Unfavorable lipoprotein profile in childhood cancer survivors with suprasellar brain tumors—a high Apo B level and increased small dense LDL-cholesterol

Objective  The purpose of this study is to evaluate atherosclerotic potency among childhood cancer survivors (CCS) with suprasellar tumors. Study design  Patients with remitted suprasellar tumors were recruited. A total of 17 subjects with simple obesity of similar ages served as obese controls. Fasting sera were subjected to determination of lipids and apolipoproteins (Apo), including small dense LDL-cholesterol (sdLDL-C). Results  Twenty-three patients (4–22 years old) were enrolled. Patients, 12/23, had a body mass index (BMI) above the 90th percentile and were designated as ‘obese patients’. Obese patients had lower BMI scores (mean 26.4 kg/m², p < 0.01) compared to obese controls (mean 31.5 kg/m²). Both groups had identical levels of total cholesterol, triglycerides, LDL-C, and HDL-C. However, obese patients were found to have a higher incidence of Apo B/Apo A1 ratio elevation (6/12) than obese controls (0/17, p < 0.01). In addition, obese patients had higher sdLDL-C level (47.6 ± 14.8 mg/dL) than obese controls (28.3 ± 7.1 mg/dL, p < 0.01). BMI showed strong correlations with both the Apo B/Apo A1 ratio (r = 0.663, p < 0.001) and sdLDL-C (r = 0.606, p < 0.01). Conclusion  CCS with suprasellar tumors, especially patients with a high BMI, had an unfavorable lipoprotein profile characterized by increased Apo B and sdLDL-C.     

Are Constructs of the Transtheoretical Model for Physical Activity Measured Equivalently Between Sexes,Age Groups,and Ethnicities?

Background/Purpose  Identifying mediators of physical activity change requires measurement instruments that are reliable, valid, and generalizable to multiple populations. Despite continued application of the transtheoretical model (TTM) to the study of physical activity, the structural components of the TTM measurement instruments have been understudied in diverse populations. Methods  A multiethnic sample (N = 700, M _age = 47, 63% women, 38% Caucasian) of participants living in Hawaii completed TTM measures. The factor validity and measurement equivalence/invariance (ME/I) of decisional balance, barrier self-efficacy, temptations, and processes of change instruments were explored between men, women, age groups, and ethnicities. Results/Conclusions  Measurement models of barrier self-efficacy and revised models of temptations and processes of change demonstrated sufficient evidence for ME/I among all subgroups. A revised model of decisional balance demonstrated sufficient evidence for ME/I between genders and among ethnicities, but not among age groups. Future research should examine the stability of these constructs across time.     

Comparing Psychosocial Predictors of Physical Activity Adoption and Maintenance

Background   Most health behavior models do not distinguish between determinants of behavior adoption and maintenance. Purpose   This study compared psychosocial predictors of physical activity (PA) adoption and predictors of PA maintenance among 205 initially sedentary adults enrolled in a home-based PA promotion trial. Methods   Psychosocial variables were measured at 6 months (at which point 107 participants remained inactive and 98 participants adopted regular PA) and used to predict 12-month PA status (an indicator of PA adoption among those inactive at 6 months and an indicator of PA maintenance among those active at 6 months). Results   Six-month PA status moderated the relationships between 6-month measures of home access to PA equipment (p = .049), self-efficacy (p = .086), and perceived satisfaction (p = .062) and 12-month PA status. Simple effects analyses revealed that home access to PA equipment was predictive of PA adoption (OR = 1.73; 95% CI: 1.05, 2.85), but not PA maintenance (OR = 0.88; 95% CI: 0.58, 1.35), whereas self-efficacy and perceived satisfaction were predictive of PA maintenance (OR = 2.65; 95% CI: 1.55, 4.52; OR = 1.95; 95% CI: 0.93, 4.06), but not PA adoption (OR = 1.50; 95% CI: 0.87, 2.57; OR = 0.82, CI: 0.44, 1.52). Conclusion   Results suggest that these psychosocial variables may operate differently in predicting PA adoption versus maintenance.     

