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PubMed2001

Surgical treatment of hypothalamic hamartoma and refractory seizures: a case report and review of the literature.

Refractory gelastic seizures are often associated with hypothalamic hamartoma (HH). Presurgical evaluation in such children often points to a distinct cortical region as the source of the seizures. A case of a child with HH and refractory seizures is presented. Video-EEG monitoring revealed a well-defined epileptic focus in the left frontal region. In accordance with the current understanding of the nature of hamartoma-related seizures, the hamartoma was resected. Follow-up evaluations revealed a marked improvement in seizure frequency and global functioning.

Child, Preschool↗

PubMed1994

What predicts the persistence of delusional beliefs?

The persistence of delusional beliefs may to a marked degree influence the patients' global functioning. It is therefore clinically relevant to search for predictors of this course. In a study sample of 75 delusional first admitters such demographic, social and clinical variables were investigated which concern the course during 8 years. A number of variables had predictive value, e.g. characteristics of the delusional beliefs themselves such as theme and dimensions, absence of mood disturbance and subjective thought disorder but not hallucinations. The variables of diagnosis (schizophrenia according to the ICD-10 or the DSM-III-R at discharge from first admission) was a highly significant predictor of which only the following variables had a significant and independent predictive value: living alone, no psychosocial stressor, main delusion of persecution, and main delusion other than reference. In spite of the diagnostic uncertainty among first admitters the new systems of classification provide diagnostic categories as the most significant predictor of persistent delusional beliefs. Two logistic regression models for prediction are presented. In the presence of all independent predictors, the persistence of delusional beliefs is predicted for 94% of the present patient sample.

Adult↗

PubMed1996

Schizophreniform disorder: a 1-year follow-up study.

The study reports the preliminary data from a small 12-patient sample assessed at the time of their first psychotic episode and diagnosed as having a schizophreniform disorder. After a 1-year follow-up period all the patients were newly evaluated on clinical and global functioning variables, using clinical diagnosis as an outcome measure. A diagnostic stability in the schizophrenic spectrum was found.

Adult↗

PubMed1981

M-mode and two-dimensional echocardiographic features in cardiac amyloidosis.

Twenty-eight patients with cardiac amyloidosis were studied by echocardiography -- 26 by M-mode and 13 by two-dimensional (2D) studies. All had heart failure and biopsy-proved amyloidosis, M-mode features included (1) normal left ventricular (LV) dimension in all; (2) thickened ventricular septum (88%), LV posterior wall (77%), and right ventricular (RV) anterior wall (79%); (3) decreased thickening of ventricular septum (96%) and of LV posterior wall (65%) and reduced LV global function (62%); (4) left atrial enlargement (50%); and (5) pericardial effusion (58%). Two-dimensional echocardiography provided additional features: (1) thickened papillary muscles (five of 13); (2) thickened valves (four of 13); (3) better appreciation of thickened RV wall; and (4) a characteristic "granular sparkling" appearance of thickened cardiac walls -- presumably secondary to the amyloid deposit -- which was noted in 12 of 13 patients. Thus, M-mode echocardiography is helpful in the recognition of cardiac amyloidosis. However, the better appreciation with 2D echocardiography of thickened cardiac walls with a "granular sparkling" appearance in patients with unexplained cardiac failure is virtually diagnostic of cardiac amyloidosis.

Adult↗

PubMed1987

Transverse stiffness: a method for estimation of myocardial wall stress.

Determination of regional ventricular wall stress would allow quantification of both regional contractile state and its interplay with global function. Current methods for quantifying regional stress include mathematical modelling and measurements with strain gauges. Both methods are difficult to validate. We hypothesized that transverse stiffness (i.e., the ratio of indentation stress to strain as the ventricular wall is indented in the direction perpendicular to the wall) would be proportional to the stresses in the plane of the wall and could be used to estimate the latter. To test this hypothesis, 6 arterially perfused canine ventricular septa were mounted in an apparatus that could exert biaxial load in the plane of the wall. A servo system maintained the central third of the septa isometric during active contractions while the septa were paced at 30-60 pulses/min. In the center of the isometric region, a probe of 7 mm diameter indented the septa while the transverse indentation stress and strain were measured. For values of peak systolic in-plane stress from 0.56 to 2.6 g/mm2, the transverse stiffness varied from 1.2 to 11.7 g/mm2 and was linearly related to the in-plane wall stress in each septum (p less than 0.001, ANOVA). After cardioplegia, the transverse stiffness also correlated with passively applied wall stress for each dog (p less than 0.001). The slopes of the individual relations between transverse stiffness and wall stress from active contractions were similar to those from passively applied stress (mean +/- SEM; 1.82 +/- 0.36 versus 1.45 +/- 0.31, NS).(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

