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PubMed1996

Temperament as a correlate of adolescent defense mechanisms.

The Revised Dimensions of Temperament Survey, which assesses nine dimensions of temperament, and the Defense Style Questionnaire, used to assess defense mechanisms, were completed by 107 female adolescents. Temperament was found to be strongly correlated with defense style, particularly with immature defenses (p = 0.0001). The findings support the hypothesis that the biological dimension of temperament is correlated with specific defense mechanisms.

Adolescent↗

PubMed1991

A predictive and follow-up study of abusive and neglectful families by case analysis.

The aim of this study was to develop methods, categories, and criteria for investigating and evaluating parental functioning and potential and to relate the accuracy of such categories to prognosis. A case analysis, a predictive study, and a follow-up study of 17 abused and/or neglected children was conducted 5-6 years later. Categories were developed and cases analyzed for stress factors in childhood, youth, and early adult life and for factors related to social network, finances, work, accommodation, pregnancy, and marriage. The cases were also analyzed with regard to the following dimensions: immaturity, emotional problems, psychosis, mental retardation, alcohol and drugs. Seven areas of parental functioning were scored on a 4-point scale. The child's role and the effect of parents' unresolved problems upon the parent-child interaction were also studied. The findings of this study, limited though it is in scope, suggest that the prognosis for abusive and/or neglectful parents is poorer when they are scored high on immaturity than when they are scored high on emotional problems.

Adult↗

PubMedDate not supplied

[Anorexia nervosa - thoughts on psychogenesis and psychotherapy].

In this work I tried to classify Anorexia nervosa into two groups, the central group and the reactive group. The central group contains four different subgroups, the immature, the schizoid, the hysterical and the compulsive type. In the first two subgroups the lack of appetite appears primarily at the onset of the disease, and the fear of growing up plays an important role. In the latter two subgroups the lack of appetite comes later on the basis of a conscious or subconscious suppression of the appetite; here prevails a wish to be slender and the disturbance of the aesthetic value orientation. The basis of this syndrome lies in the interpersonal constellation in the family during the childhood. In tests and interviews of the parents of 20 patients was proved, that the fathers have weak and immature character structures, show little interest in the family, they are hypochondriacl, undecisive and not self-confident. On the contrary the mothers are more normative and they endeavour to accept or compensate some parts of the father-role. In the course of these excessive efforts they lose their motherhood and become secondarily dominating grumbling persons. By the lack of the normal father-daugher-relationship, the maturation of sexuality and feminity is disturbed. The method of psychotherapy of those ambivalent, unmotivated patients with ego-splitting is different from that of other neuroses in many points, such as activity, flexibility and educational control on the part of the therapist instead of the psychoanalytic neutrality. In such cases therapists should not be reluctant to act as an object of identification for these patients.

Anorexia Nervosa↗

PubMed1983

A factor analytic study of screening scales of adjudicated delinquent males and females.

Obtained a factor analysis of demographic and behavioral variables from self-ratings and observations of trained raters on a sample of 200 incarcerated delinquents, which resulted in eight identifiable factors with eigenvalues over 1.0. These were described as: The undersized youthful offender with emotional problems, the aggressive threatening offender, the drug subculture repeat offender, the neurotic polyabuse offender, the institutionally unadjusted offender, the bright offender, the immature neurotic offender, and the "established" psychopathic offender. Results provide understanding of the relationships and disparities between self-ratings, the ratings of others, and demographic variables.

Adolescent↗

PubMed1995

The relationship between normal variation in IQ and common childhood psychopathology: a clinical study.

The relationship between normal variation in IQ and common psychopathology was examined in a sample of 339 5- to 16-year-olds who were seen at a tertiary psychiatric clinic. The mean IQ was 9.6 points lower (95% CI 5.5 to 13.6 points lower) for conduct than for emotional disorders, with mixed disorders in between. For these common disorders, the mean IQ was 6.0 points lower (95% CI 1.6 to 10.3 points lower) for females than males. IQ variation in the normal range was inversely related to a dimensional measure of conduct problems - an association that was not attributable to social class or mediated by scholastic attainments. Other dimensional measures of psychopathology - covering emotional symptoms, developmental immaturity and relationship difficulties - were not significantly correlated with IQ. Limitations of the study are discussed in the paper.

