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Biomedical subjects

D B Clark

Publications and source records attributed to D B Clark.

At least 19 recordsLinked to original sources
PubMed1992

Dental care for the psychiatric patient: chronic schizophrenia.

In recent years, there has been a shift in philosophy concerning the overall delivery of mental health services. As a result, the treatment and management of patients with various psychiatric and behavioral disorders have undergone some fundamental changes. Improved diagnostic and treatment modalities have, in many instances, reduced the need for long-term institutionalization for a large number of these patients. Consequently, community-based mental health agencies (e.g., group homes, homes for special care patients, etc.) are now assuming an increasingly important role in the long-term management of these patients, providing, for example, more sophisticated mental health promotion programs and counselling services. A greater positive interaction now exists between these individuals and the surrounding community, thereby encouraging a more favorable integration within society as a whole. Due to this shift from primarily an institutional-based treatment regimen to a more community-oriented approach, the general dental practitioner can expect to see and be requested to treat an increasing number of these patients, many of whom present with significant dental pathology. The purpose of this paper will be to provide an overview of the oral health findings and management protocols for those individuals suffering from one specific form of psychiatric illness--chronic schizophrenia. An attempt will be made to familiarize the practising dentist with the main psychopathological features of this disorder as well as the specific oral health care requirements and management protocols for these patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Dental Care for Persons with Disabilities↗
PubMed1991

How "blind" are double-blind studies?

Psychopharmacological studies usually attempt to eliminate "nonspecific" influences on outcome by double-blind designs. In a randomized, double-blind comparison of alprazolam, imipramine, and placebo, the great majority of panic disorder patients (N = 59) and their physicians were able to rate accurately whether active drug or placebo had been given. Moreover, physicians could distinguish between the two types of active drugs. Inasmuch as correct rating was possible halfway through treatment, concerns about the internal validity of the double-blind strategy arise.

Adult↗
PubMed1991

The assessment and treatment of performance anxiety in musicians.

OBJECTIVE: Performance anxiety in musicians may be severe enough to require intervention but has been the subject of relatively little clinical research. The authors' objectives were to describe the results of a comprehensive clinical and laboratory assessment and to perform a double-blind, placebo-controlled study comparing buspirone, cognitive-behavior therapy, and the combination of these treatments for performance anxiety. METHOD: Ninety-four subjects were recruited by mass media announcements and were seen in a university-based outpatient psychiatric clinic. Assessments were 1) questionnaires for all 94 subjects, 2) diagnostic interview of 50 subjects, and 3) laboratory performance of 34 subjects. Treatment conditions were 1) 6 weeks of buspirone, 2) 6 weeks of placebo, 3) a five-session, group cognitive-behavior therapy program with buspirone, or 4) the cognitive-behavior therapy program with placebo. Treatment outcome measures included subjective anxiety ratings and heart rate measures during a laboratory performance, a questionnaire measure of performance confidence, and a blind rating of musical performance quality. RESULTS: All subjects fulfilled criteria for DSM-III-R social phobia. Of the 15 full-time professional musicians, ten had tried propranolol and three had stopped performing. Most of the subjects had substantial anxiety and heart rate increases during laboratory speech and musical performances. Cognitive-behavior therapy resulted in statistically significant reductions in subjective anxiety, improved quality of musical performance, and improved performance confidence. Buspirone was not an effective treatment. CONCLUSIONS: Cognitive-behavior therapy is a viable treatment approach for performance anxiety in musicians.

Adult↗
PubMed1990

Effect of feed flow-rate, antigen concentration and antibody density on immunoaffinity purification of coagulation factor IX.

A simple physical model of immunoaffinity chromatography (IAC) demonstrates that immobilized monoclonal antibody (MAb) capacity in IAC purification will be a function of many parameters, including feed flow-rate and antigen concentration, and MAb density (mg MAb immobilized/ml resin). We studied IAC of factor IX, and examined the effect of parameter variation on MAb capacity. MAb capacity (1) was not affected by feed flow-rate or antigen concentration, and (2) decreased as MAb density increased. (1) Suggested that diffusion of factor IX into the resin bead was not limiting. Characteristic diffusion, convection and reaction times were calculated and used in dimensional analysis to compare their relative magnitudes. If MAb was assumed to be localized to the outer 10% of the bead volume, this analysis concluded that diffusion was not limiting, consistent with the suggestions of our experimental data. (2) Suggests that high MAb densities make MAb less accessible.

Antibodies, Monoclonal↗
PubMed1990

Oral inverted ductal papilloma.

A case of oral inverted ductal papilloma that appeared on the lower lip of a 44-year-old man is described. A literature review and discussion of the histopathologic features and histogenesis of this uncommon lesion of minor salivary gland origin are also presented.

Adult↗
PubMed1990

Motor activity and tonic heart rate in panic disorder.

Motor activity and tonic heart rate were monitored in 62 drug-free panic disorder patients and 40 normal control subjects. Mean daily activity, mean waking heart rate controlled for activity, and mean sleeping heart rate were determined. Panic disorder patients without phobic avoidance showed higher activity than control subjects or patients with limited or extensive avoidance. Similarly, an "inverted U", relationship between trait anxiety and activity was observed. On the other hand, neither mean waking nor sleeping heart rate showed significant differences between patients and controls, suggesting that the differences previously reported in laboratory studies result from anticipatory anxiety.

Adult↗
PubMed1990

I-123 hydroxyiodobenzyl propanediamine (HIPDM) cerebral blood flow imaging demonstrating transtentorial diaschisis.