PubMed2003

Efficacy and tolerability of donepezil in vascular dementia: positive results of a 24-week, multicenter, international, randomized, placebo-controlled clinical trial.

BACKGROUND AND PURPOSE: Clinical observations suggest that patients with vascular dementia (VaD) may benefit from treatment with cholinesterase inhibitors. This study evaluated the efficacy and safety of donepezil for relieving symptoms of dementia in VaD. METHODS: Patients (n=603; mean age, 73.9 years; 55.2% men) with probable (70.5%) or possible (29.5%) VaD, according to criteria of the National Institute of Neurological Disorders and Stroke (NINDS) and the Association Internationale pour la Recherche et l'Enseignement en Neurosciences (AIREN), were randomized to 24 weeks of treatment with donepezil 5 mg/d (n=198), donepezil 10 mg/d (5 mg/d for first 28 days; n=206), or placebo (n=199). Analyses were based on the intent-to-treat population. RESULTS: At week 24, both donepezil groups showed significant improvement in cognition versus placebo on the Alzheimer's Disease Assessment Scale-cognitive subscale (mean change from baseline score effect size: donepezil 5 mg/d, -1.90; P=0.001; donepezil 10 mg/d, -2.33; P<0.001). Significant improvements in patients' global function were seen versus placebo at week 24 (observed cases), on the Clinician's Interview-Based Impression of Change-Plus version only for patients on donepezil 5 mg/d (P=0.014), and on the Sum of the Boxes of the Clinical Dementia Rating only for patients on 10 mg/d (P=0.007). Donepezil-treated patients showed significant benefits in activities of daily living over placebo on the Alzheimer's Disease Functional Assessment and Change Scale (mean change from baseline score effect size at week 24: donepezil 5 mg/d, -1.31, P=0.02; donepezil 10 mg/d, -1.31, P=0.02). Donepezil was well tolerated. Withdrawal rates due to adverse events were relatively low (placebo, 11.1%; donepezil 5 mg/d, 11.1%; donepezil 10 mg/d, 21.8%; P=0.005 versus placebo). CONCLUSIONS: These data demonstrate that donepezil is an effective and well-tolerated treatment for VaD and show it may have an important place in the management of this condition.

Activities of Daily Living↗

PubMed1986

The prognostic significance of obsessive-compulsive symptoms in schizophrenia.

Obsessive-compulsive symptomatology has been described in schizophrenia for more than 60 years, but its clinical significance has yet to be explored systematically. This report details the clinical characteristics and long-term course of a group of 21 schizophrenic patients with prominent obsessive-compulsive symptoms from the Chestnut Lodge Follow-Up Study. While this group differed on admission only minimally from schizophrenic patients without obsessive-compulsive symptoms, their long-term outcome in the areas of social relations, employment, psychopathology, and global functioning was significantly, and almost uniformly, poorer. Persistent obsessive-compulsive symptoms thus appear to be a powerful predictor of poor prognosis in schizophrenia.

Adolescent↗

PubMed1994

Psychopathology in male and female intravenous drug users with and without HIV infection.

