Beyond the surface: Understanding obsessive symptoms and body perceptions, from shape concerns to fear of blushing.

INTRODUCTION: Recent reclassifications have expanded the understanding of Obsessive-Compulsive Disorders (OCDs), now incorporated into a broader category known as Obsessive-Compulsive Disorder and Related Disorders (OCRDs). This study sought to assess obsessive-compulsive symptoms and body uneasiness among outpatients seeking treatment for Eating Disorders (ED). Additionally, we aimed to explore associations and potential mediation effects between obsessive-compulsive symptoms and body uneasiness. This investigation extended beyond concerns related solely to body shape and weight, encompassing fears associated with specific body components (such as facial features, abdominal region, and limbs) or functions (including sweating, blushing, emitting noises, and releasing odors). METHODS: Psychometric assessments included the Obsessive-Compulsive Inventory-Revised (OCI-R) and the Body Uneasiness Test (BUT). Statistical analyses involved bivariate correlations, linear regression, and mediation analysis to explore the associations and potential mediation effects between obsessive-compulsive symptoms and different manifestations of body uneasiness. RESULTS: The sample (N = 210) demonstrated substantial obsessive-compulsive symptoms and notable body discomfort. OCI-R scores positively correlated with various dimensions of body dissatisfaction, including shape, weight, and specific body components or functions. Linear regression revealed significant associations between OCI-R scores and overall body uneasiness (BUT-A) as well as concerns about body components or functions (BUTB). Mediation analysis indicated that BUT-A mediated the relationship between obsessive-compulsive symptoms and BUTB. CONCLUSION: This study offers new insights into the comprehensive landscape of OCRDs. It specifically emphasizes the association between obsessive-compulsive symptoms and body uneasiness, embracing not only concerns about body shape and weight but also extending to body components and functions.

Go beyond the limits of genetic algorithm in daily covariate selection practice.

Covariate identification is an important step in the development of a population pharmacokinetic/pharmacodynamic model. Among the different available approaches, the stepwise covariate model (SCM) is the most used. However, SCM is based on a local search strategy, in which the model-building process iteratively tests the addition or elimination of a single covariate at a time given all the others. This introduces a heuristic to limit the searching space and then the computational complexity, but, at the same time, can lead to a suboptimal solution. The application of genetic algorithms (GAs) for covariate selection has been proposed as a possible solution to overcome these limitations. However, their actual use during model building is limited by the extremely high computational costs and convergence issues, both related to the number of models being tested. In this paper, we proposed a new GA for covariate selection to address these challenges. The GA was first developed on a simulated case study where the heuristics introduced to overcome the limitations affecting currently available GA approaches resulted able to limit the selection of redundant covariates, increase replicability of results and reduce convergence times. Then, we tested the proposed GA on a real-world problem related to remifentanil. It obtained good results both in terms of selected covariates and fitness optimization, outperforming the SCM.

Effects of short-to-long term enzyme replacement therapy (ERT) on skeletal muscle tissue in late onset Pompe disease (LOPD).

AIMS: Pompe disease is an autosomal recessive lysosomal storage disorder resulting from deficiency of acid α-glucosidase (GAA) enzyme. Histopathological hallmarks in skeletal muscle tissue are fibre vacuolization and autophagy. Since 2006, enzyme replacement therapy (ERT) is the only approved treatment with human recombinant GAA alglucosidase alfa. We designed a study to examine ERT-related skeletal muscle changes in 18 modestly to moderately affected late onset Pompe disease (LOPD) patients along with the relationship between morphological/biochemical changes and clinical outcomes. Treatment duration was short-to-long term. METHODS: We examined muscle biopsies from 18 LOPD patients at both histopathological and biochemical level. All patients underwent two muscle biopsies, before and after ERT administration respectively. The study is partially retrospective because the first biopsies were taken before the study was designed, whereas the second biopsy was always performed after at least 6 months of ERT administration. RESULTS: After ERT, 15 out of 18 patients showed improved 6-min walking test (6MWT; P = 0.0007) and most of them achieved respiratory stabilization. Pretreatment muscle biopsies disclosed marked histopathological variability, ranging from an almost normal pattern to a severe vacuolar myopathy. After treatment, we detected morphological improvement in 15 patients and worsening in three patients. Post-ERT GAA enzymatic activity was mildly increased compared with pretreatment levels in all patients. Protein levels of the mature enzyme increased in 14 of the 18 patients (mean increase = +35%; P < 0.05). Additional studies demonstrated an improved autophagic flux after ERT in some patients. CONCLUSIONS: ERT positively modified skeletal muscle pathology as well as motor and respiratory outcomes in the majority of LOPD patients.

