Anxiety disorders: a conceptual history.
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Biomedical subjects
Publications and source records attributed to G Berrios.
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The agar dilution method was used to test the activity of ampicillin, benzylpenicillin, cefoxitin, imipenem, clindamycin, metronidazole, chloramphenicol, gentamicin, methicillin and vancomycin against 241 anaerobic and 227 aerobic bacteria isolated from 136 patients with intraabdominal infections and 49 with nonintraabdominal infections. Beta-lactamase production was tested in all strains. Overall, imipenem, metronidazole and chloramphenicol were the most active antimicrobial agents against anaerobic bacteria followed by clindamycin. Only the Bacteroides fragilis group was shown to be less susceptible to clindamycin (MIC90 8 mg/l). Ampicillin and cefoxitin were the least active beta-lactam antibiotics against the most common isolated B. fragilis group strains (MIC(90) >1024 and 64 mg/l, respectively) and against Escherichia coli strains (MIC(90) >1024 and >1024 mg/l, respectively). Chloramphenicol showed low activity against the Gram-negative aerobic bacteria, while gentamicin had good activity against the aerobic bacteria tested, except for E. coli and Pseudomonas. Among the Gram-positive aerobic and anaerobic bacteria tested, Staphylococcus aureus was shown to be less susceptible to beta-lactam antibiotics (29% were methicillin resistant). No vancomycin-resistant S. aureus strains were found. A good correlation between beta-lactamase production and beta-lactam resistance was observed.
The agar dilution method was used to test the activity of ampicillin, benzylpenicillin, cefoxitin, imipenem, clindamycin, metronidazole, chloramphenicol, gentamicin, methicillin and vancomycin against 241 anaerobic and 227 aerobic bacteria isolated from 136 patients with intraabdominal infections and 49 with nonintraabdominal infections. Beta-lactamase production was tested in all strains. Overall, imipenem, metronidazole and chloramphenicol were the most active antimicrobial agents against anaerobic bacteria followed by clindamycin. Only the Bacteroides fragilis group was shown to be less susceptible to clindamycin (MIC90 8 mg/l). Ampicillin and cefoxitin were the least active beta-lactam antibiotics against the most common isolated B. fragilis group strains (MIC(90) >1024 and 64 mg/l, respectively) and against Escherichia coli strains (MIC(90) >1024 and >1024 mg/l, respectively). Chloramphenicol showed low activity against the Gram-negative aerobic bacteria, while gentamicin had good activity against the aerobic bacteria tested, except for E. coli and Pseudomonas. Among the Gram-positive aerobic and anaerobic bacteria tested, Staphylococcus aureus was shown to be less susceptible to beta-lactam antibiotics (29% were methicillin resistant). No vancomycin-resistant S. aureus strains were found. A good correlation between beta-lactamase production and beta-lactam resistance was observed.
Psychiatric classificatory systems consider obsessions and compulsions as forms of anxiety disorder. However, the neurology of diseases associated with obsessive-compulsive symptoms suggests the involvement of fronto-striatal regions likely to be involved in the mediation of the emotion of disgust, suggesting that dysfunctions of disgust should be considered alongside anxiety in the pathogenesis of obsessive-compulsive behaviours. We therefore tested recognition of facial expressions of basic emotions (including disgust) by groups of participants with obsessive-compulsive disorder (OCD) and with Gilles de la Tourette's syndrome (GTS) with an without co-present obsessive-compulsive behaviours (GTS with OCB; GTS without OCB). A group of people suffering from panic disorder and generalized anxiety were also included in the study. Both groups with obsessive-compulsive symptoms (OCD; GTS with OCB) showed impaired recognition of facial expressions of disgust. Such problems were not evident in participants with panic disorder and generalized anxiety, or for participants with GTS without obsessions or compulsions, indicating that the deficit is closely related to the presence of obsessive-compulsive symptoms. Participants with OCD were able to assign words to emotion categories without difficulty, showing that their problem with disgust is linked to a failure to recognize this emotion in others and not a comprehension or response criterion effect. Impaired recognition of disgust is consistent with the neurology of OCD and with the idea that abnormal experience of disgust may be involved in the genesis of obsessions and compulsions.
