bluuebunny/crossref_metadata_2025 huggingface dataset:
Marginal and internal fit of all‐ceramic CAD/CAM crown‐copings on chamfer preparations
Authors: BINDL A. , MÖRMANN W. H.
Published: May 2005

summary:  Evaluation of the marginal and internal fit of all‐ceramic molar crown‐copings hypothesizing that Computer Aided Design/Computer Aided Manufacturing (CAD/CAM) fabrication shows the same accuracy of fit as conventional techniques. A set of six individual crown preparations was duplicated 12 times yielding 72 plaster dies. Slip‐cast (In‐Ceram Zirconia®), heat‐pressing (Empress II®) and CAD/CAM crown‐copings (Cerec inLab®, DCS®, Decim® and Procera®) were seated on 12 dies each. Marginal and internal gap width was measured in the SEM at 120× magnification. Marginal gap of slip‐cast (25 ± 18 μm) was significantly (P < 0·05) smaller than that of Empress II® (44 ± 23 μm) copings. Procera® (17 ± 16 μm) and Decim® (23 ± 17 μm) did not differ (P > 0·05) from slip‐cast (25 ± 18 μm) but were smaller (P < 0·001/P < 0·01) than Empress II® (44 ± 23 μm) and Cerec inLab® (43 ± 23 μm) (P < 0·001/P < 0·05). DCS® (33 ± 20 μm) did not differ (P > 0·05) from any of the others. The internal mid‐orobuccal gap width of Procera® (136 ± 68 μm) was larger (P < 0·001) than that of Decim® (81 ± 30 μm) and slip‐cast (94 ± 84 μm) (P < 0·05) while Empress II® (105 ± 53 μm), DCS (110 ± 79 μm) and Cerec inLab® (114 ± 58 μm) did not differ significantly (P > 0·05) from Decim®, Procera® and slip‐cast. Internal mesiodistal gap width was similar. The fit of conventional and CAD/CAM all‐ceramic molar crown‐copings covered the same range of gap width confirming the assumed hypothesis.
The effects of phosphoric acid, sodium hypochlorite, ferric oxalate and Scotchbond Multipurpose on the rate of pressure change across dentine: a laboratory study
Authors: NG L. P. , WILSON P. R.
Published: May 2005

summary  The aim of this study was to investigate the consequences of dentine treatment on dentine permeability of crown preparations treated with phosphoric acid, sodium hypochlorite (NaOCl), and then ferric oxalate (Sensodyne sealant) or bis‐phenol‐A‐diglycidyldimethacrylate (BIS‐GMA) and hydroxyethylmethacrylate (HEMA) resin combination (Scotchbond Multipurpose). Thirty human premolars received full crown preparations (stage A), were then acid etched (stage B) and subsequently the pulp chamber flushed with NaOCl (stage C). They were then randomly assigned to two groups: group 1 was treated with Scotchbond Multipurpose and group 2 with 6% ferric oxalate (Sensodyne sealant) (stage D). Both groups were acid etched a second time (stage E) as the final step in the sequence. The rise in pressure in the pulp chamber because of the transmission of saline from the pressure chamber through cut dentine was recorded by a pressure transducer after each of the stages described (A to E). The mean rate of pressure change across dentine (Pa s−1) for each measurement point (A to E) (n = 30) were A = 2·3; B = 9·8; C = 16; D = 2·1; E = 3·1. Acid etching and NaOCl were both effective in producing significant increases in the rate of pressure change across dentine (P < 0·05). Sensodyne sealant and Scotchbond Multipurpose are both effective dentine sealants and there is no significant difference (P > 0·05) in their abilities in sealing dentine. Acid etching‐sealed dentine produced a significant increase in the rate of pressure change across dentine (P < 0·05). The sealing of dentine appears to be a sensible consideration following crown preparations on vital teeth.
The impact of eicosanoids on the crosstalk between innate and adaptive immunity: the key roles of dendritic cells
Authors: Harizi H. , Gualde N.
Published: May 2005

Abstract:  The innate immune response is essentially the first line of defense against an invading pathogen. Through specialized receptors, known as pattern recognition receptors, especially Toll‐like receptors, specialized cells of myeloid origin, including macrophages and dendritic cells (DCs) are able to phagocytose microorganisms and induce an innate inflammatory response. Although B and T lymphocytes recognize tissue antigens with high specificity, they are unable to initiate immune responses. The decision to activate an appropriate immune response is made by unique DC, the most professional antigen‐presenting cells (APCs) which control the responses of several types of lymphocytes and play central role in the transition between innate and adaptive immunity. Increased secretion of inflammatory endogenous mediators such as cytokines and arachidonic acid‐derived lipid mediators, also termed eicosanoids, can activate APC, particularly DC, which in turn induce an adaptive immune response. There is an increasing evidence that eicosanoids play an important role in connecting innate and adaptive immunity by acting on cells of both systems. Prostanoids, a major class of eicosanoids, have a great impact on inflammatory and immune responses. PGE2 is one of the best known and most well‐characterized prostanoids in terms of immunomodulation. Although cytokines are known as key regulators of immunity, eicosanoids, including PGE2, PGD2, LTB4, and LTC4, may also affect cells of immune system by modulating cytokine release, cell differentiation, survival, migration, antigen presentation, and apoptosis. By acting on various aspects of immune and inflammatory reactions, these lipid mediators emerge as key regulators of the crosstalk between innate and adaptive immunity.
Natural killer cell HLA‐C epitopes and killer cell immunoglobulin‐like receptors both influence outcome of mismatched unrelated donor bone marrow transplants
Authors: De Santis D. , Bishara A. , Witt C.S. , Nagler A. , Brautbar C. , Slavin S. , Christiansen F.T.
Published: May 2005