Small Changes in Nutrition and Physical Activity Promote Weight Loss and Maintenance: 3-Month Evidence from the ASPIRE Randomized Trial

Background  Current obesity interventions use intensive behavior changes to achieve large initial weight loss. However, weight regain after treatment is common, and drop out rates are relatively high. Smaller behavioral changes could produce initial weight loss and be easier to sustain after active treatment. Purpose  We examined the efficacy of an intervention that targeted small but cumulative participant-chosen changes in diet and physical activity (ASPIRE) and compared this treatment to standard didactic and wait-list control groups. The primary outcome measures were body weight, waist circumference, and intra-abdominal fat. Methods  Fifty-nine overweight or obese sedentary adults were randomized to one of three groups: (1) the ASPIRE group (n = 20), (2) a standard educationally-based treatment group (n = 20), or (3) a wait list control group (n = 19) for 4 months. Active treatment groups received identical resistance and aerobic training programs. Results  Intention-to-treat analyses showed that participants in the ASPIRE group lost significantly more weight than the standard and control groups (−4.4 vs. −1.1 and +0.1 kg, respectively), and the greater initial weight loss in the ASPIRE group was sustained 3 months after active treatment (4.1 kg). An alternative analytic strategy (0.3 kg/month weight gain for those lost to follow-up) showed continued weight loss (−0.2 kg after active treatment; −4.6 kg from baseline) at follow-up in the ASPIRE group. Similar patterns were observed for the other adiposity measures. Conclusion  More modest behavioral changes are capable of promoting weight loss, decreasing adiposity markers and sustaining these changes over 3 months. Longer-term studies comparing this approach with traditional behavioral weight loss treatments are warranted.     

Efficacy of a Brief Image-Based Multiple-Behavior Intervention for College Students

Background  Epidemiologic data indicate most adolescents and adults experience multiple, simultaneous risk behaviors. Purpose  The purpose of this study is to examine the efficacy of a brief image-based multiple-behavior intervention (MBI) for college students. Methods  A total of 303 college students were randomly assigned to: (1) a brief MBI or (2) a standard care control, with a 3-month postintervention follow-up. Results  Omnibus treatment by time multivariate analysis of variance interactions were significant for three of six behavior groupings, with improvements for college students receiving the brief MBI on alcohol consumption behaviors, F(6, 261) = 2.73, p = 0.01, marijuana-use behaviors, F(4, 278) = 3.18, p = 0.01, and health-related quality of life, F(5, 277) = 2.80, p = 0.02, but not cigarette use, exercise, and nutrition behaviors. Participants receiving the brief MBI also got more sleep, F(1, 281) = 9.49, p = 0.00, than those in the standard care control. Conclusions  A brief image-based multiple-behavior intervention may be useful in influencing a number of critical health habits and health-related quality-of-life indicators of college students.     

Comparison of Two School-Based Smoking Prevention Programs among South African High School Students: Results of a Randomized Trial

Background  Smoking rates are projected to increase substantially in developing countries such as South Africa. Purpose  The aim of this study was to test the efficacy of two contrasting approaches to school-based smoking prevention in South African youth compared to the standard health education program. One experimental program was based on a skills training/peer resistance model and the other on a harm minimization model. Method  Thirty-six public schools from two South African provinces, KwaZulu-Natal and the Western Cape, were stratified by socioeconomic status and randomized to one of three groups. Group 1 (comparison) schools (n = 12) received usual tobacco use education. Group 2 schools (n = 12) received a harm minimization curriculum in grades 8 and 9. Group 3 schools (n = 12) received a life skills training curriculum in grades 8 and 9. The primary outcome was past month use of cigarettes based on a self-reported questionnaire. Result  Five thousand two hundred sixty-six students completed the baseline survey. Of these, 4,684 (89%) completed at least one follow-up assessment. The net change in 30-day smoking from baseline to 2-year follow-up in the control group was 6% compared to 3% in both harm minimization (HM) and life skills training (LST) schools. These differences were not statistically significant. Intervention response was significantly moderated by both gender and race. The HM intervention was more effective for males, whereas the life skills intervention was more effective for females. For black African students, the strongest effect was evident for the HM intervention, whereas the strongest intervention effect for “colored” students was evident for the LST group. Conclusion  The two experimental curricula both produced similar overall reductions in smoking prevalence that were not significantly different from each other or the control group. However, the impact differed by gender and race, suggesting a need to tailor tobacco and drug use prevention programs. More intensive intervention, in the classroom and beyond, may be needed to further impact smoking behavior.

