Executive dysfunction in bipolar disorder and borderline personality disorder.

OBJECTIVE: The boundary between bipolar disorder (BD) and borderline personality disorder is a controversial one. Despite the importance of the topic, few studies have directly compared these patient groups. The aim of the study was to compare the executive functioning profile of BD and BPD patients. METHOD: Executive functioning (sustained attention, problem-solving, planning, strategy formation, cognitive flexibility and working memory) was assessed in BD (n=30) and BPD outpatients (n=32) using a computerized assessment battery (Cambridge Neuropsychological Test Automated Battery, CANTAB). The groups were compared to one another as well as to healthy controls. RESULTS: BD patients showed deficits in strategy formation and in planning (indicated by longer execution time in the ToL task) in comparison to BPD patients and healthy controls. BPD patients showed deficits in planning (short deliberation time in the ToL task) in comparison to BD patients and in comparison to healthy controls. In comparison to healthy controls, BPD patients displayed deficits in problem-solving. CONCLUSIONS: Differences in executive dysfunction between BD and BPD patients suggest that this cognitive dimension may be relevant for the clarification of the boundary between the disorders.

I think therefore I am: Rest-related prefrontal cortex neural activity is involved in generating the sense of self.

The sense of self has always been a major focus in the psychophysical debate. It has been argued that this complex ongoing internal sense cannot be explained by any physical measure and therefore substantiates a mind-body differentiation. Recently, however, neuro-imaging studies have associated self-referential spontaneous thought, a core-element of the ongoing sense of self, with synchronous neural activations during rest in the medial prefrontal cortex (PFC), as well as the medial and lateral parietal cortices. By applying deep transcranial magnetic stimulation (TMS) over human PFC before rest, we disrupted activity in this neural circuitry thereby inducing reports of lowered self-awareness and strong feelings of dissociation. This effect was not found with standard or sham TMS, or when stimulation was followed by a task instead of rest. These findings demonstrate for the first time a critical, causal role of intact rest-related PFC activity patterns in enabling integrated, enduring, self-referential mental processing.

The effect of intranasal administration of oxytocin on fear recognition.

The oxytocinergic system has recently been placed amongst the most promising targets for various psychiatric treatments due to its role in prosocial behavior and anxiety reduction. Although recent studies have demonstrated a general effect of administration of oxytocin on emotion recognition, no study to date has examine the effect of oxytocin on each emotion separately. In the present study, a double-blind placebo-controlled crossover design was used in a dynamic facial expression task, in order to assess the effects of administration of oxytocin on emotion recognition. A single dose of oxytocin or a placebo was administered intranasally to 27 healthy male subjects 45 min prior to task performance. The results showed that a single intranasal administration of oxytocin, as opposed to the placebo, improved the subjects' ability to recognize fear, but not other emotions. These results suggest a specific role for oxytocin in fear recognition, which could be relevant for clinical disorders that manifest deficits in processing emotional facial expressions, particularly fear.

Use of rubella seroepidemiological data for assessment of previous vaccination policy and for decision making in response to epidemics in Israel.

We examined the prevalence of rubella antibodies in a representative sample of the Israeli population. Three thousand three hundred and twenty-six sera collected during 1997 and 1998, from an age-stratified general population sample were tested for specific IgG antibodies against rubella. The sero-positivity rates to rubella were higher among females as compared with males (89.1% versus 82.3%, respectively (p < 0.001). This difference was the result of much lower sero-positivity rates among males in the age group 13-17, with the lowest value (56.3%) among subjects aged 16. Male subjects of this age group were in 2000 the target of an outbreak of rubella among 18-19-year old male recruits of the Israel Defense Force. The data of this study served to assess previous exposure to the wild virus or vaccine strains, to identify pockets of low level of immunity and contributed to decision making in response to the onset of a rubella outbreak.

[Occupational exposure to fungicides in floriculture in Ecuador]. / Esposizione professionale a fungicidi in floricoltori dell'Ecuador.

Floriculture represents one of the major sources of income in the Ecuadorian Andean Region that can be carried out either in open fields as in greenhouses by using chemical compounds, growing hormones and xenobiotics. Among pesticides, ethylenbisdithiocarbamate (EBDTCs) fungicides represent the most extensively used. The aim of the study was the assessment of exposure to EBDTCs in Ecuadorian floricultural workers by the determination of the urinary excretion of the main metabolite of these compounds, ethylenethiourea (ETU). For this purpose, thirty-six floriculture workers and 7 unexposed healthy subjects were recruited for the study. Median level of ETU excretion in agricultural workers before the work shift was 3.2 micrograms/g creatinine, ranging from 0.4 to 34.5 micrograms/g creatinine. After pesticide application, urinary ETU increased to 6.2 micrograms/g creatinine (1.5-26.5) microgram/g creatinine. Urinary ETU resulted significantly higher in overall workers, taken as pre- and post-shift samples, when compared to controls (0.7, 0.4-2.1 micrograms/g creatinine, p < 0.01). According to jobs, applicators showed the highest levels of ETU excretion whereas growing, post-harvesting and maintenance workers showed similar levels of exposure. Higher level ETU excretion was observed in greenhouse compared to open field workers.