Social cognition in people with schizophrenia: a cluster-analytic approach.

BACKGROUND: The study aimed to subtype patients with schizophrenia on the basis of social cognition (SC), and to identify cut-offs that best discriminate among subtypes in 809 out-patients recruited in the context of the Italian Network for Research on Psychoses. METHOD: A two-step cluster analysis of The Awareness of Social Inference Test (TASIT), the Facial Emotion Identification Test and Mayer-Salovey-Caruso Emotional Intelligence Test scores was performed. Classification and regression tree analysis was used to identify the cut-offs of variables that best discriminated among clusters. RESULTS: We identified three clusters, characterized by unimpaired (42%), impaired (50.4%) and very impaired (7.5%) SC. Three theory-of-mind domains were more important for the cluster definition as compared with emotion perception and emotional intelligence. Patients more able to understand simple sarcasm (⩾14 for TASIT-SS) were very likely to belong to the unimpaired SC cluster. Compared with patients in the impaired SC cluster, those in the very impaired SC cluster performed significantly worse in lie scenes (TASIT-LI <10), but not in simple sarcasm. Moreover, functioning, neurocognition, disorganization and SC had a linear relationship across the three clusters, while positive symptoms were significantly lower in patients with unimpaired SC as compared with patients with impaired and very impaired SC. On the other hand, negative symptoms were highest in patients with impaired levels of SC. CONCLUSIONS: If replicated, the identification of such subtypes in clinical practice may help in tailoring rehabilitation efforts to the person's strengths to gain more benefit to the person.

A systematic review of metabolic side effects related to the use of antipsychotic drugs in dementia.

BACKGROUND: In clinical practice, Second Generation Antipsychotics (SGAs) are often used as first-line treatment for the Behavioral and Psychological Symptoms of Dementia (BPSD) in older adults due to their fewer neurological adverse events and similar effectiveness compared with First Generation Antipsychotics (FGAs). SGAs, however, are associated with more severe metabolic side effects (weight gain, hyperglycemia, diabetes risk, and hyperlipidemia) than FGAs are. In general, older patients, especially those affected by dementia, are at increased risk for malnutrition, and tend to have lower basal metabolism and reduced liver and kidney function. However, little is known about the metabolic side effects of antipsychotic drugs in this population. METHODS: A comprehensive review of the literature published between January 1996 and December 2012 investigating the metabolic side effects related to FGAs and SGAs use in old patients affected by dementia. RESULTS: Antipsychotic drugs currently used to treat BPSD in subjects with mild to moderate dementia are associated with weight gain. Currently, there are insufficient data to support a causal relationship between the use of FGAs and SGAs and changes in glucose homeostasis or lipid metabolism in older persons affected by severe dementia (MMSE <14). CONCLUSION: A possible association between antipsychotic drugs use and weight gain might exist, in particular in subjects with mild to moderate dementia whereas no significant effects are demonstrated regarding glucose homeostasis and lipid metabolism. The antipsychotic drugs potential for causing metabolic abnormalities in older patients requires further specifically designed studies. Clinicians must be aware of this possibility even if the shorter periods of treatment administered in late-life might not be as harmful as it is in younger individuals.