OBJECTIVE: The authors report on results of systematic clinical assessment of psychopathology among HIV-positive and HIV-negative intravenous drug users. METHOD: As part of a multidisciplinary baseline assessment, 147 male (85 HIV-positive and 62 HIV-negative) and 76 female (39 HIV-positive and 37 HIV-negative) intravenous drug users were evaluated with the Structural Clinical Interview for DSM-III-R and measures of psychiatric symptom severity, global functioning, and stress. RESULTS: Prevalence of a diagnosis of current depression (26%) and severity of depressive and anxiety symptoms in both HIV-positive and HIV-negative subjects were greater than in the general community, but not greater than in other studies of intravenous drug users. HIV-positive men had a higher prevalence of depressive disorders than HIV-negative men (33% and 16%, respectively), although this pattern was not found among women (26% and 30%). Diagnosis of depressive disorders and severity of depressive and anxiety symptoms were associated with a symptom-based measure of HIV illness stage, but not with indices of immune functioning (CD4+ cell count and CD4+ cell percent). CONCLUSIONS: Despite selective associations between HIV illness variables and depression, high rates of depression across HIV status in this cohort suggest that intravenous drug use and associated factors are more salient than HIV illness factors in understanding psychopathology in this population.

Anxiety Disorders↗

PubMed2006

Predictors of 2-year outcome for patients with borderline personality disorder.

OBJECTIVE: The primary purpose of this report was to investigate whether characteristics of subjects with borderline personality disorder observed at baseline can predict variations in outcome at the 2-year follow-up. METHOD: Hypothesized predictor variables were selected from prior studies. The patients (N=160) were recruited from the four clinical sites of the Collaborative Longitudinal Personality Disorders Study. Patients were assessed at baseline and at 6, 12, and 24 months with the Structured Clinical Interview for DSM-IV Axis I Disorders; the Diagnostic Interview for DSM-IV Personality Disorders, a modified version of that instrument; the Longitudinal Interval Follow-Up Evaluation; and the Childhood Experiences Questionnaire-Revised. Univariate Pearson's correlation coefficients were calculated on the primary predictor variables, and with two forward stepwise regression models, outcome was assessed with global functioning and number of borderline personality disorder criteria. RESULTS: The authors' most significant results confirm prior findings that more severe baseline psychopathology (i.e., higher levels of borderline personality disorder criteria and functional disability) and a history of childhood trauma predict a poor outcome. A new finding suggests that the quality of current relationships of patients with borderline personality disorder have prognostic significance. CONCLUSIONS: Clinicians can estimate 2-year prognosis for patients with borderline personality disorder by evaluating level of severity of psychopathology, childhood trauma, and current relationships.

Adult↗

PubMed2005

Differences in clinical features and mental health service use in bipolar disorder across the lifespan.

OBJECTIVE: Because of the scarcity of research in geriatric bipolar disorder, the authors examined the prevalence, clinical features, and service use of persons with bipolar disorder among older adults treated in a large public mental health system. METHODS: From San Diego County's Adult and Older-Adult Mental Health Services database (N=34,970, fiscal year 2002-2003), the authors selected patients with bipolar disorder, divided them into three age-groups (young: age 18-39, middle-aged: age 40-59, and elderly: age 60+) and compared them on demographic, clinical, and mental health service use characteristics. RESULTS: The authors identified 2,903 patients who received services for bipolar disorder at least once during the fiscal year, accounting for a slightly lower proportion of diagnosis among elderly patients (7.0%) than middle-aged (8.7%) or younger groups (8.3%). Elderly patients were less likely to have substance use disorder comorbidity, but more likely to have a cognitive disorder diagnosis and lower global functioning scores than their younger counterparts. Elderly bipolar patients were less likely than younger groups to use inpatient, outpatient, and emergency room psychiatric care, but more likely to use case-management and conservator services. DISCUSSION: Bipolar disorder was only slightly less common among elderly patients in a large, public mental health system, compared to younger age-groups. Available clinical data revealed a mixed picture of bipolar disorder in late life, with more functional and cognitive impairment and less substance use disorder comorbidity and use of acute psychiatric services. Our findings suggest that older adults with bipolar disorder have unique mental health service needs.

Adolescent↗

PubMed2003

The schizophrenia phenotype in 22q11 deletion syndrome.

