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Objective: This review examines herbs commonly used for psychiatric symptoms-St. John's wort, kava, ginkgo biloba, and valerian., Methods: MEDLINE was searched for articles related to the use of herbs in psychiatry published after 1990. A secondary search examined sources cited in articles obtained from the MEDLINE search., Results: Of nine controlled and standardized trials of St. John's wort, five showed the herb's superiority to placebo, and four found no differences in effectiveness when compared with antidepressant drugs. The pharmacologically active components are not known. Several double-blind, placebo-controlled trials have demonstrated the anxiolytic efficacy of kava, but these studies had ill-defined patient populations, small sample sizes, and short treatment duration. All but one of 40 controlled trials of ginkgo extracts in the treatment of dementia found clinically significant improvement in memory loss, concentration, fatigue, anxiety, and depressed mood. Most studies of gingko had poorly defined patient populations and small sample sizes and used nonstandard measures. A recent well-designed multicenter study showed significantly less decline in cognitive function among patients with dementia receiving gingko. Valerian has been shown to decrease sleep latency and nocturnal awakenings and improve subjective sleep quality, but placebo effects were marked in some studies, and in some cases the beneficial effects were not seen until two to four weeks of therapy., Conclusions: Although evidence of the efficacy of herbal preparations in treating psychiatric conditions is growing, translating the results of efficacy studies into effective treatments for patients is hampered by the chemical complexity of the products, the lack of standardization of commonly available preparations, and the paucity of well-controlled studies.

Rapid progress in the identification and characterization of axon guidance molecules and their receptors has left the field poised to explore the intracellular mechanisms by which signals are transduced into growth cone responses. The TUC (TOAD/Ulip/CRMP) family of proteins has emerged as a strong candidate for a role in growth cone signaling. The TUC family members reach their highest expression levels in all neurons during their peak periods of axonal growth and are strongly down-regulated afterward. When axonal regrowth in the adult is triggered by axotomy, TUC-4 is reexpressed during the period of regrowth. Mutations in unc-33, a homologous nematode gene, lead to severe axon guidance errors in all neurons. Furthermore, the TUC family is required for the growth cone-collapsing activity of collapsin-1. An important role for the TUC family is also suggested by its high degree of interspecies amino acid sequence identity, with the rat TUC-2 protein showing 98% identity with its chick ortholog and 89% identity with its Xenopus ortholog. Information gained from the study of the TUC family will be of key importance in understanding how growth cones find their targets., (Copyright 1999 John Wiley & Sons, Inc.)

Background: HIV-infected children are at high risk of developing tuberculosis after infection by Mycobacterium tuberculosis. Emphasis is placed on tuberculin skin testing (TST) for diagnosing tuberculosis in children; however, its value in HIV-infected children is controversial., Objectives: To determine whether concurrent antigen testing and/or CD4+ lymphocyte counts help in the interpretation of the TST in children with tuberculosis., Methods: Children eligible for the study were diagnosed as having tuberculosis on clinical criteria. CD4+ lymphocyte counts and delayed-type hypersensitivity (DTH) test, using the CMI Multitest were performed when tuberculosis was diagnosed., Results: One hundred thirty children were enrolled. Tuberculin reactivity was lower in HIV-infected children at all cutoff levels than in HIV-uninfected children (P < 0.0001). The positive predictive value of normal CD4+ lymphocyte counts in predicting tuberculin reactions of > or =5 mm (in HIV-1-infected) and > or =10 mm (in HIV-uninfected patients) were 50 and 80.3%, respectively (P < 0.0001). An intact DTH reaction to the CMI Multitest in predicting reactions of > or =5 mm and > or =10 mm to tuberculin in HIV-infected and -uninfected children were 55 and 76%, respectively (P < 0.001). Kwashiorkor was responsible for 53.3% of false-negative TST in HIV-uninfected children with normal CD4+ lymphocyte counts., Conclusion: TST is of limited value as an adjunct in diagnosing tuberculosis in HIV-infected children. CD4+ lymphocyte counts and concurrent DTH testing are not useful for predicting tuberculin reactivity in HIV-infected patients with tuberculosis.

During development, the Notch signaling pathway is essential for the appropriate differentiation of many cell types in organisms across the phylogenetic scale, including humans. Notch signaling is also implicated in human diseases, including a leukemia and two hereditary syndromes known as Alagille and CADASIL. To generate tools for pursuing the role of the Notch pathway in human disease and development, we have cloned and analyzed the expression of three human homologues of the Notch ligands Delta and Serrate, human Jagged1 (HJ1), human Jagged2 (HJ2), and human Delta1 (H-Delta-1), and determined their chromosomal localizations. We have also raised antibodies to HJ1, and used these antibodies in conjunction with in situ hybridization to examine the expression of these ligands in normal and cancerous cervical tissue. We find that, as reported previously for Notch, the ligands are up-regulated in certain neoplastic tissues. This observation is consistent with the notion that Notch signaling is an important element in these pathogenic conditions, raising the possibility that modulation of Notch activity could be used to influence the fate of the cells and offering a conceivable therapeutic avenue.

