Rorschach markers in offspring of manic-depressive patients.

BACKGROUND: Previously published data show large differences between euthymic Israeli adult bipolar patients and US normative data on several measures of psychological functioning as assessed with a sensitive projective measure (Rorschach Inkblot Test). The current study examines the Rorschach performance of healthy offspring of bipolar parents and compares them to matched normal controls. METHODS: 14 asymptomatic offspring of Israeli manic-depressive parents were matched for age, gender, and other demographic variables with 14 children of normal parents. All subjects were individually administered the Rorschach Inkblot Test, and protocols were scored blindly according to the Exner Comprehensive System. RESULTS: Offspring of bipolar parents, like bipolar patients themselves, show significantly increased incidence and severity of thought disorder (as defined by Exner), lower numbers of cognitively mediated affective responses, and fewer responses indicating conventional perceptions. LIMITATIONS AND CONCLUSIONS: Although the sample size is small, this study strengthens the possibility that these measures of psychological functioning may serve as markers for manic-depressive illness.

Decreased morbidity and use of hospital services in English HIV-infected individuals with increased uptake of anti-retroviral therapy 1996-1997. National Prospective Monitoring System Steering Group.

OBJECTIVE: To investigate the relationship between changing morbidity patterns, the use of hospital services by HIV-infected patients and the uptake of antiretroviral therapy (ART) in England. DESIGN: Prospective serial cross-sectional analyses based on data collected through the National Prospective Monitoring System (NPMS), a multi-centre prospective monitoring system. SETTING: HIV-infected patients seen in 10 clinics, five London and five non-London, during the three semesters, 1 January 1996 to 30 June 1997. MAIN OUTCOME MEASURES: The mean use of hospital services per patient-year, mean new HIV-related opportunistic illnesses per 1000 patient-years and percentage uptake of ART. RESULTS: The use of inpatient services changed particularly among AIDS patients. The mean number of inpatient days for AIDS patients decreased from 19.7 [95% confidence interval (CI) 13.7-25.7] in 1996 to 11.2 (95% CI 6.1-15.6) per patient-year in 1997. Concurrently the number of new AIDS-defining events decreased significantly from 567 (95% CI 529-607) to 203 (95% CI 183-225) per 1000 patient-years. The overall uptake of ART increased significantly from 33% (95% CI 31-35%) to 50% (95% CI 48-52%), and a switch from mono or dual to triple therapy or quadruple or more therapy was observed. However, by mid-1997 only 29% (95% CI 26-32%) of asymptomatic patients and 51% (95% CI 49-54%) of patients with symptomatic non-AIDS were on ART, compared with 69% (95% CI 66-71%) of AIDS patients. CONCLUSION: The observed reduction in new AIDS-defining events has led to a reduction in the need for inpatient hospital care and has been associated with an increased uptake of ART, including a switch to triple therapy. All of these factors are likely to have contributed to the observed reduction in mortality among English AIDS patients. As the overall uptake of ART remained relatively low in English centres further improvements can be anticipated. However, the medium to long-term effects of these treatment regimens will need to be closely monitored.

Patient satisfaction with HIV service provision in NPMS hospitals: the development of a standard satisfaction questionnaire. NPMS Steering Group.

A self-completion satisfaction questionnaire evaluating the standard of care of HIV outpatient services was developed as part of the National Prospective Monitoring System on the Use, Cost and Outcome of HIV Service Provision in English Hospitals (NPMS). The questionnaire was designed in conjunction with service users and health care professionals, and piloted in three London and three non-London HIV clinics. In addition to testing alternative methods of administering the questionnaire, the pilot provided satisfaction scores on a variety of aspects of service provision for participating clinics. The questionnaire was completed by 548 respondents and was most effectively collected using a sealed box in the clinic waiting area. Mean satisfaction scores for the attitude and skills of staff members was 4.7 (95% CI 4.6-4.7) but satisfaction scores were significantly lower for the clinic environment with a mean of 4.1 (95% CI 4.1-4.2). Satisfaction scores did not differ significantly by gender, age, sexual orientation, ethnic group, employment status or severity of symptoms. London respondents were more satisfied with the clinic environment and seeing preferred members of staff than their non-London counterparts, however there were no other differences between clinics. The questionnaire functioned well in practice and provided meaningful and useful information for individual clinics as well as at aggregate level.