Adolescent↗

PubMed2003

Mutations in proto-oncogene GFI1 cause human neutropenia and target ELA2.

Mice lacking the transcriptional repressor oncoprotein Gfi1 are unexpectedly neutropenic. We therefore screened GFI1 as a candidate for association with neutropenia in affected individuals without mutations in ELA2 (encoding neutrophil elastase), the most common cause of severe congenital neutropenia (SCN; ref. 3). We found dominant negative zinc finger mutations that disable transcriptional repressor activity. The phenotype also includes immunodeficient lymphocytes and production of a circulating population of myeloid cells that appear immature. We show by chromatin immunoprecipitation, gel shift, reporter assays and elevated expression of ELA2 in vivo in neutropenic individuals that GFI1 represses ELA2, linking these two genes in a common pathway involved in myeloid differentiation.

Adult↗

PubMed2006

Risk reduction for adverse drug events through sequential implementation of patient safety initiatives in a children's hospital.

BACKGROUND: Medication management is a complex, multifaceted system. Prescribing errors occur upstream in the process, and as such, their effects can be perpetuated, and sometimes even exacerbated, in subsequent steps. These errors place patients at risk of adverse drug events. Children, especially young infants, are at particular risk because of their size, unique physiology, and immature ability to metabolize drugs. OBJECTIVE: The purpose of this study was to reduce the risk of harm to children resulting from prescribing errors. METHODS: We sequentially implemented patient safety initiatives over a 1-year time frame at a pediatric tertiary care academic facility. The initiatives included an educational Web site with competency examination, distribution of a personal digital assistant-based standardized dosing reference, a zero-tolerance policy for incomplete or incorrect medication orders, prescriber performance feedback, and presentation of outcome data at citywide grand rounds. A total of 8718 orders were collected and analyzed to assess the impact of these initiatives. RESULTS: The absolute risk reduction from prescribing errors was 38 per 100 orders, with a relative risk reduction of 49%. Web-based education with point-of-care drug references and a zero-tolerance policy for incomplete or incorrect orders were most effective in decreasing potential adverse drug events. Documentation of appropriate weight-based dosing and indication for therapy increased by 24% and 42%, respectively. CONCLUSIONS: Process-improvement initiatives focusing on prescriber education and behavior modification can reduce the risk of harm to pediatric patients from prescribing errors.

Child↗

PubMed1986

Do immature T cells accumulate in advanced age?

The hypothesis that decreased T cell function in the elderly involves an increased number of less differentiated T cells was examined. Three markers known to change during thymocyte development were analyzed; ratio of adenosine deaminase (ADA) to purine nucleoside phosphorylase (PNP), lactate dehydrogenase (LD) H/M subunit ratios and the T cell associated antigens, T3, T4, T8 and T10. Cells tested were from 10 old (greater than 75 years) and 10 young (less than 35 years) persons with equal numbers of males and females in each group. Before analysis, cells were purified into three groups; unfractionated, and monocyte depleted T cell and B cell enriched populations. Results for ADA/PNP ratios showed no significant differences between old and young in any of the fractions analyzed. H/M ratios however, were significantly reduced in all three fractions from old donors when compared with young. Surface marker distribution pattern as illustrated by the T3 - (T4 + T8) difference was lower in samples from old donors but not significantly so. There was a very significant reduction in percent cells positive for T3 in all three fractions from old persons. Although some of the changes seen in these markers could be due to a failure of normal differentiation, they could also be caused by the general phenomenon of altered gene expression known to occur with advanced age in a variety of non-lymphoid cells. The absence of any difference in the ADA/PNP ratio suggests that T cell dysfunction in the elderly may not be due to increased numbers of less differentiated cells as a result of thymic involution.

