Assessment of Interpersonal Motivation in Transcripts (AIMIT): an inter- and intra-rater reliability study of a new method of detection of interpersonal motivational systems in psychotherapy.

Assessing Interpersonal Motivations in Transcripts (AIMIT) is a coding system aiming to systematically detect the activity of interpersonal motivational systems (IMS) in the therapeutic dialogue. An inter- and intra-rater reliability study has been conducted. Sixteen video-recorded psychotherapy sessions were selected and transcribed according to the AIMIT criteria. Sessions relate to 16 patients with an Axis II diagnosis, with a mean Global Assessment of Functioning of 51. For the intra-rater reliability evaluation, five sessions have been selected and assigned to five independent coders who where asked to make a first evaluation, and then a second independent one 14 days later. For the inter-rater reliability study, the sessions coded by the therapist-coder were jointly revised with another coder and finally classified as gold standard. The 16 standard sessions were sent to other evaluators for the independent coding. The agreement (κ) was estimated according to the following parameters for each coding unit: evaluation units supported by the 'codable' activation of one or more IMS; motivational interaction with reference to the ongoing relation between patient and therapist; an interaction between the patient and another person reported/narrated by the patient; detection of specific IMS: attachment (At), caregiving (CG), rank (Ra), sexuality (Se), peer cooperation (PC); and transitions from one IMS to another were also scored. The intra-rater agreement was evaluated through the parameters 'cod', 'At', 'CG', 'Ra', 'Se' and 'PC' described above. A total of 2443 coding units were analysed. For the nine parameters on which the agreement was calculated, eight ['coded (Cod)', 'ongoing relation (Rel)', 'narrated relation (Nar)', 'At', 'CG', 'Ra', 'Se' and 'PC'] have κ values comprised between 0.62 (CG) and 0.81 (Cod) and were therefore satisfactory. The scoring of 'transitions' showed agreement values slightly below desired cut-off (0.56). Intra-rater reliability was very good (κ values for Cod = 0.90; κ for all IMS = 0.78). Data seem to support the validity of the AIMIT method in terms of reliability, and encourage to further implementation of the AIMIT approach.

Thyroid nodules with microfollicular findings reported on fine-needle aspiration: invariably surgical treatment?

OBJECTIVE: To assess whether fine-needle aspiration (FNA) can be a diagnostic procedure for identification of malignant thyroid nodules when the smear reveals the cytologic (microfollicular) finding of "follicular neoplasm" (FN). METHODS: We reviewed a group of 79 patients with FN who underwent surgical treatment and evaluated the possible significance of the cytologic features of anisokaryosis, amount of colloid, and nuclear overlapping (NO). We excluded from the study those patients with FN who had other highly suspicious cytologic features, such as sporadic grooves and sporadic pseudonucleoli. RESULTS: In our series of 79 patients with FN at FNA, we found anisokaryosis in 49.4%, scant or no colloid in 31.6%, and NO in 5.1%. Thyroid cancer (TC)--follicular cancer or follicular variant of papillary cancer--was found in six patients (7.6%): four patients (10.2%) with anisokaryosis and two patients (5.0%) without anisokaryosis (P<0.5; chi2 test). All the patients with malignant lesions had scant or no colloid in the smears, and four of them were those with NO. Therefore, TC was found in 24.0% of nodules with scant or no colloid versus 0.0% of nodules with abundant colloid (P<0.001; chi2 test), and TC was found in 100% of nodules with NO versus 2.6% of nodules without NO (P<0.001; chi2 test). CONCLUSION: Because of the high prevalence of thyroid nodules and the frequency of FN at FNA, the number of unnecessary interventions may be very high. FNA cannot be diagnostic in FN because invasion of the tumor capsule and blood vessels can be evidenced only at histologic examination. Although it is common opinion that microfollicular nodules should be surgically treated, simple cytologic features can help select patients at low risk who can be monitored and reassessed clinically and by FNA. Patients with high-risk cytologic features such as NO should be advised that a total thyroidectomy may be necessary.

Verapamil acute administration: a new dynamic test in hyperprolactinemic states.

We studied the effect of acute administration of the calcium-channel blocker verapamil (VER) in 27 patients with tumoral hyperprolactinemia ([THPRL] prolactinomas and pseudoprolactinomas). We also studied the effect of VER in seven patients with idiopathic hyperprolactinemia (IHPRL) and a small group of patients with normal prolactin (PRL) levels and minimal incidental anomalies shown by magnetic resonance imaging (MRI). The study was performed on 2 separate days: on the first day, all subjects received VER, and on the second they received placebo. Acute administration of VER evoked a remarkable increase in serum PRL in IHPRL (as in normal healthy subjects used as controls), but no response was shown in THPRL, with no overlap between the two conditions. Acute administration of VER stimulated PRL secretion in patients with minimal incidental lesions shown by MRI; however, this increase was smaller in patients whose PRL level consistently reached the upper-normal limit. Although the meaning of such minimal anomalies shown by MRI is unknown, this could suggest that the test is precociously altered. To further elucidate the action of VER on lactotropes, we investigated the effect of VER given intravenously (IV) and compared different oral formulations in healthy subjects. Our data show that the VER test is effective in distinguishing between THPRL and IHPRL, but unfortunately, like other tests, it is not able to individualize patients in whom THPRL is the result of diminished dopaminergic tone (pseudoprolactinoma). From a pathophysiological point of view, calcium influx would appear less important in PRL regulation in chronic disorders of PRL secretion. VER given IV did not stimulate PRL release in normal subjects. This suggests that IV administration could produce a peak with an inadequate duration or that oral formulations may act also by metabolites formed on first-pass metabolism in the liver.

