Personality disorders and nonfatal unintentional injuries among US adults.

OBJECTIVE: To investigate the association between personality disorders and nonfatal unintentional injuries in a representative sample of US adults. METHODS: Data on self-reported nonfatal unintentional injuries during the 12 months before the interview were obtained from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) were analyzed; 43,093 adults > or = 18 years participated in the NESARC wave I survey in 2001-02. Personality disorders were determined using the NIAAA Alcohol Use Disorders and Associated Disabilities Interview Schedule-DSM-IV. RESULTS: Individuals with at least one personality disorder had a significantly higher 12-month incidence of injuries than people without any personality disorder (p<0.001). After accounting for sociodemographic characteristics or other mental disorders, OR was 1.54 (95% CI 1.39 to 1.71) for individuals with one personality disorder and 1.80 (95% CI 1.58 to 2.05) for individuals with two or more personality disorders compared with people with no personality disorder. CONCLUSION: Personality disorders were associated with a significantly increased risk of unintentional injuries. This information has important implications for the treatment of patients with these disorders.

Primary care clinicians' use of standardized psychiatric diagnoses.

OBJECTIVE: Treatment of child mental health (MH) problems should be informed by psychiatric diagnosis. Whether primary care clinicians (PCCs) use standardized psychiatric diagnostic criteria to direct the treatment of child MH problems is unknown. This study investigated PCCs' use of Diagnostic and Statistical Manual of Mental Disorders (DSM) criteria during office visits. METHODS: The data were obtained from 3674 children ages 4-15 years who were recognized as having one or more MH problems during office visits by clinicians participating in the Child Behaviour Study. Parents completed questionnaires before seeing the clinician. Clinicians completed a survey after the visit. The primary outcome was whether PCCs used standardized criteria to generate a diagnosis for children with recognized MH problems. RESULTS: Clinicians used DSM criteria in 23% of visits in which a psychosocial problem was recognized, and 57% of PCCs reported no use of DSM. DSM criteria were used most frequently (38% of visits) when PCCs reported attention problems. Medications were much more likely to be prescribed during visits when PCCs diagnosed using DSM criteria (63% of visits vs. 19% when criteria were not used). However, only 51% of psychotropic medication prescriptions were based on a DSM diagnosis. CONCLUSIONS: Clinicians used standardized criteria infrequently, and primarily to diagnose attention problems.

What happens to "bad" girls? A review of the adult outcomes of antisocial adolescent girls.

OBJECTIVE: The purpose of this article is to review critically the data on the adult outcomes of adolescent girls with antisocial behavior. METHOD: Five literature databases were searched for studies on the adult outcomes of girls with either conduct disorder or delinquency. RESULTS: Twenty studies met the inclusion criteria. As adults, antisocial girls manifested increased mortality rates, a 10- to 40-fold increase in the rate of criminality, substantial rates of psychiatric morbidity, dysfunctional and often violent relationships, and high rates of multiple service utilization. Possible explanations for these findings include a pervasive biological or psychological deficit or baseline heterogeneity in the population of antisocial girls. CONCLUSIONS: This review establishes that female adolescent antisocial behavior has important long-term individual and societal consequences. At present, there are insufficient data to enable us to prevent these outcomes or treat them if they occur. Future research should include cross-sectional studies detailing the phenomenology of female antisocial behavior and longitudinal investigations that not only track development into adulthood but also explore the role of potential modifying variables such as prefrontal lobe dysfunction and psychiatric comorbidity.

Neuropsychiatric side effects of FK506 vs. cyclosporine A. First-week postoperative findings.

The authors studied 31 liver transplant patients to compare neuropsychiatric side effects of a newer immunosuppressant, FK506, to cyclosporine A (CYA). Patients were randomly assigned to either FK506 or CYA. At the 1-week postoperative stage, cognitive status was assessed with the Mini-Mental State Exam, Trailmaking Tests (TMT) A and B, Delirium Rating Scale, and a neuropsychiatric symptom checklist. No statistically significant differences were found on any outcome variable between these two drugs, though scores on the TMTs were impaired as compared with published norms. The FK506 patients had moderately impaired TMT scores, whereas the CYA patients had only mild impairment. The patients demonstrate good cognitive recovery at 1 week post-transplantation, with only mild evidence of cognitive impairment.

