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PubMed1983

Lack of correlation between contraceptive pills and Down's syndrome.

A case-control study has been made on the use of oral contraceptives before pregnancy and the birth of an infant with Down's syndrome. Controls were matched for age and parity and selected from the Medical Birth Register. Information on Pill usage was obtained from the Swedish standardized maternity health record which contains dates for when the women stopped using the Pill and for last menstrual period. There was no indication of any relation between the use of oral contraceptives and Down's syndrome.

Adolescent↗
PubMed1988

Educational late effects in long-term survivors of childhood acute lymphocytic leukemia.

Records of levels of school achievement in long-term survivors of childhood acute lymphocytic leukemia were obtained for 23 children who had received 2,400-rad cranial irradiation and intrathecal methotrexate and standard chemotherapeutic agents 8 to 10 years previously. The children had been evaluated with standardized tests of intelligence at the time of diagnosis and periodically thereafter. Declines in IQ and cognitive dysfunctions have been previously described. School placements, educational histories, attendance records, learning strengths and weaknesses, social/emotional adjustments, and grade level achievements in reading and mathematics as measured by standardized achievement tests are reported here. Children achieved less than the expected levels in both reading and mathematics given both pretreatment and most recent IQ scores. Neither sex nor initial IQ were related to achievement scores. Children experienced difficulty with attention/concentration, memory, sequencing, and comprehension when performing school tasks. Individual children showed different degrees of dysfunction, but results of this study suggest that there are patterns of specific learning disabilities rather than global retardation. A small number of children achieved greater than expected levels, indicating that individualized instruction, tutoring, and parental support may reduce some learning deficits. Early educational intervention is recommended for similarly treated patients.

Age Factors↗
PubMed1977

Patient compliance: the effect of the doctor as a therapeutic agent.

This paper is a review of the available literature on patient complicance with medical regimens. An effort is made to focus on those features or characteristics associated with compliance or noncompliance that are clinically relevant for the practicing physician. These include the intelligence of the patient, the patient's knowledge of his disease, the complexity of the medical regimen, the influence of the family, the health belief model, and the doctor-patient relationship. From this review of research data, 12 concrete suggestions are presented for the purpose of enhancing patient compliance and enabling the doctor himself to be more effective as a therapeutic agent.

Attitude to Health↗
PubMed2006

Open-label, prospective trial of olanzapine in adolescents with subaverage intelligence and disruptive behavioral disorders.

OBJECTIVE: Olanzapine, an atypical antipsychotic, has been shown to be efficacious for treatment of psychotic and mood disorders in adults. This prospective, open-label study was conducted to examine the safety and usefulness of olanzapine in treating disruptive behavior disorders in adolescents with subaverage intelligence. METHOD: Sixteen adolescents (ages 13-17 years) with borderline to moderate mental retardation and disruptive behavior were enrolled in an 8-week olanzapine trial (5-20 mg/day). Dependent measures included the Aberrant Behavior Checklist, Conners Parent Rating Scale, Clinical Global Impressions, and two side effects scales. RESULTS: Statistically significant improvement (p <.002) was found on the Irritability and Hyperactivity subscales of the Aberrant Behavior Checklist and the Conners Parent Rating Scale Hyperactivity Index. No subjects developed extrapyramidal side effects. However, four were terminated prematurely from the trial because of either worsening of symptoms (requiring psychiatric inpatient hospitalization in two subjects) or side effects. The most common side effect for the sample was weight gain (averaging 12.7 lb), with 67% of subjects gaining > or =10 lb. Although there was also a statistically significant increase in prolactin levels, no subjects reported prolactin-related side effects (e.g., gynecomastia, galactorhea, amenorrhea). CONCLUSION: Olanzapine may be useful in treating disruptive behavior in adolescents with subaverage intelligence. However, side effects, especially weight gain, are a significant issue. Future double-blind, placebo-controlled studies need to confirm these findings and assess long-term safety and outcome of olanzapine treatment.

