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 277,896 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

In this paper, the relationship between schizophrenia, suicide and serotonin will be examined. Throughout, it will be argued that the fundamental problem does not lie with the neurotransmitter per se, but rather with uncontrolled fluctuations of brain glycaemic levels acting in conjunction with insulin resistance. It will be shown that the area of dopaminergic and serotonergic activity in the brain is intimately tied to the relative distribution of the central glucose transporters and, hence, to glucose metabolism and insulin activity. It will be argued that mania and positive schizophrenia represent a continuum of liability associated with hyperglycaemia, hyperdopaminergia, and hyperserotonergia. In contrast, depression and negative schizophrenia represent another continuum of liability involving hypoglycaemia, hypodopaminergia, and hyposerotonergia. This serves as a useful distinction in drawing together a large number of seemingly unrelated, diverse facts concerning both schizophrenia and suicide and, in particular, the possible relationship that obtains between cholesterol-lowering drugs, low serotonin and suicide. Essentially, this paper reaffirms a previously stated contention that mental illness, in its many guises, is a general manifestation of a diabetic brain state which has been termed 'cerebral diabetes'.
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PMID:Schizophrenia, suicide and the serotonin story. 858 68

We assessed the prevalence of minor mental disorder and depression in elderly patients with non-insulin-dependent (Type 2) diabetes mellitus as compared with control subjects and evaluated the associates of impaired mental well-being in diabetic patients. The study consists of a community-based group of patients (n = 82) with a 10 years' known duration of disease and nondiabetic control subjects (n = 115). In addition to clinical and laboratory examinations, self-rating questionnaires assessing minor mental disorder (General Health Questionnaire, GHQ) and depression (Zung Self-rating Depression scale) were completed by the patients and control subjects. The mean scores of GHQ and Zung scores tended to be higher in diabetic than in control subjects, but the frequency of case subjects was not different between the diabetic (GHQ: 40%; Zung: 11%) and nondiabetic groups (GHQ: 36%; Zung: 7%). These findings were explained by more severe symptoms in diabetic case subjects as compared to nondiabetic case-subjects. From the various parameters studied, the presence of symptomatic neuropathy was most strongly associated with depression and minor mental disorder in diabetic subjects. The results suggest that the impact of Type 2 diabetes per se on minor mental disorder or depression in elderly subjects is not overwhelming. However, a subgroup of diabetic patients seems to have markedly impaired mental well-being, and the treatment of its underlying factors may improve overall treatment compliance.
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PMID:Mental well-being in people with non-insulin-dependent diabetes. 861 45

Major advances in molecular genetics over the last 15 years have made it possible to identify the genes responsible for human diseases using purely genetic approaches that do not require knowledge about disease pathophysiology. Many successes have been achieved for single gene disorders and methods are being adapted and refined for complex diseases. The main strategies include linkage and association studies to map the position of disease genes followed by investigation of potential candidate genes within these genomic regions. Successes have already been achieved in complex disorders such as diabetes and Alzheimer's disease, and it is almost certain that genes predisposing to the major psychiatric disorders will be identified over the next few years. This will lead to major advances in treatment, prevention and classification of mental illness and is likely to have a dramatic impact on clinical practice.
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PMID:Modern molecular genetic approaches to psychiatric disease. 894 48

The purpose of this study was to evaluate the influence of psychiatric symptoms and illness status on the health-related quality of life (HRQOL) of out-patients with Type I and Type II diabetes mellitus. Using a two-stage design, all patients were assessed by two measures of quality of life (Diabetes Quality of Life Measure; Medical Outcome Study Health Survey) and a psychiatric symptoms checklist (SCL-90R). Patients scoring 63 or greater on the global severity index of the SCL-90R and 30% below this cutoff were then evaluated using the Structured Clinical Interview for the DSM-III-R (SCID). Quality of life in both Type I and Type II diabetes was influenced by the level of current psychiatric symptoms and presence of co-morbid psychiatric disorder, after controlling for number of diabetic complications (e.g. effect of lifetime psychiatric illness on diabetes-related HRQOL; F = 46.8; df = 3, 135; p < 0.005). These effects were found consistently across specific domains. Both recent and past psychiatric disorders influenced HRQOL. Separate analyses comparing patients with and without depression showed similar effects. No interaction effects between diabetes type, number of complications, and psychiatric status were found in analyses. Finally, increased severity of psychiatric symptoms was correlated with decreased HRQOL in patients without current, recent, or past psychiatric diagnosis. This study shows the consistent, independent contribution of psychiatric symptoms and illness to the HRQOL of patients with a co-existing medical illness. Thus, psychiatric interventions addressing common conditions, such as depression, could improve the HRQOL of patients without changing medical status.
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PMID:The effects of psychiatric disorders and symptoms on quality of life in patients with type I and type II diabetes mellitus. 906 37

