Neurotensin and cholecystokinin contract gallbladder circular muscle in chickens.

The contractile effects of neurotensin (NT) and cholecystokinin octapeptide (CCK-8) on isolated circular smooth muscle strips of chicken gallbladder were investigated. The NT (0.25-300 nM) produced concentration-dependent contractions on smooth muscle with an EC50 of 8.5 nM (95% confidence limits = 5.3-13.6 nM). In comparison, CCK-8 produced concentration-dependent contractions with an EC50 of 13 nM (95% confidence limits of 9-20 nM). There were no statistical differences in contractile responses when comparing NT and CCK-8 at equimolar concentrations. The NT appears to act directly on smooth muscle tissue in the chicken; the contractile responses were not blocked by 10 µM atropine or tetrodotoxin. A portion of the activity is mediated by extracellular calcium as 100 nM nifedipine inhibited 30% of peptide-induced muscle tension. The NT receptor (NTR) type 1 antagonist SR 48692 (0.1 µM) did not significantly reduce NT potency. The contractile effects of CCK-8 remained unaltered in tissues pretreated with atropine, TTX, or nifedipine. The CCK-A antagonist lorglumide, at a concentration of 1 µM, reduced the contractile potency of CCK-8 by one-half. Avian receptors for NT and CCK may differ pharmacologically from their mammalian counterparts, but their contractile actions on the gallbladder resulting in increased biliary output by flow are further evidence of their role in the postprandial regulation of lipid digestion in chickens.

Sleep in depressed and nondepressed participants with chronic low back pain: electroencephalographic and behaviour findings.

STUDY OBJECTIVES: To study the nature of sleep disturbance in depressed and nondepressed patients with chronic low back pain (CLBP). DESIGN: A controlled, consecutive 4-night polysomnographic study. PATIENTS: Participants were screened (psychologic, psychiatric, and physical) to determine their study group, and 21 participants (CLBP: 4 depressed, 6 nondepressed and 11 controls) were studied. MEASUREMENTS AND RESULTS: On all nights, standard polysomnographic sleep measures as well as midline occipital and frontal electroencephalography and respiration were recorded on a Grass Model 7 polygraph. Pain, sleep quality, and depression were also measured. Participants with CLBP reported significant levels of pain and sleep disturbance as compared to controls, but all groups had equivalent amounts of sleep and comparable sleep architecture. The electroencephalographic power spectral analyses revealed significant differences, with controls having more sigma across sites, more low beta activity occipitally and frontally than nondepressed patients with CLBP, and more occipital sigma and less high beta activity than depressed participants. Between pain subgroups, the depressed participants showed more occipital delta, more occipital and central alpha, and more high beta activity across all sites than did the nondepressed participants. CONCLUSIONS: Lower sigma power in participants with CLBP suggests less-effective sensorimotor gating that may contribute to poor sleep quality. Pain subgroup differences underscore the need to consider the influence of depression in the evaluation of sleep in clinical populations. This study controlled for many factors other than pain that may contribute to the sleep complaints in this population. Consequently, the absence of signs of major sleep disturbance must not be interpreted as evidence of a lack of a true sleep problem in CLBP but more likely reflects control of these factors as well as the difficulty in measuring sleep quality.

Consultation-liaison psychiatry as a subspecialty. A Canadian survey.

In Canada, in recent years, there has been increased interest in the issue of subspecialization in psychiatry. One hundred and forty-four members of the Section on Psychosomatic Medicine of the Canadian Psychiatric Association responded to a survey about their opinions on teaching, training, continuing education, and designation of consultation-liaison (C-L) psychiatry as a subspecialty. Fifty-five percent of respondents agreed that C-L psychiatry should receive designation as a psychiatric subspecialty, 35% were opposed, and 10% did not give an opinion. The results also indicated that formal teaching in C-L psychiatry has increased, particularly over the past 20 years; that training in C-L psychiatry is believed by many to have been inadequate, regardless of when the training took place; and recent graduates were more likely than psychiatrists graduating more than 10 years ago to agree that C-L psychiatry should be designated as a subspecialty. Psychiatrists who devote more of their time to the care of patients with combined medical and psychiatric illness were also more likely to favor subspecialty designation. Factors unique to Canada that may influence attitudes toward psychiatric subspecialization include the number and geographic distribution of psychiatrists, their educational background, and governmental funding priorities.

