Impacts of stigma and discrimination in the workplace on people living with psychosis.

BACKGROUND: Employment holds many benefits for people living with psychosis. However, significant barriers to employment for this cohort appear to exist, notably stigma and discrimination against people living with serious mental health conditions. We asked: Would a qualitative sample including multiple stakeholder groups reveal similar results and if so, what would be the main impacts of such stigma and discrimination? METHOD: This analysis used data from a qualitative study that had employed focus groups and interviews to investigate the employment barriers and support needs of people living with psychosis, including views of the multiple stakeholders (those living with mental health conditions, health professionals, care-givers, employments consultants and community members and employers). RESULTS: The impacts of workplace stigma and discrimination on people living with psychosis included work avoidance, reluctance to disclose mental health conditions to employers, work-related stress, and reduced longevity of employment. CONCLUSIONS: Significant impacts from such stigma and discrimination were found in this study. The findings indicate a need to provide support mechanisms and to change the culture of workplaces to improve employment opportunities and outcomes for people living with psychosis.

Human handedness: a partial cross-fostering study.

The hand preference of college students correlated significantly with the writing hand of their biological parents but not that of their stepparents. The results are consistent with a genetic theory of the origin of human handedness.

Removal of contaminants from soils by electric fields.

Application of a direct-current electric field in soils that contain contaminated liquid is expected to produce an important in situ means of environmental restoration. The electric field induces a motion of the liquid and dissolved ions that transports the contaminant to wells for removal. Electrode chemistry plays an important role, and reagents can be introduced at the electrodes to enhance contaminant removal rates. Experiments and modeling demonstrate high degrees of contaminant removal, propagation of sharp acid and base wave fronts from the electrodes, and a "focusing" effect by which metals accumulate in regions of the soil.

Tardive dyskinesia in young mentally retarded individuals.

The results of a systematic neuroleptic withdrawal study in 38 mentally retarded children, adolescents, and young adults are described. The focus of the study was the occurrence of side effects of chronic neuroleptic treatment: tardive dyskinesia, transient withdrawal dyskinesia, nondyskinetic withdrawal symptoms, and a possible behavioral analogue of withdrawal dyskinesia. Transient side effects were noted in 34% of the subjects, and tardive dyskinesia in an equal proportion. The data suggest that cumulative neuroleptic dose may play a role as a risk factor in the development of severe tardive dyskinesia.

Effect of alternative on-site wastewater treatment on the viability and culturability of Salmonella choleraesuis.

The objective of this study was to determine how alternative on-site wastewater treatment systems (i.e. subsurface flow constructed wetlands, intermittent sand filters and intermittent peat filters) affect the viability and culturability of Salmonella choleraesuis (serotype typhimurium, ATCC 23567). Influent was a high strength septic tank effluent (BOD5 240-344 mgL(-1), TN approximately 100 mgL(-1), TP approximately 15 mgL(-1)) at the Natural Resources Research Institute's (NRRI) alternative treatment system test facility in northern Minnesota. Treatment systems were inoculated with cultures of S. choleraesuis for 5-7 consecutive days in summer and winter during 1998-99. After the seeding, outflow samples were taken until Salmonella counts were sustained at background levels. In addition to culture-based enumeration, S. choleraesuis abundances were also measured using fluorescent in situ hybridization (FISH) alone and in combination with the direct viable count method (DVC) to determine if plate counts underestimated total and viable Salmonella abundances and if the Salmonella cell viability changed after passing through the treatment systems. In most cases, total and viable cell abundances in treatment system effluents were several orders of magnitude higher than cultured cell abundances. Our results indicate that the culture-based method underestimated viable concentrations of the model pathogen, S. choleraesuis. Salmonella cell viability decreased in effluents during the summer but increased during the winter. Using a culture-based enumeration method alone to determine removal efficiencies of bacterial indicators and pathogens for wastewater treatment systems may result in artificially high estimates of effective treatment.

