Lateral ventricular enlargement in schizotypal personality disorder

Although an increase in the ratio of ventricular space to brain (ventricle-brain ratio), VBR) on computed tomography (CT) has been among the most robust findings in chronic schizophrenia, VBR has not been investigated in a large, well-characterized clinical population of patients with schizotypal personality disorder (SPD), a clinical entity with a phenomenologic, gentle biological, and treatment response relationship to chronic schizophrenia. Accordingly, CT scans were obtained in 36 male SPD patients, 23 males with other personality disorders, 133 male schizophrenic patients, and 42 male normal volunteers. The mean body of the lateral VBR was significantly greater in the SPD patients than in the patients with other personality disorders. The VBR of the SPD patients did not differ significantly from either that of the normal volunteers or the schizophrenic patients but was intermediate between the two groups. There were no correlations with either psychotic-like or deficit-related symptoms of SPD in either the SPD or total personality disorder cohorts. SPD patients, like schizophrenic patients, may have increased VBRs compared wit patients with other personality disorders; their VBRs fall between the means of schizophrenic patients and normal control subjects.

Cytogenetic and flow cytometric analysis of a pancreatoblastoma

A pancreatoblastoma from a 4-year old male was examined by flow cytometric ploidy analysis and cytogenetics. To detect differences within the tumor, the specimen was divided into four portions and sampled separately. Flow analysis revealed that each sample contained a diploid and a tetraploid population of tumor cells. These findings correlated well with the cytogenetic analysis, which also revealed differences in structural rearrangements between samples. A t(13;22)(q10;q10) was the only rearrangement found in near-diploid cells as well as one near-tetraploid line. Other common structural changes in near-tetraploid cells included t(13;13)(q10;q10), i(6p)(p10), and del(1). Chromosomes 1, 6, 13, and 22 were consistently missing from all near-tetraploid cells lines. To our knowledge, this is the first flow cytometric and cytogenetic study of a pancreatoblastoma.

Medical disorders in the schizophrenic patient

OBJECTIVE

The primary purpose of this review of medical disorders in the schizophrenic patient is to provide the clinician interested in Consultation/Liaison psychiatry and psychosomatic issues a comprehensive and current review of the subject.

METHOD

The authors used the Index Medicus and Medline to find recent review articles and research articles related to medical disorders in the schizophrenic patient. Also, the authors described their clinical experience in Consultation/Liaison psychiatry working with schizophrenic patients in a large, tertiary-care academic medical center.

RESULTS

The authors divided their review into: 1) mortality and morbidity in schizophrenia, 2) differential diagnosis, 3) specific comorbidity management problems, 4) caring for schizophrenics on medical/surgical wards, and 5) antipsychotic drugs in the medical setting. Schizophrenia remains an important subject for Consultation/Liaison psychiatrists.

CONCLUSIONS

Schizophrenia and its protean manifestations confound the care of the medical patient. The psychosis of schizophrenia may impair the patient's capacity to recognize or articulate emerging medical illness, or to respond to therapeutic interventions. The psychiatrist caring for and consulting on patients with medical illnesses bears major responsibility for understanding the complex interface of schizophrenia and medical illnesses. Psychiatrists need to educate our medical and surgical colleagues how schizophrenia alters the usual presentation, clinical course, and response to treatment of common medical and surgical illnesses.

Penetrating keratoplasty in infants with congenital glaucoma

The efficacy of corneal transplantation in infants with corneal opacity secondary to congenital glaucoma has not been established. We retrospectively reviewed our results of nine penetrating keratoplasties performed on eight eyes of six infants who had multiple risk factors for poor prognosis: age < 2 years at the time of grafting; uncontrolled glaucoma in four eyes; concurrent lensectomy, retinal, or glaucoma surgery in five eyes; aphakia in five eyes; and an acute perforation in one eye. Six of the nine grafts (67%) remained clear during a mean follow-up of 24 months (30 months in eyes with clear grafts). Development of ambulatory vision or better occurred in six of eight (75%) eyes after corneal transplantation and treatment of refractive errors and amblyopia. Graft failure occurred in three eyes--two from corneal decompensation, and one from homograft rejection. Complications included one total retinal detachment, one case of Streptococcus pneumoniae keratitis, and three cases that lost intraocular pressure control, requiring further glaucoma surgery. We conclude that useful vision can be achieved after penetrating keratoplasty even in some high-risk infants with congenital glaucoma.

