Transmission of serum hepatitis. 1970.

There is evidence that transmission of serum hepatitis is associated with transmission of virus-like particles, approximately, 20 millimicron in diameter, containing the Australia or serum hepatitis (SH) antigen, which is currently referred to as the hepatitis associated antigen (HAA). Virus-like particles containing HAA were in the following materials, inoculation of which produced serum hepatitis: (1) a pool of human plasma, (2) serum obtained during the acute phase of hepatitis from a recipient of the plasma pool, (3) a preparation of human thrombin, and (4) serum from a proved hepatitis carrier. The HAA appeared in the serum samples of 61 individuals inoculated with these materials; serum hepatitis developed in 38 of them. Inoculation of dilutions of the plasma pool showed that serum hepatitis can be transmitted by materials containing HAA in amounts too low to be detected by current techniques.

The relationship between men's sexual aggression inside and outside the laboratory.

The purpose of this study was to develop a laboratory analogue of sexually aggressive behavior. Subjects viewed neutral, sexual-violent, and violent-sexual film vignettes and chose a vignette to show to a female confederate. Among highly sexually aggressive men (n = 25) according to the Coercive Sexuality Scale (CSS; Rapaport & Burkhart, 1984), 24% showed the sexual-violent vignette and 28% showed the violent-sexual vignette. Among men who did not report being sexually aggressive on the CSS (n = 13), none showed the sexual-violent vignette and only one showed the violent-sexual vignette. The between-group difference in vignette showing was statistically significant (p < .024). Subjects who showed the sexually aggressive vignettes reported that the female confederate was upset (p < .0001) and uncomfortable (p < .0001) in viewing these vignettes more than the subjects did who showed the neutral vignette. These results support the validity of this film-showing procedure as a laboratory analogue of sexually aggressive behavior.

The role of sexual arousal in sexually aggressive behavior: a meta-analysis.

Meta-analyses were performed on 9 studies of subjects' (N = 434) penile responsivity to rape stimuli. The mean effect size for raw score data suggested that most sexual aggressors against women exhibit slightly more rape arousal than control or comparison subjects, whereas the mean effect size for rape index (rape arousal:consenting sexual arousal) data suggested a moderate between-groups difference. Rape index effect sizes in individual studies, however, were heterogeneous. The rape index appears sensitive to differences between sexually aggressive men and those who are not but is not sensitive to differences between men who sexually aggress against women versus other types of sexual aggressors. Also discussed are the needs for standardization and methodological and statistical improvements.

Psychopathology associated with Alzheimer's disease and related disorders.

BACKGROUND: This study compared the occurrence of psychiatric symptoms in a large group of community-residing participants enrolled in an Alzheimer's disease patient registry who met clinical diagnostic criteria for Alzheimer's disease or multi-infarct dementia, as well as mixed Alzheimer's disease and multi-infarct dementia. METHODS: Psychiatric morbidity observed from a psychiatric examination of 514 patients with Alzheimer's disease, 135 patients with multi-infarct dementia, and 86 cases with mixed dementia was analyzed using analysis of variance comparing symptoms across groups and chi-square test for differences in frequency of occurrence. Associations between pairs of symptoms were also reported. RESULTS: The frequency of occurrence and patterns of psychiatric problems were similar in patients with Alzheimer's disease and multi-infarct dementia. Agitation was the most frequent symptom, followed by depression, apathy, and behavioral disorders. Patients with mixed dementia had significantly more psychopathology. CONCLUSION: This study demonstrated that significant psychopathology occurs in individuals with Alzheimer's disease or multi-infarct dementia. The high levels of symptoms in mixed dementia suggest that the two conditions have a synergistic effect on behavioral problems. The prevalence of multiple symptoms is higher than previously reported.

Drug use patterns of persons with Alzheimer's disease and related disorders living in the community.

OBJECTIVE: To describe drug use patterns by persons with Alzheimer's disease, multi-infarct dementia, and mixed Alzheimer's disease and multi-infarct dementia. DESIGN: Multicenter, patient registry. SETTING: Community-living persons evaluated in primary care, geriatric, and Alzheimer ambulatory settings. PARTICIPANTS: Of the 930 persons in three diagnostic categories, there were 671 with probable or possible Alzheimer's disease by NINCDS/ADRDA criteria or Alzheimer's disease by DSM-III-R criteria, 162 multi-infarct cases by DSM-III-R criteria, and 97 mixed cases by DSM-III-R criteria. In each diagnostic category, 65% were women, and the majority were 70 years or older. MEASUREMENTS: The average number of all prescription and non-prescription drugs and selected therapeutic categories by age, sex, diagnosis, and mini-mental status score at the time of diagnosis or evaluation. RESULTS: Alzheimer patients average 2.3 drugs compared with multi-infarct (4.3; P < 0.0001) and mixed (3.7; P = 0.002) patients, and their pattern of drug use was different when stratified by therapeutic categories and drug classes. Drug use increased with age, and women used significantly more drugs than men in all three diagnostic categories. Women with Alzheimer's disease used significantly more cardiovascular drugs than men with Alzheimer's disease (P < 0.05). The lower the mini-mental status score in patients with any dementia, the greater the mean number of central nervous system agents used. The higher the mini-mental status score in a patient with multi-infarct or mixed dementia, the greater the use of cardiovascular drugs. CONCLUSION: Drug use by Alzheimer patients was lower than in multi-infarct and mixed patients, primarily due to a lower prevalence of cardiovascular drugs.