Does Bilio-intestinal Bypass Still have a Role in the Treatment of Super-obesity?

BACKGROUND: Super-obesity (BMI > 50) is life-threatening. The jejunoileal bypass had Potential long-term problems, and weight loss with gastroplasty May be inadequate. METHODS: From 1988 to 1995, 19 Patients with morbid obesity had jejunolleal bypass with anastomosis of the fundus of the gallbladder to the proximal end of the bypassed jejunum. Of these patients, 11 were superobese, with ages 19-49 years, weight 125-172 kg, mean excess weight 97 kg (73-119) and BMI 56 (50-67). RESULTS: Mean weight loss at 3 years was 60 kg. There was no mortality and no major complications. Patients had 5-6 stools per day and some flatulence. There have been no hepatic, renal, calcium or electrolyte problems. Diseases secondary to obesity resolved. CONCLUSION: Billo-intestinal bypass has been effective and safe thus far.

[Clozapine in adolescence onset schizophrenia].

Clozapine is an atypical neuroleptic agent given when schizophrenia is resistant to other neuroleptic drugs. Its use is restricted because of the risk of agranulocytosis, which appears in 1% of cases and therefore necessitates frequent WBC counts. We cite the only 2 surveys of the treatment of adolescents with clozapine and report our experience. We treated 7 boys and 6 girls between the ages of 14-17 years (mean 16.6) with clozapine after failure of all other neuroleptic agents tried. Our usual dose was 300 mg/day, for an average of 245 days. In only 2 patients was improvement only partial. In 1 treatment had to be stopped because of symptomatic orthostatic hypotension which appeared 36 hours after the drug was started. In our opinion, clozapine should be considered when severe schizophrenia in adolescents is refractory to other neuroleptic agents, provided the WBC count is monitored.

Immunity to measles in young adults in Israel.

The likelihood of an epidemic of measles in 1990-92 in Israel prompted us to study the immune status against measles in a random sample of 454 recruits aged 18-19 years in order to obtain data that might be used in determining vaccination policy. This cohort had received one dose of measles vaccine at 12 months of age. The measles immunity status was studied by determination of antibody values that were measured by means of an enzyme-linked immunosorbent (ELISA) IgG antibody test. Of the recruits, 84.6% were found to have positive sera for anti-measles IgG antibodies, while 13.7% had negative sera. Eight (1.7%) subjects had borderline results. The results of this study indicate the need to administer a second dose of measles vaccine at an older age in addition to the MMR (measles, mumps, rubella) vaccine that is now given in Israel at 12 months of age. This step will help achieve the World Health Organization's target of complete eradication of measles.

Role perceptions in a community mental health setting.

The increasing trend of utilizing nonprofessional personnel in community mental health has led to considerable controversy. It is suggested that studies comparing the relative competence and efficacy of professional therapists to that of nonprofessional therapists may be counterproductive and in need of augmentation. The present study employed a role perception procedure in which members of three different randomly chosen groups (11 professional therapists, 11 nonprofessional therapists, and 11 children-clients) from a community mental health program were asked to rank various aspects of the therapeutic relationship in order of importance to the children-clients' improvement. It was hypothesized that (a) due to their relatively low self-concept, nonprofessionals would underestimate their own role importance in comparison to that of the professionals; (b) professionals would overestimate their own role importance; and (c) children would selectively value certain aspects of each role without preferring one over the other. The last two hypotheses were supported, but the first hypothesis was not: nonprofessionals, in fact, showed the highest level of overestimation of their own role importance. A further analysis of the data showed that inexperienced nonprofessionals did not overestimate their own role performance. This suggested specific training procedures for nonprofessionals.

Locus of control and therapists' occupational role as determinants of clinical prognoses.

Clinical studies that used the internal-external locus of control model developed by Rotter (1967) have shown a marked preference among clinicians for clients with an internal locus of control. In the belief that occupational roles can affect such preferences, this study examined clinicians' (sychiatrists, psychologists, social workers) prognoses for clients who had described their problems in terms of either an internal, external, or no locus of control. As hypothesized, a 5 X 3 X 3 replicated Latin Square design found that while clients who attributed their problems to an internal locus of control were given better prognoses, clinicians differed along occupational role dimensions in their prognoses for the same client. The implications of those occupational differences for professional practice were discussed.