Bias in beliefs about the self is associated with depressive but not anxious mood.

BACKGROUND: Biases in beliefs about the self are associated with psychopathology and depressive and anxious mood, but it is not clear if both negative and positive beliefs are associated with depression or anxiety. We examined these relationships in people who present with a wide range of depressive and anxious mood across diagnostic categories. METHODS: We probed positive and negative beliefs about the self with a task in which 74 female participants with either affective disorder (depression and/or anxiety), borderline personality disorder or no psychiatric history indicated the degree to which 60 self-related words was "like them" or "not like them". Depressive and anxious mood were assessed with the Beck Depression Inventory-II and the Beck Anxiety Inventory. RESULTS: The participants with no psychiatric history (n=25) reported a positive bias in their beliefs about the self, the participants with affective disorder (n=23) reported no bias, and the participants with BPD (n=26) reported a negative bias. Two hierarchical multiple regressions demonstrated that the positive and negative beliefs contributed additively to the ratings of depression (corrected for anxiety), but did not contribute to the ratings of anxiety (corrected for depression). LIMITATIONS: Despite the apparent small sample size, the regression analyses indicated adequate sampling. Anxiety is a much more heterogeneous condition than is depression, so it may be difficult to find relevant self-descriptors. Only measures of endorsement were used. CONCLUSIONS: Biases in beliefs about the self are associated with depressed, but not anxious mood, across diagnostic categories.

Cognitive behaviour therapy for violent men with antisocial personality disorder in the community: an exploratory randomized controlled trial.

BACKGROUND: Little information exists on treatment effectiveness in antisocial personality disorder (ASPD). We investigated the feasibility and effectiveness of carrying out a randomized controlled trial of cognitive behaviour therapy (CBT) in men with ASPD who were aggressive. METHOD: This was an exploratory two-centre, randomized controlled trial in a community setting. Fifty-two adult men with a diagnosis of ASPD, with acts of aggression in the 6 months prior to the study, were randomized to either treatment as usual (TAU) plus CBT, or usual treatment alone. Change over 12 months of follow-up was assessed in the occurrence of any act of aggression and also in terms of alcohol misuse, mental state, beliefs and social functioning. RESULTS: The follow-up rate was 79%. At 12 months, both groups reported a decrease in the occurrence of any acts of verbal or physical aggression. Trends in the data, in favour of CBT, were noted for problematic drinking, social functioning and beliefs about others. CONCLUSIONS: CBT did not improve outcomes more than usual treatment for men with ASPD who are aggressive and living in the community in this exploratory study. However, the data suggest that a larger study is required to fully assess the effectiveness of CBT in reducing aggression, alcohol misuse and improving social functioning and view of others. It is feasible to carry out a rigorous randomized controlled trial in this group.

Thyroxine treatment in patients with symptoms of hypothyroidism but thyroid function tests within the reference range: randomised double blind placebo controlled crossover trial.

OBJECTIVES: To determine whether thyroxine treatment is effective in patients with symptoms of hypothyroidism but with thyroid function tests within the reference range, and to investigate the effect of thyroxine treatment on psychological and physical wellbeing in healthy participants. DESIGN: Randomised double blind placebo controlled crossover trial. SETTING: Outpatient clinic in a general hospital. PARTICIPANTS: 25 patients with symptoms of hypothyroidism who had thyroid function tests within the reference range, and 19 controls. METHODS: PARTICIPANTS were given thyroxine 100 microgram or placebo to take once a day for 12 weeks. Washout period was six weeks. They were then given the other to take once a day for 12 weeks. All participants were assessed physiologically and psychologically at baseline and on completion of each phase. MAIN OUTCOME MEASURES: Thyroid function tests, measures of cognitive function and of psychological and physical wellbeing. RESULTS: 22 patients and 19 healthy controls completed the study. At baseline, patients' scores on 9 out of 15 psychological measures were impaired when compared with controls. Patients showed a significantly greater response to placebo than controls in 3 out of 15 psychological measures. Healthy participants had significantly lower scores for vitality when taking thyroxine compared to placebo (mean (SD) 60 (17) v 73 (16), P<0.01). However, patients' scores from psychological tests when taking thyroxine were no different from those when taking placebo except for a poorer performance on one visual reproduction test when taking thyroxine. Serum concentrations of free thyroxine increased and those of thyroid stimulating hormone decreased in patients and controls while they were taking thyroxine, confirming compliance with treatment. Although serum concentrations of free triiodothyronine increased in patients and controls taking thyroxine, the difference between the response to placebo and to thyroxine was significant only in the controls. CONCLUSIONS: Thyroxine was no more effective than placebo in improving cognitive function and psychological wellbeing in patients with symptoms of hypothyroidism but thyroid function tests within the reference range. Thyroxine did not improve cognitive function and psychological wellbeing in healthy participants.