Transthyretin sequesters amyloid beta protein and prevents amyloid formation

The cardinal pathological features of Alzheimer disease are depositions of aggregated amyloid beta protein (A beta) in the brain and cerebrovasculature. However, the A beta is found in a soluble form in cerebrospinal fluid in healthy individuals and patients with Alzheimer disease. We postulate that sequestration of A beta precludes amyloid formation. Failure to sequester A beta in Alzheimer disease may result in amyloidosis. When we added A beta to cerebrospinal fluid of patients and controls it was rapidly sequestered into stable complexes with transthyretin. Complexes with apolipoprotein E, which has been shown to bind A beta in vitro, were not observed in cerebrospinal fluid. Additional in vitro studies showed that both purified transthyretin and apolipoprotein E prevent amyloid formation.

Eye movement impairment and schizotypal psychopathology

OBJECTIVE

Eye movement dysfunction in relation to a smooth pursuit task has been documented in schizophrenic patients and in patients with the related personality disorder, schizotypal personality disorder. To investigate which quantitative measures are associated with the eye movement dysfunction and whether the dysfunction is more related to the psychotic-like or the deficit-like symptoms of schizotypal personality disorder, ratings of eye movements in several groups of subjects were compared.

METHOD

The study groups consisted of 26 patients with schizotypal personality disorder, 42 patients with other personality disorders (22 who also had two or more schizotypal personality traits and 20 who had fewer than two), and 37 normal comparison subjects. Smooth pursuit eye tracking of sinusoidal and constant velocity targets was recorded by an infrared eye tracking system. Two raters evaluated pursuit gain and large and small saccades in the direction of the target and in the direction opposite to that of the target (quantitative ratings) and constant velocity (qualitative rating).

RESULTS

Patients with schizotypal personality disorder and patients with other personality disorders and two or more schizotypal traits, but not those with fewer than two schizotypal traits, had significantly poorer qualitative ratings of tracking than the normal comparison subjects. Neither gain nor any of the saccadic measures significantly differed between groups. The number of large saccades in the direction of the target was the only quantitative variable that predicted low qualitative ratings. Qualitatively poor tracking was associated with the deficit-like, but not the psychotic-like, symptoms of schizotypal personality disorder.

CONCLUSIONS

Patients with schizotypal personality disorder demonstrate qualitatively poorer tracking than comparison groups, and the impaired tracking is associated with deficit-like symptoms.

Enchondroma in a rhesus monkey

A 2.5-year-old rhesus monkey was examined because of a bony enlargement of the distal portion of the right tibia. On the basis of radiographic and histologic findings, enchondroma was diagnosed. The tumor enlarged over the next 2 years, but the monkey continued to have normal use of its limb.

Adult cat flea (Siphonaptera: Pulicidae) excretion of host blood proteins in relation to larval nutrition

Protein content and ion composition of host blood and feces from blood-fed adult cat fleas, Ctenocephalides felis (Bouché), were examined. Total fecal protein differed slightly from host blood indicating that there was little digestion of host blood by adult fleas. Sodium dodecyl sulfate-polyacrylamide gel electrophoresis gels of host blood and flea feces also revealed little digestion, as evidenced by the quantitatively and qualitatively similar protein banding patterns. Blood and fecal ion compositions also were similar, except for fleas fed in vivo on cats, where both potassium and chloride compositions of feces were approximately 50% lower. Host blood or flea feces alone were not of sufficient food value to allow > 12.5% of larvae to develop to adults. The addition of yeast or dog chow increased larval development to the pupal stage to 100% and 87.5% of first instars tested, respectively. Although some larval survival occurred with diets of dog chow + yeast (37.5%), feces + hair (20%), and feces + stratum corneum (16.7%), the period to cocoon formation was twice as long as that of larvae fed diets containing blood or flea feces + yeast. In contrast to fleas, feces of adults of two other hematophagous insects--bed bugs, Cimex lectularius L., and mosquitoes, Aedes aegypti (L.)--contained significantly less protein and more digested protein than the blood that they had fed upon. We propose that host blood excretion evolved in response to larval nutritional requirements.

