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1.
Theor Appl Genet ; 112(7): 1382-91, 2006 May.
Article in English | MEDLINE | ID: mdl-16552554

ABSTRACT

Modern sugarcane cultivars (Saccharum spp) are highly polyploïd and aneuploid interspecific hybrids (2n = 100-130). Two genetic maps were constructed using a population of 198 progeny from a cross between R570, a modern cultivar, and MQ76-53, an old Australian clone derived from a cross between Trojan (a modern cultivar) and SES528 (a wild Saccharum spontaneum clone). A total of 1,666 polymorphic markers were produced using 37 AFLP primer combinations, 46 SSRs and 9 RFLP probes. Linkage analysis led to the construction of 86 cosegregation groups for R570 and 105 cosegregation groups for MQ76-53 encompassing 424 and 536 single dose markers, respectively. The cumulative length of the R570 map was 3,144 cM, while that of the MQ76-53 map was 4,329 cM. Here, we integrated mapping information obtained on R570 in this study with that derived from a previous map based on a selfed R570 population. Two new genes controlling Mendelian traits were localized on the MQ76-53 map: a gene controlling the red stalk colour was linked at 6.5 cM to an AFLP marker and a new brown rust resistance gene was linked at 23 cM to an AFLP marker. Besides another previously identified brown rust resistance gene (Bru1), these two genes are the only other major genes to be identified in sugarcane so far.


Subject(s)
Chromosome Mapping , Genes, Plant , Immunity, Innate/genetics , Plant Diseases/microbiology , Saccharum/genetics , Basidiomycota , Chromosomes, Plant , Crosses, Genetic , Hybridization, Genetic , Polyploidy , Saccharum/microbiology
2.
Schizophr Res ; 84(1): 165-9, 2006 May.
Article in English | MEDLINE | ID: mdl-16567080

ABSTRACT

The purpose of this study was to determine if patients with schizophrenia or schizoaffective disorders and comorbid posttraumatic stress disorder (PTSD) are at higher risk for suicidality than patients without comorbid PTSD. Participants were 165 male veterans with primary diagnoses of schizophrenia or schizoaffective disorder. Those with comorbid PTSD reported higher rates of suicidal ideation and suicidal behaviors compared to those without comorbid PTSD. These findings suggest that patients with comorbid PTSD are at higher risk for suicidality. Enhanced screening and targeted interventions may be warranted to address comorbid PTSD and increased suicide risk in this population.


Subject(s)
Psychotic Disorders/epidemiology , Stress Disorders, Post-Traumatic/epidemiology , Suicide, Attempted/statistics & numerical data , Veterans/statistics & numerical data , Adult , Comorbidity , Demography , Diagnostic and Statistical Manual of Mental Disorders , Humans , Male , Psychotic Disorders/diagnosis , Severity of Illness Index , Stress Disorders, Post-Traumatic/diagnosis , Substance-Related Disorders/epidemiology
3.
Phys Rev Lett ; 93(26 Pt 1): 267205, 2004 Dec 31.
Article in English | MEDLINE | ID: mdl-15698019

ABSTRACT

Our electron photoemission experiments demonstrate that the magnetization of the ferromagnetic state of UTe is proportional to the binding energy of the hybridized band centered around 50 meV below EF. This proportionality is direct evidence that the ferromagnetism of UTe is itinerant; i.e., the 5f electrons are not fully localized close to the atomic core. This mechanism of itinerant ferromagnetism differs from the traditional picture for 5f-electron magnetism in an essential and a novel way. We propose a simple model for the observed proportionality between the temperature dependence of the magnetization and the binding energy of the hybridized band near EF. This model allows us to estimate the effective magnetic interaction and to identify signatures of itinerant ferromagnetism in other materials.

4.
Phys Rev Lett ; 91(17): 176401, 2003 Oct 24.
Article in English | MEDLINE | ID: mdl-14611363

ABSTRACT

The electronic structure of the first Pu-based superconductor PuCoGa5 is explored using photoelectron spectroscopy and a novel theoretical scheme. Exceptional agreement between calculation and experiment defines a path forward for understanding the electronic structure aspects of Pu-based materials. The photoemission results show two separate regions of 5f electron spectral intensity, one at the Fermi energy and another centered 1.2 eV below the Fermi level. The results for PuCoGa5 clearly indicate 5f electron behavior on the threshold between localized and itinerant. Comparisons to delta phase Pu metal show a broader framework for understanding the fundamental electronic properties of the Pu 5f levels in general within two configurations, one localized and one itinerant.

