Dissemination of UTC(NIST) over 20 km of commercial optical fiber with active phase stabilization.

We demonstrate the transfer of a cesium frequency standard steered to UTC(NIST) over 20 km of dark telecom optical fiber. Our dissemination scheme uses an active stabilization technique with a phase-locked voltage-controlled oscillator. Out-of-loop characterization of the optical fiber link performance is done with dual-fiber and single-fiber transfer schemes. We observe a fractional frequency instability of 1.5 × 10-12 and 2 × 10-15 at averaging intervals of 1 s and 105 s, respectively, for the link. Both schemes are sufficient to transfer the cesium clock reference without degrading the signal, with nearly an order of magnitude lower fractional frequency instability than the cesium clocks over all time scales. The simplicity of the two-fiber technique may be useful in future long-distance applications where higher stability requirements are not paramount, as it avoids technical complications involved with the single-fiber scheme.

Ventricular enlargement in schizophrenia evaluated with computed tomographic scanning. Effects of gender, age, and stage of illness.

We evaluated ventricular-brain ratio with computed tomographic scanning in a sample of 108 DSM-III-diagnosed schizophrenic patients and 75 healthy normal volunteers. Significant differences were noted between the patients and controls, but our large sample size also permitted us to determine that the statistically significant difference was contributed primarily through the male patients. Ventricular enlargement occurs only in some schizophrenic patients. In this particular sample, only 6% of schizophrenics had ventricular-brain ratios greater than 2 SDs from the control mean, and 28% were 1 SD greater than the control mean. However, the corresponding figures for male schizophrenics were 19% and 43%, indicating that there is much less overlap between normal individuals and ill subjects in the male population. First-admission schizophrenic patients also had significantly greater ventricular enlargement than did their age-equivalent normal controls, suggesting that ventricular enlargement in schizophrenia may antedate the onset of symptoms. Examination of ventricular size in schizophrenics and normal subjects from a broad age range suggests that ventricular enlargement does not progress over time at a greater rate in schizophrenic patients than in normal subjects.

Genetic-environmental interaction in the genesis of aggressivity and conduct disorders.

BACKGROUND: The purpose of this study was to determine the effect of an adverse adoptive home environment on adoptee conduct disorder, adult antisocial behavior, and two measures of aggressivity, all of which are behaviors that contribute to adult antisocial personality disorder and that also are associated with increased vulnerability to drug abuse and/or dependence. METHODS: The study used an adoption paradigm in which adopted offspring who were separated at birth from biologic parents with documented (by prison and hospital records) antisocial personality disorder and/or alcohol abuse or dependence were followed up as adults. They and their adoptive parents were interviewed in person. These adoptees were compared with controls whose biologic background was negative for documented psychopathologic behavior. Subjects were 95 male and 102 female adoptees and their adoptive parents. RESULTS: Multiple regression analysis was used to measure separately genetic and environmental effects. It showed that (1) a biologic background of antisocial personality disorder predicted increased adolescent aggressivity, conduct disorder, and adult antisocial behaviors, and (2) adverse adoptive home environment (defined as adoptive parents who had marital problems, were divorced, were separated, or had anxiety conditions, depression, substance abuse and/or dependence, or legal problems) independently predicted increased adult antisocial behaviors. Adverse adoptive home environment interacted with biologic background of antisocial personality disorder to result in significantly increased aggressivity and conduct disorder in adoptees in the presence of but not in the absence of a biologic background of antisocial personality disorder. CONCLUSIONS: Environmental effects and genetic-environmental interaction account for significant variability in adoptee aggressivity, conduct disorder, and adult antisocial behavior and have important implications for the prevention and intervention of conduct disorder and associated conditions such as substance abuse and aggressivity.

Adoption study demonstrating two genetic pathways to drug abuse.

