIVES

We evaluated the analytical performance of the Elecsys 2010 immunoanalyzer (Boehringer Mannheim Canada), which is based on a new detection technology, electrochemical luminescence.

DESIGN AND METHODS

We used six representative assays from the initial launch menu of the instrument: thyroid stimulating hormone (TSH), free thyroxine (FT4), troponin T, human chorionic gonadotropin (hCG), carcinoembryonic antigen (CEA), and prostate specific antigen (PSA). Within-run and between-day imprecision were evaluated using pools of human specimens at low, mid and high concentrations. Linearity was evaluated by diluting specimens with high analyte concentrations with specimens that had a low level of this analyte. Carry over and hook effect were investigated using specimens with high concentrations of hCG. Functional sensitivity was studied by running low TSH specimens over 21 daily runs, and by comparing the scatterplot of FT4 as a function of TSH. Over 100 specimens distributed across the analytical range were analyzed with two comparison methods: ES 300 (Boehringer Mannheim Canada) and AxSYM (Abbott Laboratories).

RESULTS

Within-run and between-day imprecisions were less than 4% and 10%, respectively, for most assays. All assays were linear over the whole analytical range. Carry over was minimal (< 0.0002%). A hook effect was present for hCG levels greater than 560,000 U/L. The functional sensitivity of the TSH assay was lower than 0.02 mlU/L. Correlation coefficients were all > 0.94. Small proportional errors were observed in comparison studies for the CEA and PSA assays.

CONCLUSIONS

The Elecsys 2010 system was shown to have an acceptable analytical performance for the rapid analysis of a wide variety of analytes. The hook effect observed with hCG assay would imply that the laboratory informs the clinicians of the possibility of falsely low values in trophoblastic diseases or that all specimens with values greater than 3000 U/L are reassayed after dilution.