Dissociation in patients with dissociative seizures: relationships with trauma and seizure symptoms.

BACKGROUND: This study aimed to extend the current understanding of dissociative symptoms experienced by patients with dissociative (psychogenic, non-epileptic) seizures (DS), including psychological and somatoform types of symptomatology. An additional aim was to assess possible relationships between dissociation, traumatic experiences, post-traumatic symptoms and seizure manifestations in this group. METHOD: A total of 40 patients with DS were compared with a healthy control group (n = 43), matched on relevant demographic characteristics. Participants completed several self-report questionnaires, including the Multiscale Dissociation Inventory (MDI), Somatoform Dissociation Questionnaire-20, Traumatic Experiences Checklist and the Post-Traumatic Diagnostic Scale. Measures of seizure symptoms and current emotional distress (Hospital Anxiety and Depression Scale) were also administered. RESULTS: The clinical group reported significantly more psychological and somatoform dissociative symptoms, trauma, perceived impact of trauma, and post-traumatic symptoms than controls. Some dissociative symptoms (i.e. MDI disengagement, MDI depersonalization, MDI derealization, MDI memory disturbance, and somatoform dissociation scores) were elevated even after controlling for emotional distress; MDI depersonalization scores correlated positively with trauma scores while seizure symptoms correlated with MDI depersonalization, derealization and identity dissociation scores. Exploratory analyses indicated that somatoform dissociation specifically mediated the relationship between reported sexual abuse and DS diagnosis, along with depressive symptoms. CONCLUSIONS: A range of psychological and somatoform dissociative symptoms, traumatic experiences and post-traumatic symptoms are elevated in patients with DS relative to healthy controls, and seem related to seizure manifestations. Further studies are needed to explore peri-ictal dissociative experiences in more detail.

Sex differences in behavior and pro-inflammatory cytokine mRNA expression following stressor exposure and re-exposure.

Stressful events promote a wide range of neurotransmitter and neuroendocrine changes, which likely serve in an adaptive capacity. However, with repeated stressor exposure, behavioral disturbances, such as anxiety and depression, may develop. Moreover, re-exposure to a stressor for some time following an initial aversive experience may instigate especially pronounced neurochemical variations that favor the emergence of depression and anxiety. These outcomes may stem from any number of neurobiological changes, but increasing attention has focused on the potential contribution of inflammatory factors, such as cytokines. Given the distinct differences in stressor responsiveness that have been reported between males and females, alongside a much higher rate of mood disorders in females, we sought to examine whether repeated exposure to stressors would differentially influence elevated plus-maze behavior in male and female CD-1 mice, and whether such changes would be paralleled by variations of pro-inflammatory mRNA cytokine expression within the prefrontal cortex (PFC) and the hippocampus. In males, the sensitization of interleukin (IL)-1ß was evident in both brain regions in those mice that had initially been stressed and then 6 weeks later re-exposed to a stressor exhibiting higher IL-1ß expression than did mice stressed on only a single occasion. Females demonstrated higher baseline expression of cytokine expression within the hippocampus, but neither a single exposure nor re-exposure stressor treatment produced significant cytokine elevations. In the PFC an acute stressor treatment increased IL-1R expression, but otherwise had little effect. In a plus-maze test, stressed male mice displayed markedly reduced latencies to the open arms that was evident in a test 6 weeks later irrespective of whether mice were re-exposed to a stressor, whereas in females this outcome was less evident. These studies are consistent with the perspective that female mice are relatively resilient toward stressor-induced cytokine elevations even though in humans females are generally more prone to developing mood disturbances.

Stressor exposure of male and female juvenile mice influences later responses to stressors: modulation of GABAA receptor subunit mRNA expression.

Stressors encountered during the juvenile period may have persistent effects on later behavioral and neurochemical functioning and may influence later responses to stressors. In the current investigation, we evaluated the influence of stressor exposure applied during the juvenile period (26-28 days of age) on anxiety-related behavior, plasma corticosterone and on GABA(A) α2, α3, α5 and γ2 mRNA expression within the prefrontal cortex (PFC) and amygdala measured during adulthood. These changes were monitored in the absence of a further challenge, as well as in response to either a social or a non-social psychogenic stressor administered during adulthood. Exposure to an acute adult stressor elicited anxiety in females and was still more pronounced among females that had also experienced the juvenile stressor. Among males, arousal and impulsivity predominated so that anxiety responses were less notable. Furthermore, experiencing the stressor as a juvenile influenced adult GABA(A) subunit expression, as did the adult stressor experience. These changes were differentially expressed in males and females. Moreover, these subunit variations were further moderated among mice that stressed as juveniles and were again exposed to an adult stressor. Interestingly, under conditions in which the juvenile stressor increased the expression of a particular subunit, exposure to a further stressor in adulthood resulted in the γ-aminobutyric acid (GABA) subunit variations being attenuated in both sexes. The current results suggest that juvenile and adult stressor experiences elicit variations of GABA(A) receptor subunit expression that are region-specific as well as sexually-dimorphic. Stressful events during the juvenile period may have pronounced proactive effects on anxiety-related behaviors, but linking these to specific GABA(A) subunits is made difficult by the diversity of GABA changes that are evident as well as the dimorphic nature of these variations. Nevertheless, these GABA(A) sex-specific subunit variations may be tied to the differences in anxiety in males and females.

