Gamma knife capsulotomy for intractable OCD: Neuroimage analysis of lesion size, location, and clinical response

Obsessive-compulsive disorder (OCD) affects 2-3% of the population. One-third of patients are poorly responsive to conventional therapies, and for a subgroup, gamma knife capsulotomy (GKC) is an option. We examined lesion characteristics in patients previously treated with GKC through well-established programs in Providence, RI (Butler Hospital/Rhode Island Hospital/Alpert Medical School of Brown University) and São Paulo, Brazil (University of São Paolo). Lesions were traced on T1 images from 26 patients who had received GKC targeting the ventral half of the anterior limb of the internal capsule (ALIC), and the masks were transformed into MNI space. Voxel-wise lesion-symptom mapping was performed to assess the influence of lesion location on Y-BOCS ratings. General linear models were built to compare the relationship between lesion size/location along different axes of the ALIC and above or below-average change in Y-BOCS ratings. Sixty-nine percent of this sample were full responders (≥35% improvement in OCD). Lesion occurrence anywhere within the targeted region was associated with clinical improvement, but modeling results demonstrated that lesions occurring posteriorly (closer to the anterior commissure) and dorsally (closer to the mid-ALIC) were associated with the greatest Y-BOCS reduction. No association was found between Y-BOCS reduction and overall lesion volume. GKC remains an effective treatment for refractory OCD. Our data suggest that continuing to target the bottom half of the ALIC in the coronal plane is likely to provide the dorsal-ventral height required to achieve optimal outcomes, as it will cover the white matter pathways relevant to change. Further analysis of individual variability will be essential for improving targeting and clinical outcomes, and potentially further reducing the lesion size necessary for beneficial outcomes.

American Academy of Nursing Expert Panel consensus statement on nursing's roles in ensuring universal palliative care access

The purpose of this consensus paper was to convene leaders and scholars from eight Expert Panels of the American Academy of Nursing and provide recommendations to advance nursing's roles and responsibility to ensure universal access to palliative care. Part I of this consensus paper herein provides the rationale and background to support the policy, education, research, and clinical practice recommendations put forward in Part II. On behalf of the Academy, the evidence-based recommendations will guide nurses, policy makers, government representatives, professional associations, and interdisciplinary and community partners to integrate palliative nursing services across health and social care settings. The consensus paper's 43 authors represent eight countries (Australia, Canada, England, Kenya, Lebanon, Liberia, South Africa, United States of America) and extensive international health experience, thus providing a global context for the subject matter. The authors recommend greater investments in palliative nursing education and nurse-led research, nurse engagement in policy making, enhanced intersectoral partnerships with nursing, and an increased profile and visibility of palliative nurses worldwide. By enacting these recommendations, nurses working in all settings can assume leading roles in delivering high-quality palliative care globally, particularly for minoritized, marginalized, and other at-risk populations.

International consensus-based policy recommendations to advance universal palliative care access from the American Academy of Nursing Expert Panels

The purpose of this consensus paper was to convene leaders and scholars from eight Expert Panels of the American Academy of Nursing and provide recommendations to advance nursing's roles and responsibility to ensure universal access to palliative care. On behalf of the Academy, these evidence-based recommendations will guide nurses, policy makers, government representatives, professional associations, and interdisciplinary and community partners to integrate palliative nursing services across health and social care settings. Through improved palliative nursing education, nurse-led research, nurse engagement in policy making, enhanced intersectoral partnerships with nursing, and an increased profile and visibility of palliative care nurses worldwide, nurses can assume leading roles in delivering high-quality palliative care globally, particularly for minoritized, marginalized, and other at-risk populations. Part II herein provides a summary of international responses and policy options that have sought to enhance universal palliative care and palliative nursing access to date. Additionally, we provide ten policy, education, research, and clinical practice recommendations based on the rationale and background information found in Part I. The consensus paper's 43 authors represent eight countries (Australia, Canada, England, Kenya, Lebanon, Liberia, South Africa, United States of America) and extensive international health experience, thus providing a global context for the subject matter.

Preparing Oncology Advanced Practice RNs as Generalists in Palliative Care

OBJECTIVES

To train and support oncology advanced practice RNs (APRNs) to become generalist providers of palliative care.

SAMPLE & SETTING

APRNs with master's or doctor of nursing practice degrees and at least five years of experience in oncology (N = 165) attended a National Cancer Institute-funded national training course and participated in ongoing support and education.