Bilateral anterior cingulotomy for chronic noncancer pain.

OBJECTIVE: To document the value of bilateral anterior cingulotomy for patients with intractable chronic noncancer pain. METHODS: Twenty-three patients who underwent 28 cingulotomies between 1979 and 1996 for chronic refractory pain were sent questionnaires regarding their subjective response to the surgery and its impact on their pain. Questions dealt with pre- and postoperative pain, ability to resume work or usual activity, medications, family and social interactions, and overall benefit of cingulotomy. Results were compared with long-term (average, 8 yr) clinical follow-up. In 13 patients, pain was predominantly caused by lumbar adhesive arachnoiditis or "failed back." The remainder had venous occlusive disease, ischemic bilateral leg pain, phantom leg pain, postoperative neck pain, or atypical facial pain. RESULTS: Eighteen patients returned questionnaires; two patients died of unrelated causes. Seventy-two percent of patients reported improvement in their pain, 55% were no longer taking narcotics, 67% noted improvement in their family life, and 72% noted improvement in their social interactions. Fifty-six percent of patients reported that the cingulotomy was beneficial, and 28% returned to their usual activities or work. Thirty-nine percent of patients developed transient or well-controlled seizures. Five patients required a second cingulotomy, and one patient did well despite developing brain abscesses. Patient assessments corresponded closely with clinical assessments. CONCLUSION: Bilateral anterior cingulotomy is safe for patients with refractory chronic pain. Seizures reported in this series were well controlled with medication. More than half of all respondents thought they had a positive outcome and that cingulotomy was beneficial to them. There were no deaths related to the procedure.

Severe pulmonary hemorrhage in the premature newborn infant: analysis of presurfactant and surfactant eras.

We undertook a case-control study of premature infants who developed clinically significant, severe pulmonary hemorrhage (PH) in the presurfactant and surfactant eras to learn more about the cause of severe PH and whether the pathogenesis of severe PH has changed with the advent of surfactant therapy. Severe PH was defined as an acute onset of severe endotracheal bleeding with an acute drop in hematocrit and the development of multilobar infiltrates on chest radiograph. Eleven premature infants from the presurfactant era population and 17 premature infants from the surfactant era population met the criteria for severe PH, all with gestational ages <32 weeks and birth weights <1,500 g (very low birth weight infants). These were each matched by gestational age, date of birth, birth order (for twins), and birth weight to 2 controls. The incidence of severe PH in infants of gestational age <32 weeks was similar in the two eras (1.8% in the presurfactant era and 3.0% in the surfactant era). Severe PH was not associated with maternal characteristics such as drug use or prenatal care, pregnancy complications, evidence of intrauterine anoxia, hyaline membrane disease, frequency of endotracheal suctioning, or patent ductus arteriosus. Premature infants suffering from severe PH in the presurfactant era required more delivery room resuscitation and had more severe early respiratory disease during the first 12 h of life as compared with their controls. However, these differences were not present in the group from the surfactant era. Infants with severe PH were more likely to have birth weights below the third percentile for gestation (severe intrauterine growth restriction). The proportion of infants receiving surfactant, and the number of surfactant doses used, did not differ between severe-PH infants and their controls in the surfactant era group. We conclude that severe intrauterine growth restriction represents a risk factor for severe PH in very low birth weight infants. The introduction of surfactant therapy has not altered the incidence of severe PH, even though it has apparently helped remove the severity of early lung disease as a risk factor. The physiological basis of severe PH requires further investigation.

Co-morbid depression and drinking outcome in those with alcohol dependence.

