COVID-19 Pandemic Associations on Mental and Physical Health in African Americans Participating in a Behavioral Intervention.

The COVID-19 pandemic has had disproportionate effects on communities of color, with higher death rates among African Americans (AA). The purpose of this study was to assess associations in African Americans' mental and physical health with the COVID-19 pandemic. Data for this study came from a larger nutrition intervention of AAs in the Southeastern United States, the Nutritious Eating with Soul study. Data collected before and after March 15, 2020 (the day when local South Carolina schools and businesses closed), were analyzed to assess the association of the pandemic on participants' stress, control of healthy eating, physical activity, and body mass index. Repeated measures analysis of covariance using full maximum likelihood estimation to handle missing data was used. At the onset of the COVID-19 pandemic, 150 participants were enrolled in the study (48.2 ± 10.6 years old, 79% female, 75% with college degree or higher). Participants' reporting of stress did not show statistically significant change over time. Cognitive control increased 1.43 points (F = 20.60, p < 0.0001) and body mass index increased 0.72 kg/m2 (F = 10.68, p = 0.001). Future longitudinal studies should investigate how the COVID-19 pandemic continues to present challenges to understanding and improving health among African Americans. The study is registered at www.clinicaltrials.gov NCT03354377.

Syphilis in clinical psychiatry: a review.

Syphilis is a potentially fatal infectious disease that has a long history of association with psychiatry. Recent developments in epidemiology, diagnosis, and treatment guidelines warrant a review of the current relationship of syphilis to clinical psychiatry. After a recent peak of incidence in the United States, syphilis is once again on the decline. Although the prevalence of syphilis remains endemic in certain locations, it has been targeted for elimination. Meanwhile, diagnostic testing remains complex and imperfect, especially for the detection of late stages of infection and neurosyphilis. The U.S. Public Health Service recently revised guidelines for the evaluation and management for syphilis. This paper discusses these developments and their specific implications to psychiatric practice. The likelihood of discovering previously unsuspected cases through screening and recommendations on high-risk groups to screen are discussed. A case example illustrates some of the key concepts.

Psychodynamics of a prostitute: a case report.

The topic of prostitution has been examined from many viewpoints, but psychodynamic contributions have been limited. The authors present material from a psychoanalytic psychotherapy with a prostitute. The intrapsychic determinants of the patient's choice to become a prostitute are discussed. The prostitution appeared to offer numerous hidden gratifications for this patient, including fulfillment of passive sexual wishes and opportunity to experience closeness with men without fear of abandonment or betrayal.

Studies of cerebrospinal fluid flow and penetration into brain following lateral ventricle and cisterna magna injections of the tracer [14C]inulin in rat.

Parasynaptic communication, also termed volume transmission, has been suggested as an important means to mediate information transfer within the central nervous system. The purpose of the present study was to visualize by autoradiography the available channels for fluid movement within the extracellular space following injection of the inert extracellular marker [14C]inulin into the lateral ventricle or cisterna magna. Bolus injections of 5 microl of 1 microCi of [14C]inulin were made in awake rats via chronically implanted cannulae. After survival times ranging from 5 min to 4 h, brains were processed for in vivo autoradiography. At 5 min the tracer distributed throughout the ventricles, subarachnoid spaces and cisterns "downstream" of the injection sites. Penetration into the brain from these sites was complex with preferential entry along the ventral side of the brain, especially into the hypothalamus and brainstem. By 4 h virtually the entire brain was labeled irrespective of the site of tracer application. Sustained tracer entry from subarachnoid spaces suggests that some areas act as depots to trap circulating material. This mechanism may contribute to the pattern of deep penetration at later time-points. The spatial and temporal characteristics of fluid movement throughout the brain are instructive in the interpretation of many experimental procedures involving injection of molecules into the cerebrospinal fluid.

Subtle psychiatric presentations of endocrine diseases.

Endocrine disorders frequently present initially to psychiatrists. This article reviews the differential diagnosis of psychiatric and endocrine disorders. The range of endocrinopathies is presented, with emphasis placed on the common psychiatric symptomatology associated with these conditions. Various signs and symptoms that might stimulate a psychiatrist to pursue a work-up for each endocrine disorder are also emphasized.

Folate and cobalamin in psychiatric illness.