METHODS & VARIABLES

Course participants completed a precourse, postcourse, and six-month follow-up evaluation regarding palliative care practices in their settings, course evaluation, and their perceived effectiveness in applying course content in their practice.

RESULTS

The precourse results showed deficiencies in current practice, with a low percentage of patients having palliative care as part of their oncology care. Barriers included lack of triggers that could assist in identifying patients who could benefit from palliative care. Six-month postcourse data showed more APRNs participating in family meetings, recommending palliative care consultations, speaking with family members regarding bereavement services, and preparing clinical staff for impending patient deaths.

IMPLICATIONS FOR NURSING

APRNs require palliative care training to integrate this care within their role. APRNs can influence practice change and improve care for patients in their settings.

A Framework for Integrating Oncology Palliative Care in Doctor of Nursing Practice (DNP) Education

Doctor of Nursing Practice (DNP) faculty play a critical role in preparing students to meet the complex needs of the nation as the number of cancer rates and survivors rise (National Cancer Institute, 2018) and as an unprecedented number of older Americans enter into the healthcare system with complicated comorbidities (Whitehead, 2016). Palliative care has dramatically expanded over the past decade and has been increasingly accepted as a standard of care for people with cancer and other serious, chronic, or life-limiting illnesses. Advanced practice registered nurses (APRNs) are recognized as important providers of palliative care (Walling et al., 2017). A 2-day course was held with support from the National Cancer Institute to enhance integration of palliative oncology care into DNP curriculum. The course participants (N = 183), consisting of DNP faculty or deans, practicing DNP clinicians, and students, received detailed annotated slides, case studies, and suggested activities to increase student engagement with the learning process. Course content was developed and delivered by palliative care experts and DNP faculty skilled in curriculum design. Participants were required to develop goals on how to enhance their school's DNP curriculum with the course content. They provided updates regarding their progress at integrating the content into their school's curriculum at 6, 12, and 18 months post course. Results demonstrated an increase in incorporating oncology palliative care in DNP scholarly projects and clinical opportunities. Challenges to inclusion of this content in DNP curricula included lack of: perceived time in curriculum; faculty educated in palliative care; and available clinical sites.

Endovascular treatment of pulsatile tinnitus caused by dural sinus stenosis

A patient presenting with progressive pulsatile tinnitus was found to have an ipsilateral dural sinus stenosis. This problem was successfully treated by an endovascular approach with angioplasty and subsequent sinus stenting. The diagnostic evaluation, therapeutic method, and follow-up concerning this problem and its treatment are discussed.

End-of-Life Nursing Education Consortium. Geriatric Training Program: improving palliative care in community geriatric care settings

Recent studies of end-of-life care in nursing homes and other long-term care settings point to a significant need to improve care. The End-of-Life Nursing Education Consortium (ELNEC)-Geriatric Training Program is an important educational initiative to advance palliative care and end-of-life education for licensed nurses and nursing assistants. The ELNEC-Geriatric Training Program prepares nurses as educators and leaders to improve the quality of end-of-life care in geriatric care facilities. This article presents evaluation data from the 2007 pilot ELNEC-Geriatric Training Program and follow-up evaluation of the "train-the-trainer" model to disseminate comprehensive palliative care education in geriatric settings.

The naming deficit in early Alzheimer's and vascular dementia

Patients with early Alzheimer's disease (AD) were compared to normal controls and patients with early vascular dementia (VaD) on their naming errors using the Boston Naming Test (H. Goodglass & E. Kaplan, 1983). All naming errors were classified into three general error categories: visuoperceptual, semantic, and phonemic. Semantic errors were further classified into coordinate errors (responses that belong to the same semantic category as the target words), superordinate errors (responses that belong to a broader semantic category than the target word), and functional-circumlocutory errors (circumlocutions and responses that functionally describe the target word). The findings indicated that AD participants display more overall naming errors than VaD participants, although the pattern of general errors was similar between the patient groups. However, the qualitative difference between the patient groups was observed within the semantic errors because the AD group made more superordinate errors.

The naming deficit in early Alzheimer's and vascular dementia

Patients with early Alzheimer's disease (AD) were compared to normal controls and patients with early vascular dementia (VaD) on their naming errors using the Boston Naming Test (H. Goodglass & E. Kaplan, 1983). All naming errors were classified into three general error categories: visuoperceptual, semantic, and phonemic. Semantic errors were further classified into coordinate errors (responses that belong to the same semantic category as the target words), superordinate errors (responses that belong to a broader semantic category than the target word), and functional-circumlocutory errors (circumlocutions and responses that functionally describe the target word). The findings indicated that AD participants display more overall naming errors than VaD participants, although the pattern of general errors was similar between the patient groups. However, the qualitative difference between the patient groups was observed within the semantic errors because the AD group made more superordinate errors.

