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Biomedical subjects

P Fink

Publications and source records attributed to P Fink.

At least 19 recordsLinked to original sources

Psychiatric morbidity in primary public health care: a multicentre investigation. Part II. Hidden morbidity and choice of treatment.

A total of 1,281 patients were examined during consultation with their GP in a Nordic multicentre study focusing on the prevalence of psychiatric illness, hidden psychiatric morbidity, treatment and pathways to specialized care. The methodology and prevalence were reported in an accompanying paper. The present paper presents results concerning the variables hidden psychiatric morbidity, treatment and pathways to specialized care. The GPs detected 44% of the psychiatric cases compared with the result of a diagnostic interview (PSE). The distinction between psychosis and non-psychosis did not influence the GPs' ability to detect a mental illness. According to the GPs' assessment the majority of patients suffering from a mental disorder consulted their GP about physical complaints. The GPs treated the patients themselves, and only a limited number of cases were referred to psychiatrists or psychologists.

Adolescent

Health services research on mental health in primary care.

OBJECTIVE: The article seeks to provide an international perspective on the facilitating role of health services research in the treatment of psychiatric disorders in primary care. It builds on Goldberg and Huxley's model describing pathways to mental care for the psychiatrically ill in the community. METHOD: Seventy studies were selected for review by Medline search, sixteen studies by contacting prominent researchers in the field. All studies are discussed more or less extensively. RESULTS: Case identification strategies including screening tools and diagnostic modules have been developed. Other strategies include educational training programs and psychiatric consultation services designed to facilitate psychopharmacological and other types of treatment of psychiatric disorders in primary care. Several models for the linkage of primary care and specialty mental health providers are discussed, and a primary care psychiatry programme is examined. CONCLUSION: Better psychiatric training of general practitioners (GPs), on-site consultation, and better communication between mental health professionals and GPs can improve the recognition, management, and referral of psychiatrically ill primary care patients. The further development of guidelines focusing on anxiety disorders, somatization, subthreshold disorders, and effectiveness in primary care is recommended.

Forecasting

Sustained antidepressant effect of PEA replacement.

Phenylethylamine (PEA), an endogenous neuroamine, increases attention and activity in animals and has been shown to relieve depression in 60% of depressed patients. It has been proposed that PEA deficit may be the cause of a common form of depressive illness. Fourteen patients with major depressive episodes that responded to PEA treatment (10-60 mg orally per day, with 10 mg/day selegiline to prevent rapid PEA destruction) were reexamined 20 to 50 weeks later. The antidepressant response had been maintained in 12 patients. Effective dosage did not change with time. There were no apparent side effects. PEA produces sustained relief of depression in a significant number of patients, including some unresponsive to the standard treatments. PEA improves mood as rapidly as amphetamine but does not produce tolerance.

Adult

A cDNA encoding the human type I hair keratin hHal.

A full-length cDNA of a human type I hair keratin was isolated that encodes a protein of 416 amino acids. Northern blot analysis shows that the mRNA is present in human scalp but not in hairless skin. Based on sequence homology comparisons with the four known mouse type I hair keratins mHal-4 the keratin could be identified as the human hair keratin hHal.

Amino Acid Sequence

Psychiatric morbidity in primary public health care: a Nordic multicentre investigation. Part I: method and prevalence of psychiatric morbidity.

The prevalence of mental illness in five different Scandinavian primary care populations was investigated in this study. Patients consecutively consulting their general practitioner a particular week-day were included in the study. Initially the SCL-25 was applied and next the high scores and a sample of the low scores were interviewed by the PSE. In the analysis the screening procedure was first validated. The internal validity of the SCL was tested by means of Rasch latent structure analysis and the external validity tested by ROC/QROC analysis. Based on this, a short 8-item version of the SCL was developed. The prevalence of mental illness in all centres was 0.26 with a minimum of 0.14 in Nacka and a maximum of 0.34 in Turku.

Adolescent

Psychiatric illness in patients with persistent somatisation.

