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PubMed2002

Effects of cardioselective KATP channel antagonism on basal, stimulated, and ischaemic myocardial function in in vivo failing canine heart.

Inhibition of cardiomyocyte-specific ATP-sensitive potassium (K(ATP)) channels prolongs the action potential during intense ischaemia with attendant antiarrhythmic effects. However, this is accompanied by contractile depression in some models. These changes may be particularly troublesome in dilated cardiomyopathic hearts that display basal systolic dysfunction, limited energy reserve, and prolonged repolarization favouring arrhythmia. Mechanical effects of selective myocyte K(ATP) channel blockade on basal, beta-adrenergic stimulated, and ischemic responses were therefore tested in dogs with cardiac failure induced by tachypacing. Cardiovascular function was assessed by pressure - dimension relationships in 10 conscious, chronically instrumented dogs (sonomicrometry/micromanometry), with or without cardiac failure. Cardiomyocyte K(ATP) channels were inhibited by HMR 1098, and data obtained under basal conditions, during epinephrine infusion to raise metabolic demand, during regional ischaemia, and with combined ischaemia+epinephrine. HMR 1098 had no effect on baseline cardiac function nor did it induce arrhythmia in normal or failing hearts. Epinephrine raised cardiac work 65% and oxygen consumption 55%, yet HMR 1098 had no functional effect in either heart condition. Regional ischaemia with or without epinephrine co-stimulation depressed regional and global function, yet both were also unaffected by HMR 1098. There was minimal arrhythmia without HMR 1098, and drug infusion did not alter this. Thus, myocyte-K(ATP) channels play a negligible role modulating intact in vivo cardiac contraction or arrhythmia in normal and failing heart with and without increased metabolic demand and/or regional ischaemia. This supports the feasibility of administering such agents to depressed hearts, despite underlying contractile and electrophysiologic abnormalities.

Animals↗

PubMed1985

Pathophysiology of chronic cyanosis in a canine model. Functional and metabolic response to global ischemia.

To investigate the pathophysiology of chronic cyanosis, we subjected 14 adult mongrel dogs to diversion of the inferior vena cava to the right inferior pulmonary vein. This produced a mean oxygen tension of 42 +/- 2 mm Hg and a calculated right-to-left shunt of 52.0% +/- 3.9%. These animals (Group C) and 15 normal dogs (Group N) were subjected to cardiopulmonary bypass with 20 minutes of normothermic global ischemia. Functional indices studied were rate of rise of left ventricular pressure and the end-systolic pressure/volume ratio. Metabolic status was assessed by obtaining transmural myocardial biopsy specimens for measurement of adenosine triphosphate content. Myocardial blood flow was measured with radiolabeled microspheres. There were no significant differences between Group C and Group N in either functional index or blood flow measurement prior to global ischemia. At 45 minutes after ischemia, Group N animals had a significantly greater rate of rise of left ventricular pressure (at a left ventricular end-diastolic pressure of 0, 5, 10, and 15 mm Hg, p less than 0.025 to 0.05) and subendocarial perfusion (endocardial/epicardial flow ratio 0.961 +/- 0.037 versus 0.815 +/- 0.021, p less than 0.01). At 90 minutes after ischemia, Group N animals exhibited a significantly higher end-systolic pressure/volume ratio (4.9 +/- 0.7 versus 3.0 +/- 0.4 mm Hg/ml, p less than 0.05), rate of rise of left ventricular pressure (at an end-diastolic pressure of 0 to 20 mm Hg, p less than 0.005 to 0.05), and endocardial/epicardial flow ratio (1.065 +/- 0.046 versus 0.829 +/- 0.059, p less than 0.01). No differences in adenosine triphosphate content were found at any sampling period. The Group C left ventricles exhibited no hypertrophy but were significantly dilated compared to Group N (38.8 +/- 0.3 versus 30.1 +/- 0.2 mm, p less than 0.05). Inferior vena cava to pulmonary vein diversion produces cyanosis with left ventricular dilatation but without hypertrophy. It is proposed that abnormal loading characteristics of the left ventricle are responsible for the functional derangements that result from global ischemia.