Neuropsychiatric correlates and treatment of lenticulostriatal diseases: a review of the literature and overview of research opportunities in Huntington's, Wilson's, and Fahr's diseases. A report of the ANPA Committee on Research. American Neuropsychiatric Association

This report reviews clinical neuropsychiatric findings and opportunities for research in Huntington's, Wilson's, and Fahr's diseases. Consistent, systematic methodology is lacking among neuropsychiatric studies in these lenticulostriatal diseases. Systematic cross-sectional and longitudinal assessments are needed to ascertain the prevalence of psychiatric disorders as a function of disease course. Preliminary synthesis of existing data suggests the following heuristic relationships in these diseases: depression with parkinsonian states; personality changes with caudate or putamen disease; psychosis, impulsivity, and sexual disorders with caudate disease; dementia and mania with caudate and pallidal diseases; and compulsions with pallidal disease. Correlation of neuropsychiatric findings with disease stage, clinical signs, and radiologic, metabolic, physiologic, and pathologic markers of disease will add to our understanding of these conditions.

Adult psychiatric status of hyperactive boys grown up

OBJECTIVE

Numerous studies have examined the adolescent and young adult fate of children with attention deficit hyperactivity disorder (ADHD). In marked contrast, relatively little is known about the adult outcome of these children. There have been only two controlled, prospective studies of psychiatric status into adulthood. The present study was conducted to gain further understanding of the natural course of this common childhood condition.

METHOD

This was a prospective follow-up of clinically diagnosed, white boys of average intelligence who were referred by teachers to a child psychiatric research clinic at an average age of 7.3 years. At a mean age of 24.1 years, 85 probands (82% of the childhood cohort) and 73 comparison subjects (94% of adolescent comparison subjects) were directly interviewed by trained clinicians who were blind to group status.

RESULTS

Evaluations of the probands and comparison subjects indicated significantly higher prevalences of antisocial personality disorder (12% versus 3%) and nonalcohol substance abuse (12% versus 4%) in the probands, whereas mood disorders (4% versus 4%) and anxiety disorders (2% versus 7%) were not significantly different. At adult follow-up, ADHD was rare, occurring in only 4% of the probands (no comparison subjects).

CONCLUSIONS

The results of the present study are consistent with the authors' previously reported major findings. They strongly suggest that children with ADHD are at significantly higher risk for a specific negative course marked by antisocial and substance-related disorders.

Emergent/urgent therapeutic irradiation in pediatric oncology: patterns of presentation, treatment, and outcome

PURPOSE

We reviewed all pediatric cases referred for emergent/urgent therapy (requiring treatment within 48 hours) to identify frequency, patterns of presentation, and efficacy of therapy. We defined five categories of emergent/urgent therapy based on irradiated site and/or signs: Group I, spinal cord compression; Group II, respiratory compromise; Group III, infradiaphagmatic distress; Group IV, intracranial signs; Group V, pain.

MATERIALS AND METHODS

From 2/1/88-3/1/ 94, 104 children with 115 problems were referred by specialists at the Children's Hospital of Philadelphia. Diagnosis, nature of the emergency, and response were examined. Responses were categorized as complete resolution, improvement or stabilization, and progression.

RESULTS

The 104 children represented 12% of referrals during the study period. The most common tumors were CNS PNET and gliomas (20%); and neuroblastoma (20%). Forty-five problems occurred with newly diagnosed tumors and 70 after progression. Ninety-one episodes were managed with radiation therapy and 24 with other modalities. Patients with spinal cord/cauda equina (n = 33) compression improved (55%) or stabilized (30%). Patients with respiratory compromise from thoracic (n = 14) or abdominal (n = 5) disease had a response rate of 72%. Eight patients in group III had a 66% response. In Group IV (n = 16), 63% had complete responses and 19% had stabilization. Group V (n = 15) patients had a complete or partial response of 93%.

CONCLUSION

Approximately 10% of children referred for radiation therapy required emergent/urgent treatment. Eighty percent of patients achieved stabilization or showed improvement in signs and symptoms, indicating that radiotherapy is a valuable and reliable component of multimodal care in such situations.

