Low prevalence of ataxic polyneuropathy in a community with high exposure to cyanide from cassava foods

Introduction Ataxic polyneuropathy, which occurs in endemic form in an area in southwest Nigeria, is attributed to exposure to cyanide from cassava foods. Exposure to cyanide from cassava is, however, not exclusive to this endemic area. In this study, the occurrence of ataxic polyneuropathy was compared in two communities in Nigeria, one located in the endemic area and the other located outside the endemic area. Both communities have been shown to have high exposure to cyanide from cassava foods. Method The prevalence of ataxic polyneuropathy in Jobele, Nigeria, a community located outside the endemic area, was compared with the prevalence of ataxic polyneuropathy in Ososa, Nigeria, a reference community located in the endemic area. Subjects aged 10 years and above in both communities were screened for ataxic polyneuropathy. Ataxic polyneuropathy was diagnosed if sensory gait ataxia and sensory polyneuropathy were present. The intake of cassava foods, biomarkers of exposure to cyanide, and intake of protein and sulphur were measured. Results Prevalence of ataxic polyneuropathy were 490 per 10 000 in Ososa, and 17 per 10 000 in Jobele. The age-adjusted prevalence ratio is 4 (95 % CI 0-9). The mean intake of all cassava foods in Jobele was 7 meals/person/week (95 % CI 6-8), while the mean intake of all cassava foods in Ososa was 10 meals/person/week (95 % CI 9-11). The concentration of thiocyanate in the plasma was above the reference limit in 65 % (95 % CI 57-73) in Jobele, and 40 % (95 % CI 27-52) in Ososa. The intake of protein was significantly lower in Ososa than in Jobele, but the concentrations of glutathione, cysteine and γ-glutamylcysteine in the plasma were within the same range in Jobele and Ososa. Conclusion This study shows that the occurrence of ataxic polyneuropathy is low in a community where exposure to cyanide is high. This suggests that exposure to cyanide is not a direct cause of ataxic polyneuropathy. Received: 29 November 2001 Received in revised form: 6 February 2002 Accepted: 7 February 2002     

Psychiatric comorbidity and the prevalence of HIV infection in a sample of patients in treatment for substance abuse

This article compares the differences in HIV prevalence and risk behaviors in singly diagnosed patients with substance abuse problems and dually diagnosed patients with comorbid psychiatric and substance abuse problems. The National Treatment Improvement Evaluation Study (NTIES) was used to conduct a cross-sectional study on 6593 persons treated for substance abuse disorders. Logistic regression using hierarchal linear modeling (HLM) was utilized to compare risk behaviors of singly and dually diagnosed persons. Compared with singly diagnosed patients, dually diagnosed patients were more likely to share a needle, have sex for money or gifts, have sex with an intravenous drug user, and report being raped. Patients dually diagnosed with psychiatric and substance abuse disorders are an especially high-risk group for HIV infection, in part due to a higher likelihood of engaging in high-risk behavior, and should be targeted for more intense HIV interventions.     

Evolution of HIV dementia with HIV infection

Dementia remains one of the most fearsome complications of HIV infection. It also poses a significant challenge for the clinician both in terms of diagnosis and treatment. The use of antiretroviral agents has led to a decrease in the incidence of HIV dementia but the prevalence of milder forms of neurocognitive impairment has increased. Occasionally, the immune reconstitution caused by these agents may target the brain leading to a syndrome characterized by a severe, progressive and often fatal dementia. The progression of HIV dementia may also be determined by host and viral genetic factors, and the existence of co-morbid factors such as drug abuse, hepatitis C infection and aging. Oxidative stress markers appear to be predictive of active dementia. However, currently there is no specific treatment available for HIV dementia.     

Living with HIV infection

By its chronic nature, HIV infection represents a period of time where persons are coping with the social and physiological changes of the infection across the spectrum of acute infection, illness, and death. As a person moves through the stages of infection, he or she also experiences different psychological states, whether they be a reaction to the disease process itself, to social reactions to HIV/AIDS, or to the threat of developing AIDS in the future. The purpose of this article is to describe in both quantitative and qualitative terms the psychosocial functioning of infected men from the time they learn they are seropositive to their demise, and to contrast this to seronegative men. This paper specifically examines the longitudinal patterns of psychological states, social support, social conflict, and HIV-risk behavior as measured prospectively in a cohort of homosexual men in Chicago. The men participating in the Chicago Multicenter AIDS Cohort and Coping and Change Studies enrolled in 1984, before the development of the HIV-1 antibody test, and voluntarily received their test results and counseling beginning November, 1985. This allowed us to follow their psychological and behavioral patterns over time after receiving HIV serostatus information. By comparing these patterns for prevalent seropositive men with those for consistently seronegative men, we are able to observe the time course of psychological and behavioral adaptation, both before and after learning serostatus, and relate those patterns to the natural history of HIV infection in homosexual men.     