Tardive dyskinesia and other clinical consequences of neuroleptic treatment in children and adolescents.

Of 41 children, adolescents, and young adults who were withdrawn from chronic neuroleptic treatment, 18 developed tardive dyskinesia, withdrawal dyskinesia, nondyskinetic withdrawal symptoms, or transient behavior deterioration. Development of neuroleptic-related problems seemed to be associated with cumulative neuroleptic dose and possibly with the sex of the subject. Only 12 of the 41 subjects required resumption of neuroleptic treatment after a prolonged trial withdrawal period.

Changes in extravascular lung water during venovenous perfusion.

The accumulation of extravascular lung water was related to changes in plasma colloid osmotic pressure and pulmonary hydrostatic pressures in 12 normal dogs and 13 dogs that had venovenous perfusion for 2 hours at 45 to 70 ml. per kilogram per minute. The venovenous perfusion system included a membrane oxygenator and a roller pump. Net intravascular filtration pressure was calculated from plasma colloid osmotic pressure and pulmonary hydrostic pressures. Rapid accumulation of extravascular lung water occurred in control and bypass animals when net intravascular filtration pressure exceeded zero. At lower filtration pressures, venovenous perfusion did not affect accumulation of extravascular lung water.

Successful treatment of varicella pneumonia with prolonged extracorporeal membrane oxygenation in a child with leukemia.

A 5-year-old boy with acute lymphoblastic leukemia in complete continuous remission developed life-threatening varicella pneumonia and acute respiratory insufficiency (ARI). The child recovered after 92 hours of partial venoarterial perfusion with a membrane oxygenator. Functional asplenia developed. Serial pulmonary function tests after perfusion indicate moderately severe restrictive lung disease which has slightly improved during an 18 month period.

The persistence of stimulant effects in chronically treated children: further evidence of an inverse relationship between drug effects and placebo levels of response.

Seventeen hyperactive children who had been treated for 1-5 years with methylphenidate were studied in a double-blind placebo-controlled crossover study. Specific measures of stimulant response were found to be inversely related to the subject's level of response in the placebo condition. This inverse relationship was previously found to characterize the clinical effects of hyperactive children in an acute-treatment paradigm. It is equally valid in a chronic-treatment study. "State-contingency" is not, therefore, simply a function of the "novelty" of initial drug treatment.

Extracorporeal membrane oxygenation during bronchopulmonary lavage.

Extracorporeal membrane oxygenation (ECMO) in a venoarterial perfusion circuit was used to provide support of gas exchange during bronchopulmonary lavage in a 32-year-old man with pulmonary alveolar proteinosis and severe arterial hypoxemia. Prior to the lavage, Pao2 during mechanical ventilation with 100% oxygen and positive end-expiratory pressure was only 125 mm Hg. Extracorporeal perfusion at a flow rate of 3 liters/min, with oxygen delivery of 244 ml/min, increased the Pao2 to 227 mmHg and lowered the mean pulmonary artery pressure from 28 to 24 mm Hg. During bronchopulmonary lavage and ECMO, the Pao2 ranged between 46 and 96 mm Hg. After the procedure, pulmonary performance decidely improved. By reducing the chances of fatal hypoxemia, ECMO allowed treatment to be instituted for this potentially reversible disorder and proved helpful as a form of support during the management of pulmonary alveolar proteinosis when severe hypoxemia may have other wise precluded bronchopulmonary lavage.

Cecal necrosis after open-heart operation.

Two patients with isolated transmural ischemic necrosis of the cecum after cardiopulmonary bypass are discussed. Superimposed upon the multiple cardiovascular abnormalities in these patients, cardiopulmonary bypass adds another risk factor for nonocclusive intestinal infarction. In patients undergoing open-heart procedures, postoperative nonspecific abdominal complaints should be evaluated with a high degree of suspicion for this lethal complication. An intensive diagnostic effort is indicated, including contrast and angiographic radiological studies. Consideration of early abdominal exploration is indicated.

