David A. Baron

Quality of Life Survey of Urinary Diversion Patients: Comparison of Ileal Conduits versus Continent Kock Ileal Reservoirs

There has been a recent marked increase in interest in continent urinary diversions. While considerable time has been spent on the technical aspects of these diversions the psychological impact has not yet been fully explored. We describe an extensive survey that was conducted among 100 consecutive adults (87 respondents) who had undergone urinary diversion via an ileal conduit and 100 consecutive adults (85 respondents) in whom a continent Kock ileal reservoir was created during the last 3 to 5 years at our university by the same surgeons. The Kock pouch patients were stratified further into 63 with primary diversion and 22 who underwent conversion from previous conduit diversions. The survey consisted of a questionnaire that included a social and sexual survey, the Beck Depressive Inventory, the Profile of Mood States and a physical impact study. The results revealed that all patients surveyed generally were satisfied with the diversions and they had adapted reasonably socially, physically and psychologically. The key to adaptation seemed to be a detailed, realistic preoperative education about the type of diversion used. Patients with ileal conduit diversions had the lowest expectations of the form of diversion as defined by the preoperative awareness of the need to wear an external ostomy appliance with its associated inconveniences and change in the external body image. Postoperatively, ileal conduit patients also had the poorest self images as defined by a decrease in sexual desire and in all forms of physical contact (sexual and nonsexual). The subset of patients who underwent conversion from conduit diversions to Kock pouches, however, were statistically the most satisfied, and they were the most physically and sexually active. We conclude that the Kock continent urostomy offers an important alternative to noncontinent forms of diversion.

Beta-lactam antibiotic reduces morphine analgesic tolerance in rats through GLT-1 transporter activation

Glutamate transporter subtype 1 (GLT-1) activation is a promising - and understudied - approach for managing aspects of morphine tolerance caused by increased glutamatergic transmission. Identification of beta-lactam antibiotics as pharmaceuticals which activate GLT-1 transporters prompted us to hypothesize that repeated beta-lactam antibiotic (ceftriaxone) administration blocks development of tolerance to morphine antinociception through GLT-1 activation. Here, we injected rats with morphine (10mg/kg, s.c.) twice daily for 7 days to induce tolerance and used the hot-plate assay to determine antinociception on days 1, 4 and 7 of repeated morphine administration. Ceftriaxone and a selective GLT-1 transporter inhibitor dihydrokainate (DHK) were co-administered with morphine to determine if GLT-1 activation mediated the ceftriaxone effect. Tolerance was present on days 4 and 7 of repeated morphine administration. Ceftriaxone (50, 100 or 200mg/kg, i.p.) administration dose-dependently blocked development of morphine tolerance. DHK (10mg/kg, s.c.), administered 15 min before each morphine injection, prevented inhibition of morphine tolerance by ceftriaxone (200mg/kg, i.p.). These results identify an interaction between ceftriaxone and morphine in opioid-tolerant rats and suggest beta-lactam antibiotics preserve analgesic efficacy during chronic morphine exposure.

β-lactam antibiotic inhibits development of morphine physical dependence in rats

β-Lactam antibiotics enhance cellular glutamate uptake. As increased glutamatergic transmission is a primary mediator of opiate dependence, we tested the hypothesis that a β-lactam antibiotic (ceftriaxone) prevents development of morphine physical dependence in rats. Morphine (20 mg/kg) was injected twice daily for 10 days to induce physical dependence. Naloxone (10 mg/kg) administration 1, 48, and 96 h after the last morphine injection induced a withdrawal syndrome characterized by the appearance of wet-dog shakes, teeth chattering, eye blinking, jumping, and paw tremor. Ceftriaxone (150, 200 mg/kg) injected once daily during chronic morphine exposure inhibited each naloxone-precipitated withdrawal sign. Ceftriaxone efficacy persisted even after the 96 h-naloxone (10 mg/kg) injection. These results suggest that β-lactam antibiotics inhibit processes leading to development of morphine physical dependence.

Preadolescent Children of Substance-Dependent Fathers with Antisocial Personality Disorder: Psychiatric Disorders and Problem Behaviors

We compared psychiatric disorders and problem behavior scores in pre-adolescent children of fathers with alcohol or other drug dependence and ASP (SD+/ASP+), children whose fathers had substance dependence without ASP (SD+/ASP-), and children whose fathers were without either disorder (SD-/ASP-). SD+/ASP+ children showed elevated rates of major depression, conduct disorder, attention deficit hyperactivity disorder, oppositional defiant disorder, and separation anxiety disorder when compared to SD+/ASP- and SD-/ASP- children. SD+/ASP+ children had higher internalizing and externalizing problem behavior scores than the other two groups of children. The results suggest that SD+/ASP+ children are at significant risk for internalizing and externalizing psychopathology.

A nitric oxide synthase inhibitor (L-NAME) attenuates abstinence-induced withdrawal from both cocaine and a cannabinoid agonist (WIN 55212-2) in Planaria

We previously reported that planarians (Dugesia dorotocephala) that have been exposed to cocaine for 1 h undergo abstinence-induced withdrawal when placed into cocaine-free, but not cocaine-containing, water. We now report that planarians also display dose-related abstinence-induced withdrawal following exposure to the synthetic cannabinoid agonist WIN 55212-2, but not its inactive enantiomer (WIN 55212-3). The withdrawal from WIN 55212-2 was manifested as a significant (P < 0.05) decrease in the rate of planarian spontaneous locomotor activity over a 5-min observation period, using a recently designed metric (pLMV). We also report that withdrawal from cocaine (80 microM) or WIN 55212-2 (10 microM) was attenuated by the selective inhibitor of nitric oxide synthesis L-NAME (L-nitro-arginine methyl ester), which had no effect of its own on pLMV. These results suggest a common NO-dependent pathway of withdrawal from cocaine and WIN 55212-2 in Planaria.