5.
Proc Inst Mech Eng H ; 217(2): 147-53, 2003.
Article in English | MEDLINE | ID: mdl-12666782

ABSTRACT

Wear of polyethylene and the resulting wear debris-induced osteolysis remains a major cause of long-term failure in artificial hip joints. There is interest in understanding engineering and clinical conditions that influence wear rates. Fluoroscopic studies have shown separation of the head and the cup during the swing phase of walking due to joint laxity. In ceramic-on-ceramic hips, joint laxity and microseparation, which leads to contact of the head on the superior rim of the cup, has led to localized damage and increased wear in vivo and in vitro. The aim of this study was to investigate the influence of joint laxity and microseparation on the wear of ceramic on polyethylene artificial hip joints in an in vitro simulator. Microseparation during the swing phase of the walking cycle produced contact of the ceramic head on the rim of the polyethylene acetabular cup that deformed the softer polyethylene cup. No damage to the alumina ceramic femoral head was found. Under standard simulator conditions the volume change of the moderately crosslinked polyethylene cups was 25.6 +/- 5.3 mm3/million cycles and this reduced to 5.6 +/- 4.2 mm3/million cycles under microseparation conditions. Testing under microseparation conditions caused the rim of the polyethylene cup to deform locally, possibly due to creep, and the volume change of the polyethylene cup when the head relocated was substantially reduced, possibly due to improved lubrication. Joint laxity may be caused by poor soft tissue tension or migration and subsidence of components. In ceramic-on-polyethylene acetabular cups wear was decreased with a small degree of joint laxity, while in contrast in hard-on-hard alumina bearings, microseparation accelerated wear. These findings may have significant implications for the choice of fixation systems to be used for different types of bearing couples.


Subject(s)
Ceramics , Equipment Failure Analysis/instrumentation , Hip Prosthesis , Joint Instability/etiology , Materials Testing , Polyethylenes , Compressive Strength , Elasticity , Equipment Failure Analysis/methods , Femur/physiopathology , Friction , Hip Joint/physiopathology , Humans , Joint Instability/physiopathology , Lubrication , Motion , Osteolysis/etiology , Osteolysis/physiopathology , Prosthesis Design/methods , Prosthesis Failure , Viscosity , Walking , Weight-Bearing
6.
Int Clin Psychopharmacol ; 16(4): 197-203, 2001 Jul.
Article in English | MEDLINE | ID: mdl-11459333

ABSTRACT

Because the atypical antipsychotic olanzapine may be efficacious in treating post-traumatic stress disorder (PTSD) symptoms, we conducted a 10-week, double-blind, placebo-controlled evaluation in which 15 patients were randomized 2:1 to either olanzapine or placebo. The initial dosage was 5 mg/day and was titrated to a maximum of 20 mg/day. Eleven patients completed the study. Patients in both groups showed improvement in PTSD symptoms, but no between-group differences in treatment response were observed and a high placebo response rate was found. Both treatments were tolerated well, although the olanzapine treatment group had more weight gain. Olanzapine fared no better than placebo in this preliminary study in the treatment of PTSD. The lack of difference between olanzapine and placebo may in part be due to olanzapine's not being effective in PTSD or, alternatively, a small sample size, a high placebo response in certain forms of PTSD and the chronicity of PTSD symptoms in some patients.


Subject(s)
Pirenzepine/analogs & derivatives , Pirenzepine/administration & dosage , Stress Disorders, Post-Traumatic/drug therapy , Adolescent , Adult , Aged , Benzodiazepines , Dose-Response Relationship, Drug , Double-Blind Method , Drug Administration Schedule , Female , Humans , Male , Middle Aged , Olanzapine , Pilot Projects , Pirenzepine/adverse effects , Stress Disorders, Post-Traumatic/diagnosis , Stress Disorders, Post-Traumatic/psychology , Treatment Outcome
7.
J Heart Valve Dis ; 10(2): 269-75, 2001 Mar.
Article in English | MEDLINE | ID: mdl-11297215