Specifying the relations between affect and heavy alcohol use among young adults.

Current reformulations of the tension reduction hypothesis posit that only a subset of vulnerable individuals are at risk for drinking in response to negative affect. To further specify this model, this study examined the types of mood and social contexts under which affect and alcohol use are associated. Participants were 74 college students who completed repeated assessments of mood, alcohol use, friendship quality, and social support. A complex pattern of findings supported the moderating influences of gender, friendship factors, and the timing of behavior (i.e., weekends vs. weekdays) on the relation between affect and alcohol use. Young adults with less intimate and supportive friendships, as compared with their peers, showed risk for greater drinking following relative elevations in sadness and hostility. Such drinking episodes, in turn, predicted subsequent elevations in these same negative moods the following week. Gender differences in such a cyclical pattern of affect and alcohol use were found to vary across differing emotional experiences. Recommendations for a more refined theory of affect and alcohol use are discussed.

Neuropharmacology of methylphenidate and a neural substrate for childhood hyperactivity.

What began as a simple chemical question about the clinical utility of MPH SL measurement has led our group across a broad expanse of research endeavors, from the problem of nonintercorrelated stimulant effects to a theory of hyperactivity as a dysregulatory disorder based on frontal-striatal dysfunction or dysmaturation. The transition has been from a traditional and fairly circumscribed question in psychopharmacology to a new interest in the neuropsychological approach to hyperactivity and its treatment. Biologic psychiatry and neuropsychology have developed as distinct disciplines well insulated from one another, but a degree of cross-fertilization is beginning to occur. Rather than thinking of childhood hyperactivity in terms of vague metapsychological concepts such as "attention" or "arousal," it will be perhaps more constructive to base a model for the disorder on the foundation of known elements of brain function. Perhaps the most interesting research areas to pursue will be neuropsychological and neurodiagnostic (for example, PET). The specific locus of disorders, such as the HKS and the specific mechanisms of drug action, may not be so elusive after all.

Influence of sex of antecedent siblings on the human sex ratio.

Analysis of family configurations in a population of 649,366 American secondary school students confirmed that sex of later-born children is influenced by the sex of antecedent siblings. Antecedent brothers decrease the probability of subsequent male births. This observation, a confirmation of an earlier report in a substantially smaller sample, is consistent with an immunologic influence on human sex determination.

Antagonism of marihuana effects by indomethacin in humans.

To investigate whether the nonsteroidal anti-inflammatory drug (NSAID) indomethacin antagonized the effects of marihuana, an exploratory single-blind, placebo-controlled study was conducted. Subjects (n = 4) smoked marihuana after pre-treatment with placebo and indomethacin. The subjective rating of marihuana "high", heart rate, word recall, time estimation/production, and plasma concentrations of THC and PGE2 were measured. It was found that: 1) indomethacin pre-treatment decreased the elevation of prostaglandins induced by THC; 2) indomethacin significantly attenuated the subjective "high" and the heart rate accelerating effects of THC, although the magnitude of this effect was modest; 3) indomethacin abolished the profound effect of THC on time estimation and production; and 4) indomethacin pretreatment did not affect the decremental effects of THC on word recall. We conclude that prostaglandins are involved in the neurophysiologic mechanisms that mediate some of the typical clinical effects of THC, particularly the distortion of time perception.

A neuropathic substrate for stimulant drug effects in hyperactive children.

Behavioral, physiological, and cognitive data are presented from a sample of 55 hyperactive children undergoing methylphenidate treatment. Consistent with previous research, considerable variability exists on these measures in this clinical population with little evidence for a consistent profile on any of these dimensions. A theoretical discussion is offered reflecting these findings with reference to a proposed pathophysiologic basis for the disorder. The proposed model postulates a particular emphasis on the functional responsibilities of the frontal-striatal system. A neural substrate for the abnormal oscillations that characterize hyperactive children, the correction of which is germane to therapeutic stimulant effects, is presented in terms of the regulatory functions of the frontal lobe.