Case report: Asp194Ala variant in MFN2 is associated with ALS-FTD in an Italian family.

Background: MFN2 gene encodes the protein Mitofusin 2, involved in essential mitochondrial functions such as fusion, trafficking, turnover, and cellular interactions. We describe a family carrying a novel MFN2 mutation associated with ALS-frontotemporal dementia (FTD) clinical phenotype in the mother and Charcot-Marie-Tooth disease type 2A (CMT2A) in her son. Case presentation: The mother, a 67-year-old woman, referred to us for a three year-history of mood disturbance and gait impairment, and a more recent hypophonia, dysarthria, dysphagia, and diffuse muscle wasting. Family history was positive for psychiatric disorders and gait disturbances. Brain 18F-FDG PET showed severe hypometabolism in the fronto-temporal brain cortex bilaterally. Electrodiagnostic studies (EDX) showed severe motor axonopathy in the bulbar, cervical and lumbosacral districts. Her 41-year-old son had a history of mood depression and sensory disturbances in the limbs, along with mild muscle wasting, weakness, and reduced reflexes. Nerve conduction studies revealed a moderate sensory-motor polyneuropathy, while brain MRI was normal. Whole exome sequencing of the patients' DNA identified the novel MFN2 (NM_014874.4) variant c.581A>C p.(Asp194Ala). Conclusion: Our findings provide evidence of heterogenous clinical manifestations in family members sharing the same MFN2 molecular defect. Additionally, we present the first documented case of ASL-FTD associated with an MFN2 mutation, thereby expanding the range of MFN-related disorders. Further research involving larger cohorts of patients will be needed to better understand the role of MFN2 as a contributing gene in the development of ALS-FTD.

Clinical features and new molecular findings in Carnitine Palmitoyltransferase II (CPT II) deficiency.

Carnitine palmitoyltransferase II (CPT II) deficiency is the most common inherited disorder of lipid metabolism characterized in its adult form by attacks of myalgia and myoglobinuria. We analyzed a cohort of 22 CPT II-deficient patients (representing 20 independent probands) to correlate clinical presentation and molecular data. The common p.Ser113Leu mutation was detected with an allelic frequency of 67.5% (27/40), in association with mild adult-onset phenotype. In addition to the p.Ser113Leu mutation, other 10 disease-causing mutations were identified, 5 of which were novel. They are a micro-insertion within exon 5, three aminoacid substitutions within the coding region, namely p.Arg151Trp, p.Asp576Gly, p.Arg247Trp and a truncating stop codon mutation (p.Arg554Ter). Our data expand the spectrum of CPT II mutations and help to evaluate possible correlations between genotypes and phenotypes.

The missing link between philosophy and psychopathology.

INTRODUCTION: The uncertainty regarding the scientific status of psychiatry arises from psychiatry's involvement with some unsolved problems, or put in another way, from its enmeshment in certain points of transition of contemporary science. There is, in primis, the unsolved problem of the relationship between the mind and the body and, moreo- ver, the intricate relationship of connection/disjunction among biology, social science, anthropology, philosophy, etc. To speak about what psychopathology can expect from philosophy is, above all, to immerse oneself in a debate about the conditions of possibility of psychiatry as a science. This debate is especially concerned with the models of knowledge that have, until now, been proposed to psychiatry. Those models oscillate between the Dilthey's paradigms of the "Science of Nature" and the "Science of Spirit". METHODS: It is certain that psychopathology, as already indicated by Jaspers, is a discipline which is among the most involved regard- ing the use of the two different cognitive strategies. The first strategy concerns the concept of "explanation" and its rigid approach to the objective and ultimate cause of the phenomenon. The second strategy is the "comprehensive" approach. This model, which the hermeneutic thought defines "interpretative", theorizes the provisional character, the subjectiveness and the finiteness of every cognitive project. RESULTS: The interest of the authors is orientated towards the hermeneutic side (comprehensive-interpretative) of psychiatry, that which deals with the specificity of every clinical history, with the continuity of sense, and with intrinsic narrative intelligibility of every human event, psychopathological or not. CONCLUSIONS: This approach to psychopathology is based on the statement: "a clinical history is a text which must be interpreted". From this perspective, every clinical history should be perceived as a text to decipher but, above all, as a "text" to listen to, in the persevering expectation that it could disclose its particular "project of world". When speaking about psychiatry, we always face a problem which dominates all the others: the unsolved problem of the relation- ship between typicalness and singularity of subjective events. B.B. Mandelbrot, theorist of "fractals", sums this dilemma up clearly. He suggests that the innumerable variety of the configurations of Nature is a challenge to investigate the morphology of that which is "irregu- lar" in order to discover in it, as far as possible, a rule.