Abstract:  Matching of donor and recipient for the class I human leukocyte antigen‐C (HLA‐C)‐encoded natural killer (NK) epitopes has been reported to influence stem‐cell (SC) graft outcome, but a consistent picture has not yet emerged. We have analyzed transplant outcome in 104 unrelated SC grafts in relation to NK epitope (C1 and C2) matching and donor killer cell immunoglobulin‐like receptor (KIR) genotype. NK epitope mismatching in the rejection direction was strongly associated with an increased probability of rejection subsequent to engraftment. The prevalence of grades III–IV acute graft‐vs‐host disease (GVHD) was significantly higher and occurred significantly earlier when there was NK epitope mismatching in the GVH direction. Higher transplant‐related mortality and lower disease‐free survival rates were associated with epitope mismatching regardless of the mismatch direction. A greater number of KIR receptors, both activating and inhibitory, in the donor protected against grades III–IV GVHD and improved survival.
HLA‐B*5701 typing by sequence‐specific amplification: validation and comparison with sequence‐based typing
Authors: Martin A.M. , Nolan D. , Mallal S.
Published: May 2005

Abstract:  Susceptibility to abacavir hypersensitivity (ABC HSR) is strongly associated with alleles carried on the 57.1 ancestral haplotype including HLA‐B*5701 and Hsp70 Hom M493T. In one study, prospective testing for HLA‐B*5701 and exclusion of individuals carrying this allele, from receiving abacavir, substantially lowered the incidence of ABC HSR to 0% (95% confidence interval 0–0.075%). The presence of HLA‐B*5701 is usually detected by standard serological tests and by molecular genetic methods such as sequence‐based typing (SBT). While the former test cannot discriminate between HLA‐B57 subtypes, the expensive SBT may not be readily available in all laboratories. Hence, an alternate method was developed to detect HLA‐B*5701 using allele and group‐specific polymerase chain reaction‐sequence‐specific primers (PCR‐SSP) typing. This PCR‐SSP‐typing method positively amplified all HLA‐B*5701 alleles in concordance with their SBT‐assigned typing. This multiplexed SSP assay was able to distinguish between HLA‐B*5701 (n = 10) and closely related HLA‐B57 alleles B*5702 (n = 2), ‐B*5703 (n = 1), ‐B*5704 (n = 1) alleles and non‐HLA‐B*57 alleles (n = 61). In conclusion, this method of HLA‐B*5701 detection is a rapid and accurate typing method with high specificity, sensitivity and reproducibility.
Identification of a novel HLA‐A*0278 allele in a Chinese family*
Authors: Ji Y. , Sun J.‐L. , Du K.‐M. , Xie J.‐H. , Ji Y.‐H. , Yang J.‐H. , Fu M. , Sun Y. , Jin Y. , Liu D.‐Z. , Zhao T.‐M.
Published: May 2005

Abstract:  A novel human leukocyte antigen‐A (HLA‐A) allele, A*0278, has been identified in a Chinese family using DNA‐based typing and molecular cloning methods. The alleles A*0278 differs from its closest matching HLA sequence of A*0256 by a silent substitution at 102 A > C and by two replacement substitutions, 98T > A and 292 C > G in exon 2, resulting in a change of codon 33 from Phe (TTC) to Tyr (TAC) and codon 98 from His (CAC) to Asp (GAC). Serology study revealed that A*0278 is associated with HLA‐A2 broad specificity. A polymerase chain reaction‐sequence‐specific primers‐based assay was developed to identify A*0278. Family study indicated that the propositus inhered his father's HLA haplotype A*0278, B*35, DRB1*15. No further individuals of A*0278 were found in 5000 Chinese bone marrow donor volunteers.
Interleukin‐18‐promoter polymorphisms are not relevant in rheumatoid arthritis
Authors: Rueda B. , González‐Gay M.Á. , Mataran L. , López‐Nevot M.Á. , Martín J.
Published: May 2005

Abstract:  Interleukin‐18 (IL‐18), a member of the IL‐1 family, is known to play a relevant role in rheumatoid arthritis (RA) physiopathology mainly by promoting the inflammatory response. The aim of this work was to investigate the possible implication of two single‐nucleotide polymorphisms (SNPs) [−607 A/C (rs1946518) and −137 G/C (rs187238)] within the IL‐18‐promoter region in RA predisposition and clinical course. A total of 362 unrelated RA patients and 339 healthy controls were genotyped using a real‐time polymerase chain reaction (PCR) method for the −607 A/C SNP and a sequence‐specific PCR method (PCR‐SSP) for the −137 G/C polymorphism. No statistically significant differences were observed for both −607 and −137 IL‐18‐promoter polymorphisms between RA patients and controls, considering either allelic or genotypic frequencies. In addition, no association was found with the haplotypes inferred by the two polymorphisms and RA susceptibility. This was also the case when RA patients were stratified according to sex, age at the onset of the disease, rheumatoid factor status, and extraarticular manifestations. Our data suggest that −607 A/C (rs1946518) and −137 G/C (rs187238) polymorphisms within the IL‐18‐promoter region do not play a major role in RA predisposition.
Sequence of the canine major histocompatibility complex region containing non‐classical class I genes
Authors: Wagner J.L. , Palti Y. , DiDario D. , Faraco J.
Published: May 2005

