Risk-taking in schizophrenia and controls with and without cannabis dependence.

BACKGROUND: Risk-based decision making is altered in people with schizophrenia and in people with cannabis use compared to healthy controls; the pattern of risk-assessment in people with co-occurring schizophrenia and cannabis dependence is poorly understood. This study examined measures of risk-taking and decision-making in people with and without schizophrenia and/or cannabis dependence. METHODS: Participants with schizophrenia (n=24), cannabis dependence (n=23), schizophrenia and co-occurring cannabis dependence (n=18), and healthy controls (n=24) were recruited from the community via advertisements and completed a one-visit battery of symptom, risk-based decision making, gambling behavior, cognitive, and addiction assessments. This report presents self-assessments of self-mastery, optimism, impulsivity, and sensation seeking and a behavioral assessment of risk (Balloon Analog Risk Task [BART]). RESULTS: On self-report measures, participants with schizophrenia and co-occurring cannabis dependence were intermediate between those with only cannabis dependence or only schizophrenia on ratings of self-mastery, sensation-seeking, and impulsivity. There were no group differences on ratings of optimism. Their behavior on the BART was most similar to participants with only cannabis dependence or healthy controls, rather than to participants with only schizophrenia. CONCLUSIONS: People with schizophrenia and co-occurring cannabis dependence may represent a unique group in terms of risk-perception and risk-taking. This has implications for interventions designed to influence health behaviors such as motivational interviewing.

Participants with schizophrenia retain the information necessary for informed consent during clinical trials.

OBJECTIVE: Cognitive impairment is a characteristic of schizophrenia. This impairment may affect the retention of information required for ongoing knowledgeable participation in clinical trials. This study monitored retention of study-related knowledge-including assessment of therapeutic misconception-in people with stable, DSM-IV schizophrenia during participation in placebo-controlled clinical trials of adjunctive agents. Stability was defined as being on an antipsychotic with no change in medication or dose over the previous 4 weeks. METHOD: This longitudinal study assessed retention of clinical trial-related consent information. Individuals enrolling in 1 of 8 clinical trials were approached for participation. Participants came from research clinics and community mental health centers. At baseline, clinical trial consent forms were reviewed and study knowledge assessed. Participants were randomized to follow-up assessments at weeks 1, 4, and 8; weeks 4 and 8; or at week 8 only. Clinical trial consent forms were not rereviewed at any follow-up visit. RESULTS: Fifty-nine participants were enrolled; analysis included 52 participants with at least 1 follow-up visit. Study knowledge did not decrease meaningfully in any group. Therapeutic misconception was not observed in participants during the study. The group assessed most frequently demonstrated significant improvement over baseline (t44 = 3.43, P = .001). Retention of study knowledge was not related to symptoms but had a weak correlation with cognitive capacity (R = 0.28, P = .07). Performance did not differ between participants from research clinics and those from community mental health centers. CONCLUSIONS: Clinically stable people with schizophrenia enrolling in a placebo-controlled adjunctive medication study, once determined to have capacity to consent to a clinical trial, retained appropriate study knowledge for at least 8 weeks. In the absence of a specific reason to suspect a loss of decisional capacity, there appears to be no need to routinely reevaluate participants during this type of clinical trial.

Cortical structural abnormalities in deficit versus nondeficit schizophrenia.

OBJECTIVE: To examine the structural integrity of the dorsolateral prefrontal-basal ganglia-thalamocortical circuit in people with the deficit form of schizophrenia. METHOD: A three-dimensional structural MRI sequence was used to conduct morphometric assessments of cortical and subcortical regions in deficit and nondeficit outpatients with schizophrenia and healthy controls. RESULTS: The superior prefrontal and superior and middle temporal gyral gray matter volumes were significantly smaller in the deficit versus the nondeficit group and normal control groups. There were no significant group differences in examined subcortical structures. CONCLUSION: People with deficit schizophrenia are characterized by selective reductions in the prefrontal and temporal cortex.

Short interval between symptom onset and medical care as an indication of rapid onset of interstitial cystitis/painful bladder syndrome.

