Recovery from psychotic illness: a 15- and 25-year international follow-up study.

BACKGROUND: Poorly defined cohorts and weak study designs have hampered cross-cultural comparisons of course and outcome in schizophrenia. AIMS: To describe long-term outcome in 18 diverse treated incidence and prevalence cohorts. To compare mortality, 15- and 25-year illness trajectory and the predictive strength of selected baseline and short-term course variables. METHODS: Historic prospective study. Standardised assessments of course and outcome. RESULTS: About 75% traced. About 50% of surviving cases had favourable outcomes, but there was marked heterogeneity across geographic centres. In regression models, early (2-year) course patterns were the strongest predictor of 15-year outcome, but recovery varied by location; 16% of early unremitting cases achieved late-phase recovery. CONCLUSIONS: A significant proportion of treated incident cases of schizophrenia achieve favourable long-term outcome. Sociocultural conditions appear to modify long-term course. Early intervention programmes focused on social as well as pharmacological treatments may realise longer-term gains.

Origins of the many NPY-family receptors in mammals.

The NPY system has a multitude of effects and is particularly well known for its role in appetite regulation. We have found that the five presently known receptors in mammals arose very early in vertebrate evolution before the appearance of jawed vertebrates 400 million years ago. The genes Y(1), Y(2) and Y(5) arose by local duplications and are still present on the same chromosome in human and pig. Duplications of this chromosome led to the Y(1)-like genes Y(4) and y(6). We find evidence for two occasions where receptor subtypes probably arose before peptide genes were duplicated. These observations pertain to the discussion whether ligands or receptors tend to appear first in evolution. The roles of Y(1) and Y(5) in feeding may differ between species demonstrating the importance of performing functional studies in additional mammals to mouse and rat.

Relationship issues of women with breast cancer.

This in-depth, qualitative pilot study explored the impact of breast cancer on specific dimensions of the relationships and roles of women. It included interaction within the partner relationship as well as with family, friends, and colleagues. Data were obtained by individual and group interviews from 10 women with a diagnosis of breast cancer and 5 male partners. Both partnered and single women participated. There were four major findings seldom discussed in the literature, which have important implications for preventive intervention. First, partner relationships troubled before the diagnosis as well as those characterized by mutual caring faced challenges and negative changes. Second, in an effort to protect each other, communication within the partner dyad became less open, and there were changes in the usual manner of conflict resolution. Third, unpartnered women appeared to be more vulnerable to problems of negative adjustment, largely because of relationship issues. Fourth, participants confirmed the need for a comprehensive intervention to facilitate coping with issues relative to relationships, intimacy, and sexuality. Although the sample was small, in-depth data were obtained that provide a basis for specific areas in which further empirical investigation is needed, and they indicate that preventive intervention may well be warranted.

Chicken neuropeptide Y receptor Y2: structural and pharmacological differences to mammalian Y2(1).

Here we report the molecular cloning of the chicken (Gallus gallus) neuropeptide Y (NPY) receptor Y2, the first non-mammalian Y2 receptor. It displays 75-80% identity to mammalian Y2 and has a surprisingly divergent cytoplasmic tail. Expression of the receptor protein in a cell line showed that the receptor did not bind the mammalian Y2 selective antagonist BIIE0246. Furthermore, porcine [Leu(31), Pro(34)]NPY, which binds poorly to mammalian Y2, exhibited an unexpectedly high affinity for chicken Y2. In situ hybridisation revealed expression in the hippocampus. Thus, the chicken Y2 receptor exhibits substantial differences with regard to sequence and pharmacological profile in comparison to mammalian Y2 receptors, while the expression pattern in the central nervous system resembles that observed in mammals.

A new model for the mental health nursing change of shift report.

Nursing shift reports are intended to enhance the continuity and quality of nursing care delivered by providing results of nursing assessments, summarizing medical information, and drawing attention to specific nursing interventions and goals anticipated during the upcoming shift. In this article, contemporary literature on shift reports is reviewed with specific attention to the unique characteristics and problems that commonly occur in change of shift reports in a mental health setting. The framework proposed is Gordon's functional health patterns because it provides a holistic structure for organizing patient data in a clear, objective manner. Additional methods for enhancing shift reports are recommended, including the use of specific behavioral descriptions, the inclusion of data from targeted nursing assessments, and the discussion of alternative care approaches that support the development of consistent, collaborative nursing interventions across shifts. A case example is used for demonstration.

The cloned guinea pig neuropeptide Y receptor Y1 conforms to other mammalian Y1 receptors.

We have cloned the guinea pig neuropeptide Y (NPY) Y1 receptor and found it to be 92-93% identical to other cloned mammalian Y1 receptors. Porcine NPY and peptide YY (PYY) displayed affinities of 43 pM and 48 pM, respectively. NPY2-36 and NPY3-36 had 6- and 46-fold lower affinity, respectively, than intact NPY. Functional coupling was measured by using a microphysiometer. Human NPY and PYY were equipotent in causing extracellular acidification with EC50 values of 0.59 nM and 0.69 nM, respectively, whereas NPY2-36 and NPY3-36 were about 15-fold and 500-fold less potent, respectively, than NPY. The present study shows that the cloned guinea pig Y1 receptor is very similar to its orthologues in other mammals, both with respect to sequence and pharmacology. Thus, results from previous studies on guinea pig NPY receptors might imply the existence of an additional Y1-like receptor sensitive to B1BP3226.

Ambient sound levels in a state psychiatric hospital.