Abstract:  We have sequenced a segment of 150,102 nucleotides of canine major histocompatibility complex (MHC) DNA, corresponding to the junction of the class I and class III regions. The distal portion contained five class III genes including two tumor necrosis factor genes and the proximal portion contained five genes or pseudogenes belonging to the class I region. The order of the class III region genes was conserved as in the porcine and human MHC regions. The order of the class Ib loci from the proximal side outwards was DLA‐53, DLA‐12a, DLA‐64, stress‐induced phosphoprotein‐1, followed by DLA‐12. Only DLA‐64 and DLA‐12 display an overall predicted protein sequence compatible with the expression of membrane‐anchored glycoproteins. The other class 1b loci do not appear to be functional by sequence analysis. In all, these 10 genes spanned 24% of the total sequence. The remaining 76% comprised of a number of non‐coding and repetitive DNA elements including long interspersed nuclear element (LINE) fragments, short interspersed nuclear elements (SINE), and microsatellites.
Distribution of killer cell immunoglobulin‐like receptor genes in the Chinese Han population
Authors: Jiang K. , Zhu F.‐M. , Lv Q.‐F. , Yan L.‐X.
Published: May 2005

Abstract:  Killer cell immunoglobulin‐like receptors (KIRs) on natural killer cells recognize groups of HLA class I alleles. Seventeen KIR genes have been identified at present, and two kinds of KIR haplotypes (group A and B) have been described based on their gene contents. Immunogenetic analysis of different ethnic populations shows significant differences in terms of the distribution of group A and B haplotypes. Here, genomic DNA from 104 healthy unrelated Chinese Han individuals was typed for the presence or absence of KIR genes. All 17 KIR genes were observed in the population, and framework genes 3DL3, 3DP1, 2DL4, and 3DL2 were present in all individuals. Twenty‐six different genotypes were found, four of which could not be assigned to haplotypes according to the model of Hsu et al. (J Immunol 2002: 169: 5118). Group A haplotypes outnumbered group B haplotypes in frequency by approximately 3 : 1, with individuals having two group A haplotypes accounting for 58.7%. Analysis indicated that some pairs of KIR genes showed remarkable linkage disequilibrium. Our data demonstrated that the Chinese Han population is distinct in KIR gene frequencies and putative KIR haplotypes in comparison to some other populations.
A novel A*24 allele, A*2442, was detected through routine bone marrow donor screening
Authors: Witter K. , Sala M. , Zahn R. , McNicholas A. , Volgger A. , Albert E.D.
Published: May 2005

Abstract:  In this article, we report the identification of a new HLA‐A allele found in a DNA sample which was part of the routine bone marrow donor typing performed in our laboratory. This novel allele officially designated as A*2442 was found in a sample from a female Caucasoid donor (Franken, Bavaria, Germany; lab code 142654) and differs from the closest related allele A*2408 by two nucleotide exchanges. In position 81, the A (A*2408) is changed to 81 C in the novel allele A*2442, resulting in an amino acid substitution at codon 27, glutamine (A*2408) is replaced by histidine (31Gln→31His). In position 292, the G (A*2408) is changed to C also resulting in an amino acid replacement, the codon 98 asparagine is mutated to histidine (98Asn→98His) in the new A*2442 allele. The second allele was determined to be A*0301. Further typing of this sample is B*1501 B*4001.
Sirolimus for solid organ transplantation in children
Authors: Gupta Puneet , Kaufman Stuart , Fishbein Thomas M.
Published: May 2005

Abstract:  Sirolimus represents a major advancement in the field of solid organ transplantation and is being used as a rescue agent for acute and chronic rejection as well as for primary immunosuppression with good graft outcome. Although initial studies with sirolimus were in adults, now significant data have accumulated on the role of sirolimus in pediatric solid organ transplantation. This article reviews the current status of sirolimus in pediatric transplantation.
Growing pains: Non‐adherence with the immunosuppressive regimen in adolescent transplant recipients
Authors: Dobbels Fabienne , Damme‐Lombaert Rita Van , Vanhaecke Johan , Geest Sabina De
Published: May 2005

Abstract:  One‐year graft and patient survival are better in adolescent transplant recipients (age 11–19 years) than in younger (age < 11 years) pediatric transplant recipients. However, several groups found that long‐term outcomes (> i.e. 5 year post‐transplant) in the adolescent age group are significantly worse than in younger transplant recipients.

A behavioral factor that could explain an important part of the poorer clinical outcome in adolescent transplant recipients is non‐compliance with medication taking. Adolescents, like all organ transplant recipients irrespective of their age, must adhere to a life‐long immunosuppressive regimen in addition to other aspects of their therapeutic regimen. Therefore, adolescent transplant recipients, as all transplant patients, should be regarded as a chronically ill patient population in whom behavioral and psychosocial management is equally important as state‐of‐the‐art medical management.

This paper provides an overview of the current knowledge on prevalence, clinical consequences, and risk‐factors for non‐compliance with the immunosuppressive regimen in adolescent transplant recipients and offers some suggestions for adolescent‐tailored interventions to improve medication adherence.
Clinical correlates of current level of functioning in primary care‐treated bipolar patients
Authors: Hajek Tomas , Slaney Claire , Garnham Julie , Ruzickova Martina , Passmore Michael , Alda Martin
Published: May 2005

Objectives:  In this study we examined general assessment of functioning (GAF), and its relation to clinical and demographic factors in bipolar patients. A number of studies, mostly from specialized programs, show that bipolar disorder often leads to occupational and social impairment. Here we report data from patients in a primary care setting.

Methods:  A total of 252 patients from the Maritime Bipolar Registry with DSM‐IV diagnoses of bipolar I or bipolar II disorder participated in the study. GAF ratings during maintenance treatment were compared across clinical and demographic variables.

