Predictors of functional status at service entry and discharge among young people with first episode psychosis.

OBJECTIVE: Most patients with first episode psychosis (FEP) are neither studying nor employed (have a poor functional status) when first accessing care. Knowledge of the characteristics of patients with poor functioning and the features influencing functional status over time may pave the way to better treatment. METHOD: A medical file audit was used to collect data on premorbid, entry, treatment and 18-month outcome characteristics on 661 FEP patients who consecutively attended the Early Psychosis Prevention and Intervention Centre, Melbourne, Australia, between 1998 and 2000. Functional status was ascertained using the modified vocational status index and was rated at baseline (poor or good) and according to its evolution over the treatment period (stable good, stable poor, deteriorating or improved functional status). RESULTS: 52.0% of patients had a poor functional status at service entry. They were more likely to be male with a non-affective psychosis. They also had lower levels of premorbid global functioning and education, and were more likely to have self-reported histories of learning disability, forensic issues, traumatic experiences and substance use. At service entry, they had more severe symptoms and poorer global functioning. 37% of these patients maintained a poor functional status at discharge, and 18% of those with a good functional status at service entry experienced a decline. CONCLUSIONS: Although psychosocial interventions might assist a young person with FEP with working towards functional goals, for some, the impact of factors such as ongoing substance use and forensic issues on functional status needs to be addressed.

Camouflage therapy.

Camouflage therapy is a system of cosmetic techniques designed for patients to use to assist themselves in coping constructively with the psychological and physical trauma of their disfigurements. It is described as a "system" because these techniques are interrelated. A camouflage therapist may teach the patient to use one, two, or all of the techniques at the same time in order to normalize their appearance. Four basic techniques have been described in this article. They are as follows: (1) the use of opaque, waterproof cover creams to conceal scarring; (2) the application of pancake makeup for patients with oily or acne-prone skin; (3) color correctors to obliterate discoloration from postoperative trauma; and (4) recreating imperfections on the skin. For more information about the use of cosmetics to normalize the appearance of physical disfigurements, the following books are recommended.

Cosmetic rehabilitation.

Appearance is one of the most powerful factors influencing social interactions with others. What patients with disfigurements experience from society on a daily basis is a very real stigma. Cosmetic rehabilitation is a system of cosmetic techniques devised for patients to use to assist themselves to cope constructively with the psychological and physical trauma of their disfigurements.

Assessing camouflage therapy for the disfigured patient: a personal perspective.

Camouflage therapy can restore the self-esteem of the disfigured patient and thus has the potential to improve their psychological and physical well-being. Camouflage technique and the nurses' role in assessing and treating these patients are discussed.

Characteristics of the internal anal sphincter and the rectum of the vervet monkey.

1. The physiology of the internal anal sphincter of the vervet monkey was investigated. 2. Strips of sphincter in vitro contracted to noradrenaline and adrenaline; adrenoceptors were mainly alpha-excitatory. Strips of rectal circular muscle relaxed to noradrenaline and contained both inhibitory alpha- and beta-adrenoceptors. 3. All strips contracted to acetylcholine. After hyoscine or atropine, high doses of acetylcholine relaxed all strips by stimulating intramural inhibitory neurones as relaxations were blocked by tetrodotoxin and hexamethonium. Nicotine and DMPP gave relaxations with similar characteristics. 4. It was concluded that relaxations to acetylcholine, nicotine and DMPP were not adrenergic as relaxations still occurred in strips from sympathetically denervated or reserpinized animals. The block of these relaxations by propranolol and guanethidine was considered to be unrelated to their actions as adrenergic blocking drugs. 5. All strips relaxed to field electrical stimulation (1--5 Hz) through stimulation of intramural inhibitory neurones as tetrodotoxin blocked these relaxations. Adrenergic blocking drugs, prior reserpinization or prior section of the hypogastric nerves did not block these responses. The relaxations were not therefore adrenergic. 6. 5-Hydroxytryptamine relaxed all strips but was not the transmitter in relaxations to acetylcholine, DMPP or nicotine, nor to field electrical stimulation, as desensitization of strips of 5-HT did not alter these responses. 7. The circular smooth muscle of the internal anal sphincter had a dense terminal adrenergic innervation which rapidly decreased orad. 8. In vivo, hypogastric nerve stimulation relaxed the rectum but contracted the sphincter. Sacral nerve root stimulation caused an after-contraction in both rectum and sphincter. In vivo, a close arterial injection of adrenaline or noradrenaline inhibited the spontaneous contraction waves of the rectum, but contracted the sphincter. Both these responses were blocked by phentolamine. 9. It was concluded that the internal anal sphincter is a discrete high pressure zone which was excitatory cholinergic and adrenergic innervations and an inhibitory non-adrenergic innervation.

