Effects of labeling and treatment of hypertension on perceived health

The effects of labeling a person as hypertensive have important implications for hypertension screening. The Hypertension Detection and Follow-up Program (HDFP) provides an opportunity to examine the effects of labeling, treatment, and study assignment on a large group of hypertensives (n = 10,070). Their answers to questions regarding perceived health and general well-being asked at baseline and again one year later were analyzed. There was no significant change in the perceived health status of persons who were unaware of their hypertension at baseline and remained untreated at one year (labeling alone). The effect of labeling plus treatment was associated with a significant decrease in perceived health. The effect of antihypertensive drug therapy on perceived health status was examined in persons who were aware of their hypertension but not on treatment at baseline, and on treatment at one year. The stepped care group (SC) had a significant improvement in their perceived health and a significant decrease in the amount of time spent worrying about their health. The referred care group (RC) had no change. Program assignment effects were studied in individuals aware of their hypertension and on treatment both at baseline and one year later. Both the SC and RC groups had a significant improvement in their perceptions of their health status. The SC group had a significant decrease in time spent worrying about their health, while the RC group showed no change. These reassuring results fail to support the suggestion that labeling persons as hypertensive is necessarily followed by negative psychological consequences.(ABSTRACT TRUNCATED AT 250 WORDS)     

Disturbances of cross-localization of fingertips in a callosal patient

If defective cross-localization of fingertips (CLF) in callosal patients is due to a deficit in the interhemispheric transfer of somesthetic information, when the patient's eyes are open, CLF should be affected when the stimulated hand is excluded from vision, not when the responding hand is excluded from vision. In order to investigate this hypothesis, a patient with a callosal lesion was subjected to CLF with eyes closed and open. With eyes closed, the CLF score in the left-to-right direction was significantly lower than that in the right-to-left direction. With eyes open, the CLF performance in the right-to-left direction was impaired when it was the responding hand to be excluded from vision, not when it was the stimulated hand to be excluded from vision. It would, therefore, appear that the patient's CLF disturbance was not due to a somesthetic transfer deficit, but to left unilateral apraxia for the right-to-left direction errors and to left tactile finger anomia for the left-to-right direction errors.     

Clinico-pathological comparative study between brainstem encephalitis of Iizuka type and neuro-Beh?et's disease

We experienced one necropsy case of brainstem encephalitis of Iizuka type (BSE) and one necropsy case of the brain-stem syndrome (BSS) of typical neuro-Beh?et's disease, and compared them clinically and neuropathologically. Clinically both of these cases showed chronic progressive mental disturbance, pseudobulbar paresis, spastic tetraparesis, cerebrospinal fluid pleocytosis, increased protein, and brainstem atrophy observed by X-CT. Neuropathologically, irregular, boundary-indistinct demyelinating lesions and obsolete softening lesions were sporadically found, associated with perivascular lymphocytic infiltration and gliosis centering on the brainstem. In this way, both cases were similar in many points except for the presence or absence of cutaneo-muco-ocular signs specific for Beh?et's disease. Also BSE and BSS reports in the literature showed that both diseases were similar not only in clinical findings consisting of mental disturbance and brainstem signs but also in neuropathological findings with similar topographical distribution of the same histopathological changes, including the variations and diversity of these characteristics. Especially of much interest is their similarity in characteristic mental disturbance. In discriminating BSE from multiple sclerosis and other diseases with exclusive involvement of the brainstem, it is important to understand their clinical characteristics. The characteristic mental disturbance includes damage to memory and sentiment, a change in personality, and lowering in spontaneity, but calculation ability and orientation are comparatively preserved. Of course the similarity in clinical and neuropathological findings does not necessarily mean the identical etiopathogenesis. However, it is possible to consider that neuro-Beh?et's disease (syndrome) may form a wide spectrum with BSE and typical neuro-Beh?et's disease at the both ends, regarding the time and spatial diversity of the appearance of cutaneo-muco-ocular signs.     

Child psychopathology and environmental influences: discrete life events versus ongoing adversity

Patterns of exposure to distinct types of life stressors were compared between 134 children attending a military child psychiatric clinic and a matched military community control sample. Compared with the community sample, clinic-referred children had experienced significantly higher levels of normative stressful events as well as events confounded with their own adjustment and events related to parental psychosocial functioning. Differences in levels of normative stressful events were no longer significant, however, when controlling for events related to parental functioning. Ratings of stressful events during the past year significantly underestimated the lifetime stress exposure differences between clinic and community control children. Although normative stressful events, parent-related events, and parent symptomatology ratings were significantly related to child behavior problem ratings, normative stressful events did not contribute to predictions of child behavior problems beyond the variance attributable to parent-related events and parent symptomatology. Implications of these findings for life stress and child maladjustment research are discussed.     

