SEARCH · PubMed Health

Results for “global functioning”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 1,675 records · Page 93Linked to original sources

PubMed1991

Discriminant analysis of a sexual-functioning inventory with intrafamilial and extrafamilial child molesters.

Several suggestions have been offered by clinicians who work with sex offenders concerning etiological distinctions between incest offenders and extrafamilial child molesters. In this study we hypothesized that nonincestuous child molesters would have more sexual problems in general than would incestuous offenders. Ninety-five incest offenders and 127 nonincestuous child molesters were administered the Derogatis Sexual Functioning Inventory (DSFI), a self-report instrument. On the global Sexual Functioning Index the total sample of child molesters scored below the first percentile compared to the normative sample. In a direct discriminant analysis of the 10 subscales, satisfaction, fantasy, and experience were the principle variables discriminating between incestuous and nonincestuous offenders. Incest offenders were higher on experience and satisfaction and lower on fantasy. However, the discriminant analysis failed to yield clinically relevant distinctions between the sexual problems of extrafamilial and intrafamilial child molesters. DSFI scores for both groups indicated that their overall level of sexual functioning is poor relative to the general population.

Child↗

PubMed1996

User requirements on the future laboratory information systems.

Today numerous information technology solutions exist for the clinical laboratory which operate either as stand-alone functionalities or with ad hoc integration solutions. The OpenLabs (A2028) AIM Project puts emphasis on the design and specification of a framework for the interoperability of existing systems and new advanced services, and consequently concentrates on the issue of integration. The purpose of the OpenLabs open architecture is to serve as a functional solution to this integration. A basic principle for this open architecture is that each of the advanced services shall be able to function individually or in any combination with an existing Laboratory Information System (LIS), and that it shall enable new modular functionalities to be incorporated in a 'plug-and-play' fashion. The synthesis of the main user needs and requirements implies that the future IT solutions: (a) must be highly flexible and maximally customizable--by the users themselves; (b) are based on the concept of open systems, both technically and functionally, which enables modular functionalities from different vendors to co-operate forming a global LIS functionality; (c) are future viable and able to incorporate already installed IT functionalities; (d) support management of failure prevention, of repair, of success, and of change. The establishment of an open architecture implies that a market will develop for modular, scaleable, and cost-effective LIS features without today's dependence on individual manufacturers and hardware/software platforms.

Clinical Laboratory Information Systems↗

PubMed1993

Coupling between regional myocardial oxygen consumption and contraction under altered preload and afterload.

OBJECTIVES: This study was designed to assess the relation between left ventricular regional myocardial oxygen consumption (VO2) and variables of regional myocardial contractile function under various loading conditions. BACKGROUND: Although the relation between global VO2 and global ventricular function has been extensively studied, the relation between regional VO2 and regional myocardial contraction is not fully understood. METHODS: Myocardial shortening (regional area shrinkage), regional work, regional total mechanical energy index and regional VO2 were measured under variously altered loading conditions in the isolated, blood-perfused dog left ventricle. Regional total mechanical energy per beat was quantified by wall tension-regional area area (TAA) by the analogy of left ventricular pressure-volume area. Left ventricular loading conditions were altered by changing end-diastolic volume and stroke volume with a servo pump as follows: 1) increased preload (increased end-diastolic volume and stroke volume at a constant ejection fraction), 2) decreased afterload (increased stroke volume at a constant end-diastolic volume), 3) increased preload and afterload (increased end-diastolic volume at a constant stroke volume), and 4) altered mode of contraction (ejecting vs. isovolumetric contractions). RESULTS: During increased preload, all three variables correlated positively with regional VO2 (r = 0.78 to 1.00). During decreased afterload, the correlation was negative for area shrinkage (r = -0.65 to -0.91) and variable for regional work (r = -0.55 to 0.98) but positive and highly linear for TAA (r = 0.80 to 0.99). During increased preload and afterload, the correlation was again negative for area shrinkage (r = -0.77 to -0.97) but positive for regional work (r = 0.83 to 0.93) and TAA (r = 0.95 to 0.99). During altered mode of contraction, the correlation was insignificant for area shrinkage (r = 0.24 to 0.57) and moderate for regional work (r = 0.50 to 0.79), whereas again highly linear for TAA (r = 0.95 to 0.98). Thus, only TAA correlated closely with regional VO2 under any loading conditions. Furthermore, the slope and regional VO2 intercept of the regional VO2-TAA relation was remarkably consistent among the different hearts and loading conditions. CONCLUSIONS: We conclude that there is a tight coupling between regional VO2 and regional total mechanical energy represented by TAA regardless of left ventricular afterload and preload conditions.

