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In view of the relatively understudied status of work-related posttraumatic stress disorder (PTSD), this study retrospectively examined 44 workers whose claims were accepted for workers' compensation benefits in the absence of significant coexisting physical injuries. The majority of workers (82%) directly experienced the traumatic event while the rest witnessed the event. Over half (54%) of those directly experiencing the event were involved in armed robberies, whereas 38% were physically or verbally assaulted in nonrobbery situations. Almost half of the workers were assigned a coexisting mood or anxiety diagnosis. Psychoactive medication was prescribed to 66% of workers, and 93% of all workers received some form of psychological/psychiatric treatment. Twenty-three percent of the group received vocational rehabilitation assistance and only 43% returned to their previous job with the accident employer. Findings suggest that work-related PTSD is both complex and disabling and merits further investigation. [ABSTRACT FROM AUTHOR] more...

The article presents a discussion on a woman with tetra-X chromosomes, who has maintained good physical health for so long. All this may be partially due to possible mosaicism in the present instance, though without evidence of a normal cell line. Mosaics are reportedly not necessarily less markedly affected, physically or mentally, than females in whom only tetra-X sex chromosomes are apparent. It is notable that intellectual deterioration has not occurred either on the basis of clinical evidence or of formal psychometric testing. Indeed, the latter, using the Wechsler Adult Intelligence Scale, currently showed higher scores than 26 years ago, perhaps due to living in a congenial and attentive private home in contrast to earlier life in a large. inevitably less personal and stimulating. institutional setting. more...

Late-onset Huntington's disease is more common than has been generally appreciated and is associated with a wide range of psychiatric symptoms and syndromes. Geriatric psychiatrists have an important role to play in establishing the diagnosis and providing guidance to elderly patients and their families as they struggle with difficult management decisions. An illustrative case report and selective literature review are presented that highlight the genetic and clinical aspects of the condition. (J Geriatr Psychiatry Neurol 1996; 9:26-29). [ABSTRACT FROM PUBLISHER] more...

As our elderly population continues to increase, diseases that are more prevalent with aging, such as Alzheimer's dis ease, are assuming ever greater relevance for society and the practicing clinician. An important practical situation faced by physicians caring for individuals with Alzheimer's disease is advising the affected individuals, their families, and often the licensing authorities about whether the patient can safely drive an automobile. Surprisingly, there is little guidance on how to arrive at a clinical impression of the fitness of an individual with Alzheimer's disease to drive. This article outlines potential inadequacies in driving skills that may occur with elderly people in general, and more specifically those with Alzheimer's disease. Studies that focused on Alzheimer's disease and driving are then reviewed. We conclude with rec ommendations for dealing with the problem of driving abilities in Alzheimer's disease. [ABSTRACT FROM PUBLISHER] more...

Objective: Primary caregivers should be aware of recent progress in the genetics of Alzheimer disease (AD) and of the clinical and ethical considerations raised regarding the introduction of genetic testing for purposes of disease prediction and susceptibility (risk) analysis in asymptomatic individuals and diagnosis in patients who present clinically with dementia. This statement addresses arguments for and against clinical genetic testing.Participants: The 20 participants were selected by the investigators (S.G.P., T.H.M., A.B.Z., and P.J.W.) to achieve balance in the areas of genetics, counseling, ethics, and public policy, and to include leadership from related consensus projects. The consensus group met twice in closed meetings and carried on extensive correspondence over 2 years (1995-1997). The project was supported by the National Human Genome Research Institute of the National Institutes of Health.Evidence: All 4 involved chromosomes were discussed in group meetings against a background of information from several focus group sessions with AD-affected families. The focus groups comprised volunteers identified by the Cleveland Area Chapter of the Alzheimer's Disease and Related Disorders Association and represented a variety of ethnic populations.Consensus Process: The first draft was written in April 1996 by the principal investigator (S.G.P.) after the consensus group had met twice. The draft was mailed to all consensus group members 3 times over 6 months for extensive response and redrafting by the principal investigator until all members were satisfied.Conclusions: Except for autosomal dominant early-onset families, genetic testing in asymptomatic individuals is unwarranted. Use of APOE genetic testing as a diagnostic adjunct in patients already presenting with dementia may prove useful but it remains under investigation. The premature introduction of genetic testing and possible adverse consequences are to be avoided. [ABSTRACT FROM AUTHOR] more...

A letter to the editor is presented in response to a paper by Corbett in the April 1987 issue about the possible role of carbamazepine in the late onset of Gilles de la Tourette's syndrome in patient in Down's syndrome. more...

