Sex and psychiatric comorbidity correlates of the premonitory urge for tic scale in youth with persistent tic disorders.

The premonitory urge for tics scale (PUTS) is a common self-report measure of premonitory sensations preceding tics. The present study aimed to examine the internal consistency and concurrent validity of the PUTS by sex and psychiatric comorbidity status; and explored interactions between sex and psychiatric comorbidity in predicting premonitory urge and tic symptom severity. Seventy-four youth and young adults with persistent tic disorders completed the PUTS, while their parents completed the parent tic questionnaire (PTQ) and a demographic measure. Independent samples t-tests revealed no significant sex differences in PUTS items or total score. The PUTS total score also did not significantly differ between participants with and without attention-deficit hyperactivity disorder (ADHD) and/or obsessive-compulsive disorder (OCD) comorbidity. Internal consistency did not significantly differ between females (α = 0.85) and males (α = 0.75), and those with comorbid ADHD and/or OCD (α = 0.83) relative to those without (α = 0.69). With respect to concurrent validity, the PUTS total was significantly correlated with PTQ tic frequency, intensity, number, and severity for males but not for females. Among those with ADHD and/or OCD, the PUTS total score was correlated significantly and strongly with tic number and moderately with tic intensity. Interactions between sex and psychiatric comorbidity performed using 2 × 2 analysis of variance did not significantly predict the PUTS total or PTQ subscale scores. Findings suggest sex and comorbidity status may influence premonitory urge expression. Results have implications for understanding and measurement of the premonitory urge.

Locomotor-respiratory synchronization after body weight supported treadmill training in incomplete tetraplegia: a case report.

STUDY DESIGN: Case report. OBJECTIVES: To report on the respiratory and kinematic changes associated with body weight supported treadmill training (BWSTT) in an individual with an incomplete cervical spinal cord injury (SCI). SETTING: Human Locomotion Research Laboratory, Vancouver, BC, Canada. METHODS: A 38-year-old man with an incomplete SCI at the C1/C2 level, graded on the American Spinal Injury Association Impairment Scale (AIS) as AIS D, participated in this case study. He performed three BWSTT sessions (45 min) per week for 12 weeks. Before and after training, respiration was measured at the mouth using a pneumotachograph while treadmill walking at 1.6 km h(-1). RESULTS: Completion of 12 weeks of BWSTT resulted in a lowering of minute ventilation during treadmill exercise. A coupling of locomotion and respiration was observed during treadmill walking after the training program, whereas the relationship was initially absent. CONCLUSION: This case illustrates that BWSTT can result in a reduced ventilatory demand and promote locomotor-respiratory coupling during walking in an individual with an incomplete cervical SCI.

Validity of patients' self-reported drug use as a function of treatment status.

Recent reviews conclude that there is some evidence that drug abusers' self-reports are reliable and valid. However, there are wide variations among studies depending upon the samples and procedures used to obtain the data. The current study was conducted to extend the findings in this area. An examination of the intake interviews and same day urinalyses on 150 patients enrolling for outpatient opioid detoxification or maintenance revealed a fairly high agreement between drug use self-reports and urinalyses. A second study (N = 70) looking at the validity of self-reported drug use at intake and at 4 weeks follow-up revealed some noticeable changes in validity measures, suggesting that contingencies on positive urine results influence self reported drug use of addicts.

Meniscal injury in the anterior cruciate-deficient knee. A rationale for clinical decision-making.

Meniscal injury is common in acute or chronic anterior cruciate ligament insufficiency. The patterns of meniscal lesions are predictable in the acute and chronically unstable knee. The early incidence of meniscal injury is high and increases with time. Meniscal repair has become increasingly successful. Techniques for anterior cruciate ligament reconstruction have also improved, and with more progressive rehabilitation programmes, this has become a more tolerable procedure for both patients of highly athletic lifestyles and more moderate recreational athletes. The decision-making process for the sports medicine physician requires an overall assessment of many variables. A delicate balance of factors such as age, sex, joint laxity, activity level, individual motivation, social circumstances, associated meniscal, collateral ligament and/or chondral damage may sway the surgeon towards a nonoperative or operative decision. At the present time, a 'cook book' answer to each case presented is not available. As in all of medicine, each patient is an entity that requires an individual evaluation and a specific course of treatment. This review aims to help in this decision-making process. Future prospective studies investigating the many variables mentioned will hopefully objectively delineate guidelines for the choice of the most effective therapeutic regimen.