Animals↗

PubMed2003

Impact of diabetes on cognitive function among older Latinos: a population-based cohort study.

BACKGROUND AND OBJECTIVES: Type 2 diabetes, which is highly prevalent in older Mexican Americans, may influence cognitive functioning. We examined the association of diabetes with decline in global cognitive function and memory function over a 2-year period. METHODS: Study subjects were derived from an existing cohort of Latinos aged 60 and over in the SALSA project (n=1,789). Statistical analysis was conducted using logistic regression and a generalized estimating equation (GEE). RESULTS: Logistic regression analysis indicated that baseline diabetes was a significant predictor of major cognitive impairment in Modified Mini Mental State Exam (3MSE) (OR=1.68, 95% CI=1.21, 2.34) and word-list test (OR=1.31, 95% CI=0.99, 1.75). GEE analysis showed that there was no significant difference between diabetic and nondiabetic subjects in change of cognitive scores over 2 years (3MSE, mean=-0.58, 95% CI=-1.48, 0.32; word-list test, mean=-0.10, 95% CI=-0.32, 0.11). CONCLUSIONS: More diabetic complications were associated with major cognitive decline among diabetic subjects. Research on long-term impact of treatment for type 2 diabetes is warranted.

Aged↗

PubMed2002

The Key Behaviors Change Inventory and executive functioning in an elderly clinic sample.

The Key Behaviors Change Inventory (KBCI) was developed to assess executive, behavioral, and emotional functioning following brain insults and to track the course of recovery. The purpose of this study was to investigate, in an elderly memory disorder clinic sample, the convergent and discriminant validity of the KBCI by examining the relationships between various measures of executive functioning and the KBCI scales that theoretically relate to executive functions. The KBCI was administered to the caregivers of 97 consecutive patients who came to a memory disorders clinic seeking services. The KBCI scales of Inattention, Apathy, Unawareness of Problems, and Communication Problems were significantly correlated with cognitive measures of executive functioning but not with measures of memory, visuospatial abilities or global cognitive functioning. In contrast, KBCI scales of Interpersonal Difficulties, Somatic Difficulties, and Emotional Adjustment were not related to any cognitive measures, either executive or nonexecutive. Contrary to predicted findings, the Impulsivity Scale was not associated with cognitive measures of executive functioning. This lack of relationship most likely reflects the failure to include executive measures of orbitofrontal functioning in this study. Results provide convergent and discriminant validity support for the KBCI. The KBCI may be a useful tool for assessing and tracking the executive, behavioral, and emotional sequelae of neurologic disorders.

Adaptation, Psychological↗

PubMed1992

Improved isovolumetric relaxation in canine reperfused myocardium after beta 1 adrenergic stimulation.

OBJECTIVE: beta 1 Adrenergic stimulation with the partial agonist xamoterol improves the systolic recovery of reperfused ("stunned") myocardium. The effects of this agent on isovolumetric relaxation and diastolic ventricular filling were evaluated. METHODS: In 15 open chest dogs, the distal left circumflex coronary artery was occluded for 15 min and then reperfused. Eight dogs served as placebo controls, and seven received xamoterol (100 micrograms.kg-1 intravenously) at 10 min reperfusion. Diastole was divided into an isovolumetric relaxation phase and a subsequent filling phase, and wall excursion velocities were calculated. RESULTS: In the control group isovolumetric wall thinning velocity in the reperfused myocardium recovered only slowly, from -5.67(SD 5.29) mm.s-1 at 10 min reperfusion to -4.84(6.35) mm.s-1 at 30 min reperfusion and 2.99(7.97) mm.s-1 at 8 h reperfusion. Xamoterol increased isovolumetric wall thinning velocity in the reperfused myocardium, from -7.78(6.25) mm.s-1 at 10 min reperfusion to 3.43(6.09) mm.s-1 at 30 min reperfusion, and 12.04(5.66) mm.s-1 at 8 h reperfusion, whereas wall thinning velocity during the filling phase was unaffected. At 8 h reperfusion the difference between the groups was still significant. When compared with the effects on systolic wall thickening velocity, the impairment of isovolumetric wall thinning velocity during occlusion and the improvement due to xamoterol were both more marked. These functional differences were not reflected by the two indices of global diastolic function, peak negative dP/dt and relaxation constant tau. CONCLUSIONS: beta 1 Adrenergic stimulation with xamoterol improves isovolumetric relaxation in reperfused myocardium more markedly than systolic contraction, but it has no direct effect during diastolic filling.

