Longitudinal Clinical Observation Research Articles

Stages of decompensation in combat-related posttraumatic stress disorder: a new conceptual model.

This conceptual article presents a model of severe, chronic combat-related PTSD based on several years of longitudinal clinical observations of Vietnam veterans. The model describes a repeating cycle of decompensation that profoundly disrupts the veteran's life. There appear to be "stages" of decompensation that can be described clinically and may be distinct physiologically. The stages describe a wide range of functioning, from adaptive to totally dysfunctional PTSD core symptoms, as well as several other dimensions of clinical functioning, such as affect regulation, defenses, ego states, interactions with the environment, capacity for self-destruction/suicide and capacity for attachment and insight are described for each stage. Clinical and research implications are discussed.

Danish—American family (family E) with ‘Parkinson's Disease’: Pitfalls of genetic studies

Clinical and genetic investigations were undertaken to evaluate a large Danish-American kindred with a possible autosomal dominant parkinsonian syndrome (PS) as indicated by the index case. After full investigation of available data a suspected autosomal dominant inheritance pattern of PS could not be confirmed. However, it is possible that this kindred represents familial tremor. Longitudinal clinical observations on this family are planned.

The subgingival microflora and gingival crevicular fluid cytokines in refractory periodontitis

Refractory periodontitis manifests as a rapid, unrelenting, progressive loss of attachment despite the type and frequency of therapy. This study examined possible relationships between cytokine levels in gingival crevicular fluid (GCF), occurrence of specific periodontopathic microflora, and disease activity in patients with refractory periodontitis. Refractory periodontitis patients (7 male and 3 female) were selected on the basis of history and longitudinal clinical observations. In each patient, 2 teeth with pocket depths greater than 6 mm were selected and individual acrylic stents were fabricated with reference grooves for each site. The sites were examined at both baseline and 3 months later. The pattern and amount of alveolar bone resorption were assayed by quantitative digital subtraction radiography. Pocket depth and attachment loss were measured with a Florida Probe. The gingival index was measured at 4 sites around each sample tooth. Sites were divided into active sites (> or = 2.1 mm loss of attachment in 3 months) or inactive sites (< or = 2.0 mm loss of attachment in 3 months). The distribution and prevalence of the predominant microflora in active and inactive sites were compared using anaerobic culture and indirect immunofluorescence. Interleukin-1 beta, 2, 4, 6 and tumor necrosis factor-alpha (TNF-alpha) levels in gingival crevicular fluid (GCF) were quantified by ELISA. Prevotella intermedia and Eikenella corrodens significantly decreased in inactive sites but remained the same in active sites after 3 months. The active sites revealed significantly higher GCF levels of IL-2 and IL-6 than inactive sites at both baseline and at 3 months. IL-1 beta was also significantly greater in active sites than in inactive sites at 3 months. Alveolar bone loss in active sites correlated with increased GCF levels of IL-1 beta and IL-2. These results suggest that GCF levels of IL-1 beta, IL-2 and IL-6 and P. intermedia and E. corrodens in subgingival plaque may serve as possible indicators of disease activity in refractory periodontitis.

HTLV-III antibody prevalence among young delinquent drug abusers in long-term residential treatment at a North-German drug clinic.

To date, long-term intravenous drug users studied at regional European centers of illicit drug use have had a high number of LAV/HTLV-III infections. Among 200 patients remanded by court or referred from prison to a special clinic in northern Germany for young delinquent drug abusers, 26 (17%) of 157 IV drug abusers were HTLV-III seropositive. With 40% seropositive, female patients showed a significantly higher prevalence of HTLV-III infection than males. The results of longitudinal serological, immunological, and clinical observations over periods of 12 months and 2-3 years indicate that under conditions of continuous medical surveillance, sound preventive counseling, and steady therapeutic care during long-term coeducative residential treatment of drug abusers, neither detectable HTLV-III transmission nor definite progression of HTLV-III induced impairment of immune regulatory functions must ensue.

Concurrent diagnostic validity of a structured psychiatric interview.

In order to estimate the concurrent validity of a structured psychiatric interview, we compared interview diagnoses obtained for 101 psychiatric inpatients to those recorded in the same patients' hospital charts. For most diagnoses considered, concordance was found to be high. For those in which concordance was low, we examined the reasons for the diagnostic discrepancy. Diagnostic errors that were judged to have occurred on the basis of the structural interview often seemed to have resulted from a lack of longitudinal clinical observation. However, more errors were judged to have occurred in the hospital charts, apparently because of physician oversight. We conclude that the concurrent validity of this structured interview is high and that such examinations might be useful not only for research but also for the routine initial evaluation of psychiatric patients.