OBJECTIVE: To assess how many patients with interstitial cystitis/painful bladder syndrome (IC/PBlS) obtain medical care soon after symptom onset, and to determine how these patients differ from those who have medical care later. PATIENTS AND METHODS: In a risk-factor study of IC/PBlS, we recruited women with IC/PBlS symptoms of < or =12 months' duration and carefully identified the onset date, first medical encounter and early clinical findings. RESULTS: Of 138 women with IC/PBlS for < or =12 months, 49% sought medical care within 7 days and another 31% within 4 weeks. These patients had no easier access to medical care but rather experienced symptoms differently, with more evidence for discomfort and inflammation. However, subsequently they did not differ from those with more gradual onset in features indicative of IC/PBlS, i.e. Hunner's ulcers, petechial haemorrhages, symptoms, medications, or quality of life. CONCLUSIONS: A shorter time to the first medical encounter was not a function of greater access to medical care but instead was associated with more discomfort and evidence of inflammation, as distinct from those with more gradual onset. The 6-month follow-up of both groups indicated that no significant differences in IC/PBlS symptoms persisted. A careful study of rapid-onset IC/PBlS might provide clues to the pathogenesis of this enigmatic disease.

Assessing urgency in interstitial cystitis/painful bladder syndrome.

OBJECTIVES: Interstitial cystitis/painful bladder syndrome (IC/PBS) at present is a symptom-based diagnosis. The Interstitial Cystitis Symptom Index (ICSI), also known as the O'Leary-Sant Symptom Index, is a widely used scale that assesses the four cardinal symptoms of IC/PBS (ie, bladder pain, urgency, frequency, and nocturia), by asking how often each is experienced. In an ongoing case-control study of recent-onset IC/PBS, we compared the ICSI with a series of questions that addressed the severity of these symptoms. METHODS: Recruiting nationally, we enrolled women with IC/PBS symptoms of 12 months' duration or less. We assessed the severity of pain, frequency, and urgency using Likert and categorical scales, and how often these symptoms were experienced using the ICSI. We compared these scales by frequency distributions and interscale correlations. RESULTS: In 138 women with recent-onset IC/PBS, the scores for frequency were correlated and, for pain, appeared to be complementary. However, for urgency, the ICSI question of "the strong need to urinate with little or no warning" consistently yielded lower scores than the severity question of "the compelling urge to urinate that is difficult to postpone." Some patients denied urgency to the ICSI question yet reported intense urgency to the severity question. CONCLUSIONS: Compared with the severity question, the ICSI underestimated the prevalence and degree of urgency. This observation is consistent with the views of others that sudden urgency does not define the sensation experienced by many patients with IC/PBS. Clarifying this symptom description may assist in developing a usable case definition for IC/PBS.

Dysuria at onset of interstitial cystitis/painful bladder syndrome in women.

OBJECTIVES: In an ongoing national study of women to identify risk factors for interstitial cystitis/painful bladder syndrome (IC/PBS), dysuria was identified at the onset of IC/PBS in a small majority and the evidence for urinary tract infection was evaluated. METHODS: In women with IC/PBS of 12 months' duration or less, symptoms and pertinent laboratory tests at onset were assessed by telephone interview and medical record review. RESULTS: Of 138 women, 75 (54%) reported that they had started to experience burning or pain on urination at the onset of IC/PBS. Of those with urine cultures, 12 (34%) of 35 women with dysuria versus 1 (5%) of 21 without dysuria yielded a uropathogen (P = 0.01). Similarly, the microscopic white blood cell count and dipstick nitrites and leukocyte esterase were each significantly more common in the urine samples of those with dysuria than in those without. Additionally, 7 of 75 of those with dysuria versus 1 of 62 without dysuria reported chills or fever at the onset of IC/PBS. Using various definitions, the prevalence of urinary tract infection at the onset of IC/PBS, at a minimum, was 16% to 33% of those with dysuria versus less than 2% of those without dysuria (P < or = 0.003). CONCLUSIONS: A slight majority of women with IC/PBS reported dysuria at onset of their IC/PBS symptoms. The available laboratory data have suggested that dysuria may be a sensitive indicator of urinary tract infection at the onset of IC/PBS; however, its specificity is as yet undetermined.

Occupational exposure to pfiesteria species in estuarine waters is not a risk factor for illness.

