Bipolar affective disorder. II. EEG, neuropsychological, and clinical correlates of CT abnormality

Since the clinical significance of CT abnormalities found in bipolar patients remains obscure, we studied 26 DSM-III bipolar patients who had specific CT abnormalities (third ventricle enlargement, and hyperdensity of the caudate, thalamus, anterior frontal white matter, and right temporal lobe) on numerous parameters such as EEG, the Halstead-Reitan Neuropsychological Battery, premorbid personality adjustment, family history of affective disorder, positive and negative symptoms, employment history, and response to lithium carbonate treatment. None of these measures could differentiate between the CT abnormal and CT normal subgroups. The implications of these findings are discussed.     

人大肠肥大细胞多态性光镜特征(两种新类群:CTMC-1与MMC-1的发现)

人体肥大细胞的多态性已受到广泛关注,对于肥大细胞分型的研究已成为这一问题的关键。本实验研究了42例人大肠4种肥大细胞类群光镜特征,其中两种为作者的新近发现,暂命名为结缔组织肥大细胞-1(CTMC-1)和粘膜肥大细胞-1(MMC-1)。     

When stress is mental illness: A study of anxiety and depression in employees who use occupational stress counselling schemes

A previous study found that 86 per cent of employees (n = 111) who experience stress in the workplace and sought help from their workplace counselling schemes (Employee Assistance Programmes) had serious mental health problems, but the low participation rate (24 per cent) restricted generalizability and the measure used [General Health Questionnaire (GHQ‐12)] did not allow diagnosis. The present study (n = 58) improved the participation rate to 35 per cent and used a different version of the original measure (GHQ‐28) that allowed diagnostic differentiation as well as validation of the original findings. This new study found almost exactly the same high levels of mental health problems existed (86 per cent) in employees who remained at their work and that participants had higher rates of anxiety than depression. This finding is at variance with the usual co‐morbid presentation of anxiety and depression found in community based mental health services and suggests that depression may be an important differentiating factor between those who can remain at work and use counselling and those who cannot. There are implications for those who provide mental health services. The results of this study further reinforce the suggestion that workplace stress may be yet another name for common mental health problems that require professional help and treatment. Copyright © 2005 John Wiley & Sons, Ltd.     

危重病患者血浆胰岛素水平与细胞因子含量的关系

目的探讨危重病患者是否存在高胰岛素血症、胰岛素抵抗(IR)及与肿瘤坏死因子(TNF-α)、白细胞介素-6(IL-6)的关系.方法测定危重病患者123例和对照组30例的空腹血糖(FBG)、空腹胰岛素(FINS)、TNF-α、IL-6的水平,并计算胰岛素敏感性指数(IAI),以评估危重病患者IR的严重程度,并分析各参数之间的相关性.结果危重病组与对照组的IAi分别为-1.95±0.38和-1.5±0.29,两者差异显著(P＜0.01).危重病按病因分组后各组IAI相比无显著差异(P＞0.05).IAI与危重病严重程度、TNF-α及IL-6的直线回归分析,直线关系r分别为0.86,-0.89,-0.87,差异有显著性(P＜0.01).结论危重病患者存在高胰岛素血症及IR.IR的程度与危重病程度、TNF-α、IL-6的水平有显著相关性.危重病患者的IR与TNF-α的升高有关,提示IAI可作为危重病患者病情严重程度的预测指标.     

孕妇凝血指标的数学模型及指标异常变化警戒值探讨

目的探讨孕妇不同孕期凝血指标变化趋势的数学模型及凝血指标异常变化的警戒值估计,帮助临床医生及预防保健人员及早期发现高危人群,有效预防产科出血和凝血并发症的发生。方法对214例孕妇的孕期凝血指标进行回顾性追索,根据聚类分析的结果,建立方差分析、回归分析及ARIMA时间序列分析模型,比较各检测指标在不同孕期的变化规律。结果所建模型均能够很好的模拟不同孕期凝血指标的变化规律,结果显示:PLT指标值在孕晚期出现明显的下降(P0.05),PT与INR指标值在妊娠中期的下降明显(P0.01),APTT在整个妊娠期均下降(P0.01),FG指标值在妊娠晚期出现上升(P0.01),不同孕期凝血指标的警戒值表达式为:μ±2σ。结论所建模型能够较好的模拟不同孕期凝血指标变化规律,不同孕期凝血指标的正常参考值范围及异常警戒值具有一定的医学应用价值。     