Post-weaning to pre-pubertal ('juvenile') stress: a model of induced predisposition to stress-related disorders.

Human studies suggest that childhood trauma predisposes individuals to develop stress-related disorders such as depression and post-traumatic stress disorder (PTSD). Recent years have witnessed growing interest in effectively modeling in animals the long-term effects of childhood emotional trauma on stress responses in adulthood. Most studies concerned with the impact of early-life stress on subsequent stress responses in adulthood in rodents have focused on the post-natal pre-weaning period. However, psychiatric studies often refer to human childhood rather than infancy when investigating the patients' traumatic history of stress-related psychopathologies. In accordance with that, we have examined the consequences of stress exposure at a later early-life period, the post-weaning, pre-puberty (juvenile) period, which holds greater resemblance to human childhood. This review summarizes a series of studies examining the impact of exposure of rats to stressors during 'juvenility' ('juvenile stress') on the ability of these animals to cope with stress later in life. Exposure to relatively brief but significant stress experience during juvenility was found to impair the ability of animals to cope with stressful challenges in adulthood. These behavioral manifestations were associated with lasting alterations in limbic system brain regions of neuromodulatory pathways, such as alterations in the expression of cell adhesion molecules, GABAergic system functioning and alterations in levels of circulating corticosterone. Importantly, these studies have also demonstrated considerable individual and sex differences, which call for the development of adequate analysis approaches. The juvenile stress model combined with characterization of individual profiles is presented as a useful model to study in rodents different facets of stress-related disorders and neural mechanisms of vulnerability and resilience to stress.

Quietly working for school-based sexuality education in Mexico: strategies for advocacy.

In the past decade, there have been dramatic changes in Mexico in public opinion and support for sexuality education. The growing recognition that young people are sexually active before marriage and need information in order to make responsible choices is the result of intensive health promotion efforts by public and private entities. This paper is about the work of a Mexican non-governmental organisation, IMIFAP, which has designed and evaluated sexuality education programmes for children from pre-school age through adolescence and for their parents, based on formative research. IMIFAP has also been advocating with others for the wider provision of sexuality and life skills education in schools, work that was rewarded in 1998 when the Ministry of Education announced its support for comprehensive sexuality education in the standard school curriculum. IMIFAP's strategies for formulating, implementing and evaluating an integrated programme of sexuality education in a developing country, and advocating for its inclusion in national curricula, could serve as a model which others can adapt.

AIDS prevention training for pharmacy workers in Mexico City.

Mexican pharmacies play an important adjunct health care role in sexually transmitted disease prevention and treatment. In light of the rapid spread of the AIDS pandemic, research was initiated in 1989 to investigate the feasibility of pharmacies assisting in AIDS and STD prevention and control through community education and condom promotion. This study was implemented in three stages: a needs assessment, development of a training course and complementary materials, and an evaluation of the course and materials. The instruments used in the needs assessment were a KAP questionnaire and 'mystery shopper' visits to pharmacies. The evaluation design utilized pre- and post-tests, condom sales tracking and 'mystery shopper' visits. The needs assessment found that pharmacy employees have some basic knowledge about AIDS and STDs, but lack important information and do not communicate effectively with clients in spite of client interest in these topics. Pharmacy workers expressed great in learning more about AIDS and STDs. The evaluation of the intensive 8-hour course and supporting materials showed that, when given together, the course and materials increased short term knowledge about AIDS and condom use. However, the interventions were less successful in achieving longer term information retention, transfer of knowledge to clients or in influencing condom sales. Adjustments in the training course content and in participant recruitment strategies are recommended.

Impact of the family on the sex lives of adolescents.

This article presents the results of three studies as they relate to the influence of the family on adolescents' sex lives. The first study examined sexual and contraceptive practices among girls aged 12-19 in Mexico City. It was found that both communication with the mother and pregnancy history of close female relatives were predictors of initiation of sexual relations, contraceptive use, and pregnancy. The second study examined differences between young men who had gotten their partner pregnant and young men who had not. Again, communication levels with parents were found to influence behavior. The final study examined levels of communication about sex as perceived by parents and their children. Mothers had higher levels of communication with their children about sex than did fathers, and fathers' perception of what they were communicating differed substantially from their children's perception. As a whole, the three studies' results support the hypothesis that the family has a substantial influence on adolescents' sexual and contraceptive behavior and provides justification for the incorporation of such issues as parent-child communication into sex education programs.

Mechanism of selective inhibition of the inducible isoform of prostaglandin G/H synthase.