Functional status and clinical findings in patients with Alzheimer's disease.

We analyzed the association of clinical findings with impaired functional status, i.e., activities of daily living (ADLs), in a sample of 240 patients diagnosed with Alzheimer's disease by NINCDS/ADRDA or DSM-III-R criteria. Logistic regression models were used to determine independent predictors of both the number of ADL impairments and number of ADL impairments characterized as moderate to severe. Two psychiatric problems, behavioral disorders and apathy, as well as a history of hypertension were significantly associated with ADL impairment independent of age, sex, race, and cognitive impairment. Behavioral disorders and apathy were also significantly associated with moderate to severe ADL impairment, but hypertension was not significant at this level.

Are there clinical differences between familial and nonfamilial Alzheimer's disease?

OBJECTIVE: The purpose of the study was to determine whether there are differences in clinical characteristics in two groups of patients with Alzheimer's disease, those reported to have a family history of dementia and those without a family history of dementia. METHOD: Using a data set from an Alzheimer's disease patient registry, funded as part of a National Institute on Aging cooperative agreement, the authors made comparisons of sociodemographic and clinical variables in a group of 462 patients with Alzheimer's disease, 172 reported to have at least one first-degree relative with dementia and 290 classified with no family history. RESULTS: Patients with a presumptive family history differed from those without a family history in two ways: the course of dementia was described as having a fast rather than a slow progression from onset of symptoms to diagnosis, and caregivers reported a higher prevalence of family history of psychiatric disorders. There were no significant differences in age at onset, duration, female gender, aphasia and apraxia, handedness, family history of Down's syndrome, or number of children, brothers, and sisters. CONCLUSIONS: The association of faster course and family history of psychiatric disorders in the patients with a family history of dementia is consistent with the hypothesis of heterogeneity, but the overall results could also be explained by a genetic-environmental model of Alzheimer's disease.

Severe family violence and Alzheimer's disease: prevalence and risk factors.

This study describes the prevalence of violence and the putative risk factors for violence in 184 Alzheimer patients and their primary caregivers living in the community. Analysis of the severe violence subscale of the Conflict Tactics Scale indicated that 15.8% of patients had been violent in the year since diagnosis. A total of 5.4% of caregivers reported being violent toward the patient. The overall prevalence of violence was 17.4%. The variables most associated with violence were caregiver depression and living arrangement.

An empirical evaluation of the Global Deterioration Scale for staging Alzheimer's disease.

OBJECTIVE: Although the Global Deterioration Scale has been widely used since its publication in 1982, its stages are based on implicit assumptions about the linearity, temporality, and interdependence of cognitive, functional, and behavioral impairment in Alzheimer's disease. The authors evaluated the validity of these assumptions and tested the hypothesis that psychopathology and functional impairment would occur in earlier stages than the Global Deterioration Scale predicts. METHOD: The analyses were based on data on 324 patients with Alzheimer's disease who were selected from a registry of such patients. Data analyses included 1) descriptive statistics on the frequency of psychiatric symptoms and difficulties with activities of daily living and 2) logistic regression, with symptoms and functional impairment as independent variables, to test for significant changes in patients' status between stages of the Global Deterioration Scale. RESULTS: More than 50% of the patients at stage 2 displayed psychopathology, and 32% had two or more symptoms. The significant increase in psychiatric symptoms occurred between stages 3 and 4, not between stages 5 and 6 as predicted by the Global Deterioration Scale. Impairment in functional status was observed at all stages, and significant increases occurred between stages 3 and 4 as well as between stages 5 and 6. CONCLUSIONS: Psychiatric symptoms and functional impairment occur earlier than predicted by the Global Deterioration Scale, and the rate of change is also different from that specified in the scale. Separate scales to describe cognitive, clinical, and functional status may be the best way to describe the illness until better multidimensional instruments are developed.

Introduction to special section on theories of sexual aggression.

Sexual aggression is a serious societal problem, yet treatments for sexual aggressors have generally been ineffective in part because of the lack of unified theories to guide treatment. This brief article introduces the Special Section, which includes five theories of sexual aggression.