BACKGROUND: Exposure to the dinoflagellate Pfiesteria has, under certain circumstances, been associated with deficits in human learning and memory. However, uncertainties remain about the health risk of chronic, low-level exposures (as seen among occupationally exposed commercial fishermen), particularly in light of studies suggesting that Pfiesteria strains are widespread in the estuarine environment in the U.S. mid-Atlantic region. METHODS: We selected an initial cohort of 152 persons, including 123 persons with regular, occupational exposure to the Chesapeake Bay ; 107 of the cohort members were followed for the full four summer "seasons" of the study. Cohort members were questioned biweekly about symptoms, and data were collected about the areas of the bay in which they worked. These latter data were matched with data on the presence or absence of Pfiesteria in each area, based on polymerase chain reaction analysis of > 3,500 water samples. Cohort members underwent neuropsychological testing at the beginning and end of each summer season. RESULTS: No correlation was found between work in an area where Pfiesteria was identified and specific symptomatology or changes on neuropsychological tests. CONCLUSIONS: Although high-level or outbreak-associated exposure to Pfiesteria species (or specific strains within a species) may have an effect on health, routine occupational exposure to estuarine environments in which these organisms are present does not appear to pose a significant health risk.

Using the International Continence Society's definition of painful bladder syndrome.

OBJECTIVES: To determine what proportion of patients with recent-onset interstitial cystitis (IC)/painful bladder syndrome (PBS) met the International Continence Society (ICS) definition and how those who met the definition differed from those who did not. METHODS: We recruited women who had recent-onset IC/PBS for an ongoing case-control study to identify its risk factors and studied our first 138 eligible patients to identify those who met the ICS definition. We then compared those who met the definition with those who did not by variables acquired from interviews and medical records. RESULTS: The 138 participants had intensities of pain, urgency, frequency, and nocturia, as well as O'Leary-Sant Symptom Index scores, similar to those of previously reported patients with IC/PBS. Six percent of cystoscopies demonstrated Hunner's ulcers, and 89% of hydrodistensions under anesthesia revealed glomerulations. The most liberal interpretation of the ICS definition did not include 47 (34%) of our patients. Comparing these with the 91 (66%) who did meet the ICS criteria, we found that 96 of 97 clinical variables, including many generally thought to be characteristic of IC/PBS, were not significantly different between the two groups. CONCLUSIONS: The ICS definition identified only 91 (66%) of the 138 patients whom study investigators and caregivers diagnosed as having IC/PBS. Furthermore, those who met the ICS definition did not differ in important ways from those who did not. These observations taken together suggest that the ICS definition may not be sufficiently sensitive. Minor modifications of the definition appeared to increase its sensitivity. Validation of a case definition (ie, assessing its sensitivity and specificity) would require testing it in patients with IC/PBS, as well as in patients with other diseases with similar symptoms.

Racial differences in the prevalence of vertebral fractures in older men: the Baltimore Men's Osteoporosis Study.

Older black men have higher adjusted bone mineral density (BMD) and a lower adjusted rate of decline in hip BMD than older white men. There are few published data on the prevalence of morphometric vertebral fractures in older white men and no published data for older black men. The study's objective was to estimate the prevalence of vertebral fractures in older men and explore differences in prevalence between older white and black men. Subjects included five hundred forty-two men (415 white and 127 black) aged 65 and above (mean age of 74.0+/-5.7 years) participating in the longitudinal component of the Baltimore Men's Osteoporosis Study. Radiographs of the thoracic and lumbar spine were obtained using standard protocols and read for the presence of vertebral deformities using binary semiquantitative techniques. Quantitative morphometry was performed and vertebral fractures were defined using the Melton-Eastell method. BMD was measured at the femoral neck, total hip and lumbar spine. Participants also completed self- and interviewer-administered questionnaires and underwent standardized clinical examinations. One or more vertebral fractures were present in 30 of 514 men with available radiographs: estimated prevalence 5.8% (95% confidence intervals [CI]: 4.0, 8.3%). Prevalence was significantly higher in white than black men, 7.3% vs 0.9% (Fishers' exact p =0.01): age-adjusted odds ratio=8.3 (95% CI: 1.1, 62.5). Among white men, there was no significant difference in age-adjusted femoral neck or total hip BMD or frequency or severity of back pain between men with and without vertebral fractures. In conclusion, older white men have a higher prevalence of vertebral fractures than older black men. This may be related to differences in BMD between these groups.

Racial differences in rate of decline in bone mass in older men: the Baltimore men's osteoporosis study.

