Depression in patients with schizophrenia during an acute psychotic episode.

There is disagreement about whether depressive symptoms in schizophrenia are part of the basic disease process, or whether they represent adverse effects of treatment with antipsychotic medications. In a sample of initially antipsychotic drug-free acutely hospitalized patients with schizophrenia (N = 104), we measured change in depressive symptoms after 4 weeks of treatment. We also examined the relationship of changes in depressive symptoms to changes in positive and negative schizophrenic symptoms. Depressive symptoms improved after 4 weeks of antipsychotic medication treatment, and their improvement corresponded with improvement in both positive and negative schizophrenic symptoms. These results suggest that depressive symptoms in schizophrenia are related to the disease process itself, at least during acute exacerbations of schizophrenia. Depressive symptoms may be responsive to antipsychotic medications directly or as a secondary response to improvement in positive and negative symptoms.

A comparison of the Allen Cognitive Level Test and the Wisconsin Card Sorting Test in adults with schizophrenia.

OBJECTIVE: This study examines the relationship among executive function, visuospatial problem solving, and measures of occupational functioning in 33 adult men with schizophrenia or schizoaffective disorder. METHOD: Three measures were administered in a one-time assessment session. The Wisconsin Card Sorting Test (WCST) was used to measure executive functioning, abstract reasoning, and problem-solving abilities. The Allen Cognitive Level (ACL) Test was used to measure learning, problem solving, and visuospatial abilities. The Routine Task Inventory (RTI) measured the level of performance in activities of daily living. RESULTS: Using multiple regression controlling for age, the WCST significantly predicted performance on the ACL the RTI. Perseverative errors on the WCST were negatively correlated with the ACL (r = -.47) and RTI scores (r = -.59). The ACL and RTI were also significantly correlated (r = .67). CONCLUSION: Both the WCST and the ACL are sensitive to similar domains of functioning and are predictive of task performance. The results support the use of the ACL as a quick measure of a person's cognitive and functional abilities.

Occupational health transfer of records.

Corporate mergers, downsizing and buy-outs can have an impact on the practice of occupational health nurses. With these changes, occupational health departments are frequently transferred to a new corporation, or existing occupational health services may be eliminated. This can create multiple dilemmas for the employer, employee and for the occupational health nurse who is the custodian of the employee's health records.

Defamation actions.

Registered nurses working in today's fast paced, high-tech health care environments are aware of their professional accountability and that, at some point, they may be involved in legal proceedings related to their practice. A civil lawsuit alleging negligence is the predominant concern nurses have when they turn their minds to this issue.

A timely risk management resource.

The Hospital Information Services program and the work of the HLC members has resulted in a significant increase in the number of physicians and institutions willing to co-operate with bloodless treatment of patients. Over a five-year period the number of physicians willing to co-operate in this matter has increased from 5,000 to more than 50,000 in 65 countries. This dramatic increase in the number of informed co-operative clinicians has also resulted in the development of more than 80 bloodless surgery and medical centres in various countries.

Supervision of psychiatric patients.

Nurses are frequently part of a health care team providing services to psychiatric patients. From a health care and legal perspective, one of the pressing issues that must often be addressed is the amount of supervision or intervention required to protect the patient from self-harm or from injuring others.

Frequency of neuropathology in a brain bank from a long-term, domiciliary population.

Postmortem analysis of brain chemistry and anatomy in the study of psychiatric disorders has enjoyed renewed interest recently. There are myriad difficulties in establishing a brain bank, including proper diagnosis and confounding neuropathology. These difficulties may become more pronounced in a long-term domiciliary facility. In order to begin to address neuropathologic considerations, we performed neuropathological examinations on each patient included in our bank of 20 brains. Forty-five per cent of all patients had significant and unexpected neuropathology. Selection of patients to be included in postmortem studies requires careful screening to enhance accurate neuropathological assessment.

Schizophrenia, narcolepsy, and HLA-DR15, DQ6.

A strong association between HLA-DR2, DQ1 and narcolepsy-cataplexy has been known since 1986. In 1990 a subdivision (HLA-DR15, DQ6) was shown to be equally associated. Narcolepsy symptoms include rapid eye movement (REM)-sleep intrusion hallucinations during the day. Some narcoleptics may be so hallucinated that they become delusional and receive a diagnosis of schizophrenia. Fifty-six inpatient schizophrenics and 56 normal controls were compared to see if there was an excess of the narcolepsy-associated antigens (NAA) among schizophrenics. Patients had frequency of the NAA 3.89 times higher than controls. After a subset was studied by night (n = 9) and day (n = 7) polysomnography, two patients were found to be true narcoleptics. Their psychosis improved with treatment for narcolepsy. When NAA(+) and NAA(-) schizophrenics were compared, the NAA(+) subgroup had significantly higher Brief Psychiatric Rating Scale (BPRS) scores and more hospitalizations. There were no effects attributable only to gender or race. We conclude that narcolepsy can simulate schizophrenia in some cases, and that even in nonnarcoleptic patients, the HLA-DR15,DQ6 antigens mark a group of severe schizophrenics that merits further study.

Oestriol in the treatment of postmenopausal urgency: a multicentre study.