Results:  The mean GAF score in this sample was 67 ± 17 (range 10–100). The GAF scores followed bimodal distribution with mean values of 50.5 ± 10.3 and 79.0 ± 10.3. Decreased functioning was found in patients with chronic illness course, history of rapid cycling, suicidal behaviour, psychiatric comorbidity, hypothyroidism, and diabetes mellitus, regardless of treatment of these conditions. There were no differences in the level of functioning between men and women, bipolar I and II patients, those with and without psychotic episodes, hypertension, treatment with antidepressants or antipsychotics.

Conclusions:  Functioning in primary care‐treated bipolar patients in maintenance phase of treatment is decreased not only due to specific disorder‐related variables, but also due to frequent comorbidity with other psychiatric and medical conditions.
Pharmacotherapy of bipolar mixed states
Authors: Krüger Stephanie , Trevor Young L , Bräunig Peter
Published: May 2005

Objective:  Mixed episodes comprise up to 40% of acute bipolar admissions. They are difficult‐to‐treat, complex clinical pictures. This review provides an overview of the available literature on the pharmacotherapy of manic‐depressive mixed states and suggests treatment options.

Method:  Literature was identified by searches in Medline, Embase and the Cochrane Controlled Trials Register. Studies were considered relevant if they contained the keywords mixed mania, mixed state(s), mixed episode(s), treatment, therapy, study or trial.

Results:  Overall, there were very few double‐blind, placebo‐controlled studies specifically designed to treat manic‐depressive mixed states. Rather, patients with mixed states comprised a sub‐group of the examined patient cohorts. Nevertheless, the data show that acute mixed states do not respond favourably to lithium. Instead, valproate and olanzapine are drugs of first choice. Carbamazepine may play a role in the prevention of mixed states. Antidepressants should be avoided, because they may worsen intraepisodic mood lability. Lamotrigine may be useful in treating mixed states with predominantly depressive symptoms.

Conclusions:  More treatment studies specifically designed to treat the complex clinical picture of mixed states are clearly needed. Current treatment recommendations for clinical practice based on the available literature can only target select aspects of these episodes.
Gabapentin withdrawal syndrome in the presence of a taper
Authors: Tran Kien T , Hranicky Diane , Lark Tracey , Jacob NJ
Published: May 2005

Objective:  To report a case report of a geriatric patient with a 5‐year history of gabapentin use for enhanced bipolar control, who was tapered off of gabapentin over 1 week. The patient displayed unique withdrawal symptoms after the taper of gabapentin.

Methods:  The patient is an 81‐year‐old white female with a life‐long history of schizoaffective disorder with bipolar type I tendencies who had been prescribed gabapentin for 5 years.

Results:  The patient displayed moderate upper respiratory tract infection symptoms and somatic complaints 1 day after termination of gabapentin. These symptoms gradually worsened until 10 days after, at which time she acutely developed severe mental status changes, severe somatic chest pain, and hypertension. Physical examination, electrolytes, electrocardiogram, computerized tomography, magnetic resonance imaging, and magnetic resonance angiography were all normal. Upon reintroduction of gabapentin, the patient returned to baseline within 1–2 days.

Conclusions:  Gabapentin is widely utilized currently for the chronic treatment of recalcitrant migraines, bipolar illness, pain, and epilepsy. It has a wide therapeutic index with few side effects and drug interactions, is not hepatically metabolized, and is excreted by the kidneys. Past reports have suggested that some withdrawal symptoms can present after 1–2 days upon abrupt discontinuation of gabapentin after chronic use within young to middle‐aged patients. These symptoms mimic that of alcohol and benzodiazepine withdrawal purportedly due to a similar mechanism of action. Unique to this case is that this geriatric patient developed debilitating withdrawal symptoms after a gradual, week‐long taper of gabapentin along with flu‐like symptoms. It is proposed herein that a gabapentin taper should follow a course similar to that of a benzodiazepine taper – slowly and over a period of weeks to months.
Neuropsychological dysfunction in bipolar affective disorder: a critical opinion
Authors: Savitz Jonathan , Solms Mark , Ramesar Rajkumar
Published: May 2005

Data from the imaging literature have led to suggestions that permanent structural brain changes may be associated with bipolar disorder. Individuals diagnosed with bipolar disorder display deficits on a range of neuropsychological tasks in both the acute and euthymic phases of illness, and correlations between experienced number of affective episodes and task performance are commonly reported. These findings have renewed interest in the neuropsychological profile of individuals with bipolar disorder, with deficits of attention, learning and memory, and executive function, asserted to be present. This paper critically reviews five different potential causes of neurocognitive dysfunction in bipolar disorder: (i) iatrogenic, (ii) acute functional changes associated with depression or mania, (iii) permanent structural lesions of a neurodegenerative origin, (iv) permanent structural lesions that are neurodevelopmental in origin, and (v) permanent functional changes that are most likely genetic in origin. Although the potential cognitive effects of residual symptomatology and long‐term medication use cannot be entirely excluded, we conclude that functional changes associated with genetically driven population variation in critical neural networks underpin both the neurocognitive and affective symptoms of bipolar disorder. The philosophical implications of this conclusion for neuropsychology are briefly discussed.
Divalproex sodium for pediatric mixed mania: a 6‐month prospective trial
Authors: Pavuluri Mani N , Henry David B , Carbray Julie A , Naylor Michael W , Janicak Philip G
Published: May 2005

Objective:  This prospective 6‐month open trial examined the effectiveness and safety of divalproex sodium (DVPX) in pediatric mixed mania.

Method:  Thirty‐four subjects with a mean age of 12.3 (SD = 3.7) years, DSM‐IV diagnosis of a current mixed episode and a baseline Young Mania Rating Scale (YMRS) score >20 were treated with DVPX monotherapy. The primary outcome measures were the YMRS and the Child Depression Rating Scale‐Revised. Secondary measures were the Clinical Global Impression Scale for Bipolar Disorder (CGI‐BP) and the Children's Global Assessment of Functioning Scale (C‐GAS). Measures of safety and tolerability were also administered.