Adenosine Triphosphate↗

PubMed2000

Changes in the rCBF images of patients with Alzheimer's disease receiving Donepezil therapy.

Alzheimer's disease is associated with a loss in presynaptic cholinergic function. It has been suggested that cholinergic inhibitors such as donepezil hydrochloride (Donepezil) could restore this function and improve some of the symptoms of Alzheimer's disease. Previous work has shown that Donepezil improves cognitive and global function in patients with mild to moderate Alzheimer's disease. This study reviewed retrospectively 12 patients who had previously had a 99Tcm-hexamethylpropylene amine oxime (99Tcm-HMPAO) single photon emission tomography (SPET) regional cerebral blood flow (rCBF) examination and had gone on to receive Donepezil therapy. These patients were recalled for a further 99Tcm-HMPAO SPET rCBF examination and the image data sets were compared. The results showed an overall increase in global cerebral blood flow (P = 0.04) averaged over the group with a percentage change in blood flow ranging from -1.8% to 6.4%. However, some patients showed a slight decrease in blood flow. When the data were analysed in terms of regional cerebral blood flow, we found that the most significant increase in blood flow occurred in the frontal lobes (P = 0.02).

Aged↗

PubMed2006

A randomized, controlled trial of distal radius fractures with metaphyseal displacement but without joint incongruity: closed reduction and casting versus closed reduction, spanning external fixation, and optional percutaneous K-wires.

OBJECTIVES: To compare closed reduction and casting with closed reduction and external fixation with optional K-wire fixation for distal radius fractures with metaphyseal displacement but without joint incongruity. DESIGN: Prospective study. SETTING: Multicenter study at 3 University teaching hospitals. PATIENTS/PARTICIPANTS: A total of 113 skeletally mature patients with distal radius fractures with metaphyseal displacement, but without joint incongruity, were randomized to receive 1 of 2 standardized treatment protocols. Patients were evaluated at 6 weeks, 6 months, 1 year, and 2 years. INTERVENTION: Closed reduction and casting (n = 59) or closed reduction and external fixation (n = 54). MAIN OUTCOME MEASUREMENTS: Upper extremity function was measured using upper extremity MFA domain scores, overall Jebsen Taylor scores, and pinch and grip strength tests. Global function and pain were measured using the SF-36. Radiographic evaluation and range of motion were documented. RESULTS: Upper extremity MFA scores, Jebsen Taylor scores, SF-36 bodily pain scores, and grip strength improved significantly during the first year for all patients. By 2 years, mean Jebsen Taylor scores and SF 36 bodily pain scores for patients in both groups were similar to scores for normal age- and gender-matched population controls. At all points, there was a trend for better function in the external fixation; however, this did not reach statistical significance. There was a trend for better length and palmar tilt restoration with external fixation. CONCLUSIONS: For distal radius fractures with metaphyseal displacement but with a congruous joint, there exists a trend for better functional, clinical, and radiographic outcomes when treated by immediate external fixation and optional K-wire fixation.

Adult↗

PubMed1999

Long-term functional outcome after intensive care.

