The potential use of artificial intelligence in the therapy of borderline personality disorder

This paper explores the possibility of AI-based addendum therapy for borderline personality disorder, its potential advantages and limitations. Identity disturbance in this condition is strongly connected to self-narratives, which manifest excessive incoherence, causal gaps, dysfunctional beliefs, and diminished self-attributions of agency. Different types of therapy aim at boosting self-knowledge through self-narratives in BPD. The suggestion of this paper is that human-to-human therapy could be complemented by AI assistance holding out the promise of making patients' self-narratives more coherent through improving the accuracy of their self-assessments, reflection on their emotions, and understanding their relationships with others. Theoretical and pragmatic arguments are presented in favour of this idea, and certain technical solutions are suggested to implement it.

Intrathecally injected Ile-Pro-Ile, an inhibitor of membrane ectoenzyme dipeptidyl peptidase IV, is antihyperalgesic in rats by switching the enzyme from hydrolase to synthase functional mode to generate endomorphin 2

We have found recently that membrane-bound dipeptidyl peptidase IV (DPP-IV) generated extracellularly immunoreactive endomorphin-2 from Tyr-Pro precursor in a depolarisation-sensitive manner in rat isolated L4,5 dorsal root ganglia when the enzyme was switched to synthase mode by the hydrolase inhibitor Ile-Pro-Ile. Presently, we induced hyperalgesia in rats by injecting carrageenan into the right hindpaw and measured the reduction in nociceptive threshold (hyperalgesia) to pressure (Randall-Selitto test). The hyperalgesia, peaking at 180 min after injection, was fully reversed by intrathecal administration of 30 nmol/rat Ile-Pro-Ile. The antihyperalgesic action was antagonized by s.c. naloxone (1 mg/kg) and intrathecally injected specific antiserum to endomorphin-2 indicating that the opioid receptor-mediated effect was produced by an endogenously generated endomorphin-2-like immunoreactive substance. Intrathecal Ile-Pro-Ile was ineffective as an analgesic in the acute nociceptive test such as the rat tail-flick, whereas endomorphin-2 (EC(50)=13.3 nmol/rat), endomorphin-1 (6.8 nmol/rat), morphine (0.11 nmol/rat) and DAMGO (0.0059 nmol/rat) exerted opioid receptor-mediated analgesia given by the same route. We concluded that carrageenan-induced C-fiber barrage (wind-up) may create ideal conditions for the de novo synthesis of endomorphin-2 in rat spinal cord dorsal horns if the DPP-IV enzyme is switched to the synthase functional mode by Ile-Pro-Ile.

Triacontanol-supported micropropagation of woody plants

 The effectiveness of triacontanol in the micropropagation of two woody, economically important fruit plant species was investigated. Triacontanol was added to the routine multiplication and rooting media of apple (Malus domestica cv. JTE-E4) and sour cherry (Cerasus fruticosa cv. Probocskai) rootstocks at concentrations of 2, 5, 10 and 20 μg/l. It was found to increase the number of shoots and the fresh weight of apple in the multiplication phase and to enhance root number and chlorophyll content in the rooting phase. The addition of indole-3-butyric acid (IBA) to the media further improved the effect of triacontanol. A less pronounced effect could be seen in the multiplication phase of sour cherry, although there was an enhancement of shoot proliferation. In the rooting phase, however, the application of triacontanol caused a significant increase in the number of roots per plant, and this effect was further improved when triacontanol was combined with 0.5 mg indole-3-butyric acid/l.

Relationship between intracranial pressure and cervical lymphatic pressure and flow rates in sheep

Previous reports from our group demonstrated that about one-half of the total volume of cerebrospinal fluid (CSF) removed from the cranial vault in sheep is transported into extracranial lymphatics, especially cervical lymphatic vessels in the neck. In this study, we tested the hypothesis that an elevation of intracranial pressure (ICP) would increase cervical lymphatic pressure and lymph flow rates in anesthetized sheep. Catheters were inserted into both lateral ventricles, the cisterna magna, cervical lymphatics, and the jugular vein. A ventriculo-cisternal perfusion system was employed to regulate ICP. Mean (P = 0.008), peak (P = 0.007), and baseline (P = 0.013) cervical lymphatic pressures increased as ICP was elevated from 10 to 70 cmH2O in 20-cmH2O increments. Similarly, cervical lymph flow rates increased (P < 0.001), with flows at 70 cmH2O ICP observed to be approximately fourfold higher than those at 10 cmH2O ICP. No changes were observed in mesenteric lymph flow rates (vessels not expected to drain CSF). We conclude that cervical lymphatic vessels play an important role in the transport of CSF from the cranial vault when ICP is elevated.

