Factors influencing illness representations and perceived adherence in haemophilic patients: a pilot study.

Illness representations of chronic patients are important to explain adherence and preventive behaviours. However, it is unclear if the patient's objective health status may influence illness representations and perceived adherence. This study explored if health status and socio-demographic characteristics influence illness representations and perceived adherence in haemophilic patients. Fifty patients (25 on-demand and 25 on prophylaxis) ageing from 13-73, completed the Illness Perceptions Questionnaire-Revised and the Morisky Medication Adherence Scale. Patients' cognitive illness representations were influenced by type of treatment, haemophilia severity, presence of inhibitor and co-morbidity. Perceived chronicity was influenced by patient's age (P = 0.021). Perceived adherence was not influenced by the health status, but was affected by the relationship status (P = 0.048). Perceived adherence was predicted by perceived chronicity (ß = 0.412; P = 0.003) and by emotions (ß = -0.308; P = 0.023). Patient's health status seems to affect cognitive illness representations but not perceived adherence. Perceived chronicity and negative emotions, which affected perceived adherence, were not influenced by the health status. Physician-patient communication addressing perceived chronicity and emotions rather than patients' health status may influence patient's adherence. Psycho-educational groups could be offered to promote patient's well-being and adjustment to haemophilia, and improve adherence.

How individuals with phenylketonuria experience their illness: an age-related qualitative study.

BACKGROUND: The aim of the study was to explore the illness experience of individuals affected by phenylketonuria (PKU) and its differences in different patient age groups. METHODS: A qualitative-interpretative methodology was used through in-depth interviews. Textual data were explored using the principles of grounded theory. RESULTS: Forty-seven patients participated in the study, aged from 10 to >25 years old. The results suggested the age-related PKU experience: (1) a paradox, either to feel normal but isolated from the social context, or to be different while participating in the convivial aspects of the social being; and (2) the need for education about the disease tailored to the individual and growing needs. Specific themes seem to characterize each age range. CONCLUSIONS: This study constitutes a first attempt at understanding PKU from a non-medical-biological perspective.

"All the rest is normal". A pilot study on the communication between physician and patient in prenatal diagnosis.

The aim of the study was to verify in the context of prenatal diagnosis if the communicative style in consultations is modified in relation to the seriousness of the diagnosis. Videoed consultations after executing amniocentesis and ultra-sound scanning of II level were included in the study with the consent of participants. Only visits with Italian speaking couples without psychiatric problems were analyzed for the study. Selected visits were grouped into "low" (L, minor anomalies) and "high" (H, serious anomalies) visits. A modified version of the RIAS tailored for the specific context was used in the analysis. 27 visits, respectively 13 H and 14 L, were studied. Analysis of the communicative structure of the consultations did not show significant differences between the two groups. The communication during the consultation seems to be mostly influenced by a highly disease-centered model that is not dependent on the content of the consultation itself. Only emotional exchanges showed a marginally significant decrease in the H visits (t = 1.995, p = 0.057), suggesting the probable difficulty of the disease-centered model to manage emotional items during a highly dramatic consultation. Due to the exploratory nature of the study, further research is needed to test the preliminary results.

Tryptophan depletion in obsessive-compulsive patients.

Twelve patients with obsessive-compulsive disorder were studied after the administration of a mixture of amino acids devoid of tryptophan (TRP) or a mixture containing all the essential amino acids, in a double-blind, crossover design. The TRP-free mixture caused a marked depletion of plasma TRP. After TRP decrease, mean ratings of obsessions and compulsions, measured by Visual Analogue Scales (VAS) ratings, did not worsen. In contrast with other reports in literature, TRP depletion also failed to alter mood in our subjects.

Dose response and time course effects of N,N-dimethyltryptamine on disruption of rat shuttlebox avoidance.

N,N-Dimethyltryptamine (DMT) was given (ip) in different doses (0.25, 0.5, 1.0, 2.0, 4.0, 8.0 mg/kg) in a randomized order to a group of ten rats (Fisher 344/Mai) who were trained to a high, stable base line of conditioned avoidance responding in the shuttlebox. DMT produced dose-dependent disruptive effects, as a sigmoid function, with 1.0 mg/kg the minimal dose causing disruption and progressively more disruption with increasing doses, reaching a plateau at the highest dose. The disruptive effects were time-related, with onset and peak 8 min after injection, gradual decline thereafter, and disappearance by about 25-30 min. Both the threshold dose and time course for the disruptive effects correspond closely to what has been previously reported for DMT's psychological effects in humans.