ABSTRACT

BACKGROUND AND AIM OF THE STUDY: Hydrodynamic function testing using pulsatile flow simulators provides a valuable means of comparative assessment of heart valves in vitro. The majority of pulsatile flow simulators consist of modular rigid chambers and a positive displacement pump with an infinite input impedance, in which the inertia of the test fluid results in pressure oscillations when the valves under test are opening and closing. For mechanical and stented bioprosthetic valves these pressure oscillations decay quickly. However, due to the highly compliant nature of tissue roots, the resulting pressure and flow oscillations are extreme and extend throughout systole. With increasing interest in the use of free-sewn roots and valves it is most desirable to improve this hydrodynamic model. The aim of this study was to investigate the influence in changes in ventricular input impedance on the hydrodynamic characteristics of free-sewn aortic roots and stented valves. METHODS: The Leeds pulsatile flow simulator was modified to incorporate additional compliance chambers in the form of a viscoelastic impedance adaptor (VIA) at the pump/ventricular interface. Six 23 mm bioprosthetic aortic roots fixed with 0.5% buffered glutaraldehyde at zero pressure, and a size 23 mm stented porcine aortic bioprosthesis were tested in this modified simulator, at the conditions of maximum and minimum input compliance. RESULTS: The pressure and flow waveforms for the fixed aortic roots showed considerable differences at the conditions of maximum and minimum input compliance. Indeed, the extreme pressure oscillations observed at minimum compliance (infinite input impedance) were not present at maximum compliance, and the forward flow waveform was much smoother. In contrast, for the stented valve, the differences in the pressure and flow waveforms between maximum and minimum input compliance were minimal, but this was expected due to the lack of compliance in the stented valve itself. In addition, the flow and pressure waveforms at maximum compliance in the VIA were comparable for the fixed aortic roots and the stented bioprosthesis, thus allowing direct comparison of the characteristics of these two different devices. Using test conditions of maximum input compliance, effective orifice area for the roots was 1.69 cm2 compared with 1.47 cm2 for the stented valve. CONCLUSION: An appropriate physiological model for the hydrodynamic testing of compliant tissue roots has been established.


Subject(s)
Aortic Valve/physiology , Bioprosthesis , Electric Impedance , Heart Valve Prosthesis , Ventricular Function/physiology , Heart Valve Diseases/physiopathology , Hemodynamics/physiology , Humans , In Vitro Techniques , Models, Cardiovascular , Prosthesis Design , Pulsatile Flow/physiology
8.
Am J Public Health ; 91(1): 31-7, 2001 Jan.
Article in English | MEDLINE | ID: mdl-11189820

ABSTRACT

OBJECTIVES: This study assessed seroprevalence rates of HIV, hepatitis B virus (HBV), and hepatitis C virus (HCV) among individuals with severe mental illness. METHODS: Participants (n = 931) were patients undergoing inpatient or outpatient treatment in Connecticut, Maryland, New Hampshire, or North Carolina. RESULTS: The prevalence of HIV infection in this sample (3.1%) was approximately 8 times the estimated US population rate but lower than rates reported in previous studies of people with severe mental illness. Prevalence rates of HBV (23.4%) and HCV (19.6%) were approximately 5 and 11 times the overall estimated population rates for these infections, respectively. CONCLUSIONS: Elevated rates of HIV, HBV, and HCV were found. Of particular concern are the high rates of HCV infection, which are frequently undetected. Individuals with HCV infection commonly fail to receive appropriate treatment to limit liver damage and unknowingly may be a source of infection to others.


Subject(s)
HIV Infections/epidemiology , Hepatitis B/epidemiology , Hepatitis C/epidemiology , Mental Disorders/epidemiology , Adolescent , Adult , Comorbidity , Female , Humans , Male , Mental Disorders/virology , Middle Aged , Odds Ratio , Risk Factors , Seroepidemiologic Studies , Sexual Behavior , Substance-Related Disorders/epidemiology , United States/epidemiology
9.
J Heart Valve Dis ; 10(1): 105-10, 2001 Jan.
Article in English | MEDLINE | ID: mdl-11206756

