The Psychiatric Diagnosis of Alcoholism: Critique and Proposed Reformulation

A taxonomy of alcohol problem involvement is proposed which encompasses categorical and dimensional approaches to classification. It is argued that contemporary nosology such as that described in DSM or ICD cannot, in principle, yield discrete categories containing homogeneous membership. Nor does current classification and diagnosis yield sufficient specific information necessary for effective treatment. These limitations are not resolvable by additional empirical research; rather, as discussed herein, a new conceptual framework and focus are required. The proposed new taxonomy comprises the first step in developing a comprehensive and clinically useful method for characterizing the alcohol consuming population.     

Acute Annular Urticaria in Infants and Children

Abstract: Characteristic features of acute annular urticaria in 34 infants and small children were large, erythematous annular and polycyclic lesions with violaceous centers, eyelid, hand, and foot edema, absence of angioedema of the airway, absence of pruritus, spontaneous resolution in 8 to 10 days, and frequent history of furazolidone medication for diarrhea. Nondermatologists often misdiagnose acute annular urticaria as erythema multiforme and unnecessarily overtreat patients. The differential diagnosis with other conditions presenting with annular lesions in children is discussed.     

Immunohistochemical Localization of Nitric Oxide Synthase Activity in Upper Respiratory Epithelium

Nitric oxide (NO) production in the respiratory epithelium of the upper airways has recently been described. To better delineate the role of epithelial NO, the authors of this study attempted to identify the cell type responsible for the production of NO in rat tracheal epithelium and human nasal epithelium. They localized the activity of NO through immunohistochemical analysis with an antibody to L-citrulline, a marker for activity of the L-arginine-dependent nitric oxide synthase (NOS) pathway. Using anti-inducible NOS (iNOS) and anti-constitutive NOS (cNOS) antibodies, they also attempted to identify the specific NO isotypes that were present. The tracheal and nasal epithelium demonstrated strong immunoreactivity to citrulline in ciliated cells. The ciliated cells of the nasal turbinates demonstrated strong iNOS positivity, but no significant cNOS immunoreactivity. The study findings that iNOS activity is present in ciliated epithelial cells of rat and human upper respiratory epithelium suggest that NO may play a role in epithelial homeostasis and could potentially play a role in the pathogenesis of mucociliary dysfunction.     

Fetal Heart Rate Part II: Behavioral Correlates

Relatively recent technological developments have made possible continuous electronic monitoring of fetal heart rate (FHR) during labor. These developments have added a new dimension to the understanding of fetal responses to labor. The FHR response to labor is thought to be a multidimensional phenomenon. This study was designed to determine the type and degree of relationship between multiple FHR factors and dimensions of neonatal behavior scored with the Brazelton Newborn Behavior Assessment Scale. Due to the exploratory nature of the study, infants from complicated pregnancies and deliveries were excluded. The behavioral assessment was administered to 90 2–3 day old newborn infants. FHR was recorded during labor and the last hour of recorded FHR was analyzed for the study. Six factors were derived from measures of FHR (e.g. amplitude, frequency, decelerations, accelerations) and were used in a step-wise multiple regression analysis. Significant multiple correlations were found between FHR factor composites and infant behavioral dimensions of attention-orientation and arousal.     

Divalent cation interactions with a carboxylated derivative of scleroglucan

Divalent cation binding was investigated on a semisynthetic carboxylate derivative obtained from the fungal polysaccharide scleroglucan. Polarography, circular dichroism and isothermal microcalorimetry were used to study both the binding ability of Cu(II), Pb(II), and Zn(II) ions and the macromolecular properties of the systems under investigation. A theoretical model, proposed by Schwarz for the cooperative binding, was used to evaluate binding constants and the parameter σ related to the degree of cooperativity. All findings are discussed in terms of the differences in the binding ability of the different cations investigated. Pb(II) ions exhibit the higher affinity for oxidised scleroglucan and, in addition to this, its binding process is characterised by a cooperative behavior due to the onset of a disorder-to-order conformational transition of the polysaccharidic backbone. On the other hand, Cu(II) ions are less effective in the binding and unable to induce the conformational transition.     

DSM-III Criteria for Alcohol Abuse: Associations with Alcohol Consumption Behavior

DSM-III criteria for diagnosing alcohol abuse in a sample of hospitalized alcoholics highly correlated with each other and were poorly correlated with self-reported drinking pattern, quantity, and consequences of alcohol consumption. These findings question the specificity and the construct validity of the DSM-III criteria for diagnosing alcohol abuse.     

Influence of neuronal uptake on the presynaptic α-adrenergic modulation of noradrenaline release

Summary Conditions required for the inhibitory feedback modulation of noradrenergic neurotransmission were studied in isolated atria of the rat.The alpha adrenergic antagonist, yohimbine, 0.8 M, or phentolamine, 1 M, did not affect the chronotropic response to 4 or 8 shocks at 0.8 Hz but increased it when a higher number of shocks was applied. When neuronal uptake was inhibited by cocaine, 2.9 M, or desipramine, 0.1 M, the enhancement of neurotransmission by yohimbine or phentolamine was higher than that observed in the presence of -adrenergic antagonists alone.In atria preincubated with ³H-noradrenaline, the effect of the drugs on the ³H-overflow evoked by 240 shocks at 2.0 Hz was studied. Cocaine 2.9 M, did not increase the evoked overflow but yohimbine, 0.8 M, did. The ³H-overflow obtained in the group of yohimbine plus cocaine was significantly higher than was expected from the effects of both drugs alone.It is concluded that yohimbine or phentolamine enhance the chronotropic response in rat atria only when the concentration of noradrenaline in the biophase is sufficiently high to activate presynaptic receptors. In this tissue, the efficiency of the neuronal uptake influences the degree of -adrenergic autoinhibition.     

Use of health services by the climacteric women in primary health care: The need for an integral approach

During the climacteric, women experience multiple health problems. As their needs are not catered for in an integral fashion due to the lack of any specific programme or mechanism to provide for this, they show an increased use of the health services, and an increased rate of referrals to different specialists. This study, carried out in a Basic Health Zone in San Fernando (Cádiz, Andalusía, Spain) on a sample of climacteric women who attended the Health Centre during 1995, examines these points and shows a significantly higher use of the health services in relation to the rest of the female population (those who are not in the climacteric age group) as well as a high percentage of referrals (74.6%) to specialists. It was found that both the level of knowledge about the climacteric and the use of the health services were influenced by the educational level (p<0.001) and age (p<0.05). Women who felt that their families provided an understanding and supportive attitude were found to have less psychological problems and, consequently, less consultations and referrals for this reason (p<0.00001). The authors hope that their findings will provide a basis for the setting up of a programme of integral health care for climacteric women at the level of primary health care. With careful planning and the drawing up of a strategic plan, it would be possible to provide for the needs of this population group in a more satisfactory way, and it would also permit a rationalization of the resources available.     

The prediction of recovery using a multivariate model in 1471 depressed inpatients

Summary Stepwise multiple logistic regression was used in an attempt to develop a statistical model which would predict recovery in a group of 1471 depressives admitted to a tertiary care hospital. Six variables identified by this approach included: Electroconvulsive therapy, personality disorder, chronicity, anxiety disorder, organic mental disorder, and dysthymia. The meaning and significance of the findings are discussed.