Total Symptomatology Research Articles

Nutraceuticals and phytoceuticals in the treatment of schizophrenia: a systematic review and network meta-analysis "Nutra NMA SCZ".

Sub-optimal response in schizophrenia is frequent, warranting augmentation strategies over treatment-as-usual (TAU). We assessed nutraceuticals/phytoceutical augmentation strategies via network meta-analysis. Randomized controlled trials in schizophrenia/schizoaffective disorder were identified via the following databases: PubMed, MEDLINE, EMBASE, Scopus, PsycINFO, CENTRAL, and ClinicalTrials.gov. Change (Standardized Mean Difference = SMD) in total symptomatology and acceptability (Risk Ratio = RR) were co-primary outcomes. Secondary outcomes were positive, negative, cognitive, and depressive symptom changes, general psychopathology, tolerability, and response rates. We conducted subset analyses by disease phase and sensitivity analyses by risk of bias and assessed global/local inconsistency, publication bias, risk of bias, and confidence in the evidence. The systematic review included 49 records documenting 50 studies (n = 2384) documenting 22 interventions. Citicoline (SMD =-1.05,95%CI = -1.85; -0.24), L-lysine (SMD = -1.04,95%CI = -1.84; -0.25), N-acetylcysteine (SMD = -0.87, 95%CI = -1.27; -0.47) and sarcosine (SMD = -0.5,95%CI = -0.87-0.13) outperformed placebo for total symptomatology. High heterogeneity (tau2 = 0.10, I2 = 55.9%) and global inconsistency (Q = 40.79, df = 18, p = 0.002) emerged without publication bias (Egger's test, p = 0.42). Sarcosine improved negative symptoms (SMD = -0.65, 95%CI = -1.10; -0.19). N-acetylcysteine improved negative symptoms (SMD = -0.90, 95%CI = -1.42; -0.39)/general psychopathology (SMD = -0.76, 95%CI = -1.39; -0.13). No compound improved total symptomatology within acute phase studies (k = 7, n = 422). Sarcosine (SMD = -1.26,95%CI = -1.91; -0.60), citicoline (SMD = -1.05,95%CI = -1.65;-0.44), and N-acetylcysteine (SMD = -0.55,95%CI = -0.92,-0.19) outperformed placebo augmentation in clinically stable participants. Sensitivity analyses removing high-risk-of-bias studies confirmed overall findings in all phases and clinically stable samples. In contrast, the acute phase analysis restricted to low risk-of-bias studies showed a superior effect vs. placebo for N-acetylcysteine (SMD = -1.10, 95%CI = -1.75,-0.45), L-lysine (SMD = -1.05,95%CI = -1.55, -0.19), omega-3 fatty acids (SMD = -0.83,95%CI = -1.31, -0.34) and withania somnifera (SMD = -0.71,95%CI = -1.21,-0.22). Citicoline (SMD = -1.05,95%CI = -1.86,-0.23), L-lysine (SMD = -1.04,95%CI = -1.84,-0.24), N-acetylcysteine (SMD = -0.89,95%CI = -1.35,-0.43) and sarcosine (SMD = -0.61,95%CI = -1.02,-0.21) outperformed placebo augmentation of TAU ("any phase"). Drop-out due to any cause or adverse events did not differ between nutraceutical/phytoceutical vs. placebo+TAU. Sarcosine, citicoline, and N-acetylcysteine are promising augmentation interventions in stable patients with schizophrenia, yet the quality of evidence is low to very low. Further high-quality trials in acute phases/specific outcomes/difficult-to-treat schizophrenia are warranted.

Use of photo filters is associated with muscle dysmorphia symptomatology among adolescents and young adults

It has been documented in the literature that the use of photo filters to alter one’s appearance may negatively impact body image and increase the risk for thinness-oriented disordered eating behaviors. However, the prior research has neglected to investigate the association between use of photo filters and muscle dysmorphia symptomatology, which was the aim of this study. Data from the Canadian Study of Adolescent Health Behaviors (2022; N = 912), a national study of adolescents and young adults in Canada, were analyzed. Linear regression analyses revealed that the use of photo filters was associated with greater muscle dysmorphia symptomatology, including total symptomatology and Appearance Intolerance, among the overall sample. Gender significantly moderated the association between photo filter use and muscle dysmorphia symptomatology, whereby boys and young men, compared to girls and young women, who reported photo filter use had greater Drive for Size and Functional Impairment symptomatology. Findings expand prior research by emphasizing that photo filter use is related to muscularity-oriented body image concerns and behaviors. Future research is needed to elucidate the mechanisms that underpin this association.