Results:  Effect size (Cohen's d) based on change scores from baseline was 2.9 for the YMRS and 1.23 for the CDRS‐R. Response rate (≥50% change from baseline YMRS score and ≤40 score on CDRS‐R at the end of study) was 73.5%. The remission rate (≥50% change from baseline on YMRS, ≤40 on CDRS‐R, CGI‐BP‐Improvement subscale of ≤2, and ≥51 CGAS score) was 52.9%. Significant improvements (p < 0.001) from baseline were seen for mean scores on all outcome measures (i.e., YMRS, CGI‐BP, CDRS‐R, and C‐GAS). DVPX was safe and well tolerated with no serious adverse events during the 6‐month trial.

Conclusion:  This study provides evidence for the effectiveness and safety of DVPX in the treatment of pediatric mixed mania over a 6‐month period. Placebo‐controlled, randomized trials involving larger samples will ultimately shed light on the efficacy of this agent.
Functional impairment in the remission phase of bipolar disorder
Authors: Fagiolini Andrea , Kupfer David J , Masalehdan Azadeh , Scott John A , Houck Patricia R , Frank Ellen
Published: May 2005

Objectives:  The purpose of this study was to evaluate functional impairment in a group of patients with bipolar disorder in remission and to determine the extent of relationships between overall functioning and current depressive, manic and panic spectrum symptoms.

Method:  A subset of the patient population at the Pittsburgh site of the Systematic Treatment Enhancement Program in Bipolar Disorder (STEP‐BD) study was evaluated in this study. The subsample comprises 103 male and female subjects with bipolar I disorder (n = 70), bipolar II disorder (n = 24), schizoaffective disorder – bipolar type (n = 4), or bipolar disorder NOS (n = 5). Subjects were evaluated in a period of remission (at least 4 weeks with no more than two depressive or manic symptoms). Subjects were assessed for overall functional status using the Work and Social Adjustment Scale (WSAS) and for current bipolar and panic spectrum symptoms using the Mood Spectrum Self‐Report questionnaire (MOODS‐SR) and Panic‐Agoraphobic Spectrum Self‐Report questionnaire (PAS‐SR).

Results:  The median WSAS total score in these remitted subjects was 14, indicating significant functional impairment. Regressing WSAS on current depressive, manic, and panic spectrum total scores, we observed a highly significant depressive spectrum effect (t = 4.9, df = 94, p < 0.0001), but non‐significant panic and manic spectrum effects (t = 1.3, df = 94, p = 0.19 and t = −1.8, df = 94, p = 0.07, respectively).

Conclusion:  Bipolar disorder is associated with functional deficits even during periods of sustained and substantial remission. The degree of functional impairment is correlated with the degree of depressive spectrum symptoms.
The management of bipolar disorder in primary care: A review of existing and emerging therapies
Authors: BERK MICHAEL , DODD SEETAL , BERK LESLEY
Published: May 2005

Abstract  Recent evidence suggests that the prevalence of bipolar disorder is as much as fivefold higher than previously believed, and may amount to nearly 5% of the population, making it almost as common as unipolar major depression. It is, therefore, not unrealistic to assume that primary care or family physicians will frequently encounter bipolar patients in their practice. Such patients may present with a depressive episode, for a variety of medical reasons, for longer‐term maintenance after stabilization, and even with an acute manic episode. Whatever the reason, a working knowledge of current trends in the acute and longer‐term management of bipolar disorder would be helpful to the primary care physician. In addition, an understanding of important side‐effects and drug interactions that occur with drugs used to treat bipolar disorder, which may be encountered in the medical setting, are paramount. This paper will attempt to review existing and emerging therapies in bipolar disorder, as well as their common drug interactions and side‐effects.
Efficacy of 3‐year psychiatric daycare treatment in patients with schizophrenia
Authors: INADOMI HIROYUKI , TANAKA GORO , WATANABE SACHIE , NAGATOMI YASUHIRO , MITARAI KAZUYA , OHSAWA RIE , KUSUMEKI KIYOMI , SHIMATANI TAKAO , HATANAKA KUNIKO , HIROIKE TOYOKO , TERAMOTO KAZUKO , UTSUNOMIYA HIROSHI , ETOH RYU , OHTA YASUYUKI
Published: May 2005

Abstract  The present study investigated the efficacy of a 3‐year psychiatric daycare (DC) program with regard to psychiatric symptoms and difficulties with daily living experienced by patients with schizophrenia. The subjects were 28 patients who met the diagnostic criteria from the 4th edition of the Diagnostic and Statistical Manual for schizophrenia and continued DC treatment for 3 years. The present study assessed participants at two points: at the start of DC and after 3 years, by evaluating socioeconomic factors and Brief Psychiatric Rating Scale (BPRS) scores. In addition, in order to measure difficulties with daily living, the Life Assessment Scale for the Mentally Ill (LASMI) and the Etoh Daycare Assessment Scale (ETODAS) developed at the Etoh Hospital, were used. Results indicated that no significant changes in socioeconomic factors or BPRS scores occurred during the 3‐year period of DC treatment. However, over this period, mean scores (± standard deviation [SD]) for LASMI subcategories decreased from 1.6 ± 0.8 points to 0.9 ± 0.7 for daily living and from 1.7 ± 0.8 to 1.2 ± 0.7 for interpersonal relations, indicating significant improvement (P < 0.05). In addition, mean scores (±SD) for the ETODAS subcategories increased from 3.4 ± 0.8 to 4.1 ± 0.8 for expressiveness, from 3.3 ± 0.9 to 4.0 ± 0.8 for communication, from 3.1 ± 0.6 to 3.6 ± 1.0 for initiative within a group, and from 3.4 ± 0.5 to 3.8 ± 0.7 for cooperation in work activities, indicating significant improvement (P < 0.05). The present study suggests that DC can enable patients with schizophrenia to maintain their condition without worsening the psychiatric symptoms, and to improve their daily living skills, social skills in human relations, and work skills.
Delirium in inpatients with respiratory diseases
Authors: TAKEUCHI TAKASHI , MATSUSHIMA EISUKE , MORIYA HIROBUMI , SHINTANI MASAHIRO , NAKAMURA SEIICHI
Published: May 2005

