Change in tear film characteristics in visual display terminal users.

PURPOSE: To evaluate changes in symptoms and tear film characteristics in young computer users. METHODS: Fifty-one computer users and 26 controls were evaluated at the beginning and the end of the working day. Subjects with ocular or systemic disease, history of ocular surgery, use of contact lenses or glasses with antireflective surfaces, and use of topical or systemic medications were excluded from the study. Computer use duration, Ocular Surface Disease Index (OSDI) questionnaire, tear osmolarity, Schirmer test, tear break-up time (TBUT), and ocular surface vital dye staining were performed prevocationally and postvocationally. RESULTS: The mean age was 31.2 ± 6.3 years in computer users and 33.7 ± 5.8 in controls. The mean reported computer use was 6.9 ± 2.7 hours/day in computer users and 0.4 ± 0.5 hours/day in controls. The mean prevocational and postvocational values in computer users for OSDI, osmolarity, TBUT, and Schirmer test were 23.2 ± 16.6 and 27.0 ± 17.6, 306.6 ± 14.9 and 311.0 ± 12.5 mOsm/L, 13.9 ± 4.0 and 13.2 ± 3.8 seconds, 22.7 ± 11.8 and 20.6 ± 12.5 mm, respectively. The vocational change was significant for all parameters in the computer user group but not in the control group. The osmolarity-based dry eye diagnosis was 27.4% in the computer users while it was 15.4% in the control group. Oxford score was only grade 1 in 5.9% of visual display terminal users and did not change at the end of the day. CONCLUSIONS: Both symptoms and signs of dry eye increased significantly with computer use. Approximately 1 of every 3-4 computer users was found to have dry eye with higher tear osmolarity values.

Diagnosing comorbidity: concepts, criteria, and methods.

BACKGROUND: The clinical and etiologic implications of comorbid psychiatric and substance-use disorders are relevant across countries and cultures. The DSM-IV now places greater emphasis on the clinical and research utility of the substance-induced disorders classification, and clarifies several important diagnostic issues specific to primary and substance-induced disorders. However, no research consensus exists over the core problem of identifying and differentiating the drug and alcohol intoxication and withdrawal symptoms that can mimic psychiatric symptoms in heavy drinkers and drug users. OBJECTIVE: To investigate how various diagnostic instruments have measured comorbid psychiatric and substance-use disorders and how each instrument operationalizes the DSM-IV classification. METHOD: We review the evolution of the concept of comorbidity beginning with its formalization as the 'primary-secondary' distinction in the Feighner Criteria. We address the 'organic-non-organic' distinction found in the RDC, DSM-III, and DSM-III-R; and finally, review the 'primary' and 'substance-induced' categories of DSM-IV, DSM-IV-TR and ICD-10. We describe how these distinctions have been operationalized in widely used diagnostic instruments. CONCLUSION: Further understanding of these classifications and the relationship of co-occurring psychiatric and substance disorders can be accomplished with the range of available measures, particularly the Psychiatric Research Interview for Substance and Mental Disorders (PRISM), which reliably utilizes and refines DSM-IV classification distinctions.

[Carcinomatous meningitis revealing a cancer: study of two cases]. / Meningite carcinomateuse révélatrice de cancer: étude de deux cas.

Meningeal Carcinomatosis (MC) is rare (4 to 5% of patients with solid tumors). We report two cases. The first case is a 53 year-old man presenting flaccid paraplegia and the second is a 76 year-old man presenting a clinical picture suggestive of normal pressure hydrocephalus. In the two cases, the diagnosis of MC was achieved by the demonstration of malignant cells in the CSF. Prognosis was poor in the two cases. The clinical presentation of MC is non specific and the diagnosis is only confirmed by demonstrating carcinomatous cells in CSF.

When acute-stage psychosis and substance use co-occur: differentiating substance-induced and primary psychotic disorders.