Toward a theory of sexual aggression: a quadripartite model.

Sexually aggressive behavior against adult females is an increasingly serious societal problem. The need for a unified theoretical model is addressed by integrating the elements of existing models into a quadripartite model in which the heterogeneity of sexual aggressors is accounted for by the prominence of potential etiological factors. The components of the model--physiological sexual arousal, cognitions that justify sexual aggression, affective dyscontrol, and personality problems--function as motivational precursors that increase the probability of sexually aggressive behavior. The relative prominence of these precursors within different sexually aggressive populations is used to define major subtypes.

Hodgkin's disease and AIDS. Twenty-three new cases and a review of the literature.

Despite numerous reports suggesting an association of Hodgkin's disease (HD) with the acquired immunodeficiency syndrome (AIDS), HD in an individual seropositive for the human immunodeficiency virus (HIV) still is not considered a criterion for the diagnosis of AIDS. The authors report 23 new cases of HD in individuals at risk for AIDS and review the literature. As a group, individuals at risk for AIDS who develop HD have a more aggressive form of the illness (82% with stage III or IV), have or develop AIDS-related opportunistic infections (54%), second neoplasms (10%), and /or profound cytopenias (32%), and 85 to 90% are HIV positive when tested. More than two thirds die within 1 year of the diagnosis of HD. The authors conclude that HIV infection alters the clinical course of HD, that advanced or high-grade HD in HIV-infected individuals should be considered indicative of AIDS, and all patients with HD should be tested for HIV.

Effects of paced respiration on anxiety reduction in a clinical population.

The purpose of this study was to examine the effects of paced respiration on autonomic and self-report indices of affect within a clinical population. Thirty-six alcohol-dependent inpatients scoring high in trait anxiety were randomly assigned to either a pacing or attention control group. The paced subjects received 10 minutes of slow-breathing training during the first experimental session, while control subjects simply counted the pacing tones. In a second session, paced subjects were asked to breathe at the same lowered rate (10 cycles per minute) on their own, while the remaining subjects were instructed to relax. Prior to and following each session, self-ratings of tension level and state anxiety were collected. As expected, paced subjects evidenced greater reductions in self-rated tension, state anxiety, and skin conductance levels compared to the control subjects. It was concluded that respiratory pacing is an easily learned self-control strategy and potentially may be a useful therapeutic tool.

Global increase in response latencies by early middle age: complexity effects in individual performances.

Ten young women (age 20 to 22 years) and 10 middle-aged women (age 36 to 44 years) served as subjects in choice reaction time, letter classification, and abstract matching-to-sample tasks. In each of seven conditions, the older group responded more slowly than the younger group. Age differences showed a complexity effect. That is, differences between the latencies of young and old subjects increased as the latency of the young subjects increased. Both linear and power functions accurately described the relation between the latencies of the middle-aged and young adult groups. This was true not only for the relation between average latencies but also for the relation between corresponding quartiles of latency distributions. Similar results were observed at the individual level: All middle-aged subjects showed complexity effects, and, for each middle-aged subject, the relation between her latencies and those of the average young adult was well described by linear and power functions. These findings indicate that age-related slowing is apparent by age 40, and that complexity effects are observable in individual performances. This slowing is global and not specific to particular tasks, as indicated by the fact that the latencies of older adults can be predicted directly from those of younger adults without regard to the nature of the task.

Carcinoma of the breast in three siblings.

Reported are three siblings, a sister and 2 brothers, who had breast cancer. The paternal grandmother of the proband was known to have had breast cancer. It is our belief that this report supports further the genetic etiology of certain breast cancers. The study examines the literature with regard to genetically transmitted female breast cancer and also implies a genetic etiology of male breast cancer. Of special interest is the fact that the female sibling had bilateral breast cancer during her premenopausal years and that one of the two brothers also developed his lesion at an early age, 41 years.

A cognitive developmental approach to smoking prevention.

Most smoking prevention programs for middle-schoolers target non-smokers. These programs seek to educate young people about the hazards of smoking, influence young peoples' attitudes toward smoking, and reduce initial experimentation with cigarettes by providing social- and life-skills training. The program described in this chapter incorporates these features and adds a component which explores, in some depth, the nature of the user's response to cigarettes. This component focuses on the young person's physical and psychological reaction to cigarette smoking, and provides a knowledge base which promotes a negative evaluation of that reaction. This component targets all young people, but it is anticipated that it will be especially effective with pre-addictive experimenters who are wondering what smoking can "do for them". One challenge for the future is the development of intervention strategies that have something to offer the young addicted smoker who wishes to quit smoking. These young people are largely unserved by school-based smoking education programs, drug abuse programs, and organized smoking therapies.