The accuracy of double-contrast arthrographic evaluation of the anterior cruciate ligament. A retrospective review of one hundred and sixty-three knees with surgical confirmation.

In a retrospective review of 163 knees, the double-contrast arthrogram proved to be an accurate method of evaluating the anterior cruciate ligament. The status of the ligament was examined arthrographically with two stress lateral projections: a horizontal cross-table radiograph and a fluoroscopic spot radiograph. The condition of the ligament was interpreted as being normal, lax but intact, torn with intact synovial tissue, or torn or absent. The status of the ligament was subsequently determined at either arthrotomy or arthroscopy by inspection, palpation, and judgment of the degree of tension under stress. The arthrographic diagnosis was found to be 91.4 per cent accurate within the individual subclassifications and 95 per cent accurate in confirming the ligament to be either intact or abnormal. Injury to the anterior cruciate ligament frequently occurs in association with meniscal tears. In our series, 138 of the 163 knees had either a meniscal or a cruciate lesion, or both. Of these, forty-one (30 per cent) had a meniscal lesion, thirty-four (25 per cent) had a cruciate lesion, and sixty-three (45 per cent) had both. We have found the double-contrast arthrogram to be an accurate method of determining the condition of both the anterior cruciate ligament and the menisci in a single outpatient examination.

An in vitro biomechanical evaluation of anterior-posterior motion of the knee. Tibial displacement, rotation, and torque.

We tested the anterior-posterior motion of nine normal cadaver knees in zero to 90 degrees of flexion using a specially designed apparatus. This apparatus applied a dynamic anterior-posterior force to each knee and measured the resulting tibial displacement, rotation, and torque. In the intact knee, an anterior force produced an internal tibial torque and internal tibial rotation, while a posterior force produced an external torque and external rotation. Anterior-posterior displacement increased by 30 per cent when the tibia was allowed to rotate freely about its neutral rotation position. Isolated section of the anterior cruciate ligament produced more than double the amount of anterior displacement without affecting posterior displacement. Isolated section of the posterior cruciate ligament produced almost triple the amount of posterior displacement without affecting anterior displacement. After cutting either the anterior or the posterior cruciate ligament, the resulting internal or external secondary tibial rotation disappeared. It appears, therefore, that the anterior and posterior cruciate ligaments are the primary restraints to motion in the anterior and posterior directions as well as the causes of internal and external tibial rotation during anterior and posterior motion.

Bilateral simultaneous rupture of the infrapatellar tendon in a recreational athlete. A case report.

Bilateral rupture of the infrapatellar tendons is a rare event in an otherwise healthy athletic individual. The event is usually quite severe and diagnosis can be readily made on a clinical examination. In the case presented here, predisposing factors consisted of an underlying patella alta and a long history of repetitive trauma to the knee. Prompt diagnosis and surgical repair will lead to a good functional result.

Adolescent personality disorder symptoms mediate the relationship between perceived parental behavior and Axis I symptomatology.

A study was conducted to investigate whether adolescent personality disorder symptoms mediate the relationship between perceived parental behavior and Axis I psychiatric symptomatology. The Parental Behavior Form, Personality Diagnostic Questionnaire-Revised, and Revised Hopkins Symptom Checklist (SCL-90-R) were administered to 187 first-year undergraduate students during their first week of college enrollment. One hundred fifty seven participants were readministered the SCL-90-R two months later. Results of correlational and hierarchical multiple regression analyses indicated that: (1) Adolescents' perceptions of parental acceptance/nurturance and harsh, controlling parental behavior were associated with baseline personality disorder symptom levels. (2) Perceived harsh parental control predicted both baseline and follow-up Axis I symptomatology. (3) In turn, baseline personality disorder symptoms were associated with Axis I symptom levels, both at baseline and at follow-up assessment after baseline Axis symptoms were accounted for. (4) Perceived parental behavior did not predict baseline or subsequent Axis I symptomatology after personality disorder symptom levels were accounted for. The present findings thus indicate that personality disorder symptoms completely mediated the relationship between adolescent perceptions of harsh, controlling parental behavior and Axis I psychiatric symptomatology.

Patterns of meniscal injury with acute anterior cruciate ligament tears.