BACKGROUND: Studies of adoptees have demonstrated that there are two genetic factors leading to alcohol abuse and/or dependence (abuse/dependence). In addition, environmental factors found in the adoptive family also predict alcohol abuse/dependency independently. One study has found evidence that a similar model of two genetic factors and independent adoptive family factors were involved in drug abuse. Our study was designed to test the hypothesis that genetic factors defined by alcohol abuse/dependency and anti-social personality disorder in biologic parents were etiologic in drug abuse/dependency and that psychiatric problems in adoptive parents were an additional factor associated with drug abuse/dependence. METHODS: A sample of 95 male adoptees, separated at birth from their biologic parents, were followed up as adults to determine their psychiatric diagnosis and their substance use/abuse in a structured interview administered blind to biologic parent diagnoses. A high-risk, case-control design was used wherein half of the adoptees came from biologic parents known to be alcohol abuser/dependent and/or have antisocial personalities (diagnoses from hospital or prison records). These adoptees were matched for age, sex, and adoption agency to a control group of adoptees whose biologic parents were not found in the hospital and prison record search. Adoptive home environment was assessed by structured interviews, including psychiatric assessment of both adoptive parents. RESULTS: Data were analyzed by log-linear modeling, which showed evidence of two genetic pathways to drug abuse/dependency. One pathway went directly from a biologic parent's alcoholism to drug abuse/dependency. The second pathway was more circuitous, and started with anti-social personality disorder in the biologic parent and proceeded through intervening variables of adoptee aggressivity, conduct disorder, antisocial personality disorder, and, eventually, ended in drug abuse/dependency. Environmental factors defined by psychiatric conditions in adoptive families independently predicted increased antisocial personality disorder in the adoptee. Adoptees born of alcohol-abusing mothers showed evidence of fetal alcohol syndrome, but controlling for this did not diminish the evidence for the direct genetic effect between an alcohol-abusing biologic parent and drug abuse/dependency in offspring. CONCLUSIONS: This study confirms the model of two independent genetic factors involved in drug abuse/dependence and previous findings that disturbed adoptive parents are associated with adoptee drug abuse/dependency.

Distinct contributions of conduct and oppositional defiant symptoms to adult antisocial behavior: evidence from an adoption study.

BACKGROUND: We conducted an exploratory multivariate analysis of juvenile behavior symptoms in an adoption data set. One goal was to see if a few DSM-interpretable symptom dimensions economically captured information within the data. A second goal was to study the relationships between any such dimensions, biological and environmental background, and eventual adult antisocial behavior. METHODS: The data originated from a retrospective adoption study. Probands with a biological background for parental antisocial personality or alcoholism were heavily oversampled. Symptoms were ascertained by proband and adoptive parent interview. We performed, by gender, orthogonal rotated principal component analyses of juvenile behavior disturbance symptoms (females, n = 87; males, n = 88). We used structural equation modeling to examine the relationships hypothesized above. RESULTS: For both genders, an oppositional defiant disorder (ODD) component and at least 1 conduct component emerged. Regardless of the conduct component scores, the ODD components were significant predictors of adult antisocial behavior. For males, the ODD component was predicted by an antisocial biological background, but not by scores on the Adverse Adoptive Environment Scale. The conduct components were predicted by adoptive environment alone. For females, biological background or biological-environmental interactions predicted each of the components. CONCLUSIONS: There has been little previous distinction between conduct disorder and ODD in studies of genetic and environmental influences on juvenile behavior. The study suggests that adolescent ODD symptoms may be a distinct antecedent of adult antisocial personality. In males, adolescent ODD symptoms may represent early expression of genetic sociopathic personality traits.

Psychosexual effects of three doses of testosterone cycling in normal men.

BACKGROUND: Testosterone is receiving increased attention for contraceptive and therapeutic indications. The potential psychosexual side effects of testosterone therapy and withdrawal are unclear. METHODS: Healthy men between the ages of 21 and 40 years were recruited via advertisement for a randomized, controlled, double-blind study of acute and withdrawal effects of three doses of testosterone. Two weeks of placebo injections were followed by one of three randomized weekly doses of testosterone cypionate (100 mg, 250 mg, or 500 mg) for the next 14 weeks. Twelve weeks of placebo injections followed during the withdrawal phase of the study. Psychosexual effects were monitored throughout the study. RESULTS: All doses of testosterone demonstrated only minimal effects on measures of mood and behavior during acute and withdrawal phases for all study completers. There were no effects on psychosexual function. There was no evidence of a dose-dependent effect on any measure. One noncompleter on 500 mg of testosterone developed a brief syndrome with symptoms similar to an agitated and irritable mania. CONCLUSIONS: Doses of testosterone up to five times physiologic replacement dose appear to have minimal risk of adverse psychosexual effects in the majority of normal men; however, beginning at around 500 mg per week of testosterone cypionate, a minority of normal men may experience significant adverse psychological effects. Because illicit anabolic steroid users may use larger doses of multiple drugs under less restrictive conditions, our study may significantly underestimate the psychological effect of steroid use in the community.