Cryptococcal Meningitis in An Immunocompetent Patient

A fungal illness called cryptococcal meningitis is most often thought of as an opportunistic infection that affects immunocompromised people, typically those who have HIV infection. Numerous problems are linked to it, including widespread illness and neurologic ones such as intracranial hypertension, cerebral infarcts, vision loss, and other abnormalities. Here is a case 18-year-old male patient, who presented with persistent headache and fever. A lumbar puncture revealed a cryptococcal infection in him. His workup indicated no known underlying illness that may have compromised his immune system. CSF was then tested for cryptococcal species using an Indian ink preparation, and the results were positive. He was admitted to the hospital for initiation of antifungal therapy with amphotericin B along with serial serum creatinine and electrolytes levels and after the 5th day of getting amphotericin B, he had shown remarkable improvement in total symptomatology.

Measures of executive functions predicting Attention-Deficit/Hyperactivity Disorder core symptoms

Attention-deficit/hyperactivity disorder (ADHD) is a common childhood disorder, and in many children, ADHD is thought to be aggravated by a deficit in executive functions (EFs). This study tried to establish whether commonly used neuropsychological tests of EF also predicted the core symptoms of ADHD, namely hyperactivity/impulsiveness (H/I) and inattention, as well as total ADHD symptomatology, according to the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision (DSM-IV-TR). The participants were children from the Limpopo province, South Africa, aged from 6 to 15 years (M = 11.7 years; SD = 1.7). One hundred and fifty-six children (51.3% girls) were assessed by neuropsychological tests of EFs: the Tower of London (ToL), Digits Forward and Digits Backward, Trails-A and Trails-B and Wisconsin Card Sorting Test (WCST). Forward stepwise regression analysis was employed to predict H/I and inattention, as well as total ADHD symptomatology, based on DSM-IV-TR criteria. All the tests, except Trails-A, were found to predict ADHD symptomatology. The WCST (total errors) was the best predictor of all the ADHD symptoms and also for H/I and inattention separately, followed by Trails-B and Digits Backwards, which were found to predict more symptoms of inattention than H/I. Perseverative errors on the WCST predicted more H/I symptomatology, whilst non-perseverating errors were more associated with inattention. The ToL and Digits Forward predicted fewer ADHD symptoms. The ToL seemed more sensitive to inattention, whilst Digits Forward showed a stronger association with H/I. The WCST, Digits Backwards and Trails-B may be used to measure EF to support the diagnosis of ADHD in a clinical setting and to indicate cognitive impairment.

A U-shape trend between total and red meat consumption and depressive symptomatology in apparently healthy women: highlights from the ATTICA prospective (2002–2012) study

Abstract Background/Introduction Increasing amount of evidence currently suggests that in the context of vegetarianism, where meat is completely excluded from daily diet, the risk to develop depression-related symptoms is impressively high. Purpose The aim of the present work was to evaluate the association of meat consumption with prevalent depressive symptomatology in apparently healthy individuals. Methods ATTICA study was conducted during 2001–2012 including n=1,514 men and n=1,528 women (aged >18 years old) from the greater of our region in Greece. At baseline, depressive symptomatology through Zung Self-Rating Depression Scale (range 20–80) and meat consumption (total meat, red, white and processed meat) through validated semi-quantitative food frequency questionnaire were assessed. Follow-up (2011–2012) was achieved in n=2,020 participants (n=317 cases); n=845 participants with complete psychological metrics were used for the primary analysis. Results Ranking from 1st to 3rd total meat consumption (low to high) tertiles, participants assigned in 2nd tertile had the lowest depressive-symptomatology scoring (p<0.001). This trend was retained in multi-adjusted logistic regression analysis; participants reporting moderate total and red meat consumption had ∼20% lower likelihood to be depressed (i.e. Zung scale<45) compared with their 1st tertile counterparts (Odds Ratio (OR)total meat 0.82, 95% Confidence Interval (95% CI) (0.60, 0.97) and ORred meat 0.79 95% CI (0.45, 0.96)). Non-linear associations were revealed; 2–3 serving/week total meat and 1–2 servings/week red meat presented the lowest odds of depressive symptomatology (all ps<0.05). All aforementioned associations were more evident in women (all ps for sex-related interaction<0.05). Conclusions The present findings generate the hypothesis that moderate total meat consumption and impressively, red meat may be more beneficial to prevent depressed mood and probably in turn hard CVD endpoints. Funding Acknowledgement Type of funding source: Other. Main funding source(s): This work was supported by a research grant from Hellenic Atherosclerosis Society. The ATTICA study is supported by research grants from the Hellenic Cardiology Society [HCS2002] and the Hellenic Atherosclerosis Society [HAS2003].

