Maurice W. Dysken

The Yale-Brown Obsessive-Compulsive Scale : measures of internal consistency

We examined the construction of the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) and performance of subscale items based on data from 204 patients with obsessive-compulsive disorder (OCD) who participated in a multicenter drug treatment study. Factor analysis was used to examine the relationship among the 10 items that make up the Y-BOCS instrument. Models were computed in which both two- and three-factor solutions were estimated. Within the two-factor solution analyses, the factor distribution was not so consistent as in the three-factor solution analyses, and a shift in the factor distribution was noted after treatment. In the three-factor solution analyses, an independent resistance construct emerged in addition to the obsessive and compulsive constructs. Examination of the postreatment factor scores showed that the Y-BOCS resistance items did not assess OCD symptom change as sensitively as the rest of the Y-BOCS items did.

Neuropyschological performance in obsessive-compulsive disorder

Abstract Neuropsychological functioning was examined in a group of 18 nondepressed patients with obsessive-compulsive disorder (OCD) and 18 age-, education-, and gender-matched normal controls. A recent nonverbal memory deficit was identified in the patients with OCD. From performance on timed and untimed measures of the same constructs, it appears that OCD patients score more poorly than controls when speed is a factor. Although performance on a timed tactual-spatial motor test was also impaired, it is unclear whether this deficit is attributable to the nonverbal memory and/or speed deficits. Deficits in verbal abilities, including recent verbal memory, were not identified. Results were equivocal for executive function and visual-spatial abilities. The previously established association of recent nonverbal memory abilities with functioning of the right mestal temporal area is discussed in the context of current hypotheses about the neuroanatomic substrate of OCD.

Where the brain grows old: decline in anterior cingulate and medial prefrontal function with normal aging.

Even healthy adults worry about declines in mental efficiency with aging. Subjective changes in mental flexibility, self-regulation, processing speed, and memory are often cited. We show here that focal decreases in brain activity occur with normal aging as measured with fluorodeoxyglucose and positron emission tomography. The largest declines localize to a medial network including the anterior cingulate/medial prefrontal cortex, dorsomedial thalamus, and sugenual cingulate/basal forebrain. Declining metabolism in this network correlates with declining cognitive function. The medial prefrontal metabolic changes with aging are similar in magnitude to the hypometabolism found in Mild Cognitive Impairment or Alzheimers disease. These results converge with data from healthy elderly indicating dysfunction in the anterior attention system. The interaction of attention in the anterior cingulate cortex with memory in the medial temporal lobe may explain the global impairment that defines dementia. Despite the implications for an aging population, the neurophysiologic mechanisms of these metabolic decreases remain unknown.

Serum Anticholinergic Activity in Hospitalized Older Persons with Delirium: A Preliminary Study

OBJECTIVE: To evaluate the relationship between total serum anticholinergic activity (SAA) and the presence or absence of delirium in older hospitalized persons on general medical wards.

Calcium and vitamin D supplementation and cognitive impairment in the women's health initiative.

To examine the effects of vitamin D and calcium on cognitive outcomes in elderly women.

The Yale-Brown obsessive-compulsive scale: A reliability and validity study

Twenty-eight nondepressed patients with DSM-III obsessive-compulsive disorder completed both the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) and the Leyton Obsessional Inventory (LOI) once a week for a total of three times change. In general, the correlations between the Y-BOCS change scores and the Global Ratings were significantly greater than between the LOI and the Global scores, the Y-BOCS was found to be more reliable than the LOI. Correlations were also obtained for the baseline period between the Y-BOCS and Leyton scores. At the end of a 14-week trial of clomipramine, the Y-BOCS and the LOI were again administered along with a Physician and Patient Global Rating of change. In general, the correlations between the Y-BOCS change scores and the Global Ratings were significantly greater than between the LOI and the Global Ratings. This last finding suggests that the Y-BOCS is a better measure of clinical change than is the LOI.

A Review of Disorders of Water Homeostasis in Psychiatric Patients

Disorders of water homeostasis are common in psychiatric patients and include compulsive water drinking, the syndrome of inappropriate antidiuretic hormone secretion (SIADH), and the syndrome of self-induced water intoxication (SIWI). Although water intoxication was recognized nearly 70 years ago, the physiological basis of these disorders of water metabolism still remains elusive. This review will provide a historical overview, critique current studies on compulsive water drinking and SIWI, discuss possible etiologies, and present current approaches to treatment of these disorders. Because of the complexity of the subject, a review of normal water homeostasis and the SIADH will be included.

Dementia and Alzheimer's Disease in Community-Dwelling Elders Taking Vitamin C and/or Vitamin E

BACKGROUND Since increased oxidative stress may impair cognition and be a risk factor for dementia, there has been interest in determining whether use of antioxidants could protect against such events. OBJECTIVE To determine whether supplement use of vitamins C and/or E in a community-based sample of older African American and white individuals delayed incident dementia or Alzheimers disease (AD). METHODS We selected a subgroup from the Duke Established Populations for Epidemiologic Studies of the Elderly, a longitudinal study of community-representative persons aged 65–105 years living in 5 adjacent counties in North Carolina, and followed them for dementia (1986–1987 through June 2000). Information gathered during in-home interviews included sociodemographic characteristics, health status, health service use, and vitamin use. Diagnosis of dementia and AD was based on evaluations using the clinical and neuropsychological batteries of the Consortium to Establish a Registry for Alzheimers Disease, with final determination by consensus agreement of specialists using Diagnostic and Statistical Manual of Mental Disorders, third revision, and National Institute for Neurological and Communicative Disorders and Stroke–Alzheimers Disease and Related Disorders criteria. RESULTS Of 616 persons initially dementia-free (mean age 73 y; 62% female; 62% African American), 141 developed dementia, of whom 93 developed AD. Increased age and mobility problems were risk factors for dementia (only age for AD), while an increased number of outpatient visits reduced the likelihood of developing dementia. Neither use of any vitamins C and/or E (used by 8% of subjects at baseline) nor high-dose use reduced the time to dementia or AD. CONCLUSIONS In this community in the southeastern US where vitamin supplement use is low, use of vitamins C and/or E did not delay the incidence of dementia or AD.

Fluphenazine pharmacokinetics and therapeutic response

We conducted a double-blind study of therapeutic outcome versus mean steady-state levels in 29 newly admitted schizophrenic and schizoaffective patients who were treated with a constant dose of fluphenazine HCl over a 2-week period. Both an upper and lower end of the therapeutic window were suggested by three nonresponders whose plasma levels were above 2.8 ng per ml and by two nonresponders and one partial responder whose plasma levels were below 0.2 ng per ml. The mean terminal half-life of fluphenazine (±SD) was 16.4±13.3 h. We found that concomitant use of benztropin mesylate during the initial 4 weeks of fluphenazine treatment did not significantly alter fluphenazine plasma levels.

Are All Commonly Prescribed Antipsychotics Associated with Greater Mortality in Elderly Male Veterans with Dementia

OBJECTIVES: To estimate mortality risk associated with individual commonly prescribed antipsychotics.