The use and cost of HIV service provision in England in 1996. National Prospective Monitoring System (NPMS) Steering Group and NPMS Working Party on Costs.

OBJECTIVE: The aim of the study was to measure the use and estimate the cost of HIV service provision in England. DESIGN AND SETTING: Standardised activity and case-severity data were collected prospectively in 10 English HIV clinics (5 London and 5 non-London sites) for the periods 1 January 1996 to 30 June 1996 and 1 July 1996 to 31 December 1996 and linked to unit cost data. In total, 5440 patients with HIV infection attended during the first 6 months and 5708 during the second 6 months in 1996. MAIN OUTCOME MEASURES AND RESULTS: The mean number of inpatient days per patient-year for patients with AIDS was 19.7 [95% confidence interval (CI): 13.7 to 25.7] for January to June and 20.8 (95% CI: 15.3 to 26.4) for July to December 1996. The mean number of outpatient visits for asymptomatic patients with HIV infection was 14.8 (95% CI: 11.9 to 17.6) and 13.3 (95% CI: 10.8 to 15.7) for the respective periods and 16.1 (95% CI: 13.21 to 18.97) and 15.7 (95% CI: 11.2 to 20.2), respectively, for patients with symptomatic non-AIDS (i.e. symptomatic patients with HIV infection but without AIDS-defining conditions). Substantial centre-to-centre variation was observed, suggesting that many clinics can continue the shift from an inpatient- to an outpatient-based service. Cost estimates per patient-year for HIV service provision for 1996 varied from 4695 Pounds (95% CI: 3769 Pounds to 5648 Pounds) for asymptomatic patients, to 7605 Pounds (95% CI: 6273 Pounds to 8909 Pounds) for symptomatic non-AIDS patients to 20,358 Pounds (95% CI: 17,681 Pounds to 23,206 Pounds) for patients with AIDS. CONCLUSIONS: Different combinations of antiretroviral therapy affect the cost estimates of HIV service provision differently. Anticipated reduction in inpatient-related activity through the increased use of combination antiretroviral therapy will further shift service provision from an inpatient- to outpatient-based service and reduce costs per patient-year. The extent and duration of such effects are currently unknown. The long term effects of combination treatment on the morbidity and mortality patterns of individuals infected with HIV are also currently unknown, as are their implications on the use and cost of HIV service provision. Multicentre databases like the National Prospective Monitoring System (NPMS) will provide healthcare professionals with information to improve existing services and anticipate the impact of new developments.

The impact of phenotypic variation on genetic analysis: application to X-linkage in manic-depressive illness.

Genetic linkage studies have opened new vistas for behavioral and psychiatric genetics. However, phenotypic diversity and diagnostic uncertainties can lead to spurious linkage findings. A method of analysis is proposed that takes these factors into account. When applied to manic-depressive disease, the results indicate that previous evidence for a major gene localized on the distal long arm of the X-chromosome cannot be ascribed to phenotypic uncertainties and misclassifications, i.e., a type I error. Although the lod score (the logarithm of odds) favoring linkage is reduced with the more restrictive clinical definitions of the phenotype, it remains significant nonetheless. Thus, the linkage finding is robust over a range of phenotypic patterns and presumed phenocopy frequencies. The results also suggest that the X-linked phenotype is a particularly severe form of manic depression characterized by early onset, high familial prevalence of the bipolar form, and high recurrence rate of major depression. These findings may have important implications for the design and interpretation of genetic linkage studies and for refining diagnostic techniques in mental disorders.

In search of psychological markers of bipolar manic-depressive illness (BMDI): commonalities in psychological functioning between adult euthymic BMDI patients and offspring of BMDI-affected parents.

