Antisocial traits in psychiatrically ill veterans without antisocial personality disorder: relationship to Axis I disorders and effects on functioning

The prevalence of antisocial traits was investigated in a group of veterans who were in treatment at an out-patient psychiatric clinic and who did not meet diagnostic criteria for an antisocial personality disorder. Standardized DSM-III-R interviews were used to diagnose Axis I disorders and antisocial personality disorders and traits. Frequencies of antisocial traits were compared between patients and controls as well as between diagnostic subgroups in the clinical population. Odds ratios were used to assess the effect of antisocial traits on several standardized measures of functioning. There was no overall difference in the dimensional measure of antisocial traits between the clinical and normal groups. There were trends for the frequency of individual traits to vary by Axis I diagnosis. The amount of antisocial traits (measured dimensionally) negatively affected measures of functioning for the overall clinical population. Different specific antisocial traits were associated with trends towards poorer functioning in the alcohol, major depression and post-traumatic stress syndrome subgroups. It is recommended that future research in the area of antisocial traits pay careful attention to the possible negative effects on functioning of subthreshold antisocial traits and also to Axis I comorbidity.

Resistance to bismuth among gram-negative bacteria is dependent upon iron and its uptake

Bismuth antimicrobial action is poorly understood. Many trivalent metals possess antibacterial activity, especially under low iron conditions. Protection of bacteria from the deleterious effects of bismuth and other trivalent metals was demonstrated in iron-fortified media. Near-equimolar quantities of Fe3+ neutralized the growth-inhibitory effects of 250 microM Bi3+. Resistance to bismuth action also depended on the production of virulence-related siderophores. Escherichia coli, Aeromonas hydrophila or Pseudomonas aeruginosa producing aerobactin, amonabactin or pyoverdin respectively, were most resistant to Bi3+. Enterochelin or pyochelin producers were less resistant to Bi3+, but more resistant than strains lacking siderophores. Purified pyoverdin restored Bi3+ resistance in a mutant lacking this siderophore, but not in one lacking the pyoverdin receptor. Bismuth-treated bacteria exhibited unique outer membrane proteins, similar in size to iron-repressible proteins. Thus, resistance to the inhibitory action of Bi3+ among Gram-negative bacteria is inversely related to iron concentration and strongly dependent on iron transport mechanisms. The data suggest that bismuth action is largely a nonspecific, competitive interference with iron-transport, related primarily to atomic valence Furthermore, resistance to Bi3+ among bacteria is predictive of virulence.

The infrequency of "pure culture" diagnoses among the anxiety disorders

BACKGROUND

Anxiety disorders are known to commonly coexist in individuals, both with other anxiety disorders and with mental disorders from other groupings, such as affective disorders. We questioned how frequently anxiety disorders actually occur in isolation, as "pure cultures."

METHOD

We examined diagnostic patterns among the 711 subjects entered into a large, multicenter study of anxiety disorders, the Harvard/ Brown Anxiety Disorders Research Program (HARP), which focused on panic, agoraphobia, generalized anxiety disorder, and social phobias as "index disorders" required for intake.

RESULTS

We used various definitions for "pure culture." By all definitions, subjects with "pure culture" represented a minority, especially in cases of generalized anxiety disorder and social phobia, where comorbidity was virtually ubiquitous. "Pure culture" status was associated with later onset of illness and less chronicity.

CONCLUSION

Future studies of anxiety disorder should aim to document the extensive comorbidity, rather than eliminate it by restrictive diagnostic exclusion criteria, lest they yield atypical or even misrepresented groups of patients. Clinicians should not stop at identifying only the "main" diagnosis but look for other, comorbid diagnoses that are often present.

Early visual recovery after excimer laser surgery for myopia: the Melbourne OmniMed results

BACKGROUND AND OBJECTIVE

Although the refractive outcome can change for months after photorefractive keratectomy (PRK), early visual results are of particular importance during pre-operative counseling of prospective PRK candidates. The expected vision in the first week post-operatively, following 6.0 mm or larger zone photoablation for myopia with the Summit OmniMed (Apex) laser, has not been analyzed in the literature to date. This study is intended to provide an indication of the early visual acuity that may be experienced by a patient undergoing PRK for myopia.

