Management of oral anticoagulant-induced intracranial haemorrhage.

Intracranial haemorrhage is an infrequent but often fatal complication of oral anticoagulant therapy which will become more common as anticoagulant use increases. The risk of anticoagulant-induced intracranial haemorrhage may be reduced by judicious prescribing, identification of patients at high risk of bleeding, and close monitoring by experienced staff. The presenting features of intracranial haemorrhage are often vague and physicians should be aware of the need for urgent investigation of all anticoagulated patients with neurological symptoms. Current guidelines for immediate reversal of anticoagulation recommend administration of vitamin K1 and factor replacement with either factor concentrates or fresh frozen plasma. In this review we discuss recent evidence suggesting prothrombin complex concentrates lead to faster, and more complete, correction of coagulation and, in the context of intracranial bleeding, may be associated with improved neurological status. Evidence for the risks of short-term cessation of anticoagulants, in the immediate period following an intracranial haemorrhage, and their subsequent reintroduction is also discussed.

Cluster analysis of depressed college students' social behaviors.

Measures of interpersonal behaviors exhibited by depressed college students toward their dormitory roommates were cluster analyzed, and this procedure produced 2 relatively distinct subgroups: a dependent, friendly, overgenerous type and an autocratic, competitive, aggressive, mistrustful type. These 2 groups were studied over a 9-month period; findings revealed that behaviors associated with each cluster were relatively stable and unrelated to gender or initial symptom severity. In longitudinal analyses, depressives in one group showed symptom abatement across time, whereas symptoms of the other group remained elevated. The roommates of depressives exhibited relatively high levels of hostility and a progressive decline in social contact and satisfaction with their depressed cohabitant. The results are discussed in relation to other typological approaches to unipolar depression.

A comparison of self-esteem lability and low trait self-esteem as vulnerability factors for depression.

Self-esteem lability (SEL), defined as daily event-related variability in state self-esteem, and low trait self-esteem (TSE) were assessed among 205 male and female undergraduates who were currently depressed (CD), previously depressed (PD), and never depressed (ND). SEL scores were derived for the effect of positive, negative, and combined events on state self-esteem over 30 days. Consistent with psychodynamic and cognitive theories, SEL was found to be a better index of depression proneness than TSE. PD Ss showed higher lability on all SEL scores than ND controls but did not differ from controls on TSE. Ss were reassessed 5 months later, and new cases showed higher premorbid SEL than ND controls but did not differ from controls on premorbid TSE. SEL at Time 1 was found to increase risk for depression at Time 2 among Ss reporting high life stress at Time 2. Theoretical and methodological implications are discussed.

Dysfunctional beliefs discriminate personality disorders.

This study examines whether specific sets of dysfunctional beliefs are differentially associated with five personality disorders (PDs) as predicted by cognitive theory. Seven hundred fifty-six psychiatric outpatients completed the Personality Belief Questionnaire (PBQ) at intake and were assessed for PDs using a standardized clinical interview conducted by assessors who were blind to patients' PBQ responses. Findings showed that patients with avoidant, dependent, obsessive-compulsive, narcissistic, and paranoid PDs preferentially endorsed PBQ beliefs theoretically linked to their specific disorders. The study results support the cognitive theory of personality disorders. Suggestions are made regarding the clinical utility of the PBQ with personality-disordered patients and future research on the PBQ.

Restarting anticoagulation in prosthetic heart valve patients after intracranial haemorrhage: a 2-year follow-up.

35 patients with oral anticoagulant (OAC) related intracranial or intraspinal haemorrhage were studied to determine treatment received, outcome and rate of recurrent bleeding and thromboembolism after restarting OAC. All patients underwent active anticoagulant reversal and in 14 patients with prosthetic heart valves (PHV) the INR remained below 2.0 for 0-19d (median 7) with no thromboembolic events. 10 patients received heparin, although a therapeutic level was rarely achieved. 13 patients with PHV were restarted on OAC and followed for a median 23.5 months. One patient had recurrent intracranial bleeding. 3/13 patients had cerebral embolic events despite anticoagulation. We conclude that in PHV patients temporary cessation of OAC is safe and the risk of recurrent bleeding after restarting OAC is low.

Partial trisomy 22 (q11.2-q13.1) as a result of duplication and pericentric inversion.

A case of a 27 year old male with a duplication of part of the long arm of chromosome 22 (22q11.2-q13.1) together with a pericentric inversion of the same chromosome is reported. Particular phenotypic features of note include absence of speech, persistent self-injury, lack of daily living skills, colobomata, and very poor vision. Similarities between this case and other case reports of duplications of the long arm of chromosome 22 are discussed.

Molecular mapping of Alzheimer-type dementia in Down's syndrome.

Previous research has hypothesized an association between Alzheimer's disease and the amyloid precursor protein (APP) gene found on chromosome 21. We report the case of a 78-year-old woman with Down's syndrome with partial trisomy 21 [46,XX,rec(21)dup q, inv(21) (p12q22.1)]. No evidence of Alzheimer's disease was found on neuropsychological, magnetic resonance imaging, and neuropathological assessment. The gene sequence for APP was present in only two copies. This case further supports the hypothesis that Alzheimer's disease is associated with trisomy for proximal chromosome 21q, including the APP gene.