Biomedical subjects
Publications and source records attributed to L M Nicholas.
Suicide is a major public health problem. Worldwide, approximately 1% of deaths are due to suicide. In the United States, suicide is the eighth leading cause of death. More than 30,000 Americans commit suicide each year, and nearly 500,000 others make a serious suicide attempt warranting emergency medical attention. Suicide attempts account for 23% of psychiatric visits to emergency rooms.
Children referred for growth hormone (GH) treatment have increased school achievement problems, lack appropriate social skills and show several forms of behavior problems. A multicenter study in the United States has revealed that many GH-impaired children exhibit a cluster of behavioral symptoms involving disorders of mood and attention. Anxiety, depression, somatic complaints and attention deficits have been identified. These symptoms decline in frequency over a period of 3 years, beginning shortly after GH replacement therapy is started. Many of the patients who have received GH and had good growth responses show lower than average quality of life in young adulthood after treatment is completed. GH-deficient adults placed on GH therapy report improvement in psychological well-being and health status, suggesting that GH might have a central neuroendocrine action. Among a group of adults who were GH deficient as children, we find a high incidence of social phobia, a psychiatric disorder linked to GH secretion and usually accompanied by poor life quality. An ongoing study of non-GH-deficient short individuals suggests that short stature is not the cause of this outcome. We conclude that the origins of psychiatric comorbidities, such as social phobia and depression, in GH deficient adults are likely to be neuroendocrine as well as psychosocial.
Chronic left ventricular-atrial regurgitation (LVAR) was created in 8 dogs by means of an external conduit so that the effects of acute correction of regurgitation on the mechanics of left ventricular performance could be studied in detail. LVAR of 46 to 77 per cent of the total left ventricular (LV) output was associated with a depression of the LV inotropic state (downward displacement of the stress-velocity relationship, reduction in V max), reduced forward flow, and signs of cardiac failure. Acute occlusion of the shunt (analogous to return of mitral valvular competence) in the anesthetized, open-chest animal resulted in a statistically significant increase in the integrated LV systolic wall stress (afterload), which averaged 18 per cent. In the dog with greatest depression of the LV inotropic state, the increase in afterload was associated with a decrease in forward flow. Occlusion of the shunt had no significant effect on the inotropic state. This model of mitral regurgitation appears to be useful in assessing the effect of chronic LVAR on cardiac performance and may explain the hemodynamic deterioration observed in some patients with severe mitral regurgitation following valve replacement.
This study was designed to determine if symptoms of delirium were mistaken for symptoms of depression in hospitalized patients referred for psychiatric consultation. Records were surveyed for all patients seen by a university hospital psychiatric consultation-liaison service for a 38-month period. Of 737 patients referred for depressive symptoms, 42 received a final diagnosis of delirium. Those patients with delirium tended to be older and were more likely to be male when compared with all patients referred for symptoms of depression. Given the grave prognostic implications of delayed or missed diagnosis, one needs to be aware that the presentation of delirium may be disguised as depression.
OBJECTIVE: We have reported high rates of social phobia in growth hormone-deficient (GHD) adults who had been treated with growth hormone during childhood. This follow-up study was conducted to determine whether the increased social phobia observed in GHD subjects was secondary to the effects of short stature. METHODS: Twenty-one age- and sex-matched non-GHD short adults were evaluated for social anxiety and compared with the previously studied 21 GHD subjects. RESULTS: Thirty-eight percent (8 of 21) of GHD and 10% (2 of 21) of short subjects met DSM-III-R criteria for social phobia. GHD subjected scored significantly higher than short subjects on the following self-report questionnaires: Fear of Negative Evaluation (p = .03), Fear Questionnaire (p = .01), Social Avoidance and Distress Scale (p = .01), Beck Depression Inventory (p = .007), and the Tridimensional Personality Questionnaire-harm avoidance subscale (p = .0004). CONCLUSIONS: These data suggest that the high prevalence of social phobia in GHD adults is not explained by short stature alone.