Bipolar I and II versus unipolar depression: clinical differences and impulsivity/aggression traits.

OBJECTIVE: To investigate distinguishing features between bipolar I, II and unipolar depression, and impulsivity/aggression traits in particular. METHODS: Six hundred and eighty-five (n=685) patients in a major depressive episode with lifetime Unipolar (UP) depression (n=455), Bipolar I (BP-I) disorder (n=151), and Bipolar II (BP-II) (n=79) disorder were compared in terms of their socio-demographic and clinical characteristics. RESULTS: Compared to unipolar patients, BP-I and BP-II depressed patients were significantly younger at onset of their first depressive episode, and were more likely to experience their first depressive episode before/at age of 15. They also had more previous affective episodes, more first- and second-degree relatives with history of mania, more current psychotic and subsyndromal manic symptoms, and received psychopharmacological and psychotherapy treatment at an earlier age. Furthermore, BP-I and BP-II depressed patients had higher lifetime impulsivity, aggression, and hostility scores. With regard to bipolar subtypes, BP-I patients had more trait-impulsivity and lifetime aggression than BP-II patients whereas the latter had more hostility than BP-I patients. As for co-morbid disorders, Cluster A and B Personality Disorders, alcohol and substance abuse/dependence and anxiety disorders were more prevalent in BP-I and BP-II than in unipolar patients. Whereas the three groups did not differ on other socio-demographic variables, BP-I patients were significantly more often unemployed that UP patients. CONCLUSION: Our findings comport with major previous findings on differences between bipolar and unipolar depression. As for trait characteristics, bipolar I and II depressed patients had more life-time impulsivity and aggression/hostility than unipolar patients. In addition, bipolar I and II patients also differed on these trait characteristics.

Updated feasibility trial experience with the Viaderm percutaneous access device.

The percutaneous access device (PAD) is used to connect an external drive unit to the Kantrowitz CardioVad (KCV), a cardiac assist device for the treatment of chronic heart failure. The PAD conveys pneumatic power from a drive unit to the implanted blood pump and an electrocardiogram signal from the myocardium to the drive unit. The device-tissue interface of the PAD is precoated with autologous fibroblasts cultured from a skin sample of the intended recipient. This preparation demonstrated long-term stability in animals and was adopted for use in patients receiving the KCV. The KCV is activated intermittently, and the drive unit may be connected and disconnected by the patient, which subjects the PAD to frequent manipulation. To date, the PAD has been implanted in nine patients ranging in age from 41 to 74 years. Implant times ranged from 2 to 458 days, for a total of 1082 days, of which 557 days were in an outpatient setting. Two patients experienced episodes of infection that did not originate from the PAD-tissue interface. This feasibility study demonstrated that (1) the PAD is stable and infection resistant in long-term ambulatory patients, (2) the PAD withstood the challenge of daily manipulation (the KCV is turned on and off electively), and (3) PADs can be replaced, if necessary.

Five new species of Coccidia (Apicomplexa: Eimeriidae) from colubrid snakes of Ecuador.

Fecal samples from 11 colubrid snakes, representing 10 species, collected in Ecuador during October 1994 were examined for coccidian parasites. Feces of 4 individuals, representing 4 host species, contained coccidian oocysts. Three species of Eimeria and 2 species of Isospora were observed and are described here as new. Oocysts of both Eimeria and Isospora were found in the feces of a slug-eating snake, Dipsas vermiculata. Sporulated oocysts of the Eimeria sp. are spheroid to subspheroid, 16.7 by 16.6 microm (14-18 by 14-18 microm) and those of the Isospora sp. are spheroid and 15.0 microm (13-18 microm) in diameter. Imantodes cenchoa, the common bluntheaded treesnake, was infected with a species of Eimeria. These sporulated oocysts are ellipsoid, 23.3 by 16.2 microm (25-21 by 15-17 microm). Sporulated eimerian oocysts from Leptodeira annulata, the southern cat-eyed snake, are subspheroid, 22.5 by 18.8 microm (19-26 by 17-21 microm). Feces of a juvenile Imantodes lentiferus, the bluntheaded vine snake, contained ovoid to ellipsoid isosporan oocysts, which measured 21.6 by 15.0 microm (20-23 by 14-16 microm) when sporulated.