BACKGROUND: This study explores the incidence and nature of mental illness among persistent somatisers, and analyses their use of mental health services. METHOD: Individuals with at least ten admissions to non-psychiatric departments during an 8-year period were studied. Persistent somatisers (n = 56) were compared with other frequent users (n = 57) of non-psychiatric services. RESULTS: Of the persistent somatisers, 82% had been examined by a psychiatrist at least once (median, 3 times). Sixteen per cent were mentally retarded, 48% were dependent on alcohol or drugs, and 48% had DSM-III-R personality disorder. The most prevalent ICD-10 diagnoses were anxiety states (54%), depressions (30%), phobias (18%) and psychoses (20%). CONCLUSIONS: Persistent somatisation is associated with severe mental illness and a broad spectrum of heterogeneous psychiatric diagnoses and syndromes. Persistent somatisers impose a serious burden on the mental health care system.

Adolescent

Retinoic acid-induced normal and tumor-associated aberrant expression of the murine keratin K13 gene does not involve a promotor sequence with striking homology to a natural retinoic acid responsive element.

The type I keratin K13, normally restricted to suprabasal cells of internal stratified epithelia, is aberrantly expressed in 7,12-dimethylbenz[a]anthracene (DMBA)-12-O-tetradecanoyl-phorbol-13-acetate-induced murine epidermal tumors and constitutes an early marker of malignant progression. Aberrant K13 expression also occurs in epidermal cell lines derived from DMBA-TPA-induced tumors. As in cultured primary keratinocytes from normal internal stratified epithelia, the in vitro expression of K13 in transformed epidermal cell lines can be induced either by Ca2+ or by retinoic acid (RA). We have found that the promoter of the K13 gene contains a sequence element GGTTCA(N)5TGTTCT, in the following referred to as K13-RARE, that is highly related to the natural retinoic acid responsive element (RARE) of the retinoic acid receptor beta 2 gene. Both elements differ only in the second half-motifs, in which the first and sixth position is occupied by thymidines (K13-RARE) instead of adenines (beta 2-RARE), as well as in their pentameric spacer sequences. Despite this striking homology in the receptor binding domains, we show by transfection of reporter gene constructs of the elements into primary fore-stomach keratinocytes and transformed epidermal cell lines that in both cell systems, unlike beta 2-RARE, the wild-type K13-RARE completely lacks transactivating properties in the presence of RA. A recent hypothesis proposes that aberrant gene expression during tumorigenesis may occur through conversion of inactive response elements with high homology to hormone response elements into functional enhancers by carcinogen-induced point mutations at critical positions (Nawaz et al., Mol. Carcinogen., 7, 76-82, 1993). To investigate whether the aberrantly expressed K13 gene falls into the category of those genes, reporter gene constructs of K13-RARE variants in which either the initial or the terminal thymidine of the second half-motif was replaced by adenine were transfected into epidermal cell lines. Neither mutant exhibited RA-dependent transactivating properties. Strong transactivation could only be achieved by a K13-RARE mutant in which both critical thymidines were substituted by adenines. This type of closely spaced base exchange, unlikely to be created during DMBA initiation of mouse epidermis, was not detectable on sequencing genomic DNA of a squamous cell carcinoma and a transformed epidermal cell line. Instead, in both cases, only the wild-type K13-RARE could be demonstrated. A regulatory role of this RARE-like sequence in the promoter of the murine K13 gene for both normal and aberrant expression of the gene can therefore be excluded.

9,10-Dimethyl-1,2-benzanthracene

Somatization in patients newly admitted to a neurological department.

The incidence of somatization and sociodemographic, clinical and mental factors in 100 consecutive patients newly admitted to a neurological department was investigated. Forty percent of the neurological inpatients were somatizers; they reported higher levels of distress and hypochondriacal concerns and were more often considered as having significant mental disorders by the neurologists. The somatizers were similar to patients with organic symptoms with respect to sociodemographic factors, duration of and number of symptoms, mode of admission and earlier consultations of and number of symptoms, mode of admission and earlier consultations of psychiatric or other specialists. Most of the patients with somatization only believed that psychological factors influenced their somatic symptoms. No sex differences were found except that female somatizers had shorter duration of admission.

Adult

Admission patterns of persistent somatization patients.

Persistent somatization patients put a serious burden on the health care system with multiple admissions, tests, surgeries, and medications. This study reports on factors relevant to the health-seeking behavior of somatizing patients and aspects of the health care system that facilitate their overutilization of health resources. Individuals (age 17-49 years) from the general population of two Danish municipalities with at least 10 general admissions during an 8-year period were studied comparing persistent somatizers with other high utilizers of medical admissions. Results are reported on geographical mobility, change in family doctors, route and distribution of admissions by time of day or week, discharges against medical advice, physical disease overlooked, and distribution of admissions to specialties. Although the health-seeking behavior of persistent somatizers may in part explain their overutilization of health care resources, such overutilization could be reduced and much suffering avoided if physicians displayed the same enthusiasm in diagnosing somatization as in ruling out organic pathology.