A longitudinal study of Alzheimer's disease: measurement, rate, and predictors of cognitive deterioration

OBJECTIVE

This study measured the annual rate of cognitive change in patients with Alzheimer's disease and determined the effects of clinical variables on that rate. It also compared the ability of two cognitive scales to measure change over the entire range of dementia severity.

METHOD

The cognitive subscale of the Alzheimer's Disease Assessment Scale and the Blessed test for information memory and concentration were given to 111 patients with Alzheimer's disease and 72 nondemented elderly comparison subjects at 6-month intervals for up to 90 months. Longitudinal changes in scores on the cognitive subscale were measured with several different methods of data analysis.

RESULTS

For the patients with Alzheimer's disease, the annual rate of change in cognitive subscale scores showed a quadratic relationship with dementia severity in which deterioration was slower for mildly and severely demented patients than for patients with moderate dementia. Gender, age at onset, and family history of dementia had no effect on the rate of cognitive deterioration. The comparison group showed a slight improvement in cognitive performance over time. All data analytic methods gave similar results. The cognitive subscale of the Alzheimer's Disease Assessment Scale was more sensitive to change in both mild and severe dementia than was the Blessed test.

CONCLUSIONS

These results suggest that cognitive deterioration is slow during the early and very late stages of Alzheimer's disease and more rapid during the middle stages. No clinical variables other than degree of cognitive impairment and previous rate of cognitive decline predicted rate of deterioration. These results have implications for treatment trials and attempts to identify subgroups.

The consulting psychiatrist and the polydipsia-hyponatremia syndrome in schizophrenia

OBJECTIVE

The authors seek to extend understanding and treatment of hospitalized schizophrenics presenting with complications of polydipsia and dilutional hyponatremia. Attending physicians may ask the consultation/liaison psychiatrist to see schizophrenics with hyponatremically-induced delirium or other psychiatric syndromes. The referring physician may or may not have identified polydipsia and dilutional hyponatremia and their complications. This article will help the consultation/liaison psychiatrist recognize early evidence of water imbalance, describe evaluation, and provide somatic and behavioral treatment approaches to this life-threatening syndrome.

METHOD

Over the past ten years, the authors have treated more than 100 patients with the polydipsia-hyponatremia syndrome. The authors discuss their and others' experience with drugs that help and hinder patients suffering from dilutional hyponatremia. They review current key articles from the polydipsia-hyponatremia syndrome literature including articles identified via Medline search 1985-94.

RESULTS

Schizophrenics with the polydipsia-hyponatremia syndrome most commonly present with polydipsia, polyuria, urinary incontinence, cognitive, affective, and behavioral changes, seizures, or coma. Quantitating polydipsia, hyponatremia, and diurnal changes in body weight facilitate therapeutic interventions. Treatment include patient and caregiver education, drug therapies to better treat psychosis and better treat osmotic dysregulation, behavioral interventions to interdict polydipsia, and diurnal weight monitoring.

CONCLUSIONS

Once recognized, acute, subacute, and chronic complications of the polydipsia-hyponatremia syndrome are readily treatable. Besides treating the patient, consultation/liaison psychiatrists can teach their medical colleagues about this syndrome. In so doing, they will enhance the quality of their patients' lives and help the internist and surgeon feel more comfortable when working with schizophrenics.