Adenosine Deaminase↗

PubMed2003

Parental attitudes regarding newborn screening of PKU and DMD.

The ability to perform predictive genetic testing of children raises ethical concerns. Current guidelines support the screening of newborns for conditions in which early treatment reduces morbidity and mortality, and oppose most other predictive genetic screening and testing in childhood. Little is known, however, about parental attitudes. We conducted focus groups to gain information on the attitudes, beliefs, and concerns of parents about newborn screening and testing for both treatable and untreatable conditions that present in childhood. Respondents across racial groups support mandatory newborn screening for treatable conditions like phenylketonuria (PKU), citing lack of parental knowledge, and concerns about immature parental decision-makers. Parents do, however, want more information. Citing a variety of psychosocial concerns, respondents believe that parents should have access to predictive genetic testing for childhood onset conditions, even when there are no proven treatments. Respondents want this information to make reproductive and non-reproductive plans and decisions. Although respondents varied in their personal interest in testing, overwhelmingly they believed that the decisions belong to the parents. Professional guidelines that proscribe predictive testing for untreatable childhood onset conditions should be re-examined in light of consumer attitudes.

Age of Onset↗

PubMed1995

Microcallus formations of the cancellous bone: a quantitative analysis of the human spine.

Microcallus formations are demonstrable in nearly all spongy bone by means of suitable preparation techniques. Histologically, these structures are immature fibrous bone. Their genesis, frequency, and importance are largely unknown. To address these issues, 26 normal human spines, 11 osteoporotic spines, and different parts of the skeleton (femur head, iliac crest) were investigated for microcallus using a new preparation technique--allowing a combined 2- and 3-dimensional analysis. According to our analysis, microcallus formation occurs frequently in persons older than 45 years of age. These formations are mainly localized in the lower thoracic and lumbar spine and are obviously more frequent in females than in males. In individuals with a trabecular bone volume (BV/TV) in the spine below 11%, microcallus formations occur regularly. But the number of microcallus formations depends more on the microarchitecture of the cancellous bone (trabecular bone pattern factor, TBPf), than on individual trabecular parameters (trabecular number, TbN; trabecular bone volume, BV/TV; and trabecular thickness, TbTh). In about 33% of cases microfractures are demonstrable in the center of the microcallus formation. It is unclear whether microcallus may be the result of a nontraumatic process. In therapy studies the bone mass could be misrepresented due to the amount of microcallus. Although it indicates instability of the bone structure, microcallus formation is not only a negative mechanism, but stabilizes and regenerates the bone tissue. Furthermore, complete new trabeculae can be formed due to bridges of microcallus between the remnant trabeculae. Osteoporosis is not the result of an inability to form microcallus formations.

Adolescent↗

PubMed1975

Teacher race, student race, and the Behavior Problem Checklist.

The ratings of 458 fourth- and fifth-grade boys were investigated to determine whether or not scores on the Behavior Problem Checklist vary systematically with teacher or student race. Analyses of the data for conduct problems, inadequacy-immaturity, and socialized delinquency indicated that white teachers demonstrate a strong tendency to rate black children as more deviant and white children as less deviant when contrasted with the ratings of black teachers. The ratings of black teachers were found not to vary with student race. No differences among any of the variables were found with regard to personality problems. Possible explanations for the results are discussed, along with implications for the use of the Behavior Problem Checklist in the field.

Attitude↗

PubMedDate not supplied

[Glycosaminoglycans in leukocytes in myeloproliferative disorders].