A pilot study of treatment of social phobia with alprazolam.

Fourteen patients with DSM-III social phobia were treated with alprazolam in an open study. Multiple measures of symptoms and disability showed significant improvement. The symptoms improved during the first and second weeks, and disability improved at 3 weeks and beyond. After medication withdrawal the symptom and disability measures were no longer significantly different from those at baseline.

Cerebellar atrophy in schizophrenia and affective disorder.

The authors evaluated 108 patients with schizophrenia, 50 patients with affective disorder, and 74 age- and sex-matched control subjects by CAT scan for evidence of global cerebellar atrophy. No difference was found between control subjects and schizophrenic patients or between control subjects and patients with affective disorder. This study does not confirm previous reports linking cerebellar atrophy to schizophrenia.

A family study of generalized anxiety disorder.

The frequency of generalized anxiety disorder was higher among first-degree relatives of probands with generalized anxiety (N = 20) than among the relatives of control subjects (N = 20), but it was not higher among relatives of probands with panic disorder (N = 40) or agoraphobia (N = 40). Also, the frequency of panic disorder was higher among relatives of probands with panic disorder than among control relatives but was not higher among relatives of generalized anxiety probands. Relatives of probands with generalized anxiety who had the same disorder had a mild, stress-related illness. The results confirm the separation between generalized anxiety disorder and panic disorder but challenge the distinction between generalized anxiety and adjustment disorders.

Depression spectrum disease, I: The role of gene-environment interaction.

OBJECTIVE: This study used an adoption study design to separate genetic from environmental factors in the etiology of depression spectrum disease, a type of major depression characterized by families in which male relatives are alcoholic and females are depressed. The genetic etiology hypothesis of depression spectrum disease proposes that an alcoholic genetic diathesis predisposes to depression in females but alcoholism, not depression, in males. METHOD: The study examined 197 adult offspring (95 male and 102 female) of alcoholic biological parents and used logistic regression models to determine the contribution to major depression in male and female adoptees that could be explained by the genetic alcoholic diathesis combined with an environmental factor that was characterized by psychiatrically or behaviorally disturbed adoptive parents. RESULTS: Major depression in females was predicted by an alcoholic diathesis only when combined with the disturbed adoptive parent variable. The same regression model failed to predict depression in males. Other possible environmental confounding factors contributing to an increased chance of depression were found in females: fetal alcohol exposure, age at the time of adoption, and a family with an adopted sibling who had a psychiatric problem. These variables did not diminish the significance of the prediction of depression with the alcohol genetic diathesis and disturbed parent model. CONCLUSIONS: The results show that a genetic factor is present for which alcoholism is at least a marker, and which exerts its effect in women as a gene-environment interaction leading to major depression. This finding suggests that an important etiologic factor in depression spectrum disease is gene-environment interaction.

Alprazolam treatment of avoidant personality traits in social phobic patients.

The authors examined the effect of alprazolam treatment on avoidant personality traits in 14 DSM-III-R social phobics. Six of the nine avoidant traits examined improved with treatment. However, all but one trait (avoiding social or occupational activities requiring interpersonal contact) returned to baseline levels posttreatment. Treatment response and intercorrelation of items indicated two traits that may represent a separate segment of avoidant personality: "No close friends or confidants outside of relatives and family members" and "Exaggerates the potential dangers or risks of everyday situations."

Anabolic steroid use among substance abusers in treatment.

