Multiple, giant lymphangectatic pilomatricomas: A rare clinical entity.

This case highlights the rare and atypical presentation of giant, multiple pilomatricomas (PMs) with a pseudo-bullous appearance and lymphangiomatous pathology. It underscores the importance of considering PM in the differential diagnosis of atypical lesions, especially those mimicking cystic or hemorrhagic malignant conditions, to prevent misdiagnosis and ensure appropriate management.

Is spirituality relevant to the practice of medicine?

The interrelationship between spirituality and medical science has been looked upon with suspicion for centuries. While in ancient societies medicine and religion were intertwined, in the West separation between these two since the Middle Ages has created a wall of mistrust which undermined the relationship. During the last two decades, however, there has been an upsurge of interest in the role of spirituality in medical practice in North American universities.

A case of seasonal bipolar disorder exacerbated by Cushing's disease.

While depression is common in Cushing's syndrome from whatever cause (pituitary, adrenal, or ectopic adrenocorticotropic hormone-secreting tumor or hyperplasia, or exogenous administration of glucocorticoids) and hypercortisolemia is prevalent in major depression, any association between seasonal affective disorder and Cushing's syndrome is unknown. We present a case of seasonal bipolar disorder, gradually worsening for more than 9 years (1985-1994), accompanied by increasing osteoporosis, mild weight gain, and slight truncal obesity in a middle-aged woman. In January 1991, her seasonal affective disorder was successfully treated with light therapy, but in the following year, bipolar mood swings with a seasonal pattern emerged, which were refractory to light therapy and antidepressants but responsive to lithium.

Elevated levels of some neuroactive progesterone metabolites, particularly isopregnanolone, in women with chronic fatigue syndrome.

Chronic fatigue syndrome (CFS) is a controversial entity whose cause is unknown. In this study we have explored the possibility that progesterone metabolites may be involved. Plasma levels of the progesterone precursor pregnenolone, progesterone itself, and five ring A-reduced metabolites of progesterone were measured in 20 women with CFS and in 13 age-matched controls.

Depressive relapse following acute tryptophan depletion in patients with major depressive disorder.

Acute tryptophan depletion (ATD) lowers serotonin synthesis and elicits depressive symptoms in some, though not all, remitted patients with major depressive disorder (MDD). In the present study, eight medication-free remitted patients with MDD, seasonal pattern, were tested twice, once following the ingestion of a tryptophan-containing mixture, once following ATD. ATD significantly increased Hamilton depression scores (p < 0.

Seasonal mood patterns in eating disorders.

There has been an increasing body of research literature suggesting a seasonal pattern of mood fluctuations and eating behavior in bulimic patients. Fornari et al. [5] reported worsening of bulimic symptoms during winter.

Vitamin B12 and folate levels and lithium administration in patients with affective disorders.

Background: It is unclear whether there is a relationship between lithium administration and vitamin B12 metabolism.

Methods: We compared serum B12, serum folate, and red blood cell folate concentrations in patients receiving and not receiving lithium at two Mood Disorders Clinics. As the two centers differed in vitamin assay methods, data were first analyzed separately and then combined.

Efficacy of light versus tryptophan therapy in seasonal affective disorder.

Background: Although light therapy has become the accepted treatment for patients suffering from seasonal affective disorder (SAD, winter depression), almost 40% of these patients do not respond, and require an alternative treatment.

Methods: The therapeutic effects of light versus tryptophan on SAD were studied in a repeated measures design in 13 SAD patients (11 women, 2 men). Light therapy for 2 weeks or tryptophan for 4 weeks was given, separated by a one week washout period.

Neuroendocrine responses to inhibitors of steroid biosynthesis in patients with major depression resistant to antidepressant therapy.

Objective: Patients with major depression frequently have high cortisol levels and resistance to dexamethasone. We sought to determine to what extent major depression might be influenced by inhibitors of steroid biosynthesis and to study the endocrine changes produced.