Reflections on stillness: mothers' reactions to the still-face situation.

The still-face procedure, in which mothers maintain a neutral face and are noninteractive with their infants, has been used to study the effects of maternal withdrawal on the mother-infant interaction. In this study, 56 mothers' reactions to their own experience during a still-face procedure were explored using an open-ended interview. The associations between the mothers' reported experience, the infants' behavior during the procedure, and the mothers' behavior during subsequent play were examined. Over half of the mothers reported experiencing discomfort during the session and were more likely to report discomfort if their infants protested their affective absence. Mothers reporting discomfort were significantly more likely to pick up their infants and continue to reflect verbally on their own feelings after the still-face ended. These results are discussed in terms of their clinical implications for understanding the early development of the social dialogue between mother and infant.

The role of dyadic affect in play and infant sex in predicting infant response to the still-face situation.

This study was designed to examine mothers' and 3-month-old infants' affect in play and infant sex as predictors of infants' response to the still-face situation. Infants who evidenced negative affect in play were likely to respond with negative displays during a subsequent still-face situation. Maternal positivity in play was positively correlated with infants' social gaze in the still-face situation. In addition, maternal positivity and infant sex significantly interacted in predicting infant affective response in the still-face situation. For girls, maternal positivity was associated with decreased expressivity. For boys, maternal positivity was associated with early positive bids, which were followed by negative bids and moderately negative affect. Finally, maternal positivity and its interaction with infant sex provide unique information beyond the carry-over effect from infant affect in play to infant response to the still-face. Results are discussed in terms of patterns of individual and joint regulation.

Comparison of inhibitory actions of chlorpromazine or its 7,8-dihydroxy and 7,8-dioxo-didesmethyl analogs on DA-sensitive adenylate cyclase and calmodulin activation of phosphodiesterase in rat striatum.

Two chlorpromazine analogs, 7,8-diOH- and 7,8-dioxo-didesmethyl-chlorpromazine were compared to chlorpromazine (CPZ) with regard to inhibition of three parameters of enzyme activity in rat striatum: 1) dopamine + GTP-sensitive adenylate cyclase in homogenates; 2) dopamine, GTP, calmodulin and Ca++-sensitive adenylate cyclase in washed particulate fractions; and 3) calmodulin-Ca++ activation of high Km cyclic AMP dependent phosphodiesterase in dialyzed supernatant fractions. Chlorpromazine was clearly the most potent antagonist in all three experimental conditions. The CPZ derivatives displayed greatest potency on the particulate adenylate cyclase and all three drugs were 1 to 2 orders of magnitude more effective as inhibitors of the adenylate cyclase preparations than with the calmodulin-Ca++ phosphodiesterase.

Analytical methodology for assays of serum tryptophan metabolites in control subjects and newly abstinent alcoholics: preliminary investigation by liquid chromatography with amperometric detection.

A rapid, isocratic assay for the determination of all major tryptophan metabolites in serum samples from control non-alcoholic subjects, recovered alcoholics and newly abstinent alcoholics is described. The sample preparation involves only precipitation of protein with sulfosalicylic acid. The complete liquid chromatographic analysis is short (25 min) and the sensitivity of amperometric detection permits the routine assessment of catabolites at the picogram level. This preliminary longitudinal study of the basal and post-tryptophan load serum metabolites revealed a considerable scatter of experimental results for kynurenine and serotonin in all groups examined, probably owing to the clinical heterogeneity of the sample populations.

Attenuation of catecholamine-coupled adenylate cyclase following surgical isolation of rat caudate.

Six weeks following complete unilateral surgical isolation of the rat caudate nucleus, activation of adenylate cyclase was reduced in response to dopamine (DA), norepinephrine (NE), 5' -guanylyl-imidodiphosphate [Gpp(NH)p], DA + Gpp(NH)p, and NaF. The low Km form of cyclic AMP phosphodiesterase was elevated in the isolated side when compared to the intact caudate. No changes in activities of guanylate cyclase or in high Km cyclic AMP phosphodiesterase (with or without the calcium-dependent regulator protein, calmodulin or CDR) were observed between the control and isolated caudate. Histologically, the neural damage to the isolated caudate was principally confined to reduced numbers of dendritic spines of the remaining intrinsic caudate neurons.