Adrenergic beta-Agonists↗

PubMed1989

Self-report questionnaire scores in rheumatoid arthritis compared with traditional physical, radiographic, and laboratory measures.

STUDY OBJECTIVE: To assess whether scores on a simple self-report questionnaire to depict the clinical status of patients with rheumatoid arthritis are correlated with traditional measures of physical, radiographic, laboratory, functional, and global status. DESIGN: The self-report questionnaire was administered at the same time the following variables were assessed: American Rheumatism Association functional class, joint count, hand radiograph, erythrocyte sedimentation rate, rheumatoid factor titer, walking time, grip strength, button test, and global self-assessment. SETTING: University rheumatology clinic, the rheumatology clinic of a Veterans Administration hospital, and a private rheumatology practice. PATIENTS: The study included 259 patients who met the criteria of the American Rheumatism Association for a diagnosis of definite or classic rheumatoid arthritis. INTERVENTIONS: Standard rheumatologic care for patients with rheumatoid arthritis. MEASUREMENTS AND MAIN RESULTS: Self-report questionnaire scores were significantly correlated with the joint count, radiographic score, erythrocyte sedimentation rate, grip strength, button test, walking time, American Rheumatism Association functional class, and global self-assessment. Patients were categorized into five questionnaire score categories of 1.00, indicating no dysfunction, and 1.01 to 1.50, 1.51 to 2.00, 2.01 to 3.00, and 3.01 to 4.00, indicating progressive dysfunction. In these five categories, more than ten involved joints were seen in 11%, 37%, 67%, 79%, and 100% of patients, respectively, and erythrocyte sedimentation rates greater than 20 mm/h in 29%, 49%, 64%, 74%, and 85% of patients, respectively. Similar results were seen for other physical and radiographic measures. The questionnaire score was as effective in explaining other measures of clinical status as was any other available measure. CONCLUSIONS: A simple self-report questionnaire provides information similar to many traditional measures in rheumatoid arthritis and appears to be an attractive, cost-effective approach to assessing and monitoring quantitatively the status of an individual patient.

Activities of Daily Living↗

PubMed2006

Global-local visual processing in high functioning children with autism: structural vs. implicit task biases.

Global-local processing was examined in high-functioning children with autism and in groups of typically developing children. In experiment 1, the effects of structural bias were tested by comparing visual search that favored access to either local or global targets. The children with autism were not unusually sensitive to either level of visual structure. In experiment 2 a structural global bias was pitted against an implicit task bias favoring the local level. Children with autism were least sensitive to the structural global bias but showed greater sensitivity to the implicit task bias. This suggests that autism is associated with differences in the executive control processes used to guide attention to either the global or local level, and strategies may be more "data driven".

Attention↗

PubMed2004

A feasibility study of the childhood depression medication algorithm: the Texas Children's Medication Algorithm Project (CMAP).