Background: A simple, inexpensive serological assay is required for the early determination of HIV infection status among infants born to HIV-1-seropositive women in developing countries., Objectives: To evaluate the use of a commercially available capture enzyme immunoassay (EIA), the MUREX*ICE HIV-1.O.2, for the early identification of seroreverting, uninfected infants., Study Design: Infants with a clearly defined HIV-1 infection status, as determined by polymerase chain reaction results and/or seroreactivity at 18 months, were tested for antibodies to HIV. The time to seroreversion using the capture EIA was compared with the results obtained using an indirect assay, the GENELAVIA MIXT EIA., Results: Seroreverting infants were identified earlier with the capture than the indirect EIA; all of the uninfected infants were seronegative at 12 months with the capture EIA while 100% seroreversion was only seen at 18 months with the indirect EIA., Conclusions: In general, the capture EIA identified seroreverting infants 3-6 months earlier than the indirect EIA. However, caution must be exercised in interpreting seroreactivity in a breast-fed population where HIV infection may occur in a child who has previously seroreverted.

The status of plasma taurine and whether its concentration can be influenced by total parenteral nutrition (TPN) was determined in 51 malnourished fasting cancer patients after surgery and 7-14 days after starting TPN providing 41 +/- 2 kcal, 0.30 +/- 0.02 g N kg-1.day-1 and 40 mg pyridoxine. Plasma taurine was 50% lower in patients than in control subjects. Plasma taurine was significantly greater than baseline only after 14 days of TPN. We also studied the effects of surgery and taurine supplementation (8.6 mg.kg-1.day-1) on plasma and urine taurine concentrations in 12 malnourished patients. Preoperatively, all patients had normal plasma taurine concentrations; postoperatively, it was in the deficient range in 4 patients. Taurine-supplemented patients initially had higher than baseline concentrations; by day 10, none had subnormal levels. Subnormal taurine concentrations commonly occur in malnourished postoperative cancer patients; surgery further precipitates their fall. Plasma concentrations were maintained only with taurine-supplemented TPN.

1. Transcultural psychopharmacology is a discipline that seeks to determine the relative importance of society, culture, environment, genetics, and biophysiology on the prescribing and metabolism of, and response to psychotherapeutic medications. 2. Studies and surveys comparing psychotropic medication use in Asian and non-Asian populations suggest that differences may exist in drug dosage requirements, plasma drug concentrations corresponding to therapeutic and toxic effects, and the incidence and severity of adverse drug reactions. 3. This paper reviews and critiques the published controlled studies on Asian/non-Asian transcultural tricyclic antidepressant psychopharmacology, provides guidelines for the use of psychotropic medications in Asian populations, and offers suggestions for future transcultural studies. 4. Anecdotal reports suggest that differences exist between Asian and non-Asian populations in the pharmacokinetics of tricyclic antidepressants. Controlled studies have not consistently supported this view. 5. Studies with larger sample sizes and more rigorous controls are needed to determine if such differences do, in fact, exist.

We used retrovirus-mediated gene transfer to study the migration of clonally related cells in the developing chicken optic tectum. Clonal cohorts initially form radial arrays in the ventricular zone (approximately E5), but eventually divide into three separate migratory streams. In the first migration, a minor population of cells migrates tangentially along axon fascicles in medio-laterally directed files (approximately E6-E7); these eventually differentiate into multipolar efferent cells. After E7, the majority of cells in each clone migrate radially along fascicles of radial glia to form the tectal plate, wherein they differentiate into neurons and astrocytes. Around E9, a set of small cells leaves the radial arrays in superficial layers to form a second tangential migration; at least some of these differentiate into astrocytes. Thus, as the tectum develops, cells derived from a single multipotential precursor migrate along three separate pathways, follow separate guidance cues, and adopt distinct phenotypes.