Content and composition of glycosaminoglycans (GAG) was studied in leukocytes of 30 healthy persons and of patients with different types of myeloproliferative disorders: 32 patients with chronic myeloid leukemia (CML), 10 patients with polycythemia vera (PV), 5 patients with idiopathic myeloid fibrosis (IMF) and 10 patients with acute myelo blast leukemia (AML). The total content of GAG in healthy persons was 97.7 +/- 3.9 micrograms of uronic acid per 100 mg of dry cells, in CML and IMF it was 2-4-fold increased, in PV it was elevated by 20%, in AML it was diminished 3-5-fold. The elevated level of GAG in CML and IMF was due to presence of basophils and considerable quantity of immature cell forms: promyelocytes and myelocytes. In these cells changes in GAGs composition and their properties were shown: an increase of chondroitins deficient in sulfate groups and of heparan sulfate content, especially in basophils. The observed changes in GAG content and composition may be important for biological activity of the leukemic cells.

Chondroitin↗

PubMed1999

Long-term changes in defense style among patients recovering from major depression.

The long-term stability of ego defenses was examined in a group of 68 patients with major depression being treated in a rural private psychiatric practice. Current symptomatology and dispositional characteristics, including defense style (40-item Defense Style Questionnaire), were assessed pretreatment and at approximately 6 months and 2 years after treatment commenced. Age- and gender-matched comparison groups were also selected from two community-based studies that utilized similar instruments and time periods. The major depression group reported significantly lower usage of mature defenses initially, but with recovery they moved progressively toward the range of mature defenses displayed by the nonpatient comparison group. Neurotic defenses were relatively stable throughout the study, as were immature defenses during the first 6 months. Comparisons between patients who discontinued treatment (N = 24) and those who remained in treatment (N = 33) revealed similar rates of symptom reduction; however, the latter group reported continuing reductions in their use of immature defenses, to a level below that of the nonpatient comparison group.

Adult↗

PubMed2002

Can human fetal cortical brain tissue transplant (up to 20 weeks) sustain its metabolic and oxygen requirements in a heterotopic site outside the brain? A study of 12 volunteers with Parkinson's disease.