PATIENTS AND METHODS

The visual acuity recorded for 123 consecutive patients, (79 low myopes [-1.00 to -5.90 diopters (D)], 44 high extreme myopes [-6.00 to -19.00 D]), one week after they had undergone PRK, was analyzed. All patients included in the study had undergone PRK with the Summit OmniMed (Apex) excimer laser, leaving small degrees of astigmatism uncorrected.

RESULTS

One week after PRK, uncorrected visual acuity was better for low myopes than high myopes. Of the low myopes, 83.0% were 20/40 or better compared with high myopes of whom 61.4% were 20/40 or better.

CONCLUSION

Patients can be counseled that functional vision will be present in the period immediately after re-epithelialization.

Familial vulnerability factors to post-traumatic stress disorder in male military veterans

The question has been frequently raised about whether there are emotional disorders that predispose to post-traumatic stress disorder (PTSD). We do know that those with PTSD do have many comorbid disorders, but due to the difficulty in performing prospective studies it is hard to tell what is cause and what is effect. This study bypassed the problem caused by comorbidity by examining family history of four proband groups: PTSD, mixed anxiety disorders, coexisting anxiety and depressive disorders, and screened normal controls. Two questions were examined. First, whether family history predicted who experienced combat situations and second, whether the proband groups could be distinguished by family history. Logistic regression identified two variables that predicted the experience of combat: major depression (odds ratio 2.17) and the DSM-III dramatic personality disorder cluster (odds ratio 1.36). Although there was considerable overlap, family history variables distinguished PTSD from other proband groups. Overall, the pattern of psychopathology in the families of the PTSD probands most closely resembled that in the families of the coexisting anxiety and depressive disorders probands. We conclude that family history methods may be an addition to possible variables that predict who will be exposed to combat and also that family history variables may be able to distinguish a PTSD population from some other types of emotional disorders.

The morbidity of DSM-III-R dependent personality disorder

Dependent personality has long been discussed by clinicians, and by empirical researchers more recently. Little empirical evidence so far has been presented as the type and degree of disability with which it is associated. This report provides some empirical data in that regard. To examine this question, those with and without DSM-III-R dependent personality were compared in male veterans drawn from an outpatient psychiatry clinic (dependent and nondependent groups). Standardized interview assessments were used to determine axes I and II disorders and family history. The dependent personality disorder group had significantly lower socioeconomic status and poorer functioning in the family/home sphere. They had significantly more social phobia, borderline traits, and histrionic traits. In relatives, there was significantly more generalized anxiety disorder, simple phobia, drug abuse, and dramatic personality disorder cluster. There are clearly documentable vulnerabilities and morbidities associated with dependent personality disorder.

Selective arterial embolization of idiopathic priapism

We report a case of idiopathic priapism that was only identified as high-flow or arterial priapism after drainage of the corpora cavernosa. Following failure of conservative and surgical treatment attempts, two consecutive embolizations of a unilateral penile artery were performed with gelgoam particles.

Family history of DSM-III-R dramatic personality disorder cluster and functioning in patients with major depressive disorder

Clinicians and researchers have noted that personality dysfunction related to borderline personality significantly predicts a poorer course in major depressive disorder. There is also some evidence that some aspects of personality are heritable. The goal of this report was to determine whether family history of dramatic personality disorder cluster indicated differences in functioning in patients with major depressive disorder. Patients with major depression were divided into two groups: those with a family history of dramatic personality disorder cluster (N = 49) and those without (N = 22). These were the clinical groups. A screened normal group was also added to determine how far the clinical groups differed from ordinary functioning (N = 31). Compared with the other clinical group, the group with the family history of dramatic personality disorder tended, in general, to have fewer personality traits as measured by the Personality Disorder Examination, similar Hamilton Anxiety and Depression scores and several significantly better functioning measures. It appears that a family history of dramatic personality disorder cluster identifies a group with different, but not necessarily lower, levels of functioning. Implications of these findings are discussed.