Memory processes in depressed geriatric patients with and without subcortical hyperintensities on MRI

In this study, 12 patients over age 60 with depression with moderate to severe subcortical hyperintensities (SH) localized to the periventricular white matter were identified by quantitative MRI. Using the California Verbal Learning Test, they were compared with 12 age-, education-, and severity-matched patients with depression with minimal white matter changes on specific aspects of memory performance. Patients with cortical lesions, neurologic or systemic illness affecting cognition, and history of substance abuse were excluded. Patients in the group with high SH showed reduced use of semantic encoding strategies (p < 0.05), reduced learning efficiency (p < 0.05), and a greater discrepancy between free recall and recognition discriminability (p < 0.05) than their low SH counterparts. This pattern of performance on memory tasks is similar to that found in previous studies to be associated with subcortical degenerative disorders such as Huntington's and Parkinson's diseases. Geriatric patients with depression with SH may represent a subgroup with greater subcortical involvement, with associated cognitive and functional decline.

Educational and occupational outcome of hyperactive boys grown up

OBJECTIVE

Little is known about the adult outcome of attention-deficit hyperactivity disorder (ADHD), a very prevalent childhood disorder that is known to affect deleteriously academic performance and other areas of child functioning. This study represents a third wave of evaluations that examine the long-term educational achievement and occupational rank of children with ADHD.

METHOD

This is a prospective follow-up of white boys of average intelligence whose ADHD was clinically diagnosed according to systematic criteria at an average age of 7 years. Follow-up intervals range from 15 to 21 years (mean, 17 years). At average age 24 years, 85 probands (representing 82% of the childhood cohort) and 73 controls (84%) were directly interviewed by trained clinicians who were blind to group membership.

RESULTS

First, probands completed significantly less formal schooling than controls (about 2 years less, on average). Second, probands had lower-ranking occupational positions than controls. Finally, these disadvantages were not accounted for by adult mental status.

CONCLUSIONS

The present study suggests that childhood ADHD predisposes to specific disadvantages and continues to affect important functional domains unrelated to current psychiatric diagnosis.

The limbic system: an anatomic, phylogenetic, and clinical perspective

The limbic system is the border zone where psychiatry meets neurology. The authors provide a model of limbic function that combines phylogenetic, anatomic, functional, and clinical data to interpret diseases relevant to neuropsychiatry. They provide evidence supporting two major divisions in the limbic system: a paleocortical division with the amygdala and orbitofrontal cortex at its center, and an archicortical division with the hippocampus and cingulate cortex at its center. The implicit integration of affect, drives, and object associations is the function of the paleocortical limbic division; explicit sensory processing, encoding, and attentional control is the function of the archicortical limbic division. The two work in concert to integrate thought, feeling, and action. Understanding their development and organization informs us about how best to care for our patients.

A case of late-onset psychosis: integrating neuropsychological and SPECT data

We report the case of a 67-year-old woman who experienced a sudden onset of psychotic illness (i.e., prominent delusions and hallucinations) that has endured for approximately 3 years. As part of her neurobehavioral work-up, a SPECT scan revealed right frontal and left anterior temporal-lobe hypoperfusion. Serial neuropsychological evaluations obtained 2 years apart demonstrated a steady decline on tests of executive control (monitoring, allocation of attention, perseveration) and visuospatial abilities, whereas performance in other areas of cognitive functioning have remained steady and in the normal range for the patient's age. Over this same period of time, serial EEG, MRI, and neurology examinations have been within normal limits. Thus, there was little evidence with which to diagnose dementia. It is suggested that concomitant impairment in executive control, coupled with a degraded capacity to process perceptual information, can give rise to enduring psychotic behavior.

MRI and neuropsychological differences in early- and late-life-onset geriatric depression

We sought to determine whether geriatric patients with late-life-onset major depression have more subcortical hyperintensities on MRI and greater cognitive impairment than age-matched geriatric patients with early-life-onset major depression, suggesting that subcortical disease may be etiologic in late-life depression. Most negative studies of the clinical significance of subcortical hyperintensities on MRI in geriatric patients have sampled from a restricted range of subjects, have employed limited batteries of neuropsychological tests, or have not quantified MRI changes; the present study attempted to address these limitations. Thirty subjects from a geriatric psychiatry inpatient service who were over 60 years of age and presented with major depression were divided into groups with onset of first depression after age 60 (mean = 72.4 years, 15 women, 0 men), and onset of first depression before age 60 (mean = 35.8 years, 12 women, 3 men). Quantitative analysis of MRI yielded the volume of: periventricular hyperintensities (PVH) and deep white-matter hyperintensities (DWMH). Subjects were administered a neuropsychological battery and measures of depression by raters blind to age of onset. The late-onset group had significantly more PVH and DWMH. They were also more impaired on executive and verbal and nonverbal memory tasks. Discriminant analysis using the severity or subcortical signal hyperintensities on MRI, cognitive index, and depression scores correctly predicted late versus early onset of depression in 87% of the early-onset group and 80% of the late-onset group. These findings suggest that late-life-onset depression may be associated with an increased severity of subcortical vascular disease and greater impairment of cognitive performance.

gamma-Glutamyl transpeptidase as a response predictor when using alpha-interferon to treat hepatitis C

BACKGROUND/AIMS

This study was performed to identify response predictors for Interferon therapy given to patients with chronic hepatitis C.