Small intestinal motility and transit by electromyography and radiology in the fasted and fed pig.

The pattern of small intestinal digesta transit was studied in six young pigs (20-30 kg) by simultaneous electromyography and radiology. Pigs showed migrating myoelectric complexes (m.m.c.s) in the small intestine both when fasted and after feeding. The m.m.c.s were modified by feeding; quiescence was much reduced in duration and irregular spiking activity (i.s.a.) was prolonged; m.m.c.s were not disrupted and phases of regular spiking activity (r.s.a.) were still seen after feeding. The r.s.a. phase could be recognized on the screen and in spot films from both fasting and fed pigs as a band of intense rhythmic contractions pinching off the intestine and propelling all intestinal contents ahead of it. The r.s.a. moved caudad clearing the small intestine of digesta and leaving an empty quiescent intestine behind it. It was particularly characteristic in the fasted pig where it was usually associated with the progression of a gas bubble. The pattern of m.m.c.s in both fasted and fed animals along with the intermittent nature of stomach emptying, divided digesta into batches which progressed through the small intestine. Each batch--propelled by a m.m.c.--normally took 180-190 min to pass through the small intestine. M.m.c.s had a cycle length of 70-115 min in different parts of the small intestine. Usually two or three m.m.c.s and batches of intestinal contents were present in the small intestine at any one time. 22-33% of the m.m.c.s faded out in the proximal ileum. Batches of digesta propelled by these m.m.c.s had transit times increased by one m.m.c. duration and fused with the subsequent batch. Sometimes new m.m.c.s were generated in the terminal ileum. Two patterns of transport into the large intestine were seen. Usually digesta was transported by peristaltic rushes starting 100-200 cm from the ileo-caecal junction. The rush then continued through 1-1 1/2 turns of the spiral colon; occasionally the terminal ileum emptied by slow peristalsis. In this case there was no colonic rush and digesta went into the caecum.

Do the blood vessels of the antler velvet of the red deer have an adrenergic innervation?

Samples of antler velvet and pedicle skin of Red deer were snap-frozen, freeze-dried and treated with hot formaldehyde vapour. Sections (4 microns thick) were epi-illuminated with ultra-violet light. No blue-green fluorescence characteristic of adrenergic nerves was seen in sections from the antler velvet except in one castrate, although the blood vessels of the pedicle skin were well innervated. Yellow fluorescence characteristic of 5-hydroxytryptamine was present in mast cells in the velvet. The lack of a discrete adrenergic vasomotor innervation of the antler blood vessels makes it unlikely that antlers in velvet control heat loss by functioning as heat radiators.

Initiation of the migrating myoelectric complex in dogs.

1. Contractile and spike activity in the conscious dog were recorded from strain gauge force transducers and electrodes chronically implanted on the antrum, duodenum and jejunum. The pattern of activity was related to the time elapsed after feeding a daily meal, both in intact dogs and in dogs with antro-jejunal or oesophago-duodenal anastomoses. 2. From 8 to 10 h after feeding, transient reductions of the continuous antral spiking activity were recorded while phases of regular spiking activity (RSA) and contractions developed on the proximal intestine. 3. About 18 h after feeding, the post-prandial antral activity became intermittent, each period of contractions being accompanied by the duodenal development of a RSA phase. 4. The RSA phases were still initiated on the duodenum after an antro-jejunal anastomosis and after gastrectomy. 5. It is concluded that phases of RSA of the migrating myoelectric complex are initiated in the proximal part of the small intestine rather than in the stomach. It is suggested that the RSA phase exerts an inhibitory effect on the antrum which may serve to reduce the flow of digesta through the pylorus when the ability of the duodenum to receive chyme is restricted.

The influence of intestinal infusion of fats on small intestinal motility and digesta transit in pigs.