Clinical features of patients with Graves' disease undergoing remission after antithyroid drug treatment.

The clinical course of 306 Graves' patients treated with methimazole (MMI) was reviewed with the aim of establishing criteria able to predict remission of hyperthyroidism after medical treatment. One hundred and ninety-four (149 females, 45 males) of 306 (63.4%) patients had relapse of hyperthyroidism after antithyroid drug (ATD) withdrawal. Relapse was more frequent during the first months of the follow-up, but still it was observed 3 years after MMI withdrawal. The relapse rate was dependent on the age of the patient, the size of goiter, and the level of TSH-receptor antibody (TRAb) at diagnosis, being observed in 40 of 47 (85%) patients with high (> 30 U/L) TRAb level and in 54 of 101 (53%) patients with low TRAb level (< or = 30 U/L; p <.0002). Remission was more frequent (43.3%) in patients having the combination goiter size < or = 40 mL, TRAb level < or = 30 U/L, than in patients with goiter size > 40 mL and high TRAb levels (9%). In the subgroup of patients with the combination: goiter < or = 40 mL- TRAb < or = 30 U/L - age at onset > 40 years, the remission rate was 80%, and all relapses occurred within the first 9 months after MMI withdrawal. In conclusion, our study confirms that hyperthyroidism relapses in the majority of patients with Graves' disease treated with ATD. Among different clinical and laboratory features, age at onset of hyperthyroidism, goiter size and TRAb level are particularly helpful in identifying those patients who are more prone to undergo a remission of hyperthyroidism after medical treatment and may be useful to select the minority of Graves' patients who will benefit from antithyroid drug treatment as a first choice.

Effects of abscisic acid and cytoplasmic pH on potassium and chloride efflux in Arabidopsis thaliana seedlings.

The effects of ABA, isobutyric acid (IBA) and nicotine on K+ and Cl- efflux were studied in Arabidopsis thaliana seedlings, and the role of pHcyt and Em in the regulation of the efflux of these ions was discussed. The data show that treatments with IBA and nicotine influenced in opposite directions the efflux of either K+ or Cl-: K+ efflux was increased by nicotine and reduced in the presence of IBA, whereas Cl- efflux was stimulated by IBA and decreased by nicotine treatment. Under all the conditions tested ABA induced cytoplasmic acidification and inhibition of K+ and Cl- net efflux. Experiments aimed to estimate the individual contribution of pHcyt and Em in modulating K+ efflux indicated that, within the range of acidic pHcyt values, a regulation of K+ efflux was imposed by pHcyt on the control exerted by Em, the efflux being inhibited by lower pHcyt values. Conversely, in the alkaline side of pHcyt K+ efflux seemed linked only to the Em values. These results are consistent with the hypothesis that the decrease in K+ efflux observed in non-stomatal tissues in the presence of ABA may be mediated by the cytoplasmic acidification induced by the hormone.

Thyroid hypoechogenic pattern at ultrasonography as a tool for predicting recurrence of hyperthyroidism after medical treatment in patients with Graves' disease.

An abnormal thyroid echographic pattern characterized by a diffuse low echogenicity has been described in Hashimoto's thyroiditis and Graves' disease. The aim of the present work was to study the relationship between thyroid hypoechogenicity and the outcome of treatment for hyperthyroidism with antithyroid drugs in patients with Graves' disease. The study group included 105 patients who underwent a course of methimazole treatment. Thyroid ultrasonography was carried out at diagnosis, and autoantibodies to thyrotropin receptor (TR-ab) were measured at the end of treatment. During the follow-up after methimazole treatment, 87/105 (83%) patients had relapse of hyperthyroidism and 18/105 (17%) were in remission. Recurrence of hyperthyroidism occurred in 71/76 (93%) patients with thyroid hypoechogenicity and in 16/29 (55%) of those with normal thyroid echogenicity (chi 2 = 19.0; p less than 0.0001). Positive TR-ab values at the end of methimazole treatment were found in 59/76 (78%) patients with thyroid hypoechogenicity and in 12/29 (41%) patients with normal thyroid echogenicity (chi 2 = 10.9; p less than 0.0001). Sixty-five/87 (74%) patients with relapse of hyperthyroidism and 6/18 (33%) of those who remained euthyroid were TR-ab-positive at the end of methimazole treatment (chi 2 = 9.8; p less than 0.002). The finding of thyroid hypoechogenicity at diagnosis had higher specificity (0.81) and sensitivity (0.72) with respect to TR-ab positivity at the end of methimazole treatment (0.74 and 0.66 respectively) for the prediction of relapse of hyperthyroidism. Therefore, the evaluation of thyroid echographic pattern can be considered a useful prognostic tool in patients with Graves' disease.

Mortality rates among psychiatric patients, during and after the "psychiatric reform", in the area of Rome (Italy).

The issue of supposedly high mortality rates among psychiatric patients discharged from mental hospitals after the implementation in Italy of Law 180 is controversial. We have studied a cohort of 1858 long-term psychiatric inpatients of Public Mental Hospitals in the area of Rome (Italy), followed up for 9 years during and after the implementation of Law 180. As expected, age adjusted mortality rates were higher than those observed in the general population living in the study area, and death rates among patients with "organic mental disorders" were higher than those among patients with "functional disorders". No difference in death rates was observed between the group of discharged patients and that of patients not yet discharged.