Dose-response effects of beta-phenylethylamine on stereotyped behavior in pargyline-pretreated rats.

We studied the dose-response and the time-course effect of beta-phenylethylamine (4.0-64.0 mg/kg, ip) on stereotyped behavior and motor activity in male Sprague-Dawley rats pretreated 2 hr eariler with pargyline (0.25-8.0 mg/kg, iv). Stereotyped behavior, defined as repetitive, nongoal-directed head movements and sniffing, and changes in motor activity were observed immediately after injection of beta-phenylethylamine for a 1 hr period. With increasing doses of pargyline pretreatment, beta-phenylethylamine produced, in a dose-response relationship, progressively more stereotyped behavior accompanied by increased motor activity. Without pargyline pretreatment, only 64.0 mg/kg beta-phenylethylamine induced behavioral changes. Stereotyped behavior and increased motor activity had an onset at 4-6 min after the injection of beta-phenylethylamine, peak at 10-30 min, and gradual decline in the next 10-20 min. These results are discussed in terms of a possible relationship with the degree of inhibition of Type a and Type B monoamine oxidase acused by the different doses of pargyline.

Testosterone-attenuated stereotype and hyperactivity induced by beta-phenylethylamine in pargyline-pretreated rats.

Testosterone pretreatment (1.0-4.0 mg/kg) attenuated, in a dose-response fashion, the induction of stereotyped behavior and hyperactivity by pargyline (0.25, 4.0 mg/kg) and beta-phenylethylamine (8.0, 16.0 mg/kg) in preubertal, male rats. The dyskinetic movements induced by pargyline and beta-phenylethylamine were proposed as a possible animal model for tardive dyskinesias. Attenuation by testosterone of these effects suggested an hormonal involvement consistent with the reported predominant occurrence of tardive dyskinesias in women and in the elderly.

Double-blind evaluation of the safety and hypnotic efficacy of lormetazepam in general practice.

The efficacy and safety of lormetazepam (LMZ) and placebo were compared in 30 patients with sleep difficulties who were treated by general practitioners. During the three weeks of the study, each patient received placebo during either the first or last week and 1 mg/night of LMZ during the other two weeks. Neither patients nor physicians knew which week's medication was active drug and which was placebo. Twenty-three of the 30 patients completed the three-week trial. Both the quantity and the quality of sleep were significantly better during the weeks patients were given LMZ than during the week they used placebo. Physicians also rated the hypnotic performance as significantly better than that of placebo. Adverse reactions were evenly distributed among the LMZ and placebo treatment periods and were usually minor. Vital signs and laboratory values were unchanged during either treatment period. It is thus concluded that LMZ is a safe and effective hypnotic for use in general practice.

Dose-response decrease in plasma tryptophan and in brain tryptophan and serotonin after tryptophan-free amino acid mixtures in rats.

Rats fasted 15 hours were treated p.o. with increasing amounts (660 and 1320 mg/kg body weight) of a mixture containing a fixed proportion of seven essential amino acids (L-phenylalanine 13.6%, L-leucine 6.0%, L-isoleucine 12.1%, L-methionine 12.1%, L-lysine 30.3%, L-threonine 10.6%, L-valine 15.2%) and lacking tryptophan. The mixtures produced a dose-response decrease of free (by 34% after the lower dose and by 58% after the higher dose of the mixture) and total (by 10 and 31%) plasma tryptophan and of brain tryptophan (by 38 and 65%), serotonin (by 17 and 41%) and 5-hydroxyindole acetic acid (by 21 and 49%). The mechanisms of these changes are discussed.

Decrease in plasma phenylalanine and tyrosine after phenylalanine-tyrosine free amino acid solutions in man.