ABSTRACT

BACKGROUND AND AIM OF THE STUDY: The synthetic flexible tri-leaflet heart valve offers considerable potential for improvement in both hydrodynamic and biomechanical performance of replacement heart valves. To date, success with the synthetic leaflet heart valve has been limited, partly due to limitations in the biostability of the polyurethanes used. With the synthesis of new biostable polyurethanes, the integration of advancing technology, and better knowledge of the functional and biomechanical design requirements necessary to increase the long-term durability of the polyurethane heart valve, novel clinical solutions are now in sight. METHODS: This study describes the design characteristics, hydrodynamic and biomechanical performance of a new design of polyurethane heart valve. The function and durability characteristics of this novel design of heart valve, manufactured using a proven durable non-biostable polyurethane, was compared with that of a single AorTech porcine bioprosthetic heart valve and a single tilting disc mechanical heart valve, the Björk-Shiley Monostrut valve (BSM), of similar size. RESULTS: For equivalent sizes of valve, the new polyurethane heart valve design had significantly lower pressure gradients compared with the porcine valve at all flow rates and to the BSM valve at the higher flow rates. The effective orifice area of the polyurethane valve was greater than the other two valves studied; regurgitation and total energy loss were less. The new polyurethane valve design reached over 360 million cycles in an accelerated durability tester, without failure. CONCLUSION: This new design of polyurethane heart valve showed improved hydrodynamic function in comparison with either the porcine bioprosthetic or the BSM mechanical heart valve. The pulsatile flow results showed a lower total energy loss associated with this valve, indicating improved potential patient benefit. The durability of this new design of polyurethane heart valve was demonstrated when manufactured using a medical-grade polyurethane.


Subject(s)
Heart Valve Prosthesis , Polyurethanes , Biomechanical Phenomena , Bioprosthesis , Equipment Failure Analysis , Hemodynamics , Humans , Models, Cardiovascular , Prosthesis Design
10.
J Trauma Stress ; 14(4): 615-32, 2001 Oct.
Article in English | MEDLINE | ID: mdl-11776413

ABSTRACT

The problem of violence against individuals with severe mental illness (SMI) has received relatively, little notice, despite several studies suggesting an exceptionally high prevalence of victimization in this population. This paper describes the results of an investigation of the prevalence and correlates of past year physical and sexual assault among a large sample of women and men with SMI drawn from inpatient and outpatient settings across 4 states. Results confirmed preliminary findings of a high prevalence of victimization in this population (with sexual abuse more prevalent for women and physical abuse more prevalent for men), and indicated the existence of a range of correlates of recent victimization, including demographic factors and living circumstances, history of childhood abuse, and psychiatric illness severity and substance abuse. The research and clinical implications of these findings are discussed.


Subject(s)
Crime Victims/psychology , Crime Victims/statistics & numerical data , Mental Disorders/epidemiology , Mental Disorders/psychology , Stress Disorders, Post-Traumatic/epidemiology , Stress Disorders, Post-Traumatic/psychology , Adolescent , Adult , Age Factors , Child , Child Abuse/statistics & numerical data , Female , Humans , Male , Mental Disorders/diagnosis , Middle Aged , Prevalence , Stress Disorders, Post-Traumatic/diagnosis , Time Factors
11.
Phys Rev Lett ; 84(11): 2346-9, 2000 Mar 13.
Article in English | MEDLINE | ID: mdl-11018881

ABSTRACT

A method for measuring the asymmetry parameter gamma arising from dipole-quadrupole interference in core-level photoemission is proposed which is based on condensed thin films and exploits the influence of this asymmetry in photoemission monitoring of x-ray standing wave field absorption. The high density of material in this method offers some advantages over a conventional gas-phase measurement. Results are presented for C, O, and F 1s photoemission at photon energies around 3 keV. The combined nondipole asymmetry factor (delta+gamma/3) for non- s-states can be determined in a similar way.

12.
Womens Health Issues ; 10(5): 278-85, 2000.
Article in English | MEDLINE | ID: mdl-10980445

ABSTRACT

This study examined whether self-rated health predicted health service use among women in an equal access primary care clinic setting. Women veterans (n = 139), 23-76 years of age were administered the PRIME-MD questionnaire at their outpatient clinic (OPC) visit which included a self-rated health item and assessment of symptoms. Number of prospective OPC visits was the outcome variable. Women who had poor/fair health were significantly more likely (OR = 3.25) to have more (>12) OPC visits than women who reported excellent/very good health. We conclude that poor perception of one's health is an important predictor of health care use among women veterans.


