Biomedical subjects
Publications and source records attributed to B Pepper.
Our first generation of young adult chronic psychiatric patients since deinstitutionalization has emerged in the community. Updated research results and case studies show different patterns of emergence but similar indications for clinician response.
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Murine malarial parasites have long been characterized by their requirement for either antibody-mediated immunity (AMI) or cell-mediated immunity (CMI) for suppression of acute parasitemia, with Plasmodium yoelii reportedly requiring AMI for suppression and P. chabaudi requiring CMI. To assess this characterization in terms of the current T(H1)/T(H2)-CMI/AMI hypothesis, we infected gene-targeted "knockout" mice lacking either a type-1 cytokine (IL-2 or IFN-gamma) or a type-2 cytokine (IL-4 or IL-10) with one or the other species of Plasmodium. We observed that type-1 cytokine-deficient mice developed exacerbated malaria with either P. yoelii or P. chabaudi, compared with that seen in heterozygote controls. Moreover, type-2 cytokine knockout mice showed a similar time course of infection with either parasite compared with that seen with their controls. We conclude that the mechanism of resolution of these well characterized malarial infections cannot be linked definitely to these T(H1)- and T(H2)-associated cytokines as predicted by the T(H1)/T(H2)-CMI/AMI hypothesis.
Dual diagnosis of severe mental illness and substance disorder is a frequent and difficult challenge to the mental health and substance abuse systems. This chapter reviews the dual diagnosis problem and introduces the chapters that follow.
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Motor vehicle emissions are a major source of CO, NOx and lead particulate concentrations to urban air quality. London urban Boroughs with high traffic densities are therefore a particular cause for concern. The air quality was monitored at an urban background site in the London Borough of Haringey for 2-years. The results of this study are assessed and their effect on human health is considered in the light of EC Directives and WHO guidelines. A desk top modelling technique based on Gaussian diffusion theory was used to predict the CO levels found at the background site. All predicted levels had a accuracy of better than 30%.
The ingestion and inhalation of heavy metals through soil, surface dust, air and food contamination may have a detrimental effect on human health. Metal levels have been measured in a Local Authority in London, UK and are discussed where possible in relation to health risk and relevant guidelines.
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Psychological evaluation included tests of brain-behavior functioning and academic level for 110 young adults (16 to 39 yr. of age), each a moderate to heavy user of mental health services. The composite patient manifested borderline, diffuse brain dysfunction with deficiencies in language, visuospatial, motor, concentration, and higher-order problem-solving skills, together with below normal performance on tests of intelligence, reading comprehension, arithmetic calculation, and spelling. Standard mental health services appear inadequate for habilitation or rehabilitation of many such people. The findings suggest that one reason for these patients' lack of response to conventional mental health treatments is that clinicians fail to identify patients' fundamental deficiencies and to incorporate this knowledge in planning treatments and evaluating progress. Suggestions for further studies are offered.
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Uninstitutionalized young adults with chronic mental disorders and social disabilities pose a new challenge in community psychiatry. These attention-seeking, help-rejecting young men and women spend most of their lives in the community and differ markedly from older deinstitutionalized chronic psychiatric patients. Many confound identification by their abuse of drugs and/or alcohol. Most deny their mental illness and make inappropriate use of mental health services available to them. Because of the different problems and aspirations of these patients compared to older chronic patients, treatment programs must be age segregated to address these differences. Young adult chronic patients are best helped via flexible, accessible, nonstigmatizing, team-oriented treatment programs. Some patients require long-term neuroleptic therapy at low maintenance doses. In addition to their role as the primary provider of psychiatric care to these patients, psychiatrists must act as advisors to families and community planners and as political activists to focus additional attention on community-based (rather than state hospital-oriented) programs.
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Unified services is a further development of the concept of a community mental health center, with the aim of providing coordinated, flexible, continuous, and nonduplicated services. Various states have attempted to translate the concept into systemic changes through legislation, usually making the approach optional. New York State, where five counties have adopted unified services, is used as the primary example; planning and coordinating for all services are in the hands of the counties. The authors discuss over-all benefits of unified systems, and territorial and fiscal problems in implementing them. States are at different stages of developing unified systems, ranging from maintenance of two separate systems of institutional and community programs to integration of planning and services but not funding. What is needed is a mechanism to integrate funding as well, a mechanism through which funds going to agencies will reflect the actual proportions of patients served.