The Vitamins in Psychosis Study: A Randomized, Double-Blind, Placebo-Controlled Trial of the Effects of Vitamins B12, B6, and Folic Acid on Symptoms and Neurocognition in First-Episode Psychosis

BackgroundElevated homocysteine is observed in schizophrenia and associated with illness severity. The aim of this study was to determine whether vitamins B12, B6, and folic acid lower homocysteine and improve symptomatology and neurocognition in first-episode psychosis. Whether baseline homocysteine, genetic variation, sex, and diagnosis interact with B-vitamin treatment on outcomes was also examined. MethodsA randomized, double-blind, placebo-controlled trial was used. A total of 120 patients with first-episode psychosis were randomized to an adjunctive B-vitamin supplement (containing folic acid [5 mg], B12 [0.4 mg], and B6 [50 mg]) or placebo, taken once daily for 12 weeks. Coprimary outcomes were change in total symptomatology (Positive and Negative Syndrome Scale) and composite neurocognition. Secondary outcomes included additional measures of symptoms, neurocognition, functioning, tolerability, and safety. ResultsB-vitamin supplementation reduced homocysteine levels (p = .003, effect size = −0.65). B-vitamin supplementation had no significant effects on Positive and Negative Syndrome Scale total (p = .749) or composite neurocognition (p = .785). There were no significant group differences in secondary symptom domains. A significant group difference in the attention/vigilance domain (p = .024, effect size = 0.49) showed that the B-vitamin group remained stable and the placebo group declined in performance. In addition, 14% of the sample had elevated baseline homocysteine levels, which was associated with greater improvements in one measure of attention/vigilance following B-vitamin supplementation. Being female and having affective psychosis was associated with improved neurocognition in select domains following B-vitamin supplementation. Genetic variation did not influence B-vitamin treatment response. ConclusionsWhile 12-week B-vitamin supplementation might not improve overall psychopathology and global neurocognition, it may have specific neuroprotective properties in attention/vigilance, particularly in patients with elevated homocysteine levels, patients with affective psychosis, and female patients. Results support a personalized medicine approach to vitamin supplementation in first-episode psychosis.

Identity Development, Family Relations, and Symptomatology in Adolescents from Seven Countries

Identity Development, Family Relations, and Symptomatology in Adolescents from Seven Countries This study analyzed identity development and parental rearing in adolescents from seven countries. In a sample of 2,259 adolescents (M = 15 years; 54 % female) from France, Germany, Turkey, Greece, Peru, Pakistan, and Poland, maternal parenting (support, psychological control, anxious rearing), identity development (exploration, commitment and ruminative exploration) and psychopathology was assessed. Adolescents from central Europe (France and Germany) were characterized by quite low scores in most identity dimensions, compared to adolescents from all other countries. Particular high were scores in exploration and commitment among adolescents from Turkey, Greece, Peru and Pakistan. In some countries, adolescents described the family relations as characterized by high levels of anxious rearing and psychological control, which was, however, not associated with elevated levels of total symptomatology. The findings show that what is adaptive in one cultural context is depending on cultural norms and family traditions. This information is helpful in designing interventions.

Emerging Adults’ Psychopathology in Seven Countries: The Impact of Identity-Related Risk Factors

The impact of identity-related risk factors on psychopathology was analyzed in 2,113 emerging adults ( M = 22.0 years; 66% female) from France, Germany, Turkey, Greece, Peru, Pakistan, and Poland. Identity stress, coping with identity stress, maternal parenting (support, psychological control, and anxious rearing), and psychopathology (internalizing, externalizing, and total symptomatology) were assessed. After partialing out the influence of stress, coping, and perceived maternal behavior, country did no longer exert a significant effect on symptom scores. The effect for gender remained, as did an interaction between country and gender. Rather unexpected, on average, males reported higher internalizing symptomatology scores than females. Potential causes for the higher scores of males are therefore discussed. Partialing out covariates resulted in a clearer picture of country-specific and gender-dependent effects on psychopathology, which is helpful in designing interventions.