The influence of duodenal and ileal infusion of nutrients on small intestinal transit of digesta, measured by the passage of phenol red marker, was studied in twelve pigs fitted with duodenal and ileal catheters, and a terminal ileal cannula. Changes in gastrointestinal motility were observed by electromyography and by use of an X-ray image intensifier in four of the pigs fitted additionally with nichrome wire electrodes in the gut wall and in seven pigs fitted only with a gastric catheter. Small intestinal transit time was unaffected by intestinal catheterization per se, or by duodenal or ileal infusion of glucose or peptone. It was reduced by duodenal infusion of fat or of some of the products of fat digestion including oleic acid and a monoglyceride containing unsaturated fatty acids (monoglyceride LS) but was not affected by infusion of glycerol, stearic acid or a monoglyceride containing saturated fatty acids (monoglyceride P). Ileal transit time was greatly reduced by ileal infusion of soya bean oil mixed with bile salts and lipase and by monoglyceride LS but not by soya bean oil alone. Total small intestinal transit time was reduced to a lesser degree by ileal infusion of soya bean oil mixed with bile salts and lipase and by monoglyceride LS and was unaffected by soya bean oil alone. The level of irregular spiking activity of the small intestine was greatly reduced by both duodenal and ileal infusion of fat, but rapidly propagated spike bursts were initiated from the point of infusion (identified radiologically as peristaltic rushes) many of which travelled right through to the ileo-caecal junction. It is concluded that intestinal infusion of fat accelerates small intestinal transit in pigs by induction of peristaltic rushes; that since the ileal transit times were more severely reduced than total small intestinal transit times by ileal infusion of fat the response is probably only seen over those areas of intestine in direct contract with the fat; and that the effect depends upon the presence of fat digestion products, i.e. the fatty acid and the monoglyceride, although probably only those containing unsaturated fatty acids.

Chronic intracerebroventricular morphine and lactation in rats: dependence and tolerance in relation to oxytocin neurones.

1. Acutely, opioids inhibit oxytocin secretion. To study the responses of oxytocin neurones during chronic opioid exposure, forty-five lactating rats were infused continuously from a subcutaneous osmotically driven mini-pump via a lateral cerebral ventricle with morphine sulphate solution from day 2 post-partum for 5-7 days; the infusion rate was increased 2- or 2.5-fold each 40 h from 10 micrograms/h initially up to 50 micrograms/h; controls were infused with vehicle (1 microliter/h, twenty-eight rats) or were untreated (eight rats). 2. Maternal behaviour was disrupted in 27% of the morphine-treated rats; in rats that remained maternal morphine did not affect body weight or water intake but increased rectal temperature by 0.82 +/- 0.14 degrees C (mean +/- S.E.M.) across the first 4 days. 3. Weight gain of the litters of maternal morphine-treated rats was reduced by 32% during 7 days, predominantly in the first day of treatment when milk transfer was also reduced. Observation of pup behaviour during suckling showed decreased frequency of milk ejections on only the second day of morphine treatment. Plasma concentration of prolactin after 6 days was similar in maternal morphine-treated and control rats, but reduced by 90% in non-maternal morphine-treated rats, indicating normal control of prolactin secretion by suckling in morphine-treated rats. 4. Oxytocin and vasopressin contents, measured by radioimmunoassay, in the supraoptic and paraventricular nuclei and in the neurohypophysis were similar between fourteen maternal morphine-treated, twelve vehicle-treated and eight untreated lactating rats; thus exposure to morphine did not involve increased production and storage of oxytocin. 5. Distribution of [3H]morphine infused intracerebroventricularly into six virgin female rats for 6 days was measured by scintillation counting of tissue extracts. Morphine concentration in the hypothalamus and neurohypophysis was 2.7 and 12.8 micrograms/g, respectively, and in blood plasma 0.75 micrograms/g. Tolerance was not due to failure of morphine infusion. In addition, naloxone (5 mg/kg s.c.) provoked typical withdrawal reactions ('wet dog' shakes, defaecation, burrowing) in lactating rats infused with morphine for 5 days. 6. Pups were suckled onto seven maternal morphine-infused and five vehicle-infused rats anaesthetized with urethane for recording of intramammary and arterial blood pressures after treatment for 5 days. The incidence and pattern of milk ejections, and mammary gland sensitivity to oxytocin were similar in the two groups.(ABSTRACT TRUNCATED AT 400 WORDS)

Effects of motilin, somatostatin, and pancreatic polypeptide on the migrating myoelectric complex in pig and dog.