Thirty-seven healthy volunteers (18 Asian, 19 Caucasian) ingested a single desipramine (DMI) dose of 1.0 mg/kg of body weight. Saliva and plasma samples were obtained at 1, 3, 5, 7, 12, 24, 48, 72, and 96 hrs after dosing. A nested repeated-measures analysis of variance (ANOVA) design was used to determine if the plasma/saliva DMI ratio varied between Asians and Caucasians over time. Regression analysis was used to assess the ability of saliva DMI to predict plasma DMI at any time point. The ANOVA results indicated no significant differences in DMI plasma/saliva ratios between Asians and Caucasians. There was a major effect of sampling time on the DMI plasma/saliva ratio (p = 0.0001), with the ratio falling from 1.78 at 1 hr to 0.15 at 96 hrs. At any given time at least 24 hrs after the dose, there was a significant relationship between saliva and plasma levels across individuals. However, across subjects, the 95 percent confidence limits for predicting plasma DMI from saliva DMI levels were relatively large. The potential roles and limitations of saliva DMI in pharmacokinetic studies and clinical drug monitoring are discussed.

To determine if hypoalbuminemia is a consequence of protein-energy malnutrition rather than an associated feature of cancer, we reviewed results when vigorous nutritional support was given to 13 men and 9 women who had solid tumors (head and neck [10], gastrointestinal [8], other [4]) and an initial serum albumin less than 3.5 g/dl. Patients had received a minimum of 21 days of nutritional support with total parenteral nutrition (TPN) supplying an average daily energy intake of at least 1.5 x basal energy expenditure (BEE). The TPN was started at a dosage commensurate with the patient's estimated postoperative caloric requirements, and patients had received an average of 2358 kcal/day (1.97 x BEE) and 1.54 g of protein/kg of body weight. Patient body weights increased by an average of 2.75 kg during the 21 days of TPN, but there was no statistically significant change in serum albumin, suggesting that factors other than malnutrition were primarily responsible for the hypoalbuminemia. Although TPN is useful as an adjunct in patients with cancer, it may not reverse the hypoalbuminemia commonly seen in this population.

Age-standardized breast cancer rates were approximately 30% lower in U.S. black women compared to white women. This observation concealed the fact that black women under age 40 years had a higher incidence of breast cancer than did white women, whereas white women over 40 years had a higher incidence. The known risk factors for breast cancer development (early age at menarche, late age at first full-term delivery, and a late age of menopause) differed in black and white populations, which might explain this difference in breast cancer incidence between blacks and whites at different ages.

The use of vitamin A supplements and the risk of cancer was examined in a cohort of 11,888 residents of a retirement community near Los Angeles, California. After 2 1/2 years of follow-up, 445 incident cancers occurred in 435 of the study participants. Overall, the relative risk of cancer for supplement users versus nonusers was 1.0. In a subset of 32 randomly selected individuals, the 14 supplement users had a significantly higher mean serum retinol level (86 micrograms/dl) than did the 18 nonusers (74 micrograms/dl).

The pharmacokinetic differences of tricyclic antidepressants (TCAs) in Asians and Caucasians remain controversial. Thirty-seven age-matched healthy volunteers (18 Asians and 19 Caucasians) ingested a single desipramine (DMI) dose of 1.0 mg/kg of body weight. Blood was obtained at 1, 3, 5, 7, 12, 24, 48, 72, and 96 hours after dosing. Serial 24-hour urine samples were collected for 5 days. There were no statistically significant differences in plasma levels between the two groups. DMI concentrations peaked a median of 5 hours after ingestion in Asians vs. 3 hours in Caucasians. Total clearances of DMI (CL DMI) and hydroxylated DMI (OH-DMI) were greater in Caucasians. These differences were no longer significant when corrected for body weight. Clearances appeared to follow tri-modal distributions. The proportions of Asians and Caucasians falling into the slow, intermediate, and rapid clearance groups were not significantly different, but there was a tendency for more Caucasians to be in the rapid clearance group.

The nutritional consequences of dementia and the role of diet in the etiology, treatment, and prevention of dementia are the subjects of this review. The major cause of dementia is Alzheimer's disease. Although it has been suggested that aluminum intake may cause this disease, the bulk of scientific evidence suggests that this is unlikely. Dietary supplements of choline and lecithin have been used to treat Alzheimer's disease but are ineffective. Alzheimer's disease patients are at risk of developing protein-energy malnutrition because of poor food intake and increased energy requirements. The second most common cause of dementia is multi-infarct dementia, caused by multiple strokes. Diet may play a role in the prevention of this form of dementia through effects on blood pressure and other risk factors. Control of risk factors may also prevent further progression of the dementia. Patients with multi-infarct dementia often have dysphagia. The third most common cause of dementia appears to be excessive alcohol intake, due both to the direct neurotoxic effects of alcohol and to the effects of alcohol on nutritional status. Alcoholic dementia may be at least partially reversible with abstinence and good nutrition. Other causes are vitamin B-12 and folate deficiencies; these are reversible dementias. In all types of dementia, adequate nutrition may improve physical well-being, help maximize the patient's functioning, and improve the quality of life.