Selective inhibition of the inducible isoform of prostaglandin G/H synthase (cyclooxygenase-2; COX2; EC 1.14.99.1) can be achieved with compounds of the general form of aryl methyl sulfonyls and aryl methyl sulfonamides. DuP 697 and NS-398 are representative examples of these compounds. Both inhibit the constitute (COX1) and inducible (COX2) isoforms of the enzyme with equal potency shortly after mixing, but their potencies increase with time for COX2 selectively. This time-dependent inhibition follows first-order kinetics, and the rate constant for inactivation of COX2 is dose dependent for both compounds. Kinetic analysis allows us to determine KI and kinact (the maximal rate of inactivation) for each inhibitor. The potency of both compounds is substrate concentration dependent, as expected for time-dependent competitive inhibitors. COX2 that has been incubated with these inhibitors, and then extensively dialyzed against buffer, shows no recovery of enzyme activity, while complete recovery of activity is seen for COX1. Thus, these inhibitors irreversibly inactivate COX2 with time, while showing minimal reversible inhibition of COX1. We isolated these inhibitors after long incubation with excess enzyme and subsequent denaturation of the enzyme. Both inhibitors showed no loss of potency resulting from interactions with COX2, suggesting that inhibition is not mediated by covalent modification of the enzyme. These data suggest that binding of these inhibitors to COX2 induces a slow structural transition of the enzyme that results in its selective inactivation.

IL-1 and its role in rat carrageenan pleurisy.

The carrageenan pleurisy model, which is characterized by cellular influx and oedema, has been used to examine the effects of anti-inflammatory compounds such as naproxen. Interleukin-1alpha and beta (IL-1) are known to be pro-inflammatory mediators, and their roles in this model are unknown. Intrapleural injection of 1% viscarin carrageenan or saline was administered to male Lewis rats. Four to 24 h later, cell counts, fluid volumes and IL-1beta levels (measured by ELISA) were determined in the pleural cavity. Serum corticosterone levels were measured only at 4 h. Significant increases in IL-1beta levels precede cell influx suggesting IL-1beta plays a role in the maintenance of cell accumulation in the pleural cavity. None of the drugs tested, including the IL-1 receptor antagonist, maintained pleural cell influx and IL-1beta levels at control levels. When human IL-1alpha or beta or rat IL-1beta were injected individually into the pleural cavity, none of these cytokines were pro-inflammatory, as measured by increased cell influx and fluid extravasation. These results suggest that although IL-1beta levels increase in the pleural cavity in response to carrageenan, IL-1 per se is not the initiator of the pro-inflammatory events of cell influx and oedema in this model.

[Abortion: who should make the decision]. / El aborto. Quien debe tomar la decision.

PIP: Selected results are presented of a national opinion survey on abortion conducted in Mexico in 1991 by the Gallup Organization. 2579 subjects were asked, among other things, who should have the right to make decisions regarding abortion. The respondents were 15-46 years old and were evenly divided by sex. 19.8% were of upper, 40.2% of middle, and 39.9% of lower socioeconomic status. Among men, women, and the total sample, respectively, 38.8%, 46.3%, and 42.5% claimed the decision should be made exclusively by the woman; 38.7%, 32.1%, and 35.5% that it should be made by the couple; 18.0%, 15.3%, and 16.6% that it should be made by the woman with advise of a physician, priest, or the government, and 4.8%, 7.0%, and 5.8% that no one had a right to make such a decision. 50.9% of women but only 39.3% of men said that the opinion of the Catholic Church should be considered. The proportions believing that the decision should be made exclusively by the woman ranged from 42.1% for respondents 15-20 years old to 44.9% for those 26-35. 48.2% of upper, 42.3% of middle, and 42.0% of lower socioeconomic status felt the decision should be made by the woman. 47.0% of upper, 39.7% of middle, and 48.5% of lower socioeconomic status felt the opinion of the Church should be considered. Only 32.9% of respondents in the city of Guadalajara compared to 44.0% in Mexico City and 48.9% in Monterrey felt the decision should be made exclusively by the woman.^ieng

Enfermedad de Niemann-Pick. Estudio de dos casos. / Niemann-Pick disease.Study of 2 cases

Se presentan los dos primeros casos de enfermedad de Niemann-Pick diagnosticados en el Instituto Nacional de Pediatria DIF. Se describen sus caracteristicas clinicas y sus datos de laboratorio. Se hace una revision de la literatura de este trastorno congenito del metabolismo

[Gilbert's disease]. / Enfermedad de Gilbert.

An extensive review of Gilbert's disease (unconjugated, non-hemolytic hyperbilirubinemia) is made with incidence not exactly determined, but it is a disease linked to hereditary factors. Two types of the disease, together with the controversy existing as to their pathogenesis are discussed. The clinical picture and all laboratory studies carried out to reach a diagnosis are reviewed. Also, the histopathology and treatment are briefly described. Two cases of this disease in the same family are presented.