RESUMEN
OBJECTIVE: This study was carried out to compare the efficacy of lithium carbonate with that of valproate in acute mania and to determine whether pretreatment clinical characteristics, such as the presence of a mixed affective state, might predict a differential response to the two drugs. METHOD: Twenty-seven patients meeting DSM-III-R criteria for acute manic episodes underwent a 3-week, randomized, double-blind, parallel-groups trial of treatment with lithium carbonate or valproate. Symptom severity was measured by using the Schedule for Affective Disorders and Schizophrenia, change version (SADS-C), the Global Assessment Scale (GAS), and the Brief Psychiatric Rating Scale (BPRS). Drug effects were compared by using repeated measures analysis of variance (ANOVA). RESULTS: At the end of the study, nine of 14 patients treated with valproate and 12 of 13 patients treated with lithium had responded favorably, as measured by changes in the SADS-C mania, BPRS, and GAS scores. Elevated pretreatment SADS-C depression scores were associated with good response to valproate. ANOVA revealed a significant interaction between drug and mixed affective state with respect to treatment response. CONCLUSIONS: Lithium and valproate were both effective in improving manic symptoms, and lithium was slightly more efficacious overall. Unlike the case with lithium, favorable response to valproate was associated with high pretreatment depression scores. Therefore, treatment with valproate alone may be particularly effective in manic patients with mixed affective states.
Asunto(s)
Trastorno Bipolar/tratamiento farmacológico , Carbonato de Litio/uso terapéutico , Ácido Valproico/uso terapéutico , Análisis de Varianza , Trastorno Bipolar/diagnóstico , Trastorno Bipolar/psicología , Método Doble Ciego , Femenino , Humanos , Masculino , Escalas de Valoración PsiquiátricaRESUMEN
The current study used a paired stimulus paradigm to investigate the P1 midlatency auditory evoked potential in Vietnam combat veterans with posttraumatic stress disorder (PTSD) and three comparison groups: alcohol dependents, combat-exposed normals, and combat-unexposed normals. Compared to each comparison group, PTSD subjects exhibited significantly diminished habituation of the P1 potential. P1 potential habituation within the PTSD group, correlated significantly with intensity of PTSD reexperiencing symptoms, such as trauma-related nightmares and flashbacks. These findings are discussed as consistent with a sensory gating defect at the brainstem level in PTSD, and are further discussed in the context of other psychophysiological measures in PTSD and of P1 potential findings in psychiatric disorders other than PTSD.
Asunto(s)
Potenciales Evocados Auditivos/fisiología , Trastornos por Estrés Postraumático/fisiopatología , Veteranos , Guerra , Análisis de Varianza , Humanos , Masculino , Persona de Mediana Edad , Pruebas Neuropsicológicas , Tiempo de Reacción , VietnamRESUMEN
We report an epidemic of Plasmodium falciparum malaria in the remote valley of Bamian (altitude 2250 m-2400 m) in the central highlands of Afghanistan. A team of malaria experts from the World Health Organization and HealthNet International carried out the investigation. A total of 215 peripheral blood smears were obtained and 63 cases of malaria (90.5% P. falciparum, the remainder P. vivax) were confirmed. The study revealed that areas vulnerable to malaria in Afghanistan are more widespread than previously recognized. The area had been malaria-free until recently, when the disease appears to have been introduced as a consequence of protracted conflict and resultant population movement, and transmitted locally during the short summer months. The outbreak led to severe morbidity and high mortality in a province having only a few poorly-provisioned health care facilities.