OBJECTIVE: This study investigated the schizophrenia phenotype in 24 subjects with 22q11 deletion syndrome (22qDS) and schizophrenia (22qDS-schizophrenia), a rare but relatively homogenous genetic subtype of schizophrenia associated with a microdeletion on chromosome 22. Individuals with 22qDS are at genetically high risk for schizophrenia. METHOD: Standard measures of signs, symptoms, and course of schizophrenia were assessed in 16 adults with 22qDS-schizophrenia who did not meet criteria for mental retardation and in 46 adults with schizophrenia without evidence of 22qDS from a community familial sample. RESULTS: There were no significant differences in age at onset, lifetime or cross-sectional core positive and negative schizophrenic symptoms, or global functioning between the two groups of patients with schizophrenia. Patients with 22qDS-schizophrenia had higher excitement subscale scores and less lifetime substance use than the comparison patients with schizophrenia, but no significant differences in anxiety-depression symptom severity were found between the groups. CONCLUSIONS: These findings indicate that the core clinical schizophrenia phenotype would not distinguish individuals with a 22qDS subtype from those with schizophrenia who did not have the 22qDS subtype. The results provide further support for the utility of 22qDS-schizophrenia as a neurodevelopmental model of schizophrenia as well as support for prospective studies of individuals with 22qDS to help identify precursors of schizophrenia.

Adult↗

PubMed2002

Inpatient psychotherapy compared with usual care for patients who have schizophrenic psychoses.

The study examined whether some patients with schizophrenia benefit from intensive inpatient psychodynamic psychotherapy while others are harmed by it. Multiple regression analyses were conducted with combined data from a follow-up study of 25 inpatients who were treated in a psychotherapeutic program and a follow-up study of 71 patients who received standard hospital treatment. The mean duration of the follow-up period was seven years. The analyses showed that improvement in global mental health status from the index admission to follow-up was associated with the type of treatment and with the patient's clinical condition at the index admission. A strong interaction effect was found between these two variables. Psychotherapeutic inpatient programs may be beneficial to patients who have higher levels of global functioning at the start of treatment but detrimental to other patients.

Follow-Up Studies↗

PubMed2002

Psychodynamic psychotherapy and clomipramine in the treatment of major depression.

OBJECTIVE: The authors compared a combination of clomipramine and psychodynamic psychotherapy with clomipramine alone in a randomized controlled trial among patients with major depression. METHODS: Seventy-four patients between the ages of 20 and 65 years who were assigned to ten weeks of acute outpatient treatment for major depression were studied. Bipolar disorder, psychotic symptoms, severe substance dependence, organic disorder, past intolerance to clomipramine, and mental retardation were exclusion criteria. RESULTS: Marked improvement was noted in both treatment groups. Combined treatment was associated with less treatment failure and better work adjustment at ten weeks and with better global functioning and lower hospitalization rates at discharge. A cost savings of 2,311 dollars per patient in the combined treatment group, associated with lower rates of hospitalization and fewer lost work days, exceeded the expenditures related to providing psychotherapy. CONCLUSIONS: Provision of supplemental psychodynamic psychotherapy to patients with major depression who are receiving antidepressant medication is cost-effective.

Adult↗

PubMed2003

Pervasive developmental disorders among children and adolescents attending psychiatric day treatment.

OBJECTIVE: This study sought to determine the prevalence of pervasive developmental disorders (PDD) among children admitted to a state hospital day treatment service and to characterize the psychiatric disturbance of patients with PDD. METHODS: A total of 146 consecutively admitted patients were evaluated for PDD. Patients who had PDD were compared with a sample of age- and sex-matched patients in day treatment who did not have PDD. Psychiatric symptoms, family history, and developmental and educational histories were examined. RESULTS: Of the 146 patients, 20 (14 percent) met criteria for PDD. An additional five patients who had PDD were included, yielding a final sample of 25. Only two of an array of psychiatric symptoms were more prevalent among patients with PDD: engaging in unusual fantasy and talking to themselves, animals, or inanimate objects. Significantly more patients with PDD had a history of speech delay, language abnormalities, and inexplicable or lengthy episodes of crying or screaming. The groups did not differ significantly in IQ or global functioning. Seven patients with PDD (28 percent) met criteria for childhood-onset schizophrenia, and 19 (76 percent) had symptoms of a tic disorder. CONCLUSIONS: The study found that PDD is not rare and that children with PDD represent a significant subgroup of children with serious emotional disturbance referred for psychiatric treatment. The findings support the view that PDD may be easily missed because it may be mild and associated with psychiatric disturbances that are present among other severely ill youngsters.