A review of laboratory animal anesthesia with chloral hydrate and chloralose

Chloral hydrate (CH) and alpha-chloralose (CS) are often used to anesthetize laboratory animals although, to our knowledge, there have been no controlled studies of their anesthetic or analgesic effects. Induction of and recovery from anesthesia can be stressful, and anesthesia and analgesic quality have been questioned. Intraperitoneal (i.p.) administration of CH has resulted in adynamic ileus and peritonitis in rats, gastric ulcers in rats, and peritonitis in swine. Light anesthesia is induced in rats. In dogs, CH induces sedation to deep anesthesia when given intravenously. Gastric irritation in dogs can occur when CH is given orally. Chloral hydrate is considered a good sedative-hypnotic for farm animals. Intravenously administered CS anesthetizes dogs and cats for 5 to 10 hours, but the animals may require respiratory support. Chloralose appears to be a satisfactory anesthetic for dogs when stage III thiobarbiturate anesthesia is first induced. It is difficult to gauge the depth of anesthesia and analgesia with CS. In our clinical experience with swine and calves, CH given i.p. leads to adynamic ileus. We have found that CS given i.p. causes an inflammatory response in guinea pigs, rats, and calves. We observed that CS analgesia varies with the type of surgical procedure performed. Based on a literature review and our clinical experience, we suggest that CH or CS anesthesia should be preceded by administration of barbiturates, opioids, alpha-2 agonists, or phenothiazine tranquilizers. Chloral hydrate should only be used as a sedative or hypnotic for dogs; CS should not be used as a sole anesthetic agent. Neither drug should be used i.p. for survival surgery.

CSF homovanillic acid in schizotypal personality disorder

CSF concentrations of homovanillic acid (HVA) were measured in 10 patients with schizotypal personality disorder and 14 patients with other personality disorders. The patients with schizotypal personality disorder had higher CSF HVA concentrations than the patients with other personality disorders. Furthermore, the psychotic-like schizotypal symptoms correlated positively with the CSF HVA concentrations. These results suggest a central dopaminergic dysfunction associated with the psychotic-like symptoms of schizotypal personality disorder.

Morbidity risk for alcoholism and drug abuse in relatives of cocaine addicts

The morbidity risks for alcoholism in the first-degree relatives of a cohort of male cocaine addicts with or without alcoholism comorbidity were studied. Of the 71 patients who participated in our study, 40 (56.3%) had a history of alcoholism and 37 (59.1%) a history of opioid abuse. Twenty-two patients (30.1%) also met criteria for a lifetime diagnosis of a major psychiatric disorder. Significant increases in morbidity risks for alcoholism were found among male relatives of cocaine addicts with comorbid alcohol dependence when compared with relatives of cocaine addicts with no alcohol comorbidity. Among fathers, risks were .69 vs .32 (z = 2.98, p < .003). Among brothers, risks were .38 vs .15 (z = 2.35, p < .03). Significantly increased risks were also observed in male relatives when probands with a psychiatric diagnosis were excluded from the analyses. Among female relatives, increases in morbidity risks were found but they failed to reach statistical significance. Two interpretations are consistent with these findings. One of these interpretations is that alcoholism is a disorder distinct from other addictions and has its own mode of transmission. The second interpretation is that the transmission of substance use disorders lacks specificity and that the substances selected are influenced by sociocultural or biological factors.

The lipid composition of milk from mice fed high or low fat diets

Total fatty acids and the proportions of methyl esters of individual fatty acids were measured in mouse milk. Pregnant mice were fed either a high fat (HF) diet or a low fat (LF) diet from 14 days of gestation. After parturition, each dam was milked once a day for a period of 18 days. The mean total fatty acid concentration over the entire study period was 110 mg/g of milk (approximately 11.7% fat as triglyceride) for both dietary treatment groups. During days 2 to 6 postpartum, the mean total fatty acid concentration for dams fed HF diet was lower than for the LF group. Although the concentration of total fatty acids of mouse milk was not affected by the level of dietary fat fed to the dam, several variations in the proportions of individual fatty acids were observed.

