The Intelligent Dosing System (IDS, Dimensional Dosing Systems, Inc., Wexford, PA) is a software suite that incorporates patient-specific, dose-response data in a mathematical model, and then calculates the new dose of agent needed to achieve the next desired therapeutic goal. We evaluated use of the IDS for titrating insulin therapy. The IDS was placed on handheld platforms and provided to practitioners to use in adjusting total daily insulin dose. Fasting glucose, random glucose, and hemoglobin A1c were used as markers against which insulin could be adjusted. Values of markers expected at the next follow-up visit, as predicted by the model, were compared with levels actually observed. For 264 patients, 334 paired visits were analyzed. Average age was 54 years, diabetes' duration was 10 years, and body mass index was 33.2 kg/m(2); 57% were female, 88% were African American, and 92% had type 2 diabetes. The correlation between IDS suggested and actual prescribed total daily dose was high (r = 0.99), suggesting good acceptability of the IDS by practitioners. Significant decreases in fasting glucose, random glucose, and hemoglobin A1c levels were seen (all P < 0.0001). No significant difference between average expected and observed follow-up fasting glucose values was found (145 vs. 149 mg/dL, P = 0.42), and correlation was high (r = 0.79). Mean observed random glucose value at follow-up was comparable to the IDS predicted level (167 vs. 168 mg/dL, P = 0.97), and correlation was high (r = 0.73). Observed follow-up hemoglobin A1c was higher than the value expected (7.9% vs. 7.4%, P < 0.0055), but correlation was good (r = 0.70). These analyses suggest the IDS is a useful adjunct for decisions regarding insulin therapy even when using a variety of markers of glucose control, and can be used by practitioners to assist in attainment of glycemic goals.

Objective: This study assessed the effects of race on neuropsychological functioning in patients with schizophrenia.Method: A total of 160 patients with schizophrenia completed an extensive neuropsychological test battery. Scores were standardized to a group of 99 psychiatrically and physically healthy subjects and categorized into seven functional domains: concentration, executive function, language, motor function, spatial memory, verbal memory, and visual processing.Results: African Americans (N=25) had significantly lower mean scores on executive function, language, spatial memory, and visual processing than did Caucasians (N=135). Statistical control for patient and family education eliminated all significant effects.Conclusions: Educational differences in patients and families may account for some of the performance heterogeneity reported in patients with schizophrenia and should be routinely analyzed with other sociodemographic factors such as race and sex.

Despite NIMH efforts to facilitate the study of women and minorities in federally funded schizophrenia research, there is a significant lack of information about race differences in brain morphology and neuropsychological function in schizophrenia. A review of three major psychiatric journals between 1994 and 1996 revealed that only 14 (2.8%) of 502 schizophrenia articles reported the results of race analyses. Only 84 (16.7%) even reported the racial composition of the study sample. The study of race differences in schizophrenia, although fraught with methodological complexity and social/political tension, is necessary to prevent inappropriate generalization of research results across racial groups.

The high rate of comorbid substance abuse in schizophrenia and the consistently poor outcome of this comorbidity are well established findings in the research literature. However, the reasons for the high rate of comorbidity are not adequately understood, and the question of why some patients with schizophrenia abuse substances and others do not remains unanswered. There is widespread agreement about the clinical heterogeneity of schizophrenia, and there is some evidence suggesting that the heterogeneous clinical presentation may reflect a parallel underlying heterogeneity of brain morphology. We were interested in examining the possibility that the high rate of substance abuse and the characteristically poor outcome may be associated with the underlying brain morphology. Our hypothesis was that study subjects with schizophrenia and substance abuse would have higher rates of gross brain abnormalities than subjects with only schizophrenia. In an attempt to explore this possibility, we looked at qualitative differences in magnetic resonance imaging scans for a large sample (n=176) of schizophrenia patients. In the group of patients who abused both alcohol and drugs, we found the rate of gross brain abnormalities to be slightly less than half the rate found among the patients with no history of alcohol or substance abuse (8 vs. 19). Although these results are not statistically significant, they reflect a trend that is compatible with previous findings, suggesting that substance abuse history may be accompanied by less impairment in certain areas, which in turn may be reflected in a better premorbid adjustment. However, our findings are not compatible with previous findings that show substance abuse to be associated with more severe symptoms and a poorer outcome in schizophrenia.