Expressed-emotion development and course of schizophrenic illness: considerations based on results of a CFI replication

This study examines the correlation between development of expressed emotion (EE) in relatives and course of illness of 99 DSM-III schizophrenic patients. Patients whose relatives were high EE at baseline and at the 2nd CFI approximately 20 months later had a poor prognosis at the very outset of the study and an unfavourable course of illness. They had a higher rehospitalisation rate, more symptoms, lower psychosocial assessment, and a poorer 2-year and even 8-year outcome. Patients from families with a fluctuating EE or a consistently low EE had better courses. Expessed emotion is therefore a valid predictor not only of symptomatic relapses, but also of other important aspects of schizophrenia. The connection between EE index and course of illness seerns not to be simply reactive or causal, but complex and non-uniform.     

Le rôle des représentations de la maladie et de la douleur dans la relation patient-thérapeute

Résumé  La rencontre entre patient et thérapeute dans la relation de soins met en présence non seulement deux individus, mais aussi deux systèmes de pensée. Elle suppose donc l'articulation de deux types de savoirs, profane d'une part et scientifique d'autre part. La clarification et la prise en compte des représentations du patient à propos de l'atteinte dont il souffre constitue un enjeu important de la relation. Il en va de même des attentes du thérapeute par rapport à ce qu'il considère comme un comportement douloureux adéquat, par exemple. Faute de la prise en compte des modèles de référence explicites et implicites tant du patient que du thérapeute, la relation peut déboucher sur des malentendus, des réactions d'agressivité, d'anxiété, et conduire à une rupture de cette relation.

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Summary  The patient-therapist relationship involves not only two individuals, but also two systems of thinking. It calls forth lay knowledge on the one hand and scientific knowledge on the other hand. The patient's representations about his pain and suffering may play an important role in the patient-health care provider relationship and thus need to be clarified and taken into account. This need also holds true where the therapist's expectations are concerned, for example with regard to what is considered as an adequate pain behavior. Failing to take into account the explicit and implicit models of both the patient and the therapist may lead to misunderstandings, aggressive behaviors, anxious reactions, and thus hamper or even disrupt the patient-therapist relationship.

     

Prediction of outcome from intensive care after gastroenterologic emergency

Prognostic factors determining the outcome from intensive care were studied in 952 patients admitted to 25 Finnish ICUs after gastroenterologic emergency. Logistic regression analysis was used to create predictive models based on the APACHE II–system. The models were constructed by using data from a random two–thirds of the study population and validated in the remaining independent one–third together with the original APACHE II–index. The Acute Physiology Score, age, and a pre–existing liver disease were the three most important determinants of outcome. The inclusion of the TISS score describing the intensity of treatment into a model did not enhance the accuracy of the prediction. Our models were better calibrated than the original APACHE II–equation when tested by the goodness–of–fit –statistics. These statistical models may help the clinicians to predict the outcome for an individual patient by providing them information about the relative impacts of predictive factors or about the probability of death. These probabilities should be interpreted cautiously, taking into acount the limitations of statistical methods. This is especially important when assessing the highrisk patients. Their number in our study was too low for accurate outcome prediction.     

The Impact of Family Relations on Caregivers' Positive and Negative Appraisal of Their Caretaking Activities

This study examined the impact of family support and relationship difficulties between the caregiver and the care recipient on caregivers' satisfaction received from caregiving activities and subjective burden. Ninety‐seven individuals caring for a spouse or an adult child with schizophrenia or bipolar disorder participated in the study. Using hierarchical multiple regression analyses, findings showed that relationship difficulties between the caregiver and the care recipient were associated with both satisfaction received from caregiving activities and subjective burden, after the effects of personal, contextual, and stressor variables were controlled. Family support was not associated with caregivers' appraisal of the situation.