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Query: UMLS:C0011849 (diabetes)
 277,896 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The relationships of psychiatric characteristics to metabolic control and psychosocial functioning were examined in a group of 16 patients with insulin-dependent diabetes mellitus (IDDM) (mean age: 14.3+/-5.1 years, mean duration of follow-up: 5.0+/-2.3 years) and psychiatric disorders. The comparison is also made to 69 IDDM controls (mean age: 17.0+/-6.7 years) without psychiatric disorders. Metabolic control was evaluated in terms of glycosylated hemoglobin (HbA1c). Psychosocial functioning at both psychiatric treatment entry and discharge was assessed using the global assessment of functioning (GAF) scale. Subjects were divided into three subgroups - Somatoform Type (25%), Behavioral Type (50%) or Psychotic Type (25%) - according to the Diagnostic and Statistical Manual of Mental Disorders, third edition revised (DSM-III-R), based on semi-structured interviews. Four patients (25%) were diagnosed as having schizophrenia or schizoaffective disorder (Psychotic Type), which is rather rare. The mean HbA1c level in the Behavioral Type patients was significantly higher than in the other subgroups (P<0. 01). After psychiatric treatment a significant difference (P<0.0001) in the GAF Scale was observed in the Psychotic Type compared with the other subgroups. We conclude that the Behavioral Type is associated with poor metabolic control and that for the Psychotic Type, improved psychosocial functioning can be achieved through psychiatric treatment.
Diabetes Res Clin Pract 2000 Jun
PMID:Psychiatric disorders in juvenile patients with insulin-dependent diabetes mellitus. 1080 56

Sixty White middle-class infants were seen in the Ainsworth Strange Situation at 12 months of age; 50 of these participants (21 males, 29 females) were recontacted 20 years later and interviewed by using the Berkeley Adult Attachment Interview (AAI). The interviewers were blind to the participants' Strange Situation classifications. Overall, 72% of the infants received the same secure versus insecure attachment classification in early adulthood, K = .44, p < .001. As predicted by attachment theory, negative life events-defined as (1) loss of a parent, (2) parental divorce, (3) life-threatening illness of parent or child (e.g., diabetes, cancer, heart attack), (4) parental psychiatric disorder, and (5) physical or sexual abuse by a family member-were an important factor in change. Forty-four percent (8 of 18) of the infants whose mothers reported negative life events changed attachment classifications from infancy to early adulthood. Only 22% (7 of 32) of the infants whose mothers reported no such events changed classification, p < .05. These results support Bowlby's hypothesis that individual differences in attachment security can be stable across significant portions of the lifespan and yet remain open to revision in light of experience. The task now is to use a variety of research designs, measurement strategies, and study intervals to clarify the mechanisms underlying stability and change.
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PMID:Attachment security in infancy and early adulthood: a twenty-year longitudinal study. 1095 34

The information derived from the Human Genome Project, an international effort to decode the information embedded in the human genome, will revolutionize the practice of medicine in the 21st century by providing the tools to determine the hereditary component of virtually all diseases. This will lead to improved approaches to predict increased risk, provide early detection, and promote more effective treatment strategies. To be ultimately successful, these improvements in research and health care must reach everyone. This success will depend on participation from a broad spectrum of the population. such as scientists, clinicians, research participants, and active discussants, in deliberations of ethics and public policy. The Human Genome Project has helped to inform us about how remarkably similar all human beings are--99.9% at the DNA level. Those who wish to draw precise racial boundaries around certain groups will not be able to use science as a legitimate justification. However, studying the 0.1% of human genetic variations, particularly the distribution of single nucleotide polymorphisms, between affected and nonaffected individuals will significantly inform biomedical researchers about the genetic contributions to complex diseases such as cancer, diabetes, and mental illness. We must all work together to ensure that the risks of such research are considered carefully and that the medical benefits are made available to all.
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PMID:The Human Genome Project. Revealing the shared inheritance of all humankind. 1114 83

Classical molecular genetic strategies have succeeded in identifying mutations responsible for numerous rare diseases with Mendelian patterns of inheritance, but have been largely unsuccessful in unravelling the (genetic basis of complex medical conditions like cardiovascular disease' diabetes and mental illness. These common disorders are shaped by multiple genes that exert weak allelic effects in the setting of confounding environmental variables. Association study designs provide statistical povwer to reveal the modest contributions of weak alleles, and evidence is mounting that common genetic polymorphisms play a role in complex diseases. Cataloguing genetic variation in human populations is a prerequisite for further validation of the 'common variants-common disease' hypothesis, and polymorphism discovery has begun in earnest in the academic and private sector. We will review several strategies for high-throughput polymorphism discovery and discuss the implications of early results from polymorphism screens for future genetic studies.
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PMID:Mining for SNPs: putting the common variants--common disease hypothesis to the test. 1125 94

Delusions associated with cerebrovascular diseases have been sporadically reported. Although both psychiatrists and neurologists attempted to link delusions with anatomical locations of the brain lesion, comorbid psychiatric and neurological disorders make the interpretation of delusions difficult. The purpose of the present paper is to report the clinical features and magnetic resonance imaging (MRI) characteristics in patients with delusional disorder due to diffuse cerebrovascular diseases, and to redefine the concept of 'vascular delusion'. The clinical features and MRI findings were reviewed retrospectively in a series of seven patients with 'delusional disorder due to cerebrovascular disease' as defined in Diagnostic and Statistical Manual of Mental Disorders (DSMIV). The average age of onset is 64. No patient had a prior personal or family history of major psychiatric illness. The illness is presented as acute, subacute or stepwise course. Hypertension was present in all patients. Two had diabetes mellitus, and one had atrial fibrillation. Three had clinical evidence of previous cerebrovascular attacks, only one showed minor neurological deficits. Three had diffuse cortical slow wave in electroencephalogram. No patient had significant cognitive impairment but had multiple cortical and subcortical cerebrovascular lesions in MRI, with white-matter lesions (WML) in bilateral frontal areas. Delusional disorder due to diffuse cerebrovascular change is characterized by late-onset, stepwise course, and comorbid medical and neurological diseases. The results of vascular changes in the present study did not establish a cause-effect relationship and should be considered as multifactorial in pathogenesis. The findings suggested the hypothesis of neural circuit theory. Further studies in larger numbers of patients and newer neuroimaging techniques are needed to expand the knowledge learned from these findings.
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PMID:Magnetic resonance imaging findings in patients with delusional disorder due to diffuse cerebrovascular disease: a report of seven cases. 1128 90