T44. A RANDOMISED, DOUBLE-BLIND, PLACEBO-CONTROLLED TRIAL OF THE EFFECTS OF VITAMIN B12, B6 AND FOLIC ACID ON COGNITION AND SYMPTOMS IN FIRST-EPISODE PSYCHOSIS: THE VITAMINS IN PSYCHOSIS STUDY

BackgroundVitamin B12, vitamin B6 and folic acid are homocysteine-reducing agents. People with schizophrenia have been found to have increased homocysteine levels. Elevated homocysteine has been associated with impaired cognition. Previous research in chronic schizophrenia has shown that supplementation with folate plus vitamin B12 can improve cognition and clinical symptoms. Whether homocysteine lowering agents are effective in first-episode psychosis is unknown. The aim of this study was to investigate if adjunctive vitamin B12, B6 and folic acid can lower homocysteine and improve symptomatology and cognition in people with first-episode psychosis.MethodsThis was a randomised, double-blind, placebo-controlled trial conducted at the Early Psychosis Prevention and Intervention Centre (EPPIC) in Melbourne, Australia. One hundred and twenty patients aged 15–26 years with first-episode psychosis consented and were randomised to receive folic acid 5mg, vitamin B12 0.4mg, and vitamin B6 50mg or placebo, each taken once-daily for 12 weeks as an adjunct to antipsychotic medication. Co-primary measures were change in cognition as measured by a composite score from a battery of 11 tests and total symptomatology (PANSS) over 12 weeks. Secondary outcomes included additional cognitive, symptom, functioning, tolerability and safety measures.ResultsOf the 120 participants randomised in the study, 20 dropped out with no follow-up assessments and were excluded from analysis. Of the remaining 100 participants, 52 were in the vitamins group and 48 the placebo group. At baseline, the two treatment groups had lower levels of folate and vitamin B12 intake than healthy controls, but did not differ from each other. Vitamin B12, B6 and folic acid reduced homocysteine levels in the vitamin group over 12 weeks. The homocysteine lowering effects of the vitamins did not confer a major advantage over placebo therapy in improving the co-primary PANSS (p=.75) or composite cognition (p=0.79) outcomes over 12 weeks. There was a significant difference between groups among females in the cognitive domain of speed of processing (p=.049) and attention/vigilance (p=0.002), in which the mean performance of the placebo group declined over 12 weeks, whereas performance in the vitamin group remained showed improvement.DiscussionFolic acid, B12 and B6 supplementation appears well tolerated and safe in first-episode psychosis and lowers homocysteine levels in this population. However, supplementation may not offer extra benefits to all patients with first-episode psychosis, with the possible exception of speed of processing and attention/vigilance. Although previous research suggests that males preferentially benefit, our findings suggest that there may be a specific beneficial effect on cognition for females with first-episode psychosis.

Culture beats gender? The importance of controlling for identity- and parenting-related risk factors in adolescent psychopathology

This study analyzed the unique effects of gender and culture on psychopathology in adolescents from seven countries after controlling for factors which might have contributed to variations in psychopathology. In a sample 2259 adolescents (M = 15 years; 54% female) from France, Germany, Turkey, Greece, Peru, Pakistan, and Poland identity stress, coping with identity stress, maternal parenting (support, psychological control, anxious rearing) and psychopathology (internalizing, externalizing and total symptomatology) were assessed. Due to variations in stress perception, coping style and maternal behavior, these covariates were partialed out before the psychopathology scores were subjected to analyses of variance with gender and country as factors. These analyses leveled out the main effect of country and revealed country-specific gender effects. In four countries, males reported higher internalizing and total symptomatology than females. Partialing out the covariates resulted in a clearer picture of culture-specific and gender-dependent effects on psychopathology, which is helpful in designing interventions.