Family psychiatric histories in male patients with generalized anxiety disorder and major depressive disorder

It has been hypothesized, from twin study results in females, that the genetic predisposition in females for major depressive disorder (MDD) and generalized anxiety disorder (GAD) is identical. This report attempted to replicate these findings on a male population using family history methods. There were 119 subjects who completed standardized assessment of Axis I, Axis II, and family history. The family history of four groups was compared--GAD without MDD, MDD without GAD, GAD/MDD, and normals. As expected, GAD and MDD subjects showed trends toward more MDD family history than normals. The GAD and MDD groups showed only trend differences in family history of relatives. Unexpectedly, however, the MDD/GAD group had no higher level of either anxiety or depressive family history than normals (although they did have higher levels of personality family history). Both the GAD and the MDD groups had a significantly higher level of family history of depression than the GAD/MDD group. Within the limits of the family history method, the finding of similarity of the family predisposition of MDD and GAD was confirmed in a male population. However, it does appear that the combined disorder of MDD/GAD in clinical settings might have very different family history predispositions and possibly could be a separate disorder from both MDD and GAD when they are not comorbid.

A prospective follow-along study of the course of social phobia

The goals of this study were to delineate the courses of social phobia and to determine whether the course of generalized and specific social phobia differed. In the Harvard/Brown Longitudinal Study of Anxiety Research Project, 66 specific and 74 generalized social phobic subjects were identified for whom adequate course data were available. These subjects had been followed prospectively with a standardized follow-along measure of psychopathology. The probability of remission was calculated for each individual group and both groups combined. Demographics were the same for both groups except that the specific social phobia group had a marginally higher mean score on the Global Assessment Scale. Complete remission for the combined group was not different from that for either subgroup and was 0.11 at 65 weeks. Social phobia appears to be a disorder with considerable long-term morbidity. Surprisingly, both subtypes took a comparably long time to remit and were similar in their high level of psychosocial dysfunction.

Carriers of healthcare's load of information

As the market for telemedicine products and services expands, many long distance telecommunications carriers and regional Bell operating companies developed strategies for meeting healthcare's needs. Some initiated projects to display their capabilities or to receive returns on investments in telecommunications infrastructures. Their capabilities and use of advanced technologies vary. The level of their healthcare commitment and involvement also varies. Regional Bell companies compete fiercely with each other and with national carriers for consulting and implementation contracts, unrestricted by service area boundaries. On the following pages, representatives from most of the major telecommunications carriers express their firms' healthcare strategies and offer synopses of their notable healthcare projects. For many, their resources are vast, their expertise undisputed. Access to high-quality healthcare services stands to benefit from their involvement.

Personality disorder traits in generalized anxiety and panic disorder patients

Eight-four panic disorder (PD) and 29 generalized anxiety disorder (GAD) patients were compared with respect to abnormal personality traits assessed by a structured interview (Structured Interview for DSM-III Personality [SIDP]) and a self-report inventory (Personality Diagnostic Questionnaire [PDQ]). An earlier study using many of the same patients by Noyes et al. found PD patients to have more extensive axis I psychopathology than GAD patients. However, in this study it was the GAD patients who appeared to have greater axis II pathology. In particular, when using a subset of patients who had been matched for age and gender, the GAD patients reported more antisocial traits. This finding is particularly interesting, since the matched samples consisted primarily of women in their forties and fifties.

Paranoid personality traits in a panic disorder population: a pilot study

To better understand the relationship between panic disorder and paranoid personality, panic disorder patients (N = 28) who were referred to an anxiety disorder clinic in a community mental health center were evaluated for paranoid personality traits on a standardized personality self-report instrument. Paranoid personality disorder was found in 54% of subjects. Paranoid subjects were found to have an earlier age of onset, longer duration of illness, and more psychopathology. Possible etiologies and implications for treatment of these findings are discussed.