Adolescent

A study of hospital admissions over time, using longitudinal latent structure analysis.

The aim was to study patterns of utilization of non-psychiatric admissions over time and factors affecting the utilization. The study cohort includes all individuals born 1934-66, living in one of two Danish municipalities and admitted to a non-psychiatric department at least once in 1977 (n = 2,686). The hospitalizations of the cohort were followed during a 5-year period by means of the Danish National Patient Register. The data were analysed using a longitudinal latent class (LC) model and a longitudinal latent Markov (LM) model. The LC model suggests that among the cases in the cohort there were 4 variants of utilization patterns. The LM model adequately described the sample in only 3 variants or classes. These classes may be interpreted as a small group of "chronically ill" individuals (1.9% of the cohort), a major group of "healthy" individuals, with no, or only a single, random re-admission during the follow-up period (74.4% of the sample), and finally an intermediate group of "high utilizers" (23.7% of the sample). This "chronicity" variable was markedly associated with mental illness, multiple discharge diagnoses from non-psychiatric departments and total utilization of hospitalizations during the follow-up period. Conversely, gender, age and days in hospital per admission were without importance. The study implies that the analysis of patterns of hospital admissions over time can yield important insight into health service utilization and that longitudinal latent structure analyses are powerful statistical tools in this aspect.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult

Surgery and medical treatment in persistent somatizing patients.

This study describes the utilization of surgical operations, frequency and outcome of medical and surgical treatment in a group of persistent somatizers compared with a control group of non-somatizers. The study was carried out using the Danish national medical register to identify persons in the general population (age range 17-49 yr) with at least 10 general admissions during an 8-yr period. Persistent somatizers were defined as persons with more than six medically unexplained general hospital admissions in their lifetimes before 1985. Conversely, non-somatizers were patients whose admissions could mainly be ascribed to well-defined somatic disorders. The findings show that persistent somatizers had been exposed to extensive surgery, outnumbering the non-somatizers. Surgical operations were of several categories, with gastrointestinal and gynaecological operations being the most frequent. The physicians used medical and surgical treatment nearly as often for treating persistent somatizers as in the treatment of the non-somatizers. Surgical or medical treatment was used in nearly half of the medically unexplained admissions. The outcome of the surgical treatment of the persistent somatizers was, however, generally unsuccessful in that the effect was unsatisfactory in three quarters of cases. Similarly, two thirds of the medical treatments were judged to be unsuccessful in persistent somatizers. The findings suggest that the costs of somatic diagnostic procedures and fruitless surgical and medical treatment attempts on persistent somatizers are enormous, and only exceeded by the risk of iatrogenic harm. This emphasizes the need for an early diagnosis of somatization and of treating it properly.

Adolescent

Physical complaints and symptoms of somatizing patients.

The purpose of the study was to describe the physical complaints and symptoms of persistent somatization patients. Individuals in the general population (age 17-49 yr) with at least 10 general admissions during an 8-yr period were studied. Persistent somatizers (i.e. patients with more than six medically unexplained general admissions) were compared with patients whose admissions could be ascribed to well-defined somatic disorders. Somatizers were characterized by multiple symptoms from many organ systems, and their physical complaints simulated most types of somatic disorder. Although some symptoms were more common than others, none were infrequent, so neither 'classic' conversion symptoms nor pain symptoms were found to be especially characteristic of the persistent somatizer. Gender had no influence on number of registered symptoms, whereas the number increases with age. The finding question the use of a predefined symptom checklist in the diagnostic criteria for somatizing disorder. The major part of the somatizers present a different illness picture when admitted with medically unexplained disorders compared with admission for which no adequate medical explanation could be found. However, one fifth had, when admitted with a medically explained diagnosis, also been admitted with the diagnosis medically unexplained at another admission. One fifth of the persistent somatizers had been admitted at least once for factitious illness, but apart from the fact that they had more symptoms and admissions, they did not differ from the other persistent somatizers.