After an overnight fast, 5 male healthy subjects ingested increasing amounts of a solution containing a fixed proportion of seven essential amino acids (L-isoleucine, 13.3%; L-leucine, 21.0%; L-lysine, 15.2%; L-methionine, 21.0%; L-threonine, 9.5%; L-tryptophan, 4.8% and L-valine, 15.2%) and lacking phenylalanine and tyrosine. The solutions caused a rapid fall in plasma phenylalanine and tyrosine which was proportional to the total amount of amino acids ingested. Following the highest dose administered (31.5 g) plasma phenylalanine and tyrosine fell to a minimum of, respectively, 12.7% and 29.8% the initial levels and remained markedly reduced at 6 hours after treatment. The decrease of tyrosine and phenylalanine levels was associated with a decrease of systolic and diastolic arterial pressure.

Decrease in plasma tryptophan after tryptophan-free amino acid mixtures in man.

Male healthy subjects, fasting 12 hours, ingested increasing amounts of a mixture containing a fixed proportion of seven essential amino acids (L-isoleucine 11.5%, L-leucine 18.0%, L-lysine 13.1%, L-methionine 18.0%, L-phenylalanine 18.0%, L-threonine 8.2%, L-valine 13.1%) and lacking tryptophan. The diets produced a rapid fall in plasma tryptophan which was proportional to the total amount of the amino acids ingested. Following the highest dose administered (36.6 g) plasma tryptophan fell to a minimum of about 35% the initial level and remained markedly reduced at 6 hours after treatment. The mechanism of this decrease and its potential clinical relevance are discussed.

Cycloheximide blocks the fall of plasma and tissue tryptophan levels after tryptophan-free amino acid mixtures.

The hypothesis that incorporation of tryptophan (TRY) into proteins is the mechanism underlying the decrease in plasma and tissue TRY levels after a TRY-free amino acid mixture was investigated. Rats fasted 15 hours were pretreated with saline or with the protein synthesis inhibitor cycloheximide (CHEX) and treated with saline or a TRY-free amino acid mixture. In a first experiment, in saline pretreated rats the TRY-free mixture caused a decrease of 49% in total plasma TRY, of 64% in free plasma TRY, of 66% in brain TRY and of 42% in liver TRY. After 5 mg/kg of CHEX the same TRY-free diet caused a decrease of 5% in total plasma TRY, 14% in free plasma TRY, 18% in brain TRY and 9% in liver TRY. In a second experiment, the TRY-free diet caused a 43% decrease of total plasma TRY in saline pretreated animals and a decrease of 15%, 6% and 2% respectively after the pretreatment with 0.3, 1.0 and 5.0 mg/kg of CHEX. In brain TRY, the TRY-free diet caused a 62% decrease in saline pretreated rats and a decrease of 38%, 20% and 19% respectively after the pretreatment with 0.3, 1.0 and 5.0 mg/kg of CHEX. Since 5.0 mg/kg of CHEX almost completely block protein synthesis and since doses of CHEX from 0.3 to 5.0 mg/kg cause a dose-dependent inhibition of protein synthesis, our data support the hypothesis that protein synthesis is the mechanism through which TRY-free mixtures decrease TRY levels.

Decrease in plasma tryptophan after a tryptophan-free amino acid solution. A comparison between cirrhotic and control subjects.

In healthy subjects the administration of an amino acid mixture devoid of tryptophan causes a marked decrease of plasma tryptophan. This is because amino acid mixtures induce protein synthesis and tryptophan in blood is incorporated into newly synthesized proteins. We hypothesized that a tryptophan-free mixture could differently affect plasma tryptophan levels in subjects with an impaired protein synthesis such as chronic liver patients. We studied tryptophan levels after a tryptophan-free amino acid solution in controls and cirrhotics fasting 12 hours. Plasma total tryptophan fell to 91% of the initial level 60 minutes after the administration of the diet, to 71% after 120, and to 50% after 210' in controls. In cirrhotics the solution caused a decrease of plasma tryptophan that began significantly later than in controls, the delay being proportional to the severity of the disease. Cirrhotics were subdivided into two groups in accordance to the Pugh modification of the Child-Turcotte criteria. Total plasma tryptophan was 100% of base line levels after 60', 88% after 120', and 65% after 210' in less severe clinical condition; total plasma tryptophan was 102% of base line levels after 60', 98% after 120', and 75% after 210' in more severe clinical condition.

Failure of a tryptophan-free amino acid mixture to modify sexual behavior in the female rat.