The objective of this study is to determine how patient age, sex, creatinine level, and comorbidity affect referral decisions for the treatment of end-stage renal disease (ESRD) and whether these decisions are affected by physician characteristics in three countries: Canada, the United States, and Britain. A vignette-based questionnaire was mailed to a random sample of family physicians in Ontario, Canada (1,818 physicians); all family physicians in the state of New York (1,814 physicians); and a sample of general practitioners from the south of England (2,228 physicians) in 1996. Physicians were presented with clinical scenarios involving a patient with varying degrees of renal insufficiency and a complicating comorbidity, including angina, diabetes, cancer, mental illness, or socioeconomic circumstances. They were asked to indicate the likelihood of referral. Half the physicians received a questionnaire describing a male patient, and half, a female patient. Mean creatinine levels at which physicians would refer were 260 micromol/L for British physicians, 297 micromol/L for Canadian physicians, and 340 micromol/L for American physicians. No difference in referral rates was found based on the sex of the patient or physician. Sixty-five percent of American and Canadian physicians would refer regardless of patient age, but only 49% of British physicians would do so. Family physicians in the United States, Canada, and Britain function as gatekeepers for patients with ESRD. They are less likely to refer based on increasing severity of comorbid conditions. They also discriminate based on age, but not sex.
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PMID:End-stage renal disease: factors affecting referral decisions by family physicians in Canada, the United States, and Britain. 1143 Nov 80

Isoniazid, efficient antituberculosis drug, can provoke neuropsychiatric manifestations at certain patients. Two mechanisms of action for isoniazid-related psychosis are kept by the majority of authors: pyridoxin deficiency isoniazid toxicity, molecule near chemically to iproniazid, powerful IMAO (monoamine oxydase inhibitor). The predisposing factors are: slow acetylator, diabetes, hepatic insufficiency, old age, alcoholism. Family and personal history of mental illness are also predisposing factors. We report here the observation of a 53-year-old man presented with psychotic symptoms suspected to be relation with isoniazid. The favorable evolution after the definitive stop of isoniazid therapy is in favor of this hypothesis. Although rare, the neuropsychiatric symptoms during tuberculosis treatment by isoniazid, the possibility of iatrogenic etiology must be evoked. Isoniazid, antituberculosis very used in Africa, is mentioned by several authors like the cause of psychiatric disorders. Pyridoxin deficiency seems to play a role of trigger. Supplementation with vitamin B6 during the treatment by isoniazid must be therefore systematic to warm these unrests.
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PMID:[Behavioral disorders after treatment with isoniazid]. 1147 27

In four patients, two women aged 68 and 73 years and two men aged 65 and 57 years, serious diseases were not recognised because of more prominent psychiatric symptoms. Three of the patients had malignancies and one was suffering from dehydration with a urinary tract infection and de novo diabetes mellitus. The patient with a meningioma recovered after surgery, the other three patients died despite treatment. Somatic diseases may not be recognised in patients with psychiatric illness because doctors may be more likely to ascribe the symptoms to a psychiatric cause. Patients may also present their symptoms in an unusual way. It is important not only to diagnose the psychiatric disease but also to check the patient's physical condition. This applies particularly to elderly patients, because they are more likely to have somatic diseases. Good education of psychiatrists in terms of somatic diseases remains important.
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PMID:[Psychiatric illness does not protect against a somatic disease]. 1158 51

The analysis of the genetic basis of phenotypic traits is moving towards the complex diseases prevalent in wealthy populations. There is an increasing requirement for the detection of different types of sequence variation, particularly single-nucleotide polymorphisms (SNPs). SNPs occur about once every 100 to 300 bases. High-density SNP maps will help to identify the multiple genes associated with complex diseases such as cancer, diabetes, vascular disease, and some forms of mental illness.
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PMID:Rolling circle amplification for scoring single nucleotide polymorphisms. 1156 39

Selection of patients for kidney transplantations is necessary due to the shortage of organs. The process has not been greatly studied. Twelve hypothetical cases were constructed, each with one or several relative contraindications, such as cardiovascular disease, diabetes, old age or a mental disorder. The cases were submitted to 40 nephrologists, chosen to represent the recruitment areas of the four Swedish transplant units. They were asked to declare whether the 'patient' was suitable for transplantation or not, and, independently, whether the patient would be referred to the transplant unit. The same cases were evaluated by 3-4 representatives of each transplant unit. The response rate was 100%. A median of 6 cases was considered suitable (range 3-11). The acceptance rate differed significantly between the four unit areas, from 4 cases (3-7) to 7 (4-11), p=0.014. Nephrologists would accept fewer patients than staff from the transplant units, 5 (3-10) vs. 7 (3-11), p=0.009. Most of the latter difference was compensated for by referral of borderline cases to the unit. Only 5 individual cases were equally judged by at least 75% of the respondents. Discrepancies in view were noted with respect to the significance of old or young age, the patient's determination and severe obesity.
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PMID:Selection of uremic patients for kidney transplantation. 1168 21


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