[Impact of the summer 2003 heat wave on the activity of two psychiatric emergency departments]. / Impacto de la ola de calor del verano 2003 en la actividad de dos servicios de urgencias psiquiátricas.

INTRODUCTION: Heat waves have been related with lethal effects, especially in Europe during the intensely hot summer of 2003. However, besides increased deaths and ailments, there are no specific data on the psychiatric effects of heat waves. METHODS: We have compared psychiatric emergencies in Barcelona during a 15-day heat waves period with the rest of the 2003 summer days. The main variables of the study were total emergencies, admissions, diagnoses, Severity of Psychiatric Illness scale (SPI), psychosocial variables, treatment rendered (including use of restraints), and referrals. RESULTS: No differences were found in the number of emergencies and admissions. During the heat wave, there were more patients with psychiatric backgrounds, more diagnoses of alcohol and drug abuse, but fewer anxiety disorders. The proportion of patients with mechanical restraint increased, but this only occurred in half of the cases in patients with drug or alcohol abuse. The item "dangerousness toward others" (part of the SPI scale) scored significantly higher during the heat waves. CONCLUSIONS: There were no significant increases or decreases in psychiatric emergencies or admissions. However, the heat wave was related to more violent behavior and higher drug and alcohol abuse. It should be noted that anxiety conditions and benzodiazepine prescriptions were lower during this period. These findings may be useful to implement medical-psychiatric preventive measures against the heat wave phenomenon.

Impacto de la ola de calor del verano 2003 en la actividad de dos servicios de urgencias psiquiátricas / Impact of the summer 2003 heat wave on the activity of two psychiatric emergency departments

Introducción. La ola de calor se ha relacionado con efectos letales, especialmente en Europa durante el caluroso verano de 2003. Pero aparte del incremento de muertes y enfermedades, no existen datos específicos de los efectos psiquiátricos de la ola de calor. Metodología. Se compararon las urgencias psiquiátricas de dos hospitales de Barcelona durante los 15 días de la ola de calor con el resto del verano de 2003. Las principales variables del estudio fueron: urgencias totales, ingresos, diagnósticos, gravedad, variables psicosociales, tratamientos aplicados (incluyendo contención mecánica), y derivaciones. Resultados. No se encontraron diferencias en el número de urgencias ni de ingresos. Durante la ola de calor, hubo más pacientes con antecedentes psiquiátricos, más diagnóstico de abuso de alcohol y drogas, pero menos trastornos de ansiedad. También aumentó la proporción de pacientes con sujeción mecánica, pero sólo en la mitad de casos, esto ocurrió en pacientes con abuso de alcohol o drogas. El ítem «peligro hacia los demás» de la escala de gravedad se puntuó significativamente más alto en la ola de calor. Conclusiones. No hubo incrementos o disminuciones significativos en urgencias o los ingresos psiquiátricos, aunque los que acudieron tenían más antecedentes psiquiátricos. Durante la ola de calor hubo un cierto incremento significativo de violencia y de abuso de alcohol y drogas, pero menor porcentaje de trastornos de ansiedad y menos prescripciones de benzodiazepinas durante este período. Estos datos exploratorios indican el interés de considerar medidas preventivas médico psiquiátricas frente al fenómeno de la ola de calor (AU)

Introduction. Heat waves have been related with lethal effects, especially in Europe during the intensely hot summer of 2003. However, besides increased deaths and ailments, there are no specific data on the psychiatric effects of heat waves. Methods. We have compared psychiatric emergencies in Barcelona during a 15-day heat waves period with the rest of the 2003 summer days. The main variables of the study were total emergencies, admissions, diagnoses, Severity of Psychiatric Illness scale (SPI), psychosocial variables, treatment rendered (including use of restraints), and referrals. Results. No differences were found in the number of emergencies and admissions. During the heat wave, there were more patients with psychiatric backgrounds, more diagnoses of alcohol and drug abuse, but fewer anxiety disorders. The proportion of patients with mechanical restraint increased, but this only occurred in half of the cases in patients with drug or alcohol abuse. The item «dangerousness toward others» (part of the SPI scale) scored significantly higher during the heat waves. Conclusions. There were no significant increases or decreases in psychiatric emergencies or admissions. However, the heat wave was related to more violent behavior and higher drug and alcohol abuse. It should be noted that anxiety conditions and benzodiazepine prescriptions were lower during this period. These findings may be useful to implement medical-psychiatric preventive measures against the heat wave phenomenon (AU)

The relationship between frequency and intensity of fears and a collagen condition.