BACKGROUND: Neural and stem cell transplantation is emerging as a potential treatment for neurodegenerative diseases from Parkinson's to Huntington's disease. Stereotactic placement of dopaminergic neurons in the caudate-putamen (striatum), is being attempted in centers of excellence and has proved to be beneficial. Basic research using cell transplantation indicates that structural development mechanisms seen in immature brains, i.e., fetal brains, can also function in the adult brain. The adult brain consumes 15% of the resting cardiac output for its metabolic needs. While most human tissues can sustain an anaerobic assault for a few minutes up to 30 minutes, a sudden total lack of oxygen supply to the brain cells in an adult will render the person unconscious within five to ten seconds. Our team has been working on the problem of human fetal tissue response to antigenic assault for the last two decades. In the present series, 12 patients with prolonged histories of Parkinsonism, who were not responding to anti-Parkinsonian drugs, and could not afford costly stereotactic surgery or deep brain stimulation and other modalities of recent Parkinson's disease treatment, were enrolled in the study. MATERIALS AND METHOD: After obtaining proper informed consents from the patients or their guardians and from the multidisciplinary ethical committee, the patients, varying in age from 45 to 75 years and suffering for many years with Parkinsonism, were enrolled in the heterotopic brain tissue transplant programme. We followed standard antiseptic, aseptic and premedication protocols, after selecting a proposed site of transplantation of the brain in the axillary fold of the skin, under local infiltration anaesthesia. In an adjacent OR, a fetus was collected from a consenting patient undergoing hysterotomy and ligation (before 20 weeks), under general anaesthesia. Within a minute of hysterotomy, the fetal brain tissue was dissected, and under the guidance of the operative microscope, 1 g of fetal cortical brain tissue was dissected and weighed in an electronic machine. The tissue was collected from around 1 cm of the frontal opercula of the developing human fetal brain and grafted in the already dissected and prepared subcutaneous site in the axilla and the skin was closed. Hematological parameters (Hgb; total count, Tc; differential count, Dc; erythocyte sedimentation rate, ESR) were estimated sequentially up to one month. A small portion of the transplanted tissue was retrieved after one to two months, and a serial histological study was done along with a clinical assessment of the disease condition as per the specifications of the Unified Parkinson's Disease Rating Scale. The results were matched with the pre-transplant ratings of the individual cases. Presenting dyskinesia was also rated (0-4), on the basis of objective criteria assessment like walking, putting on a coat, lifting a cup to drink, etc. RESULTS AND ANALYSIS: Initially 30 patients suffering from advanced Parkinson's disease (PD) were approached after getting the necessary clearance from the institutional multidisciplinary ethical committee; however, we have been able to arrange transplantation in only 12 cases so far. These patients were evaluated at the pre- and one month post-transplant period by the Unified Parkinson's Disease Rating Scale (0-108) and the minimum score was 40 in the motor portion of the unified scale at the pre-transplant state. Evaluation of the patients after one month revealed mild improvement of the pre-transplant scoring (up to 33.3%) in 41.6% of the cases, and moderate improvement (up to 66.6%) in another 41.6% of the cases. While 16.8% of the cases did not show any improvement from the basal score, i.e., the pre-transplant score, there was a definite sense of well being and rise in weight (2-4 pounds) noted in each case and there was also a reduction of the L-Dopa dosage in 75% of the cases. There was also a 58.3% improvement in the bradykinesia scoring from the pre-transplant level. What is intriguing is the survival, growth and proliferation of the grafted fetal brain tissue in the HLA- and sex-randomized adult axilla without any immunosuppressive support. Not a single histological study of the fetal brain tissues after removal from the axilla showed any signs of graft vs. host or inflammatory reaction (Figures 1-9) but there were features of growth of the transplanted cortical brain tissue along with its different components like neurogenesis, gliogenesis, early neovascularisation and angiogenesis, etc. There was also no systemic leucocytosis or lymphocytosis. DISCUSSION AND CONCLUSION: Histological evidence at the transplanted tissue site suggests that fetal cortical brain tissue can sustain life in sex-randomized, HLA-randomized adult hosts, without the support of immuno-suppressive drugs and the tacit support of the blood-CSF and blood-brain barrier and other specific requirements of adult brain cells in the skull. Whether the clinical improvement in PD is transient or long lasting is presently under investigation along with basic questions like, is it due to transplanted fetal dopaminergic or non-dopaminergic neurons or is it the growth factors and the cytokine mediated hitherto unknown reactions causing the clinical improvement.

Aged↗

PubMed1988

The infant as a member of society.

An analysis of the social development of the infant and young child offers a salutary view of human nature. To defend that claim I use as an example a recent study of how boys and girls in the second year of life assist their mothers and fathers and other persons in performing some everyday tasks. Although the behavior falls under the rubric of social behavior, it will be examined by the different components comprising it. In turn I consider the social, emotional, cognitive, and motor components of the children's helping and briefly trace their development. Their behavior revealed a well-developed concept of self and despite the children's immaturity deserved the appellation of prosocial. Although wide differences appeared among pairs of children and parents, no differences were found by sex of child or parent, and no differences by culture are anticipated. No current theory of the development of social behavior encompasses all the facets of the whole child here portrayed as active and perceptive, enterprising and creative, and above all responsive. The parents of this study, as well as those of other studies, such as sharing and caregiving, and even obeying, by children in the second year of life, seemed scarcely aware of these socially valued behaviors. In fact, parents, like the rest of us, tend to ignore what goes right and fasten on what goes wrong. Not only a good start to mental health but a better start can come from recognizing and rewarding such behaviors at their onset. If we wait until we think children are ready to be taught them, we pay the penalty of a lost opportunity. At any age children are indeed important members of families, but above all they qualify as members of society by providing a glimpse of what could be accomplished by nurturing the early and spontaneous development of their praiseworthy behavior.

Child Development↗

PubMedDate not supplied

Developmental models of social cognition in assessing the role of family stress in relatives' predictions following traumatic brain injury.