Method: After drug washout, 20 treatment-resistant patients with major depression were given aminoglutethimide, metyrapone, and/or ketoconazole, along with a small dose of cortisol for 8 weeks.

The effect of tryptophan depletion on mood in medication-free, former patients with major affective disorder.

Acute tryptophan depletion (ATD) induces transient clinical relapse in medicated patients with major affective disorder. Our objective was to determine whether this effect persists once patients are euthymic and off antidepressants. Thus, we examined the effects of ATD in fully remitted, medication-free, former patients with major depression (n = 14).

Familial eating concerns and psychopathological traits: causal implications of transgenerational effects.

Objective: This study extends an earlier investigation on the link between familial traits and eating disorders (EDs), and examines the extent to which selected eating attitudes and psychopathological traits are (a) familial in nature and (b) specific to anorexia- and bulimia-spectrum disorders.

Methods: We measured various ED-relevant dimensions (eating and body image attitudes) and psychopathological traits (e.g.

A cross-sectional study of parkinsonism and tardive dyskinesia in lithium-treated affective disordered patients.

Background: The purpose of this study was to investigate the prevalence of extrapyramidal symptoms (EPS) and tardive dyskinesia (TD) in affective disordered patients treated with lithium and to study the association of these symptoms with medication and other factors.

Methods: This cross-sectional study was carried out in all consenting outpatients attending an affective disorders clinic in a psychiatric hospital. The study sample consisted of 130 stable outpatients: 110 with bipolar disorder, 18 with unipolar (major) depression, and 2 with atypical affective disorder.

Controlled study of eating concerns and psychopathological traits in relatives of eating-disordered probands: do familial traits exist?

To examine the extent to which first-degree relatives of eating-disordered (ED) probands endorse maladaptive eating attitudes and personality/affective traits, we compared self-reported eating concerns (Restraint, Emotional Eating, Body Dissatisfaction, and maladaptive eating attitudes) and psychopathological traits (Affective Instability, Anxiousness, Compulsivity, and Narcissism) across groups of restricter (n = 19), binger (n = 56), psychiatric control (PC, n = 38), normal dieter (ND, n = 29), and nondieter control (NC, n = 28) probands, and then across participating nuclear family members. Results among probands were as anticipated: ED probands showed expected elevations in both areas, and predicted restricter/binger differences were obtained. However, corresponding differences were not obtained on measures of mothers', fathers', or siblings' eating concerns and traits.

Prevalence and symptoms at onset of bipolar illness among adolescent inpatients.

The records of 236 adolescents (116 males and 120 females) admitted to an inpatient psychiatric unit over an eight-year period were retrospectively reviewed to determine the characteristics of patients with a discharge diagnosis of bipolar disorder. Forty-two patients had a diagnosis of an affective disorder, including 18 patients (nine males and nine females) with bipolar disorder. Mean age at onset of illness for patients with bipolar disorder was 15.

The psychotropic effects of inhibitors of steroid biosynthesis in depressed patients refractory to treatment.

Twenty patients, diagnosed as suffering from treatment-resistant major depression, were treated with one or more drugs that decrease corticosteroid biosynthesis. Nine were psychotic, 11 nonpsychotic. Seventeen completed the treatment (8 psychotic, 9 nonpsychotic); 13 responded (5 psychotic, 8 nonpsychotic; 11 responded completely (i.

Eating and psychiatric symptoms as a function of Axis II comorbidity in bulimic patients. Three-month and six-month response after therapy.

Using DSM-III-R criteria, the authors organized 61 bulimic patients into "Borderline," "Other Personality Disorder," and "No Personality Disorder" groups, and then examined eating and comorbid symptoms at 3-month intervals during 6 months of multimodal therapy. Personality-disorder classifications seemed to predict neither the severity nor responsiveness to treatment of bulimic symptoms; all groups showed reliable and clinically significant improvements in eating habits over time. Conversely, the borderline patients showed reliably more comorbid symptoms than did any other group; their scores on disorder-specific dimensions--like borderline "traits" and maladaptive defenses--remained distinctly elevated throughout treatment.

