Monoamine oxidase inhibitor-induced speech blockage.

Speech blockage has been identified by recent case reports as a side effect of tricyclics in the treatment of depression. The first report of speech blockage associated with a monoamine oxidase inhibitor is presented and the possible mechanisms are discussed. All reports, including this one, associate this phenomenon with clinical improvement.

Functioning and well-being of patients in a consultation-liaison psychiatry clinic.

Outpatient consultation-liaison (C-L) psychiatry clinics are valuable settings for research and teaching endeavors. However, little is known about psychiatric symptoms and health status of persons treated in such settings. In this study, 80 persons seen in an outpatient C-L psychiatry clinic were compared with 100 persons seen in a mood disorder clinic on a variety of self-report instruments. Outpatient C-L clinic patients were found to have significantly poorer health status than mood clinic patients on the following domains as measured by the RAND instrument: general health perception, pain, physical functioning, and role functioning due to physical problems. Both groups had poor role functioning due to emotional problems and poor social functioning. The groups did not differ in depressive symptoms but C-L patients were significantly less anxious. Thus, it appears that patients in an outpatient C-L setting not only have significant medical comorbidity, as expected, but have levels of psychiatric distress comparable to that seen in a traditional psychiatry outpatient setting. These findings indicate that such a clinic is a fertile area for research and training in the diagnosis and treatment of persons with comorbid physical and mental disorders.

AIDS and women in Brazil: the emerging problem.

This paper compares and problematizes the public discourse on AIDS and sexuality with the actual private discourse of low-income urban women in Brazil. Women's perspectives on sexuality are explored by examining what they say about anal sex, virginity, and fidelity and are seen as approximating culturally scripted ideals for sexual behavior. AIDS discourses that are being proposed by the Brazilian government, Brazilian AIDS activist groups and the women's movement are examined in light of these perspectives. Condom literacy, a central component to the Brazilian AIDS activist campaign, is problematized within the context of low-income women's lives.

Case report: psychosis with Stevens-Johnson syndrome and toxic epidermal necrolysis.

A case is presented of a 36-year-old woman who developed a psychosis following an apparent systemic allergic reaction to phenytoin and/or phenobarbital. She was initially diagnosed as having Stevens-Johnson syndrome and toxic epidermal necrolysis with the subsequent development of a psychosis. The authors were able to demonstrate a previously undiagnosed neurological impairment that they feel may be related to both the drug reaction and the psychosis.

Borderline symptom inventory: assessing inpatient and outpatient borderline personality disorders.

The Borderline Symptom Inventory (BSI), a 52-item self-report inventory, was administered to cohorts of patients diagnosed with borderline personality disorder (BPD), affective disorder and a normal control sample. The study failed to demonstrate that the inventory could effectively discriminate either ambulatory or hospitalized BPD patients from those with affective disorders, but that the inventory could correctly specify a control group without a psychiatric disorder. The results suggest that it is premature to utilize the BSI as a reliable screen to detect BPD.

Thigh bleeding time as a valid indicator of hemostatic competency during surgical treatment of patients with advanced renal disease.

We compared the usefulness of the modified Ivy bleeding time performed in the forearm (arm bleeding time) with that performed in the thigh (thigh bleeding time) as an indicator of hemostatic competence during surgical treatment in 16 patients with chronic renal failure. In 22 normal adults, the arm bleeding time (mean plus or minus standard deviation, 6.6 +/- 1.4 minutes) was significantly longer than the value in the thigh (mean plus or minus standard deviation, 4.1 +/- 1.3 minutes) (p less than 0.001), and there was no correlation between arm and thigh bleeding time. Preoperatively, the arm bleeding time in patients with renal disease was markedly prolonged (greater than 20 minutes) in 15 patients and slightly prolonged in one patient. There was no abnormal perioperative bleeding in 13 patients whose preoperative thigh bleeding time was seven minutes or less. Prolonged and excessive perioperative bleeding was observed in three patients whose thigh bleeding time was 8.0, 9.5 and 26.5 minutes. These findings suggest that thigh bleeding time is a better indicator of competence of primary hemostasis during the operation than the arm bleeding time in patients with advanced renal failure.