OBJECTIVE: Although age-related mortality after intensive care unit (ICU) admission has been studied, functional recovery for different age groups following ICU admission is not well characterized. We hypothesized that compared with younger age groups, fewer patients older than age 65 admitted to an ICU would regain their full prehospitalization functional ability and that their recovery would be slower than that of younger patients. DESIGN: A prospective observational cohort study with convenience sampling. SETTING: Intensive care units of an urban university-affiliated Veterans Administration Medical Center. PARTICIPANTS: A total of 222 patients during the first 72 hours after entry to a medical or surgical ICU at the Denver Veteran's Administration Medical Center between September 1991 and July 1992. MEASUREMENTS: We collected baseline data on patient demographics and on the severity of acute illness using the Acute Physiology and Chronic Health Evaluation (APACHE II), Acute Physiology Score (APS), and functional status (highest level of physical activity level 1 month before admission). We recorded survival and patient-perceived global functional status at 6 weeks and 6 months after admission. Post-ICU function was adjusted for baseline function, age, APACHE II, and APS using multiple regression. RESULTS: Average patient age was 62+/-.74 years (mean +/- SEM). Fifty-two percent of the entire cohort returned to baseline function at 6 months. Although baseline function was better for younger people, there was no difference in recovery at 6 weeks in older compared with younger patients. Most functional recovery occurred by 6 weeks, with maintenance of this recovery at 6 months. Baseline function was the major determinant of both 6 week recovery (P < .001) and 6 month recovery (P = .002), whereas APACHE II was not (P = .3). Age predicted recovery significantly (P = .04) at 6 months but not at 6 weeks (P = .26). APACHE II (P < .001) and baseline function (P = .03) predicted mortality. CONCLUSIONS: Older people had worse functional ability at ICU admission, but the proportion of older people who recovered and their rate of recovery was the same as for younger people. Baseline functional status, rather than abnormal physiologic status (as measured by APACHE II) on admission, was the major determinant of recovery, whereas APACHE II was the main correlate of mortality. Together, baseline function and physiologic status provide valuable complementary information for clinically relevant outcomes following an ICU admission.

APACHE↗

PubMed2005

Quality of life may be affected more by disease parameters and response to therapy than by haemoglobin changes.

Earlier studies showing a negative impact of anaemia on quality of life (QOL) lack adequate adjustment for confounding factors such as disease stage and tumour response. We examined the impact of haemoglobin concentration on QOL scores of 745 multiple myeloma patients followed from diagnosis, adjusting for objective disease parameters. Data from two Nordic studies with the EORTC QLQ-C30 questionnaire were analysed using linear regression analysis. Haemoglobin was independently related only to fatigue at baseline (P = 0.001) and at 12 months (P = 0.010). In multivariate analysis, extent of skeletal disease was at least as strong a predictor for fatigue at diagnosis as haemoglobin and was also related to other important QOL scores such as physical functioning, role functioning, global QOL and pain (P < 0.001). At 12 months' follow-up, response to therapy was related to physical functioning (P < 0.001) and pain (P = 0.001). In conclusion, haemoglobin and extent of skeletal disease were both predictors for fatigue in patients with newly diagnosed multiple myeloma, but extent of skeletal disease was also associated with other important QOL scores. During follow-up, response to therapy emerged as an important predictor variable. When examining the effect of haemoglobin on QOL, it is essential to adjust for disease parameters and response to therapy in order not to overestimate the impact of haemoglobin on QOL. Our findings imply that uncontrolled studies on the effect of erythropoietin (EPO) in cancer patients may be making exaggerated claims for the effect of EPO on QOL.

Adult↗

PubMed1993

Treatment of cognitive impairment secondary to degenerative dementia. Effectiveness of oxiracetam therapy.

The effectiveness of Oxiracetam (1600 mg/day) versus placebo was assessed in a group of 96 out-patients suffering from cognitive disorders secondary to primary degenerative dementia. The study lasted twelve months and was performed in two stage, a) double-blind (26 weeks) and b) open study (26 weeks). The assessment of the results obtained at two, six and twelve months was carried out following both the methodology based on neuropsychological tests and scales, and the study of the simple reaction time by any of a computerized portable tachystoscope. The patients treated with Oxiracetam showed a statistically significant improvement of simple reaction time and cognitive function detected by the Attention matrix. In the placebo group after twelve months a significant worsening of cognitive and global function was observed in comparison with baseline scores. The patients themselves appeared in favor of Oxiracetam. The drug tolerability proved to be very good for the whole duration of the treatment. The authors believe that Oxiracetam favorably acts on the symptoms of senile cerebral deterioration and can improve the capability of information processing, as suggested by the better performances obtained at the reaction time test and at the Attentional Matrix test.