MATERIALS AND METHODS

The biochemical measures of liver injury that characterize viral hepatitis due to hepatitis C were followed prospectively in 84 individuals treated with alpha-Interferon. In addition, the liver histology and the hepatic iron content of these same individuals, prior to the initiation of Interferon therapy, were determined.

RESULTS

Patients not responding to the interferon therapy showed an increase in liver iron content from an average of 337 micrograms/g wet weight. In responder to a value of 1075 micrograms/g wet weight in non responders. gamma-glutamyl transpeptidase levels in responders were significantly lower than in partial or non-responders.

CONCLUSIONS

Both the hepatic iron content of the liver and the gamma-glutamyl transpeptidase value prior to treatment were able to predict a clinical response to Interferon therapy. More importantly, the gamma-glutamyl transpeptidase level measured in serum could be used to monitor the IFN response during treatment and was found to predict clinical exacerbations of hepatitis following withdrawal of Interferon therapy.

Assessment of treatment outcomes in neuropsychiatry: a report from the Committee on Research of the American Neuropsychiatric Association

The ANPA Committee on Research conducted a survey of its members and those of the British Neuropsychiatry Association to determine the extent to which neuropsychiatrists employ formal measures of clinical outcome. Results revealed that although respondents endorsed the practice of outcome assessment, formal diagnostic evaluations and outcome measures were rarely applied consistently to the broad range of neuropsychiatric conditions encountered clinically. These findings have implications for clinical research and managed care in neuropsychiatry and will form the basis for future work by the Committee on Research.

Drinking outcomes of alcohol abusers diagnosed as antisocial personality disorder

Clinical research and wisdom suggest that alcoholics with antisocial personality (ASPs) disorders have poorer drinking outcomes after treatment than alcoholics without this disorder. The present study challenges this wisdom, suggesting that poor prognosis and response to treatment have been confounded by not covarying on pretreatment drinking measures. Thirty-one ASPs are compared with 118 non-ASPs randomly assigned to extended cognitive behavioral and relationship enhancement treatments. Thirteen to 18 months after treatment initiation, ASPs average more abstinent days than do non-ASPs. Drinking intensity is a function of a patient-treatment matching effect: ASPs treated with cognitive behavioral treatment (CB) drink less/drinking day than do either non-ASPs treated in CB or ASPs treated in relationship enhancement. This finding is supportive of a comparable matching effect for CB and ASP found by Kadden et al. (1989). Examination of the process indicates that, irrespective of drinking index, ASPs respond poorly when they experience high posttreatment support for abstinence, whereas non-ASPs respond better with support. We conclude that early pessimism for successful treatment of ASP alcoholic drinking outcome may be unwarranted.

Novel structural organisation of a Mus musculus DBA/2 chromosome shows a fixed position for the centromere

Chromosome 1 of the inbred mouse strain DBA/2 shows an unusual polymorphism associated with its centromeric satellite DNA sequences. The minor satellite array has undergone amplification and is present as two blocks separated by major satellite sequences. Both minor satellite blocks appear to carry the sequence motif necessary for CENP-B protein binding. Despite this apparent similarity the functional centromere, as defined by the location of CREST antigens, appears to form only within the more terminal block. The two blocks also vary in that sister chromatid association only occurs with this more terminal block.

