Testing DSM-III symptom criteria for schizotypal and borderline personality disorders

Schizotypal and borderline personality disorders (SPD and BPD, respectively) appear to be different at follow-up, yet they are poorly discriminated from each other by current DSM-III symptom criteria. In the Chestnut Lodge Follow-up Study, three axis II study cohorts (pure SPD, n = 10; pure BPD, n = 81; mixed SPD/BPD, n = 18) with distinctive outcomes are defined using current borderline systems. This study compares the relative frequency with which individual symptom criteria from each system discriminate across study cohorts. Findings suggest that for SPD, the most characteristic (core) DSM-III symptoms are odd communication, suspiciousness/paranoid ideation, and social isolation, while the least discriminating symptom is illusions/depersonalization/derealization; the core DSM-III symptoms for BPD are unstable relationships, impulsivity, and self-damaging acts, while the least discriminating symptoms are inappropriate anger and intolerance of aloneness; depression as a symptom does not discriminate between SPD and BPD; and transient psychoses and brief paranoid experiences and/or regression in treatment discriminate for SPD but against BPD and therefore fit better as SPD criteria. Results support the retention of some, but the elimination of other, DSM-III symptom criteria for the diagnosis of SPD and BPD.     

Contributions of the Brisbane Liver Group to knowledge of iron metabolism

In celebrating this very special day, it is appropriate to look back on the achievements of the Brisbane Liver Group, in which June Halliday has played such a key and pivotal role. Over the years the group's interests have included a whole range of interwoven iron themes, but as hereditary (genetic) haemochromatosis (HH) is central to a number of these themes, it provides a good starting point.     

Characteristics of patients with serious suicidal intentions who ultimately commit suicide

Patients in a long-term follow-up study who had made a serious suicide threat or attempt before admission were further studied to determine if there were characteristics that discriminated between those who ultimately committed suicide and those who did not. The results showed that patients who committed suicide were more likely to have a DSM-III axis I diagnosis, to be male, and to be discharged against medical advice. Those alive at follow-up were more likely to have a borderline personality disorder, to be female, impulsive, and self-mutilating, to be discharged with medical advice, and to have a healthier postdischarge course.     

Bowel function, mental health, and psychosocial function in adolescents with Hirschsprung's disease

Congenital intestinal malformations are uncommon and may pose lasting somatic difficulties. Patients with anorectal anomalies have a high frequency of persistent faecal dysfunction and psychosocial problems. This study examined whether adolescents with Hirschsprung's disease have more psychosocial problems than their healthy peers. Nineteen adolescents (mean age 15.7 years) with Hirschsprung's disease were assessed for bowel function, anorectal physiology, mental health, and psychosocial functioning by physical examinations, semistructured interview, and standardised questionnaires. The adolescents were compared with controls. The parents of 13 adolescents with Hirschsprung's disease were interviewed and completed questionnaires. Thirty two per cent of the adolescents with Hirschsprung's disease had significant impairment of continence, but no more psychopathology (16%) nor psychosocial dysfunction as a group than their healthy peers. Faecal incontinence was associated with poorer psychosocial functioning and parental criticism. The fact that a significant number of patients with Hirschsprung's disease have incontinence into adulthood indicates the need for parental counselling, encouraging realistic expectations about continence.     