High environmental and psychosocial stress contribute to the onset and relapse of major psychiatric disorders. High sound levels in general hospitals are common and may be indirectly associated with negative physical effects because of increased physiological stress on the body. Excessive sound also interferes with cognitive functioning, especially affecting prefrontal cortical processes, but no information about sound levels in psychiatric hospitals was available. This study critically examines literature on sound stress and reports findings from an exploratory study of sound levels in a tertiary care psychiatric hospital. An overall mean sound level of 75.68 dB was found, with peak sound levels as high as 85 to 90 dB, in the range that causes hearing loss. These levels, higher than sound levels on medical, surgical, and intensive care units, suggest the need for more attention to the effect that environmental sound has on the behavior of patients hospitalized with acute psychiatric symptoms.

Health and self-care practices of persons with schizophrenia.

Data on the self-care and health-related practices and health status of 22 outpatients with schizophrenia were collected from interviews using a series of health survey instruments and a review of patient records. The patients practiced fewer health-promoting behaviors than nonpsychiatric samples described in the literature and were at risk for premature death primarily due to over-eating and smoking. They were most similar to persons with chronic physical illness in their perception of the locus of control of their health. More than half of the patients had physical conditions requiring medical management.

Cloning and functional expression of the guinea pig neuropeptide Y Y2 receptor.

Five neuropeptide Y (NPY) receptor subtypes have been cloned in mammals. The degree of sequence conservation differs considerably between subtypes as well as between evolutionary lineages. To shed further light on this, we have cloned the five NPY receptors in the guinea pig. Here, we report the cloning of the guinea pig Y2 receptor. The Y2 receptor is generally highly conserved, with 90-95% identity between different orders of mammals, including the guinea pig. The guinea pig receptor has a divergent cytoplasmic tail, indicating possible differences in regulation of signalling and/or down regulation. COS-7 cells transiently transfected with the gpY2 receptor show saturable 125I-PYY binding with a Kd = 6 pM. In displacement experiments, the gpY2 receptor was similar to the human and rat receptors with the following rank order of potencies: pNPY > pPYY > pNPY13-36 = pNPY22-36 >> [Leu31Pro34]NPY > BIBP3226. Thus, the guinea pig Y2 receptor is well conserved in comparison with human and rat with regard to both amino acid sequence and pharmacological profile.

The cloned guinea pig pancreatic polypeptide receptor Y4 resembles more the human Y4 than does the rat Y4.

Pancreatic polypeptide (PP) is involved in gastrointestinal functions and forms, together with neuropeptide Y (NPY) and peptide YY (PYY), the PP-fold family of peptides. The PP-binding receptor subtype Y4 has so far been cloned in human, rat, and mouse, and displays extensive species differences regarding sequence, pharmacology, and distribution. To explore this variability further, we have cloned the Y4 receptor in the guinea pig, which is evolutionarily equally distantly related to both humans and rodents. The guinea pig Y4 receptor is 84% identical to the human Y4 receptor, but only 74-75% identical to the rat and mouse receptors. The two latter are 75-76% identical to human Y4. The guinea pig Y4 receptor bound 125I-hPP with a dissociation constant (Kd) of 29+/-3 pM. The pharmacological profile of guinea pig Y4 has the following rank order of potencies: PP > NPY approximately = PYY approximately = LP-NPY approximately = LP-PYY > NPY2-36 >> [D-Trp32]NPY. Thus, the guinea pig receptor is more similar to the human Y4 than to the rat Y4 both in sequence and pharmacology. This agrees with the greater identity between guinea pig and human PP compared to rat PP. These comparisons suggest that the rodent PPs and Y4 receptors have an accelerated replacement rate.

A walking program for wanderers: volunteer training and development of an evening walker's group.

In this article, the author describes an innovative program for wandering. A walker's group was developed in response to the explicit but nonverbal message from persons with dementia about their need for physical activity. The group was initiated in a nursing home, with volunteers to implement the program under the direction of clinical staff. The article details the volunteer orientation program and specific methods of implementation. The walker's group has been active for more than 4 years and is considered a valuable resource for managing residents who wander during the early evening hours.

Evaluation of a clinical intervention for wanderers on a geriatric nursing unit.

In this article, a clinical intervention designed to decrease unsafe wandering and reduce interpersonal tension on a dementia unit of a nursing home is described and evaluated. The intervention, a walking program for physically active persons with severe dementia, was designed to meet residents physical activity and social needs. Based on therapeutic milieu concepts, positive effects in the environment, were expected in addition to the individual benefits for participants. To measure the effect of the intervention on the nursing unit environment, the frequency of resident-to-resident and resident-to-staff aggression in the 24 hour period after the walking group was compared to time periods when the group did not meet. T-test analysis revealed a statistically significant reduction in the frequency of aggression in the 24 hour periods after the walkers group. An average reduction of aggressive events by 30% shown in this small study is important clinically. Further study of modifications in care on geriatric nursing units is warranted.

Severe psychiatric disorder and physical health risks.

IN THIS ARTICLE, research findings are discussed that indicate a high rate of general physical health problems in persons with persistent, long-term psychiatric disorders. The self-regulation theory of health behaviors is proposed as a method to examine the complexity of interpreting physical complaints and discomforts. Attribution of meaning to vague physical symptoms is confounded by mood states, especially negative moods. Little is known about how persons with persistent mental disorders assess physical symptoms, which is relevant to self-care behavior. Research evidence suggests that persons with chronic health problems use different patterns of symptom interpretation and management than do healthy persons with similar symptoms.