Aged↗

PubMed1998

Effects of critical coronary stenosis on global systolic left ventricular function quantified by pressure-volume relations during dobutamine stress in the canine heart.

OBJECTIVES: In this study we quantified the effects of a critical coronary stenosis on global systolic function using pressure-volume relations at baseline and during incremental dobutamine stress. BACKGROUND: The effects of coronary stenosis have previously been analyzed mainly in terms of regional (dys)function. Global hemodynamics are generally considered normal until coronary flow is substantially reduced. However, pressure-volume analysis might reveal mechanisms not fully exposed by potentially load-dependent single-beat parameters. Moreover, no systematic analysis by pressure-volume relations of the effects of dobutamine over a wide dose range has previously been presented. METHODS: In 14 dogs left ventricular volume and pressure were measured by conductance and micromanometer catheters, and left circumflex coronary flow by Doppler probes. Measurements in control and with left circumflex stenosis were performed at baseline and at five levels of dobutamine (2.5 to 20 microg/kg/min). The end-systolic pressure-volume relation (ESPVR) dP/dtMAX vs. end-diastolic volume (dP/dtMAX - V(ED)) and the relation between stroke work and end-diastolic volume (preload recruitable stroke work [PRSW]) were derived from data obtained during gradual caval occlusion. RESULTS: In control, dobutamine gradually increased heart rate up to 20 microg/kg/min, the inotropic effect blunted at 15 microg/kg/min. With stenosis, the chronotropic effect was similar, however, contractile state was optimal at approximately 10 microg/kg/min and tended to go down at higher levels. At baseline, the positions of ESPVR and PRSW, but not of dP/dtMAX - V(ED), showed a significant decrease in function with stenosis. No differences between control and stenosis were present at 2.5 microg/kg/min; the differences were largest at 15 microg/kg/min. CONCLUSIONS: Pressure-volume relations and incremental dobutamine may be used to quantify the effects of critical coronary stenosis. The positions of these relations are more consistent and more useful indices than the slopes. The positions of the ESPVR and PRSW show a reduced systolic function at baseline, normalization at 2.5 microg/kg/min and a consistent significant difference between control and stenosis at dobutamine levels of 5 microg/kg/min and higher.

Animals↗

PubMed2005

Assessment of quality of life of nasopharyngeal carcinoma patients with EORTC QLQ-C30 and H&N-35 modules.

PURPOSE: The current study reports on long-term quality of life (QoL) status after conventional radiotherapy in 187 nasopharyngeal carcinoma patients from 14 centers in Turkey. PATIENTS AND METHODS: Patients with the diagnosis of nasopharyngeal carcinoma, who were treated in 14 centers in Turkey with minimum 6 months of follow-up and were in complete remission, were asked to complete Turkish versions of EORTC QLQ-C30 questionnaire and the HN-35 module. Each center participated with the required clinical data that included age at diagnosis, gender, symptoms on admission, follow-up period, treatment modalities, radiotherapy dose, and AJCC 1997 tumor stage. Each patient's 33 QoL scores, which included function, global health status, and symptoms, were calculated as instructed in EORTC QLQ-C30 scoring manual. All of the scales and single-item measures range from 0 to 100. A high score represents a higher response level. Kruskal-Wallis and Mann-Whitney U nonparametric tests were used for comparisons. RESULTS: One hundred eighty-seven patients with median age of 46 years (range, 16-79 years) participated and completed the questionnaires. Median follow-up time was 3.4 years (range, 6 months-24 years). All patients have received external-beam radiotherapy. Beside external-beam radiotherapy, 59 patients underwent brachytherapy boost, 70 patients received concomitant chemotherapy, and 95 patients received adjuvant/neoadjuvant chemotherapy. Most of the patients in the analysis (75%) were in advanced stage (Stage III, n = 85 [45.4%]; Stage IV, n = 55 [29%]). Mean global health status was calculated as 73. Parameters that increased global health status were male gender, early-stage disease, and less than 4-year follow-up (p < 0.05). Functional parameters were better in males and in early-stage disease. Factors that yielded better symptom scores were short interval after treatment (10 scores), male gender (7 scores), and lower radiation dose (6 scores). Neoadjuvant or adjuvant chemotherapy did not have any effect on QoL, whereas concomitant chemotherapy adversely affected 5 symptom scores. CONCLUSION: Quality of life is adversely affected in our nasopharyngeal carcinoma patients treated with combined therapies. The factors that adversely affect quality of life are advanced tumor stage, female gender, and long-term follow-up. Further controlled studies to evaluate both preradiotherapy and postradiotherapy status are necessary to clarify the contribution of each treatment modality to QoL.