Possible use of glucocorticoid receptor antagonists in the treatment of major depression: preliminary results using RU 486.

The rationale for the use of anti-glucocorticoids in the treatment of major depression has been reviewed. Four patients with chronic severe depression who were resistant to conventional therapies were given RU 486 (200 mg/day) for periods up to eight weeks. Substantial levels of RU 486 were achieved within the first few days, and the levels fell gradually over the week after the treatment was discontinued.

A longitudinal CNV study of the evolution and treatment of bipolar illness.

In a longitudinal CNV study of bipolar illness we followed the evolution of this illness in six bipolar patients by recording their CNV and mood changes as well as their psychopharmacological treatment for a period of 8 months. The longitudinal CNV recordings of these patients did not show changes corresponding to their mood variations. The most salient result emerging from this study was the consistency in the patterns of the records in different patients in spite of variations in their clinical state and medications.

Prevalence of psychosomatic and other medical illnesses in anorexic and bulimic patients.

The occurrence of psychosomatic disorders (PSD) in patients with anorexia nervosa and bulimia nervosa has rarely been investigated. We examined the prevalence of four psychosomatic disorders [peptic ulcer (PU), bronchial asthma (BA), neurodermatitis (ND), and rheumatoid arthritis (RA)] in patients consecutively admitted to an eating disorders (ED) program. Responses to a validated questionnaire and clinical file information were obtained from 152 patients, 60% of whom were bulimic and 40% were anorexic.

Depression and guilt in Indian and north american patients: a comparative study.

One hundred and nineteen Indian and one hundred and fourteen North American depressed patients were compared to assess the differences in psychopathology. The study revealed two important findings: 1) Indian patients scored significantly higher than American patients on the HAMD items of poor appetite, hypochondriasis, diurnal variation, and psychomotor retardation; and lower on the items of anxiety and middle insomnia. 2) Guilt was expressed less often by Indian patients.

Comorbid features in bulimics before and after therapy: are they explained by axis II diagnoses, secondary effects of bulimia, or both?

This study evaluated the extent to which personality disorder (PD) diagnoses drawn in active bulimics explained pretreatment and posttreatment comorbid features, once possible secondary effects of bulimia nervosa (BN) on the mental status were controlled. We used structured interviews to assign axis II diagnoses to 73 DSM-III-R bulimics, and then examined whether or not classification into borderline PD (BPD), other PD (OPD), or no PD (NPD) groups (a) predicted pretreatment and posttreatment differences in comorbid symptoms, and (b) explained the severity of comorbid symptoms independent of effects attributable to BN sequelae. Groups never differed on eating-symptom measures, with all showing satisfactory average improvements over 3 months.

Lithium, benzodiazepines, and sexual function in bipolar patients.

Objective: Lithium and benzodiazepines are widely used in the treatment of bipolar patients. Yet studies of the effect of these drugs on sexual function are scarce. This study surveyed sexual function in bipolar patients treated with lithium, either alone or in combination with other drugs.

Lithium treatment and memory assessment: methodology.

Clinical observations have suggested that lithium may exert adverse effects on memory. The difficulty in achieving empirical consensus regarding this issue has reflected several methodological problems: diversity of research designs, heterogeneous samples, lack of control groups and the possible confounding of memory test scores by variables such as depression, other acute psychopathologies, organicity, treatment duration, and age. The diversity of memory tests in terms of the complexity and modality of the stimuli as well as the types of memory assessed (immediate, short- and long-term, logical, visuo-practic) has further complicated the comparison of results across studies.

Substance misuse among native and rural high school students in Quebec.

A questionnaire exploring the smoking habits, past and current use of alcoholic beverages, cannabis, and other illicit drugs was distributed among Francophone and Native high school students in a rural area of Quebec. The lifetime prevalence figures indicated that use of illicit drugs was significantly higher among Native students. This held true particularly for stimulants and inhalants (p less than .