The effect of social investment on treatment outcome

Social support is associated with better response to treatment. Treatments focused on relationships, such as marital and family therapy, are directed in part at promoting this support. However, the strength of the relationship between support and abstinence is modest, as is the demonstrated incremental effectiveness of treatments focused on relationships. Treatment-matching research needs to determine under what set of conditions treatments focused on relationships will enhance abstinence. The primary aim of this study was to determine whether the relationship between alcohol involvement and alcohol-specific social support is moderated by a person's social investment. The second aim was to determine the set of circumstances under which extended individually focused cognitive behavioral (CB) treatment and a relationship enhancement (RE) of brief cognitive behavioral treatments would improve outcomes. Patients were randomly assigned to individual or relationship-enhanced outpatient treatment and followed for 12 months. Results indicated that a patient's social investment did moderate the strength of the relationship between support and posttreatment alcohol involvement: Among high investors, there was a strong positive relationship, while the association was weak for low investors. A hypothesized triple-order interaction between social investment, posttreatment support and treatment did not materialize. However, an interaction between support and treatment showed that those with high support did equally well in either treatment, while those posttreatment support was low benefited from CB, but experienced poor outcomes when treated in relationship enhancement of CB. Further analyses indicated that increasing alcohol-specific support for low investors was probably contraindicated. We suggest that patients with low investment should be treated in an extended cognitive behavioral modality, while relationally enhanced CB treatment should be limited to high investors who are likely to experience support for their abstinence following treatment.

Adult outcome of hyperactive boys. Educational achievement, occupational rank, and psychiatric status

OBJECTIVE

The paucity of data concerning the long-term natural history of attention-deficit hyperactivity disorder (ADHD), a common childhood psychiatric disorder, prompted a longitudinal study to investigate the adult sequelae of the childhood disorder.

DESIGN

Prospective study, follow-up intervals ranging from 13 to 19 years (mean, 16 years), with blind systematic clinical assessments.

SUBJECTS

Ninety-one white males (mean age, 26 years), representing 88% of a cohort systematically diagnosed as hyperactive in childhood, and 95 (95%) of comparison cases of similar race, gender, age, whose teachers had voiced no complaints about their school behavior in childhood.

RESULTS

Probands had significantly higher rates than comparisons of ADHD symptoms (11% vs 1%), antisocial personality disorders (18% vs 2%), and drug abuse disorders (16% vs 4%). Significant comorbidity occurred between antisocial and drug disorders. Educational and occupational achievements were significantly compromised in the probands. These disadvantages were independent of psychiatric status. We did not find increased rates of affective or anxiety disorders in the probands.

CONCLUSIONS

Childhood ADHD predicts specific adult psychiatric disorders, namely antisocial and drug abuse disorders. In the adolescent outcome of this cohort, we found that these disturbances were dependent on the continuation of ADHD symptoms. In contrast, in adulthood, antisocial and drug disorders appeared, in part, independent of sustained ADHD. In addition, regardless of psychiatric status, ADHD placed children at relative risk for educational and vocational disadvantage. The results do not support a relationship between childhood ADHD and adult mood or anxiety disorders.

The orbitomedial frontal syndrome

An orbitomedial frontal syndrome is proposed, characterized by anosmia, amnesia with confabulation, Go-NoGo deficits, personality change, and hypersensitivity to pain. The orbitomedial frontal syndrome is distinct from the clinical picture that results from dorsolateral frontal damage. Aspects of orbitomedial damage have been discussed previously in isolation, but we argue that recognition of this syndrome in toto is clinically important. It appears to be associated with poor social and vocational adjustment after brain injury, and the co-occurrence of features of the syndrome provides clues to underlying mechanisms for disinhibition and confabulation in frontal lobe patients.

Hyperactive boys almost grown up. V. Replication of psychiatric status

We previously reported a prospective follow-up study of 101 young adult males whose conditions had been diagnosed as hyperactivity in childhood. Compared with controls, probands had significantly higher rates of attention-deficit, antisocial, and drug use disorders at follow-up (mean age, 18 years). The present study was an attempt to replicate these findings on an independent sample of 94 hyperactive boys who were seen at the same clinic, compared with 78 normal controls. Assessments were made by clinicians who were blind to group membership. Information was obtained for 90% of the original cohort. As in the previous study, significantly more probands than controls were given ongoing diagnoses of attention-deficit disorder (43% vs 4%), antisocial disorders (32% vs 8%), and drug use disorders (10% vs 1%). Furthermore, the absolute rates of these disorders were comparable for corresponding groups across studies, and the adjusted odds ratios did not differ significantly. As previously, there was no increased risk for affective disorders in the grown hyperactive children. The present study provides a powerful replication of the nature of the young adult outcome of childhood hyperactivity.

Neuropsychological deficits in myotonic muscular dystrophy

Twenty patients with myotonic muscular dystrophy (MMD) were compared with twenty controls on a battery of standardised neuropsychiological tests measuring motor and cognitive functions. The MMD patients performed significantly poorer on both motor and cognitive tests, particularly those assessing spatial functions. Although both motor and cognitive scores were correlated with age, significant diagnostic group by age interactions were present only for the motor measures. Therefore, while motor deficits in MMD may progress with ageing, cognitive deficits are mainly developmental and relatively stable.