Mandatory reporting of abuse: practical, moral, and legal issues for psychiatric home healthcare nurses.

Psychiatric home healthcare nurses (PHHNs) work directly with clients and their families in the community and serve as consultants to other home health nurses when concerns of mental health arise. They must be able to identify areas of possible or actual family violence or abuse and intervene appropriately. They must be cognizant of the laws regarding abuse reporting in their states. Decisions to report abuse are practical and moral and, when combined with legal imperatives, create ethical dilemmas for healthcare professionals. Guidelines are presented to help PHHNs understand the complex issues associated with mandatory reporting of abuse.

A chemical dependence clinical experience.

Chemical dependence treatment clinical experiences in undergraduate nursing programs can provide appropriate entry-level experiences for students in community settings when supervised adequately and arranged carefully. They increase students' awareness of the pervasiveness of alcohol and substance-related problems and its impact on individuals, families, and societies. With careful attention to entry barriers and orientation issues, faculty can develop clinical sites that provide a wealth of experience and opportunity for students to develop themselves both personally and professionally.

Protecting partial-hospitalization patients from suicide.

TOPIC: Assessing suicide potential and intervening to prevent suicide in partial-hospitalization patients. PURPOSE: To provide information for assessing and intervening with outpatients who express suicidal thoughts and to propose a decision tree. SOURCE: Literature review, clinical experience. CONCLUSIONS: Careful assessment and sound management are required to provide treatment in outpatient settings while maintaining patient safety. A decision tree can help the clinician make sound decisions.

Crib sheets or security blankets?

This article describes the sanctioned use of crib sheets as a nursing intervention to decrease test anxiety when the classroom is the practice setting for psychiatric/mental health nursing faculty. The products that the students created offered additional unsuspected benefits. The faculty were convinced that the use of crib sheets can be a sound intervention to reduce students' test-taking anxiety.

Perseverance: the meaning of patient education in psychiatric nursing.

This phenomenological study was undertaken to discern the meaning psychiatric nurses attach to their patient education experiences. Although patient education crosses all nursing specialty areas, no studies have attempted to describe how it is unique to psychiatric nursing. Hermeneutic analysis of audiotaped, semistructured, in-depth interviews revealed three themes, The Teaching Way, Being In-Between, and Seeing Inside, which, when taken together, formed one constitutive pattern: perseverance. The results indicate that psychiatric nurses are very much involved in educating their patients and that the process differs from traditional expectations of learning readiness. There is also an apparent need to educate students about the realities of health care settings and how to deal with them. The researcher, herself a psychiatric nurse, came away from this study with a renewed respect for nurses' commitment to patient education, for their ability to use themselves as therapeutic tools, and for their ability to practice from within political settings which seldom encourage or reward nurses for patient education. Further studies are needed to explore how nurses deal with the political realities affecting their practices and how they maintain their commitment to patient care under such circumstances.

Macrophages that have ingested apoptotic cells in vitro inhibit proinflammatory cytokine production through autocrine/paracrine mechanisms involving TGF-beta, PGE2, and PAF.