OBJECTIVE: To evaluate the usefulness of standardized neuropsychological tests in the psychometric differentiation of patients with very mild or mild Alzheimer's Disease (AD) and/or major depression presenting in a tertiary clinic with memory/attention complaints. DESIGN: Controlled prospective clinicoexperimental design. SETTING: Multidisciplinary Memory Clinic at Addenbroke's Hospital, Cambridge, England. PARTICIPANTS: Twenty-four patients with a clinical diagnosis of Alzheimer's disease (12 with major depression and 12 without), 12 patients with major depressive illness but without AD, and 12 healthy control subjects, all matched for age, sex, education levels, and estimates of premorbid intellectual potential. MEASUREMENTS: Mini-Mental State Examination (MMSE), Wechsler's Logical Memory (WLM) and Visual Reproduction (WVR), immediate and delayed reproduction, Wechsler's paired Associate Learning (WPAL), including the Easy and Hard subsets. Warrington's Recognition Memory for Faces (WRMF), Kendrick's Object Learning (KOLT) and Digit Copying (KDCT) Tests. OUTCOME MEASURES: Minimum 2-year follow-up diagnosis. RESULTS: Statistically, patients with very mild AD were distinguished clearly from those without AD on most tests of memory functions. Psychometrically, only KOLT and an index of retention on WLM and WVR were specific enough to avoid false positives, a requirement for second-stage tools. They also proved sensitive enough to suggest their role as first-stage instruments when screening for primary dementia in high-functioning patients scoring above the cut-point on MMSE. CONCLUSIONS: As efforts intensify to develop more powerful means to identify patients with Alzheimer's disease in its earliest stages, inclusion of specialist tests posing greater cognitive challenge than standard mental status scales has been one strategy. Our study explored how some of these neuropsychological tools behave psychometrically when analyzed on a single-case basis, and the results suggest a few are sensitive enough to boost detection above base rates alone while also being specific enough to reduce false alarms. Retention on Wechsler's Logical Memory and Visual Reproduction tasks and scores on Kendrick's Object Learning Test helped decrease the degree of ambiguity when cognitive profiles were used to distinguish depressed patients with Alzheimer disease from those without.
We evaluated the anti Vi test to detect S typhi carriers in 1006 food handlers of 65 locations in central Santiago (Chile): 710 males and 296 females, age range 17 to 67. Positive reactions were found in 27 subjects, titers varying from 1/40 in 9 to 1/160 in 1 subject. Culture of feces, along with urine and bile cultures in those with very high titers allowed isolation of S typhi in 2 subjects, one with a 1/40 titer, the other 1/160. None had clinical history of typhoid fever, both had received parenteral vaccination. These results compare favorably with the classic technique which would have required 3018 fecal cultures (vs 108 in the present study) and a total cost of US$ 1730 vs US$ 364. In addition, anti-Vi detection is readily accepted by the subjects. Therefore, we recommend this technique as a screening prior to culture techniques in the identification of chronic S typhi carriers.
We previously described the Dahl salt-sensitive rat as a potential model of cataractogenesis in which cataract formation is associated with hypertension. Cataractous lesions were characterized by a marked lenticular and aqueous humor electrolyte imbalance. In the present study the effects of chronic dietary sodium restriction on cataract formation were evaluated in salt-sensitive rats to determine whether or not modification of the hypertensive process might reduce the incidence of cataracts in this genetic model. In addition, the possibility that early cataractous lesions in adult hypertensive salt-sensitive rats might be reversed by acute sodium restriction was evaluated. Chronic dietary sodium restriction modified the development of hypertension and prevented cataract formation in salt-sensitive rats. Furthermore, acute dietary sodium restriction (1 week) completely and consistently reversed early cataractous lesions (pinpoint opacities) in adult hypertensive salt-sensitive rats. Both the prevention and reversal of cataracts were associated with normalization of the lenticular and aqueous humor parameters measured. These data suggest that cataractogenesis is not the consequence of sustained arterial hypertension, but rather that initiation of both hypertension and cataract formation in this genetic model may be the result of extracellular fluid volume state.
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INTRODUCTION: The Cambridge Depersonalisation Scale (CDS) is a self-rating questionnaire constructed to capture the frequency and duration of depersonalization symptoms over the last six months. The instrument has proved to be valid and reliable and can be useful in both clinical and neurobiological research. METHODS: This paper presents the Spanish adaptation and validation of the CDS. The study was carried out in two stages. First, we developed the Spanish version of the CDS by means of a cross-cultural adaptation methodology. Second, the CDS was tried on a sample of 130 subjects: 77 patients meeting DSM-IV-TR criteria for schizophrenia, 35 with depression disorders and 18 with anxiety disorders. Scores were compared against clinical diagnoses (gold standard). Furthermore, all the subjects of the study were administered the following: Dissociation Experiences Scale (DES), Positive and Negative Syndrome Scale (PANSS), Beck's Depression Inventory (BDI), and the Hamilton Anxiety Rating Scale (HARS). RESULTS: 38 patients (29.2 %) had depersonalization symptoms. The scale showed high internal consistency (Cronbach's alpha > 0.9 and split-half reliability > 0.8) and a test-retest reliability of 0.391. Convergent validity was 0.65 (p < 0.001) and discriminant validity was 0.308 (p < 0.05). The area under the ROC curve was 0.94. A cut-off of 71 appears to be most useful (sensitivity and specificity were 76.3 % and 89.1 %, respectively). CONCLUSION: The Spanish version of the CDS has good reliability and validity, similar to the original instrument.
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