Adolescent↗
PubMed2000

Thyroid function and intellectual development of infants nursed by mothers taking methimazole.

For many years, breast-feeding was forbidden if antithyroid drugs were being used. Recently, limited studies have shown the relative safety of propylthiouracil and methimazole (MMI). It is not known whether MMI therapy of lactating mothers for 1 yr is safe for breast-fed infants and does not cause alterations in thyroid function and intellectual development. Between 1988 and 1998, 139 thyrotoxic lactating mothers and their infants were studied. Fifty-one thyrotoxic lactating mothers were treated with MMI during pregnancy, and MMI was continued during breast-feeding. Eighty-eight mothers were given 10 mg MMI (n 46) or 20 mg MMI (n = 42) daily for 1 month, 10 mg daily for the second month, and 5-10 mg daily thereafter. Serum T4, T3, and TSH concentrations were measured in thyrotoxic lactating mothers and their infants, before and at 1, 2, 4, 8, and 12 months. Serum MMI was measured in the infants of thyrotoxic lactating mothers taking 20 mg MMI. Thyroid function, urinary iodine, thyroid antibodies, intelligence quotient (IQ), verbal and functional components (Wechsler and Goodenough tests) were performed on 14 children of thyrotoxic lactating mothers between 48 and 74 months of age and on 17 controls. Mean +/- SD of FT4I in thyrotoxic lactating mothers treated with 10 mg MMI for 1 month decreased from 19.4 +/- 4.1 to 11.6 +/- 4.4 and from 20.5 +/- 4.7 to 9.8 +/- 1.5 when treated with 20 mg MMI. Values for FT3I decreased from 462 +/- 52 to 194 +/- 52 with 10 mg MMI and from 481 +/- 92 to 171 +/- 38 with 20 mg MMI. FT4I and FT3I were normal from the third to the twelfth months. In all infants FT4I, FT3I, and TSH concentrations were normal before and up to 12 months of MMI therapy in their lactating mothers. The lowest T4 and T3 values were 108 and 1.87 nmol/L, and the highest TSH value was 4.0 mU/L. Serum MMI levels in infants were less than 0.03 microg/mL. Six mothers receiving 20 mg MMI had increased serum TSH concentrations ranging from 26-135 mU/L after 1 month of treatment. Their infants were euthyroid with serum TSH values less than 2.6 mU/L. At 48-74 months of age, height, weight, FT4I, FT3I, TSH, and antithyroid antibody titers were not different than controls. The mean IQ was 107 +/- 14 vs. 106 +/- 16 (Goodenough test) and 103 +/- 10 vs. 103 +/- 16 (Wechsler test) for infants of thyrotoxic lactating mothers and control infants, respectively. Similarly, there was no difference in verbal and performance IQ and their components between infants of thyrotoxic lactating mothers and control children. No deleterious effects occur in thyroid function and physical and intellectual development of breast-fed infants whose lactating mothers were treated with doses of MMI up to 20 mg daily.

Adult↗
PubMed2004

Active and intelligent inhaler device development.

The dry powder inhaler, which has traditionally relied on the patient's inspiratory force to deaggregate and deliver the active agent to the target region of the lung, has been a successful delivery device for the provision of locally active agents for the treatment of conditions such as asthma and chronic obstructive pulmonary disease (COPD). However, such devices can suffer from poor delivery characteristics and/or poor reproducibility. More recently, drugs for systemic delivery and more high value compounds have been put into DPI devices. Regulatory, dosing, manufacturing and economic concerns have demanded that a more efficient and reproducible performance is achieved by these devices. Recently strategies have been put in place to produce a more efficient DPI device/formulation combination. Using one novel device as an example the paper will examine which features are important in such a device and some of the strategies required to implement these features. All of these technological advances are invisible, and may be irrelevant, to the patient. However, their inability to use an inhaler device properly has significant implications for their therapy. Use of active device mechanisms, which reduce the dependence on patient inspiratory flow, and sensible industrial design, which give the patient the right clues to use, are important determinants of performance here.