Adolescent

The use of hospitalizations by persistent somatizing patients.

Medical records were selected from the Danish National Patient Register in order to study individuals between the ages of 17 and 49 years in the general population who, during an 8-year period, were admitted at least 10 times to a general hospital (N = 282). Fifty-six subjects (19%) were found to be persistent somatizers, i.e. they were admitted repeatedly to general hospitals for physical symptoms without an organic basis. This corresponded to a frequency of persistent somatization in the population 0.6 per 1000 men and 3.2 per 1000 women. Seventy-five per cent of the subjects were under 25 years old at the onset of their disorder, and all were under 35. Their illnesses were long-lasting, with one-third having a hospital 'career' of more than 20 years. They had a lifetime median of 22 medical admissions, and had utilized 3% of the general population's admissions to non-psychiatric departments. This investigation shows that persistent somatization is not a rare phenomenon, and that taking the heavy utilization of health-care resources into account it constitutes a considerable problem for the health-care system. The long hospital career and the relatively early start of somatization in some subjects emphasize the importance of an early identification of the condition, and of efforts to try to prevent its persistence.

Adolescent

Invariant chain distinguishes between the exogenous and endogenous antigen presentation pathways.

Class I MHC molecules acquire peptides from endogenously synthesized proteins, whereas class II antigens present peptides derived from extracellular compartment molecules. This dichotomy is due to the fact that the invariant chain associates with class II molecules in the endoplasmic reticulum, preventing binding of endogenous peptides. The mutually exclusive binding of peptide and invariant chain to class II molecules suggests that the invariant chain might play a part in autoimmune disease.

Amino Acid Sequence

Adult expression of the Drosophila Lsp-2 gene.

Previous work has demonstrated expression of the larval serum protein-2 gene, Lsp-2, uniquely during the late larval and pupal stages of development in Drosophila melanogaster. Here we report that the LSP-2 polypeptide accumulates in the hemolymph throughout adult life as well. Western blot analysis using an LSP-2 antiserum reveals notable differences in the molecular weight of the larval and adult polypeptides. Lsp-2 transcription results in a unique mRNA of 2.3 kb, exhibiting the same 5' end in both larvae and adults. However, adult Lsp-2 mRNa is only expressed at 1% of the high level detectable in late third-instar larvae. Whereas Lsp-2 mRNA accumulates uniformly in all fat body cells of third-instar larvae, over 80% of the adult Lsp-2 transcript is expressed in the adipose tissue of the head. These results suggest a differential regulation for expression of the Drosophila Lsp-2 gene in adults and larvae.

Animals

Physical disorders associated with mental illness. A register investigation.

On the basis of nationwide patient register data the diagnostic pattern of the medical admissions of a general population (17-49 year-olds; N = 30427) during an 8-year period was studied by comparing those individuals who had been admitted to the psychiatric department (i.e. psychiatric patients) with those individuals who had not. The results suggest that the high utilization of medical admissions by psychiatric patients could not be explained simply by coincident chronic physical illness or particular types of physical disease including the somatic complications of mental disorders. It is more likely to be attributable to other factors such as an increased general susceptibility to physical illness, different forms of illness behaviour, and the process of somatization.

Adolescent

Mental illness and admission to general hospitals: a register investigation.

Admissions to psychiatric departments and general hospitals in an 8-year period were studied for the 17- to 49-year-old population in 2 Danish municipalities. Information was extracted from the National Patient Register and the Danish Psychiatric Register, registers containing information on all admissions to nonpsychiatric and psychiatric departments, respectively, in Denmark. Fourteen percent of the patients who had been admitted at least once to a general hospital (or 7.5% of the background population) had an indication of a mental disorder. They comprised one fourth of all general admissions of the population during the 8-year period. Patients who had been admitted to a general hospital had a 4 times greater risk of having been admitted to a psychiatric department than the rest of the population and the risk increased markedly with number of general admissions. A pronounced association was found between the number of admissions to general hospitals and psychiatric departments; i.e., both types of admissions clustered in some individuals. The excessive general admissions of psychiatric patients were found to be correlated to all types of psychiatric diagnoses, but was less prominent in nonorganic psychoses. The implication is that there is a very close association between somatic and psychiatric morbidity and that the mentally disturbed use a great part of the nonpsychiatric health services.

Adolescent