Treatment Options in Severe Psychotic Depression

In our sample of 15 hospitalized patients with severe psychotic depression, six responded to therapy with tricyclic antidepressants combined with neuroleptics. Of the nine nonresponders, eight showed an excellent clinical response to electroconvulsive therapy (ECT). The clinical outcome after 6 months of treatment was similar in both groups. We recommend that protracted, complicated trials of pharmacotherapy be reevaluated in psychotic depression. A prospective comparative study of ECT and pharmacotherapy is needed to define the optimal treatment for psychotic depression.     

Behavioural consequences of the infusion of dopamine into the nucleus accumbens of the common marmoset (Callithrix jacchus)

Marmosets, shown to have comparable levels of spontaneous locomotor activity, assessed in cages equipped with infra-red photocell units, could be separated into "high", "moderate" and "low activity" responders on the basis of their locomotor hyperactivity response to peripherally administered (-)N-n-propylnorapomorphine [(-)NPA]. Animals selected as "low" and "high activity" responders to (-)NPA were subjected to chronic infusion of dopamine, or its solvent, bilaterally into the nucleus accumbens for 13 days through Alzet osmotic minipumps. Both "low" and "high activity" responders exhibited an increased locomotor activity which peaked on days 6-7 of the infusion. This hyperactivity, caused by infusion of dopamine was antagonised by small doses of sulpiride and fluphenazine. After the infusion, the level of spontaneous locomotor activity of the marmosets was unchanged from pre-infusion values. However, 2-3 weeks after discontinuing the infusion, the animals initially classified as "low activity" responders showed markedly enhanced activity when challenged with (-)NPA, and conversely, animals initially classified as "high activity" responders showed a reduced responsiveness to (-)NPA. It is concluded that the consequences of a persistent increase in the activity of dopamine in the nucleus accumbens of the brain of the marmoset are to (a) enhance locomotor activity during infusion and (b) after discontinuing infusion, to modify the locomotor responsiveness to challenge with a dopamine agonist, with the direction of the change dependent on the initial basal locomotor responsiveness to (-)NPA.     

When the universal is particular: a re-examination of the common morality using the work of Charles Taylor

Medicine, Health Care and Philosophy - Beauchamp and Childress’ biomedical principlism is nearly synonymous with medical ethics for most clinicians. Their four principles are theoretically...     

The cost of lost productivity due to premature mortality associated with COVID-19: a Pan-European study

The European Journal of Health Economics - Economic cost estimates have the potential to provide a valuable alternative perspective on the COVID-19 burden. We estimate the premature mortality...     

Local-Level Immigration Enforcement and Risk of Pediatric Hospitalization for Ambulatory Care Sensitive Conditions

Immigration enforcement may disrupt access to health care, potentially increasing hospitalizations for Ambulatory Care Sensitive Conditions (ACSC). We aimed to assess the effect of local-level 287(g) immigration enforcement on North Carolina pediatric ACSC hospitalizations. Pediatric (<?19 year) ACSC hospitalizations were identified based on ICD-9 codes. We compared ACSC hospitalizations pre and post 287(g) implementation using a difference-in-difference analysis of Fiscal Year (FY)2006-2009 data. We used multi-level models to assess the effects of 287(g) programs on ACSC hospitalizations during FY2011-2015. Difference-in-difference analyses showed that ACSC hospitalizations increased by more than 2.48% in the year following 287(g) implementation (95% CI: 0.99%, 3.97%). Among the counties that had ever implemented a 287(g) program, the ACSC-increasing effect of an active 287(g) program was greatest in counties with a shorter tenure of their 287(g) program and for Hispanic/Latino children/adolescents. Our findings underscore the importance of describing the effects of local-level immigration enforcement on pediatric access to care and potentially avoidable hospitalizations.

     

Heart Transplantation for Giant Cell Myocarditis: A Case Series

BackgroundGiant cell myocarditis (GCM) has a poor prognosis without heart transplant, but post-transplant survival is unknown.PurposeTo describe the post-transplant survival of patients with GCM at a large transplant center.MethodsSeven patients underwent heart transplant for histologically confirmed GCM of the explanted heart. The median age was 59 years, and 43% (3 of 7) were female. All patients had cardiogenic shock, multiorgan failure, elevated troponin, and recurrent ventricular tachycardia, and some required mechanical circulatory support. All patients received rabbit antithymocyte globulin (rATG) in the perioperative period at a dose of 1.5 mg/kg daily for 1 to 5 days and 4 received intravenous immunoglobulin 1 g/kg daily for 2 days after rATG. All patients had early initiation of tacrolimus by first to third postoperative day depending on renal function, early mycophenolate, and high dose steroid. All were maintained using tacrolimus, mycophenolate, and prednisone.ResultsOne patient had asymptomatic recurrence of GCM at 3 months, managed by up-titration of tacrolimus, and had asymptomatic 2R cellular rejection at 4 months, managed with steroid bolus. No patient had high-grade rejection. One patient died at 267 days, possibly of GCM. Six of 7 (86%) remain alive at a median of 842 days (2.3 years) post transplant.ConclusionsPatients with GCM have excellent post-transplant survival with use of rATG and triple drug immunosuppressive therapy; however, some patients remain at risk for GCM recurrence after transplant, which may respond to augmented immunosuppression.     

Is romantic partner betrayal a form of traumatic experience? A qualitative study

According to a growing body of research, betrayal by a romantic partner is increasingly considered as a form of interpersonal trauma. Between 30% and 60% of betrayed individuals experience symptoms of post-traumatic stress disorder (PTSD), depression and anxiety to clinically meaningful levels. From a clinical perspective, this constellation of symptoms can be conceptualized as a stressor-related adjustment disorder. Yet, no qualitative research has examined the association between romantic betrayal and traumatic stress from the perspective of betrayed individuals. Face-to-face semi-structured interviews were conducted with 13 participants who had completed a clinical trial for a new treatment for adjustment disorder stemming from betrayal. Data were analysed using thematic content analysis. Although betrayal was experienced as a shocking and destabilizing event, and participants used trauma or ‘feeling traumatized’ as a metaphor to describe their experience, few had constructed their reaction as traumatic stress. In fact, participants reported experiencing difficulties understanding the intensity of their experience. However, when exposed to external sources (e.g., books and interviews by psychologists and researchers) that used a trauma and PTSD framework to explain the effects of betrayal, participants reported feeling clarity, validation and relief. Findings are discussed in the light of theoretical and clinical implications.