To assess the clinical significance of transtentorial diaschisis (TTD) as demonstrated by I-123 HIPDM brain imaging, SPECT and/or planar images of 35 patients with stroke, 26 patients with Alzheimer's disease (AD), 2 patients with Creutzfeldt-Jakob disease (CJD), and 1 patient with a schizoaffective disorder were analyzed. TTD was observed in 21 of the 35 patients with strokes. In 13 stroke patients, TTD was associated with large infarcts in the middle cerebral artery (MCA) territory; in the remaining 8 stroke patients, TTD was associated with internal capsule and/or basal ganglia infarcts. TTD was not associated with small occipital or parietal infarcts. Despite cortical perfusion decrements, TTD was not seen in the AD patients, the CJD patients, or the patient with schizoaffective disorder. It is concluded that 1) TTD frequently occurs following cerebral infarct of the MCA territory (60% of the patients in this sample); 2) absence of TTD in the presence of a large cerebral perfusion abnormality may represent neuronal dysfunction of the cerebral cortex; and 3) the presence of TTD without a significant cortical perfusion abnormality may indicate basal ganglia and/or internal capsule infarct.

Alzheimer Disease↗
PubMed1990

Development of an immunoaffinity process for factor IX purification.

An immunoaffinity process based on monoclonal antibody (MAb) to factor IX (FIX) has been developed. Initially, vitamin-K-dependent proteins from cryoprecipitate-poor plasma are isolated on DEAE-Sephadex. The eluate is applied to an immunoaffinity column that utilizes a divalent metal-ion-dependent MAb directed against FIX. After washing the column with high salt in the presence of magnesium ion, the FIX is eluted using a citrate- or EDTA-containing buffer. Coagulation assays and Western blots show no detectable amounts of any contaminating proteins. Purity of the FIX product is established using reduced and nonreduced Coomassie-stained SDS-PAGE and HPLC. The N-terminal 20 amino acids of the single peak of the HPLC were shown to be identical to those reported for FIX. The process shows no detectable leakage of monoclonal antibodies (MAb), efficient utilization of MAb, and provides yields greater than 95%. The use of solvent/detergent treatment as a potential viral inactivation methods is incorporated in the process. Studies with tritiated Triton X-100 indicate that the detergent can be washed out of the MAb column so that less than 1 ppm (total) Triton X-100 coelutes with the FIX.

Amino Acid Sequence↗
PubMed1990

Surreptitious drug use by patients in a panic disorder study.

In a double-blind, placebo-controlled trial comparing alprazolam and imipramine for panic disorder, serum analysis revealed that a substantial proportion of the patients took explicitly prohibited anxiolytic medication. Excluding these patients changed the results.

Adult↗
PubMed1989

A semi-continuous method for purification of factor IX complex from human plasma.

We report the development of a semi-continuous method for preparation of factor IX complex from human plasma using ion exchange resins. Traditionally, stirred batch adsorption has been used due to the high pressure drops and low flow rates associated with soft gels in packed columns. Batch methods, however, typically involve higher labor costs and are more cumbersome in process environments. In the semi-continuous process, cryo-supernatant plasma is pumped through a 'stirred column' containing the resin. At both lab and pilot scale, higher recoveries of factor IX (FIX) were obtained at decreased total process times, compared to batch adsorption. A residence time of 15 min was found to be sufficient for capture of 95% of the FIX in the starting plasma. In the pilot plant, 550 liters of plasma was passed through a 50-liter column containing 8.5 liters of resin, yielding a 68% recovery of FIX. The results suggest that the recovery of FIX depends on the mode of contact (batch, continuous or packed column) between plasma and resin.

Blood Coagulation Factors↗
PubMed1988

Tonic arousal and activity: relationships to personality and personality disorder traits in panic patients.

Personality theorists have long predicted a relationship between personality traits and autonomic activation. In this study, 48 patients with panic disorder underwent personality assessment by questionnaire (Eysenck Personality Inventory: 48 patients) and by interview (Personality Disorders Examination: 35 patients). Ambulatory heart rate and activity were measured by the Vitalog method and were used as measures of activation and autonomic arousal. There was a significant positive correlation between histrionic traits and activity level and a significant negative correlation between sociability and heart rate. The findings are consistent with previous studies showing a negative relationship between sensation-seeking personality traits and cerebrospinal fluid levels of norepinephrine and a positive relationship between extroversion and cerebrospinal fluid levels of dopamine.

Adult↗
PubMed1988

Dentin in chronic renal failure: an ultrastructural study.

Disturbances in the mineralization of hard tissues in patients suffering from chronic renal failure and in patients undergoing chronic hemodialysis are a well-established phenomenon. These disturbances are the result of complex pathophysiologic alterations in calcium and phosphorus metabolism. Disturbances in the dentin of teeth, analagous to those occurring in bone, were not recognized until 1983 when it was reported that a significantly thicker predentin layer was present in the teeth of patients with chronic renal failure and in patients being treated with chronic hemodialysis (1). The aim of the present study was to conduct a comparative ultrastructural (SEM) analysis of dentin in this group of patients. A wide spectrum of changes was detected, ranging from mild disturbances with increasing tubule irregularity and focal obliteration of tubule lumens, to widespread formation of dysplastic dentin exhibiting numerous mineralized, largely atubular globules with only occasional large, irregular tubules. In general, these changes appeared to reflect the type and effectiveness of treatment rendered (renal transplant or hemodialysis therapy). The findings suggest that dentin exhibits significant ultrastructural alterations when the underlying homeostatic regulation of calcium and phosphorus metabolism is disturbed in systemic disorders such as chronic renal failure.

Adolescent↗