Can Psychological Factors Account for a Lack of Nocturnal Blood Pressure Dipping?

Background  In healthy individuals, blood pressure (BP) decreases, or “dips”, during sleep. Ethnicity and high daytime blood pressure level are known markers of nondipping status. The literature on psychological markers of nondipping is scant but suggests that anger/hostility and chronic stress may be contributors to nondipping. Purpose  We have investigated this phenomenon in drug-free hypertensives who participated in a clinical trial and supplied extensive demographic, psychological, and biological risk factor data after medication washout prior to any treatment. Method  Sixty-two patients were available for analysis (n = 30 nondippers). While most studies focus only on systolic BP nondipping, we explicitly studied both systolic and diastolic BP dipping as outcomes given that both have prognostic value. Results  Hierarchical multiple regression revealed that predictor variables in total accounted for 38% of variance in systolic blood pressure dipping and 44% of variance in diastolic blood pressure dipping. A significant positive predictor was alcohol consumption (β = 0.37, t = 2.8, p = 0.007) for systolic BP and β = 0.43, t = 3.7, p = 0.001 for diastolic BP), and an anger diffusion preference was also a positive predictor (β = 0.42, t = 2.7, p = 0.01) for systolic BP dipping. No measure of trait negative affect reached significance as a predictor for systolic or diastolic BP dipping. Conclusion  These findings suggest that for a better understanding of the nondipping phenomenon, behavioral risk factors are important, and anger response styles may also be worthy of further study. Furthermore, anger coping preferences may be as important, or even more so, than levels of negative affect.     

The Role of Percieved Parent Monitoring and Support on Urban Child and Adolescent Problem Behavior

Parental practices on problem behavior based on gender and age effects with urban youth were studied. Participants were 8–17 years old (N = 3,658; 66% African-American) and logistic regression models were conducted. For pre-teen females, decreased friend monitoring was related to high problem behavior; for teen females, lower maternal support and decreased home monitoring were significant. None of the models were significant for pre-teen males and lack of home monitoring was significant for teen males. Strategies for preventing problem behavior within urban communities will be more effective if they are tailored to gender and developmental factors.     

Methods of suicide used by children and adolescents

Although relatively rare, suicide is a leading cause of death in children and adolescents in the Western world. This study examined whether children and adolescents are drawn to other methods of suicide than adults. Swiss suicides from 1998 to 2007 were examined. The main methods of suicide were analysed with respect to age and gender. Of the 12,226 suicides which took place in this 10-year period, 333 were committed by children and adolescents (226 males, 107 females). The most prevalent methods of suicide in children and adolescents 0–19 years were hanging, jumping from heights and railway-suicides (both genders), intoxication (females) and firearms (males). Compared to adults, railway-suicides were over-represented in young males and females (both P < .001). Jumping from heights was over-represented in young males (P < .001). Thus, availability has an important effect on methods of suicide chosen by children and adolescents. Restricting access to most favoured methods of suicide might be an important strategy in suicide prevention.     

Evaluation of Cerebellar and Cerebral Volume in Migraine with Aura: A Stereological Study

Migraine is associated with an increased risk of deep white matter lesions and subclinical posterior circulation infarcts. A significant association between deep white matter hyperintensities and cerebral atrophy is true for various neurological diseases; it was not specifically proven in migraine. The aim of this study was to evaluate the cerebellar and cerebral volume and volume ratios for cerebellum using the Cavalieri principle. We also aimed to examine whether migraine with aura causes cerebellar and cerebral atrophy. Twenty three right-handed patients with migraine with aura diagnosed by means of the International Headache Society criteria and 24 age-matched subjects whose only health problem was headache due to rhinosinusitis and tension type headache were included in the study. Measurements of the cerebellar and cerebral volumes as well as cerebellar/cerebral volume ratios were made using Cavalieri’s principle by utilizing the point-counting methods. There were no significant differences between the volumes of cerebrum, cerebellum, and the ratio of cerebellum to cerebrum for males (p = 0.05, p = 0.10, and p = 0.64, respectively) and for females (p = 0.18, p = 0.89, and p = 0.24, respectively). Our results suggest that patients with migraine with aura do not have a significant difference in cerebellar and cerebral volumes and cerebellar/cerebral volume ratios compared to the non-migraine group.     

