Command hallucinations among Asian patients with schizophrenia.

OBJECTIVES: The impact of command hallucinations on patients and the determinants of patients' compliance with them are still poorly understood. The extant literature is also divided on their association with violence. This study aimed to establish the prevalence of command hallucinations and to identify the factors that affect compliance with the commands, together with patients' coping methods. METHODS: We recruited 50 consecutive male and 50 consecutive female schizophrenia inpatients who reported hearing voices in the 6 months prior to admission. We interviewed these patients, using a semistructured questionnaire. We collected information on the contents of their auditory hallucinations and their coping methods. RESULTS: Of the patients, 53 (53%) reported command hallucinations. Of these 53 patients, 58% were women and 48% were men; 62% reported complying with the commands. They were also more likely to comply with nonviolent commands. A history of self-harm predicted compliance. Those patients who did not comply with the commands adopted various methods of coping, of which praying was the most common. CONCLUSION: Command hallucinations are common in patients with schizophrenia. Patients with a history of self-harm need closer monitoring because they may be more likely to comply with these hallucinations. Assessment should also include the patient's own coping strategies, which can be incorporated into the treatment.     

Treating the cognitive deficits of schizophrenia

Schizophrenia is characterized by significant cognitive impairments that predict impairment in multiple domains of community outcome. Pharmacologic and psychosocial treatments are available that address these cognitive deficits. There is growing evidence that patients taking second-generation antipsychotic medications perform better on tests of cognitive function than those taking conventional neuroleptics. In addition, there have been a number of medications from other classes being investigated as cognitive enhancers for schizophrenia. Cognitive rehabilitation approaches focus on bypassing, compensating for, or remediating observed impairments in cognitive function. Outcomes for patients have been improved by cognitive remediation, errorless learning, and the use of supportive environments. Combining the newest pharmacologic interventions for cognitive dysfunction with state of the art psychosocial treatments aimed at ameliorating or bypassing deficits is likely to produce the most favorable outcomes for individuals with schizophrenia.     

Costello syndrome: Clinical phenotype,genotype, and management guidelines

Costello syndrome (CS) is a RASopathy caused by activating germline mutations in HRAS. Due to ubiquitous HRAS gene expression, CS affects multiple organ systems and individuals are predisposed to cancer. Individuals with CS may have distinctive craniofacial features, cardiac anomalies, growth and developmental delays, as well as dermatological, orthopedic, ocular, and neurological issues; however, considerable overlap with other RASopathies exists. Medical evaluation requires an understanding of the multifaceted phenotype. Subspecialists may have limited experience in caring for these individuals because of the rarity of CS. Furthermore, the phenotypic presentation may vary with the underlying genotype. These guidelines were developed by an interdisciplinary team of experts in order to encourage timely health care practices and provide medical management guidelines for the primary and specialty care provider, as well as for the families and affected individuals across their lifespan. These guidelines are based on expert opinion and do not represent evidence‐based guidelines due to the lack of data for this rare condition.     

Violence exposure,catecholamine excretion,and blood pressure nondipping status in African American male versus female adolescents

OBJECTIVE: Nondipping status (<10% decrease in blood pressure [BP] from awake to asleep) has been associated with end-organ disease (stroke and left ventricular hypertrophy) in adults. Nondipping status has also been observed in 30% of healthy African American adolescents, but little is known about the correlates of nondipping status in adolescents. This study examined the relationship between violence exposure, catecholamine excretion, and BP nondipping status in 56 healthy African American adolescents (27 boys, 29 girls; ages 11-18 years). METHODS: Participants completed the Survey of Exposure to Community Violence, wore an ambulatory BP monitor and provided one timed day and night urine collection for determination of epinephrine and norepinephrine excretion. RESULTS: Boys had higher daytime epinephrine (5.1 +/- 3.3 vs. 2.6 +/- 2.3 ng/min, p < .001) and norepinephrine excretion (29.2 +/- 25.1 vs. 16.5 +/- 14.9 ng/min, p < .05) and showed a greater prevalence of mean BP nondipping status than girls (37% vs. 10%, p < .03). Mean BP nondipping status was positively associated with victimization (r = 0.42, p < .0001). Regression analyses indicated a significant interaction between hearing about violence and sex for predicting daytime epinephrine (p < .02), with male nondippers showing a stronger positive association (partial correlation = 0.59, p < .05) than females (partial correlation = 0.03, p = NS). Logistic regressions also demonstrated a significant interaction between hearing about violence and sex for predicting mean BP dipping status, with male nondippers reporting the greatest exposure. CONCLUSIONS: Mean BP nondipping was associated with victimization in both boys and girls. Boys who reported higher levels of hearing about violence showed greater daytime epinephrine excretion and were more likely to be classified as nondippers.     