Abstract  The features of delirium in patients being hospitalized due to respiratory diseases were investigated. From the inpatients in the respiratory medical ward of Tokyo Metropolitan Hiroo General Hospital over the course of 1 year, the patients who had delirium were diagnosed by a semistructured interview. The total number of subjects was 454, and patients with delirium were 43. Various clinical factors were compared between the delirium group and non‐delirium group. In the delirium group, there were many elderly patients of 70 years or older. Moreover, there were many patients who had a chronic respiratory disease, patients in which the respiratory diseases were mutually complicated, and patients in whom other diseases combined with the respiratory disease in the delirium group. There were also many patients in the Intensive Care Unit (ICU), and patients with an endotracheal intubation or extubation. Based on the results of a multiple logistic regression analysis, for age, ICU accommodation, and endotracheal intubation, the value of the delirium group was more significant than that of the non‐delirium group. In half of the patients from the delirium group, delirium developed within 1 week after hospitalization. In the patients who died in the hospital, however, delirium often developed days after they had been hospitalized. It was suggested that the later developed delirium had a relation to the prognosis.
Relation of surgery, tumor site, and age group to the loss of reality testing in Japanese patients with malignant tumors: A study of a hospital‐based sample with a consultation‐liaison service
Authors: YOSHIMASU KOUICHI , TANAKA KAZUHIRO , KIYOHARA CHIKAKO
Published: May 2005

Abstract  The relation between surgery and the loss of reality testing (LRT) in Japanese patients with malignant tumors were examined, taking into account the influence of the tumor sites and age groups. The patients were comprised of 277 men and 225 women with malignant tumors in Kyushu University Hospital, Fukuoka, Japan, who underwent a check‐up at the Department of Neuropsychiatry for the first time using the consultation‐liaison system. Those with known schizophrenia, dementia, mental retardation, and paranoid or schizoid (schizotypal) personality disorder were excluded. Surgery was statistically significantly associated with LRT in elderly men (≥65 years of age), and in men with malignant tumors of the digestive organs (odds ratio [OR], 9.7; 95% confidence interval [95% CI], 3.2–29.3). Even after adjusting for tumor site and age, surgery was statistically significantly associated with LRT in men (OR, 2.6; 95% CI, 1.4–4.6) and nearly significantly associated in women (OR, 1.8; 95% CI, 0.9–3.6). There were no material associations between surgery and LRT in patients with malignant tumors of sex‐specific organs or the head and neck area. The present study showed a positive relationship between surgery and LRT in Japanese men and women with malignant tumors. The association was stronger in elderly patients. As for tumor site, surgery was most strongly associated with an increased risk of LRT in patients with malignant tumors of the digestive organs.
Behavioral and psychological symptoms of dementia characteristic of mild Alzheimer patients
Authors: SHIMABUKURO JIN , AWATA SHUICHI , MATSUOKA HIROO
Published: May 2005

Abstract  In order to clarify the characteristics of Behavioral and Psychological Symptoms of Dementia (BPSD) in patients with mild Alzheimer's disease (AD), BPSD among the severities of Clinical Dementia Rating (CDR) in 74 patients with AD were compared using the Neuropsychiatric inventory (NPI). The result, when compared between mild (CDR = 0.5, 1) and moderate or severe (CDR = 2, 3) AD, was a significant difference in frequency of euphoria, disinhibition and aberrant motor behavior, but no significant difference was found in frequency of delusions, hallucinations, agitation, dysphoria, anxiety, apathy and irritability. In addition, a significant difference was found in the mean scores of the composite score for euphoria, apathy, disinhibition and aberrant motor behavior, but no significant difference was found in the mean scores of the composite score for delusions, hallucinations, agitation, dysphoria, anxiety and irritability. That is, the mild AD groups (CDR 0.5 or 1) had delusions, hallucinations, agitation, dysphoria, anxiety, apathy and irritability as frequently as the moderate or severe AD groups (CDR 2 or 3), and had the equivalent level of composite scores to the moderate or severe AD groups (CDR 2 or 3) in delusion, hallucination, agitation, dysphoria, anxiety and irritability. Therefore, it was supposed that psychotic symptoms (delusion, hallucination) and emotional symptoms (agitation, dysphoria, anxiety, irritability) are important BPSD in patients with mild AD as well as those with moderate or severe AD, and there are needs for health, welfare and medical services for these symptoms.
Obsessive‐compulsive symptoms in schizophrenia: Prevalance and clinical correlates
Authors: KAYAHAN BULENT , OZTURK OZGUR , VEZNEDAROGLU BAYBARS , ERASLAN DEFNE
Published: May 2005