Extrapyramidal reactions. Neuropsychiatric mimics in patients with AIDS.

The use of neuroleptic medication as antiemetics, or in the treatment of neuropsychiatric disorders in patients with AIDS, may be associated with extrapyramidal side effects and lead to difficulty with diagnosis and management. Two cases are presented that describe severe extrapyramidal syndromes occurring in two patients with AIDS, one treated with prochlorperazine and the other with prochlorperazine and metoclopropramide. It is possible that the neuropathologic lesions found in patients with the AIDS dementia complex may pre-dispose to extrapyramidal side effects of neuroleptic medication. The differential diagnosis and treatment of delirium, dementia, depression, and extrapyramidal reactions in patients with AIDS is discussed.

Assessment of quality of life in patients with cardiac disease: the role of psychosomatic medicine.

OBJECTIVE: The measurement of quality of life has become important in evaluating new treatments of cardiac disease. This review focuses on definition and general concepts underlying quality of life in patients with cardiac disease, the ways in which it is measured, and the uses and limitations of quality-of-life measurement. METHODS: A Medline search, from 1988 to 1998, was undertaken using the search terms "cardiovascular disease and quality of life" and "cardiovascular disease and health status." Results of clinical trials of cardiovascular therapies using quality-of-life instruments were not reviewed. RESULTS: Quality of life is defined as "...the functional effect of an illness and its consequent therapy upon a patient, as perceived by the patient." Domains of quality of life include physical, mental, social, and occupational function; health perceptions; and symptoms of disease. CONCLUSION: Psychosomatic medicine contributions to understanding patients' reactions to physical illness and injury may offer enhanced insight into assessment of health perceptions. Generic health profiles and cardiac-disease-specific quality-of-life measures would also be useful in psychosomatic investigations of personality, hostility, depression, and social isolation in patients with cardiac disease.

Microcomputer-based portable long-term spasticity recording system.

A device for long-term monitoring of muscle activity (EMG) with surface electrodes and method of its application are described in this paper. This device is called a microcomputer two-channel EMG monitor. The device can be used for up to 24 h monitoring of EMG activity, followed by data transfer to a host computer for signal analysis. This device records amplified, rectified, and integrated EMG activity. Shorter recording time allows shorter sampling periods suitable for different other EMG analysis. Recording of spontaneous EMG in complete spinal cord injured subjects was the original reason for the design of the long-term monitor. These recordings were used for estimation of spasticity in complete spinal cord patients.

Adaptation to coronary artery disease: first pilot study in the military.

To determine how a group of 29 male military patients with coronary artery disease (CAD-MIL group) have adapted physically and psychosocially, we compared results from standard questionnaires with those from 39 healthy military men (WELL-MIL group) and 27 male civilian patients with coronary artery disease (CAD-CIV group). There was no difference in the degree of severity of coronary artery disease between the two groups with the disease. The WELL-MIL group reported a higher activity level than the CAD-MIL group, which reported a higher activity level than the CAD-CIV group. Both the CAD-MIL group and WELL-MIL groups had lower levels of state anxiety compared with the CAD-CIV group, and the CAD-MIL group had a better overall psychosocial adjustment score compared with that of the CAD-CIV group. Thus, male military patients with coronary artery disease reported better physical and psychosocial adjustment to their illness than a group of male civilian patients with a similar degree of disease severity. but they were less physically active than healthy military men.

A psychotherapeutic group for men.

Little has been written on group therapy designed to treat a group of all male patients. A group of male outpatients followed in individual psychotherapy were identified who shared several personality traits and faced similar psychosocial problems. These patients were 20 to 40 years old, unmarried, the majority unemployed and lacking heterosexual relationships. This report examines characteristics of these patients, themes arising during group sessions, aspects of group composition, techniques used in therapy and the outcome of various patients after six months of therapy.

A Canadian medical-psychiatric inpatient service.