Comparison of personality disorders in different anxiety disorder diagnoses: panic, agoraphobia, generalized anxiety, and social phobia

Recently there has been increasing interest in the relationship of the personality and the anxiety disorders. This paper presents comorbidity findings between DSM-III-R personality pathology and several DSM-III-R anxiety disorders and makes direct comparisons between anxiety groups. This is the most extensive comparison of this kind reported thus far. This report is on the first 475 anxiety patients who were recruited from multiple sites to take part in a naturalistic study of anxiety. All had a DSM-III-R diagnosis of panic, agoraphobia, social phobia, or generalized anxiety disorder (GAD). Previous studies which found a high comorbidity between the anxiety and the personality pathology were confirmed, with a significantly higher prevalence of personality pathology occurring with social phobia and GAD. Among our patients, all of whom had anxiety disorders, the presence of comorbid major depression is associated with an increase in the levels of comorbid personality pathology--as previously described in the literature. The relationship between low social functioning and the presence of personality pathology was confirmed, however, the relationship appears to be specific to certain areas of functioning, a new finding. There is a clinically important relationship between Personality Diagnostic Questionnaire--Revised personality pathology and the anxiety disorders characterized by different prevalences of personality disorders in different anxiety disorders and specific areas of social dysfunction.

Calcium binding to HMG1 protein induces DNA looping by the HMG-box domains

Electron microscopy has shown that non-histone chromosomal HMG1 could induce DNA looping or compaction in the presence (but not in the absence) of Ca2+. The effect of calcium on DNA looping and compaction was interpreted as calcium binding to the acidic C-domain of HMG1. Both individual DNA-binding HMG1-box domains A and B were found to be involved in DNA looping and compaction. Treatment of HMG1 with a thiol-specific reagent, N-ethylmaleimide, inhibited the ability of the protein to induce DNA looping and compaction but not the electrostatic interaction with DNA. These results indicated that cysteine-sulfhydryl groups of the HMG1-box domains A and B are specifically involved in DNA looping and compaction, and that in the absence of calcium the acidic C-domain down-regulates these effects by modulation of the DNA-binding properties of the HMG1-box domains.

Remission and relapse in subjects with panic disorder and panic with agoraphobia: a prospective short-interval naturalistic follow-up

This article reports on the course of uncomplicated panic disorder and panic with agoraphobia on 309 patients participating in the Harvard/Brown Anxiety Research Project, a prospective longitudinal study of patients with DSM-III-R-defined anxiety disorders. At 1 year, there was a .39 probability of full remission for uncomplicated panic disorder and a .17 probability of full remission for panic disorder with agoraphobia Similar differences in time to remission for these syndromes were still found when criteria for remission were made less stringent. However, even requiring less improvement for remission left a large percentage of subjects in an episode, and for those that remitted, relapse occurred quickly, indicating a chronic and recurrent course of illness. This is the first longitudinal, prospective, naturalistic study on a large cohort of subjects with anxiety disorders to have regular, structured, short-interval follow-up. Our results are consistent with the view that panic disorder has a chronic course with high rates of relapse after remission and longer episodes when agoraphobia is a part of the constellation of symptoms.

A prospective, follow-along study of the course of social phobia: II. Testing for basic predictors of course

This study examined the 65-week outcome of a group of subjects with social phobia to determine predictors of course. Social phobic patients in the Harvard/Brown Anxiety Disorders Research Project study were followed for 65 weeks using the Longitudinal Interval Follow-Up Evaluation-UpJohn scale. The following variables did not predict outcome over the course of the study: sex, age of onset, duration of illness, lifetime history of various anxiety disorders, current comorbidity of anxiety or depressive disorders, Global Assessment Scale score, or measures of role functioning. We find that in a social phobic population with a mean duration of illness of 18 years, none of the tested variables examined predicted 65-week outcome.

