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In a practice-based, prospective study of 917 inpatients referred to a consultation-liaison psychiatry service and diagnosed as depressed, 41% were prescribed an antidepressant: 40% tricyclics, 35% selective serotonin reuptake inhibitors (SSRIs), 15% monoamine oxidase inhibitors (MAOIs)/reversible inhibitors of monoamine (RIMAs) (mainly moclobemide), and 11% tetracyclics (mianserin). Factors associated with choice of antidepressant type included age, referral for pain, length and seriousness of physical illness, type of physical illness, and concurrent antipsychotics (P < 0.01). Tetracyclics and MAOI/RIMAs were used significantly more often than tricyclics in the more severely physically ill and the elderly. The percentage of patients prescribed an antidepressant increased significantly over time, which is accounted for by the greater use of SSRIs across all age groups and degrees of seriousness of illness. There is a paucity of randomized controlled trials on which to base practice guidelines. Practice-based research such as this helps inform those guidelines.

In a practice-based, prospective study of 1,551 inpatients referred to a consultation-liaison psychiatry service and prescribed an antidepressant, an adverse drug reaction judged sufficient to warrant discontinuation of the drug was noted in 158 (10.2%). The factors associated were older age (P < 0.05); ICD-9 genitourinary disorder (mainly renal failure) (P < 0.01); DSM-IV “delirium, dementia, etc.” (P < 0.05); length of stay (P < 0.001); number of visits (P < 0.001); and time spent on case (P < 0.05). Neither psychological functioning (GAF) nor physical functioning (Karnofsky ratings) were associated with a reaction, nor was multiple psychotropic drug prescription. Tricyclics were more likely than selective serotonin reuptake inhibitors/norepinephrine reuptake inhibitors to be associated with a reaction (P < 0.05).

Hopelessness, loss of meaning, and existential distress are proposed as the core features of the diagnostic category of demoralization syndrome. This syndrome can be differentiated from depression and is recognizable in palliative care settings. It is associated with chronic medical illness, disability, bodily disfigurement, fear of loss of dignity, social isolation, and — where there is a subjective sense of incompetence — feelings of greater dependency on others or the perception of being a burden. Because of the sense of impotence or helplessness, those with the syndrome predictably progress to a desire to die or to commit suicide. A treatment approach is described which has the potential to alleviate the distress caused by this syndrome. Overall, demoralization syndrome has satisfactory face, descriptive, predictive, construct, and divergent validity, suggesting its utility as a diagnostic category in palliative care.

The authors studied interventions recommended by consultation-liaison (C-L) psychiatrists when they diagnosed somatoform disorder prospectively in a cohort of 4,401 consecutive inpatients referred to the C-L psychiatry service of a general teaching hospital, using standardized MICRO-CARES methodology. A DSM-III-R somatoform disorder was diagnosed in 2.9%, somatoform pain disorder in 1.4%, conversion disorder in 0.7%, hypochondriasis or somatization disorder undifferentiated/not otherwise specified in 0.6%, and somatization disorder in 0.2%. In 3.4%, somatoform disorder was considered a differential diagnosis. Psychiatric comorbidity included mood disorder (39%), personality disorder (37%), and psychoactive substance use disorder (19%). Recommendations were made about antidepressants in 40% of the patients, anxiolytics in 18%, sedatives in 18%, and antipsychotics in 10%. Psychiatrists recommended the following: more laboratory tests for 14%; additional medical/surgical consultations for 11%; an increase in the vigor of medical treatment for 13%; and psychological treatment for 76%; also they stressed an earlier discharge of 16%. Psychiatrists were more likely to request a prolongation of inpatient stay for patients with comorbid somatoform, mood, anxiety, and personality disorder. Differences in characteristics and treatment of the subgroups tended to be consistent with their constructs and comorbid psychiatric diagnoses.