Subject(s)
Health Status , Veterans/statistics & numerical data , Women's Health Services/statistics & numerical data , Adult , Aged , Female , Humans , Logistic Models , Middle Aged , North Carolina , Prospective Studies , Statistics, Nonparametric
13.
Health Commun ; 12(2): 137-48, 2000.
Article in English | MEDLINE | ID: mdl-10938910

ABSTRACT

This study examined the association of the traits, health locus of control, and self-monitoring with adolescents' tobacco uptake. Participants were 112 rural adolescents (12 to 19 years old, M = 15.3). Of that sample, 33% used tobacco. Tobacco users were found to score lower on the dimension of Internality and higher on the dimension of Chance, as compared with nonusers of tobacco, indicating a more external Health Locus of Control. In addition, tobacco users were lower self-monitors than were nonusers. These results suggest that adolescents who use tobacco feel less in control of their lives in relation to nonusers, believe that chance plays a larger role in their health, and believe they may be unable to monitor and adapt their communication to achieve positive outcomes.


Subject(s)
Internal-External Control , Self Concept , Tobacco Use Disorder/psychology , Adolescent , Adolescent Behavior , Chi-Square Distribution , Female , Humans , Male , Rural Population , Tobacco Use Disorder/epidemiology , West Virginia/epidemiology
14.
J Natl Med Assoc ; 92(5): 231-6, 2000 May.
Article in English | MEDLINE | ID: mdl-10881472

ABSTRACT

Epidemiologic studies suggest that African-American women may be less likely to obtain mental health services. Racial differences were explored in wanting and obtaining mental health services among women in an equal access primary care clinic setting after adjusting for demographics, mental disorder symptoms, and a history of sexual trauma. Participating in the study were women veterans at a primary care clinic at the Durham Veterans Affairs Medical Center. Consecutive women patients (n = 526) between the ages of 20 and 49 years were screened for a desire to obtain mental health services. Patients were given the Primary Care Evaluation of Mental Disorders questionnaire (PRIME-MD) and a sexual trauma questionnaire. Mental health service utilization was monitored for 12 months. The median age of the women was 35.8 years; 54.4% of them were African-American. African-American women expressed a greater desire for mental health services than whites, yet mental health resources at the clinic were similarly used by both racial groups. African-American women may want more mental health services; however, given an equal access system, there were no racial differences in mental health use.


Subject(s)
Community Mental Health Services/statistics & numerical data , Health Services Needs and Demand , Primary Health Care , Racial Groups , Veterans , Women , Adult , Female , Humans , Logistic Models , Middle Aged , Patient Acceptance of Health Care , Surveys and Questionnaires , United States
15.
J Heart Valve Dis ; 9(1): 161-6; discussion 167, 2000 Jan.
Article in English | MEDLINE | ID: mdl-10678391

ABSTRACT

BACKGROUND AND AIM OF THE STUDY: Recent reports have given details of early clinical failures of bioprosthetic heart valves manufactured using dye-mediated photooxidized bovine pericardium. These failures were attributed to abrasion of the inflow surface of the leaflets against the cloth-covered inner face of the outer valve frame. These failures had not been detected during preclinical testing of such valves. The aim of this study was to determine if such failure modes could be replicated during fatigue testing of the photooxidized valves, and whether lining of the inflow face of the outer frame with pericardium could eliminate these failures. METHODS: The fatigue properties of six lined and six unlined PhotoFix(R) alpha valves was determined using two Rowan Ash fatigue testers which were cycled at 15 Hz for a maximum of 210 million cycles. The closing pressure within in each chamber was 110+/-10 mm Hg. Each valve was inspected every 40 million cycles for any signs of fatigue failure. All valves were tested to at least 210 million cycles. RESULTS: In all six lined PhotoFix alpha valves there was no evidence that wear, tear or abrasion of the inflow aspect of the leaflets adjacent to the inflow face of the outer frame had occurred. Only one unlined valve showed any signs of damage adjacent to the outer frame, as evidenced by loss of loose connective tissue, but this did not have the imprint of the cloth covering, which would have suggested actual wear. Effectively, after 200 million cycles, no fatigue failures of either the lined or the unlined PhotoFix alpha valves had occurred. Moreover, the leaflet tears that had been observed clinically were not replicated in this study. CONCLUSION: Previous studies have shown a good qualitative, quantitative association between fatigue failure in Rowan Ash accelerated fatigue testers, and clinical experience in glutaraldehyde-treated bovine pericardial valves. The accelerated fatigue tester did not provide an adequate model for the prediction of clinical failure for the photooxidized pericardial valves.


