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Biomedical subjects

R Spitzer

Publications and source records attributed to R Spitzer.

At least 37 records · Page 2Linked to original sources
PubMed1996

Gender, quality of life, and mental disorders in primary care: results from the PRIME-MD 1000 study.

BACKGROUND: Recently there has been increased interest in the special mental health needs of women. We used data from the PRIME-MD 1000 study to assess gender differences in the frequency of mental disorders in primary care settings, and to explore the potential impact of these differences on health-related quality of life (HRQL). SUBJECTS AND METHODS: One thousand primary care patients (559 women) were interviewed during the PRIME-MD study, which was conducted at four primary care clinics affiliated with university hospitals throughout the eastern United States. Patients completed a one-page questionnaire in the waiting room prior to being seen by the physician; patients and physicians then completed together a clinician evaluation guide that used DSM-III-R algorithms to diagnose mood, anxiety, somatoform, eating, and alcohol related disorders. Health-related quality of life was assessed with the Medical Outcomes Study SF-20 General Health Survey. RESULTS: Women were more likely than men to have at least one mental disorder (43% versus 33%, P < 0.05). Higher rates were particularly prominent for mood disorders (31% of women versus 19% of men, odds ratio [OR] = 1.9, 95% confidence interval [CI] 1.4 to 2.6), anxiety disorders (22% versus 13%, OR = 1.9, CI = 1.3 to 2.8), and somatoform disorders (18% versus 9%, OR = 2.2, CI = 1.5 to 3.4). Psychiatric comorbidity was also more common in women (26% of women had two or more mental disorders versus 15% of men, P < 0.05). Unadjusted HRQL scores, ranging from 0 to 100, with 100 = best health, were all significantly lower in women than in men (eg, physical function = 67 in women versus 76 in men, P < 0.0001; mental health = 69 in women versus 76 in men, P < 0.0001). Many HRQL differences persisted after controlling for age, education, ethnicity, marital status, and number of physical disorders; however, differences in HRQL were eliminated in 5 of 6 domains after controlling for number of mental disorders. When compared with female patients of male physicians, female patients of female physicians demonstrated similar satisfaction with care, health care utilization, HRQL, and recognition rate of mental disorders. CONCLUSIONS: In the 1,000 patients of the PRIME-MD study, mood, anxiety, and somatoform disorders and psychiatric comorbidity were all significantly more common in women than men. The HRQL scores were poorer in women than men, although most of this difference was accounted for by the difference in prevalence of mental disorders. These data suggest that one of the most important aspects of a primary care physician's care of female patients is to screen for and treat common mental disorders.

Adult↗
PubMed1994

Sodium channel mutations in acetazolamide-responsive myotonia congenita, paramyotonia congenita, and hyperkalemic periodic paralysis.

Hyperkalemic periodic paralysis (hyperKPP) and paramyotonia congenita (PC) are genetic muscle disorders sharing the common features of myotonia and episodic weakness. In hyperKPP, patient symptoms and signs are worsened by elevated serum potassium, whereas in PC, muscle cooling exacerbates the condition. There are patients in whom features of both hyperKPP and PC are present. These diseases result from molecular alterations in the adult skeletal muscle sodium channel. This report summarizes our sodium channel mutation analysis in 25 families with hyperKPP and PC. We also report the putative disease-causing mutation in acetazolamide-responsive myotonia congenita, a related disease in which myotonia is worsened by potassium but in which episodic weakness does not occur. This missense mutation (I1160V) occurs at a very highly conserved position in the sodium channel, cosegregates with the disease, and was not present in any of a large panel of normal DNAs. Electrophysiologic characterization of specific mutations will lead to better understanding of the biophysics of this voltage-gated ion channel.

Acetazolamide↗
PubMed1992

Pervasive developmental disorders: from DSM-III to DSM-III-R.

The present paper provides a brief history of the development of the DSM-III-R (American Psychiatric Association [APA], 1987) section on Pervasive Developmental Disorders. It describes the process by which the contents of the text and criteria for Autistic Disorder and Pervasive Developmental Disorder Not Otherwise Specified were decided and gives the reasons for the changes from DSM-III (APA, 1980) categories and criteria. The paper concludes with a short discussion of critical diagnostic issues.