In the summer of 2007, Rupert Isaacson and Kirsten Neff set off to Mongolia on an extraordinary journey to heal their 7-year old autistic son. Their story was captured on film by a small crew, and both the resulting documentary, The Horse Boy, and the associated book have reached a wide audience. For those involved in psychiatric education, the film represents a valuable opportunity to explore a range of relevant clinical and ethical issues with their learners, including an introduction to the world of complementary and alternative medicine and the emerging discipline of narrative medicine. Perhaps most importantly, The Horse Boy is an impetus for health professionals to consider their own responsibilities when determined patients in their care undertake such remarkable quests to heal themselves or their loved ones. more...

Objective: Physicians typically receive little continuing medical education (CME) about their role in workplace injury management as well as on workplace injuries and disease. Although new technologies may help educate physicians in these areas, careful evaluation is required, given the understudied nature of these interventions. The objective of this study is to evaluate two promising new technologies to deliver CME (online learning and videoconferencing) and to compare the effectiveness of these delivery methods to traditional CME interventions (large urban traditional conference lectures and small group local face-to-face outreach) in their impact on physician knowledge related to workplace injury management., Methods: This study utilized a prospective, controlled evaluation of two educational programs for BC physicians: 1) The Diagnosis and Management of Lateral Epicondylitis; and 2) Is Return-to-Work Good Medicine? Each educational module was delivered in each of four ways (Outreach Visit, Videoconference Session, Conference Lecture, Online) and physicians self-selected their participation--both in terms of topic and delivery method. Questionnaires related to knowledge as well as learner attitude and satisfaction were administered prior (pre-test) and following (post-test) all educational sessions., Results: 581 physician encounters occurred as a result of the educational interventions and a significant percentage of the physicians participated in the research per se (i.e. there were 358 completed sets of pre-test and post-test 'Knowledge' questionnaires). Overall the results showed that the developed training programs increased physicians' knowledge of both Lateral Epicondylitis and the physician's role in Return-To-Work planning as reflected in improved post-test performance when compared to pre-test scores. Furthermore, videoconferencing and online training were at least as effective as conference lectures and instructor-led small group outreach sessions in their impact on physician knowledge., Conclusions: Use of effective videoconferencing and online learning activities will increase physician access to quality CME related to workplace injury management and will overcome access barriers intrinsic to types of CME interventions based on instructor-student face-to-face interactions. more...

Objective: This article provides a brief overview of important issues for educators regarding medical education and technology., Methods: The literature describes key concepts, prototypical technology tools, and model programs. A work group of psychiatric educators was convened three times by phone conference to discuss the literature. Findings were presented to and input was received from the 2005 Summit on Medical Student Education by APA and the American Directors of Medical Student Education in Psychiatry., Results: Knowledge of, skills in, and attitudes toward medical informatics are important to life-long learning and modern medical practice. A needs assessment is a starting place, since student, faculty, institution, and societal factors bear consideration. Technology needs to "fit" into a curriculum in order to facilitate learning and teaching., Conclusion: Learning about computers and applying computer technology to education and clinical care are key steps in computer literacy for physicians. more...

As the World Wide Web expands, hospitals are considering how they may benefit from establishing Web sites of their own. We examined the Web sites of 20 Canadian hospitals to identify and compare their features. We developed two instruments for this assessment: a quantitative Features Checklist containing 67 items and a qualitative Categorical Rating Scale using 15 dimensions. Two of us (O.G. and D.A.M.) assessed each site. At most sites the most fully implemented feature was the provision of basic contact information, although development was inconsistent. Few sites took full advantage of multimedia capabilities. There was a strong correlation (r = 0.82, P < 0.001) between the number of features observed at a site and its score on the Categorical Rating Scale. more...

The identification of mutations in the amyloid precursor protein (APP) gene associated with the presence of early-onset familial Alzheimer disease (AD) raises the possibility of their practical clinical application, at least in some circumstances, in the diagnostic assessment for AD. As a stimulus for discussion, a hypothetical, illustrative case vignette is presented. A 48-year-old man, concerned about recent memory loss and with a family history of early-onset AD, requested testing for the APP717 Val-->Ile mutation, previously identified in his relatives affected with AD. Whether the testing should be undertaken is considered in the context of the current interpretation of potential test results as well as the competency of the individual who requested the test to provide informed consent. Informed consent includes an understanding of the foreseeable risks and benefits associated with disclosure of test results. Although molecular genetic testing in particular individuals, such as the man described herein, could be appropriate, it should not be interpreted to apply in general at this stage to individuals suspected of having AD. In view of a number of caveats, including the genetic heterogeneity of AD, which significantly limits the sensitivity and specificity of the currently available genetic tests, further research and discussion is strongly recommended before widespread introduction of molecular genetic testing for individuals with suspected AD. more...