Orexins Excite Neurons of the Rat Cerebellar Nucleus Interpositus Via Orexin 2 Receptors In Vitro

Orexins are newfound hypothalamic neuropeptides implicated in the regulation of feeding behavior, sleep–wakefulness cycle, nociception, addiction, emotions, as well as narcolepsy. However, little is known about roles of orexins in motor control. Therefore, the present study was designed to investigate the effect of orexins on neuronal activity in the cerebellum, an important subcortical center for motor control. In this study, perfusing slices with orexin A (100 nM–1 μM) or orexin B (100 nM–1 μM) both produced neurons in the rat cerebellar interpositus nucleus (IN) a concentration-dependent excitatory response (96/143, 67.1%). Furthermore, both of the excitations induced by orexin A and B were not blocked by the low-Ca²⁺/high-Mg²⁺ medium (n = 8), supporting a direct postsynaptic action of the peptides. Highly selective orexin 1 receptor antagonist SB-334867 did not block the excitatory response of cerebellar IN neurons to orexins (n = 22), but [Ala¹¹, D-Leu¹⁵] orexin B, a highly selective orexin 2 receptor (OX₂R) agonist, mimicked the excitatory effect of orexins on the cerebellar neurons (n = 18). These results demonstrate that orexins excite the cerebellar IN neurons through OX₂R and suggest that the central orexinergic nervous system may actively participate in motor control through its modulation on one of the final outputs of the spinocerebellum.     

Social support, personality and depressive symptoms over 7 years: the Health and Lifestyle cohort

  Background: We tested the hypothesis that a negative relationship between social support and depression is stronger in extroverts. Methods: Data on social support and personality were obtained from an existing cohort of 9003 adults (the Health and Lifestyle Survey, UK), of whom 3594 respondents who were followed-up 7 years later contributed to the present analysis. Six depression items from the 30-item General Health Questionnaire, summed, were divided into five levels and a proportional odds analysis was performed. Information on social support was also obtained at follow-up. Results: For females, there was a highly significant interaction between Time of Residence in Area and extroversion (P < 0.001). For males, interactions involving Adults in Household and Living as Married reached borderline significance (0.05 < P < 0.10). Eleven other interactions with extroversion were non-significant (P > 0.10). Conclusion: It is unlikely that a lack of social support is more or less harmful for introverts, although the hypothesis should be re-tested in a study with a much shorter period of follow-up and higher response rate. Accepted: 11 May 2000     

Brief Report: Executive Functioning in Autism Spectrum Disorders: A Gender Comparison of Response Inhibition

Although autism spectrum disorders (ASD) affect more males than females, it is not clear whether neurobehavioural correlates of ASD are equivalent across genders. This study examined gender differences in neurobehavioural functioning in boys and girls with ASD. Participants were males with ASD (n = 10), females with ASD (n = 13), typically developing males (n = 8), and typically developing females (n = 14). Each completed the stop task, a common measure of response inhibition. Females with ASD demonstrated a significant increase in stopping time (indicating poorer inhibition). By contrast, no response inhibition impairments were evident among males with ASD. Females with ASD may have a different neurobehavioural profile, and therefore different clinical needs, when compared with males with ASD.     

Life events, ethnicity and perceptions of discrimination in patients with severe mental illness

  Background: Whilst it is commonly believed that black and ethnic minority (B&EM) people living in the UK experience social disadvantage compared with the white British (WB) population, no study has specifically addressed this issue in patients with severe mental illness. We sought to test the hypothesis that B&EM patients experience more negative life events than their WB counterparts, and to examine the extent to which they attribute these events to discrimination. Method: Thirty-four WB, 78 African Caribbean (AC) and 35 other ethnic minority patients with psychotic illnesses, defined using Research Diagnostic Criteria, were asked to complete a Racial Life Event Questionnaire examining life events and perceptions of discrimination at baseline and 12 and 24 months later. Results: African Caribbean patients experienced more `Financial' life events across the study period, otherwise there were no significant differences between patient groups in number of life events experienced. The B&EM group collectively (n = 113), however, were significantly more likely than the WB group (n = 34) to attribute `Assault', and `Legal' life events to discrimination. The AC patient group were significantly more likely than the other two ethnic groups to attribute the `Financial' and `Health' life events they experienced to discrimination. The B&EM group was also significantly more likely, and particularly the AC patient group, to report that members of their own ethnic group are adversely affected by discrimination. Further analyses showed skin colour rather than ethnicity or nationality to be the major contributing factor to perception of discrimination; thus, the Irish (n = 11) had similar scores to the WB while Africans (n = 16) scored like the ACs. Conclusion: Our study shows that B&EM patients do not experience significantly more life events than WB patients; however, their perception of these events is clearly different, and significantly more often attributed to racism. It is reasonable to suppose that patients may be disinclined to utilise services they believe to be prejudiced against them on the basis of their skin colour, and service providers need to be aware of this in order to create health care services that B&EM patients feel confident to use. Accepted: 3 September 1999     