Adolescent↗

PubMed2006

Negligible senescence: how will we know it when we see it?

The recent public claim that "SENS is a practical, foreseeable approach to curing aging" has stirred considerable controversy among bio-gerontologists. Testing this hypothesis will not only require precise definitions for the somewhat subjective terms "practical," "foreseeable," and "curing," it will require a precise definition of the term "aging." To facilitate proper experimental design, this definition must focus on the nature of aging itself, not its causes or consequences. Aging in mammals is a process that begins early in adult life and continues steadily thereafter until death. It is manifested by a decline in the functional capacity (or, more precisely, reserve capacity) of a variety of vital physiologic systems leading to increasing risk of morbidity and mortality over time. Aging, however, cannot be measured by simply monitoring morbidity and/or mortality. Aging can only be measured by monitoring the decline of global functional capacity itself. This, in turn, will require an operational definition of aging expressed as a rate function (i.e., it will have units expressing aging as an overall rate of functional change per unit time). Widespread acceptance of such global indexes of aging rate in animal models and humans will greatly facilitate research activity specifically designed to increase the understanding of aging mechanisms and antiaging interventions.

Aging↗

PubMed1998

Beyond 'knock-out' mice: new perspectives for the programmed modification of the mammalian genome.

The emergence of gene inactivation by homologous recombination methodology in embryonic stem cells has revolutionized the field of mouse genetics. Indeed, the availability of a rapidly growing number of mouse null mutants has represented an invaluable source of knowledge on mammalian development, cellular biology and physiology and has provided many models for human inherited diseases. In recent years, improvements of the original 'knock-out' strategy, as well as the exploitation of exogenous enzymatic systems that are active in the recombination process, have considerably extended the range of genetic manipulations that can be produced. For example, it is now possible to create a mouse bearing a targeted point mutation as the unique change in its entire genome therefore allowing very fine dissection of gene function in vivo. Chromosome alterations such as large deletions, inversions or translocations can also be designed and will facilitate the global functional analysis of the mouse genome. This will extend the possibilities of creating models of human pathologies that frequently originate from various chromosomal disorders. Finally, the advent of methods allowing conditional gene targeting will open the way for the analysis of the consequence of a particular mutation in a defined organ and at a specific time during the life of a mouse.

Animals↗

PubMed2003

Organ conservation in invasive bladder cancer by transurethral resection, chemotherapy and radiation: results of a urodynamic and quality of life study on long-term survivors.

PURPOSE: Transurethral resection, chemotherapy and radiation with salvage cystectomy may be used as alternatives to immediate radical cystectomy in the management of invasive bladder cancer. Concern exists about the function of the retained bladder after such therapy. MATERIALS AND METHODS: Of 221 patients with clinical T2-4a bladder cancer treated at Massachusetts General Hospital from 1986 to 2000 with trimodality therapy, 71 were alive with native bladders and disease-free in 2001. These patients were asked to undergo a urodynamic study and to complete a quality of life questionnaire. A total of 69% participated in some component of this study with a median time from trimodality therapy of 6.3 years (range 1.6 to 14.9). RESULTS: Of 32 patients 24 had normally functioning bladders by urodynamic study. Decreased bladder compliance was seen in 7. Bladder hypersensitivity, involuntary detrusor contractions and incontinence were present in 2 women. The questionnaire showed that flow symptoms occurred in 6%, urgency in 15% and control problems in 19%. Of all women 11% wore pads. Distress from urinary symptoms was half as common as prevalence. Bowel symptoms occurred in 22% with 14% recording any level of distress. The majority of men retained sexual function. Global health related quality of life was high. CONCLUSIONS: The majority of patients treated with trimodality therapy retain good bladder function. A fifth have evidence of bowel dysfunction.