Spiking activity of the gastrointestinal tract was recorded in 4 fasted pigs and 4 fasted dogs during the intravenous infusion at two rates, 5 (rate A) and 20 (rate B) ng . kg-1 . min-1 of 13-Nle-motilin, somatostatin, and bovine pancreatic polypeptide. Infusions continued for 2 h in pigs and for 5 h in dogs. 13-Nle-Motilin was unable to induce a migrating myoelectric complex or to modify its frequency in the pig at either rate of infusion. In contrast, the infusion of 13-Nle-motilin at rate B in the dog induced a migrating myoelectric complex but delayed the occurrence of the following migrating myoelectric complex. However, the mean duration (74 +/- 22 min) of the migrating myoelectric complex interval in the 5 h of infusion did not significantly change compared with the control period (92 +/- 8 min). At rate B, somatostatin inhibited the gastroduodenal spiking activity in the pig and disrupted the migrating myoelectric complex pattern, whereas this hormone at both rates of infusion increased the frequency of the migrating myoelectric complex by 69.3% and 17.2%, respectively, in the dog. The infusion of bovine pancreatic polypeptide increased the frequency of the migrating myoelectric complex significantly by 36.4% and 82% at rates A and B in the pig and by 148% at rate A in the dog. Bovine pancreatic polypeptide also inhibited spiking activity in the duodenum but not in the jejunum at rate B in the dog. These results suggest that pancreatic polypeptide, but not somatostatin, may have a regulatory function on the rhythmicity of the migrating myoelectric complex in the dog and pig and that motilin does not control the occurrence of duodenal migrating myoelectric complex in the pig.

Insulin and myoelectric activity of the small intestine of the pig.

The effect of insulin on the myoelectric activity of the small intestine was determined in conscious pigs. Animals were implanted with electrodes along the small intestine, a strain gage on the stomach and catheters in both saphenous arteries. Feeding modified the migrating myoelectric complex (MMC), a cyclic pattern of action potential activity of the small intestine characteristic of fasting. The first period of regular spiking activity (RSA) on the duodenum after feeding was delayed and was not followed by quiescence. Plasma insulin and glucose concentrations during the first three MMC after feeding were highest just before periods of duodenal RSA. Injection or infusion of insulin into fasted pigs with production of hypoglycemia caused disruption of stomach motility and duodenal electrical activity. The duodenal MMC was not altered when glucose to prevent hypoglycemia was infused together with insulin or when glucose was infused alone. These studies suggest that insulin is not directly responsible for the postprandial modification of MMC activity as insulin infusions only modify the MMC when hypoglycemia occurs.

Motilin secretion and the migrating myoelectric complex in the pig.

The concentration of motilin in plasma from the abdominal aorta and the hepatic portal vein and the net portal motilin output varied with the phase of the migrating myoelectric complex (m.m.c.) in five of six pigs fasted for 17 h. Maximum concentrations and output occurred 9-12 min before phase III in the duodenum or upper jejunum. In fed pigs m.m.c.s occurred and the first phase III in the duodenum occurred within 90 min of feeding. Both portal and arterial motilin concentrations were reduced after feeding and no longer varied with the phase of the m.m.c. Altered secretion of motilin after feeding did not appear to be associated with absorption of glucose as infusion of glucose (50 g/l, 10 ml/min) into the duodenum raised arterial and portal plasma glucose concentrations to post-prandial levels yet motilin concentrations and output rates still varied with the phase of the m.m.c. Infusions of motilin (1 or 10 ng/kg X min) into the portal vein of 17 h fasted pigs did not induce an extra phase III or alter the duration of the m.m.c. Hydrochloric acid (100 mmol/l) infused into the duodenum of fasted pigs at 10-21 ml/min increased the concentration of motilin in the portal blood but was without effect at 5 ml/min. Rapid injections of 50 ml hydrochloric acid into the duodenum also increased the portal motilin concentration. Hydrochloric acid infusion or injection did not alter the interval between phase IIIs. It is concluded that motilin secretion is a consequence of the m.m.c. or shows the same periodicity as the m.m.c. but that motilin is not an important factor in the initiation and control of the m.m.c. in the pig.

Development and validation of an elbow score.

OBJECTIVES: Few of the questionnaires available for evaluating the function and clinical state of the elbow have been validated. An ideal score would be consistent, sensitive, reliable and elbow-specific, incorporating both patient perception and clinician assessment. This was our aim. METHODS: Items were generated using 25 patients and expert opinion, and reduced using 25 new patients to yield a nine-item patient questionnaire and a six-item clinical evaluation (of strength, motion and ulnar nerve involvement). This was validated using 63 new patients (of whom 28 were studied twice without therapy and 18 were studied again after appropriate surgery). RESULTS: The test-retest reliability coefficient of determination (R2 = 0.93) and internal consistency (Cronbach's alpha = 0.98) were both good. Convergent validity was attested by good correlations with other scores, the Disabilities of Arm, Shoulder and Hand Questionnaire (DASH) and the Nottingham Health Profile (NHP) (physical) (R2 = 0.62 and 0.29, P < 0.0005). Sensitivity to change was demonstrated by correlating preoperative-postoperative changes to those in DASH and NHP (physical) (R2 = 0.50 and 0.27, P < 0.04). CONCLUSION: This is a reliable, internally consistent score, correlating well with other, non-elbow specific scores and sensitive to change on treatment.