BACKGROUND: Increasing illicit use of anabolic steroids in adolescent and young adult populations has been reported. To determine the scope of this problem and its relationship to psychoactive substance abuse, we evaluated the prevalence of anabolic steroid use among individuals seeking inpatient treatment for substance abuse. METHOD: A randomized mail survey of 175 inpatient substance abuse treatment directors elicited information regarding the prevalence of anabolic steroid use for inpatients treated in 1989 and the first half of 1990. Additionally, directors were surveyed for experience with DSM-III-R psychoactive substance dependence criteria for anabolic steroid use. RESULTS: Only 19% of centers responding had treated at least one individual using anabolic steroids. Facilities encountering anabolic steroid users reported a prevalence of less than 1% among all admissions. Anabolic steroid users were seen more commonly in privately funded facilities. Directors reported a majority of anabolic steroid users had at least three DSM-III-R psychoactive substance dependence criteria for anabolic steroid use. Treatment directors rarely found anabolic steroid use acknowledged as a problem by users and rarely found anabolic steroid use a primary reason for treatment. CONCLUSION: Users of illicit anabolic steroids may have significant clinical differences compared with users of other psychoactive substances of abuse and dependence.

Comorbidity of bulimia nervosa and personality disorder.

Thirty patients meeting DSM-III-R criteria for bulimia nervosa with at least three bingeing episodes a week were compared with 30 age- and sex-matched controls on DSM-III personality measures. The bulimic patients were more likely to display cluster B (histrionic, narcissistic, antisocial, and borderline) personality abnormalities (odds ratio 15.0) and cluster C (avoidant, dependent, compulsive, and passive-aggressive) personality abnormalities (odds ratio 4.3) than were the community controls. This study supports the finding that personality disorder is a possible risk factor for bulimia.

Internodal conduction. Immediate and long-term effects of transverse circular incision of right atrium including atrial septum.

Immediate and long-term effects of a transverse circular incision of the entire right atrium, including the atrial septum, on internodal conduction were studied in 7 dogs. Electrocardiograms were followed up to 35 weeks, and the atrial epicardial excitation sequence was evaluated in all 7 dogs. The findings were compared with data from 3 normal dogs and 3 other dogs which underwent total atrial transverse incisions. All dogs with total atrial separation developed complete atrioventricular (A-V) block immediately after the operation and died within 3 days. All dogs with right atrial interruption exhibited persistent sinus rhythm with slight extension of P-R intervals and a normal QRS immediately after the operation. The mean P-R interval reached its maximum at the fourth day (50 per cent increase), remained prolonged through the first week, but returned to near control valves after 12 weeks. Three days later developed transient arrhythmia; sinus arrhythmia; sinus arrhythmia in 2 dogs and second-degree block in 1 appeared between the tenth and fourteenth postoperative days. Postoperative P vectors migrated toward the left. Atrial excitation sequence studies demonstrated prolongation of atrial epicardial conduction intervals (2.3 times) between the sinus node and distal right atrial wall. The presence of an interatrial conduction mechanism (whether by specific pathways or not), through which sinus node excitation was transmitted to the A-V node was demonstrated.

Practice environment is associated with obstetric decision making regarding abnormal labor.

Nonmedical factors affecting obstetric decisions regarding abnormal labor were investigated in Maine, a rural state. Obstetricians were questioned about practice structure, hospital services, anesthesia support, and legal liability. Cesarean section rates specific for abnormal labor, based on hospital discharge summaries in the previous two years, correlated inversely with improved night coverage support, 24-hour blood bank availability, and more adequate anesthesia services. Neither the payment differential between vaginal and cesarean delivery nor previous legal liability were associated with increased cesarean rates for abnormal labor. We conclude that improved ancillary services may lead to lower dystocia-specific cesarean section rates.

Risk factors for alcohol hepatotoxicity among male alcoholics.