Drug Delivery Systems↗
PubMed1997

Biological terrorism. Preparing to meet the threat.

The threat of terrorists using biological warfare agents has received increased attention in recent years. Despite the hope that, with the right mix of policies, security measures, and intelligence gathering, a major biological warfare terrorist attack can be prevented, the history of conventional terrorism indicates otherwise. The greatest payoff in combating biological terrorism lies in focusing on how best to respond to a terrorist attack. The medical and emergency service communities will play the most important role in that process. Ensuring that they are trained to recognize the symptoms of diseases caused by biological warfare agents and have Critical Incident Stress Debriefing teams available to help them cope with the emotional aspects of treating exposed survivors should be part of contingency planning. By improving our readiness to respond to biological terrorism, many lives can be saved and terrorists denied their goal of creating panic and crisis throughout the country.

Biological Warfare↗
PubMed1980

The comparison of the effects of DL-308, a potential new neuroleptic agent, and thioridazine on some psychological and physiological functions in healthy volunteers.

Eight healthy male volunteers participated in four experimental sessions in which they ingested either DL-308 (10 mg), DL-308 (20 mg), thioridazine (50 mg) or placebo. Drugs were allocated to subjects and sessions in a double-blind fashion according to a balanced cross-over design. Both DL-308 and thioridazine displayed sedative properties, as indicated by the sedated appearance of the subjects, by a decrease in subjectively rated alertness and by an impairment of performance on psychomotor tests. DL-308 appeared to be a more potent sedative than thioridazine. DL-308 (10 mg) caused an increase in subjectivey rated sweating and objectively measured heart rate, suggesting a sympathomimetic property for the drug. DL-308, similarly to thioridazine, had effects consistent with an alpha-adrenolytic action; both drugs caused miosis, hypotension and a decrease in salivation. The decrease in salivation may also be consistent with an anticholinergic effect. When equisedative doses of the two drugs were compared, DL-308 had a much smaller influence on autonomic functions than thioridazine. DL-308 had a faster time-course of action than thioridazine. Peak effects were attained 1-3 h post-drug and the effects almost completely dissipated within 5 h. DL-308, similarly to thioridazine, had little effect on the motor system, as indicated by conventional clinical neurological examination.

Adult↗
PubMed2005

The Maudsley Bipolar Disorder Project: executive dysfunction in bipolar disorder I and its clinical correlates.

BACKGROUND: Cognitive abnormalities are increasingly recognized as a feature of bipolar I disorder (BDI,) but there is limited information regarding the pattern and severity of cognitive impairment during remission and its relationship with clinical variables. METHODS: Forty-four remitted BDI patients recruited from a representative treatment sample and an equal number of matched healthy volunteers underwent comprehensive clinical and cognitive assessments. Cognitive evaluation covered the domains of IQ, memory, and executive function. The profile of cognitive deficits in patients was examined, and the correlation of executive function with clinical features and treatment variables was explored. RESULTS: Remitted BDI patients were impaired in tests of executive function compared with healthy participants. Within the patient group, current antipsychotic treatment predicted worse performance across all executive function tests, whereas duration of illness predicted loss of inhibitory control. Residual mood symptoms, regardless of polarity, had a negative impact primarily on measures of attentional interference. CONCLUSIONS: These results suggest that impaired executive function might be an important feature of BDI. Antipsychotic treatment, duration of illness, and level of symptoms are the most significant contributors to the observed impairment.

Adolescent↗
PubMed1999

Serial intelligence test scores in pediatric moyamoya disease.