Induction of proliferative lesions of ventral prostate, seminal vesicle, and other accessory sex glands in rats by N-methyl-N-nitrosourea: effect of castration, pretreatment with cyproterone acetate and testosterone propionate and rat strain

Wistar (Cpb:WU), F344 or Sprague-Dawley rats were sequentially treated with cyproterone acetate (CA) for 21 days, testosterone propionate (TP) for 3 days, followed by a single i.v. injection of N-methyl-N-nitrosourea (MNU). One group of Wistar rats was castrated 4 weeks after MNU injection, and another group 58 weeks after MNU, when the first prostatic carcinoma was detected. Control groups received only CA + TP, CA, MNU, or they remained untreated. Early or late castration inhibited the development of atypical hyperplasia of the ventral prostate in Wistar rats. This lesion was induced by the CA + TP + MNU treatment in F344 rats, but not Sprague-Dawley rats; in Wistar rats, it was induced by CA + TP treatment, irrespective of whether MNU was given. Hypertrophic-hyperplastic lesions of the seminal vesicle were induced by MNU, irrespective of pretreatment, and their development was prevented by early castration and inhibited by late orchiectomy. Dorsolateral prostate carcinomas and preneoplasia occurred only in low incidence in Wistar and Sprague-Dawley rats. These lesions were absent in F344 rats that had received treatment with CA + TP + MNU. No dorsolateral prostate (pre)neoplasia was found in Wistar rats subjected to early orchiectomy, but rats castrated at 58 weeks had an incidence similar to that for the intact group treated with CA + TP + MNU. This finding supports the contention that androgens are required for the development of MNU-induced prostatic cancer in rats but that advanced carcinomas are androgen insensitive. Differences in incidence and localization of prostatic proliferative lesions between F344 and Wistar rats and between dorsolateral and ventral prostate could not be explained by differences in epithelial cell proliferative responses to CA + TP treatment at the time of MNU injection, since they were similar in ventral and dorsolateral prostate and were more prominent in F344 rats than in Wistar rats. DNA damage as estimated by MNU-induced unscheduled DNA synthesis also did not differ between dorsolateral and ventral prostate.

Caffeine and spontaneous abortion of known karyotype

We tested associations of caffeine from beverages with spontaneous abortions of known karyotype. Spontaneous abortions (cases) were classified as chromosomally normal (n = 510) or chromosomally aberrant (n = 389) and, within the latter category, by type of aberration (237 trisomies, 54 monosomies X, 49 triploidies, 49 others). Controls registered for prenatal care before 22 weeks gestation and delivered at 28 weeks or later (n = 1,423). Caffeine intake in the perifertilization period did not differ among case groups and controls. For the highest category, 225+ mg/day, odds ratios (OR), adjusted for payment group and maternal age, were 1.0 for chromosomally normal cases, 0.9 for trisomies, 1.6 for monosomies X, and 0.8 for triploidies. Caffeine intake during pregnancy was tested for associations with chromosomally normal loss using the chromosomally aberrant cases to provide a robust comparison group. Although the proportion of subjects with intake of 225+ mg/day of caffeine intake in the perifertilization period does not influence the risk of chromosomally normal loss or trisomy. For monosomy X and triploidy, no strong associations were observed, but numbers were insufficient to rule out moderate effects. For caffeine intake during pregnancy, we found little evidence to support an influence on chromosomally normal loss.

Body weights of C3H/HeN mice fed semipurified or commercial diets of different fat content

Oncology studies often require specially formulated diets to be fed to laboratory animals. To determine the effect of dietary fat on body weight, C3H/HeN mice were carefully assigned by weight into three groups. The first group was fed a high-fat semipurified diet (23% fat by weight) from 21 to 73 days of age then returned to a low-fat semipurified diet (5% fat by weight). A second group was fed the low-fat diet from 21 to 73 days of age, then the high-fat diet until 129 days of age, then returned to the low-fat diet. A final group was fed a 4.5% fat commercial diet for the entire 193-day study. The results showed that the mice fed the semipurified diets did not differ significantly from each other in weight over the course of the study but did differ significantly between 21 and 73 days of age, possibly from a taste preference for the high-fat diet. Mice fed the commercial diet always weighed significantly less. It was estimated that mice fed the commercial diet consumed more food and were less efficient in their food utilization. Mice should be carefully assigned, by weight, into experimental groups, and all groups, including untreated controls, should be fed the same type of diet.