The linkage of cobalamin and folate deficiency to psychiatric illness has been studied and debated since these vitamins were first discovered in the 1940s. The clinical relevance of these deficiencies remains the subject of investigation and scholarly discussion. This article reviews case reports and studies derived from a MEDLINE search for English-language articles related to folate, cobalamin, and psychiatric illness. Emphasis is given to clinical research and recent developments. Preclinical evidence for direct effects of folate and cobalamin on brain functioning is compelling, and numerous associations of their deficiencies to psychiatric illness are evident. These vitamin deficiencies may typically present initially with psychiatric symptoms, but any direct causal relationship to specific neuropsychiatric illnesses are not well defined. The relationship of these vitamins in dementia is significant, but they may only rarely be a cause of truly reversible dementia. Folate deficiency appears most tightly connected with depressive disorders, and cobalamin deficiency with psychosis. Contrary to intuition, vitamin deficiencies appear to occur infrequently with eating disorders. Other diagnoses have been investigated much less extensively. The diagnosis and management of these deficiencies in the context of neuropsychiatric illness is still a matter of discussion. The quality of clinical research in this area is improving, but there are many unanswered questions that affect clinical practice. Clinicians should remain vigilant to the possibility of deficiencies of folate and cobalamin in diverse psychiatric populations. Normal hematological indices do not rule out the deficiencies. Further study is needed to refine the detection and clinical management of these vitamin deficiencies in psychiatric populations.

Pergolide mesylate treatment of cocaine withdrawal.

Side effects occasionally limit the use of bromocriptine for cocaine withdrawal. The recently released medication pergolide shares some pharmacologic properties with bromocriptine but differs in potency and dopamine receptor subtype specificity. The authors tested pergolide in the treatment of 21 patients experiencing cocaine withdrawal. Sixteen patients reported rapid improvement in sleep and decreased cocaine craving. Side effects were limited primarily to gastrointestinal complaints.

4-chloro-3-hydroxyanthranilate inhibits brain 3-hydroxyanthranate oxidase.

Quinolinic acid is synthesized from 3-hydroxyanthranilic acid via 3-hydroxyanthranilic acid oxidase. In liver, 4-chloro-3-hydroxyanthranilic acid inhibits 3-hydroxyanthranilic acid oxidase. To determine whether 4-chloro-3-hydroxyanthranilic acid also inhibits 3-hydroxyanthranilic acid oxidase in brain, 3-hydroxyanthranilic acid was injected into the cisterna magna of rats either with or without 4-chloro-3 hydroxyanthranilic acid. 3-Hydroxyanthranilic acid increased quinolinic acid concentrations throughout the brain. 4-Chloro-3-hydroxyanthranilic acid attenuated increases in brain quinolinic acid. These observations indicate that 4-chloro-3-hydroxyanthranilic acid inhibits 3-hydroxyanthranilic acid oxidase in brain. Quinolinic acid is a well established systemic metabolite of l-tryptophan which has been shown to be present in brain (Wolfensberger et al., 1983; Heyes and Markey, 1988a). QUIN has proved to be a convulsant (Lapin, 1982), neurotoxin (Schwarcz et al., 1983) and agonist of N-methyl-D-aspartate receptors (Perkins and Stone, 1983) when injected directly into the central nervous system of experimental animals. Therefore increased concentrations of QUIN in brain may have neoropathologic consequences. l-Tryptophan is converted to QUIN via the kynurenine pathway. The precursor of QUIN, 2-amino-3-carboxymuconic semialdehyde is synthesized from 3-hydroxyanthranilic acid (3-HAA) by the action of 3-hydroxyanthranilic acid oxidase (3-HAA/OX) in liver and brain (Foster et al., 1986; Okuno et al., 1987). QUIN is then formed from 2-amino-3-carboxymuconic semialdehyde by a spontaneous, non-enzymatic reaction. In liver, 3-HAA/OX is inhibited by 4-chloro-3-hydroxyantranilic acid (CL-HAA; Parli et al., 1980). In the present study, rats were given an intracisternal injection of 3-HAA and the resultant increases in regional brain QUIN concentrations quantified by gas chromatography/mass spectrometry (Heyes and Markey, 1988a,b). To determine whether CL-HAA inhibit 3-hydroxyanthranilic acid oxidase in brain, CL-HAA was co-administered with 3-HAA to see whether increases in QUIN were attenuated.