One hundred two patients underwent an arthrotomy for the primary repair of an acute ACL tear with or without an associated collateral ligament injury. The mean age was 23 years. Forty-seven patients (46%) had meniscal injuries. Meniscal injuries were found in 41% of Group I patients (isolated ACL injuries) and in 54% of Group II patients (injured ACL/collateral ligaments). Twenty-eight medial and 22 lateral meniscal tears were noted. Twenty-six of the 50 meniscal tears (52%) were sutured in an attempt to repair the menisci. Of these, 20 of the medial (71%), and 6 of the lateral (27%) meniscal injuries were sutured. No patients in this series required a total meniscectomy. A thorough evaluation of the menisci is mandatory in knees with an acutely injured ACL.

The long-term followup of primary anterior cruciate ligament repair. Defining a rationale for augmentation.

Fifty primary ACL repairs using the Marshall multiple suture technique were analyzed. The average age at surgery was 23 years (range, 15 to 56), with 76% under the age of 30. The average followup was 61.3 months (range, 48 to 86). The average time from injury to surgery was 7 days (range, 1 to 18). Eighty percent of the injuries were sports-related with football and skiing predominating. Thirty-eight percent were "isolated" ACL tears, and 62% had associated injuries. There was a 46% incidence of meniscal tear with 59% of the meniscal tears being repaired. The postoperative evaluation included a multifactorial analysis correlating 43 variables including subjective, objective, radiographic, and KT-1000 data. The Hospital for Special Surgery Knee Diagnostic Score, a clinical objective score based on the postoperative Lachman and pivot shift examination, a KT-1000 arthrometer data score, and an overall combined assessment score were determined. The results showed 59% excellent, 18% good, 14% fair, and 8% poor. The Lachman test was diagnostic in all cases. The quality of ACL tissue at repair was rated excellent or good in 62% of the cases. Four patterns of ACL tears were distinguished by the location of the tear. Football injury, younger age, increased peroperative pivot shift, midsubstance Type IV tear, and return of full motion correlated with poor postoperative results. Increasing age, tight jointedness, Type I tears, and a 5 degrees flexion contracture correlated with good postoperative results.

Relationship between alcohol expectancies and length of abstinence among Alcoholics Anonymous members.

Previous research has demonstrated a consistent relationship between alcohol expectancies (i.e., cognitive expectancies concerning the reinforcing effects of alcohol) and alcohol consumption patterns. To date, no study has examined the expectancies of recovering alcoholics who have attained extended abstinence. One hundred and fourteen Alcoholics Anonymous members were examined. Significant negative correlations were found between the recovering alcoholic's length of sobriety and many of the alcohol expectancy scales. In addition, 11 items from the Customary Drinking Record-Revised and 2 items from the Demographic Data Sheet were factor analyzed resulting in the retention of two factors, Quality of Life and Desire to Drink. These factors seemed to be tapping important dimensions in the alcoholic's recovery. Two alcohol expectancy scales were found to be significantly predictive of the Desire to Drink and Quality of Life factors that were used as criteria in multiple regression equations.

Situational determinants of alcohol abuse among Caucasian and African-American college students.

The present study examined gender, race, and binge status differences in alcohol consumption among Caucasian and African-American college students as well as situational differences as qualified by the race of binge drinkers. A confidential questionnaire was voluntarily completed by Caucasians (n = 102) and African-Americans (n = 81) at a medium-sized regional university. The data analysis revealed a significant gender effect on alcohol consumption, with men consuming more alcohol than women. There was no significant main effect of race on alcohol consumption. In addition, Caucasian binge drinkers had significantly higher interpersonal problem behavior scores than did binge-drinking African-Americans, and binge-drinking African-Americans had higher intrapersonal problem behavior scores than did binge-drinking Caucasians.

Alcohol expectancies and changes in beer consumption of first-year college students.

The present study used a prospective design to evaluate the relationship between alcohol expectancies and the progression of beer consumption of first-year college students over a 2-month period. One hundred and fifty-four first-year undergraduate students completed the Alcohol Expectancy Questionnaire (AEQ; Brown, Goldman, Inn, & Anderson, 1980) and a measure of precollege drinking during their first week of college, and completed a retrospective diary account of alcohol consumption also during the first week and at 1-month and 2-month follow-up. Beer was consumed considerably more frequently than other alcoholic beverages and was used as the dependent measure. The results showed that each AEQ subscale was positively correlated with beer consumption at almost all time points, and the magnitude of these correlations was generally higher for male subjects. Furthermore, the expectancies that alcohol increases social assertiveness and that alcohol is associated with global, positive changes were positively correlated with increases in beer consumption from Session 1 to Session 2 and from Session 1 to Session 3 for male, but not female, subjects. The findings extend previous research by demonstrating that certain alcohol expectancies are related to progressive increases over time in the amount of beer consumed.