Role of the external nasal dilator in the management of nasal obstruction

The aim of this study is to evaluate the effect of an external nasal dilator in patients with nasal obstruction secondary to mucosal congestion (n = 33) or to septal deviation in the nasal valve area (n = 28). A group of subjects with healthy nasal cavities was tested also (n = 51). Acoustic rhinometric and rhinomanometric nasal measurements were performed with and without the dilator and before and after topical decongestion of the nasal mucosa. A visual analog scale was employed to evaluate the subjective sensation of nasal obstruction. Objective measurements showed that the external dilator increased the minimum cross-sectional area and decreased the nasal resistance significantly in all three groups (P < 0.01). The effect was more impressive in patients with septal deviation (P < 0.001). Subjective assessments reflected patency in all subjects except those in the mucosal swelling group (P = 0.06). From this study the authors conclude that the external nasal dilator offers an effective, nonsurgical therapeutic approach in the management of septal deviation that obstructs the nasal valve area. Although patients with nasal obstruction secondary to mucosal congestion showed objective improvement with the nasal dilator, these changes were not accompanied by a sensation of enhanced patency.

Air quality and the frequency of emergency room visits for asthma

BACKGROUND

Atmospheric pollution has been proposed as one of the possible factors responsible for increases in asthma mortality and morbidity.

OBJECTIVE

We sought to examine whether we could demonstrate a relationship between emergency room visits for asthma and alterations in environmental conditions.

METHODS

Over a 1-year period, the frequency of emergency room visits for asthma in a large urban hospital were documented and compared to outdoor concentrations of SO2, NO2, and ozone in addition to two overall measures of air quality (air pollution index and air quality index).

RESULTS

A total of 854 emergency room visits were noted with the highest number of visits occurring in May and between September and December. Significant variations in the frequency of visits as well as environmental conditions could be seen on a daily basis. Despite comparisons of results on a daily, weekly, and monthly basis, no significant relationships could be found between any of the pollution indices and emergency room visits. Staggering visits by 1 and 7 days, however, revealed a relationship between emergency room visits and air pollution index and air quality index. An association between emergency room visits and NO2 and ozone was seen when visits were staggered by 7 but not by 1 day.

CONCLUSIONS

We conclude the fluctuations in overall air quality are associated with increased frequency of emergency room visits but only when data are lagged by a predefined period.

Response to desipramine treatment in adolescent depression: a fixed-dose, placebo-controlled trial

OBJECTIVE

To determine the efficacy and tolerability of the tricyclic antidepressant desipramine (DMI) in the treatment of DSM-III-R-diagnosed major depressive disorder in adolescents.

METHOD

Sixty adolescents (42 female, 18 male; aged 15 to 19 years) diagnosed with major depressive disorder using clinical interview and Schedule for Affective Disorders and Schizophrenia for School-Age Children were randomized to receive either DMI (200 mg daily in divided doses) or placebo for six consecutive weeks following a 1-week placebo period. Treatment outcome was determined using the Hamilton Depression Rating Scale and the Beck Depression Inventory. Tolerability was determined using a symptom side effects scale. In addition, a variety of laboratory and cardiovascular monitoring was performed.

RESULTS

No significant differences in treatment outcome between DMI- and placebo-treated groups were determined. Neither DMI, nor its metabolite 2-hydroxy-DMI, nor their ratio, was positively correlated to treatment outcome. The DMI group endorsed more side effects but there were no significant between-group differences in any laboratory, electrocardiographic, or other cardiovascular parameters apart from heart rate, which was increased in the DMI-treated group (p = .03).

CONCLUSIONS

Given the findings of this study and our review of previously published reports of tricyclic antidepressant treatment in this population, the routine use of short-term (6 weeks) DMI in the treatment of adolescent depression is not supported by the data on hand. Further investigations into what constitutes optimal psychopharmacological treatment of adolescent depression are warranted.