Substantial verbal IQ (VIQ)-performance IQ (PIQ) discrepancies may reflect brain dysfunction. The authors examined 159 patients with schizophrenia (115 men and 44 women) or schizoaffective disorder (25 men and 19 women) and 79 normal participants (33 men and 46 women), calculated mean VIQ-PIQ discrepancy scores by sex and diagnosis, and identified persons with large VIQ-PIQ discrepancies (15-point difference in either direction). Schizophrenic/schizoaffective men had a larger mean VIQ-PIQ discrepancy than did other groups. The proportion of all patients with either VIQ > PIQ or PIQ > VIQ (17.8%) was not significantly different from that of normal participants (22.8%). However, significantly more men than women with schizophrenia exhibited a VIQ > PIQ pattern (20% vs. 3.2%). No unusual discrepancy patterns were noted among normal participants. Results were interpreted in light of theories of hemisphere dysfunction in schizophrenia.

Heterogeneity of results continues to hamper schizophrenia research. The examination of sex differences in the effort to reduce this heterogeneity has had mixed results in neuropsychology. We have begun to examine the validity of both sex and onset age to define early-onset male and late-onset female prototypes of the disorder. Extensive neuropsychological assessment of 191 schizophrenia/schizoaffective patients was conducted. Analysis of performance scores revealed a significant pattern reflecting poorer performance and less lateralized function in early-onset men and late-onset women compared with late-onset men and early-onset women. The discussion addresses the etiological implications of these findings.

The authors conducted a case-control study of Parkinson's disease patients with and without visual hallucinations to investigate associations of the polymorphisms of the dopamine receptors D2 32806 C>T (Taq1A), D3 Ser9Gly and Msp1, D5 978T>C and dopamine transporter 3′-UTR 40 bp VNTR with visual hallucinations in Parkinson's disease. No significant differences were found between hallucinators and non-hallucinators in either the genotypic or allelic distributions. Our data suggest that the loci investigated here are not associated with the visual hallucinogenesis in Parkinson's disease.

OBJECTIVE:The view of schizophrenic men as having poorer premorbid development, earlier age at onset, and worse outcome than schizophrenic women predicts greater neuropsychological impairment in the former than the latter. The authors examined in detail neuropsychological functioning in a large group of schizophrenic patients and a healthy comparison group.METHOD:Neuropsychological functioning in 132 male and 63 female patients with schizophrenia or schizoaffective disorder was extensively studied and compared with that of 99 (40 male, 59 female) healthy individuals.RESULTS:As expected, the schizophrenic patients as a group were pervasively and significantly more impaired than the comparison group. Within schizophrenia, in contrast to the prediction, women performed significantly more poorly than men in verbal memory, spatial memory, and visual processing. Female schizophrenic patients also had significantly poorer right than left hemisphere performance, whereas male schizophrenic patients had identical scores for right and left hemisphere impairment.CONCLUSIONS:The findings are consistent with the hypothesis that schizophrenia among women may be partially understood as a right hemisphere dysfunction. Sampling, diagnostic, and epidemiologic factors may have affected the results.

This study examined the neuropsychological and personality functioning of four groups of "normal" subjects: (1) "clean"; (2) positive drug screen; (3) prior psychiatric diagnosis; and (4) first-degree relative with a psychiatric history. Researchers usually exclude these latter three groups based on the assumption that their neuropsychological functioning will be worse than "clean" normal subjects. Of the four groups, there was a trend for the drug group to perform worse on neuropsychological tasks and for subjects with a personal or family history of psychiatric disorder to perform better. Within the drug group, the five subjects who tested positive for cocaine or barbiturates showed worse performance than the marijuana group. Thus, it appears that it is important to screen normals for drugs, especially for cocaine and barbiturates, because of adverse neuropsychological performance.

Previous research has found that both schizophrenics and their relatives have significantly elevated rates of clinical neurologic signs—including `hard' signs screened to exclude artifacts. The present study examined whether hard signs that indicate relatively localized dysfunction in particular brain regions significantly distinguish schizophrenics and/or their non-schizophrenic relatives from psychiatrically normal controls and patients with other disorders. All patients were diagnosed with DSM-III or DSM-IIIR criteria, using information from structured interviews, supplemented by chart review and family informants. Subjects were administered clinical neurologic examinations by a neurologist blind to diagnosis. The proband sample, composed of 54 schizophrenic or schizoaffective subjects, had a significantly greater proportion of subjects with signs of cerebellar dysfunction than any of the comparison samples, which included: 44 control subjects, 24 patients with substance abuse, 37 patients with bipolar disorder, and 73 of the probands' non-schizophrenic parents and adult siblings. Proportions of both probands and their relatives with signs of dysfunction of sensory cortex were significantly higher than for other groups. Cerebellar and sensory cortical dysfunctions may distinguish different subgroups of schizophrenics and may tend to reflect, respectively, non-familial and familial neuropathological factors.

