RESUMEN
Delusional disorder has important implications for forensic psychiatrists, as delusions are not infrequently related to criminal behavior. Thus, we hypothesized that delusional disorder is over-represented in correctional populations. We conducted a retrospective chart review of the electronic medical records from 2000 to 2012 of New Jersey Department of Corrections inmates who remained incarcerated as of March 2012. Potential cases of delusional disorder were initially identified by using a search for current or past diagnoses of such disorders or other diagnoses that could be misdiagnosed cases. After an initial chart review identified an inmate as having probable delusional disorder according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) criteria, the diagnosis was confirmed by at least one concurring independent review. We estimate a point prevalence of 0.24 percent for delusional disorder in our population, which is eight times higher than that expected in the community.
Asunto(s)
Prisioneros/psicología , Prisioneros/estadística & datos numéricos , Prisiones/estadística & datos numéricos , Esquizofrenia Paranoide/epidemiología , Adulto , Psicología Criminal/legislación & jurisprudencia , Estudios Transversales , Manual Diagnóstico y Estadístico de los Trastornos Mentales , Registros Electrónicos de Salud , Humanos , Tamizaje Masivo/estadística & datos numéricos , New Jersey , Proyectos Piloto , Pronóstico , Trastornos Psicóticos/diagnóstico , Trastornos Psicóticos/epidemiología , Trastornos Psicóticos/psicología , Valores de Referencia , Estudios Retrospectivos , Esquizofrenia Paranoide/diagnóstico , Esquizofrenia Paranoide/psicología , Resultado del TratamientoRESUMEN
In psychiatry, as in other disciplines, electronic templates are replacing handwritten records to meet health care financing regulations and requirements of third-party payers. We address whether these checklists are helpful for residents, especially those beginning training, in learning the foundational skills of their discipline and in recording a comprehensive set of patient data. An informal survey of our residents suggests that residents find the templates useful, though they have advantages and disadvantages. We also review relevant literature from psychiatry and other fields on the use of electronic templates and pose questions about how we might gauge the usefulness of the templates in residents' training and in obtaining valid data for clinical decision-making.
Asunto(s)
Lista de Verificación , Documentación/métodos , Internado y Residencia , Sistemas de Registros Médicos Computarizados , Psiquiatría/educación , Programas Informáticos , Competencia Clínica , Servicio de Urgencia en Hospital , Humanos , Entrevista Psicológica , Admisión del Paciente , Derivación y ConsultaRESUMEN
Granulocyte-macrophage colony stimulating factor (GM-CSF) activity has been linked to pro-inflammatory effects in autoimmune syndromes, such as rheumatoid arthritis. Thus GM-CSF mimetics with antagonist activity might play a therapeutic role in these diseases. The human GM-CSF core structure consists of a four alpha-helix bundle, and GM-CSF activity is controlled by its binding to a two-subunit receptor. A number of residues located on the B and C helices of GM-CSF are postulated to interact with the alpha chain of the GM-CSF receptor (GM-CSFR). Several approaches have been successfully utilized to develop peptide mimetics of this site, including peptides from the native sequence, a peptide derived from a recombinant antibody (rAb) light chain which mimicked GM-CSF receptor binding activity, and structurally guided de novo design. Analysis of the rAb light chain had suggested mimicry of GM-CSF with residues mostly contributed by the CDR I region. Key residues involved in CDR I peptide/GM-CSFR binding were identified by truncation and alteration of individual residues, while the structural elements required to antagonize the biological action of GM-CSF were separately tested in binding and inhibitory activity assays of multiple cyclic analogues. A peptide designed to retain the loop conformation of the CDR I region of the rAb light chain competed with GM-CSF for both antibody and receptor binding, but the role of specific residues in antibody versus receptor binding differed markedly. These studies suggest that structural analysis of peptide mimetics can reveal differences in receptor and antibody binding, perhaps including key interactions that impact binding kinetics. Peptide mimetics of other four-helix bundle cytokines are reviewed, including helical and reverse turn mimetics of helical structures. Use of peptide mimetics coupled with structural and kinetic analysis provides a powerful approach to identifying important receptor-ligand interactions, which implications for rational design of novel therapeutics.
Asunto(s)
Antiinflamatorios/química , Antiinflamatorios/farmacología , Factor Estimulante de Colonias de Granulocitos y Macrófagos/química , Factor Estimulante de Colonias de Granulocitos y Macrófagos/farmacología , Receptores de Factor Estimulante de Colonias de Granulocitos y Macrófagos/efectos de los fármacos , Secuencia de Aminoácidos , Animales , Sitios de Unión , Diseño de Fármacos , Factor Estimulante de Colonias de Granulocitos y Macrófagos/antagonistas & inhibidores , Humanos , Imitación Molecular , Datos de Secuencia Molecular , Péptidos/síntesis química , Péptidos/farmacologíaRESUMEN
Phage display was used to identify sequences that mimic structural determinants in interleukin5 (IL5) for IL5 receptor recognition. A coiled coil stem loop (CCSL) miniprotein scaffold library was constructed with its turn region randomized and panned for binding variants against human IL5 receptor alpha chain (IL5Ralpha). Competition enzyme-linked immunosorbent assays identified CCSL-phage selectants for which binding to IL5Ralpha was competed by IL5. The most frequently selected and IL5-competed CCSL-phage contain charged residues Arg and Glu in their turn sequences, in this regard resembling a beta strand sequence in the 'CD turn' region, of IL5, that has been proposed to present a key determinant for IL5 receptor alpha chain recognition. The most dominant CCSL-phage selectant sequence, PVEGRV, contains a negative/positive charge pattern similar to that seen in the original CD turn. To test the relatedness of CCSL-phage selectant sequences to the IL5 receptor recognition epitope, PVEGRV was grafted into the sequence 87--92 of a monomeric IL5. The resulting IL5 variant, [(87)PVEGRV(92)]GM1, was able to bind to IL5Ralpha in biosensor assays, to elicit TF-1 cell proliferation and to induce STAT5 phosphorylation in TF-1 cells. The results help discern sequence patterns in the IL5 CD turn region which are key in driving receptor recognition and demonstrate the utility of CCSL miniprotein scaffold phage display to identify local IL5 mimetic sequence arrangements that may ultimately lead to IL5 antagonists.