REM latency in endogenously depressed adolescents

Twenty-three adolescents with DSM-III major depressive disorder (endogenous subtype) and 23 normal controls were studied polysomnographically (PSG). The depressed group showed significantly shortened REM latencies (P = 0.005) and longer sleep latencies (P = 0.04). No other PSG measures differentiated the two groups. The implications of these findings for adolescent depression are discussed.

Substance abuse among adolescents with chronic mental illnesses: a pilot study of descriptive and differentiating features

Twenty-six adolescents with a chronic mental illness (schizophrenia or schizoaffective disorder of at least 1.5 years' duration) were assessed for the presence or absence of comorbid substance abuse. The two groups were compared on a number of variables believed to identify or predict substance abuse. The substance abusing subgroup were significantly different in levels of social functioning, school achievement, premorbid substance abuse, having parents or siblings who abused substances, dysfunctional families, cigarette smoking, number of hospital admissions, and emergency room visits. These findings are discussed in the context of clinical issues regarding the management of adolescents with chronic mental illnesses.

Specificity of psychoanalytic hypotheses regarding the onset of adolescent psychoses: an empirical test of a psychodynamic model

The specificity of psychodynamic hypotheses regarding the onset of adolescent psychosis was assessed in a group of rigorously diagnosed psychotic (N = 75) and depressed (N = 53) adolescents. None of the four operationally defined psychodynamic hypotheses purported to be etiologically specific in the onset of adolescent psychotic illness: success and its opportunities; intimacy and its attempts; intent to act autonomously; or involved in insight-oriented psychotherapy was more commonly observed in the psychotic than the depressed group, thereby not supporting the hypotheses. The consequences of this finding are discussed.

Nocturnal cortisol, thyroid stimulating hormone, and growth hormone secretory profiles in depressed adolescents

Twelve depressed adolescents and 12 controls matched for age, sex, Tanner stage, time of menstrual cycle (females), weight, and time of year assessed were studied over 3 nights. Measurements for cortisol, thyroid stimulating hormone, and growth hormone were made on serum collected at 10 P.M., 12 midnight, 1 A.M., 2 A.M., 3 A.M., 4 A.M., and 6 A.M. in eight pairs and every 20 minutes from 8 P.M. to 7 A.M. in four pairs. Cortisol secretion did not significantly differentiate the groups. Thyroid stimulating hormone secretion was significantly elevated in the depressed group at one time point. Growth hormone secretion significantly differentiated the two groups at most time points, and the depressed adolescents significantly hypersecreted growth hormone (area under the curve). Implications for the diagnosis, etiology, and treatment of adolescent depression are discussed.

Inequalities in access to health care in Hungary

'Crisis' in health care systems has become a widely discussed issue in the last 10 years. The claim for change is argued from various points of view, and according to manifold interests throughout the industrialized world. However, the present tensions of the national health service system of Hungary can be looked upon only partially in the broader terms of some 'world-phenomenon'. There are a great number of similar features, there is the great importance of temporal co-incidence, but the roots seem totally different in several respects. The paper focuses on those structural processes (historical, as well, as current), that have lead to increasing tensions and a dysfunctional working of the system, that shape the social inequalities of access to it. The main form of deeper structural tensions is the widening gap between needs and the conditions to meet them. This paper analyzes the consequences of the double pressure put on the system at its start after the war. The rapid extension of legal entitlements for free medical care was not followed by a similar extension of available resources for developing the institutions and services of the health care system. The long-term priorities given to forced industrialization and, later, to other spheres of production led to a chronic situation of 'residual' handling of various spheres of communual consumption and to the infrastructure, including programmes of health care, the pressure of rapid extension of rights and permanent scarcity of the resources has lead to a chronic shortage, overuse and 'substitutional, temporary solutions'.(ABSTRACT TRUNCATED AT 250 WORDS)

Ultrasonic B-scan measurement of the extra-ocular muscles in Graves' orbitopathy

B-scan real time ultrasonography was performed on a series of controls and patients with thyroidal orbital disease. The thickness of the extraocular muscles was recorded. In the control group the upper value of the 97.5th confidence interval was 0.36 cm. In patients with Graves' orbitopathy the rectus muscle thickness was greater than controls in most. The data suggest that the degree of thickening correlates with the severity of the disease. Muscle thickening in Graves' disease tended to be bilateral and affect both the medial and lateral muscles in each eye.