Aged↗

PubMed2006

GO-Diff: mining functional differentiation between EST-based transcriptomes.

BACKGROUND: Large-scale sequencing efforts produced millions of Expressed Sequence Tags (ESTs) collectively representing differentiated biochemical and functional states. Analysis of these EST libraries reveals differential gene expressions, and therefore EST data sets constitute valuable resources for comparative transcriptomics. To translate differentially expressed genes into a better understanding of the underlying biological phenomena, existing microarray analysis approaches usually involve the integration of gene expression with Gene Ontology (GO) databases to derive comparable functional profiles. However, methods are not available yet to process EST-derived transcription maps to enable GO-based global functional profiling for comparative transcriptomics in a high throughput manner. RESULTS: Here we present GO-Diff, a GO-based functional profiling approach towards high throughput EST-based gene expression analysis and comparative transcriptomics. Utilizing holistic gene expression information, the software converts EST frequencies into EST Coverage Ratios of GO Terms. The ratios are then tested for statistical significances to uncover differentially represented GO terms between the compared transcriptomes, and functional differences are thus inferred. We demonstrated the validity and the utility of this software by identifying differentially represented GO terms in three application cases: intra-species comparison; meta-analysis to test a specific hypothesis; inter-species comparison. GO-Diff findings were consistent with previous knowledge and provided new clues for further discoveries. A comprehensive test on the GO-Diff results using series of comparisons between EST libraries of human and mouse tissues showed acceptable levels of consistency: 61% for human-human; 69% for mouse-mouse; 47% for human-mouse. CONCLUSION: GO-Diff is the first software integrating EST profiles with GO knowledge databases to mine functional differentiation between biological systems, e.g. tissues of the same species or the same tissue cross species. With rapid accumulation of EST resources in the public domain and expanding sequencing effort in individual laboratories, GO-Diff is useful as a screening tool before undertaking serious expression studies.

Animals↗

PubMed1991

Subarachnoid hemorrhage of unknown etiology: early prognostic factors for long-term functional capacity.

Forty-one patients suffering subarachnoid hemorrhage (SAH) of unknown etiology were re-investigated at an average of 91 months after the bleed to determine functional capacity. Nineteen patients were performing at their previous level of work, five were employed part-time, and four could not work due to the SAH. Five patients showed a moderate disability in activities of daily living but were not dependent on help, one patient was severely disabled, and two had died. There was one rebleed. Early prognosis of an unfavorable outcome was possible on the basis of three clinical variables on admission: a history of hypertension, a Hunt and Hess grade of greater than II, and the presence of focal neurological deficits. In addition, the presence of an organic mental syndrome at discharge was identified as a predictive factor for reduced functional capacity later on. Other clinical variables in the acute stage, including sex, age, history of headache, interval between SAH and admission, impaired consciousness, and cognitive deficits, were not related to a limited functional level. Residual neurological deficits and the Glasgow Outcome Scale score on discharge were also not predictive of restrictions in global functions evaluated by means of the Karnofsky Performance Scale status at follow-up review.

Activities of Daily Living↗

PubMed1980

The diastolic mechanical properties of the intact left ventricle.