Sexual Risk Reduction Interventions for Patients Attending Sexually Transmitted Disease Clinics in the United States: A Meta-Analytic Review, 1986 to Early 2009

Sexually transmitted disease (STD) patients are more likely to experience a future STD including human immunodeficiency virus (HIV). The aim of this study was to examine the efficacy of behavioral interventions to reduce sexual risk behavior and incident STDs among patients attending STD clinics in the United States. A meta-analysis of 32 studies with 48 separate interventions targeting STD patients (N = 67,538) was conducted. Independent raters coded study, sample, and intervention characteristics. Effect sizes, using both fixed- and random-effects models, were calculated. Potential moderators of intervention efficacy were assessed. Relative to controls, intervention participants increased their condom use and had fewer incident STDs, including HIV, across assessment intervals (d ₊s ranging from 0.05 to 0.64). Several sample (e.g., age and ethnicity) and intervention features (e.g., targeting intervention to a specific group) moderated the efficacy of the intervention. Behavioral interventions targeted to STD clinic patients reduce sexual risk behavior and prevent HIV/STDs. Widespread use of behavioral interventions in STD clinics should be a public health priority.     

The Prevalence of DSM-IV Attention-Deficit/Hyperactivity Disorder: A Meta-Analytic Review

This article describes a comprehensive meta-analysis that was conducted to estimate the prevalence of attention-deficit/hyperactivity disorder (ADHD), as defined by the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV). A systematic literature review identified 86 studies of children and adolescents (N = 163,688 individuals) and 11 studies of adults (N = 14,112 individuals) that met inclusion criteria for the meta-analysis, more than half of which were published after the only previous meta-analysis of the prevalence of ADHD was completed. Although prevalence estimates reported by individual studies varied widely, pooled results suggest that the prevalence of DSM-IV ADHD is similar, whether ADHD is defined by parent ratings, teacher ratings, or a best estimate diagnostic procedure in children and adolescents (5.9–7.1 %), or by self-report measures in young adults (5.0 %). Analyses of diagnostic subtypes indicated that the predominantly inattentive type is the most common subtype in the population, but individuals with the combined type are more likely to be referred for clinical services. Additional research is needed to determine the etiology of the higher prevalence of ADHD in males than females and to clarify whether the prevalence of ADHD varies as a function of socioeconomic status or ethnicity. Finally, there were no significant prevalent differences between countries or regions of the world after controlling for differences in the diagnostic algorithms used to define ADHD. These results provide important support for the diagnostic validity of ADHD, and argue against the hypothesis that ADHD is a cultural construct that is restricted to the United States or any other specific culture.     

Extended focal radiotherapy of 30 Gy alone for intracranial synchronous bifocal germinoma: a single institute experience

Objects  To evaluate the disease characteristics and treatment outcomes for patients with intracranial synchronous bifocal germinomas treated with extended focal irradiation alone. Methods  Between January 1996 and March 2007, seven patients (three males and four females) with intracranial synchronous bifocal germinomas treated at Taipei Veterans General Hospital were reviewed. The median age at diagnosis was 14 years (range, 11–28 years). Four patients had surgery before radiotherapy. All patients underwent extended focal irradiation encompassing the whole ventricle system with a total radiation dose of 30 Gy (2 Gy daily). No patient received scheduled systemic chemotherapy before or after radiotherapy. Disease characteristics, treatment outcomes, and the impact of lesion numbers (single vs. bifocal) on survivals were investigated. Results  With a median follow-up time of 49 months (range, 20–66 months), the 2- and 5-year survival rates were both 100%. After treatment, all patients had good performance without recurrence. No severe complication was observed. In comparison, the overall survival (OS, p = 0.475) and the disease-free survival (DFS, p = 0.537) rates were not significantly different between bifocal- and single-lesion groups. Lesion numbers did not affect both OS and DFS. In addition, the incidence of neuraxial seeding was not higher in patients with bifocal germinomas as compared to those with single lesion. Conclusions  Intracranial germinomas are extremely radiosensitive. Young patients with synchronous bifocal germinomas could be successfully treated with extended focal 30-Gy radiotherapy alone. The therapeutic advantage using this regimen needs to be further evaluated with larger sample size and longer follow-up time. Pin-I Huang, Yi-Wei Chen, and Tai-Tong Wong contributed equally to this work.     