Individual Differences in Optimum Sleep for Daily Mood During Adolescence

Efforts to establish an empirical basis for recommended sleep durations during adolescence need to take into account individual differences in optimum sleep, defined as the amount of sleep at which peak functioning is observed. A total of 419 adolescents (M age = 15.03 years) with Mexican American backgrounds reported their nightly sleep duration and daily mood for a 2-week period at 1 or 2 waves of data collection, 1 year apart. Adolescents also completed an established measure of symptomatology. Multilevel modeling revealed a nonlinear association between sleep duration and next-day mood, whereby both too little and too much sleep were associated with elevated levels of daily distress. Significant individual differences in optimum sleep were observed such that younger adolescents and those with elevated levels of internalizing and total symptomatology evidenced greater sleep durations on nights before they reported their lowest levels of daily distress. Younger adolescents and those with higher internalizing and total symptomatology may need more sleep to reach their peak functioning the next day, at least in terms of daily mood.

Metacognitive profiles in schizophrenia and bipolar disorder: Comparisons with healthy controls and correlations with negative symptoms

While deficits in metacognition, or the ability to notice and reflect upon mental states has been observed in schizophrenia and linked with poorer concurrent and future function, it is unknown whether these deficits are unique to schizophrenia. Accordingly, this study assessed metacognition using the Metacognitive Assessment Scale–Abbreviated (MAS-A) and the Metacognitions Questionnaire– 30 (MCQ-30) among 26 adults with schizophrenia, 23 with bipolar disorder and 23 healthy controls. Symptom levels of the psychiatric groups were assessed with the Brief Psychiatric Rating Scale. ANCOVA controlling for age and education revealed that the schizophrenia group had lower scores on the MAS-A total and its subscales compared to the bipolar group and healthy controls. The bipolar disorder group also had lower MAS-A scores than the healthy control group. No group differences were found for the MCQ-30. Examination of symptom correlates revealed MAS-A scores were most commonly related to negative symptoms in both clinical groups. The total score and need for control subscale of MCQ-30 was related to total symptomatology and positive symptoms in patients with bipolar disorder. Correlations between the two measures of metacognition revealed that higher MAS-A scores were significantly related to lower scores on the Need to Control Thoughts MCQ-30 subscale.

Raloxifene as an Adjunctive Treatment for Postmenopausal Women With Schizophrenia: A 24-Week Double-Blind, Randomized, Parallel, Placebo-Controlled Trial

The potential therapeutic utility of estrogens in schizophrenia is increasingly being recognized. Raloxifene, a selective estrogen receptor modulator, appears to act similarly to estrogens on dopamine and serotonin brain systems. One previous trial by our team found that raloxifene was useful to improve negative, positive, and general psychopathological symptoms, without having the negative side effects of estrogens. In this study, we assess the utility of raloxifene in treating negative and other psychotic symptoms in postmenopausal women with schizophrenia exhibiting prominent negative symptoms. This was a 24-week, randomized, parallel, double-blind, placebo-controlled study. Patients were recruited from the inpatient and outpatient departments of Parc Sanitari Sant Joan de Déu, Hospital Universitari Institut Pere Mata, and Corporació Sanitària Parc Taulí. Seventy postmenopausal women with schizophrenia (DSM-IV) were randomized to either adjunctive raloxifene (38 women) or adjunctive placebo (32 women). Psychopathological symptoms were assessed at baseline and at weeks 4, 12, and 24 with the Positive and Negative Syndrome Scale (PANSS) and the Scale for the Assessment of Negative Symptoms (SANS). The addition of raloxifene (60 mg/d) to regular antipsychotic treatment significantly reduced negative (P = .027), general (P = .003), and total symptomatology (P = .005) measured with the PANSS during the 24-week trial, as compared to women receiving placebo. Also Alogia SANSS subscale improved more in the raloxifene (P = .048) than the placebo group. In conclusion, raloxifene improved negative and general psychopathological symptoms, compared with antipsychotic medication alone, in postmenopausal women with schizophrenia. These data replicate our previous results with a larger sample and a longer follow-up. NCT01573637.