OBJECTIVE: To evaluate the feasibility and impact on clinical response and function associated with the use of an algorithm-driven disease management program (ALGO) for children and adolescents treated for depression with or without attention-deficit/hyperactivity disorder (ADHD) in community mental health centers. METHOD: Interventions included (1). medication algorithms, (2). clinical and technical support for the physician, (3). uniform chart documentation of outcomes, and (4). a patient/family psychoeducation program. Children eligible for entry into the study were referred to the child psychiatrist for initiation or change in medicine. Outcomes of treatment with the ALGO for up to 4 months are presented. Measures of change included clinical symptoms, functioning, and global improvement (Clinical Global Impression Scale). A historical chart cohort from the same clinics was used as a quasi-control. RESULTS: Thirty-nine individuals (depression = 24; comorbid depression with ADHD = 15) were enrolled for treatment with ALGO. One hundred fourteen children were in the control cohort (74 depressed, 40 comorbid). For the ALGO groups, Children's Depression Rating Scale-Revised depression severity scores decreased from 48.2 to 32.5 and Child Adolescent Functioning Assessment Scale function scores improved from 70.3 to 40.9 (all p < or =.0005). Clinical Global Impression Scale severity scores decreased from 5.7 to 3.7 in ALGO compared to only 5.8 to 4.8 in the control (p <.003). CONCLUSIONS: There was clear improvement in clinical symptoms, functioning, and global response with ALGO treatment. The magnitude of the improvement was greater in children and adolescents treated with the ALGO program compared with a historical cohort. These data support the need for controlled studies in larger populations examining the effects of algorithm-driven disease management programs on the clinical outcomes of children with mental illness.

Adolescent↗

PubMed2002

Investigations on rhizoplane Actinobacteria communities of papyrus (Cyperus papyrus) from an Egyptian wetland.

Wetlands have important global ecological functions, which include carbon storage and water interception. Wetland contributes to the maintenance of regional and global biodiversity. Though many important wetland ecological functions are based on microbial metabolism, we have scanty knowledge on microbial diversity in wetlands. Plant rhizoplane habitats are considered to harbor highly diverse bacterial communities. Most of the floating mats on river Nile are dominated by papyrus (Cyperus papyrus). Papyrus root samples were collected from a floating mat at the "Gold Island" inside the Nile River at Cairo, Egypt in February 1996 and May 1997 in order to investigate the rhizoplane actinobacteria communities. The root-tip regions were cut off, repeatedly washed, macerated and plated. Using the plate-count technique with three actinobacteria media, an average of 2.1 x 10(4) CFUg-1 root actinobacteria were obtained. All actinobacteria colonies were isolated, purified and investigated by classical and molecular methods. In the papyrus rhizoplane Streptomyces anulatus, Micromonospora sp., Rhodococcus luteus, Verrucosispora gifhornensis and Aureobacterium liquefaciens dominated, moreover Actinoplanes utahensis, and Str. diastaticus were also present. The physiological traits of the members of dominant groups revealed that these bacteria might be active in the rhizoplane and can be present there is their vegetative forms.

Actinobacteria↗

PubMed1994

Assessment of left ventricular dysfunction by nuclear cardiology.

Nuclear cardiology techniques may be of help in evaluating the patient with symptoms of congestive heart failure and ventricular dysfunction in two respects: quantification of functional parameters by radionuclide angiography, and differentiation of viable from nonviable myocardium by perfusion and metabolic imaging. Left ventricular ejection fraction and volumes can be accurately assessed by equilibrium radionuclide angiography with a count-based method without any geometric assumptions. Indeed, because of its high reproducibility, this method is particularly suited for making sequential measurements in the same patient. The distinction between viable or reversible and scarred or irreversible dysfunctional myocardium can be made on the basis of myocardial perfusion, cell membrane integrity, and metabolic activity. Thallium myocardial imaging is used clinically to assess the first two parameters based on experimental data. Two clinical methods may be applied to the detection of viability: stress-redistribution-reinjection imaging or rest-redistribution imaging. In both of these, the severity of the reduction in thallium activity should be assessed to discriminate viable from nonviable myocardium. Stress-redistribution-reinjection thallium imaging should be the first approach, if possible, because inducible ischemia is a much more significant clinical variable in a patient with ventricular dysfunction in terms of management and risk assessment than is knowledge of myocardial viability. Positron emission tomography (PET) provides enhanced image resolution and correction for body attenuation, thereby overcoming the two major limitations of thallium imaging. In addition, it provides the capacity to quantitate regional blood flow and to assess regional metabolic activity independent of flow. Overall, the accuracies of thallium imaging (around 70%) and PET imaging (around 82%) are similar for the prediction of segmental changes after revascularization. However, in patients with poor global left ventricular function, the accuracy of PET seems to be better. Further studies are needed in a large number of patients evaluated for regional and global function to establish algorithms using thallium and PET imaging in dysfunctional myocardium. Dobutamine echocardiography should also be evaluated in these algorithms.

