Ole J. Thienhaus

Superoxide dismutase activity in Alzheimer's disease: possible mechanism for paired helical filament formation ☆

Activity of the free radical scavenging enzyme, superoxide dismutase (SOD-1), was determined in fibroblast cell lines derived from familial Alzheimers patients, trisomy 21 patients and normal controls. In the present study, SOD-1 activity was significantly elevated by 30% in Alzheimers cell lines when compared to normal euploid cell lines. As SOD-1 activity is known to be elevated about 50% in trisomy 21 patients, these cell lines were included as a control for tissue culture and assay conditions. In the present study, SOD-1 activity was significantly increased by 42 +/- 11% in trisomy 21 patients. The elevation in SOD-1 activity observed in the familial Alzheimers patients supports the theory that paired helical filaments are synthesized in Alzheimers disease by free radical hydroxylation of proline residues in paired helical filament precursor protein(s).

Anticholinergic serum levels and cognitive performance

SummaryIntegrity of central cholinergic neurotransmission is essential for adequate cognitive functioning. Many psychotherapeutic medications have anticholinergic side-effects. In order to determine the impact of circulating anticholinergic activity on cognitive performance, 28 geropsychiatric inpatients underwent cognitive testing at different levels of anticholinergic serum activity. In 10 subjects with a diagnosis of probable Alzheimers disease, significant deterioration of selected cognitive functions was observed at anticholinergic serum levels that caused no dysfunction in the 18 non-demented subjects. The data suggest that non-demented elderly patients with psychiatric problems tolerate psychotropic pharmacotherapy without significant negative impact on their cognitive competency. By contrast, patients with Alzheimers disease are at risk of additional impairment. The introduction of anticholinergic serum activity as a monitoring technique for safe psychopharmacotherapy in geriatric patients is discussed.

A New Scale for Assessing Behavioral Agitation in Dementia

The primary purpose of the present study was to develop a reliable and valid rating instrument for assessing treatment efficacy for behavioral problems in the cognitively impaired elderly. The Behavioral and Emotional Activities Manifested in Dementia (BEAM-D) Scale was developed for the operational assessment of troublesome and disruptive behaviors in dementia. Each behavioral category of the BEAM-D was clinically considered to be a significant deviation from normative behavior for the geriatric dementia patient. The reliability and validity of the BEAM-D was assessed in a group of 45 patients diagnosed with primary degenerative dementia. The mean interrater reliability of BEAM-D items was 0.90. Concurrent validity was established by comparison with currently used rating scales, the Brief Psychiatric Rating Scale (BPRS) and the Sandoz Clinical Assessment-Geriatric (SCAG). Stepwise regression analysis revealed that the items of the BEAM-D had a strong relationship with conceptually similar behavioral dimensions on the BPRS and SCAG.

Hearing impairment and psychosis

The study explores the relationship between hearing impairment and psychotic illness in twenty hospitalized patients (aged 55-77) using as controls twenty age-matched community-based older subjects with no psychiatric illness. All subjects received full psychiatric evaluations and comprehensive audiologic assessments. Data were analyzed by discriminant analysis and ANOVA. Experimental subjects were found to have significantly poorer unilateral pure tone averages (PTA) and significantly poorer bilateral speech discrimination ability than control subjects. Patients with a mood disorder had poorer unilateral PTAs than controls, but did not exhibit significantly poorer speech discrimination. Subjects with specifically paranoid ideation were found to have significantly better left ear speech discrimination than nonparanoid subjects. Our data suggest that hearing impairment should possibly be considered a potential risk factor for the development of psychosis in the elderly.

Sexuality and Ageing

Ageing itself abolishes neither the need nor the capacity for sexual activity. A number of studies confirm the continuance of sexual activity in old age. Normal physiological changes with age affect erectile function and ejaculation in males, and the vaginal tissue in females. Psychological and social factors that affect sexual function in old age include the individuals degree of sexual activity throughout earlier life, the psychological resiliency in adapting to the altered physiological conditions, demographic factors, and societys attitudes towards sex in old age. Furthermore, pathologies that are more prevalent among the elderly can interfere with sexual function.

Residency training in emergency psychiatry : changes between 1980 and 1990.

Independent random samples of residency training programs were surveyed in 1980 and in 1990 about their emergency psychiatry training. A larger percentage of the programs required daytime emergency service duty in 1990 (80%), compared with 1980 data (50%), and a larger percentage offered a daytime block training rotation, defined as at least 5 days a week of emergency psychiatry for at least 4 weeks (48%), compared with 23% in 1980. Each sample reported that the most important topics in emergency psychiatry were being taught. In 1990, two trends were noted: 1) more faculty psychiatrist time allocated to the emergency service, and 2) more emergency patient visits per shift. In 1990, the residents said they felt more stressed by the heavy patient load and lack of disposition facilities than in 1980, but less stressed by the lack of faculty interest and backup. Based on the data, the interpretation was made that emergency psychiatry training had improved over this period; however, it was indicated that further improvement was also needed.

Length of psychiatric hospitalization and prediction of antipsychotic response.

1. Clinical variables determining length of psychiatric hospitalization for psychotic inpatients were explored. Forty psychotic inpatients received a 14 day fixed dose neuroleptic trial. 2. Neuroleptic responders (25/40) were discharged 15 +/- 2 days after initiation of pharmacotherapy. For neuroleptic non-responders (15/40) antipsychotic medication was then altered as clinically indicated. Patients requiring one change in medication (N = 8) were discharged after 27 +/- 5 days; those requiring two medication adjustments (N = 4) were discharged after 33 +/- 3 days and those requiring three alterations in pharmacotherapy (N = 3) were discharged after 42 +/- 12 days. 3. Statistical analysis of clinical and diagnostic variables indicated that 84% of the variation in length of hospitalization was accounted for by the number of alterations in pharmacotherapy required for symptom remission and discharge. It is suggested that length of hospitalization may be decreased by decreasing the length of time a clinician prescribes pharmacotherapy that subsequently proves not effective. 4. Bayesian analysis was employed to identify the minimum length of pharmacotherapy which accurately predicts subsequent antipsychotic response/non-response. During the fixed dose neuroleptic trial response/non-response could be accurately predicted for 65% of the patients by Day 3 of the trial while by Day 7 response/non-response could be predicted for 80% of the patients. 5. The present data indicate that a three to seven day trial of antipsychotics may be sufficient for making pharmacotherapy decisions as such a trial demonstrates a diagnostic efficiency similar to other predictive tests employed in clinical medicine.

Parity with what

In May 2001, The Robert Wood Johnson Foundation sponsored a one-day workshop to help federal officials in designing their evaluation of the implementation of parity in the Federal Employee Health Benefit Program. At the workshop, actuaries, economists, and key governmental officials examined the methods and evidence for estimates of the costs of parity for mental health. This report summarizes the lessons from the workshop.