Encouraged by the positive relationship between joint laxity and panic anxiety, our objective in this study was to compare widespread cultural fears in subjects with and without joint hypermobility syndrome and to assess whether this relationship is sustained for common fears as well. A sample consisting of 1,305 subjects from a rural town were assessed for joint hypermobility syndrome using Beighton's criteria. We assessed fear intensity and frequency using a modified version of the Fear Survey Schedule (FSS-III). Intense fears, defined with a score of 3-4, were compared between hypermobile and nonhypermobile subjects. The analysis was carried out separately for men and women. Nonparametric analysis was applied throughout. Joint hypermobility syndrome was found in 19.9% (141) of women and 6.9% (41) of men. Concerning the fear survey, when we compared the groups with and without joint hypermobility, the mean total scores for both genders were significantly higher for the hypermobile group. When we analyzed each item individually, 43 out of the 44 most severe fears in women and 36 out of the 39 in men, scores were significantly higher in the hypermobile group. We found significant differences between subjects with and without joint hypermobility when assessing specific fears, reinforcing the hypothesis that intensity of fears is greater in subjects with joint hypermobility syndrome. These results show that the association of joint laxity and phobic anxiety is sustained for intense fears and might represent a susceptibility factor for these anxiety conditions.

Bromus tectorum invasion alters nitrogen dynamics in an undisturbed arid grassland ecosystem.

The nonnative annual grass Bromus tectorum has successfully replaced native vegetation in many arid and semiarid ecosystems. Initial introductions accompanied grazing and agriculture, making it difficult to separate the effects of invasion from physical disturbance. This study examined N dynamics in two recently invaded, undisturbed vegetation associations (C3 and C4). The response of these communities was compared to an invaded/ disturbed grassland. The invaded/disturbed communities had higher surface NH4+ input in spring, whereas there were no differences for surface input of NO3-. Soil inorganic N was dominated by NH4+, but invaded sites had greater subsurface soil NO3-. Invaded sites had greater total soil N at the surface four years post-invasion in undisturbed communities, but total N was lower in the invaded/disturbed communities. Soil delta15N increased with depth in the noninvaded and recently invaded communities, whereas the invaded/disturbed communities exhibited the opposite pattern. Enriched foliar delta15N values suggest that Bromus assimilated subsurface NO3-, whereas the native grasses were restricted to surface N. A Rayleigh distillation model accurately described decomposition patterns in the noninvaded communities where soil N loss is accompanied by increasing soil delta15N; however, the invaded/ disturbed communities exhibited the opposite pattern, suggesting redistribution of N within the soil profile. This study suggests that invasion has altered the mechanisms driving nitrogen dynamics. Bromus litter decomposition and soil NO3- concentrations were greater in the invaded communities during periods of ample precipitation, and NO3- leached from the surface litter, where it was assimilated by Bromus. The primary source of N input in these communities is a biological soil crust that is removed with disturbance, and the lack of N input by the biological soil crust did not balance N loss, resulting in reduced total N in the invaded/disturbed communities. Bromus produced a positive feedback loop by leaching NO3- from decomposing Bromus litter to subsurface soil layers, accessing that deepsoil N pool with deep roots and returning that N to the surface as biomass and subsequent litter. Lack of new inputs combined with continued loss will result in lower total soil N, evidenced by the lower total soil N in the invaded/disturbed communities.

The early development of stereotypy and self-injury: a review of research methods.