Subject(s)
Bioprosthesis , Heart Valve Prosthesis , Equipment Failure Analysis , Humans , Pericardium , Prosthesis Design
16.
J Trauma Stress ; 13(4): 735-41, 2000 Oct.
Article in English | MEDLINE | ID: mdl-11109243

ABSTRACT

This study investigated hostility and functional health status in 90 women veterans with and without PTSD. Compared to women without PTSD, women veterans with PTSD reported significantly higher levels of hostility. Minority status was associated with increased hostility. Compared to a national sample, hostility scores for women with PTSD were greater by a factor of 1.5 PTSD diagnosis was also associated with poorer functioning on all SF-36 Health Survey scales. Controlling for age and education, hostility was related to all SF-36 Health Survey scales in the women with PTSD.


Subject(s)
Health Status , Hostility , Stress Disorders, Post-Traumatic/diagnosis , Veterans/psychology , Adult , Female , Humans , Stress Disorders, Post-Traumatic/psychology , Surveys and Questionnaires
17.
Fertil Steril ; 73(1): 61-5, 2000 Jan.
Article in English | MEDLINE | ID: mdl-10632413

ABSTRACT

OBJECTIVE: To examine the relation between insulin sensitivity and total and regional body fat in nonobese postmenopausal women. DESIGN: Cross-sectional study. SETTING: A clinical research center. PATIENT(S): Twenty-seven women in the early postmenopausal period, with a mean (+/-SD) age of 50.8 +/- 4.1 years, who had had their last menstrual period 6 months to 3 years before the study. None were taking hormone replacement therapy, and all had an FSH level of >35 mIU/mL, a body mass index of <30 kg/m2, and a waist circumference of <94 cm. INTERVENTION(S): Computed tomography scans at the L4-5 vertebral disk space, dual-photon x-ray absorptiometry scans, and euglycemic hyperinsulinemic clamps were performed. MAIN OUTCOME MEASURE(S): Intraabdominal fat, subcutaneous abdominal fat, sagittal diameter, total body fat, percent body fat, and insulin sensitivity. RESULT(S): The natural log of insulin sensitivity correlated significantly with intraabdominal fat (r = -.39), subcutaneous fat (r = -.43), and sagittal diameter (r = -.48). After adjusting for total fat, sagittal diameter remained significantly related to insulin sensitivity. CONCLUSION(S): Central abdominal fat is inversely and independently related to insulin sensitivity after adjusting for total fat in women in the early postmenopausal period. Efforts to reduce either subcutaneous abdominal fat or intraabdominal fat should be helpful in reducing the risk of noninsulin-dependent diabetes mellitus in postmenopausal women.


Subject(s)
Adipose Tissue , Body Composition , Insulin Resistance , Insulin/pharmacology , Postmenopause , Abdomen , Absorptiometry, Photon , Body Constitution , Body Mass Index , Cross-Sectional Studies , Diabetes Mellitus, Type 2/prevention & control , Female , Follicle Stimulating Hormone/blood , Glucose Clamp Technique , Humans , Insulin/blood , Middle Aged , Tomography, X-Ray Computed
18.
Biol Psychiatry ; 45(9): 1226-9, 1999 May 01.
Article in English | MEDLINE | ID: mdl-10331117

ABSTRACT

BACKGROUND: The anticonvulsant, lamotrigine, may be useful for symptom management in PTSD. METHODS: Subjects enrolled in a 12-week double-blind evaluation of lamotrigine and placebo. Patients were randomized 2:1 to either lamotrigine or placebo. Lamotrigine was initiated at 25 mg/day and slowly titrated every 1 to 2 weeks over 8 weeks to a maximum dosage of 500 mg/day if tolerated. RESULTS: Fifteen subjects entered treatment, fourteen of whom returned for subsequent visits. Of 10 patients who received lamotrigine, 5 (50%) responded according to the DGRP, compared to 1 of 4 (25%) who received placebo. Lamotrigine patients showed improvement on reexperiencing and avoidance/numbing symptoms compared to placebo patients. Treatments were generally well tolerated. CONCLUSIONS: Lamotrigine may be effective as a primary psychopharmacologic treatment in both combat and civilian PTSD and could also be considered as an adjunct to antidepressant therapy used in the treatment of PTSD. These promising results warrant further large sample double-blind, placebo-controlled trials.


