Zack Z. Cernovsky

Seasonal affective disorder in an Arctic community

Objective: To determine the rate of seasonal‐pattern depression in an Inuit community above 70°N.

Psychiatric disorders in an Arctic community.

Objective: To determine the rates of depression, anxiety, and alcohol abuse, using modern nosology, in a random sample of residents aged 14 to 85 years living in an Arctic community. Method: A cross-sectional 2-step survey of randomly selected households was undertaken, using a self-report questionnaire to screen for anxiety, depression, and alcohol abuse. The survey included the Hospital Anxiety and Depression Scale (HADS) and Ewing and Rooses 4-question alcohol screening instrument (the CAGE questionnaire). Cut-off scores for the HADS and CAGE were found by comparing HADS and CAGE scores with scores on the Structured Clinical Interview for the DSM-III-R (SCID) in a stratified subs ample. Results: Estimated rates of depression and anxiety were 26.5% and 19.0% respectively within the past week, and estimated rates of lifetime alcohol abuse were 30.5%. Conclusions: The estimated prevalence of psychiatric disorders in this Arctic community is higher than that indicated in previous findings on Native mental health.

The Long-Term Use of Cyproterone Acetate in Pedophilia: A Case Study

This investigation reports the long-term use of the antiandrogen cyproterone acetate (CPA) in a pedophile, who was studied continuously over 38 months. Measures of sexual arousal, serum testosterone, and gonadotropin levels were significantly reduced by the drug as compared with placebo and no treatment; prolactin levels were significantly elevated. Some workers have observed that long-term administration of CPA (more than one year, which was then discontinued) produced enduring (in some cases apparently permanent) anti-libidinal effects; however, in the case described, within three weeks of stopping the drug, all measures had returned to pretrial levels. The importance of continuous long-term monitoring in sex offenders receiving an antiandrogen is discussed.

Clinical correlates of insight in schizophrenia.

111 schizophrenic patients diagnosed in accordance with DSM–III were rated on Landmarks symptom checklist, on demographic variables, and on variables descriptive of the course of illness. Of the 111 patients, 108 (97.3%) showed poor insight into their illness at some time in the past and 65 (58.6%) at the time of assessment. Those presently showing poor insight were significantly (Pearson rs, p < .01, 2-tailed) more frequently rated as currently displaying poor judgement also in other matters (r = .50), as showing social withdrawal (r = .42) and poor rapport (r = .33), and as being preoccupied with their delusions or hallucinations (r = .31) and as being unreliable informants (r = .41). They usually had lower education (r = .33), their income in the last taxation year was lower (r = .47), and their work functioning was less adequate (r = .30).

Regional Differences in Molecular Cross-Linking of Periodontal Ligament Collagen of Rat Incisor, by Polarizing Microscopy

Collagen, a naturally birefringent biopolymer and key structural component of the periodontal ligament (PDL), is altered substantially with regard to its molecular cross-linked structure by the dietary lathyrogen, beta-amino-proprionitrile (beta-APN). Our purpose in studying beta-APN-fed animals was to learn if the strength of birefringence of periodontal collagen, measured microscopically by the Senarmont compensator method, correlates with the molecular changes known to occur in these lathyritic animals, and to explore this technique for the periodontal ligament. Five experimental animals were fed a diet containing 0.25% beta-APN for two weeks, and 3 control animals were fed normal rat chow. Tissues were decalcified and the mandibular incisors were cut in cross section at 4 microns and stained with eosin Y. The Senarmont compensator, an attachment for the polarizing microscope, was used to measure phase retardation. Ten measurements were taken from each of the three sides (mesial, lateral and lingual) of the triangularly shaped incisor sections. The collagen fibers of the beta-APN-fed rats had lower values of phase retardation than the controls (p < 0.001), indicating reduced molecular organization. In addition, minor but significant regional differences were revealed, supporting the method for structural studies on the periodontal collagen.

Interrelationships of systems for diagnosing schizophrenia

Abstract One hundred twenty patients (73 women, 47 men) with a hospital diagnosis of schizophrenia were reevaluated by means of 13 traditional diagnostic systems for diagnosing schizophrenia. Each system classified at least 62% of patients as schizophrenic except E. Bleulers system, used with a cut-off score of 4. Intercorrelations of the systems and their correlations to social and anamnestic variables were examined. The data lead us to favor Langfeldts system and the DSM-III.

Some factors relating to satisfactory post-discharge community maintenance of chronic psychotic patients

The length of time a group of 70 psychiatric patients could be maintained in the community following discharge from a provincial hospital was found to be significantly related to post-discharge compliance with medication and to the level of discharge planning (well planned versus unplanned, or patient prematurely self-discharged against medical advice). Various demographic and clinical variables were unrelated to the length of post-discharge survival in the community.

Suicidality in a sample of arctic households

We investigated the association of suicidal ideation and behavior with depression, anxiety, and alcohol abuse in a Canadian Arctic Inuit community. Inuit (N = 111) from a random sample of households completed assessments of anxiety and depression, alcohol abuse, and suicidality. High rates of suicidal ideation within the past week (43.6%), and suicide attempts within last 6 months (30%), were reported. Ideation was more frequent among younger persons, whereas those favoring local native language were less likely to report a wish to die. Higher overall suicidality scores were associated with higher anxiety, and alcohol abuse, but not with depression or gender. Implications for future research are discussed.

Relation of blood counts during clozapine treatment to serum concentrations of clozapine and nor-clozapine.

Objective: To determine the relation between serum clozapine and nor-clozapine levels and blood cell counts during clozapine treatment. Method: We undertook a prospective longitudinal study of 37 consecutive patients with a diagnosis of schizophrenia treated with clozapine. We obtained informed consent and then determined serum concentrations of clozapine and nor-clozapine weekly. Clozapine was administered daily in divided doses given every 12 hours and adjusted according to clinical guidelines for its use. Samples for serum concentrations were taken at steady state, immediately before the next mornings dose, for 4 to 8 weeks. Complete blood counts (CBC), weight, and vital signs (that is, blood pressure, pulse, and temperature) were also monitored weekly before the mornings dose of clozapine was administered. Results: Analyses of variance showed no significant changes over the 8-week treatment course in the observed mean white blood count (WBC), red blood count (RBC), neutrophils, and lymphocytes counts, or in the hemoglobin and hematocrit. Only a few weak correlations (r < 0.21) were found between these hematological parameters and the measures of serum clozapine and nor-clozapine. Conclusions: The mechanism of clozapine-induced hematotoxicity at the therapeutic dosage range is probably not by direct toxicity of clozapine or nor-clozapine to the blood cells or their precursors. The formation of the cytotoxic nitrenium compound from clozapine by neutrophils may be necessary.

ARE SCHIZOPHRENIC SYMPTOMS DIFFERENT IN PATIENTS WITH HIGHER EDUCATION

Ratings of 87 symptoms on a Canadian sample of 108 DSM-III schizophrenics (41 men, 67 women) were unrelated (point biserial coefficients) to their education. The only exceptions to this trend were weak correlations with ratings of apathy, insight, and of premorbid adjustment. Patients with higher education were less frequently labelled as apathetic (r = .28) or as lacking insight (r = .26) and their premorbid adjustment was better (r = .25). None of the symptoms traditionally considered as markers specific for schizophrenia was significantly related to education.