Abstract  Obsessive‐compulsive symptoms (OCS) have been observed in a substantial proportion of schizophrenic patients. In this study, the rate of occurrence of OCS and obsessive‐compulsive disorder (OCD) in schizophrenic patients, and also the interrelationship between OCS and schizophrenic symptoms and depressive symptoms were assessed. A total of 100 subjects with a diagnosis of schizophrenia from the 4th edition of the Diagnostic and Statistical Manual (DSM‐IV) were evaluated by the structured and clinical interview for axis‐1 DSM‐IV disorders – patient edition (SCID‐P), the Positive and Negative Syndrome Scale (PANSS), Yale‐Brown Obsessive‐Compulsive Scale (Y‐BOCS), and the Calgary Depression Rating Scale for Schizophrenia. The prevalance of OCS in individuals meeting criteria for schizophrenia was 64%. A total of 30 of these patients (Y‐BOCS total score ≥7) also met the DSM‐IV criteria for OCD. The total score on Y‐BOCS was significantly correlated with total score on PANSS, Positive‐PANSS score, General‐PANSS score and total score on Calgary Depression Rating Scale for Schizophrenia. OCS and OCD relatively frequent in schizophrenic patients and OCS are significantly correlated with the severity of psychosis, positive symptoms, and depressive symptoms in schizophrenic patients. These findings provide further evidence for the importance of OCS in schizophrenia.
Suicide patterns and characteristics in Akita, Japan
Authors: FUSHIMI MASAHITO , SUGAWARA JUNYA , SHIMIZU TETSUO
Published: May 2005

Abstract  Akita Prefecture currently has the highest rate of suicide in Japan. Given this alarming statistic, investigation of the underlying causes of suicide and identification of strategies for suicide prevention are imperative. Members of the Akita Prefectural Medical Association (APMA) see most of the individuals who commit suicides in Akita Prefecture, so data from the APMA would prove advantageous in any investigation of suicides. In this study, members of the APMA who had attended to individuals who had committed suicide were asked to complete a questionnaire about the case to determine the factors underlying suicide in Akita Prefecture. From 1 July 2001 to 30 June 2002, a total of 138 cases (102 males, 36 females) of suicide were reported. Most suicide cases were of 50–69 year olds. Many cases involved relatively lethal methods (such as hanging). Most suicides were performed at home and at a time when the rest of the family was asleep or absent. The most  common  complaint  appeared  to  be  economic‐related  problems.  Depressive  disorder  was the most common psychiatric disorder, and many cases displayed high depressive trait scores. The present results do not exclude the possibility that economic‐related problems are playing a major role in recent increases in suicide numbers. However, strategies for dealing with depression as well as economic‐related problems are considered important.
Gait disturbances in patients with schizophrenia and adaptation to treadmill walking
Authors: PUTZHAMMER ALBERT , PERFAHL MARIA , PFEIFF LIANE , HAJAK GÖRAN
Published: May 2005

Abstract  This study evaluated the gait patterns of schizophrenic patients at free gait and at three fixed velocities on a treadmill. The effects of illness and antipsychotic treatment on gait parameters and on adaptation to treadmill walking were compared. Gait parameters of 14 drug‐naïve schizophrenic patients, 14 patients treated with conventional antipsychotics, 14 patients treated with olanzapine, as well as 14 matched controls were assessed on a walkway and on a treadmill at three different velocities (very slow, intermediately slow, and comfortable) using an ultrasonic movement analysis system. At free gait, all patients showed a significantly decreased gait velocity, predominantly due to a shorter stride length, when compared to the controls, with the most striking difference observed between the patients treated with conventional neuroleptics and the controls (anova, P ≤ 0.001). Cadence (steps per second) did not differ between the investigated groups. When gait was evaluated on the treadmill, differences in stride length and cadence were significant only at the very slow treadmill velocity (anova, P ≤ 0.05). In all patient groups, mean stride length was decreased and cadence compensationally increased. Significant differences between the patient groups were no longer detectable. With increasing treadmill velocities, gait parameters of all patient groups normalized. The results show that, like in patients with Parkinson's Disease, impaired gait parameters can also be normalized in schizophrenic patients by external stimulation via treadmill walking.
Drug preferences in illicit drug abusers with a childhood tendency of attention deficit/hyperactivity disorder: A study using the Wender Utah Rating Scale in a Japanese prison
Authors: MATSUMOTO TOSHIHIKO , YAMAGUCHI AKIKO , ASAMI TAKESHI , KAMIJO ATSUSHI , ISEKI EIZO , HIRAYASU YOSHIO , WADA KIYOSHI
Published: May 2005

Abstract  The purpose of this study is to clarify the relationship between childhood tendencies of attention deficit/hyperactivity disorder (AD/HD) and illicit drug abuse in Japanese prisoners, and to clarify whether drug abusers with AD/HD prefer methamphetamine (MAP) more than other illicit drugs. The Japanese version of the Wender Utah Rating Scale (WURS), which is a self‐reporting instrument to retrospectively identify childhood tendencies of AD/HD tendencies, was carried given to 413 prisoners without a drug addiction and 282 prisoners with a drug addiction (192, MAP; 53, toluene; and 37, cannabis). WURS scores were compared between prisoners with and without a drug addiction, and between MAP, toluene, and cannabis abusers. Consequently, prisoners with a drug addiction showed significantly higher WURS scores than those without the addiction (P < 0.001). Toluene abusers showed significantly higher WURS scores than cannabis abusers (P < 0.001), and included a higher proportion with scores over cut‐off than MAP or cannabis abusers (P = 0.005). In conclusion, a close relationship existed between illicit drug abuse and childhood AD/HD tendencies. Drug‐abusing prisoners with AD/HD tendencies were not prone to choose MAP over other illicit drugs.
Characteristics of self‐cutters among male inmates: Association with bulimia and dissociation
Authors: MATSUMOTO TOSHIHIKO , YAMAGUCHI AKIKO , ASAMI TAKESHI , OKADA TAKAYUKI , YOSHIKAWA KAZUO , HIRAYASU YOSHIO
Published: May 2005