We used histochemical techniques [assays for adenine triphosphatase (ATPase) and succinate dehydrogenase (SDHase) activity] to identify muscle fiber types in the larynx of Xenopus laevis. Male muscle is made up of one fiber type, medium-sized fibers (approximately 9 microns2) that stain lightly for acid-stable ATPase and intensely for SDHase activity. In contrast, the female has 3 fiber types: small fibers (approximately 6 microns2) that stain intensely for ATPase and SDHase, medium-sized fibers (approximately 13 microns2) with moderate staining for ATPase and dark staining for SDHase, and large fibers (approximately 15 microns2) with little SDHase or ATPase activity. Long-term castration (6 months) has no effect on histochemical staining of adult male fibers. Long-term testosterone treatment (5 months) increases the proportion of medium-sized, moderately staining fibers in adult females, and reduces the proportion of both the small, darkly staining fibers and the large, lightly staining fibers. At metamorphosis, both males and females have 3 fiber types whose ATPase activity is similar to that of the adult female. However, no SDHase activity is observed. Treatment of juveniles for 3 weeks with testosterone results in nearly complete masculinization of muscle fibers, as judged by increased cross-sectional area, homogeneous ATPase staining, and a marked increase in SDHase activity. Thus, juvenile muscle is considerably more responsive to testosterone than is adult female muscle. We propose that the uniform metabolic properties of male laryngeal muscle contribute to the production of the rapid (66 Hz) mate call vocalizations characteristic of this species. Further, our results suggest that androgens direct the masculinization of laryngeal muscle fibers during postmetamorphic development.

Both animal experiments and certain well-established breast cancer risk factors suggest that risk to the disease is fundamentally determined by the hormones of the pituitary-gonadal axis. Although international comparisons of urinary estrogens have given support to this ypothesis, case-control studies and international comparisons of plasma estrogens and prolactin have not. Methodological problems and sampling biases probably account for the inconsistency of these investigations. Taking advantage of the known familial increased risk to breast cancer, we conducted comparative studies of teenage daughters of patients with breast cancer, including a group of girls whose mothers had bilateral breast cancer when they were less than 50 years old. The results of these studies revealed that these high-risk girls appear to have elevated levels of estrogens, prolactin, and progesterone.

As most diet therapy texts provide little information about psychiatric illnesses and their treatment, this article is intended as a brief introduction for dietitians. Several psychiatric illnesses, including schizophrenia, mood disorders, eating disorders, and substance abuse, may adversely affect food intake and nutritional status. The drugs used to treat those disorders similarly have effects on appetite and gastrointestinal function and interact with food and nutrients. Antipsychotics, antidepressants, and monoamine oxidase inhibitors (MAOIs) cause dry mouth, constipation, and weight gain. Lithium may cause nausea, vomiting, diarrhea, polydipsia, and weight gain. MAOIs have well-known interactions with foods containing tyramine. Lithium interacts with dietary sodium and caffeine; decreasing dietary intakes of those substances may produce lithium toxicity. Despite claims to the contrary, major psychiatric illnesses cannot be cured by nutritional therapies alone. Dietitians can, however, play an important role as part of a multidisciplinary team in the treatment of patients with psychiatric illness. Such a role includes nutrition assessment and monitoring, nutrition interventions, patient and staff education, and some forms of psychotherapy, including supportive and behavioral therapies for patients with eating disorders.

Forty-six psychiatric residents at a county hospital were surveyed about their exposure to patient violence. The overall incidence of assaults was 2.8 per 100 resident-months at risk. Statistically significant differences were found in the rates of assaults on different services; the rates were highest on the child and adolescent services and lowest on the adult outpatient service. Most of the assaults were committed by psychotic, male, young adults, but only male sex and age less than 13 years were statistically associated with increased risk of assaultiveness. Diagnosis and race were not associated with assaultiveness. The usual means of attack involved hitting or kicking and seldom resulted in serious injury.

Vitamin supplement were taken regularly by 62% of men and 69% of women surveyed in a Southern California retirement community. Supplement use was associated with more frequent use of health screening procedures and with several other health-related habits. A substantial proportion of residents consumed high levels of vitamins C and E, and 3.2% consumed potentially toxic doses of vitamin A.

As many as 50 per cent of hospitalized patients are estimated, in some surveys, to suffer from protein-calorie malnutrition. Anthropometry provides at least one quick and easy way to assess a patient's protein and calorie reserves. The measurements most commonly obtained are height, weight, triceps skinfold thickness, and upper arm circumference. An alternate method is suggested that compares these measurements with percentiles rather than, as in the current method, with percentages of the standard.