Hoarding and treatment response in 38 nondepressed subjects with obsessive-compulsive disorder.

OBJECTIVE: The authors studied factors associated with short-term treatment response in 38 nondepressed subjects with DSM-III-R obsessive-compulsive disorder (OCD). METHOD: The subjects completed 12 weeks of treatment with paroxetine (N = 20), placebo (N = 8), or cognitive-behavioral therapy (N = 10). Clinician and self-rated measures were gathered at baseline, during treatment, and after treatment. RESULTS: Seventeen (45%) subjects had "much" or "very much" improvement and achieved at least a 40% decrease in their total Yale-Brown Obsessive Compulsive Scale (Y-BOCS) score. Responders had lower obsessive-compulsive scores on the Symptom Checklist 90-Revised, had a lower checking score on the Maudsley Obsessive-Compulsive Inventory, were less likely to have had prior drug therapy, and in general suffered more obsessive-compulsive symptoms. They were significantly less likely to have hoarding obsessions and corresponding compulsions. The latter finding was confirmed using multiple regression analysis. CONCLUSION: Hoarding is an important symptom that predicts poor treatment response in patients with OCD.

Increasing identification and referral of panic disorder over the past decade.

The study's objective was to contrast the prevalence, phenomenology, and medical care utilization for panic disorder from 1980 to 1990. All psychiatric consultations from a university consultation service from the years 1980, 1985, and 1990 were located (N = 2,400). Patients meeting DSM-III-R panic disorder criteria were selected for chart review. Variations in demographics, comorbidity, prior medical evaluations, and referral patterns were analyzed. The prevalence rate for consultations meeting panic disorder criteria has increased (2.5% in 1980, 4.2% in 1985, and 5.1% in 1990; chi 2 = 7.5, P = 0.024). Referring physicians more frequently noted panic attacks in 1990 (5% in 1980, 21% in 1985, and 59% in 1990; chi 2 = 21.2, P = 0.0001). A summary measure of medical care utilization revealed no significant interval change. Panic disorder is being recognized and referred more frequently by medical physicians since the publication of DSM-III and DSM-III-R. However, delay of diagnosis and high medical care utilization remain significant problems.

Advanced practice nursing in the neonatal intensive care unit.

The advanced practice roles of clinical nurse specialist and neonatal nurse practitioner have enjoyed challenge and success in the neonatal intensive care unit (NICU). This article provides a historic perspective and role descriptions of advanced practice roles in the NICU, describes a theoretical framework for development of the graduate neonatal nurse practitioner, and uses this framework to describe the neonatal advanced practice nurse of the future.

Neonatal pain management.

Neonatal pain management is a challenge for the clinician. Research is just beginning to uncover the neonates' capability of expression of pain, explore pharmacologic management strategies, and identify the spectrum of intrusions that may precipitate pain or distress in the critically ill neonate. This article reviews the neonatal biologic, behavioral, and physiologic responses to pain and describes recommendations for clinical management and decision-making.

Anabolic steroid use among substance abusers in treatment.

BACKGROUND: Increasing illicit use of anabolic steroids in adolescent and young adult populations has been reported. To determine the scope of this problem and its relationship to psychoactive substance abuse, we evaluated the prevalence of anabolic steroid use among individuals seeking inpatient treatment for substance abuse. METHOD: A randomized mail survey of 175 inpatient substance abuse treatment directors elicited information regarding the prevalence of anabolic steroid use for inpatients treated in 1989 and the first half of 1990. Additionally, directors were surveyed for experience with DSM-III-R psychoactive substance dependence criteria for anabolic steroid use. RESULTS: Only 19% of centers responding had treated at least one individual using anabolic steroids. Facilities encountering anabolic steroid users reported a prevalence of less than 1% among all admissions. Anabolic steroid users were seen more commonly in privately funded facilities. Directors reported a majority of anabolic steroid users had at least three DSM-III-R psychoactive substance dependence criteria for anabolic steroid use. Treatment directors rarely found anabolic steroid use acknowledged as a problem by users and rarely found anabolic steroid use a primary reason for treatment. CONCLUSION: Users of illicit anabolic steroids may have significant clinical differences compared with users of other psychoactive substances of abuse and dependence.

A case study: urea cycle disorder.