Cardiology↗

PubMed2003

The natural course of bulimia nervosa and eating disorder not otherwise specified is not influenced by personality disorders.

OBJECTIVE: To examine prospectively the natural course of bulimia nervosa (BN) and eating disorder not otherwise specified (EDNOS) and to test the effects of personality disorder (PD) comorbidity on the outcomes. METHOD: Ninety-two female patients with current BN (N=23) or EDNOS (N=69) were evaluated at baseline enrollment in the Collaborative Longitudinal Personality Disorders Study (CLPS). Eating disorders (EDs) were assessed with the Structured Clinical Interview for DSM-IV Axis I Disorders. Personality disorders (PDs) were assessed with the Diagnostic Interview for DSM-IV PD (DIPD-IV). The course of BN and EDNOS was assessed with the Longitudinal Interval Follow-up Evaluation and the course of PDs was evaluated with the Follow-Along version of the DIPD-IV at 6, 12, and 24 months. RESULTS: Probability of remission at 24 months was 40% for BN and 59% for EDNOS. To test the effects of PD comorbidity on course, ED patients were divided into groups with no, one, and two or more PDs. Cox proportional regression analyses revealed that BN had a longer time to remission than EDNOS (p<.05). The number of PDs was not a significant predictor of time to remission, nor was the presence of Axis I psychiatric comorbidity or Global Assessment of Functioning scores. Analyses using proportional hazards regression with time-varying covariates revealed that PD instability was unrelated to changes in ED. CONCLUSIONS: BN has a worse 24-month course (longer time to remission) than EDNOS. The natural course of BN and EDNOS is not influenced significantly by the presence, severity, or time-varying changes of co-occurring PDs, co-occurring Axis I disorders, or by global functioning.

Adolescent↗

PubMed1986

Regional myocardial protection by retrograde coronary sinus infusion of cardioplegic solution.

Antegrade administration of a cardioplegic solution in the presence of a coronary artery stenosis may lead to the heterogeneous distribution of the agent and poor myocardial cooling distal to a vessel stenosis. To determine the effects of retrograde coronary sinus infusion of cardioplegic solution, coronary stenosis was created in the canine preparation by occluding the left circumflex artery (LCx) during cardioplegic arrest. Left ventricular global and regional function (assessed by sonomicrometry and solid-state micrometers) were studied after 60 min of ischemic arrest. Three groups (all n = 7) were studied: group I (control), cardioplegic solution infused via the aortic root without LCx occlusion; group II, same as group I except with LCx occlusion; group III, retrograde coronary sinus infusion of cardioplegic solution with LCx occlusion. Heart rate was controlled by atrial pacing. Statistically significant differences in global function between the three groups were seen at low filling pressures but were not seen during volume challenge. However, the recovery ratio of regional function in the LCx area at a left atrial pressure of 5 mm Hg in group II was 77.2% (% shortening) and 48.5% (segment work), which was significantly less (p less than .01) than recovery in group I (111.7% and 75.9%) and group III (108.3% and 81.5%). These differences persisted during volume loading, to a mean left atrial pressure of 15 mm Hg. Regional compliance in group II was also significantly (p less than .01) depressed after cardioplegic arrest but was well preserved in groups I and III.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

PubMed2000

Donepezil for mild and moderate Alzheimer's disease.