Serial intelligence tests in 38 patients with childhood moyamoya disease were evaluated. A total of 98 tests were administered. The IQ scores were classified into three categories: tests performed between the time of onset of symptoms and 5 years after the onset of symptoms (n = 44), tests performed 5-10 years after the onset of symptoms (n=32), and tests performed more than 10 years after the onset of symptoms (n=22). When more than one test was performed during each period, the mean of the IQ scores was used. The IQ tests were administered two or more times to 10 patients in the onset-5-years category, and 5 of them exhibited lower IQ scores on later tests. The IQ scores were significantly lower in the 5-10 years category and in the more than 10 years category (76.8 +/- 23.1 and 73.9 +/- 31.1, respectively) than in the onset-5-years category (92.9 +/- 22.7). The IQ scores for the 5-10 years category and the more than 10 years category did not differ significantly. The IQ in pediatric moyamoya disease begins to decrease after the onset of symptoms, but the decline eventually stabilizes more than 10 years after the onset of symptoms.

Adolescent↗
PubMed1995

Gender differences in schizophrenia.

In an assessment of gender differences in schizophrenia, 85 outpatients (53 men and 32 women) with schizophrenia were evaluated for illness history, symptom severity, IQ, neurocognitive status, cerebral volume loss, and cortical asymmetry. Social functioning was assessed using marital status, independent living skills, and employment status. Significant gender differences were found, as women were on lower doses of neuroleptic medications and more frequently met criteria for paranoid and disorganized subtypes of schizophrenia than men. Women also were better educated and more often married, living independently, and employed. No gender differences were found in present age, symptom severity, neurocognitive functioning, or clinical magnetic resonance imaging scan readings. Our findings suggest that women may experience less of the adverse interpersonal psychosocial consequences of schizophrenia than men, even when symptom and neurocognitive status is equivalent between groups. However, more extensive investigations are warranted to better understand the role of pathophysiological or social mechanisms in gender differences.

Activities of Daily Living↗
PubMed2005

Does neoadjuvant hormone therapy for early prostate cancer affect cognition? Results from a pilot study.

OBJECTIVE: To examine, in a prospective study, the influence that temporary reversible medical castration for localized prostate cancer has on cognition, by assessing whether temporary 3-5 month treatment with a luteinizing-hormone releasing hormone (LHRH) agonist before radical radiotherapy had a short- or long-term affect on cognitive function. PATIENTS, SUBJECTS AND METHODS: Thirty-two patients with localized prostate cancer had cognitive assessments at baseline (T1) before the start of drug treatment, at 3 months (T2) or on completing drug treatment but before radiotherapy, and 9 months later (T3). Eighteen men with no prostate cancer (controls subjects) completed the cognitive tests at the same times. In addition, psychological functioning and quality of life were assessed at the same times, together with serum free and bound testosterone, beta-oestradiol and sex hormone-binding globulin levels. RESULTS: There was a significant cognitive decline (on at least one cognitive task) at T2 in 15 (47%) patients vs three (17%) of controls (odds ratio 4.412, P = 0.033). Most patients (nine of 15) who had a change in performance declined on tasks of spatial memory and ability. At T3 there was significant cognitive decline in 11 (34%) patients and five (28%) control subjects (odds ratio 1.37, P = 0.631). CONCLUSION: This pilot study suggests that short-term LHRH therapy for early-stage prostate cancer has modest short-term consequences on men's cognitive functioning; a larger prospective study is warranted.

Aged↗
PubMed1979

Activity, depression, medication and performance on the Revised Kendrick Battery.

A theory for the cognitive assessment of the elderly has been previously reported (Kendrick, 1972), in which it was predicted that normal and depressed subjects would not differ on cognitive tests unless 'pseudodementia' was indicated. Recent studies involving the Revised Kendrick Battery have led to a modification of the theory. The theory now has to take into account the effects of activity and medication, the former enhancing performance, the latter decreasing it. The previous studies (Kendrick & Post, 1967; Kendrick, 1972), have been re-examined and explanations given for the differences found between studies.

Aged↗