The authors examined the latent structure of psychiatric symptoms occurring in patients with medical illness. Symptom data were collected from 312 hospitalized medically ill patients using the Monash Interview for Liaison Psychiatry and subjected to latent trait analysis. A model with 5 dimensions provided an acceptable fit to the data. Dimensions were characterized as demoralization, anhedonia, autonomic anxiety, somatic symptoms, and grief. The demoralization dimension was similar to the concept of demoralization described by Frank and to the “giving up-given up complex” described by Engel. The concepts of demoralization, grief, and anhedonia may be useful in increasing understanding of the minor depressions in people with medical illness and in increasing the specificity of psychological and pharmacological treatments for these disorders.

The human multidrug resistance P‐glycoprotein (P‐gp) contributes to the phenomenon of multidrug resistance during cancer and AIDS chemotherapy. A potential novel strategy to circumvent the effects of P‐gp during chemotherapy is to prevent maturation of P‐gp during biosynthesis so that the transporter does not reach the cell surface. Here we report that immature, core‐glycosylated P‐gp that is prevented from reaching the cell surface by processing mutations or by proteasome inhibitors such as lactacystin or MG‐132 exhibited no detectable drug‐stimulated ATPase activity. Disulfide cross‐linking analysis also showed that the immature P‐gp did not exhibit ATP‐induced conformational changes as found in the mature enzyme. In addition, the immature P‐gp was more sensitive to trypsin than the mature enzyme. These results suggest that P‐gp is unlikely to be functional immediately after synthesis. These differences in the structural and enzymatic properties of the mature and core‐glycosylated, immature P‐gp could potentially be used during chemotherapy, and should result in the search for compounds that can specifically inhibit the maturation of P‐gp.—Loo, T. W., Clarke, D. M. The human multi‐drug resistance P‐glycoprotein is inactive when its maturation is inhibited: potential for a role in cancer chemotherapy. FASEB J. 13, 1724–1732 (1999)

The pntAand pntBgenes of Escherichia coli, encoding the α- and β-subunits of the pyridine nucleotide transhydrogenase, were cloned individually in two different compatible plasmids into Escherichia coli mutants lacking transhydrogenase activity. Energy-linked and non-energy-linked transhydrogenase activities were produced only in cells carrying both plasmids thus showing that the products of both genes are required for the formation of an active enzyme. ATP-energized transhydrogenase activity was not increased in cells containing amplified levels of the transhydrogenase when the cell membrane ATPase was also amplified. It is suggested that the excess transhydrogenase is effectively uncoupled from the ATPase by compartmentalization in the cell.

A PC program for comparing two kappa coefficients of agreement obtained from the same sample of observations is described. The program employs a Monte Carlo permutation test to assess the statistical significance of the difference between kappa values.

The rapid determination of cysteinyl residues by Creighton's method [(1980) Nature 284, 487-489] led to the discovery of a discrepancy between protein and DNA sequence data in the α-subunit of the F 1ATPase from Escherichia coli[(1984) Arch. Biochem. Biophys. 229, 320-328]. We have isolated a cysteinyl-containing decapeptide from the α-subunit with a protein sequence (AGCAMGEYFR) which is only partially recognizable from DNA data. Re-sequencing of DNA in the region coding for the peptide has resulted in two corrections: insertion of a cytosine before position 715 and deletion of a thymine at position 731 of the uncAgene.

Objective: To determine the prevalence of psychological morbidity and describe quality of life in women with early‐stage breast cancer. Design: Cross‐sectional descriptive study (3 months after conservative breast surgery or mastectomy) of patients from nine general hospitals in Melbourne, Victoria, October 1994 to March 1997. Participants: 303 women with early‐stage breast cancer entering a randomised trial of adjuvant psychological group therapy; mean age, 46 years (SD, 8). Main outcome measures: Diagnostic and Statistical Manual of Mental Health (DSM)‐IV psychiatric diagnoses generated by the Monash Interview for Liaison Psychiatry; quality‐of‐life data based on the the European Organization for Research and Treatment of Cancer quality‐of‐life questionnaire (QLQ)‐C30 (core) and QLQ­ BR23 (breast module) instruments. Results: 45% of the women (135/303) had a psychiatric disorder; 42% (127) of the sample had depression or anxiety, or both; there was minor depression in 82 (27.1%), an anxiety disorder in 26 (8.6%), major depression in 29 (9.6%) and a phobic disorder in 21 (6.9%). 20% of women (61) had more than one disorder. On quality‐of‐life measures nearly one‐third of the women felt less attractive and most had lost interest in sexual activity. There was substantial distress about hair loss. Symptoms of lymphoedema were described by 13 women (4.3%). Breast conservation surgery was associated with a better body image (P<0.01). Conclusion: Women recently diagnosed with early‐stage breast cancer have high rates of psychiatric and psychological disturbance. Quality of life is substantially affected. Clinicians should actively explore their patients' psychological adjustment to enable early recognition and treatment of these disorders.