Sex differences in weight loss among adults with Type II diabetes mellitus

The treatment of choice for Type II or non-insulin-dependent diabetes mellitus is a behavioral program for the management of weight. However, compliance with this lifelong dietary regimen is often poor. In the current investigation male and female adults with diagnosed Type II diabetes were randomly assigned to either a behavior modification, a cognitive modification, a cognitive-behavior modification, or a control group. Patients were evaluated in terms of weight, percentage of body fat, and glycosylated hemoglobin measures. Men lost signficantly more weight than women and subjects in the behavior modification group lost more weight and demonstrated greater decreases in diabetes control than subjects in the cognitive-behavior modification, cognitive, and control groups. A significant interaction indicated that diabetic men may benefit more from behavioral weight reduction programs than diabetic women. Several explanations for these findings are considered.This work was supported by Grants K04 HL 00809 and R01 AM 27901 from the National Institutes of Health to Robert M. Kaplan.     

Two novel paradigms for the simultaneous assessment of conditioned taste aversion and food intake effects of anorexic agents

The conditioned taste aversion (CTA) is routinely used to assess the aversive consequences of anorexic agents, including potential pharmacological therapies for obesity. In a typical CTA paradigm, rats briefly sampling a novel tastant (e.g., saccharin) are acutely administered with toxin (e.g., lithium chloride, LiCl). After as few as one taste-toxin pairing, rats will reliably avoid the novel tastant. This paradigm is frequently used for the assessment of possible aversive consequences of drugs that are candidates for pharmacological therapies. The degree to which the drug supports development of a CTA is interpreted as an index of its aversive properties. Difficulties with previous work include the inability to assess affects on food intake and CTA simultaneously, particularly during chronic drug administration. We report here two novel CTA paradigms for the assessment of appetitive and aversive consequences of anorexic agents, simultaneously. In the first experiment, animals receive an intraoral infusion of a novel and highly palatable tastant immediately prior to administration of increasing doses of LiCl. In the second experiment, rats were implanted intraperitoneally with osmotic minipumps that chronically delivered a low dose of LiCl for 7 days. LiCl did not affect short or long term food intake in either experiment. However, LiCl did support the development of a CTA in both paradigms. These results suggest that both the appetitive and aversive consequences of anorexic agents can be assessed simultaneously during either acute or chronic drug administration.     

Inhibition of tumor necrosis factor in the brain suppresses rabbit sleep

Tumor necrosis factor (TNF) is a cytokine that possesses many biological activities, including enhancement of non-rapid-eye-movement sleep (NREMS). The role of endogenous TNF in the regulation of spontaneous sleep is unknown. If TNF is involved in sleep regulation, then reduction of endogenous TNF should suppress spontaneous sleep. A soluble TNF-binding protein I (TNF-BP I) and a synthetic fragment of TNF-BP I, TNF-R-(159–178), that contains the biologically active region of TNF-BP I, were used. These substances bind TNF and possess TNF-inhibitory activity; their effects on rabbit sleep after intracerebroventricular injection were determined across a 6-h recording period. Two doses of TNF-BP I (0.05 g and 0.5 g) were administered; the higher dose of TNF-BP I significantly decreased NREMS. Four doses of TNF-R-(159–178) (0.25 g, 2.5 g, 25 g and 50 g) were used. The 25 g and 50 g doses significantly suppressed NREMS. The highest dose (50 g) also decreased REM sleep. These results are consistent with the hypothesis that endogenous brain TNF is involved in the regulation of normal sleep.     

Identification of surface-exposed B-cell epitopes recognized by Haemophilus influenzae type b P1-specific monoclonal antibodies.

A panel of P1 synthetic peptides was synthesized to map the surface-exposed epitopes of Haemophilus influenzae type b outer membrane protein P1 recognized by three murine monoclonal antibodies (MAbs 7C8, 3E12, and 6B1). By using peptide-specific enzyme-linked immunosorbent assays, MAbs 6B1, 7C8, and 3E12 were shown to recognize distinct epitopes localized within residues 60 to 88, 165 to 193, and 400 to 437 of mature P1, respectively. Since MAb 7C8 was shown previously to be protective against certain H. influenzae type b subtypes in the infant rat model of bacteremia, its cognate epitope was further characterized by using truncated peptide analogs. Fine mapping of the 7C8 epitope by competitive inhibition studies revealed that it was localized within residues 184 and 193.