Recent studies have improved our understanding of the diastolic mechnical properties of intact myocardium. In order to obtain meaningful data, pressures external to the heart should be measured, forces and dimensions should be properly normalized, and measurements should be obtained over a wide range of ventricular volumes. Diastolic filling appears to be a passive phenomenon and is not affected significantly by systolic relaxation or mural inertia. Thus, the relationship between diastolic myocardial force and length is determined primarily by the elastic properties of the muscle and by viscous properties during dynamic filling. In the absence of ischemia, the diastolic mechanics of intact myocardium are not altered significantly by acute physiological interventions. Chronic changes in diastolic properties do occur, however, and are fundamentally important to the regulation of cardiac function. Myocardial creep induced by chronically elevated diastolic presssure produces ventricular dilatation, thereby altering chamber geometry, systolic loading, and overall global function. Thus, a detailed analysis of diastolic mechanical properties is essential to the assessment of the performance characteristics of the intact heart.

Animals↗

PubMed1994

[Dynamic cardiovascular studies with electron beam computed tomography].

Electron Beam CT (EBCT) is still emerging as a new functional imaging procedure in providing high morphological studies and dynamic quantitative functional data. Morphological EBCT studies have previously proven their usefulness in pathologic conditions of the thoracic aorta, in congenital diseases, in cardiac masses or tumors... Functional studies achieved using cine mode and/or flow mode are used to assess both mobility and perfusion of structures. Such dynamic analysis have confirmed that their applications will have a major impact on the knowledge of cardiac physiology, the understanding of cardiovascular diseases, if not in daily patient care. For instance, in studies on ventricular function, among the imaging modalities in current use, EBCT is probably most accurate for the evaluation of systolic regional or global function. EBCT is a cross-sectional imaging methods which overcome an important limitation shared by most other imaging modalities, namely the superimposition of overlapping cardiac and thoracic structures. Since in the method high spatial, contrast, and temporal resolution tomography displays the myocardial wall itself, an accurate delineating of endocardial and epicardial contours in contiguous levels can be obtained. Further developments in computer-automated analysis from dynamic EBCT studies have to be carried out to gain clinical acceptance and to facilitate the routine.

Cardiovascular Diseases↗

PubMedDate not supplied

[18-month follow-up of patients with schizophrenia].

This article presents the latest results of a 18 months follow-up study with schizophrenic patients, with the purpose to assess psychosocial functioning in the community after being discharged from a psychiatric hospital. The patients reported a satisfactory level of psychosocial and global functioning: mean = 2.4 at discharge; mean = 2.8 at six months (p < 0.05) and mean = 2.7 at 18 months follow-up. The use of medication was reduced from 62 per cent at six months to 59 per cent at 18 months by the patients, and the level of rehospitalization increased from 10 per cent at six months to 40 per cent at 18 months. Patients with no medication (t-test = p .001) and also rehospitalized patients (t-test = p .05) reported lower levels of satisfactory psychosocial functioning in comparison with patients under medication and also without rehospitalization. These results might contribute to a better psychosocial handling of schizophrenic patients in the community. The need for longitudinal follow-up research in Mexican schizophrenic patients is noted.

Adolescent↗

PubMedDate not supplied

Does "subthreshold" posttraumatic stress disorder have any clinical relevance?

The present report examined the extent to which subthreshold posttraumatic stress disorder (PTSD) (without lifetime PTSD) and full PTSD are associated with impairment or distress, controlling for comorbidity (i.e., major depression and panic disorder) in a sample of treatment-seeking psychiatric patients. Patients were administered diagnostic interviews and assessed for psychosocial impairment and whether or not they desired treatment for their PTSD symptoms. No significant differences were found between patients with full PTSD (N = 156) and those with subthreshold PTSD (N = 56) in degree of impairment (i.e., social and work functioning, as well as number of suicide attempts). In contrast, those with full PTSD had significantly more psychiatric hospitalizations and worse global functioning and were more likely to want treatment for their PTSD symptoms compared to those with subthreshold PTSD, albeit the majority of patients with subthreshold PTSD wanted treatment for their PTSD symptoms. These findings, like past research, suggest that subthreshold PTSD is associated with levels of social and work morbidity comparable to full PTSD. However, the report also underscores the difficulties in identifying a set of clinical criteria that clearly delineates between full PTSD and subthreshold PTSD.

Adult↗