Depressed and non-depressed (pre-admission and post-detoxification) alcohol-dependent patients were followed-up on two occasions over a period of 5 months following detoxification from alcohol. Detailed measures of alcohol consumption, alcohol-related problems and abstinence status were taken throughout the follow-up period. No significant differences were found between those with a diagnosis of depression and those with alcohol dependence alone, regardless of whether diagnosis of depression was made post-detoxification or pre-admission, on any drinking outcome measure including abstinence status, alcohol consumption, pattern of drinking, or alcohol-related problems. Neither a diagnosis of depression in the post-detoxification period nor in the pre-admission episode was related to drinking outcome at follow-up, which suggests that co-morbid depression does not confer a worse outcome in those with alcohol dependence.

Intrahepatic cholestasis of pregnancy.

Intrahepatic cholestasis of pregnancy (ICP) is a disease of the third trimester of pregnancy involving pruritus and elevated bile acid levels. Its pathogenesis likely involves a genetic hypersensitivity to estrogen. Once thought to be benign for both mother and fetus, ICP has been associated with increased rates of fetal morbidity and mortality and an increased risk of maternal coagulopathy. Optimal obstetric management includes delivery after establishment of fetal lung maturity. Many treatments have been proposed for the maternal medical management of ICP, none of which is ideal.

Acute fatty liver of pregnancy in triplet gestation.

BACKGROUND: Acute fatty liver is reported to be more common in twin than in singleton pregnancies. We report three cases of biopsy-proven acute fatty liver in triplet gestations. CASES: In all three cases of acute fatty liver complicating triplet pregnancies, the presenting features were vague abdominal complaints with elevated hepatic aminotransferase levels. A liver biopsy was performed in each case, and cesareans were performed immediately after the diagnosis was confirmed histologically. Clinical resolution occurred in all cases, and all infants did well in the neonatal period. CONCLUSION: Patients with triplet gestations should be monitored closely for the early signs of acute fatty liver. Triplet gestations may contribute to the onset of acute fatty liver by further stressing the fatty acid oxidation capabilities of the susceptible woman.

Cognitive therapy for antisocial and borderline personality disorders: single case study series.

Cognitive therapy for affective disorders has been recently adapted and developed for the treatment of personality disorders. In the present study, a specific and detailed cognitive therapy treatment manual for borderline and antisocial personality disorders was evaluated in a pilot study. The results of a single case series demonstrate that important clinical changes in dysfunctional behaviour and attitudes can be achieved with short-term cognitive therapy in patients with antisocial and borderline personality disorders, although these were not, on the whole, statistically significant.

Diagnosis of depression in alcohol dependence: changes in prevalence with drinking status.

BACKGROUND: Depression and alcohol dependence are frequently found to co-exist but the relationship between these disorders requires further elucidation. This study tested several hypotheses related to the relevance of whether the diagnosis of depression was made before admission or after detoxification in the current episode for those with alcohol dependence. METHOD: The Schedule for Affective Disorders and Schizophrenia (SADS) was administered to obtain Research Diagnostic Criteria (RDC) on 82 randomly selected alcohol dependent in-patients. Alcohol-related (Severity of Alcohol Dependence Questionnaire (SADQ), alcohol consumption and alcohol-related problems), socio-demographic variables and treatment for depression were assessed. RESULTS: For the episode of drinking which led to admission, a diagnosis of major depression was found in the majority of patients (67%). Once detoxification from alcohol took place, only the minority (13%) met criteria for major depression. CONCLUSIONS: It is suggested that depression is largely associated with the episode of drinking which led to admission in patients who are dependent on alcohol and may be due to the effect of chronic alcohol intoxication. Socio-demographic and alcohol-related characteristics appear to bear little relation to the presence of depression. Clinicians exercise appropriate judgement in not prescribing antidepressant treatments to patients whose depression may remit with abstinence from alcohol.

Long-term follow-up of patients suffering from obsessive-compulsive disorder treated as in-patients.

Few patients with obsessive-compulsive disorder (OCD) require in-patient treatment. There is sparse information on outcome of OCD patients treated as in-patients. This paper is a descriptive account of the current functioning of 54 OCD patients treated in hospital, on average 10 years prior to the study. Follow-up reveals that outcome for the majority of patients is poor with 29 (59%) of the sample showing at least mild symptomatology or some difficulty in several areas of functioning.