BACKGROUND: Alzheimer's disease is the most common cause of dementia and is a primary degenerative disease of the brain of unknown cause. Onset is usually late in life with increasing impairment of memory, developing gradually into a global impairment of cognition, orientation, linguistic ability and judgement. The clinical course is accompanied by growing disability and dependency on care. One of the characteristic features of the disease is the widely variable rate of progression seen in different patients. Acetylcholine is an important neurotransmitter associated with memory, and abnormalities in cholinergic neurones (including cell loss) are among the many neurological and neurochemical abnormalities that develop in AD. One approach to lessening the impact of these abnormalities is to inhibit the breakdown of acetylcholine by blocking the relevant enzyme. Tacrine was the first compound approved as a treatment for AD in the US and worked in this way, but caused severe side effects. E2020 (donepezil, Aricept) is a second generation cholinesterase inhibitor and appears to be highly specific, with relatively few side effects. OBJECTIVES: The objective of this review is to assess whether or not donepezil improves the well-being of patients with mild or moderate Alzheimer's disease. SEARCH STRATEGY: The Cochrane Dementia and Cognitive Impairment Group Register of Clinical Trials, was searched using the terms 'donepezil', 'E2020' and 'ARICEPT'. Medline, PsychLIT and EMBASE electronic databases were searched with the above terms. Members of the Donepezil Study Group and Eisai Inc were contacted. SELECTION CRITERIA: All unconfounded, double-blind, randomised controlled trials in which treatment with donepezil was administered for more than a day and compared with placebo in patients with Alzheimer's disease. DATA COLLECTION AND ANALYSIS: Data were extracted independently by the reviewers (JSB & DB), pooled where appropriate and possible, and the weighted or standardised mean differences or Peto odds ratios (95%CI) estimated. Where possible, intention-to-treat data were used. MAIN RESULTS: There are 4 included trials, covering treatment of 12 or 24 weeks duration in highly selected patients. The only information available on one trial (Gauthier 1998) is a conference abstract which reports no usable results. Available outcome data cover domains including cognitive function and global clinical state, but data on several important dimensions of outcome are not available. The results of three trials suggest a small beneficial effect of donepezil in improving cognitive function: at a 5mg/day dose, improvements measured -2.6 points (95%CI -3.5 -- -1.8) on weighted mean difference, in the midrange of the 70 point ADAS-Cog scale. The results of two trials show some improvement in global clinical state (assessed by an independent clinician) in those treated with donepezil compared to placebo. The patient's own rating of their Quality of Life showed no benefit of donepezil compared with placebo. There were significantly more withdrawals before the end of treatment from the 10mg/d (but not the 5mg/d) donepezil group compared with placebo, which may have resulted in some overestimation of beneficial changes at 10mg/d in progressively declining characteristics, as last available measures were used in analyses. A variety of adverse effects were recorded, but very few patients left a trial as a direct result of the intervention. REVIEWER'S CONCLUSIONS: In selected patients with mild or moderate Alzheimer's disease treated for periods of 12 or 24 weeks, donepezil produced modest improvements in cognitive function and study clinicians rated global clinical state more positively in treated patients. No improvements were present on patient self-assessed quality of life and data on many important outcomes are not available. The practical importance of these changes to patients and carers is unclear.

Alzheimer Disease↗

PubMed2000

Good correlation between gated single photon emission computed myocardial tomography and contrast ventriculography in the assessment of global and regional left ventricular function.

PURPOSE: The purpose of this study was to determine the reliability of the measured left ventricular ejection fraction (LVEF) and wall motion analysis by the recently introduced quantitative electrocardiographically (ECG)-gated myocardial perfusion single-photon emission computed myocardial tomography technique (gated SPECT) (QGS). MATERIALS AND METHODS: We compared technetium-99 m tetrofosmin gated SPECT imaging and contrast ventriculography in the assessment of global and regional left ventricular function in 74 patients with undiagnosed chest pain of whom 27 sustained a previous myocardial infarction. RESULTS: Linear regression analysis demonstrated that gated SPECT determined LVEF correlated well with LVEF determined from contrast ventriculography (y = 0.95x + 1.9, r2 = 0.84, p < 0.0001). Bland-Altman plot analysis showed no systematic difference between the two sets of values derived from the two imaging approaches over a wide range of LVEF values. Exact agreement of segmental wall motion scores was 460 of 518 (89%) segments with a kappa value of 0.76 (p < 0.0001). CONCLUSION: We conclude that gated SPECT imaging is an accurate and reliable clinical tool to accurately measure global and regional left ventricular function.

Adult↗

PubMed1991

Comparison of the effects of streptokinase and tissue plasminogen activator on regional wall motion after first myocardial infarction: analysis by the centerline method with correction for area at risk.