This study examines the relationship between folate, vitamin B12 and severity of cognitive impairment in patients with Alzheimer's disease (AD) as compared with other disorders associated with cognitive impairment. The patients were 97 consecutive referrals to an AD clinic. Forty patients had either possible or probable AD, 31 had other dementias (OD) and 26 had mild cognitive impairment (cognitively impaired, not demented; CIND). Patients had blood drawn for serum, red cell folate and B12, as well as other biochemical indicators of nutrition, within 24 h of the Mini-Mental State Examination (MMSE). In the AD group, only B12 was significantly correlated with MMSE. Using regression analysis, B12 contributed significantly to variance in MMSE. There was no correlation between MMSE and serum, red cell folate or B12 in the OD or CIND group and no significant correlation between MMSE and other nutritional indices in any group. These findings suggest the possibility of a specific relationship between B12 levels and severity of cognitive impairment in patients with AD. more...

We present prospective clinical and neuropathologic details of a pedigree segregating familial Alzheimer's disease (FAD) associated with a mutation (G----A substitution) at nucleotide 2149 in exon 17 of the amyloid precursor protein (APP) gene. This mutation, which is predicted to cause the missense substitution of isoleucine for valine at codon 717 of APP, cosegregated perfectly with the FAD trait (lod score = 3.49 at theta = 0.00). The earliest clinical manifestations of the disease relate to deficits in memory function, cognitive processing speed, and attention to complex cognitive sets. These changes occurred in the absence of changes in nonmemory language and visuospatial functions. The neuropathologic features of FAD associated with the APP717 mutation in this family include severe neuronal loss, abundant neurofibrillary tangles, amyloid plaques, and amyloid angiopathy. These results provide independent confirmation that mutations in the APP gene are linked to the FAD trait in some families. more...

The conventional psychiatric opinion that suicide is a manifestation of psychiatric illness may not apply to circumstances in which suicide or the refusal of life-sustaining medical treatment results from the rational decisions of autonomous individuals. As medical technology advances, questions about the prolongation of life and the discontinuation of medical treatment have become commonplace in the medical setting. In this context, contradictions may exist between the principle of patient autonomy and that of physician responsibility. Dilemmas about treatment decisions that emerge from these conflicting perspectives are highlighted in this article. We report two cases of attempted suicide in the context, respectively, of (1) terminal illness and (2) advanced age. Some of the complex psychiatric, ethical, and legal issues related to the case reports are addressed. more...

A retrospective review was conducted on the charts of 33 elderly inpatients (age range, 62-85 years) who received electroconvulsive therapy (ECT) in a geriatric psychiatry unit of a general hospital. Electroconvulsive therapy was found to be safe but not uniformly effective; only 42.4 per cent of patients obtained an immediate good outcome. The implications of these findings for further evaluations of the indications and efficacy of ECT in old age are discussed. more...

We measured the activities of the cholinergic marker enzymes choline acetyltransferase (ChAT) and acetylcholinesterase (AChE) in autopsied brains of seven infants (age range 3 months to 1 year) with Down's syndrome (DS), a disorder in which virtually all individuals will develop by middle age the neuropathological changes of Alzheimer's disease accompanied by a marked brain cholinergic reduction. When compared with age-matched controls cholinergic enzyme activity was normal in all brain regions of the individuals with infant DS with the exception of above-normal activity in the putamen (ChAT) and the occipital cortex (AChE). Our neurochemical observations suggest that DS individuals begin life with a normal complement of brain cholinergic neurons. This opens the possibility of early therapeutic intervention to prevent the development of brain cholinergic changes in patients with DS. more...

Alzheimer's disease is a progressive dementing illness accompanied by characteristic neuropathologic changes. Although its etiology is unknown, its risk of occurrence increases with age and in relatives of affected individuals. An additional risk factor is the presence of Down's syndrome. Almost all individuals with Down's syndrome over the age of 40 have the characteristic neuropathologic changes of Alzheimer's disease at autopsy. Although clinical evidence for Alzheimer's disease in Down's syndrome is less consistent, the association between Alzheimer's disease and Down's syndrome may contribute to an understanding of Alzheimer's disease in the general population. This article summarizes the neuropathologic and clinical observations of Alzheimer's disease in Down's syndrome and reviews the hypotheses that attempt to account for this association. more...