Sotalol for Atrial Tachycardias After Surgery for Congenital Heart Disease

Atrial tachycardias, in particular atrial flutter after surgery for congenital heart disease, is associated with a high mortality. Treatment with various antiarrhythmic drugs and/or antitachycardia pacemakers is not very successful. Sotalol, a Class III drug, has shown to be a promising drug in adults with atrial tachycardias. However, the experience with sotalol in children after surgery for congenital heart disease is limited. Therefore, we describe our results here. Between December 1990 and February 1997, 26 children with atrial tachycardias, most of them with atrial flutter or fibrillation (n = 20), after surgery for congenital heart disease were treated with sotalol orally. The age of the children at the start of treatment was 7.5 ± 5.8 years (mean ± SD). The time interval between surgery and the start of atrial tachycardia ranged from 1 day to 14.3 years (3.8 ± 3.8 years). Conversion to sinus rhythm was achieved in 16 out of 22 hemodynamically stable children with a dosage of 4.0 ±1.6 mg/kg per day. The six children without sinus rhythm on sotalol and four hemodynamically unstable patients were treated prophylactically with sotalol after DC cardioversion for their tachycardias. Two children complained of mild transient fatigue. Heart rate decreased during therapy (95 ± 33 vs 81 ± 21 beats/min; P = 0.01). QT_c-intervals did not change. Proarrhythmias such as torsades de pointes were not encountered. Two children with a preexis-tent sick sinus syndrome showed aggravation of bradycardia and needed pacemaker implantation. The percentage of children with a recurrence-free interval of 1 and 2 years was 96% and 81 %, respectively, for all atrial tachycardias, and 92% and 66% for atrial flutter. The recurrences of atrial tachycardias during the follow-up period, which ranged from 0.1-6.1 years (2.5 ± 1.8 years) could be treated with only an increase of the dosage of sotalol in all but one patient. We conclude that sotalol is an effective drug for the treatment and prevention of atrial tachycardia in children afler surgery for congenital heart disease.     

ANTINOCICEPTIVE EFFECTS OF THE HYDROPHILIC α2-ADRENOCEPTOR AGONIST ST-91 IN DIFFERENT TEST CIRCUMSTANCES AFTER INTRATHECAL ADMINISTRATION TO WISTAR RATS

The antinociceptive and motor effects of the hydrophilic α₂-adrenoceptor agonist ST-91 were studied after intrathecal administration to male Wistar rats in different heat–pain tests and different test settings. Intrathecal administration of ST-91 caused a dose-dependent increase in hind paw licking latency in the hot-plate test, while in contrast with morphine it had a much lower efficacy in the tail-flick test in freely moving conditions. Sprague–Dawley rats gave similar results to those for Wistar rats in this setting. However, when the tail-flick test was performed under chronic restraint conditions (after a 1-h restraining period), the compound caused a significant antinociception. No signs of motor impairment and no changes in electromyographic activity were detected after ST-91 administration. The results indicate a characteristic analgesic profile for ST-91. In the interpretation of ST-91 data, consideration should be paid both to test model differences and to test conditions.     

Lung cancer 1978-1981 in the black peoples of South Africa

Mortality data on lung cancer among the black populations of South Africa, newly available from the first ever nation-wide enumerations, are analysed for age-specific rates and significant geographical and intertribal variations. This study finds a higher incidence at younger ages than among whites, an urban excess similar to other population groups in South Africa and a higher incidence among the Xhosa than Zulu. It is suggested that an anti-smoking campaign is urgently required among blacks in South Africa.     

Measurement of specific IgE antibodies in individuals exposed to formaldehyde

Using an in-vitro test, the presence of formaldehyde-specific IgE antibodies was investigated in sera from four groups of individuals exposed to formaldehyde by different routes and concentrations. Group (A) 28 subjects living or working in rooms or places where formaldehyde-containing construction materials were used; (B) 18 subjects occupationally exposed to relatively high concentrations of formaldehyde; (C) 12 paramedic employees working in a renal dialysis unit where formaldehyde-sterilized dialysers were being used; and (D) 28 subjects undergoing haemodialysis with these formaldehyde-sterilized dialysers. Formaldehyde-specific IgE antibodies could be detected in only one of the 86 serum samples. This particular sample was from a worker occupationally exposed to formaldehyde (group (B], but who did not show any work-related symptoms. In two pools of control sera from unexposed subjects no specific IgE antibodies to formaldehyde were detected. It is concluded that exposure to formaldehyde, even in relatively high concentrations, rarely evokes the production of specific IgE antibodies. The presence of these specific antibodies is not necessarily attended by allergic symptoms. On the other hand, the symptoms supposed to be related to formaldehyde exposure and reported in this study by 24 out of 28 subjects in group (A), and some of the subjects in groups (B) and (C), cannot be attributed to an IgE-mediated sensitization to formaldehyde.