Factors predictive of length of stay for women in medium secure settings

Attempts to understand determinates of length of stay in secure settings has been given increased impetus by minimum standard setting and payment by results initiatives. Factors predictive of length of stay in the extant literature include, index offence, previous engagement in therapy, symptomatology, personality pathology and need. These factors were assessed for their predictive validity in a sample of 70 consecutive admissions to a women's medium secure service. Patients were divided into short- and long-stay groups A loglinear analysis of intake variables indicated that the highest order interaction (duration of stay × diagnosis × index offence/previous engagement in therapy) was significant. Analysis of dynamic variables indicated that longer stays were associated with total symptomatology, paranoid pathological personality scale scores and Camberwell Assessment of Need Forensic Version need items of psychotic symptoms and psychological distress. Short-stay patients showed higher levels of therapy engagement. Findings are confirmatory of some of the key variables to be considered when estimating length of stay and when planning treatment.

Understanding the Functionality of Depression Among Australian Breast Cancer Patients: Implications for Cognitive and Behavioural Interventions

Depression in breast cancer (BCa) patients can reduce quality of life, relationships and treatment compliance, thus constituting a major target for cognitive behavioural (CBT) interventions. Although CBT treatments, which are built upon consideration of the roles of antecedents and consequences for depressive behaviour, are effective, the nature of those antecedents which trigger depression among BCa patients has received relatively little attention. Hypotheses were (1) to determine if BCa patients were experiencing either or both of punishment type I and II and (2) to identify if these aspects of punishment were related to overall depression. Two hundred fifty-three BCa patients completed a standardised depression scale, and data were factor analysed. Components were interpreted for their relationship to punishment type I or II. Two major components emerged: (1) loss of previously available sources of personal or social reinforcement (i.e. punishment type II or negative punishment) and (2) behavioural, emotional and cognitive responses to those losses. These two components represent the total symptomatology of major depressive episode from DSM-IV-TR. These findings support the application of a functional analytic model of depression within CBT assessment and treatment procedures with BCa patients.

Relationship of Symptomatology with Closed Chamber Infrared Thermometry and Humidity in Dry Eyes

To evaluate the relationship of symptoms of dry eye with closed chamber infrared thermometry and humidity measurements. The authors studied 54 patients (108 eyes) with dry eye disorders of different grades of clinical severity (mean age 35.75+/-14.37 years), 31 cases (62 eyes) with normal eyes (mean age 33.68+/-14.42 years), and 10 cases (20 eyes) with epidemic conjunctivitis (mean age 33.68+/-14.42 years). The symptoms and the clinical tests (Schirmer-1 test, fluorescein tear break up time, Lissamine green stain; closed chamber infrared thermometry and humidity) were used to establish the diagnosis of dry eyes. The closed chamber humidity difference was used to classify the groups of dry eye. The authors noted no temperature difference from closed to open eye position in dry eyes as compared to 0.10 +/- 0.00 degrees C difference in normal eyes and epidemic conjunctivitis. Four groups of cases were identified by difference in values of humidity: Group 1 = <0.9 relative humidity (RH)% to 1 RH%; Group 2 = >1 RH% to 1.5 RH%; Group 3 = >1.5 RH% to 2 RH %; and Group 4 = >2 RH%. The symptomatology was measured in the eyes using Oxford scale (0-4) and correlated with the humidity groups. The grading of symptoms with the humidity showed a statistically significant relationship (p<0.0001) in each group. The severity of the symptoms showed an increase in frequency and severity from Group 1 to Group 4, which was statistically significant (p<0.0001). The mean sum total of global symptomatology score was statistically significant (p<0.0001): 3.43 +/- 0.31 in Group 1, 4.65+/-0.42 in Group 2, 8.56 +/- 0.78 in Group 3, and 13.35+/-1.21 in Group 4. However, total symptomatology score in epidemic conjunctivitis did not show a statistically significant value (p=0.20). The closed chamber humidity and thermometry measurements showed statistical correlation in all four groups of dry eyes to total mean symptomatology score (p<0.001) and showed an increase in value with increasing severity of symptoms. However, all individual symptoms fail to show any conclusive relationship.

Intermittent pneumatic compression in chronic venous insufficiency favorably affects fibrinolytic potential and platelet activation.