Psychiatric symptoms in polysubstance abusers: relationship to race, sex, and age.

The Symptom Check List 90R (SCL-90R) was administered to a sample of 94 polysubstance abusers seeking outpatient detoxification for opioid addiction. The relationships among race, sex, and age, and psychiatric symptoms were examined. Results obtained by an ANOVA indicated a significant effect only for race. White substance abusers reported significantly more psychiatric symptoms (on 9 out of 12 SCL-90R scales) than did Black substance abusers. A comparison of effect sizes between those found in the present study and those of related studies is also presented. Results suggest that race differences may be relevant to treatment resource and treatment planning.

Knee bracing.

Bracing the knee is a controversial, complex, and often confusing subject. Knee braces are categorized as either prophylactic, rehabilitative, or functional. Bracing goals are to prevent, assist, restrict, align, or simulate function of the knee. A working knowledge of the capabilities and limitations of specific braces in these different categories is required of the physician to properly prescribe these orthotics.

Primary repair of the anterior cruciate ligament.

The article reviews the clinical features of the acutely torn anterior cruciate ligament. The alternatives and techniques of repair are discussed. Results of primary repair are presented. A rationale for therapeutic options is presented.

Brief psychosocial assessment of a clinical sample: an evaluation of the Personal Problems Checklist for Adults.

In light of the requirements for managed health care organizations to use assessment instruments that are psychometrically sound, cost and time efficient, and theoretically useful, the present study examined the psychometric properties of one such potential instrument, the Personal Problems Checklist for Adults (PPCA). Designed to measure problems in 13 areas of everyday functioning, the PPCA along with the Brief Symptom Inventory were completed by 132 individuals in an outpatient drug rehabilitation program. Counselor ratings on the Adjective Check List were also obtained. Results clearly showed that personal problems as measured by the PPCA were related to self-reported psychological symptoms and to perceptions by their counselors. The PPCA proved to have good psychometric properties and warrants greater attention by testing psychologists given its potential to meet criteria set forth by managed health care.

Surgical management of posterior shoulder instability in a ten-year-old boy: a case report and literature review.

Posterior shoulder instability is an uncommon clinical entity. It is even more rare in the pediatric population. We report the case of a 10-year-old boy who experienced recurrent posttraumatic posterior shoulder instability that eventually required surgical intervention. A review of the literature revealed no previous report of surgical management of nonobstetrical posttraumatic posterior glenohumeral instability in a skeletally immature individual.

The relationship between perceived parental favoritism and self-esteem.

In this study of 91 male and female college subjects, we used two questionnaires to explore the relationship between the students' perceived parental favoritism and their self-esteem. In addition, the prevalence of parental favoritism, the reasons for it, and the ways it is shown were examined. Results indicated that total self-esteem and two facets of self-esteem were related to parental favoritism; the no-favoritism subjects had higher total self-esteem than the nonfavored subjects, the no-favoritism and the favored subjects had higher self-esteem with respect to home-parent relationships than the nonfavored subjects, and the no-favoritism subjects had higher social self-esteem than the favored subjects. Furthermore, the perception of parental favoritism was widespread--62% of the subjects thought one or both of their parents had a favored child. Moreover, parents were more likely to show favoritism in subtle ways than in more obvious material ways; and the predominate reasons given for favoritism were the child's intellect, behavior, birth-order, and creativity rather than his or her physical appearance or gender.

Silencing the self and the big five: a personological profile of silent women.

This study examined the correlations between scores on Jack and Dill's 1992 Silencing the Self Scale and Costa and McCrae's 1985 Big Five personality factors among 146 female undergraduates. Analyses indicated the Silencing the Self scores were positively correlated with those on Neuroticism and negatively correlated with those on Openness, Extraversion, and Agreeableness. In addition, regression analysis indicated that Neuroticism and Openness scores showed the greatest contribution to Silencing the Self scores. These findings suggest the possible importance of studying personality traits in women who utilize the silencing the self schema in interpersonal contexts.