Determinants of neuropsychological impairment in antisocial substance abusers

Persons displaying Antisocial Personality Disorder (ASP) may be at risk for neuropsychological impairment due to a number of developmental and later life experiences to which they are prone. Thirty substance abusers meeting research criteria for ASP were compared to a demographically matched non-ASP cohort on neuropsychological test performance. The ASP subjects were found to have a higher prevalence of neuropsychological deficit. The groups were then compared on factors which might lead to brain impairment. Presence of ASP was associated with earlier and heavier past drinking patterns, more negative health and behavioral effects of alcohol abuse, and greater abuse of other drugs in addition to alcohol. The ASP alcoholics also reported a high prevalence of serious head injury (58%), although they did not differ from non-ASP alcoholics in this regard. Implications for the neuropsychology of alcoholism and for treatment are discussed.

Reduced RNA synthesis levels in isolated mouse liver nuclei following reaction with [(H2O)(NH3)5Ru(II)]2+

The goal of this study is to establish the effect of [(H2O)(NH3)5Ru(II)]2+ reaction of nuclei on their RNA transcription levels. This question is important because ammineruthenium compounds share chemical and biological properties with the chemotherapeutic agent cis-dichlorodiammineplatinum(II) or cisplatin. First we demonstrate that mouse liver nuclei are active in RNA transcription in vitro and characterize the optimum conditions for in vitro transcription. Synthetic rates in the presence of inhibitors actinomycin D and alpha-Amanitin and measurements of oligo(dT)-cellulose RNA binding levels suggest that all three RNA Polymerases are active in synthesis at about the following percentages-RNA Polymerase I(30%), II(50%) and III(20%). Mouse liver nuclei reacted with [(H2O)(NH3)5Ru(II)]2+ and then oxidized had (NH3)5 Ru(III)3+n-DNA adduct levels inversely related to total RNA synthetic rates. Oligo(dT) cellulose RNA binding levels did not vary with DNA adduct density. These data suggest that direct DNA lesions rather than [(NH3)5Ru(III)]3+ effects on other aspects of the transcription system are responsible for the diminished RNA synthesis levels. Ammineruthenium complexes remain desirable candidates for chemotherapeutic agents that may be safely administered in the unreactive ruthenium(III) state and be activated toward DNA binding by reduction in the hypoxic environment of many tumour cells.

Risk factors for neuropsychological impairment in alcoholics: antisocial personality, age, years of drinking and gender

One hundred eighty-two alcoholics were studied using subtests from the Halstead-Reitan Neuropsychological Battery, Wechsler Adult Intelligence Scale and the Wechsler Memory Scale. Alcoholics who displayed antisocial personality disorder (ASPD) were more impaired on the Brain Age Quotient, a summary measure of neuropsychological impairment. Multivariate analyses indicated that presence of ASPD contributed significantly to this impairment, independent of age, length of drinking history or gender. Discriminant analysis using these variables as predictors allowed for clinically useful levels of prediction of neuropsychological impairment in individual subjects.

Topographic evoked potential mapping in obsessive-compulsive disorder: evidence of frontal lobe dysfunction

Several lines of evidence suggest that frontal lobe dysfunction may underlie obsessive-compulsive disorder (OCD). Eighteen patients with OCD were compared with 18 normals matched for age, gender, handedness, and education on a Go-NoGo task. Visual evoked potentials were measured during the task. Topographic evoked potential mapping revealed significantly smaller P300 magnitudes in orbital frontal areas in the OCD patients. Results are compared with those from studies using other methodologies, and etiological implications are discussed.

Flow cytometry measurements of human chromosome kinetochore labeling

A method for the preparation and measurement of immunofluorescent human chromosome centromeres in suspension is described using CREST antibodies, which bind to the centromeric region of chromosomes. Fluorescein isothiocyanate (FITC)-conjugated antihuman antibodies provide the fluorescent label. Labeled chromosomes are examined on microscope slides and by flow cytometry. In both cases a dye which binds to DNA is added to provide identification of the chromosome groups. Sera from different CREST patients vary in their ability to bind to chromosome arms in addition to the centromeric region. Flow cytometry and microfluorimetry measurements have shown that with a given CREST serum the differences in kinetochore fluorescence between chromosomes are only minor. Flow cytometry experiments to relate the number of dicentric chromosomes, induced by in vitro radiation of peripheral blood cells to the slightly increased number of chromosomes with above-average kinetochore fluorescence did not produce decisive radiation dosimetry results.