Never too late to be anxious: validation of the Geriatric Anxiety Inventory, Italian version.

AIM: The aim of this work was to validate the Italian version of GAI (GAI-It) and its short form (GAI-It SF) in an over 65-population. METHODS: In 3 recruitment areas across Italy, two raters reciprocally blind to results assessed eligible subjects; a semi-structured diagnostic clinical interview was performed by a psychiatrist. RESULTS: Among the 76 enrolled subjects (mean age 72.7±6.8 years), anxiety symptoms were very common: 69.7% (moderate/ severe HADS-Anxiety), 76.3% (moderate/severe STAI-state), 71.0% (moderate/severe STAI-trait), 61.8% (GAI), 55.3% (GAI-SF). Sensitivity, specificity and positive predictive value of GAI confirmed a good reliability of the Italian version, with Cronbach's Alpha equal to 0.93 for GAI-It and to 0.77 for GAI-It SF, indicating a very good and good construct validity, respectively, of the scales. The Pearson correlation index demonstrated a moderately positive correlation among GAI, GAI-SF and STAI. CONCLUSIONS: Our data confirm the validity of GAI-It as a valuable instrument to assess anxiety in an elderly population, for clinical and research purposes.

Revisiting mitochondrial ocular myopathies: a study from the Italian Network.

Ocular myopathy, typically manifesting as progressive external ophthalmoplegia (PEO), is among the most common mitochondrial phenotypes. The purpose of this study is to better define the clinical phenotypes associated with ocular myopathy. This is a retrospective study on a large cohort from the database of the "Nation-wide Italian Collaborative Network of Mitochondrial Diseases". We distinguished patients with ocular myopathy as part of a multisystem mitochondrial encephalomyopathy (PEO-encephalomyopathy), and then PEO with isolated ocular myopathy from PEO-plus when PEO was associated with additional features of multisystemic involvement. Ocular myopathy was the most common feature in our cohort of mitochondrial patients. Among the 722 patients with a definite genetic diagnosis, ocular myopathy was observed in 399 subjects (55.3%) and was positively associated with mtDNA single deletions and POLG mutations. Ocular myopathy as manifestation of a multisystem mitochondrial encephalomyopathy (PEO-encephalomyopathy, n = 131) was linked to the m.3243A>G mutation, whereas the other "PEO" patients (n = 268) were associated with mtDNA single deletion and Twinkle mutations. Increased lactate was associated with central neurological involvement. We then defined, among the PEO group, as "pure PEO" the patients with isolated ocular myopathy and "PEO-plus" those with ocular myopathy and other features of neuromuscular and multisystem involvement, excluding central nervous system. The male proportion was significantly lower in pure PEO than PEO-plus. This study reinforces the need for research on the role of gender in mitochondrial diseases. The phenotype definitions here revisited may contribute to a more homogeneous patient categorization, useful in future studies and clinical trials.

Coma After Quetiapine Fumarate Intentional Overdose in a 71-year-old Man: A Case Report.