Abstract  It was examined whether bulimia and dissociation are common in male self‐cutters, as has been found in female self‐cutters. The subjects were 796 male inmates of a juvenile prison. A self‐reporting questionnaire was used to assess self‐cutting, histories of psychoactive substance use, problem behaviors, and traumatic life events in the subjects. The Adolescent Dissociative Experience Scale and the Bulimia Investigatory Test of Edinburgh were also used. Subjects were divided into two groups: self‐cutting and non‐cutting. Questionnaire responses and dissociation and bulimia assessments were compared between the groups. Self‐cutters began smoking (P < 0.001) and drinking (P < 0.001) earlier, and more frequently used illicit psychoactive drugs (P < 0.001), experienced childhood physical abuse (P < 0.001), and reported suicide attempts (P < 0.001), suicidal ideation (P < 0.001), and outward violence toward a person (P < 0.001) or object (P < 0.001) than non‐cutters. Self‐cutters also scored significantly higher on the bulimia (P < 0.001) and dissociation tests (P < 0.001). Logistic regression analysis demonstrated that suicide attempt (odds ratio, 4.311) and suicidal ideation (odds ratio, 2.336) could discriminate between male inmates with and without self‐cutting. Male self‐cutters showed ‘multi‐impulsive bulimic’ tendencies resembling those of female self‐cutters, although to a lesser extent. Clinical features of male as opposed to female self‐cutters were influenced by gender differences.
Factors associated with suicidal ideation in an elderly urban Japanese population: A community‐based, cross‐sectional study
Authors: AWATA SHUICHI , SEKI TORU , KOIZUMI YAYOI , SATO SOICHIRO , HOZAWA ATSUSHI , OMORI KAORI , KURIYAMA SHINICHI , ARAI HIROYUKI , NAGATOMI RYOICHI , MATSUOKA HIROO , TSUJI ICHIRO
Published: May 2005

Abstract  The objective of the present study was to evaluate the association between suicidal ideation and potentially related factors in an elderly urban Japanese population. This was a community‐based, cross‐sectional study. Urban community residents aged 70 years or more were interviewed regarding suicidal ideation and sociodemographic and health‐related variables. Subjects with depressive symptoms underwent further evaluation by psychiatrists using criteria of the Diagnostic and Statistical Manual of Mental Disorders, 4th edition. Associations were evaluated using univariate and multivariate logistic regression analyses. Of the 1145 eligible participants, 52 (4.5%) reported thoughts of suicide. Of 143 subjects with depressive symptoms (Geriatric Depression Scale, 14+), 22 (15.4%) reported suicidal ideation over a 2‐week period. After controlling for depressive symptoms, lack of social support and impaired instrumental activities of daily living were significantly associated with thoughts of suicide. After controlling for the potentially associated factors detected in the univariate analysis, depressive symptoms were strongly associated with thoughts of suicide. In the elderly with depressive symptoms, mental disorders, including depressive and alcohol‐related disorders, were significantly associated with suicidal ideation over a 2‐week period. In the urban community setting, screening for lack of social support, impaired instrumental activities of daily living, and depressive symptoms, followed by diagnostic evaluation for mental disorders, particularly for depressive syndromes and alcohol‐related disorders, may provide a practical and effective means of identifying elders at high risk of suicide.
Community‐based suicide prevention through group activity for the elderly successfully reduced the high suicide rate for females
Authors: OYAMA HIROFUMI , WATANABE NAOKI , ONO YUTAKA , SAKASHITA TOMOE , TAKENOSHITA YUKA , TAGUCHI MANABU , TAKIZAWA TOHRU , MIURA REIKO , KUMAGAI KEIKO
Published: May 2005

Abstract  The lack of social support is the most common risk factor for late‐life suicide. Few previous community‐based interventions against the lack of social relationships reduced suicide. This study aims to evaluate outcomes of a community‐based prevention program against suicide amongst the elderly in rural Japan. During 1995–2002, the program based on population strategy including group activity, psychoeducation and self‐assessment of depression but no screening for depression, was implemented for elderly residents in Yuri town, Japan (5‐year average population 6817; 5‐year average suicide rate [≥65 years old] 291.4/105). Changes in the relative risk of suicide for individuals (≥65 years old) before and after the 8‐year implementation were estimated by the incidence rate ratio (IRR), using a quasi‐experimental design with a neighboring reference, Chokai town, Japan (5‐year average population 8136; 5‐year average suicide rate [≥65 years old] 216.5/105). The risk of elderly females in Yuri completing suicide was reduced by 76% (age‐adjusted IRR, 0.24; 95% CI, 0.10–0.58), while there was no change in the risks for Yuri's elderly males and both Chokai's elderly males and females. General loglinear analysis estimated a ratio of the female IRR in Yuri to that in its Akita prefecture of 0.35 (95% CI, 0.14–0.84), showing that the reduction of the risk in the intervention area was greater than a historical trend. A community‐based suicide prevention through a group intervention designed to increase knowledge and to cultivate social relationships would be effective for elderly females but not males.
Prevalence of restless legs syndrome and associated factors in the Korean adult population: The Korean Health and Genome Study
Authors: KIM JINYOUNG , CHOI CHANGHO , SHIN KYUNGRIM , YI HYERYEON , PARK MINGYU , CHO NAMHAN , KIMM KUCHAN , SHIN CHOL
Published: May 2005

Abstract  The present study was purposed to identify the prevalence of restless legs syndrome (RLS) and its associated factors in the Korean adult population. Among a total of 9939 participants derived from the Korean Health and Genome Study, 12.1% of subjects (men, 8.5%; women, 15.4%) suffered from RLS. Factors independently related with RLS were older age and frequent fatigue in both men and women.