UNLABELLED: Oestrogen deficiency in postmenopausal women is thought to be important in the genesis of lower urinary tract symptoms, in particular the 'urge syndrome'. Evidence to support the use of oestrogen therapy in symptomatic postmenopausal women is, however, limited. Oestriol is a weak, naturally occurring oestrogen that may be beneficial to the urogenital tissues without stimulating the endometrium. We have investigated the use of oestriol in the treatment of postmenopausal sensory and motor urge incontinence. MATERIALS AND METHODS: A double-blind, placebo-controlled, randomised, multicentre study of 3 mg oral oestriol/day for 3 months in the treatment of women with urge incontinence was undertaken. RESULTS AND CONCLUSIONS: Sixty-four women were recruited into the study. Although oestriol produced both subjective and objective improvement in lower urinary tract function, it was not significantly better than placebo. Some of the difficulties of running a multicentre study were encountered.

Age disorientation in Kraepelinian schizophrenia: frequency and clinical correlates.

Many schizophrenic patients exhibit significant neuropsychological impairment, and age disorientation is considered to be one of the more extreme manifestations. To evaluate clinical correlates of age disorientation with reference to the course of schizophrenic illness, we compared 39 deteriorated chronic Kraepelinian schizophrenic patients and 39 nondeteriorated schizophrenic patients early in the course of illness. Age disorientation was observed in 36% of patients in the Kraepelinian group, but in no patient in the non-Kraepelinian group. In the Kraepelinian group, age disorientation was unrelated to positive/negative symptoms or illness duration. Our data suggest that age disorientation may be a function of aging in schizophrenia, but is not merely a function of chronicity.

The treatment of detrusor instability in post-menopausal women with oxybutynin chloride: a double blind placebo controlled study.

Idiopathic detrusor instability is a common cause of incontinence in the elderly for which anticholinergic agents are regularly prescribed. Oxybutynin chloride combines anticholinergic action with direct muscle relaxant properties. We performed a double blind placebo controlled fixed dose cross over study of oxybutynin chloride in post-menopausal women suffering from detrusor instability. We found oxybutynin chloride significantly more effective than placebo at reducing the symptoms of urgency and urge incontinence and more effective at reducing the height of the highest unstable detrusor contraction. This was at the expense of an increased residual urine and considerable side effects.

The influence of nipple stimulation at term on the duration of pregnancy.

The influence of nipple stimulation (NS) at term on the duration of pregnancy was investigated among low-risk gravidas in a randomized prospective study. A significant inverse relationship was found between the duration of pregnancy and both gestational age at recruitment and cervical (Bishop) score, although the influence of cervical score was quantitatively small. Nipple stimulation did not influence either the duration of pregnancy or the probability of having a cesarean section or an instrumental delivery. Patient compliance was, however, poor, which may in part account for these findings, as there was an inverse trend between the daily average duration of NS and the duration of pregnancy.

Listeriosis revisited: the role of the obstetrician.

The clinical course and outcome is described of three pregnancies complicated by listeriosis encountered during a 6-month period. All three ended in preterm labour characterized by the passage of meconium by the fetus. Two babies died in the early neonatal period and the third survived with neurological handicap. Although the diagnosis of listeriosis was made only after delivery, all the mothers had a pyrexial illness before delivery. A high index of suspicion is needed for the early detection and prompt treatment of this life-threatening perinatal infection. Effective advice concerning prevention of listeriosis by avoidance of high-risk foods must be given to women during pregnancy.

Terodiline: a dose titrated, multicenter study of the treatment of idiopathic detrusor instability in women.

Idiopathic detrusor instability is a common cause of lower urinary tract symptoms at all ages and in both sexes. Treatment initially is conservative and often includes drug therapy. Terodiline has the theoretical advantage of being a drug with anticholinergic and calcium channel blocking effects. Theoretically, by using a drug with dual action the beneficial effect of reduced detrusor overactivity might occur at a dosage below that likely to lead to the troublesome side effects experienced by patients who take pure anticholinergic agents. A total of 70 female patients completed a study characterized by extremely strict inclusion criteria and a tight protocol. Other novel elements to the study were the extensive use of urinary diaries for symptom evaluation, standardized urodynamic studies agreed upon by the participating centers and the dose titration design of the trial. Terodiline has been demonstrated to be a safe, well tolerated and effective drug in the treatment of idiopathic detrusor instability. Drug treatment led to significant decreases in urinary frequency and incontinence episodes. Pre-micturition symptoms, such as urgency, were markedly reduced and the voided volume was significantly increased. Although there were consistent trends towards greater improvement in the urodynamic measurements, when the terodiline and placebo groups were compared these did not reach statistical significance, partly due to a large improvement in the placebo group. Nevertheless, terodiline has been shown to be a useful drug for conservative management of patients with detrusor instability.

Affective cycling in thyroid disease.

Depression in an elderly man with primary recurrent unipolar depression responded to radioactive iodine treatment of a thyrotoxic nodule, without the addition of psychotropic medications. Two months later, manic symptoms developed concomitant with the termination of the hyperthyroid state secondary to the radioactive iodine treatment. Clinical implications of these findings in relation to the possible mechanism of action of thyroid hormones on affective cycling are discussed.

The prevalence of variation of resting urethral pressure in women and its association with lower urinary tract function.

Variation of resting urethral pressure has been reported and it has been postulated that this is important in the genesis of lower urinary tract symptomatology in women. In order to differentiate between normal and abnormal urethral pressure variations several arbitrary values have been chosen and the prevalence of abnormality in symptomatic women reported. However, large variations in urethral pressure may be seen in healthy, asymptomatic volunteers. We have identified the prevalence of urethral pressure variation in a large group of female volunteers and have shown that "abnormal" urethral pressure variation is not associated with lower urinary tract symptomatology.