Point prevalence and correlates of depression in a national community sample with multiple sclerosis

Objective

The prevalence of depression in multiple sclerosis (MS) is known to be elevated, but nearly all available studies have estimated period prevalence. The objective of this study was to estimate the point prevalence of depression in a representative community sample using the Patient Health Questionnaire, Brief (PHQ-9).

Methods

The data source for this study was the Survey of Living with Neurological Conditions in Canada, which was derived from a representative sample of household residents.

Results

The sample included 630 respondents with MS. With application of the standard PHQ-9 cut point (10 +), the prevalence of depression was 26.0% (95% confidence interval 18.9%–33.0%). Depressed subjects had lower quality of life; an increased frequency of suicidal ideation; and more often reported a negative disease course, high stress, low social support and stigmatization.

Conclusions

This study adds to the existing literature by providing point prevalence data: in any 2-week period, about one quarter of community residents with MS experience substantial levels of depressive symptoms.     

The prevalence of personality disorders in a community sample

BACKGROUND: To our knowledge, no previous studies of personality disorders (PDs) in a large representative sample of the common population have been conducted. METHODS: A representative sample of 2053 individuals between the ages of 18 and 65 years in Oslo, the capital of Norway, was studied from 1994 to 1997. Information about PDs was obtained by means of the Structured Interview for DSM-III-R Personality Disorders, in conjunction with an interview recording demographic data. The subjects were interviewed primarily at home, but in some instances, also at the clinic. RESULTS: The prevalence of PDs was 13.4% (SE, 0.7). The prevalence rates (SEs) for specific PDs, irrespective of whether a person had 1 or more PD, were: paranoid, 2.4% (0.3); schizoid, 1.7% (1.6); schizotypal, 0.6% (0.2); antisocial, 0.7% (0.2); sadistic, 0.2% (0.1); borderline, 0.7% (0.2); histrionic, 2.0% (0.3); narcissistic, 0.8; (0.2); avoidant, 5.0% (0.5); dependent, 1.5% (0.3); obsessive-compulsive: 2.0% (0.3); passive-aggressive, 1.7% (0.3); self-defeating, 0.8%, (0.2). The prevalence of PDs was highest among subjects with only a high school education or less, and living without a partner in the center of the city. CONCLUSIONS: Personality disorders were found to be prevalent, with avoidant, schizoid, and paranoid PDs more common, and borderline PD less common than what is usually reported. Personality disorders tend to be more frequent among single individuals from the lower socioeconomic classes in the center of the city. It is impossible to determine what is cause and what is consequence from a cross-sectional study.     

Meningitis associated with bilateral optic papillitis following Mycoplasma pneumoniae infection

Mycoplasma pneumoniae (M. pneumoniae) is a frequent cause for human infection, and central nervous system disease associated with M. pneumoniae infection is being reported with increasing frequency. We described herein a 60-year-old woman who developed meningitis associated with bilateral optic papillitis following M. pneumoniae infection and discussed the possible mechanisms. To our knowledge, there have been only a few reports that described the meningitis complicated by bilateral optic papillitis in association with M. pneumoniae infection. Our case highlighted the protean neurological manifestations of M. pneumoniae infection.     

Meningitis and shunt infection caused by anaerobic bacteria in children

This review describes the microbiology and management of meningitis and shunt infections caused by anaerobic bacteria in children. The predominant anaerobes recovered in meningitis are Bacteriodes spp., Bacteriodes fragilis, Fusobacterium spp., and Clostridium spp. Peptostreptococcus, Veillonella, Actinomyces, Propionibacterium acnes, and Eubacterium are less commonly isolated. The predisposing conditions for meningitis are acute or chronic middle-ear infection, sinusitis, pharyngitis, and pulmonary infections. In newborn and preterm infants the predisposing conditions are rupture of membranes, amnionitis, fetal distress, necrotizing enterocolitis, gastric perforation and subsequent ileus followed by bacteremia, aspiration pneumonitis and septicemia, infected ventriculoperitoneal or ventriculoatrial shunt, and complicating dermal sinus tract infections. Shunt infection with Propionibacterium spp. has been reported in children, especially in association with ventriculoauricular and ventriculoperitoneal shunts. Clostridium perfringens has been recovered from infants with a ventriculoperitoneal shunt. Multiple-organism meningitis was reported as a complication of ventriculoperitoneal and lumboperitoneal shunts that perforated the gastrointestinal tract. Early recognition and effective therapy are essential to recovery. Management of meningitis includes the use of antimicrobials effective against anaerobes that penetrate the blood-brain barrier. These include metronidazole, chloramphenicol, the combination of a penicillin and a beta-lactamase inhibitor, and carbapenems. The treatment of shunt infection includes antimicrobial therapy and removal of the shunt.     