Adolescent↗

PubMed2001

Cognitive-behavioral family treatment of childhood obsessive-compulsive disorder: preliminary findings.

The effectiveness of a 14-week cognitive-behavioral family treatment protocol for childhood obsessive-compulsive disorder (OCD) was piloted using a volunteer sample of seven children aged 10-14 years. The primary outcome measures were diagnostic status, symptom severity, and global functioning which were assessed at pre- and post-treatment, and at three-month follow-up. A series of self-report measures assessing obsessive-compulsive symptomatology, depression, and family factors were also completed at pre- and post-treatment. The results indicated that six participants no longer met criteria for OCD at post-treatment, with a mean reduction of 60% in symptom severity. Self-reported obsessive-compulsive symptomatology and family involvement in the disorder also significantly decreased across time. The findings support the efficacy of cognitive-behavioral treatment with a structured family component for childhood OCD. Further research investigating the comparative efficacy of treatment with and without family involvement is warranted.

Adolescent↗

PubMed2006

Use of outpatient mental health services by depressed and anxious children as they grow up.

OBJECTIVE: Childhood-onset psychiatric disorders can be persistent and impairing but often go untreated. Affected individuals' treatment utilization into adulthood is not well understood. A 15-year follow-up of depressed, anxious, and never mentally ill children (control group) examined need, predisposing, and enabling factors associated with use of outpatient mental health care into early adulthood. METHODS: Between 1977 and 1985, a total of 315 children and adolescents were ascertained. Their psychiatric status and treatment utilization into adulthood were reassessed between 1991 and 1997 by clinicians blind to their childhood diagnoses. RESULTS: Respondents ascertained for depression demonstrated 13-fold, and those ascertained for anxiety demonstrated six-fold, greater odds of any treatment compared with controls. Among utilizers, childhood depression conferred 14-fold, and childhood anxiety, 23-fold, increased odds of long-term treatment. Blacks were less likely than whites to obtain treatment. Utilizers older at follow-up reported longer treatment duration. Mood disorder episodes over follow-up and poorer global functioning were associated with both increased odds of any utilization and increased treatment duration among utilizers. CONCLUSIONS: This sample demonstrated high and persistent treatment utilization. Need indicated by childhood diagnosis was the strongest predictor of treatment; however, utilization also differed by race or ethnicity. Strategies to maximize the uptake of effective, culturally relevant treatment approaches should be investigated.

Adolescent↗

PubMed1995

Therapeutic alliance and outcome in a VA intensive case management program.

A total of 143 clients and their case managers in a Veterans Affairs (VA) intensive case management program modeled on the Program for Assertive Community Treatment rated their therapeutic alliance after two years in the program. Strong case-manager-rated alliance was associated with reduced symptom severity and improved global functioning as rated by independent assessors; it was also associated with higher client ratings of community living skills and more positive outcome as perceived by both clients and case managers. Strong client-rated alliance was associated only with more positive client-perceived outcome. Alliance ratings were not associated with use of inpatient psychiatric hospitalization. The case manager-client alliance appears to be a significant component of therapeutic effectiveness.

Activities of Daily Living↗

PubMed1996

A preliminary study of partial hospital management of severe obsessive-compulsive disorder.

OBJECTIVE: The study examined the effectiveness of a partial hospital treatment program combining behavioral therapy, medication, and psychosocial intervention for severe and treatment-resistant obsessive-compulsive disorder. METHODS: A total of 58 patients with a primary diagnosis of obsessive-compulsive disorder who underwent treatment in a partial hospital program were assessed at baseline, at program discharge, and at six-, 12-, and 18-month follow-ups. Obsessive-compulsive symptoms, depression, anxiety symptoms, and global functioning were rated. RESULTS: The majority of patients (71 percent) met the criterion for a successful outcome, which was a 25 percent decrease in score on the Yale-Brown Obsessive Compulsive Scale (YBOCS). Fifty-five percent finished the program with YBOCS scores of 16 or less, indicating only mild symptoms. Most of these patients sustained their improvement at six, 12, and 18 months after discharge, and many showed further improvement with continued outpatient management. CONCLUSIONS: The partial hospital treatment program for obsessive-compulsive disorder appears to be an effective intervention that should be implemented and investigated further.

Adolescent↗