Substances such as alcohol, cocaine, amphetamine, and cannabis can produce psychotic reactions in individuals who are otherwise free of serious mental illness. However, persons with primary psychotic disorders, such as schizophrenia and bipolar disorder, who use these substances often present for treatment with signs and symptoms similar to those whose psychosis resulted from the use of drugs alone. While it is often difficult to distinguish substance-induced from primary psychoses, especially early in the course of treatment, this differential diagnosis has important implications for treatment planning. To help clinicians distinguish these two types of presentations, the authors first review the types of psychotic symptoms that can co-occur with substance use. They discuss the prevalence and patterns of substance use that have been found in patients with schizophrenia and other primary psychotic disorders and review the negative outcomes associated with substance use in this population. The prevalence of and types of symptoms and problems associated with psychotic symptoms that occur as a result of substance use alone are also reviewed. The authors describe assessment procedures for differentiating substance-induced and primary psychotic disorders. They stress the importance of accurately establishing the temporal relationship between the substance use and the onset and continuation of psychotic symptoms in making a differential diagnosis, as well as the importance of being familiar with the types of psychological symptoms that can occur with specific substances. The authors review the utility and limitations of a number of diagnostic instruments for assessing patients with co-occurring psychosis and substance use problems, including The Addiction Severity Index, The Michigan Alcohol Screening Test, and diagnostic interviews such as the Schedule for Affective Disorders and Schizophrenia and the Structured Clinical Interview for DSM. They then discuss the Psychiatric Research Interview for Substance and Mental Disorders (PRISM), an instrument that has been developed to address the lack of a diagnostic interview that is suitable for assessing the comorbidity of substance use and psychiatric disorders. The article concludes with a discussion of the importance of an appropriate match between diagnosis and treatment and the current state of our knowledge concerning the most appropriate types of treatment interventions for patients with substance-induced psychosis and those with dual diagnoses.

[Neurological manifestations indicative of brucellosis]. / Manifestations neurologiques révélatrices de brucellose.

Eight patients presented neurological signs secondary to Brucella infection. The clinical presentation was a meningoencephalitis in three cases, a meningoencephalomyelitis in one case, an epiduritis with spinal cord compression in one case, an acute polyradiculoneuritis in two cases and a chronic polyradiculoneuritis in one case. Acoustic nerve was impaired in seven cases. Cerebrospinal fluid (CSF) analysis revealed a lymphocytic meningitis and a high protein concentration in all cases. The agglutination test titers were elevated in the serum and in the CSF of seven patients (> or = 1/80) and two patients respectively. Brucella melitensis culture was disclosed in the blood of one patient and in the CSF of two patients. Three patients were treated by the association cycline and rifampicin whereas a tritherapy including cycline, rifampicin and TMP-SMZ was used in the other cases. Outcome was favorable in seven cases. This study outlines the polymorphism of neurological manifestations due to brucellosis, even in familial cases and this diagnostic must be especially done in Middle East and South Mediterranean countries.

Psychiatric Research Interview for Substance and Mental Disorders (PRISM): reliability for substance abusers.

OBJECTIVE: The purpose of this study was to investigate the reliability of a new semistructured diagnostic interview, the Psychiatric Research Interview for Substance and Mental Disorders (PRISM), for substance-abusing patients. The reliability of psychiatric diagnoses for individuals who drink heavily or use drugs has been shown to be problematic. The PRISM was designed to improve the reliability for such individuals. METHOD: A test-retest reliability study of the PRISM was conducted with 172 patients being treated in dual-diagnosis or substance abuse settings. RESULTS: Good to excellent reliability was shown for many diagnoses, including affective disorders, substance use disorders, eating disorders, some anxiety disorders, and psychotic symptoms. The interview has recently been updated for DSM-IV diagnoses. CONCLUSIONS: The PRISM offers a method of producing psychiatric diagnoses with improved reliability for patients and other research subjects who have problems with alcohol or drugs.