A 71-year-old man developed coma with severe respiratory failure, hypotension, and tachycardia induced by the intentional ingestion of quetiapine fumarate extended release (XR) 20 g. At the time, he had been treated for bipolar depression with venlafaxine 75 mg/day, lamotrigine 100 mg/day, pregabalin 75 mg/day, and quetiapine XR 400 mg/day for approximately 1 year. Comorbidities were hypertension treated with metoprolol, diabetes mellitus type 2 treated with metformin, and benign prostatic hyperplasia treated with silodosin. In the emergency room, about 4 h after ingestion of quetiapine fumarate XR, the presenting symptomatology was characterized by coma (Glasgow Coma Scale score 3), hypotension (blood pressure [BP] 90/60 mmHg), tachycardia (electrocardiogram [ECG] showed sinus tachycardia with heart rate 120 beats per minute and a QTc of 499 ms). A gastric lavage was performed and activated charcoal 50 g and magnesium sulfate 30 g was administered. About 6 h after ingestion, he developed marked desaturation and underwent mechanical ventilation; 13 h after ingestion, a severe hypotensive episode followed (BP 70/40), which was treated with an infusion of ringer lactate 500 cc. On the 3rd day after intentional overdose, an episode of agitation occurred; 4 days after ingestion, the quetiapine plasma level was found to be 42 ng/ml (within therapeutic range). At 5 days after ingestion, the patient developed septicemia caused by staphylococci (probably originating from the central vein catheter), which was treated with antibiotic therapy. On days 10 and 18 after the suicide attempt, two episodes of paroxysmal supraventricular tachycardia (PSVT) occurred and were successfully treated with intravenous adenosine triphosphate. The patient recovered completely without residual symptoms. In line with literature data, in this case report, symptoms of quetiapine overdose were tachycardia, agitation, hypotension, QT interval prolongation, and coma. A causal relationship between PSVT and quetiapine intoxication seems quite unlikely due to the drug level.

Aging and the occurrence of dementia: findings from a population-based cohort with a large sample of nonagenarians.

CONTEXT: In spite of numerous studies on the occurrence of dementia, many questions remain, such as the relation between age, aging, and dementing disorders. This question is relevant both for understanding the pathogenetic mechanism of the dementias and for the public health prospective because of the increasing number of 85-year-old or older persons in our population. OBJECTIVE: To estimate the occurrence of dementia in the very old, including nonagenarians, in relation to age, gender, and different dementia types. DESIGN: An epidemiological survey where all participants were clinically examined by physicians, assessed by psychologists, and interviewed by nurses. The Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition (DSM-III-R) criteria for dementia were followed. A category of "questionable dementia" was added when all criteria were not fulfilled. A double diagnostic procedure was used for all subjects. SETTING: Community-based population, including all inhabitants of 2 areas in central Stockholm, Sweden (N = 1848). PARTICIPANTS: Of the 1848 subjects in the study population, 168 (9.1%) had died and 56 (3%) moved before examination. Of the remaining subjects, 1424 (87.7%) were examined, and the refusal rate was 12.3%. MAIN OUTCOME MEASURES: Age- and gender-specific prevalence figures, and gender- and education-adjusted odds ratios were used. RESULTS: At the end of the diagnostic procedure, 358 clinically definite cases of dementia and 101 questionable cases of dementia were identified. Alzheimer disease (AD) contributed to 76.5%, and vascular dementia (VaD) to 17.9%. The prevalence of dementia increases from 13% in the 77- to 84-year-old subjects to 48% among persons 95 years and older (from 18% to 61% when questionable cases were included). The odds ratio for subjects 90 to 94 years and 95 years and older in comparison with 77- to 84-year-old subjects was 3.7 (95% confidence interval [CI], 2.7-5.1) and 6.5 (95% CI, 3.9-10.8) for dementia, 4.8 (95% CI, 3.3-7.0) and 8.0 (95% CI, 4.6-14.0) for persons with AD, 2.3 (95% CI, 1.3-4.2) and 4.6 (95% CI, 1.9-11.2) for VaD, respectively. CONCLUSIONS: Dementia prevalence continues to increase even in the most advanced ages. This increase is especially evident among women and is more clear for AD. We believe that our prevalence data reflect the differential distribution of dementia risk.