Suicidal behaviour in HIV infection: A case-control study of deliberate self-harm in people with HIV infection

A group of 22 individuals with HIV infection who had made acts of self-harm were compared with a sex and age-matched control group of individuals without known HIV infection who had also being involved in acts of deliberate self-harm (DSH). Compared with all DSH individuals referred to the deliberate self-harm service during the same period. men were over-represented amongst HIV subjects. Compared with matched controls, HIV subjects were more likely to include gay/bisexual men, and not be employed. Individuals with HIV infection were more likely to be receiving outpatient psychiatric care at the time of DSH. and to have received it in the past A diagnosis of depression was given mom frequently to HIV subjects, while alcohol misuses was more often diagnosed in controls. Concerns about their physical health were prominent amongst HIV seropositives. Psychiatric follow-up was offered to HIV subjects more often than to controls. The results indicate that HIV disease is a potential contributing factor to deliberate self-harm. and highlight the need for efforts to identify individuals with HIV infection at risk of deliberate self-harm, ant to develop effective interventions to prevent suicidal behaviour in this group of individuals.     

Epilepsy prevalence by individual interview in a Norwegian community.

Incomplete case finding is a problem in epidemiological studies of epilepsy. We tried to optimize case ascertainment by combining information from individual interviews and medical records. During 2 years, 1838 inhabitants of V?g?, Norway, aged 18-65 (88.6% of the target population) were interviewed as part of an epidemiological study of headache. Individuals with learning disability, mental disorders and dementia were excluded. One question concerning epilepsy was presented to 1793 consecutive cases (mean age 35, males 49%): "Have you ever had convulsions, epileptic fits or other epileptic symptoms?" The medical records of the 133 subjects who acknowledged this possibility were reviewed, and telephone interviews were performed when needed. A diagnosis of epilepsy had been made in 41 subjects. Twenty-one were treated with antiepileptic drugs, of whom 12 had had seizures within the last 5 years. By this unique method of case ascertainment, the prevalence of epilepsy in adults (cases under treatment) was 1.2%, and of active cases 0.7%, despite the fact that high-risk groups for epilepsy, such as elderly people and individuals with cognitive deficits, were excluded. Although these findings were derived from a small population in a circumscribed rural area, they suggest that the true prevalence of epilepsy may be higher than reflected in many previous studies.     

Multiple sclerosis typical clinical and MRI findings in a patient with HIV infection

Background  

Multiple sclerosis (MS) is a demyelinating disease seldom included in the differential diagnosis of leukoencephalopathy in HIV-positive patients.     

Sleepiness and sleep quality in patients with HIV infection

ObjectivesPatients with HIV infection frequently complain of sleep disturbances and daytime sleepiness. Only few data on these problems evaluated by standardized measures is available.MethodsA sample of 180 consecutive patients with HIV infection referred to the internal and to the neurological HIV clinics at the University of Münster was enrolled in this study. The data were compared to a sample of 120 age- and sex-matched control subjects. We used the Epworth Sleepiness Scale (ESS), the Pittsburgh Sleep Quality Index (PSQI), and the Beck's Depression Inventory (BDI). In addition, the clinical and immunological data of the patients were registered.ResultsAll scores of the ESS, the PSQI, and the BDI were significantly increased in the HIV infected patients as compared to the control group. There were no significant correlations between any of the immune parameters and the scores. Only a higher BDI score was correlated with both the ESS score and the PSQI score.ConclusionsPatients with HIV infection and not using evavirenz show an increased daytime sleepiness and a decreased quality of sleep. These findings could not be related to the immunological state of the patients. The only specific factor influencing daytime sleepiness in HIV infected patients is probably treatment with HAART. The most important factor determining sleepiness and sleep quality in HIV infected patients is depression which was found to be independent from the immunological state and HAART of the patients.     