Sigma sites mediate DTG-evoked hypothermia in rats.

1,3,-Di-o-tolylguanidine (DTG), a sigma agonist, produces hypothermia in rats, but the inability of purported sigma antagonists to block the hypothermia suggests that sites other than sigma may mediate the effect. Recently, N-[2-(3,4-dichlorophenyl) ethyl]-N-methyl-2-(dimethylamino) ethylamine (BD 1047) has been identified as a functional sigma antagonist in vivo because of its high selectivity for sigma sites and its ability to block DTG-induced dystonia and cocaine-evoked behaviors. Therefore, the present study investigated the effect of BD 1047 on DTG-evoked hypothermia. DTG (1, 10, 20 and 30 mg/kg sc) induced dose-dependent hypothermia. The onset of DTG-induced hypothermia was rapid, with a reduction in body temperature observed 15 min postinjection. To determine whether sigma sites mediated DTG-induced hypothermia, BD 1047 was injected 30 min prior to DTG. BD 1047 (1, 5, 7.5 and 10 mg/kg sc) attenuated the hypothermia in a dose-dependent fashion, thus revealing a sigma site mechanism. The injection of BD 1047 alone did not alter body temperature, suggesting that endogenous sigma systems do not play a tonic role in thermoregulation. The present experiments demonstrate for the first time that a selective sigma antagonist attenuates sigma agonist-induced hypothermia. Moreover, these data provide further evidence that BD 1047 is an effective antagonist for characterizing sigma-mediated effects in vivo.

Role of Leisure in Recovery From Mental Illness

Conceptually supported by recovery, positive psychology, and health promotion perspectives, this study explored the role of leisure in recovery and health among culturally diverse individuals with mental illness. One-on-one survey interviews were conducted with Black (n = 35), Hispanic/Latino (n = 28), White (n = 28), and Asian (n = 8) adults (aged between 23 and 78) with mental illness (N = 101). A variety of mental health diagnoses were represented in the sample (e.g., bipolar disorder, n = 32; major depression, n = 23; schizophrenia, n = 22). Regression analyses were performed to estimate the predictive effects of leisure variables on recovery, health, and psychiatric symptoms. The findings emphasize the importance of: (a) meanings that persons with mental illness gain from leisure (e.g., connection/belonging, identity, freedom/autonomy) (i.e., meaning making via leisure) and (b) leisure opportunities to fight against or reduce perceptions of boredom (i.e., boredom reduction in leisure) as both of these were significant predictors of recovery. Also, a greater perception of being actively engaged/involved (i.e., perceived active living) was a significant predictor of recovery and overall physical and mental health and less frequent psychiatric symptoms, whereby leisure potentially provides a key context for the pursuit of active living. Furthermore, the use of leisure both for coping with stress (i.e., stress coping via leisure) and reducing boredom significantly predicted fewer psychiatric symptoms. The findings highlight the need to consider the experiences, feelings/emotions, and meanings that people with mental illness gain from leisure beyond simply behavioral forms of leisure (i.e., leisure activities) per se by respectfully appreciating the cultural diversity of people with mental illness.

Olanzapine overdose: a pediatric case report.

This paper reports a case of an olanzapine overdose in a 12-year-old boy. An opioid-like presentation was noted. Despite a high serum level of olanzapine, the patient made a complete recovery and showed no sequelae at follow-up.

Geographic Barriers to Community-Based Psychiatric Treatment for Drug-Dependent Patients

The World Health Organization has urged governments worldwide to implement evidence-based treatment services for drug addiction and mental health disorders, but the role of geographic characteristics in influencing treatment continuity for this population has been largely understudied. Here, we employ logistic regression (N = 294) to investigate how accessibility and neighborhood socioeconomic context influenced treatment continuity for a sample of 294 drug-dependent patients who received acute inpatient psychiatric treatment at a large, inner-city hospital in Philadelphia, Pennsylvania, and who were then referred to outpatient care. Results indicate that longer travel time to treatment, a high crime rate in the patients home neighborhood, and traveling from a relatively lower to a higher crime neighborhood for treatment suppress treatment continuity. These contextual influences are moderated by ethnicity, where whites are influenced more strongly by travel time to treatment. This likely reflects the locations of treatment programs relative to patterns of residential segregation. African Americans both reside and attend treatment within the very highest crime areas, and this appears to have a particularly negative impact on treatment continuity for African Americans. This research highlights the need for more careful consideration of geographic issues in psychiatric treatment planning.

Assessment of ADHD Documentation From Candidates Requesting Americans With Disabilities Act (ADA) Accommodations for the National Board of Osteopathic Medical Examiners COMLEX Exam

Purpose: Every year increasing numbers of candidates request special accommodations for high-stakes medical licensing examinations, due to ADHD, on the basis of the Americans with Disabilities Act (ADA). This poses significant challenges for both the applicant and the medical boards and has significant financial, legal, and ethical implications. The purpose of this survey is to review all applications requesting ADA accommodations, on the basis of ADHD, submitted to the National Board of Osteopathic Medical Examiners (NBOME) COMLEX exam. Method: The authors review all 50 requests for special accommodations, on the basis of ADHD, submitted to the NBOME between 2005 and 2007. All requests are reviewed by the investigators independently and then cross-checked to determine interrater reliability. Results: Of all applicants, only 14% (7/50) provide sufficient documentation to support a diagnosis of ADHD. Interrater reliability is high. Conclusions: The majority of applicants who request special testing accommodations on the basis of ADHD do not provide adequate documentation to the medical boards to support the diagnosis.