Exercise prescription guidelines for normal and cardiac populations

The basic components of aerobic exercise prescription include recommendations for optimal frequency, intensity, duration, mode, and progression of activity. The most effective program design involves the use of each of these components and incorporates specific coexistent medical problems and objective data derived from a multistage exercise tolerance test. In addition to the prescription of aerobic exercise, the use of circuit weight training and recreational activities has become accepted as an important part of a comprehensive exercise prescription. In effecting a well-designed and safe exercise program, the clinician must also be aware of environmental considerations and the effect of cardiac medications on the response to exercise.

Karyotyping and identification of human chromosome polymorphisms by single fluorochrome flow cytometry

Frequency distributions of fluorescence intensity of ethidium bromide stained human chromosomes from nine phenotypically normal males are cross correlated and autocorrelated following repeated flow cytometric measurements. It is shown that each individual donor produces a fluorescence profile which is both visually and numerically different from those of other individuals in the set. The wide variety of chromosome heteromorphisms which occur to varying degrees for chromosomes 1, 9, 13, 14, 15, 16, 21, 22 and Y give rise to the uniqueness of a given fluorescence profile. Estimates of chromosome heteromorphisms for each individual in the set were made and then compared with parallel results obtained from inspection of Q-banded and C-banded conventional metaphase preparations. Fluorescence profiles identifiable with each individual were also obtained for Hoechst 33258 stained chromosomes.

Detecting radiation damage to human chromosomes by flow cytometry

The flow karyotype profile of ethidium bromide-stained chromosomes from human peripheral blood lymphocytes has been analysed following exposure of lymphocytes to graded series of X-ray doses in vitro. Flow analysis offers the potential for rapid counting of chromosome abnormalities and it is shown that the level of background fluorescence, the distribution of fluorescence and the area of peaks associated with the larger chromosomes, are altered in a dose-related fashion following previous exposures of cultured lymphocytes to 50-400 rad. Moreover, parallel manual analysis of the incidence of chromosome aberrations in metaphase samples of the irradiated cells show a close correlation between flow karyotype profile distortion and aberration frequency. It is estimated that for any given irradiated blood sample doses above 100 rad could be detected with certainty.

An investigation of the construct validity of the Bannister-Fransella Grid Test of Schizophrenic Thought Disorder

An attempt was made to demonstrate the construct validity of the Grid Test in a psychiatric population by showing that: (a) judgements of thought disorder based on the Grid Test were associated with judgements based on a clinical interview; (b) Grid Test scores were not associated with measures of other forms of psychopathology, intelligence, or memory. Results of a principal components factor analysis confirmed both hypothesis, supporting the validity of the Grid Test as a measure of thought disorder.

Initiation and maintenance of persistent infection by respiratory syncytial virus

Propagation of cells infected with temperature-sensitive (ts) mutants of respiratory syncytial (RS) virus at nonpermissive temperature (39 degrees C) resulted in cytolytic, abortive, or persistent infection, depending on the mutant used to initiate infection. Five mutants from complementation group B produced cytolytic or abortive infections, whereas a single mutant (ts1) from group D and a noncomplbmenting mutant produced persistent infections. The persistently infected culture initiated by mutant ts1 (RS ts1/BS-C-1) has been maintained in serial culture for greater than 100 transfers, and infectious-center assays and immunofluorescent staining indicated that all cells harbored the RS virus genome. RS ts1/BS-C-1 cultures were resistant to superinfection by homologous and some heterologous viruses, and interferon-like activity against some heterologous viruses was present in the culture medium. Small amounts (0.002 to 0.2 PFU/cell) of infectious virus were present in the culture fluid, but autointerfering defective particles were not detected. This released virus formed small plaques and produced persistent infection of BS-C-1 cells at 37 degrees C. The RS ts1/BS-C-1 cells contained abundant RS virus antigen internally, but little at the surface, although the cells showed enhanced agglutinability by concanavalin A. Nucleocapsids and the 41,000-molecular-weight nucleoprotein were present in extracts of both nucleated and enucleated cells. No infectious RS virus was obtained by transfection of DNA from RS tsl/BS-C-1 cells to susceptible BS-C-1 or feline embryo cells under conditions allowing efficient transfection of a foamy virus proviral DNA. It was concluded that persistent infection was maintained in part by a non-ts variant of RS virus partially defective in maturation. The karyotype of the RS ts1/BS-C-1 culture differed from that of unifected cells.