Subject(s)
Anticonvulsants/therapeutic use , Stress Disorders, Post-Traumatic/drug therapy , Triazines/therapeutic use , Adult , Anticonvulsants/adverse effects , Double-Blind Method , Female , Humans , Lamotrigine , Male , Middle Aged , Pilot Projects , Triazines/adverse effects
19.
J Gen Intern Med ; 14(3): 186-9, 1999 Mar.
Article in English | MEDLINE | ID: mdl-10203625

ABSTRACT

The Trauma Questionnaire (TQ) assesses a woman's history of childhood and adult sexual trauma, sexual harassment, and domestic violence. The TQ is used widely at Veterans Affairs Medical Centers, but its validity has not been thoroughly examined. In a prospective study of 127 women, we found the TQ to have good to excellent agreement with a semistructured clinician interview and good sensitivity and specificity. The TQ can be used as a valid alternative to the clinician interview in the initial elicitation of trauma history among women veterans in the primary care setting.


Subject(s)
Domestic Violence , Sexual Harassment , Veterans , Adult , Female , Humans , Prospective Studies , Reproducibility of Results , Surveys and Questionnaires , United States
20.
Psychiatr Clin North Am ; 22(4): 875-96, 1999 Dec.
Article in English | MEDLINE | ID: mdl-10623976

ABSTRACT

An understanding of victimization is critical to the practice of emergency psychiatry. Victimization histories are disturbingly common among women presenting to the PES, particularly among frequent service users. The sequelae of victimization are both psychological and physical and often impair health and functioning across numerous domains. PTSD, BPD, and substance-use disorders are often seen among women with victimization histories, which can be particularly challenging for PES providers. Screening for trauma on PES presentation or history should not be overlooked in any person, including severely mentally ill, homeless, disabled, or elderly women. PES clinicians should remember to ask about victimization and pose questions privately in a direct and an open-ended format while conveying empathic validation. Clinical assessment of women with victimization histories in the PES should be guided by the principles of standard emergency psychiatry and be informed by an understanding of trauma. This includes a working knowledge of trauma dynamics, adherence to sound professional boundaries, and care not to retraumatize patients or re-enact perpetrator-victim dynamics. Voyeurism and regression should be avoided, particularly when eliciting trauma history. The PES should be a place for screening and acute intervention, not for conducting intensive trauma therapy. In the PES, the focus should remain on triage and treatment priorities, those of safety and stabilization, and carefully evaluating for substance use and psychosis. The PES ideally provides a "holding environment" that affords a balance of nurturing, limits, consistency, and communication. A basic knowledge of cognitive-behavioral interventions affording "crisis survival strategies," such as DBT, can be particularly useful to PES clinicians. Clinicians also need to monitor issues of countertransference and the potential to be dismissive to these women with complex, comorbid, and chronic problems and diseases. The role for the use of psychotropic medication in PES cohorts with victimization histories should target acute symptoms. Involving regular providers of these decisions is advised to coordinate care and minimize splitting and risks of polypharmacy. Although the SSRIs are effective in symptom management of disorders related to victimization, patients must be reminded of the side-effect profile, particularly sexual dysfunction and withdrawal and discontinuation syndromes.


Subject(s)
Crime Victims , Emergency Services, Psychiatric/organization & administration , Mental Disorders , Women's Health , Age Factors , Emergency Services, Psychiatric/standards , Female , Humans , Interview, Psychological , Mental Disorders/diagnosis , Mental Disorders/epidemiology , Mental Disorders/etiology , Mental Disorders/prevention & control , Mental Disorders/therapy , Psychotropic Drugs/therapeutic use , United States/epidemiology
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