A hypothesis to explain paradoxical racial differences in neonatal mortality.

We suggest an explanation for a pediatric paradox: the low-birthweight-specific (LBW) neonatal mortality rate (NMR) for black infants is less than the NMR for white infants, even though the overall NMR for black infants is about twice the overall NMR for white infants. Analyzing the Delivery Interview Program data set--a large matrix of information collected at the Boston Hospital for Women (now the Brigham and Women's Hospital)--we found that, overall, black infants' gestations are about four days shorter than white infants'. However, after stratifying by birthweight, we found a reversal in our data, namely, LBW (< 2,500 g) black infants' gestations are seven days longer than the gestations of LBW white infants. We believe that this increased chronological maturity may account for some of the survival advantage of the LBW black infant compared with the LBW white infant of the same weight.

The relationship between alcohol dependence and depression.

Alcohol dependence is not a unitary or homogeneous disorder. There is substantial evidence to suggest that in both community and particularly in clinical samples, additional psychopathology is common. Although estimates of additional psychopathology differ according to the samples studied and the instruments used to classify disorders, up to two-thirds of clinical samples of patients with alcohol dependence are likely to have a lifetime diagnosis of another psychiatric disorder. Affective disorder and antisocial personality disorder appear to be the most commonly and consistently reported additional disorders. Women more than men appear to suffer from additional psychopathology, including secondary and primary depression, although this evidence is weakened by there being fewer studies carried out on mixed gender populations. Having an additional psychiatric diagnosis appears to alter the course of alcohol dependence: it may hasten the development of dependence on alcohol and may bring individuals to the attention of treatment agencies more quickly. More recent studies have examined the relationship between alcohol dependence and affective disorder in the current episode. There is consistent evidence to suggest that a diagnosis of depression in the current episode may change to one of alcohol dependence alone, once detoxification or abstinence has been achieved. The prognosis of those who continue to be depressed remains unclear.

Detection of premature rupture of the membranes.

One of the most common problems an obstetrician faces is evaluation of a patient for PROM. Proper assessment of the patient requires a careful integration of history, physical examination, and clinical testing. The most commonly used tests are analysis of vaginal pH with nitrazine paper and evaluation of vaginal secretions with the arborization test. When history, nitrazine, and arborization testing are used in combination, 90% of cases will be diagnosed correctly. When the diagnosis is questionable, other modalities, including ultrasound evaluation and intraamniotic dye injection, should be used as indicated.

Durability of the bond between bone and various 2-cyanoacrylates in an aqueous environment.

The durability of the bond strength developed between 2-cyanoacrylate esters and bone has been determined by aging specimens in water. One-day bond strength of the isobutyl and isomeric amyl 2-cyanoacrylates varied from 6.2 to 7.2 MPa. The strength of the bond decreased on storage or on thermocycling in water. Hydrolytic stability increased with increasing length of the alkyl ester group. After a six-month storage in water the various amyl 2-cyanoacrylates retained from 70% to 73% of their one-day bond strength. Pretreatment of the bone surface prior to application of the adhesive did not prove beneficial. The cured 2-cyanoacrylate can be removed from the substrate surface by appropriate solvents. Thus, it is not bonded covalently to bone. The bond strength, especially of the isobutyl and amyl 2-cyanoacrylates to bone in an aqueous environment, appears to be superior to other adhesives. Provided these monomers are biocompatible, they may be useful clinically where an intermediate-term adhesion is desired.

Modification of smoking behaviors in a correctional institution.

Effected two studies in a prison setting to determine the effectiveness of self-control procedures with institutionalized cigarette smokers. In Study I, 14 male inmates were given instruction in self-control techniques. The 6 inmates who completed treatment manifested significant reductions in their cigarette smoking. Intercorrelations between goal setting and smoking rates suggested the efficacy of a changing criterion schedule. A second study replicated Study I and suggested an appreciable (p less than .06) locus of control X type of goal setting (therapist vs. client) interaction. Study II also showed: (1) some components of treatment were perceived as significantly more helpful than others; (2) self-control treatment seemed effective with a pipe smoker; and (3) in comparison to Study I a relatively low drop-out rate occurred in this study, which used a contracting procedure to discourage drop-outs. Results are discussed in terms of treatment implications for inmate smokers, and suggestions for further research were provided.