Patients with both psychiatric and medical illnesses present complex and, at times, difficult diagnostic and management problems. Medical-psychiatric units designed to provide integrated medical and psychiatric care have been established in the United States. This paper describes the development and structure of such a unit established at a Canadian general hospital, using psychiatric facilities and resources already in place. A one year review of the characteristics of patients discharged from the service found that their mean length of stay was similar to that of inpatients discharged from the general adult inpatient services, but shorter than that of patients discharged from the psychogeriatric service. Many of these patients had neurological conditions; coexisting affective disorders, substance abuse, organic mental syndromes and somatoform disorders were diagnosed frequently. We believe that a medical-psychiatric inpatient unit can provide integrated care to patients who might otherwise receive less than adequate care.

The impact of a geriatric assessment unit on a psychiatric consultation service in a general hospital.

The opening of a geriatric assessment unit (GAU) in a large general hospital has affected the number of elderly patients referred for psychiatric consultation, the type of psychopathology seen, and the training provided for psychiatric residents and interns on the consultation-liaison service. To examine these changes, the six months prior to the opening of the GAU are compared to the six months immediately following its opening. The number of patients age 65 or older referred and diagnoses made by the consulting psychiatrists were studied. The opening of the GAU significantly increased the number of elderly patients referred for psychiatric consultation. It was found that the GAU offered unique advantages in the assessment and treatment of elderly patients with certain psychiatric problems, and the advantages and limitations of different facilities within the general hospital for the psychiatric assessment and treatment of elderly patients are discussed. A case is presented which illustrates the interplay between the consultation-liaison psychiatrist and the geriatric service in the management of an elderly patient referred for consultation. The experience of this hospital in providing psychogeriatric training for residents and interns on the psychiatric consultation service is reviewed.

Hidden grief reactions on a psychiatric consultation service.

Assessment of the family and social relationships of 123 medical and surgical patients consecutively referred to the psychiatric consultation-liaison service revealed that acute or unresolved grief was present in 15% of patients. Patients with unresolved grief often presented with depression and/or conflict with the medical or nursing staff. The referring physician in most cases recognized the presence of acute grief; however, all cases of unresolved grief presented as "hidden" grief reactions. Patients with acute grief rarely had associated psychiatric illness, whereas all patients with unresolved grief had concurrent psychiatric disorders. The management of acute and unresolved grief in hospitalized medical or surgical patients is discussed, and illustrative cases are presented.

Calf vein thrombosis in spinal cord injured patients: conservative management of two cases.

Several studies have suggested that if a calf vein thrombosis does not propagate above the knee when followed up with serial diagnostic studies, full anticoagulation may not be necessary. These studies have not included spinal cord injured patients. Two patients with spinal cord injury were diagnosed with acute calf vein thrombosis after admission to a spinal cord injury rehabilitation unit. Both patients refused intravenous heparinization. Serial duplex Doppler studies were performed on both patients to evaluate for propagation of thrombus. Neither patient developed propagation of thrombus, pulmonary embolus, or persistent thrombophlebitis. Full anticoagulation including intravenous heparinization is costly, subject to complications, and interferes with intensive rehabilitation therapies. Observation of calf vein thrombosis with appropriate serial follow-up studies may be a viable alternative to anticoagulation in spinal cord injured patients. Further studies need to be done with this unique patient population.

A psychiatric fellowship in the United States.

The development of subspecialty fields in psychiatry will likely motivate many new graduates of Canadian psychiatric residency programs to seek additional fellowship training. There is little information to guide psychiatric residents interested in arranging a fellowship year. This article discusses the experience of three Canadian psychiatrists who recently completed a fellowship year in a well known academic centre in the United States. The reasons for considering an additional year of training are discussed. The practical aspects of finding and funding a fellowship year are also addressed. The individual experiences of the authors as fellows in consultation-liaison psychiatry, psychopharmacology and psychobiology, and sleep disorders medicine are described. Finally, personal stresses which appeared to be commonly experienced by psychiatric fellows are explored.

Psychosocial aspects of coronary artery disease related to military patients.