BACKGROUND: The origin and developmental course of stereotypic and self-injurious behaviour among individuals with developmental disabilities such as intellectual disability (ID) or pervasive development disorders such as autism is not well understood. METHOD: Twelve studies designed to document the prevalence, nature, or development of stereotypic and/or self-injurious behaviour in children under 5 years of age and identified as at risk for developmental delay or disability were reviewed. Comparisons were made with similar studies with typically developing children. RESULTS: It appears that the onset of naturally occurring rhythmic motor stereotypies is delayed in young at-risk children, but that the sequencing may be similar. A very small database, differences in samples, measures, and designs limited the degree to which comparisons could be made across studies. CONCLUSION: Future work is needed based on appropriately designed prospective comparison studies and uniform quantitative measures to provide an empirical basis for new knowledge about the early development of one of the most serious behaviour disorders afflicting children with ID and related problems of development.

Cue-induced cocaine craving: neuroanatomical specificity for drug users and drug stimuli.

OBJECTIVE: Cocaine-related cues have been hypothesized to perpetuate drug abuse by inducing a craving response that prompts drug-seeking behavior. However, the mechanisms, underlying neuroanatomy, and specificity of this neuroanatomy are not yet fully understood. METHOD: To address these issues, experienced cocaine users (N=17) and comparison subjects (N=14) underwent functional magnetic resonance imaging while viewing three separate films that portrayed 1 ) individuals smoking crack cocaine, 2) outdoor nature scenes, and 3) explicit sexual content. Candidate craving sites were identified as those that showed significant activation in the cocaine users when viewing the cocaine film. These sites were then required to show significantly greater activation when contrasted with comparison subjects viewing the cocaine film (population specificity) and cocaine users viewing the nature film (content specificity). RESULTS: Brain regions that satisfied these criteria were largely left lateralized and included the frontal lobe (medial and middle frontal gyri, bilateral inferior frontal gyrus), parietal lobe (bilateral inferior parietal lobule), insula, and limbic lobe (anterior and posterior cingulate gyrus). Of the 13 regions identified as putative craving sites, just three (anterior cingulate, right inferior parietal lobule, and the caudate/lateral dorsal nucleus) showed significantly greater activation during the cocaine film than during the sex film in the cocaine users, which suggests that cocaine cues activated similar neuroanatomical substrates as naturally evocative stimuli in the cocaine users. Finally, contrary to the effects of the cocaine film, cocaine users showed a smaller response than the comparison subjects to the sex film. CONCLUSIONS: These data suggest that cocaine craving is not associated with a dedicated and unique neuroanatomical circuitry; instead, unique to the cocaine user is the ability of learned, drug-related cues to produce brain activation comparable to that seen with nondrug evocative stimuli in healthy comparison subjects.

Grandparents as parents: research findings and policy recommendations.

This article presents an overview of research on grandparenthood in the latter decades of the twentieth century. Theories contributing to understanding of the grandparenting role are discussed, and significant factors affecting the grandparenting experience--including sex, age, retirement status, race, and ethnicity--are reviewed. The special case of grandparents raising grandchildren is explored through a review of demographics, outcomes for children in grandparent foster care, and the impact of raising grandchildren on grandparents. Interventions supporting custodial grandparents and the grandchildren in their care are examined. Drawing on the findings and implications of this overview, recommendations for policy, clinical practice, professional education, and future research are offered.

Hepatitis C virus infection in cocaine users--a silent epidemic.

Over a recent three year period, approximately 600 individuals responded to newspaper advertisements for research studies requiring healthy, cocaine using subjects. These subjects were screened using a standard phone interview in order to eliminate individuals with known medical or psychiatric illnesses that would exclude them from ongoing neuroimaging studies of drug abuse. Individuals were specifically asked about their hepatitis and HIV status. Of these, 170 subjects passed the phone screen, having no known medical or psychiatric illness outside of cocaine abuse/dependence and were willing to be further evaluated for the studies. These subjects were brought to the Medical College of Wisconsin's General Clinical Research Center and tested for, among other measures, hepatitis B, hepatitis C, and HIV. Of these, 144 completed the examination and all testing. In this cohort of assumed healthy subjects, 47 (33%) tested positive for antibodies to the hepatitis C virus (HCV). Only 7 (5%) tested positive for the hepatitis B surface antigen and 2 (1.4%) to HIV. The demographics of this cohort are 56% African-American, 81% male, 75% never-married, 55% unemployed with a mean age of 36 years. The percentage of subjects reporting any lifetime intravenous drug use among the HCV(+) and the HCV(-) cohorts was 77% vs. 29% respectively. Some routes of HCV transmission are still unclear and may reflect lifestyle or other factors related to cocaine use outside of parenteral drug use. Since almost all HCV infections become chronic, and many progress to chronic active hepatitis, cirrhosis, and ultimately hepatocellular carcinoma, these observations suggest a significant epidemic in an unsuspecting population with little regular access to health care. These individuals also form a large pool for the continued transmission of HCV to the general population. Additional public health interventions are suggested.