Nineteen patients with symptoms of chronic venous insufficiency (CVI) were treated with 13-week cycles of intermittent pneumatic compression (IPC) during 2 h sessions twice weekly, with most treatments at home. At study completion, quantitative subjective scores for total symptomatology were improved in 16/19 patients (84%). Enhancement of fibrinolytic potential in vivo was detected in 86% of observations on specimens from CVI patients over 2 h of IPC, with accelerated euglobulin clot lysis times (ELT) noted within 15 min of initiating compression. The enhanced fibrinolytic potential was attributed to increased urokinase plasminogen activator (u-PA), probably released from perturbed endothelial cells by IPC. Significant decreases in total t-PA antigen (mass concentration) but not t-PA activity, were produced by IPC in CVI patients only (P = 0.0001), with greater effects noted in the non-anticoagulated versus the anticoagulated cohort. Plasminogen activator inhibitor type 1 (PAI-1) levels rose rapidly after IPC only in the controls and non-anticoagulated CVI patients. PAI-1 decreased in those receiving anticoagulation. No platelet perturbation was detected during IPC by measuring levels of beta-thromboglobulin or the thromboxane A2 metabolite, 11-dehydrothromboxane B2; however, significant (P < 0.003) decreases in plasma prostacyclin (PGI2) levels (measured as the stable 6-ketoprostaglandin F-1-alpha-metabolite) were observed after 15 min of IPC in non-anticoagulated CVI patients only. There was no evidence of increased thrombin generation by IPC, determined by urinary excretion of fibrinopeptide A and prothrombin fragment 1. Concurrent anticoagulation appears to mediate more favorable biochemical alterations in CVI, although subjective improvement did not correlate with anticoagulation. The mechanism(s) by which these physiologic changes compliment the mechanical effects of IPC remain to be elucidated and will require adequately controlled and powered studies.

Acute health effects among firefighters exposed to a polyvinyl chloride (PVC) fire.

Firefighters are frequently being called on to fight fires that are chemical in nature. In the aftermath of a chemical fire in Plainfield, New Jersey on March 20-21, 1985, the authors conducted a retrospective cohort study which surveyed 80 firefighters exposed to burning polyvinyl chloride (PVC) as well as 15 nonexposed firefighter subjects. By means of an 81-item symptom checklist, exposed firefighters reported more frequent and severe symptoms at 5-6 weeks post incident. This was true for a total symptomatology score as well as 19 individual items. Some of the items with an elevated risk were consistent with exposure to hydrogen chloride, the main pyrolysis product of polyvinyl chloride. Other items with an elevated risk appeared to be related to smoke inhalation while others seemed psychosocial in nature. Analyses conducted within the exposed firefighter group showed that fighting the fire the first day, being a truckman, and residence within 1 mile (1.6 km) of the firehouse were significant risk factors for high total symptom scores. These risk factors may have been associated with level or duration of exposure to the toxic substances produced during the fire.

Psychiatric symptoms in medical students

The current study examined the presence of psychiatric symptomatology in a sample of medical students. Results demonstrated that while medical students evidenced levels of symptomatology that were considerably lower than those previously reported in outpatient psychiatric samples, they evidenced considerably higher symptom levels than those previously reported in a general population survey. Compared to the general population, medical students showed a mild elevation in somatic symptoms, a moderate elevation in anxiety and depressive symptoms, and a substantial elevation in obsessive-compulsive symptomatology and in interpersonal sensitivity. The marked elevations in obsessive-compulsive symptomatology and in interpersonal sensitivity may reflect, in part, a sensitization to excessive performance demands that is manifested by anxiety-induced cognitive inefficiencies such as indecisiveness, blocking, or memory impairment and by excess sensitivity to the evaluative opinions of other individuals. In comparing students from the four classes, there was no significant relationship between the year in school and symptom level. In examining sex differences, women reported a significantly higher level of total symptomatology and higher symptom levels on four of the five subscales examined. The largest sex differences were observed in the symptom areas of depression and interpersonal sensitivity.

Sex differences in medical students requesting psychiatric intervention.

Although recent reports suggest that women choosing a medical career encounter unique stressors, little attention has been given to whether this additional stress places them at greater psychological risk than men. This investigation delineates sex differences in the psychopathology of medical students seeking treatment. Men and women did not differ in primary diagnosis, type of complaint, problem areas, or type of termination. However, women reported more depressive and total symptomatology, and men were more likely to receive a secondary diagnosis of personality disorder and evidenced a particular excess of obsessive-compulsive disorders. Men often requested treatment following a relationship loss or when school performance fell short of expectations. Women were frequently struggling to reconcile career desires with a feminine identification and with affiliation needs. Conflict about deviating from a traditional role was exacerbated by expressed disapproval from significant others.