The effect of education on dementia occurrence in an Italian population with middle to high socioeconomic status.

OBJECTIVE: To explore the relation between education and dementia prevalence by computing the odds ratios (ORs) for different educational levels after adjustment for age, gender, occupational level, and life habits. METHODS: A two-phase community study including 495 elderly subjects with middle to high socioeconomic status, aged more than 60 years and with a high percentage of noneducated subjects, was carried out in the province of Ravenna, Italy. Dementia and dementia type were clinically diagnosed using DSM-III-R diagnostic criteria. RESULTS: A higher prevalence of dementia was observed among noneducated subjects of both genders. Comparing no education with any education, the OR (adjusted for age, gender, and occupation) was 4.7 (95% CI = 2.3 to 9.6). The association, although present in all age groups, was extraordinarily strong among the youngest subjects (61 to 69 years) (OR = 139.5, 95% CI = 6.4 to 3,024.6) and decreased with increasing age. Life habits, such as smoking and alcohol consumption as well as current or previous history of hypertension, did not change the results. There was no significant difference in dementia prevalence among less well-educated (up to 3 years of education) and better-educated subjects (more than 3 years of schooling) after age and gender were taken into account. Similar findings were found for Alzheimer's disease and vascular dementia separately. CONCLUSIONS: Having no education is associated with dementia independent of gender, occupation, life habits, and hypertension. This association was stronger among younger old persons, and decreased with increasing age. The findings suggest that the first decade of life is a critical period for developing dementia later in life. The decrease in dementia risk may be due to schooling, according to the cerebral reserve hypothesis, or to other factors associated with a higher educational level during childhood.

Prevalence and severity of dementia among northern Italian centenarians.

Using diagnostic criteria from the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders, dementia was clinically diagnosed in 57 (62%) of 92 centenarians living in two northern Italian provinces. The condition was severely disabling in approximately 70% of the demented patients. Although clinically diagnosed AD accounted for 79% of dementia cases, almost one third of patients with AD had risk factors for vascular dementia, suggesting that the aging brain may be susceptible to multiple additive factors that impair cognition.

Serum ferritin in type I diabetes.

The concentration and degree of glycosylation of serum ferritin was evaluated in type I male diabetic patients at different levels of glycaemic control. Serum ferritin did not appear to be affected by hyperglycaemia, but some patients undergoing photocoagulation had abnormally high levels of serum ferritin. The glycosylated, (concanavalin A binding), proportion of serum ferritin was essentially the same in the control and diabetic groups. The finding that hyperglycaemia does not affect the degree of enzymatic glycosylation of this serum protein is discussed.

Self-monitoring and blood pressure.

The association between self-monitoring (regulation and control of nonverbal and expressive behavior) and blood pressure was examined in a field study of 594 municipal employees. For persons not taking antihypertensive medication, the Acting/Extraversion scale was mildly positively associated with resting blood pressure among whites in general, blue collar, clerical, and professional groups. Stronger positive correlations were obtained for attorneys and customer service representatives. These results are contrasted with slightly negative associations for blacks in general, first-level supervisors, and a group of previously studied union stewards. An interactive effect was also obtained between Acting/Extraversion and relative participation in work versus nonwork groups and activities; Acting/Extraversion and systolic pressure were inversely related for employees more active in extrawork groups but not related among other workers. Differential consequences of greater or lesser interpersonal involvement and emotional regulation in different jobs are considered.

Worldwide prevalence and incidence of dementia.