Contemporary ethical dilemmas in psychotherapy: cosmetic psychopharmacology and managed care.

Two contemporary ethical dilemmas facing psychotherapists have been noted and described: cosmetic psychopharmacology and the practice of psychotherapy in a managed care environment. Regarding cosmetic psychopharmacology: It was noted that whether a psychotherapist endorses the use of psychotropic agents for cosmetic purposes, such as self-transformation, seems to be a function of the severity of the client/patient symptoms as well as the psychotherapist's view of human nature and the human condition. However, recent research indicates that certain traits or reflections of the human condition, such as irritability, may actually be neurotransmitter deficiencies that are responsive not only to psychotropic agents but also to non-drug interventions. These findings add an additional dimension to discussions of the ethics of cosmetic psychopharmacology. Regarding psychotherapy in a managed care environment: Several ethical dilemmas, including confidentiality, were discussed. These dilemmas were outlined rather than analyzed in detail. Some of them will become major "thorns" of concern for the practice of psychotherapy. Others will be less consequential. Of critical concern is that limitations by managed care on the technique and optimal length of treatment of psychotherapy can conceivably lessen its efficacy for some patients and could possibly eliminate this powerful treatment procedure for others.

Comparison of the effects of mivacurium on the diaphragm and geniohyoid muscles.

Although subjects often report difficulty with swallowing shortly after receiving neuromuscular blocking agents, difficulty with swallowing during recovery from neuromuscular blocking agents appears to be infrequent. We have used electromyography to compare onset and recovery at the diaphragm and geniohyoid airway muscles after an intubating dose of mivacurium (0.2 mg kg-1) to determine if the geniohyoid muscles were particularly sensitive to neuromuscular blocking agents. Twelve adults undergoing elective surgery were anaesthetized with propofol and fentanyl and the trachea intubated without neuromuscular blocking agents. The left hypoglossal and right phrenic nerves were stimulated with percutaneous needle electrodes and the electromyogram recorded with surface electrodes. EMG responses were measured after a bolus dose of mivacurium 0.2 mg kg-1. Recordings were also made of the mechanical response of the adductor pollicis to supramaximal ulnar nerve stimulation. There was no difference in the rate of onset of block for geniohyoid muscles and the diaphragm, but recovery to 25% and 90% of the control response was shorter at the diaphragm (median 14.5 (95% confidence limits 12.9-15.3) min and 23.8 (21.7-26) min) than at the geniohyoid muscle (19.4 (15.6-20.1) min and 29.2 (26.3-31.4) min), respectively (P < 0.05). When the train-of-four ratio of the mechanical response of the thumb reached 70%, the diaphragm and geniohyoid muscles had recovered completely in all patients.

Understanding organizations: a primer for occupational medicine physicians.

By comparing organizational dynamics to anatomy and how those organizations work to physiology, Dr. Sperry helps occupational physicians understand the organizational dynamics under which they work. Anatomy is discussed in terms of the organization's structural, cultural, leader, worker, and strategy subsystems. The process by which organizations develop, adapt, and decline also is described.

The occupational physician as corporate chief health officer.

In this era of skyrocketing health care costs, the author makes a case for corporations to include a chief health officer on their top management team. The CHO would preferably be an occupational medicine physician who can manage the delivery of health care and who can develop a corporate culture of health that promotes wellness and the prevention of disability and injury.

A comparison of the neuromuscular blocking effects of atracurium, mivacurium, and vecuronium on the adductor pollicis and the orbicularis oculi muscle in humans.