OBJECTIVE: Coronary artery disease (CAD) is a major cause of nontraumatic morbidity and mortality in military personnel. Most studies of the psychosocial impact of CAD have dealt with civilian populations. The purpose of this paper is to highlight differences between military and civilian populations with CAD in 4 areas: depression and anxiety, social support, return to work, and stress. METHOD: A computerized literature search from 1985 to 1995 using the search terms "stress," "cardiovascular," "cardiac," "depression," "military," "anxiety" and "psychosocial" was undertaken. Controlled and prospective studies of civilian patients were selected along with relevant studies involving military populations. RESULTS: Unique characteristics of the military may be important factors in affecting the psychosocial outcome of military patients with CAD. These characteristics include a high level of denial of illness, strong social supports, a powerful military work ethic, and stressful situations unique to the military. CONCLUSIONS: Most studies of the psychosocial impact of CAD are based on civilian populations. A review of available studies suggests that little is known about how military patients adapt to CAD, particularly with regard to symptoms of depression and anxiety, social impairment, and rates of return to work. Studies in this area are needed regarding the psychosocial aspects of CAD in military populations.

Formaldehyde generation from methenamine salts in spinal cord injury.

To achieve effective suppression of bacteriuria in spinal cord injured (SCI) patients, methenamine mandelate and methenamine hippurate are commonly given with ascorbic acid. Since the effectiveness of ascorbic acid as a urinary acidifier has been challenged and as it also has been suggested that methenamine salts do not produce effective urine formaldehyde concentrations in patients with indwelling urethral catheters, we studied two groups of SCI patients to determine (1) the effect of ascorbic acid on urine pH and formaldehyde concentration when administered with methenamine salts; (2) the effect of an indwelling urethral catheter versus intermittent catheterization on formaldehyde concentration in the urine of SCI patients taking methenamine salts; and (3) the relative urine formaldehyde concentrations produced by treatment with methenamine mandelate and methenamine hippurate in SCI patients. Methenamine mandelate produced significantly higher urine formaldehyde concentrations than did methenamine hippurate, especially among patients with intermittent catheterization. Ascorbic acid produced a significant effect on urine pH but not on formaldehyde concentration.

Drug and alcohol abuse in patients with acute burn injuries.

We reviewed records of adult patients admitted to our burn unit who were reported to abuse drugs or alcohol from 1985 to 1988. The proportion of patients reported as abusing drugs increased significantly from 1987 to 1988, compared to previous years. However, there was no increase in the proportion of patients reported to abuse alcohol. Patients identified as abusing drugs had longer hospital stays, compared to patients who were not reported to abuse substances. Methamphetamine and cocaine were the drugs most often abused by patients who abused drugs or both drugs and alcohol. Mechanisms of burn injury in these patients included "accidental" burn injury related to acute intoxication, and self-injury due to psychosis or depression.

Clinical guidelines for the treatment of depressive disorders. VII. Comorbidity.

BACKGROUND: The Canadian Psychiatric Association and the Canadian Network for Mood and Anxiety Treatments partnered to produce clinical guidelines for psychiatrists for the treatment of depressive disorders. METHODS: A standard guidelines development process was followed. Relevant literature was identified using a computerized Medline search supplemented by review of bibliographies. Operational criteria were used to rate the quality of scientific evidence, and the line of treatment recommendations included consensus clinical opinion. This section, on Axis I, Axis II, and Axis III comorbidity, is 1 of 7 articles that were drafted and reviewed by clinicians. Revised drafts underwent national and international expert peer review. RESULTS: Comorbid depression on Axis I is particularly prevalent in patients with anxiety disorders, substance use disorders, and eating disorders, but it also occurs in patients with schizophrenia, attention-deficit hyperactivity disorder (ADHD), and dementia. Depressive comorbidity has implications for assessment, management, and outcome. The relation between depression and personality disorders is complex. Patient with this comorbidity often require longer, more intense, and multimodal therapies. Depression is also prevalent in medical illnesses, requires careful diagnosis, and responds to standard antidepressant treatments. CONCLUSIONS: Comorbidity can influence the course and outcome of both associated conditions. Depression-specific psychotherapy and/or pharmacotherapy should be considered when comorbid depression is diagnosed.