Clinical effects of daily methamphetamine administration.

This study investigated alterations in the disposition and pharmacodynamics of methamphetamine HCl after daily administration. Six male paid volunteers familiar with the use of amphetamines participated. Each subject was administered 10 mg of methamphetamine HCl as a slow-release preparation (Desoxyn Gradumets) at 9 a.m. for 13 consecutive days (days 2-14 of the study). On days 1 and 15 the subjects were challenged with 10 mg of oral deuterated methamphetamine HCl. Deuterated drug was used to differentiate plasma concentrations of challenge doses from those of daily doses. The heart rate, subjective perception of "high," and plasma concentrations of methamphetamine were examined on days 1 and 15. Repeated ANOVA measures indicate that a significant decrease in heart-rate acceleration in response to methamphetamine challenge occurred on day 15 [F(1,5) = 8.26, p less than or equal to 0.035]. However, no significant change in either the subjective ratings of "high" or the plasma concentrations of deuterated methamphetamine occurred. These findings indicate that the disposition of methamphetamine and its subjective effects were not altered by this period of daily exposure to a low dose of the drug. In contrast, tolerance to the heart-rate accelerating effect was observed.

The pharmacologic effects of daily marijuana smoking in humans.

Six healthy male, paid volunteers smoked one NIDA cigarette containing 1.0% THC each day for 13 consecutive days. They were tested before and after the period of drug administration by the following procedure: the subjects smoked one NIDA marijuana cigarette containing 1.0% THC followed 15 minutes later by the intravenous infusion of 52 micrograms/min of deuterated THC for 50 minutes. The THC plasma concentrations, ratings of "high" and heart rate effects produced by the combined drug administration were measured, and absolute bioavailability of smoked THC was calculated on Days 1 and 22. Statistical analyses indicate that the only significant changes induced by daily marijuana exposure were in cardioacceleration.

Dose-response studies with thyrotropin-releasing hormone (TRH) in abstinent male alcoholics: evidence for selective thyrotroph dysfunction?

A reduced thyrotropin (TSH) response to thyrotropin-releasing hormone (TRH) has been reported in subjects with a history of alcoholism whereas prolactin (PRL) responses have generally been normal. One hypothesis proposed to explain the reduced TSH response is down-regulation of pituitary TRH receptors. If this is correct, PRL response should also be diminished. To account for the different dose-response characteristics of TSH/PRL we have given four dosages of TRH (25, 100, 500 and 800 micrograms) to eight noncirrhotic, male alcoholics abstinent from ethanol a minimum of 28 days and to seven male control subjects. Across the TRH dose range the alcoholic subjects exhibited reduced basal TSH (p = .01) and a reduced TSH response (p = .0023) but no differences in basal and stimulated PRL levels. Alcoholic subjects had higher basal T4, T3 and FT4I values than did control subjects but covarying for T4, T3 and FT4I did not change the significance of either TSH or PRL findings. No significant differences in estradiol, estrone, testosterone, cortisol or glucose were noted between groups. The present study confirms the observation of a lower TSH response to TRH in abstinent alcoholics and indicates that the lower response cannot be overcome by increasing TRH dosage. The similar PRL response between groups suggests normal lactotroph function in noncirrhotic abstinent alcoholics and argues against the pituitary TRH receptor down-regulation hypothesis.

Reactive inhibition and postrest performance in continuous inverted-reversed printing.

Subjects were given continuous practice printing upside down and backward the letters of the alphabet for 4 min, followed by a variable rest interval (0, .5, 1, 2, 4, or 8 min), and then a final 2 min of practice. The amount of reminiscence was found to be a monotonically increasing function of the length of rest, and the initial negative slope of the postrest performance curve was nonmonotonically related to the length of rest. The results were interpreted in terms of a reactive inhibition model.