Identification of differentially expressed mRNA species by an improved display technique (DDRT-PCR)

We have significantly improved a method originally developed by Liang and Pardee [Science 257 (1992) 967-971] to display a broad spectrum of expressed genes and to detect differences in expression between different cell types. We have analysed various aspects of the technique and have modified it for both, the application to fast and efficient identification of genes and the use with automatic analysis systems. Based on the mathematical background we have devised the appropriate number of optimal PCR primers. We have also introduced nondenaturating gels for separating double stranded fragments as single bands. By applying the method to regenerating mouse liver, we have identified, out of a total of 38,000 bands, about 70 fragments where the expression of the corresponding genes seems to be differentially regulated at different time points. Application of the method to an automatic DNA sequencer was successfully done. Thus, we have confirmed the usefulness and increased the power of the RNA display technique, which we named differential display reverse transcription PCR (DDRT-PCR), and have extended the range of its application.

Prevalence and characteristics of sadistic personality disorder in an outpatient veterans population

This study is designed to examine the prevalence, demographics, and the Axis I and Axis II diagnoses of sadistic personality disorder (SPD) in a previously unexamined population (outpatient veterans). It also represents the first attempt to examine the family history of those with SPD. Standardized methods were used to select 144 nonpsychotic subjects from a veterans psychiatric outpatient clinic. The population was then divided into three groups: those with SPD, those without SPD but with antisocial personality disorder or traits, and those with no Axis II disorders. A fourth group consisted of 28 control veterans without psychopathology. Subjects with SPD tended to be younger and to have lower scores on the Global Assessment Scale than did clinical control subjects without personality disorders; they also had significantly more bipolar and panic disorder than were found in the antisocial traits group. High levels of depression and alcohol dependence were also present. SPD traits correlated with DSM-III-R dramatic cluster, compulsive, passive-aggressive, and self-defeating personality disorders. The SPD group could be distinguished from other groups on the basis of family history. It was concluded that sadistic personality traits and disorders are prevalent (8.1%), associated with reduced functioning, and may have specific associations with certain Axis I and Axis II disorders. It is possible that they have a distinct familial pattern.

Distinguishing mixed anxiety/depression from anxiety and depressive groups using the family history method

The relationship between anxiety and depression has long been discussed and studied. Although it appears that there are pure forms of these disorders, several investigators have suggested that there is a separate combined anxiety/depression disorder distinct from either individual disorder. Several attempts have been made to investigate this distinction using family history methods. This report compares an anxiety/depression group to a depression-only group and anxiety-only group in a veteran population (n = 71) using the family history method. The depression group was clearly differentiated from the anxiety/depression group on the variables of generalized anxiety disorder and alcohol abuse. There was also discrimination between the anxiety and anxiety/depression groups on the DSM-III-R anxious personality disorder cluster. This is the first report in this area of the literature to use standardized family history methods that include personality disorder clusters.

Levitating lung lesions due to bronchiolitis obliterans organizing pneumonia

A 68-year-old man developed symmetrical bibasal infiltrates. Transbronchial lung biopsy specimen demonstrated abnormalities consistent with bronchiolitis obliterans organizing pneumonia (BOOP). The infiltrates appeared to migrate cephalad over a period of months, gradually disappearing after reaching the pulmonary apices.

Comorbidity of panic and major depressive disorder

The objective of this report is to determine whether those patients with panic disorder who have current major depression disorder (MDD) differ from those who do not in terms of demographics, comorbid disorders, severity of illness, nature of symptoms of panic attacks and psychosocial functioning. The sample consisted of 182 patients with current or history of panic disorder measured by standardized interview techniques. For analysis these patients were then divided by presence or absence of current MDD. The two groups were not different in age, sex, or marital status, age of onset, or symptom characteristics of panic attacks. However, patients with MDD were more likely to have Social Phobia and Generalized Anxiety Disorder, been hospitalized, made suicide attempts or gestures, have poorer psychosocial functioning, and currently be experiencing panic with more severe symptoms. These findings are discussed in terms of previous literature in the area.