UNLABELLED: Older black men have higher adjusted BMD than older white men. Using data from a longitudinal cohort study of older men followed for a mean of 18.8 +/- 6.5 (SD) months, we found that older black men have a higher rate of decline in femoral neck and total hip BMD and femoral neck BMAD than older white men. INTRODUCTION: Older black men have higher adjusted BMD compared with older white men. The difference in BMD may be caused by having attained higher peak bone mass as young adults and/or having a slower rate of decline in bone mass as adults. There are few published longitudinal data on change in bone mass in older white men and no published data for older black men. MATERIALS AND METHODS: Three hundred forty-nine white men and 119 black men 65 of age (mean age, 75 +/- 5.7 and 72 +/- 5.6 years, respectively) who participated in the longitudinal component of the Baltimore Men's Osteoporosis Study returned for a second visit after a mean of 18.8 +/- 6.5 (SD) months and were not taking medications used to treat low bone mass at either visit. BMD was measured at the femoral neck and total hip by Hologic-certified technicians using a QDR 2000 at the baseline visit (V1) and QDR 4500 at the first follow-up visit (V2). Participants also completed self-administered and interviewer-administered questionnaires and underwent standardized clinic examinations. Bone mineral apparent density (BMAD) at the femoral neck was calculated as an estimate of volumetric BMD. Annual crude and multiple variable adjusted percent changes in BMD and BMAD were calculated. RESULTS: In univariate analyses, black men had lower percent decline in femoral neck and total hip BMD and femoral neck BMAD than white men. In addition, older age at baseline, lower baseline weight, current smoking, and lower baseline BMD were associated with greater percent decline per year in femoral neck BMD; older age at baseline, current smoking, and lower baseline BMD were associated with greater percent decline per year in total hip BMD; and older age at baseline and lower baseline femoral neck BMAD were associated with greater percent decline per year in femoral neck BMAD. Racial differences in bone loss persisted in multiple variable models that controlled for other factors associated with change in BMD and BMAD. CONCLUSIONS: Older black men seem to lose bone mass at a slower rate than older white men. These differences in the rate of bone loss may account, in part, for the racial disparities in BMD and BMAD and risk of osteoporotic fractures among older men.

Racial differences in bone mineral density in older men.

UNLABELLED: Studies have examined factors related to BMD in older white, but not black, men. We measured BMD in older white and black men and examined factors related to racial differences in BMD. Black men had significantly higher adjusted BMD at all sites. These results may explain, in part, the lower incidence of fractures in older black men. INTRODUCTION: Several studies have examined factors associated with bone mineral density (BMD)in older men. None, however, have had sufficient numbers of black men to allow for meaningful comparisons by race. MATERIALS AND METHODS: A total of 503 white and 191 black men aged 65 and older(75.1 +/- 5.8 and 72.2 +/- 5.7 years, respectively) were recruited from the Baltimore metropolitan area. All men completed a battery of self-administered questionnaires, underwent a standardized examination, and had BMD measured at the femoral neck, lumbar spine, and total body. Data were analyzed using multiple variable linear regression models, adjusted for potential confounding variables; two-way interactions with main effects were included in models where appropriate. RESULTS: Black men had significantly higher adjusted BMD at the femoral neck (difference 0.09 [95% CI: 0.07, 0.12] mg/cm2), lumbar spine (0.07 [0.04, 0.10] mg/cm2), and total body (0.06 [0.03, 0.08] mg/cm2) than white men. CONCLUSIONS: Older black men have significantly higher BMD than older white men, even after adjustment for factors associated with BMD. These differences, especially at the femoral neck, may explain the reduced incidence of hip fracture in black compared with white men.

Early development in males with Fragile X syndrome: a review of the literature.

This article reviews the current bibliographic knowledge on early neurobehavioral development and milestones in Fragile X syndrome (FraX), with emphasis on males affected by the condition. Three broad areas of early development were examined: (1) gross and fine motor, (2) speech and language, and (3) social. The result of the current review indicates very limited information on the developmental milestones in all three areas. The scarce literature on motor development shows that in FraX there is an early developmental delay. Research on speech and language demonstrates pervasive deficits in conversational skills and severe developmental delay, with increasing discrepancy between language level and chronological age in young males with FraX. Finally, deficits in social development in FraX include abnormal gaze, approach and avoidance conflict, and high incidence of autistic spectrum disorders.