The rapid determination of cysteinyl residues by Creighton's method [(1980) Nature 284, 487‐489] led to the discovery of a discrepancy between protein and DNA sequence data in the α‐subunit of the F1ATPase from Escherichia coli[(1984) Arch. Biochem. Biophys. 229, 320‐328]. We have isolated a cysteinyl‐containing decapeptide from the α‐subunit with a protein sequence (AGCAMGEYFR) which is only partially recognizable from DNA data. Re‐sequencing of DNA in the region coding for the peptide has resulted in two corrections: insertion of a cytosine before position 715 and deletion of a thymine at position 731 of the uncAgene.

Deletion mutants of the Ca 2+ATPase of rabbit fast-twitch skeletal muscle sarcoplasmic reticulum (SERCA1a) were constructed and expressed in COS-1 cells. The mutants were expressed at levels 7- to 15-fold lower than the wild-type and were inactive. In vitro transcription-translation-insertion experiments showed that deletion of transmembrane sequences M 1and M 2, but not of M 8, M 9, M 10or the NH 2 −terminal 30 amino acids inhibited the stable insertion of the enzyme into the membrane. Thus there was no correlation between loss of function and membrane insertion. A signal sequence for membrane insertion may exist in M 1and M 2.

The author focuses on the success of the golf player Ernie Els in his career including his Tour wins and plaque in the Hall of Fame and mentions why raising autism awareness is so important to him and mentions why he badly wants to win again.

An introduction is presented in which the editor discusses articles within the issue on topics including golfers Justin Thomas, and Steve Stricker, and the British Open golf tournament.

An introduction is presented in which the editor discusses articles in the issue that includes information of golf player Sergio Garcia; assessment of Garcia's technique for an appropriate shots; and description of the 2017 U.S. Open that will be held at the Erin Hills golf course at Wisconsin.

An introduction is presented in which the editor discusses various articles within the issue on topics including suggestions for playing golf, performance of Swedish professional golfer Henrik Stenson at the 2016 British Open, and launch of testers in 3-wood shots.

An introduction is presented in which the editor discusses articles in the issue on topics including Masters Golf Tournament, advices from golfer Danny Willett to work hard and trust one's own abilities, and tips to perform well at the Masters Golf Tournament.

An introduction is presented in which the editor discusses various topics within the issue including evaluation of new high technology golf drivers, an interview with golfer Daniel Berger, and 25th anniversary celebration of Top 100 Teachers list in the U.S.

An introduction is presented in which the editor discusses various reports within the issue on topics including golfer Bryson DeChambeau, health of golfer J. B. Holmes and use of single length irons.

An introduction is presented in which the editor discusses various reports within the issue on topics including winning of golfer Dustin Johnson at Oakmont in 2016 U.S. Open championship, efforts of U.S. golf team in Ryder Cup and stories related to Johnson.

An obituary is presented for American golfer Arnold Palmer.

The article offers information on the suggestions from golfer Justin Rose on how to play golf under pressure, improve driver swing, and make better wedge shots.

An introduction is presented in which the editor discusses various articles within the issue on topics including U.S. Ryder Cup veterans Bubba Watson and Dustin Johnson, and Darren Clarke and his European golf team.

An introduction is presented in which the editor discusses various reports within the issue on topics including golf courses, tee shot in golf and public golf.