Female Wistar rats, weekly injected with estradiol valerate after ovariectomy, were trained to cause a sexual contact with a potent male by operating a lever. Contact-response latencies, which vary according to the nature of the sexual contact, were measured as an index of the female's sexual motivation. In these experimental conditions the administration of a tryptophan-free amino acid mixture, which has been proved to decrease brain serotonin and to enhance male mounting behavior, failed to modify the sexual motivation of the female rats.

[Patient-centered medicine]. / La medicina centrata sul paziente.

The dominant model in medical practice today has been defined as the "disease-centered" model. In the past few years, it has been attacked for oversimplifying the problems of illness because it assumes disease to be fully accounted for by deviations from the norm of measurable biological variables. This article describes a patient-centered model that integrates the traditional understanding of disease with each patient's experience of illness. The transformed clinical method involves three major changes: 1) new tasks for the consultation: the patient-centered method focuses on disease and on four principal dimensions of the patients, i.e., their ideas about the illness, their feelings and fears, the impact of their problems on their lives, their expectations about what should be done; 2) new strategies to obtain these objectives: new interviewing skills and communication techniques, e.g., attentive listening; open questions; 3) new modes of teaching and learning, e.g., the use of role-playing and videotaping. Research has shown that patient-centered medicine enables better clinical results to be obtained and is associated with increased patient and physician satisfaction.

An increase in strength of tilt aftereffect associated with tryptophan depletion.

The effects of a tryptophan-free amino acid mixture on tilt aftereffect, movement aftereffect, and the Mueller-Lyer illusion were studied. 12 male subjects ingested either a balanced amino acid mixture or a tryptophan-free mixture which causes a marked depletion of brain tryptophan and serotonin. The tryptophan-free mixture significantly increased the strength of tilt aftereffect but had no effect on movement aftereffect or the Mueller-Lyer illusion. These results were discussed with reference to the pharmacological activity of serotonin and its influence on the strength of lateral inhibition in mammalian brains.

Effects of tryptophan depletion on Poggendorff illusion, corner Poggendorff illusion, and attention.

The effects of a tryptophan-free amino acid mixture on Poggendorff illusion, corner Poggendorff illusion, and attention were investigated with 12 male subjects who ingested either a balanced amino acid mixture or a tryptophan-free mixture, the latter known to cause a marked depletion of brain tryptophan and serotonin. No significant difference between the two mixtures on the perceptual illusions was found.

[The clinical implications of the use of an amino acid mixture without tryptophan in liver cirrhosis]. / Implicazioni cliniche dell' utilizzo di una miscela aminoacidica priva di triptofano nella cirrosi epatica.

The ingestion of an amino acid mixture lacking tryptophan causes a rapid fall of plasma tryptophan in healthy subjects. This is because amino acids elicit protein synthesis and endogenous tryptophan is incorporated into new proteins. If protein synthesis is the mechanism through which tryptophan-free solution decrease blood tryptophan, it may be interesting to study tryptophan levels after a tryptophan-free mixture in subjects with impaired protein synthesis. In the present paper we show that in 27 cirrhotics the administration of a tryptophan-free solution caused a fall of total plasma tryptophan that began significantly later than in 14 control subjects, the delay being significantly proportional to the severity of the disease. The difference between control and cirrhotic subjects was due to the bound fraction of plasma tryptophan. The diagnostic and clinical usefulness of our findings are discussed.

[The video recording of medical visits for the study of physician-patient rapport in general medicine. An experimental experience in Italy]. / Videoregistrazione di visite mediche per lo studio del rapporto medico-paziente in Medicina Generale. Un'esperienza sperimentale in Italia.

The communication and relationship between doctors and patients has been given increased attention in recent years. There are many different methods by which to collect data on doctor-patient communication and relationship: of these, videorecording seems to have the most advantages. The objective of this article is to describe the method we used to make videorecorded consultations in General Medical Practice in Italy. In particular, the article addresses: 1) the technical feasibility of videorecording consultations; 2) a possible answer to the problem of informed consent both from doctors and from patients. At present, the archives collect 258 videotaped consultations of 14 General Practitioners: about three patients in four (75.9%) did consent to have their consultation recorded; a high range of videorecorded consultations (94.2%) does not present technical problems. In line with published surveys, these recording consultations are an increasingly important method of studying communication and doctor-patient relationship, and of teaching/learning these aspects of medical practice.