Both the orbicularis oculi (OO) and the adductor pollicis (AP) muscles have been used to indirectly quantify the extent of neuromuscular block of the respiratory muscles. To clarify any differences in response of these muscles to neuromuscular blocking drugs, the effects of two different doses of atracurium, mivacurium, and vecuronium on the AP and OO were studied. A new technique was used to measure the evoked mechanical response of the OO with accelerometry. Fifty premedicated patients were anesthetized with 5-8 mg/kg thiopental and 2 micrograms/kg fentanyl intravenously (i.v.). They were randomly allocated to receive a single dose of either 300 or 500 micrograms/kg atracurium, 150 or 250 micrograms/kg mivacurium, or 60 or 100 micrograms/kg vecuronium i.v. After orotracheal intubation, anesthesia was maintained with nitrous oxide 60% in oxygen, isoflurane 0.5%-1.5% end-tidal, and 1-2 micrograms/kg fentanyl boluses as required. The evoked response of the AP after ulnar nerve stimulation was measured using a force transducer, and that of the OO after facial nerve stimulation was measured with accelerometry using a piezoelectric probe fixed to the eyelid. The following variables were recorded for each muscle: the maximum depression of the first twitch response to the train-of-four (EMAX), the time to achievement of EMAX (TMAX), the time to recovery of the first twitch response to 25%, 50%, 75%, and 90% of control value (TH25, TH50, TH75, and TH90, respectively) and the time to recovery of the train-of-four response to a ratio of 70% (TOF 0.7). The smaller dose of each relaxant was significantly less potent than the larger dose at the OO. TMAX was shorter for the OO than for the AP at the larger dose of each drug. TH 25 was shorter at the OO than at the AP with 0.5 mg/kg atracurium, but there was no significant difference with 0.25 mg/kg atracurium. TH25 and TH50 were both faster at the OO than at the AP with mivacurium, but there was no difference with vecuronium. TOF 0.7 was shorter with the smaller dose of each drug, but there was no difference with the higher doses. It is concluded that it is possible to record the mechanical response of the OO muscle using a noninvasive method. There are differences between the responses of the OO and the AP to neuromuscular blockers that depend upon both the specific drug itself and the dose used.

An overview of organizational and occupational psychiatry.

Although many clinicians agree in principle that work is central to personal identity and mental health, issues related to patients' experiences in the workplace have not been a central focus in clinical practice in psychiatry. However, the link between work and mental health continues to be confirmed by research, and interest in occupational and organizational psychiatry, which focuses on the psychopathology that the individual brings to the workplace and that results from the individual's experiences in the workplace, has increased in the past decade. The three main areas of practice in the field--direct clinical services, consultation, and applied research--include evaluating work-related psychiatric disability, providing case management for employees who receive psychiatric treatment, evaluating a candidate for an executive position, and conducting epidemiological research about stress-related disorders. A patient's occupational or work history can provide valuable information for routine psychiatric diagnosis and treatment planning.

Workplace mental health consultation. A primer of organizational and occupational psychiatry.

Though there are only a few hundred psychiatrists who identify themselves as specialists in organizational and occupational issues, the need for psychiatric skills in the workplace has increased dramatically in recent years. Crucial issues include distressed employees, the effects of organizational structure and change, job stress, psychiatric disability, substance abuse, and violence in the workplace. It is important for general psychiatrists to become more conversant in work and workplace-related mental health issues. Use of an occupational history with all patients, and knowledge of organizational structures and function, are just two ways to become more aware of these matters. With business and government increasingly attentive to mental health benefits and systems, appropriate psychiatric focus on organizational and occupational concerns becomes ever more important.

A double-blind controlled study of methylphenidate treatment in closed head injury.

Closed head injuries (CHI) may produce permanent, disabling changes in cognitive functions and social behaviour. Recent clinical case reports have suggested that stimulant medications may improve neurobehavioural functioning in CHI patients. In the present study, we evaluated the effects of methylphenidate (0.3 mg/kg b.i.d.) in 12 chronic CHI patients (14 to 108 months post-injury) using a double-blind, placebo-controlled, randomized, crossover design. Outcome measures consisted of cognitive tests of attention, learning and cognitive processing speed. In addition, a rating scale was completed by a close friend or relative to assess social behaviour. No significant differences were found between drug and placebo conditions on any of the neurobehavioural measures. These data do not support the clinical use of methylphenidate in the treatment of CHI patients.