Asunto(s)
Altitud , Brotes de Enfermedades/prevención & control , Malaria Falciparum/epidemiología , Adolescente , Afganistán/epidemiología , Distribución por Edad , Niño , Preescolar , Brotes de Enfermedades/estadística & datos numéricos , Femenino , Encuestas Epidemiológicas , Humanos , Lactante , Malaria Falciparum/etiología , Malaria Falciparum/prevención & control , Masculino , Morbilidad , Vigilancia de la Población , Prevalencia , Factores de Riesgo , Estaciones del Año , Distribución por Sexo , Encuestas y Cuestionarios , GuerraAsunto(s)
Trastornos de la Memoria/diagnóstico , Trastornos por Estrés Postraumático/diagnóstico , Comorbilidad , Humanos , Masculino , Trastornos de la Memoria/epidemiología , Persona de Mediana Edad , Inventario de Personalidad/estadística & datos numéricos , Proyectos Piloto , Escalas de Valoración Psiquiátrica/estadística & datos numéricos , Reproducibilidad de los Resultados , Índice de Severidad de la Enfermedad , Trastornos por Estrés Postraumático/epidemiología , Estrés Psicológico/diagnóstico , Estrés Psicológico/psicología , Veteranos/psicología , Escalas de Wechsler/estadística & datos numéricosRESUMEN
Vietnam veterans with chronic combat-related posttraumatic stress disorder (PTSD) have been frequently reported to exhibit high levels of aggression and violent behavior. In this study, gun collection and use habits, attitudes toward violence, and self-reported levels of aggression were compared between veterans with chronic PTSD and non-PTSD veterans with equivalent histories of alcohol and substance abuse. PTSD patients reported different attitudes toward violent crime, higher levels of self-reported aggression, and a significantly higher incidence of potentially dangerous firearm-related behaviors than comparison subjects.
Asunto(s)
Agresión/psicología , Actitud , Armas de Fuego , Trastornos por Estrés Postraumático/diagnóstico , Trastornos por Estrés Postraumático/psicología , Violencia/psicología , Adulto , Enfermedad Crónica , Diagnóstico Diferencial , Humanos , Masculino , Persona de Mediana Edad , Trastornos Relacionados con Sustancias/diagnóstico , Trastornos Relacionados con Sustancias/psicología , Encuestas y Cuestionarios , Veteranos/psicología , VietnamRESUMEN
A 48-year-old combat veteran sustained a right frontal cerebral infarct at the age of 45 years. The patient's family reports that prior to the infarct he had a preoccupation with memories of combat, as well as nightmares, avoidance of reminders, and multiple arousal symptoms. Since his recovery from the infarct, the patient and his family continue to relate significant arousal symptoms but deny any continued history of preoccupation with traumatic memories, reminder avoidance, or nightmares. The resolution of a limited number of symptoms in this patient following damage to the right frontal cortex suggests that some of the symptoms of posttraumatic stress disorder may be amenable to current biological interventions.
Asunto(s)
Adaptación Psicológica/fisiología , Infarto Cerebral/fisiopatología , Trastornos de Combate/fisiopatología , Dominancia Cerebral/fisiología , Lóbulo Frontal/fisiopatología , Veteranos/psicología , Nivel de Alerta/fisiología , Infarto Cerebral/psicología , Trastornos de Combate/psicología , Humanos , Masculino , Recuerdo Mental/fisiología , Persona de Mediana Edad , Remisión Espontánea , Tomografía Computarizada de Emisión de Fotón Único , Tomografía Computarizada por Rayos XRESUMEN
After two decades of war and conflict in Afghanistan, the public-health system is in disarray and malaria has re-emerged as a major disease, with Plasmodium falciparum malaria becoming increasingly common. The limited healthcare services that are available are mainly delivered by non-governmental organizations in collaboration with the Ministry of Health. Although chloroquine (CQ) remains the official first-line treatment against P. falciparum malaria, there is little information on the severity or distribution of resistance to this drug in Afghanistan. In-vivo surveys, co-ordinated by the Malaria Reference Centre in Jalalabad, were therefore performed to determine the frequency and grades of CQ resistance in the three eastern provinces of Kunar, Nangarhar and Laghman. Of the 142 cases enrolled in the study, only 47 (33%) were sensitive. Most of the cases (55%) showed RI resistance but RII/RIII resistance was not uncommon (11%). The prevalence of resistance appeared similar in children and adults, in males and females, and in each of the three provinces investigated. Gametocyte carriage post-treatment was elevated in the resistant cases. As in neighbouring Pakistan, the resurgence of P. falciparum in Afghanistan is probably associated with the transmission and spread of chloroquine-resistant strains. The first-line therapy used against P. falciparum malaria must be changed in order to reverse this trend.