Dementia is a common and disabling disorder in the elderly. Because of the worldwide aging phenomenon, existing in both developed and developing countries, dementia has a growing public health relevance. This article reviews the prevalence and incidence data for dementia reported in the international literature in the last 10 years. Results from 36 prevalence and 15 incidence studies have been examined. Prevalence is equal to 0.3 to 1.0 per 100 people in individuals aged 60 to 64 years, and increases to 42.3 to 68.3 per 100 people in individuals 95 years and older. The incidence varies from 0.8 to 4.0 per 1,000 person years in people aged 60 to 64 years, and increases to 49.8 to 135.7 per 1,000 person years when the population was older than 95 years. The international comparison allows the following conclusions: (i) both prevalence and incidence show little geographical variation, as differences between countries seem to reflect methodological rather than real differences [the low prevalence of dementia in Africa needs to be confirmed by incidence data]; (ii) both incidence and prevalence figures increase with age even in the advanced ages; (iii) regarding dementia types, most of the inconsistency in results from different studies is due to vascular dementia rather than to Alzheimer's disease (AD); (iv) it is still unclear if the reported higher frequency of vascular dementia in Asian populations is due to differential distribution of genetic and/or environmental factors, or due to methodological differences; (v) different dementia types might have different age distributions.

Analytical methods for the quality control of Prozac capsules.

Some analytical methods (two spectrophotometric and two chromatographic procedures) for the determination of fluoxetine in Prozac capsules are described. All of them are applied to the samples after extracting the drug with a methanol water mixture. The direct and derivative spectrophotometric methods are simple and reliable; the derivative method gives better recovery and lessens interference. Both methods show linearity in the 5-30 microg ml(-1) range of the fluoxetine concentration range. Both HPLC methods (spectrophotometric and spectrofluorimetric detection) use a tetramethylammonium perchlorate buffer-acetonitrile mixture as the mobile phase and a C8 reversed phase column. The UV detection is performed at 226 nm, while the fluorimetric detection is performed by exciting at 230 nm and revealing the emission at 290 nm. The HPLC method with UV detection is more precise, but the procedure with fluorimetric detection is more sensitive.

[Anxiety-generating stress]. / Stress ansiogeno.

After a definition of the condition and a discussion of its physiopathological significance, the need to examine the patient as a whole and provide total therapy is emphasised with reference to both the literature and personal cases. It is concluded: 1) that the mesodiencephalic structures, especially the hypothalamus, are of primary importance in human physiological and pathological processes. The hypothalamus is the real brain of the viscera, the functional bridge between the hypophysis, the limbic structures and the upper cortical centres; 2) that doctors should consider the role of the hypothalamus in the diagnosis and therapy of the total person: a) in evaluating the patient's real emotional and psychological situation; b) in realising that the simple administration of a drug to cure the organic symptom really means only partial treatment of the patient himself.

Blood pressure of male municipal employees: effects of job status and worksite.

Repeated measurements of resting blood pressure and heart rate were obtained at the worksite for a sample of 441 male municipal employees ranging widely in age (M = 41 yr.), job level, and education. As a result of unusually high diastolic values (M = 91), over-all uncontrolled hypertension rates were very high (33% of the men exceeding 160 systolic or 95 diastolic including those on medication). Higher rates were obtained for blue collar as opposed to white collar employees and for those plant workers in the Division of Water as opposed to Sewerage and Drainage. Net of age, weight, smoking, education, and anti-hypertensive medication use, higher systolic and diastolic mean values were obtained for supervisors who were primarily employed as foremen and clerical personnel. Inter-plant differences in blood pressure were also found for primarily blue collar Sewers and Drains employees, though whites' and blacks' values were nearly identical. Comparisons with national blood pressure data indicate significant effects for level of job and education which again disfavored supervisors and clerical employees and in addition men who had more education. Whites' and blacks' blood pressures deviated significantly from expected values, the differences favoring blacks. Social psychological mechanisms which may mediate these effects are discussed.