The present study extended the utilization of developmental models of social cognition to the investigation of stress and relatives' perception of traumatic brain injury (TBI) survivors. Structured interviews were conducted with 21 TBI survivors utilizing interpersonal negotiation strategies (INS) and self understanding (self) in the framework of Selman's model of social perspective-taking and Damon and Hart's multidimensional model of self understanding. A relative group composed of 21 participants was interviewed and their predictions of the responses of the TBI survivors to the action domain of the INS stories were obtained. The relative participant group was also administered the Beck Anxiety and Depression Inventories and Leeds Scales of Depression and Anxiety. The relationships among relative groups' predictive scores, INS and self domains and stress levels were analysed. The result of the survivor groups responses on INS and self were in agreement with the previous findings that TBI survivors respond at psychosocially immature levels. Comparison of INS action scores obtained by the survivor group and predicted by relative group were within one developmental level of each other in 87.4% of the cases. Fifty-two per cent of the relative group scored in mild to moderate or greater depression and 48% scored in the mild to moderate range of anxiety on the Beck scales. Person correlation coefficients indicated significant negative correlations between Beck scores and predictive INS scores. ANOVA indicated significantly higher Beck depression scores in relatives of TBI survivors living in residential facilities than relatives of TBI survivors in an outpatient treatment programme. The study supports the view that developmental social cognition methods appear to advance our understanding of psychosocial adjustments and relatives' perceptions of social cognition in TBI survivors.

Activities of Daily Living↗

PubMed1997

Defense style in depressed and anxious psychiatric outpatients: an explorative study.

The aim of the present study was threefold: (a) to investigate whether anxiety or depressive disorders are related to the use of specific defenses; (b) to evaluate which defenses are associated with self-report measures for anxiety and depression; and (c) to assess whether the association between defenses and anxiety or depression is gender specific. Subjects were 483 consecutive psychiatric outpatients with the following DSM-III-R diagnoses: (a) V-code or no psychiatric diagnosis (N = 71) (controls); (b) one or two anxiety diagnoses (N = 116), among which 47 patients with a single diagnosis of panic disorder; (c) one or two depressive disorder diagnoses (N = 93), among which 35 patients with a single diagnosis of dysthymia and 51 with a single diagnosis of major depression; and (d) 203 otherwise. Defense use was measured with the Defense Style Questionnaire-36 and level of anxiety and depression with the Symptom Checklist-90. Compared to controls, anxiety and depressive disorder patients scored higher for the immature defense style. Moreover, anxiety disorder patients obtained significantly higher scores for the neurotic defense style than both depressive disorder patients and controls. Panic patients made more use of the defense mechanisms of somatization, devaluation, and idealization, and dysthymic patients of somatization, devaluation, and isolation. Both anxiety and depression scores were positively related to the immature and neurotic, and negatively to the mature defense style. Anxiety was predominantly related to somatization and depression to projection. No evidence for a gender specific association between defense and anxiety or depression was found. It is concluded that the observed differences in defense between groups may be a consequence of the nature of the psychiatric disorder irrespective of gender. Prospective studies of persons at risk are needed to evaluate whether specific defenses are predictive of anxiety or depressive disorders and/or symptoms.

Adult↗

PubMed1981

Proximal femoral resection or total hip replacement in severely disabled cerebral-spastic patients.

1. Our understanding of the mechanism and origin of pain in degenerative arthritis of the hip is incomplete at this time, whether we are dealing with a neurologically intact individual or a person who has spasticity of cerebral origin. 2. Predicting whether or not a particular hip in a nonambulatory patient whose spasticity is of cerebral origin at an early age will eventually become painful at some future date is extremely difficult. Once the patient attains adolescence or adulthood, the hip may become painful whether it is located, subluxated, or dislocated. 3. In the skeletally immature patient with cerebral palsy we may be justified in operating to correct clinically relevant soft tissue and bony deformities about the hip. In the skeletally mature patient, we should operate for pain and disability, not solely for deformity. 4. We do not yet have salvage or reconstructive hip procedures that yield consistently satisfactory long-term results in severely disabled cerebral-spastic patients.

Adolescent↗