Autistic Disorder↗
PubMed1988

Treatment of human immunodeficiency virus-related polyneuropathy with 3'-azido-2',3'-dideoxythymidine.

A 72-year-old woman with human immunodeficiency virus (HIV)-related axonal polyradiculoneuropathy of the lower extremities was treated with 3'-azido-2',3'-dideoxythymidine (AZT), 250 mg every 4 hours. Before therapy she had rapidly progressive weakness in both legs and when treatment began she could move only her toes. Six weeks after therapy, there was mild improvement in her strength, which peaked 2 months later. At her best, she was able to lift her leg 30 degrees off the bed and stand with assistance. Improvement, which was also demonstrated electrophysiologically, was short lived and partially declined when AZT was discontinued. This case demonstrates that some patients with HIV-related axonal neuropathies even in advanced stages can show objective signs of improvement when given AZT. A systematic trial with AZT in the treatment of patients with HIV-related polyneuropathies is therefore warranted.

Acquired Immunodeficiency Syndrome↗
PubMed1985

Dyskeratosis congenita with hypoplastic anemia: a stem cell defect.

A case of dyskeratosis congenita (DC) with pancytopenia was studied in an attempt to elucidate the cause of the hypocellular bone marrow and pancytopenia. Levels of erythroid hemopoietic stem cells were estimated by clonal cell culture. Results showed a decrease in the number of precursor cells in both the bone marrow and the peripheral blood of this patient.

Adult↗
PubMed1980

SEM of complement-independent nephrotoxic nephritis.

Complement-independent nephritis was induced in rats by intravenous injections of duck anti-rat nephrotoxic serum (DNTS). The kidneys were examined by light and immunofluorescent microscopy, plus electron microscopy (SEM and TEM) at 15, 30 and 60 minutes and on days 1 and 5. Additional experiments included pretreatment with heparin sulfate prior to DNTS and perfusion experiments 24 hours following DNTS using normal saline and heparin sulfate. Light microscopy demonstrated no increase in inflammatory cells. Immunofluorescent microscopy showed only linear staining against duct anti-rat immune globulin. TEM and SEM showed glomerular capillary wall changes at 24 hours which correlated roughly with the level of proteinuria and varied from minimal changes, grade I, to severe foot process effacement and partial detachment of endothelium and epithelium, grade III. Pretreatment with heparin sulfate exaggerated the severity of the Grade III changes. Perfusion of DNTS rats with normal saline result in detachment of loosened podocytes. Perfusion of DNTS rats with heparin sulfate resulted in severe podocyte detachment. Examination of DNTS rats on day 5 revealed reversion to normal structure. SEM and TEM complemented each other in demonstrating the unusual DNTS induced phenomenon of weakened cell attachment unrelated to classical complement and inflammatory cellular mechanisms.

Animals↗
PubMed1979

Neurotic depressions: a systematic analysis of multiple criteria and meanings.

Neurotic depression, the most commonly used psychiatric diagnosis, has multiple meanings that are often used interchangeably in clinical practice. The authors identify six different meanings of neurotic depression and present data from a study of 90 depressed inpatients to determine how many patients met several different criteria; 16 patients met four sets of criteria. The overlap that exists between the different meanings is higher than chance alone but not sufficiently high to allow complete interchangeability. Until new diagnostic classes are developed, the authors recommend that the term "neurotic depression" no longer be used clinically because of its vagueness.

Adjustment Disorders↗
PubMed1978

Activity of the alternative pathway of complement in the newborn infant.

Levels of C3, properdin, factor B, and C3 to C9 activity were markedly reduced in cord sera taken from 94 normal newborn infants. Nevertheless, cord serum supported complete activation of its own alternative pathway by zymosan or CoF. Lysis of a target cell, however, was defective; nearly 75% of cord sera had reduced rabbit erythrocyte CH50 titers. These were partially increased by the addition of factor B and properdin, and totally restored by adding factor B, properdin, and C3 to C9. Therefore, although the alternative pathway of the neonate is intact, it appears to be limited in its ability to generate an adequate number of stable and active enzymatic sites on a target cell membrane.

Complement Activation↗