Effects on C3H mouse mammary cancer of changing from a high fat to a low fat diet before, at, or after puberty

A low fat/low calorie (LF/LC) diet is a relative inhibitor of murine mammary cancer. Because the mammary gland may be most sensitive to the action of a carcinogen at or near the age of puberty, we studied whether beginning a LF/LC diet before puberty would decrease C3H/OuJ mouse mammary cancer incidence more than if such a diet was begun at or after puberty. We also studied whether the advancement of the age of puberty by a high fat/high calorie (HF/HC) diet would in itself be a mammary cancer risk factor and whether dietary fat levels would affect mammary cancer metastases. In the first study, mice were changed from a HF/HC diet to a LF/LC diet at 12 days of age, puberty, or 60 days of age. Other groups were always HF/HC or always LF/LC. In a second experiment, mice were fed a high fat diet for the same length of time, i.e., from 21 to 75 days of age (before and through puberty) or 75 to 129 days of age (well after puberty). In one aspect of the first study, puberty was advanced by feeding a HF/HC diet until the first day of puberty. However, tumor latency, incidence, and multiplicity were not statistically different from those of the LF/LC control. Other results of the first study indicated, in general, that mice consuming a LF/LC diet beginning at or before puberty had a longer tumor latency and a lower tumor incidence and multiplicity than mice either beginning a LF/LC diet at 60 days of age or continuously fed a HF/HC diet. Lung metatases were greater in mice fed a HF/HC diet continuously compared to LF/LC continuously. In the second study, beginning the high fat diet before or after puberty did not result in statistically significant differences in tumor latency, incidence, or multiplicity. It was concluded that the longer a LF/LC diet was fed, the lower was the mammary cancer risk. An early puberty in itself was not a mammary cancer risk factor and mouse puberty had no particular significance as an age before which a LF/LC diet should begin.

What public school teachers teach about preventing pregnancy, AIDS and sexually transmitted diseases

Ninety-three percent of public school teachers in five specialties-biology, health education, home economics, physical education and school nursing--who teach grades 7-12 report that their schools offer sex education or AIDS education in some form. Almost all the teachers believe that a wide range of topics related to the prevention of pregnancy, AIDS and other sexually transmitted diseases (STDs) should be taught in the public schools, and most believe these topics should be covered by grades 7-8 at the latest. In practice, however, sex education tends not to occur until the ninth or 10th grades. Moreover, there is often a gap between what teachers think should be taught and what actually is taught. For example, virtually all the teachers say that school sex education should cover sexual decision-making, abstinence and birth control methods, but only 82-84 percent of the teachers are in schools that provide instruction in those topics. The largest gap occurs in connection with sources of birth control methods: Ninety-seven percent of teachers say that sex education classes should address where students can go to obtain a method, but only 48 percent are in schools where this is done. Forty-five percent of teachers in the five specialties currently provide sex education in some form. The messages they most want to give to their students are responsibility regarding sexual relationships and parenthood, the importance of abstinence and ways of resisting pressures to become sexually active, and information about AIDS and other STDs.(ABSTRACT TRUNCATED AT 250 WORDS)

Visceral leishmaniasis in an English foxhound from an Ohio research colony

Visceral leishmaniasis was diagnosed in a 5-year-old English Foxhound born and housed in an Ohio research colony. Physical examination revealed pyrexia, hematochezia, panuveitis, splenomegaly, and lymphadenopathy. Hematologic and serum biochemical abnormalities consisted of anemia, thrombocytopenia, hypoalbuminemia, hyperglobulinemia, azotemia, and proteinuria. Postmortem examination revealed widely disseminated (spleen, bone marrow, lymph node, liver, kidney, lungs) Leishmania amastigotes within macrophages.