AnxietyVolume 1, Issue 4 p. 192-195 Brief Report Natural killer cell activity in patients with panic disorder J. Stephen McDaniel M.D., Corresponding Author J. Stephen McDaniel M.D. Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GeorgiaEmory Clinic-Psychiatry, 1365 Clifton Road, NE, Atlanta, GA 30322Search for more papers by this authorEmile D. Risby, Emile D. Risby Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GeorgiaSearch for more papers by this authorMark Stipetic, Mark Stipetic Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GeorgiaSearch for more papers by this authorRita D. Jewart, Rita D. Jewart Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GeorgiaSearch for more papers by this authorJane Caudle, Jane Caudle Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GeorgiaSearch for more papers by this author J. Stephen McDaniel M.D., Corresponding Author J. Stephen McDaniel M.D. Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GeorgiaEmory Clinic-Psychiatry, 1365 Clifton Road, NE, Atlanta, GA 30322Search for more papers by this authorEmile D. Risby, Emile D. Risby Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GeorgiaSearch for more papers by this authorMark Stipetic, Mark Stipetic Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GeorgiaSearch for more papers by this authorRita D. Jewart, Rita D. Jewart Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GeorgiaSearch for more papers by this authorJane Caudle, Jane Caudle Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GeorgiaSearch for more papers by this author First published: 1994 https://doi.org/10.1002/anxi.3070010408Citations: 8AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Citing Literature Volume1, Issue41994Pages 192-195 RelatedInformation

CSF from cannbinoid users was examined and then compared to CSF parameters in age- and sex-matched normal control subjects

The files of 283 hospitalized patients discharged with a diagnosis of schizophrenia, schizoaffective schizophrenia, or paranoid state were examined without knowledge of the patient's subsequent history. These patients, most of whom had originally been diagnosed by DSM-I criteria, were retrospectively diagnosed by New York Research Diagnostic Criteria (RDC), the New Haven Schizophrenia Index (NHSI), the St. Louis criteria, Taylor-Abrams 1978 criteria, Schneider's first-rank symptoms (FRS), the Washington IPSS 12-Point Flexible System, Astrup's process/nonprocess distinction, and DSM-III. Kappa values measuring pairwise diagnostic agreement among the nine systems were typically low except among RDC, DSM-III, and St. Louis criteria. Long-term followup status was not significantly predicted by the FRS, NHSI, or Taylor-Abrams criteria. Diagnosis by means of the other systems, especially the Astrup process/ nonprocess distinction, was significantly correlated with followup. However, Astrup's “process” schizophrenia is not operationally defined and could not be expected to be used with the degree of interrater reliability desired by researchers. On the other hand, of the operationally defined systems, DSM-III schizophrenia has the highest correlation with followup and is thus suggested for use by researchers desiring a highly homogenous, although narrowly defined, population. Investigators wishing to cast a wider net could use a less restrictive system such as the RDC, with or without schizoaffectives included.

There has been much speculation as to the role of dopamine in the etiology and/or manifestation of positive and negative symptoms. Traditionally, cerebrospinal fluid (CSP) concentrations of homovanillic acid (HVA) has been used as an index of central dopaminergic activity. Relea~l dopamine is metabolized to HVA, by catechol-O-methyltransferase (COMT) and monoamine oxidase (MAO) (Cooper et al 1991). A review of the CSF HVA literature, however, reveals no consistent correlations between HVA and schizophrenic symptomatoiogy (reviewed by Pickax et al ! 9907. Yet there is sufficient data to suggest that dopamine activity is abnormal in schizophrenia (Davis et al 19917. Therefore the evaluation of other putative measures of dopamine release or metabolism seems warranted. Released dopamine is also converted to dopamine sulfate (DASO47 by the enzyme phenolsulphotransferase (PST7 (Jenner and Rose, 1973). in the brain, it appears that the sulfoconjugation of dopamine occurs primarily outside of dopaminergic neurons (Tyce et al 1988). Therefore CSF DASO~ concentrations may reflect an important alternate route of dopamine metabolism. Assessment of PST-dependent DASO4 independently, or in re-

Elevated levels of central D2 dopamine receptors were found on postmortem examination in cases of human narcolepsy. In vivo investigations using positron emission tomography (PET) and single photon emission tomography (SPET) found no changes of D2 binding in the striatal structures. To investigate whether the elevated D2 receptors in postmortem investigations are due to long-term treatment effects, we applied 123I-labeled (S)-2-hydroxy-3-iodo-6-methoxy-([1-ethyl-2-pyrrolidinyl]methyl) benzamide (IBZM) ([123I]IBZM, a highly selective CNS D2 dopamine receptor ligand) and SPET in narcoleptic patients in the course of treatment with stimulants and/or antidepressants. Before treatment we found no changes in D2 binding in 10 patients (in comparison to 10 normal controls). After treatment (performed in five patients for 3 months) we found changes in D2 binding in four of them, indicating that the results of the postmortem studies could have been influenced by long-term medications. Human narcolepsy seems not to be related to a striatal D2 dopaminergic disturbance.