Depressive and anxiety disorders in women with HIV infection

OBJECTIVE: This study examined whether there were differences in the rate of depressive and anxiety disorders between HIV-infected women (N=93) and a comparison group of uninfected women (N=62). Secondary objectives were to examine correlates of depression in HIV-infected women-including HIV disease stage and protease inhibitor use-and the associations between symptoms of depression or anxiety and other potential predictor variables. METHOD: Subjects underwent extensive semiannual clinical, psychiatric, neuropsychological, and immunological evaluations. Depressive and anxiety disorder diagnoses were assessed by using the Structured Clinical Interview for DSM-IV. Symptoms of depression and anxiety were evaluated with the Hamilton Depression Rating Scale (the 17-item version and a modified 11-item version) and the Hamilton Anxiety Rating Scale, respectively. RESULTS: The rate of current major depressive disorder was four times higher in HIV-seropositive women (19.4%) than in HIV-seronegative women (4.8%). Mean depressive symptom scores on the 17-item Hamilton depression scale also were significantly higher, overall, in the HIV-infected women (mean=8.7, SD=8.0) relative to comparison subjects (mean=3.3, SD=5.8). There was no significant between-group difference in the rate of anxiety disorders. However, HIV-seropositive women had significantly higher anxiety symptom scores (mean=8.8, SD=8.9) than did HIV-seronegative women (mean=3.6, SD=5.5). Both groups had similar substance abuse/dependence histories, but adjusting for this factor had little impact on the relationship of HIV status to current major depressive disorder. CONCLUSIONS: HIV-seropositive women without current substance abuse exhibited a significantly higher rate of major depressive disorder and more symptoms of depression and anxiety than did a group of HIV-seronegative women with similar demographic characteristics. These controlled, clinical findings extend recent epidemiologic findings and underscore the importance of adequate assessment and treatment of depression and anxiety in HIV-infected women.     

Treatment prevalence in a community mental health service with special regard to depressive disorders

In the community psychiatric service in Samsø, 1.24% of the male population and 3.1% of the female population were in treatment on April 1. 1976. Approximately two-thirds of the patients had 1 or 2 referrals, the rest had 3 or more. Of the 1222 consultations, 74% were home visits. Thirty-one percent had a treatment period of less than 1 year. Only 35% of the patients in treatment had previously been hospitalized in psychiatric hospitals and 21% were in a psychiatric hospital on prevalence day.Patients with manic-depressive psychoses comprised 38% of those in treatment, giving a treatment prevalence for manic-depressive disorders of 7.7 per 1000 population.A number of the patients with manic-depressive disorders had previously been treated under the diagnoses of depressive or anxiety neuroses. It is our experience that many patients with signs of depressive neuroses are, in fact, manic-depressive and respond very well to tricyclic antidepressive drugs.When comparing the incidence for manic-depressive disorders in the Samsø clinic, the Århus county register, and Danish psychiatric hospitals we found a significantly higher incidence in Samsø with 2.38 per 1000 compared with 0.62 per 1000 for the Århus county register and 0.28 for Danish psychiatric hospitals.The purpose of the present study has been to analyze a number of conditions concerning the patients in treatment on April 1. 1976, in a community psychiatric service in a Danish geographically delimited rural population. In Denmark such one-day prevalence studies have previously been made for psychiatric hospitals.^1–4 but not in a community psychiatric service.     

New-onset seizures associated with HIV infection

The authors studied new-onset seizures in 60 heterosexual black South African HIV-infected patients who had not used IV drugs. An intracranial space-occupying lesion was identified in 53% of patients, meningitis in 22%, and no additional cause in 25%. Of the patients with an identifiable cause, 64% had probable tuberculosis (tuberculoma or tuberculous meningitis). The majority of patients had late-stage HIV infection (CD4 counts <200/mm(3)).     

The estimated prevalence and correlates of adult ADHD in a German community sample

Little research on the prevalence and correlates of adult ADHD has been conducted outside the United States. The aim of the present study was to estimate the prevalence and correlates of adult ADHD in a large representative sample of the German population aged 18–64 years (n = 1,655). Two self-rating screening instruments to assess childhood and adult ADHD symptomatology were used to estimate the prevalence of ADHD. A 4-item screening tool was used to assess probable cases of current depression and anxiety (Patient Health Questionnaire). The estimated crude prevalence rate of current ADHD was 4.7%. Adult ADHD was significantly associated with lower age, low educational level, unemployment, marital status (never married and divorced), and rural residency. No association was found with gender. Adult ADHD was strongly associated with positive screening results for depression and anxiety. ADHD is a common disorder of adulthood, is associated with significant social impairment and psychiatric co-morbidity, and should receive further research attention.