In a trial of streptokinase versus recombinant tissue-type plasminogen activator (rt-PA) for a first myocardial infarction, 270 patients were randomized. Regional left ventricular function was assessed in 214 patients at 3 weeks. The infarct-related artery was the left anterior descending artery in 78 patients, the right coronary artery in 122 and a dominant left circumflex artery in 14. Analysis was by the centerline method with a novel correction for the area of myocardium at risk, whereby the search region was determined by the anatomic distribution of the infarct-related artery. Infarct-artery patency at 3 weeks was 73% in the streptokinase group and 71% in the rt-PA group. Global left ventricular function did not differ between the two groups. Mean chord motion (+/- SD) in the most hypokinetic half of the defined search region was similar in the streptokinase and rt-PA groups (-2.4 +/- 1.5 versus -2.3 +/- 1.3, p = 0.63). There were no differences in hyperkinesia of the noninfarct zone. Compared with conventional centerline analysis, regional wall motion in the defined area at risk was significantly more abnormal. The two methods correlated strongly, however (r = 0.99, p less than 0.0001), and both methods produced similar overall results. Patients with a patent infarct-related artery and those with an occluded artery at the time of catheterization had similar levels of global function (ejection fraction 58 +/- 12% versus 57 +/- 12%, p = 0.58).(ABSTRACT TRUNCATED AT 250 WORDS)

Cardiac Catheterization↗

PubMed2002

Treatment of borderline personality disorder with risperidone.

BACKGROUND: Of the various Axis II disorders, borderline personality disorder (BPD) is among the more critical to treat. There are at present few results in terms of clinical outcome with the psychotropic agents available. Possible targets for pharmacotherapy are affective symptoms, cognitive disturbances, and impulsive, self-injurious behaviors. In previous studies, atypical antipsychotics at low-to-moderate doses provided symptom reduction with good tolerability. Our purpose was to assess the efficacy of risperidone in BPD, focusing on its effects on impulsive-aggressive behavior. METHOD: Fifteen BPD outpatients (DSM-IV diagnosis) with prominent histories of aggressive behavior were included in an 8-week open-label study with risperidone at low-to-moderate doses. Axis II codiagnoses included antisocial personality disorder (N = 4). Exclusion criteria included current Axis I diagnosis or any major medical or neurologic illness. Efficacy measures were the 21-item Hamilton Rating Scale for Depression, the Brief Psychiatric Rating Scale, the DSM-IV Global Assessment of Functioning, and the self-rated Aggression Questionnaire. Evaluations were carried out at baseline and at the end of the treatment. RESULTS: Thirteen patients completed the trial; 2 patients dropped out because of lack of compliance. Final mean dose of risperidone was 3.27 mg/day. There was a significant (p = .0057) reduction in aggression based on Aggression Questionnaire scores. This amelioration was coupled with an overall improvement, including a reduction in depressive symptoms and an increase in energy and global functioning. CONCLUSION: Risperidone at low-to-moderate doses can improve BPD symptomatology. Further studies are needed to explore the efficacy of risperidone versus placebo as well as in comparison to other potential treatments for BPD.

Adult↗

PubMed2006

Should self-defeating personality disorder be revisited in the DSM?

Self-defeating personality disorder (SDPD) was proposed for consideration in the DSM-III-R, but was eventually removed from the manual because of the lack of evidence to support its validity. Yet, after DSM-IV was published, some studies suggested that SDPD may be a viable diagnosis. The purpose of this study was to evaluate SDPD's viability as a diagnostic category. Consequently, SDPD's internal consistency, comorbidity with other Axis I and II disorders, association with psychosocial impairment, and its ability to predict overall impairment in past, current, and global levels of functioning beyond other personality disorder symptomatology was assessed in 1,200 psychiatric evaluated with the Structured Clinical Interview for DSM-IV Personality (Pfohl, Blum, & Zimmerman, 1997). Cronbach's alpha for SDPD criteria was 0.61, and item-total correlations ranged between 0.22-0.38. There was substantial comorbidity of SDPD with depressive, avoidant, and borderline personality disorders, as well as major depression and anxiety disorders. The SDPD group did not significantly differ from psychiatric controls on multiple measures of psychosocial impairment, global functioning, and suicidality. SDPD did not meaningfully add to the prediction of impairment above and beyond other measures of Axis II pathology. It is concluded that the data do not support the reliability, validity, and utility of the SDPD diagnosis.

Adult↗