Alcoholic liver cirrhosis is a leading cause of morbidity and mortality in alcohol dependence. A common precursor to cirrhosis is alcoholic hepatotoxicity evident clinically by elevated serum liver enzymes. In this study 50 male patients with significant (greater than two times upper limits of normal) elevation of liver enzymes attending a veterans inpatient alcohol treatment center were matched by age and time since last drink to 50 male veterans without elevated liver enzymes. Patients with elevated liver enzymes were found to be more likely to be daily drinkers, less likely to indulge in binge drinking patterns or have alcoholic blackouts, and showed a trend towards a less severe pattern of alcoholism. Significant gamma glutamyl transferase (GGT) elevations were found in patients consuming an average of 7 beers/day for 5 years, and significant aspartate aminotransferase (AST) elevations were found in patients consuming a threshold of 12 beers/day for 10 years. These findings are consistent with current research suggesting alcoholic cirrhosis is a result of a threshold exposure to alcohol in alcoholics with an additional environmental or genetic risk factor.

An adoption study of DSM-IIIR alcohol and drug dependence severity.

OBJECTIVE: The objective of this study was to evaluate the role of genetic factors in alcohol and drug dependence at various levels of DSM-IIIR psychoactive substance dependence severity. METHOD: One-hundred-and-ninety-seven adoptees (95 case adoptees with biological parental alcoholism, drug dependence or antisocial personality disorder and 102 control adoptees) were interviewed for the presence of alcohol abuse or dependence and drug abuse or dependence using the Diagnostic Interview Schedule-DIS IIIR. RESULTS: Adoptees with five or more DSM-IIIR criteria for alcohol dependence demonstrated evidence of a genetic effect using this adoption paradigm (odds ratio = 2.3, 95% C.I. (1.1, 4.9)). Adoptees with one or more DSM-IIIR criteria for drug dependence demonstrated a genetic effect (odds ratio = 2.4, 95% C.I. (1.3, 4.4). CONCLUSIONS: This study suggests genetic factors influence the risk for alcohol and drug dependence at different thresholds of severity as determined by DSM-IIIR symptom severity count.

Combined internal medicine-psychiatry and family medicine-psychiatry training programs, 1999-2000: program directors' perspectives.

PURPOSE: Despite tremendous growth in the number of combined-training residency programs, little is known about their directorships, financing, recruitment, curricula, and attrition rates, and the practice patterns of graduates. The authors surveyed residency program directors from combined internal medicine-psychiatry (IM/PSY) and family medicine-psychiatry (FP/PSY) programs to provide initial descriptive information. METHOD: Programs' directors were determined from the American Medical Association's Graduate Medical Education Directory and FREIDA online database. Three mailings of a pretested questionnaire were sent to the 40 identified combined IM/PSY and FP/PSY residency programs. RESULTS: A total of 32 directors from 29 programs responded. Most programs were under the dual directorship of representatives from both the psychiatry department and either the internal medicine or the family medicine program. Although most directors responded that the residency program was based in psychiatry, both departments shared in administrative, recruiting, and financial responsibilities. Curricula varied widely, with limited focus on combined training experiences. Graduates (n = 41) tended to practice in academic settings (37%), where both aspects of training could be used. Others practiced in either community mental health centers or traditional private practice settings. The estimated attrition rate from combined residencies was 11%. CONCLUSIONS: Combined-training programs are directed by a diverse group of individuals, including dual-boarded physicians. Curricula vary widely, but most programs are within recommended guidelines. Further prospective studies are warranted to determine predictors of attrition and future practice plans.

Cardiovascular risk factors in affective disorder.

100 patients with affective disorder (unipolar affective disorder and bipolar affective disorder) were evaluated for evidence of increased risk for the major cardiovascular risk factors including hypertension, hypercholesterolemia, obesity, and cigarette use. Unipolar affective disorder patients showed no evidence of increased cardiovascular risk compared to population controls. Bipolar affective disorder patients displayed increased systolic blood pressure, definite hypertension, and use of cigarettes. These findings are consistent with a link between affective disorders and excess cardiovascular mortality.

Organic mood disorder: a valid psychiatry consultation diagnosis?

To determine the validity of the DSM-IIIR category organic mood disorder, we compared 50 psychiatric consultations with this diagnosis to 50 psychiatric consultations diagnosed with major depression in the medically ill. Organic mood disorder patients were more likely to be in the index affective disorder episode and have a negative family history of depression. Despite similar pharmacologic treatment between groups, the organic mood disorder group was less likely to be completely recovered at 4 years follow-up. This study suggests organic mood disorder is a valid diagnosis in the psychiatry consultation service.