Apoptosis in vivo is followed almost inevitably by rapid uptake into adjacent phagocytic cells, a critical process in tissue remodeling, regulation of the immune response, or resolution of inflammation. Phagocytosis of apoptotic cells by macrophages has been suggested to be a quiet process that does not lead to production of inflammatory mediators. Here we show that phagocytosis of apoptotic neutrophils (in contrast to immunoglobulin G-opsonized apoptotic cells) actively inhibited the production of interleukin (IL)-1beta, IL-8, IL-10, granulocyte macrophage colony-stimulating factor, and tumor necrosis factor-alpha, as well as leukotriene C4 and thromboxane B2, by human monocyte-derived macrophages. In contrast, production of transforming growth factor (TGF)-beta1, prostaglandin E2, and platelet-activating factor (PAF) was increased. The latter appeared to be involved in the inhibition of proinflammatory cytokine production because addition of exogenous TGF-beta1, prostaglandin E2, or PAF resulted in inhibition of lipopolysaccharide-stimulated cytokine production. Furthermore, anti-TGF-beta antibody, indomethacin, or PAF receptor antagonists restored cytokine production in lipopolysaccharide-stimulated macrophages that had phagocytosed apoptotic cells. These results suggest that binding and/or phagocytosis of apoptotic cells induces active antiinflammatory or suppressive properties in human macrophages. Therefore, it is likely that resolution of inflammation depends not only on the removal of apoptotic cells but on active suppression of inflammatory mediator production. Disorders in either could result in chronic inflammatory diseases.

Naltrexone: a controversial therapy for alcohol dependence.

1. Naltrexone HCL (ReVia) may be an effective adjunct in the treatment of alcohol dependence in motivated individuals. 2. Naltrexone therapy is controversial because its use conflicts with the view of abstinence held by Alcoholics Anonymous and most medical treatment programs. 3. Knowledge of the controversy can help nurses advocate for their patients, and may help nurses acknowledge the need to define their care according to a nursing paradigm.

The leukocytes of the roughtail gecko Cyrtopodion scabrum: a bright-field and phase-contrast study.

The morphology of the peripheral blood leukocytes of the roughtail gecko, Cyrtopodion scrabum, is carefully described in Wright-Giemsa and toluidine-blue-stained blood films, and in the living condition by phase-contrast microscopy, using supravitally stained preparations. Mature eosinophils, basophils and small lymphocytes commonly occur in the blood, while monocytes are rarely seen. In addition, macrophages are occasionally encountered, but neutrophils cannot be observed. Developmental stages in eosinophil and basophil differentiation can be seen. This study serves as a basis for the cytochemical localization of substances within these blood cells.

A mechanical auxiliary ventricle. Histologic responses to long-term, intermittent pumping in calves.

The mechanical auxiliary ventricle (MAV) is an avalvular, inseries left ventricular assist device (LVAD) comprised of a 60 cc Biomer blood pump implanted in the descending thoracic aorta, a percutaneous access device (PAD), and an external pneumatic drive. In four calves the MAV was implanted and activated intermittently for 192, 249, 423, and 785 days, respectively; no anticoagulants were administered. When the animals were killed, the implants were retrieved, and autopsies, including gross, light microscopic, scanning electron microscopy (SEM), and transmission electron microscopy (TEM) examinations, were performed. The MAV was securely attached to the aorta in every animal. A thin, even smooth, pseudoneointimal layer (PNI) contiguous with the aorta at the level of the suture line covered the MAV's blood-contacting surface. Areas of calcification beneath the PNI, expected in growing animals with implanted pumping devices, were noted. At autopsy there was no evidence of thrombosis or infection in the regions of the blood pump or the PAD. These findings confirm the calves' benign histologic response to the MAV, and together with the results of hematologic and biochemiccal studies, and bench tests of system components being reported elsewhere, indicate the system's readiness for limited clinical investigation in selected patients with chronic congestive failure.

Percutaneous intra-aortic balloon counterpulsation.

Intra-aortic balloon pumping is the mainstay in the management of acute left ventricular dysfunction in the critical care setting. Percutaneous insertion affords rapid initiation of the procedure. Complications are in greatest part vascular and infectious. The advent of new-generation, totally automatic, closed-loop IABP systems offers the prospect of increasing the effectiveness of IABP support under most conditions, and especially during arrhythmias. This and other developments suggest that despite its standing as the most widely used temporary cardiac assist device, IABP has still to realize its full therapeutic potential.