Early identification of symptoms consistent with a urea cycle disorder is crucial to ensure rapid initiation of therapy which, in turn, promotes the best possible prognosis for the newborn. Acute management may include the technological interventions of exchange transfusion, peritoneal dialysis or hemodialysis, prevention and treatment of seizures, prevention and/or treatment of increased intracranial pressure, and complex nutritional support with amino acids and/or essential enzymes. Long-term nursing management will also include identifying and providing supports for the family, promoting the integration of the infant into the family, and promoting infant growth and development.

Siblings as change agents for promoting the functional status of children with cerebral palsy.

This study evaluated the effectiveness of a four-month intervention program in which 31 siblings of 15 children with cerebral palsy were taught about cerebral palsy and what they could do to encourage their brother or sister to be more independent. The teaching was reinforced by home visits to develop individual plans for the children with cerebral palsy, and sibling group meetings were held to discuss progress and to provide support. Following this intervention, the children with cerebral palsy had significantly increased range of motion of the shoulder, elbow and wrist. There were also improvements in ambulation, personal hygiene, dressing and feeding. These findings indicate that siblings should be involved in the plant of care for children with disability, since they can be important teachers, rôle models and agents of change.

Inhibition of Na transport by 2-chloroadenosine: dissociation from production of cyclic nucleotides.

The adenosine analogue 2-chloroadenosine (2-CA) is often used to determine the biologic effects of adenosine because 2-CA is less susceptible to degradation than adenosine. We studied the effects of 2-CA on primary cultures of rat inner medullary collecting ducts because there is good evidence that adenosine can influence cell function through its effects on second messengers. 2-CA inhibited Na+ transport across the apical membrane and increased cAMP content of the cells. The major adenosine receptors in these cells appear to be the stimulatory (A2) type. Stimulation of cAMP by 2-CA was more potent when applied to the apical membrane than to the basolateral membrane, an effect opposite to that of vasopressin. These results imply that adenosine receptors are more numerous or more effective on the apical membrane than on the basolateral membrane. Inhibition of Na+ transport was probably not mediated by an adenosine receptor as evidenced by (i) a lack of effect of adenosine and other adenosine analogues on Na+ transport; (ii) a lack of effect of nonmetabolizable cyclic nucleotides on Na+ transport; and (iii) a clear discrepancy in the temporal course of 2-CA effects on a second messenger system (cAMP) and 2-CA inhibition of Na+ transport. Dipyridimole, an inhibitor of adenosine transport, also reduced Na+ transport. Taken together, the data suggest that 2-CA inhibits Na+ transport by interfering with adenosine transport or metabolism.

Mucosal adenosine stimulates chloride secretion in canine tracheal epithelium.

Adenosine is a local regulator of a variety of physiological functions in many tissues and has been observed to stimulate secretion in several Cl-secreting epithelia. In canine tracheal epithelium we found that adenosine stimulates Cl secretion from both the mucosal and submucosal surfaces. Addition of adenosine, or its analogue 2-chloroadenosine, to the mucosal surface potently stimulated Cl secretion with no effect on the rate of Na absorption. Stimulation resulted from an interaction of adenosine with adenosine receptors, because it was blocked by the adenosine receptor blocker, 8-phenyltheophylline. The adenosine receptor was a stimulatory receptor as judged by the rank-order potency of adenosine and its analogues and by the increase in cellular adenosine 3',5'-cyclic monophosphate levels produced by 2-chloroadenosine. Adenosine also stimulated Cl secretion when it was added to the submucosal surface, although the maximal increase in secretion was less and it was much less potent. Part, but not all, of the lower potency of submucosal adenosine resulted from submucosal uptake and metabolism of the drug. The observation that mucosal 8-phenyltheophylline blocked the effect of submucosal 2-chloroadenosine, whereas submucosal 8-phenyltheophylline did not prevent a response to mucosal or submucosal 2-chloroadenosine, suggests that adenosine receptors are located on the mucosal surface. Thus submucosal adenosine may stimulate secretion by crossing the epithelium and interacting with receptors located on the mucosal surface. Because adenosine can be released from mast cells located in the airway lumen in response to inhaled material, and because adenosine stimulated secretion from the mucosal surface, it may be in a unique position to control the epithelium on a regional level.