Circulating B7-H3(CD276) Elevations in Cerebrospinal Fluid and Plasma of Children with Bacterial Meningitis

The objective of this study was to analyze the clinical significance of cerebrospinal fluid (CSF) and plasma concentrations of B7-H3, tumor necrosis factor-alpha (TNF-α), gamma interferon (IFN-γ), and interleukin-17 (IL-17) in bacterial and aseptic meningitis in children. The participants were six children with bacterial meningitis, 16 with aseptic meningitis, and 12 control subjects. All participants were between 2 months and 12 years of age on admission. Cytokines determination was performed by enzyme-linked immunosorbent assay technique. CSF and plasma-circulating B7-H3 were significantly higher in the bacterial meningitis group as compared with the aseptic group (p = 0.001) and the control group (p = 0.000 and p = 0.001 respectively). However, CSF and plasma-circulating B7-H3 in aseptic meningitis were not significantly higher than control group (p = 0.071 and p = 0.72 respectively).CSF and plasma-circulating TNF-α were significantly higher in the bacterial meningitis group as compared with the aseptic group (p = 0.004 and p < 0.0001 respectively) and control group (p = 0.004 and p < 0.0001 respectively). Similarly, we did not observe significant elevated TNF-α levels in CSF and plasma in aseptic group compared with control group (p = 0.03 and p = 0.12 respectively). IFN-γ levels in CSF and plasma were undetectable in control group, and we did not find statistical significances in both of CSF and plasma between the elevated IFN-γ level in bacterial meningitis group and aseptic meningitis group(p = 0.055 and p = 0.095 respectively) CSF and plasma levels of IL-17 were undetectable in all subjects. There were correlations between B7-H3 and TNF-α, IFN-γ (r = 0.875, p = 0.000; r = −0.693, p = 0.000, respectively) in CSF in meningitis subjects. In plasma, levels of B7-H3 in bacterial meningitis on admission correlated positively with TNF-α (r = 0.968, p = 0.002), and white blood cell counts (r = 0.973, p = 0.001). Detectable CSF levels of B7-H3, TNF-α, and IFN-γ on admission were not associated significantly with any of CSF characteristics. Additionally, CSF and plasma levels of B7-H3 decreased remarkably after treatment. Altogether, our data indicated that circulating B7-H3 and TNF-α levels in the CSF and plasma were useful markers for distinguishing bacterial from aseptic meningitis, and Circulating B7-H3 was demonstrated to be useful in evaluating the intensity of the infectious inflammatory process in the central nervous system in children. An erratum to this article can be found at     

Psychiatric disorder and the use of benzodiazepines: an example of the inverse care law from Brazil

Background: A cross-sectional survey was conducted in Pelotas, southern Brazil, to assess the relationship between the use of benzodiazepines (BZD), minor psychiatric disorders (MPD) and social factors. Methods: A representative sample (n = 1277) was interviewed using the Self-Reporting Questionnaire (SRQ-20) for MPD. Subjects were asked about the use of BZD in the preceding 2 weeks and were also asked for socioeconomic details. Results: A total of 152 (11.9%; 95% CI 10.1–13.7) subjects had taken psychotropic drugs, with BZD being the most commonly reported (8%). The prevalence of MPD was 22.7% (95% CI 20.4–25.0): males 17.9% and females 26.5%. An inverse relationship was seen between level of income, schooling and prevalence of MPD (P < 0.001), but a positive relationship was found between income and BZD consumption (P < 0.05). Conclusions: These data suggest that the inverse care law operates in prescribing psychotropic medications for MPD. Accepted: 15 February 1999