Current status of research activity in American child and adolescent psychiatry: Part I

A survey of research activity of American academic child psychiatrists was completed in February, 1989. The survey demonstrated an increase in research activity since the 1983 report in the Current Status of Child Psychiatry. A definition of a researcher was derived from a study of internists and general psychiatrists and applied to the 488 respondents (78.5% of sample), and it was found that males outnumber females and that researchers contribute significantly more to the literature and education than nonresearchers. Early research exposure and mentoring are important influences on a research career. Recommendations by researchers for future training of researchers are presented. Periodic surveys are encouraged.     

Test for analysing nerve conduction velocity]

Recently, many attempts have been made to measure the difference in velocity between the fastest and slowest fibers in a nerve trunk or to estimate the nerve fiber conduction velocity distribution in a nerve bundle using several different methods, such as collision technique (Hopf 1963) and computer analysis of the compound action potentials (Cummins et al. 1979; Barker et al. 1979). For the computer analysis, however, some assumptions in regard to the quantitative relationship among conduction velocity, single fiber action potential and fiber diameter are necessary, and there has been little agreement about them. There is also a problem about the relationship between conduction velocity and refractory period in Hopf's technique. Using a collision technique with a method of 3-point stimulation, Gilliat et al. (1976) now suggested that surface recording was unsatisfactory for measuring the velocity of the slow-conducting nerve fibers. With this method, however, we had a preliminary experiment to analyze conduction velocities of so-called A fibers in the bullfrog's sciatic-peroneal nerve using fluid electrode, and they were divided into 3 groups (Nakanishi et al. 1986). These findings were in good agreement with those obtained by Erlanger and Gasser (1937) using monophasic recording. Therefore, clinical measurement of the nerve conduction velocities with a method of this collision technique was performed using surface recording.     

Patterns of membrane potentials and distributions of the medullary respiratory neurons in the decerebrate rat

We analyzed the membrane potential of 161 respiratory neurons in the medulla of decerebrate rats which were paralyzed and ventilated. Three types of inspiratory (I) neurons were observed: those displaying progressive depolarization in inspiration (augmenting I neurons), those which gradually repolarized after maximal depolarization at the onset of inspiration (decrementing I neurons) and those exhibiting a plateau or bell-shaped membrane potential trajectory throughout inspiration (I-all neurons). Three types of expiratory (E) neurons were also encountered: those in which the membrane potential progressively depolarized (augmenting E neurons), those in which the membrane potential repolarized during the interval between phrenic bursts (decrementing E or post-I neurons) and those exhibiting a plateau or bell-shaped membrane potential trajectory throughout expiration (E-all neurons). Axonal projections of these medullary neurons were identified in the cranial nerves (n = 34), or in the spinal cord (n = 19) as revealed by antidromic stimulation and/or by reconstruction following horseradish peroxidase (HRP) labeling. The other 108 neurons were not antidromically activated (NAA) by the stimulations tested, or had their axons terminating inside the medulla as revealed by HRP labeling. All these respiratory neurons, except for 3 which were hypoglossal motoneurons, had their somata within the ventrolateral medulla, in the region of the nucleus ambiguus, homologous to the ventral respiratory group (VRG) of the cat. No dorsal respiratory group (DRG) was detected within the medulla of the rats. Due to this absence of a DRG, it is concluded that the neural organization of respiratory centers is quite different in cats and rats.     

A patient with lambda type light-chain disease associated with Crow-Fukase syndrome and autoimmune thrombocytopenia]

A 67-year-old woman, who presented polyneuropathy, pleural effusion, ascites and sclerosing changes in the ribs, was admitted to our hospital on June 17, 1987. On admission, cerebrospinal examination showed a marked protein-cell dissociation and a delay in nerve conduction velocity. Bence-Jones protein was detected in urine, and the immunohistochemical study of biopsied bone marrow of the rib revealed lambda-chain positive plasmacytoma. Serum immunoelectrophoresis, however, showed no monoclonal gamma-globulinemia. From the findings described above, she was diagnosed as having Crow-Fukase syndrome associated with lambda-type light chain disease. Even with a therapy by prednisolone, platelet counts progressively declined to 10,000/ml3. Bone marrow aspiration showed normal number of megakaryocytes. Since platelet-associated IgG was increased to 452 ng/1.0 x 10(8) plt, a diagnosis of autoimmune thrombocytopenia was considered. Melphalan and cyclophosphamide to plasmacytoma resulted in a marked improvement of platelets. In addition, the level of platelet-associated IgG returned to normal range. Polyneuropathy, however, didn't respond to those therapies. It was suggested that both Crow-Fukase syndrome and thrombocytopenia were closely concerned with plasmacytoma but developed in a different manner.     

Million Behavioral Health Inventory: its utility in predicting physical function in patients with low back pain

The present study evaluated the use of psychologic measures, in particular, the relatively new Million Behavioral Health Inventory (MBHI), in predicting change in physical function of chronic low back pain patients undergoing a functional restoration program. The first 134 consecutive patients completing this program were assessed. Results demonstrated that various clinical scales of the MBHI were predictive of improvement in physical function. In addition, various scales enabled discrimination between patients who completed the program and those who prematurely dropped out. Although this inventory shows promise in helping to predict response to treatment, no single psychologic test can reliably be used as the sole predictor in clinical cases.