This study describes the medical practice among a sample of indigenous healers from Thaba Nchu, Ganyesa, Kurumane, Mankwe, and Molopo regions of the North West province of South Africa. Data were obtained from interviews conducted among 35 indigenous healers recommended by heads from a sample of 40 villages. Findings indicate that 60% were Botswanan. 51% were female. 85.7% were aged 30-59 years. 77% were married, and 5.7% were divorced. 31% had a lower primary education, and 25.7% finished high primary schooling. 22.4% had no formal schooling. 60% were bone throwers, and 34.2% were bone throwers and sangomas. 54% received their training "by their ancestors through dreams." 31% received formal training in indigenous healing. 14% served an apprenticeship with an experienced healer. 94% had a period of training from 2-5 years. 57% were registered with an association for indigenous healers. 77% relied on bone throwing for diagnosis of health problems. Other treatment methods included scarification, enema, induced vomiting, ritual performance, and prevention of witchcraft. Healers treated infertility, septic sores, impotence, sexually transmitted diseases, deliveries, makgome or boswagade, asthma, mental illness, high blood pressure, palpitations, tuberculosis, alcoholism, diabetes, and cancer. Pediatric diseases that were treated included tlhogwana, ditantanyane, measles, Kwashiorkor, and whooping cough. Healers relied on the following methods for disease prevention and health promotion: home fortifying, home cleansing, personal cleansing, scarification, and cultural education in taboos. 74% made referrals to either a western trained physician (17 out of 26) or other healers. All were generalists. Clients included professionals, such as nurses, teachers, and religious ministers. Although there is potential danger in some treatment methods, healers serve an important role in health prevention and treatment.
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PMID:Indigenous healers in the North West Province: a survey of their clinical activities in health care in the rural areas. 928 40

This study assessed clinical and demographic differences between 74 geriatric psychiatry outpatients with early-onset vs late-onset depression. The following data were considered: age, gender, marital status, years of education, number of prescription medications and active medical diagnoses (including presence of various categories of medical disorder), presence of any comorbid dementia or other psychiatric disorder, age of depression onset, number of depressive episodes and MMSE score. Fifteen patients (20.3%) had an early onset of depression (before age 60 years) and 59 (79.7%) had a late onset of depression. Early-onset patients had significantly more episodes of depression than late-onset patients (4.2 vs 1.9, t = 4.74, p < 0.001). Patients with early-onset depression also had a higher mean number of prescribed medications (5.3 vs 3.5, t = 2.29, p = 0.025) and active medical disorders (4.6 vs 3.1, t = 2.89, p = 0.005). Specifically, early onset of depression was associated with an elevated prevalence of cardiac disease (53.3% vs 23.7%, chi 2 = 5.0, df = 1, p = 0.025), diabetes (46.7% vs 16.9%, chi 2 = 6.0, df = 1, p = 0.015), gastrointestinal disorder (40.0% vs 12.0%, chi 2 = 6.5, df = 1, p = 0.011) and arthritis (26.7% vs 6.8%, chi 2 = 4.9, df = 1, p = 0.027). These findings support previous reports that people with a history of depression experience greater medical morbidity than those without a history of depression. The study groups did not differ with respect to MMSE score or presence of a concurrent dementia disorder. These results were unexpected given previous studies that indicate greater cognitive impairment in late- vs early-onset depression. The potential contribution of increased vascular risk factors among the early-onset depression group may have partly contributed to the finding of no difference in cognition between groups in the present study.
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PMID:Differences in geriatric psychiatry outpatients with early- vs late-onset depression. 942 94