Detection of probable psychological trait markers of Bipolar Manic Depressive Illness (BMDI) was attempted by conducting two investigations: in the first, Rorschach behavior of adult euthymic BMDI patients was compared with normal control subjects; in the second, Rorschach behavior of nonclinical children of BMDI patients was compared with matched normal controls. Comparison of investigation results revealed psychological characteristics shared by both adult euthymic BMDI patients and clinically-tested children of BMDI-affected parents, including: 1) impaired synthetic functioning; 2) complexity avoidance; 3) experiential and ideational constriction; 4) impaired perceptual accuracy and thought disorder: 5) low conventionalism; and 6) impaired object relatedness.

Genetic linkage between X-chromosome markers and bipolar affective illness.

A pedigree study shows close linkage of bipolar affective illness (manic depression) to the X-chromosome markers colour blindness and glucose-6-phosphate dehydrogenase deficiency. The maximum lod score ranges from 7.52 (assuming homogeneity) to 9.17 (assuming heterogeneity); that is, the odds in favour of linkage range between 3 X 10(7) to 1 and 10(9) to 1. These results provide confirmation that a major psychiatric disorder can be caused by a single genetic defect. As a possible first step in characterizing the primary genetic abnormality, this finding may have important implications for the aetiology, nosology, pathophysiology and, possibly, prevention and treatment of bipolar affective disorder. It also provides a means for identifying and characterizing homogeneous populations of patients and may help in clarifying aetiological heterogeneity.

Rorschach markers in euthymic manic-depressive illness.

Bipolar manic-depressive patients in remission are considered normal by phenomenological criteria but many psychotherapists have noted specific personality markers. The Rorschach test was chosen to study such personality markers since it may provide rich information at a psychological level distant from overt behavior and symptoms. 35 bipolar manic-depressives in a euthymic state were tested with the Rorschach Projective Technique. The scores were analyzed using Exner's Comprehensive System methods and compared with his stratified normal control sample. Nine variables differentiated the patients from controls so that at least 50% of the patients were beyond one standard deviation from the controls' mean. These variables might be personality expressions of the genetic predisposition to bipolar illness and might thus be measurable even when the patients are clinically free of affective illness.

Uncoating-like modification of poliovirus capsid resulting from the cooperative effects of subfreezing temperature and submolar concentrations of urea.

Inactivation of poliovirus at subfreezing temperature in the presence of unusually low concentrations of urea (less than or equal to 0.5 M) was investigated. Whereas serotypes 1 and 2 are very sensitive, type 3 is resistant. Inactivation cannot be attributed to concentration of solutes since temperature must be reduced below -13 degrees C for loss of infectivity. Characteristics of the inactivated virion are similar to those of virions in the early stages of uncoating in HeLa cells, viz., loss of infectivity, sensitivity to proteases and detergents, change in isoelectric point, retention of intact genome, and in some instances, loss of VP4. The molecular basis for inactivation is considered to be dissociation of water bound to capsid proteins thereby causing irreversible denaturation of native tertiary structure. The results of this study are discussed in terms of their relevance to the early stages of uncoating in vivo.

Profile of callers to the VD National Hotline.

Information concerning callers to the VD (venereal disease) National Hotline was gleaned from study of a sample consisting of the records of 3,272 callers; various demographic, epidemiologic, and individual perceptions of infection or exposure to disease were analyzed. These data were compared with data from the sentinel clinics for sexually transmissible diseases. Analysis showed that 62.5% of sample Hotline callers were male and 37.5% were female, a distribution similar to that of diagnosed clinic patients (69.7% male, 30.3% female). Of male callers, 57.1+ were greater than or equal to 25 years old and 38.2% of female callers had attained this age, whereas 44.4% of male patients and 43.3% of female patients were 25 years or older. Disease concerns of Hotline callers were focused on genital herpes and syphilis; however, among clinic patients, more cases of gonorrhea and nongonococcal urethritis were diagnosed. Thirty-four and one-half percent of callers indicated that they believed they were either infected with or exposed to VD, and 45.4% of callers accepted referrals to clinics for medical evaluation. There percentages remained constant, irrespective of how callers heard about Hotline services; this fact leads to further questions concerning the most effective methods of alerting and educating the public in regard to venereal disease.