Asunto(s)
Antimaláricos/uso terapéutico , Cloroquina/uso terapéutico , Malaria Falciparum/tratamiento farmacológico , Adolescente , Adulto , Afganistán , Niño , Resistencia a Medicamentos , Femenino , Humanos , Malaria Falciparum/diagnóstico , Masculino , Persona de Mediana Edad , Parasitemia/diagnóstico , Parasitemia/tratamiento farmacológicoRESUMEN
Recent findings using volumetric MRI techniques have revealed that patients with combat-related and noncombat-related posttraumatic stress disorder (PTSD) have reductions in right hippocampal volume. Twenty-one veterans with PTSD and eight age-matched control veterans were studied using proton magnetic resonance spectroscopy to test the hypothesis that the N-acetyl-L-aspartic acid/creatine (NAA/Cr) ratio would be decreased in the right medial temporal lobe structures of patients with PTSD compared to controls. Patients with PTSD displayed significantly lower NAA/Cr ratio for the right medial temporal lobe relative to the left (P < or = 0.011). Patients with PTSD also had lower NAA/Cr in right medial temporal lobe (P < or = 0.013) and lower choline/Cr in left medial temporal lobe (P < or = 0.030) compared to control subjects. Because NAA is regarded as an indicator of neuronal density, this finding suggests that the neuronal density of right-sided medial temporal structures in patients with combat-related PTSD may be decreased.
Asunto(s)
Ácido Aspártico/análogos & derivados , Creatina/metabolismo , Espectroscopía de Resonancia Magnética , Trastornos por Estrés Postraumático/diagnóstico , Trastornos por Estrés Postraumático/metabolismo , Lóbulo Temporal/metabolismo , Adulto , Ácido Aspártico/metabolismo , Humanos , Masculino , Persona de Mediana Edad , Protones , Valores de Referencia , Sensibilidad y Especificidad , Lóbulo Temporal/patología , VeteranosAsunto(s)
Fluorescencia , Iluminación , Mercurio/toxicidad , Medicina del Trabajo , Eliminación de Residuos , Contaminación del Aire/análisis , Contaminación del Aire/prevención & control , Exposición a Riesgos Ambientales , Humanos , Concentración Máxima Admisible , Mercurio/análisis , Azufre , Estados Unidos , VentilaciónAsunto(s)
Trastornos de Combate/diagnóstico , Intento de Suicidio/estadística & datos numéricos , Síntomas Afectivos/diagnóstico , Síntomas Afectivos/epidemiología , Síntomas Afectivos/psicología , Enfermedad Crónica , Trastornos de Combate/epidemiología , Trastornos de Combate/psicología , Comorbilidad , Trastornos Disociativos/diagnóstico , Trastornos Disociativos/epidemiología , Humanos , Masculino , Persona de Mediana Edad , Dolor/diagnóstico , Dolor/epidemiología , Inventario de Personalidad/estadística & datos numéricos , Escalas de Valoración Psiquiátrica/estadística & datos numéricos , Factores de Riesgo , Índice de Severidad de la Enfermedad , Trastornos Relacionados con Sustancias/diagnóstico , Trastornos Relacionados con Sustancias/epidemiología , Intento de Suicidio/psicología , Escalas de Wechsler/estadística & datos numéricosAsunto(s)
Trastornos Disociativos/epidemiología , Trastornos por Estrés Postraumático/epidemiología , Intento de Suicidio/estadística & datos numéricos , Agresión/psicología , Trastornos de Combate/diagnóstico , Trastornos de Combate/epidemiología , Comorbilidad , Trastornos Disociativos/diagnóstico , Violencia Doméstica/estadística & datos numéricos , Armas de Fuego/estadística & datos numéricos , Humanos , Conducta Impulsiva/epidemiología , Conducta Impulsiva/psicología , Masculino , Persona de Mediana Edad , Escalas de Valoración Psiquiátrica , Factores de Riesgo , Trastornos por Estrés Postraumático/diagnóstico , Trastornos Relacionados con Sustancias/epidemiología , Veteranos/psicologíaRESUMEN
We report an epidemic of Plasmodium falciparum malaria in the remote valley of Bamian [altitude 2250 m-2400 m] in the central highl and s of Afghanistan. A team of malaria experts from the World Health Organization and HealthNet International carried out the investigation. A total of 215 peripheral blood smears were obtained and 63 cases of malaria [90.5% P. falciparum, the remainder P. vivax] were confirmed. The study revealed that areas vulnerable to malaria in Afghanistan are more widespread than previously recognized. The area had been malaria-free until recently, when the disease appears to have been introduced as a consequence of protracted conflict and resultant population movement, and transmitted locally during the short summer months. The outbreak led to severe morbidity and high mortality in a province having only a few poorly-provisioned health care facilities