Concerns about high costs have led to limits on the services covered by most insurance plans for substance abuse treatment. But, the commonly used comparison group for cost analyses, all enrollees in a health-care plan, may not be appropriate because addiction is a chronic condition. Therefore, to determine whether substance abusers incur higher charges than patients with other serious chronic conditions, we used health insurance information for employees and dependents over 3 years (1989 to 1991) for two firms with a total of almost 40,000 employees to do alternate comparisons. We compared average annual charges for patients with the following diagnoses: substance abuse, substance abuse with mental illness, arthritis, asthma, and diabetes. Patients who undergo treatment for abusing alcohol, drugs, or both often (but not always) incur higher charges than people with other chronic conditions. Clear differences in average charges emerge between patients with and without mental health claims.
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PMID:Do individuals with substance abuse diagnoses incur higher charges than individuals with other chronic conditions? 943 15

The numbers of elderly people in sub-Saharan Africa are growing rapidly with increasing life expectancy while at the same time the proportions of children in the populations are declining. The number of people 80 years and above increased tenfold in large parts of Africa since the 1950's, and the number of widows is growing fast. All this has several implications, including erosion of the social support by extended families and a dramatic change in the disease pattern. There will be increasing rates of cancer, liver cirrhosis, kidney failure, eye disease, osteoarthrosis, diabetes, mental illness and chronic degenerative illnesses such as cardiovascular disease. Multiple illness and permanent disability will become more common. African health care systems are ill-prepared for this transition, and social security for the elderly need to be improved in the coming years. Local and regional research into morbidity and well-being is important for policy formulation. The situation of different categories of chronically sick needs to be investigated. Improved health in childhood and middle age will probably be followed by improved health in old age, and this may offset the burden on the health care system of the growing number of elderly.
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PMID:Health and the elderly in developing countries with special reference to sub-Saharan Africa. 952 43

Stiff-man syndrome (SMS) is a rare neurological disorder characterized by progressive rigidity of the axial musculature with superimposed spasms. Frequently, SMS remains undiagnosed for prolonged periods or the patients are diagnosed of a primary psychiatric disorder. 60% of the SMS patients harbor GAD-autoantibodies (GAD-Ab). We have analyzed the diagnostic value of GAD-Ab in a syndrome whose clinical expression is not well known, but its diagnosis is performed by clinical criteria. Five patients were studied following the established clinical criteria for diagnosis of SMS. GAD-Ab were analyzed by radioimmunoassay (RIA) and immunohistochemistry, and confirmed by immunoblot. The GAD-Ab titers were compared with those of 49 patients with insulin-dependent diabetes mellitus (IDDM), 322 with other neurological disorders, 14 non-IDDM first-degree relatives of IDDM patients with antibodies anti-islet cells and 91 normal subjects. Three patients fulfilled all clinical criteria (typical SMS). Unilateral limb symptoms alone, and acute onset with rapid progression involving the distal limb muscles constituted the atypical features of SMS in the remaining 2 patients. The 5 patients presented several serum organ-specific autoantibodies. All but one also presented autoimmune diseases. By RIA, GAD-Ab titers from all patients were elevated (mean: 24,532 +/- 26,892 U/ml) and significantly higher than the titers of IDDM patients without neurological disorders (mean: 48 +/- 112 U/ml) (p < 0.0001). GAD-Ab were absent in the non-SMS patients and in normal subjects. These findings suggest that clinical expression of SMS is more extensive than that recognized by the established criteria. GAD-Ab are helpful to define the clinical spectrum of SMS.
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PMID:[Diagnostic usefulness of glutamic acid decarboxylase antibodies in stiff-man syndrome]. 956 81

The Maori are the indigenous people of New Zealand. They and other Polynesian peoples who have migrated here in more recent times are over represented in our health statistics in ways that are of concern to New Zealand health care providers. Maori and Polynesian have higher rates of infant mortality, lung cancer, mental illness and, pertinent to this discussion, higher rates of diabetes and End Stage Renal Failure. Some of the issues raised by these statistics are the subject of my presentation today.
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PMID:Cultural safety and renal care. 966 96


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