A previous symptom-based survey of veterans of the 1990-1991 Persian Gulf War suggested a neurological syndrome (blurred vision, loss of balance/dizziness, tremors/shaking, and speech difficulty). The authors conducted the present study to determine whether specific findings could indicate an organic basis for this possible syndrome. They completed an extensive clinical and laboratory evaluation on Gulf War veterans with all 4 symptoms, using 3 comparison groups. A single clinically based neurological syndrome could not be identified. No deployment-related exposure appeared to explain the pattern of symptoms, but this evaluation suggested comorbidities and possibly multiple vaccines as important contributors. Many of the neurological symptoms reported by the studied veterans appear to have an organic basis, but comorbidities must be excluded before researchers can conclude that a definitive syndrome exists.
Antidepressant use in the treatment of bipolar disorder is controversial due the risks of affective switching and cycle acceleration. Studies of non-comorbid samples suggest that the risk can be mitigated with the use of a concomitant mood stabilizer. However, the majority of patients with bipolar disorder will experience a comorbid substance use disorder and little is known about these individuals because they are typically excluded from clinical trials. Patients entering a substance abuse treatment program who had a history of bipolar disorder were interviewed to evaluate antidepressant-induced affective switching with and without concomitant mood stabilizer. Among 41 comorbid participants, the total lifetime antidepressant-induced switch rate was 76%. The switch rate was 56% for patients taking a mood stabilizer and an antidepressant concomitantly. There was no difference between patients with bipolar I and bipolar II disorders.
BOOK REVIEWS 721 lorsville the British were sure the South would win, that northern industrialists were afraid the war and their profits would cease, that Lincoln's order to supply Sumter "caused" the war, that in all probability had Davis been in command at First Manassas he would have taken Washington, that (the bad) Johnston was completely at fault at Vicksburg, and that the war "most likely" would have ended with Gettysburg "except for the indomitable will and courage of Jefferson Davis." These points of view can be defended with less anguish, however, than the implied extra-sensory perception of the Confederate President. Strode never seems to understand that Davis' many quarrels were historic not because he was right or wrong but because he indulged in them at all. The gallant Mississippian made his share of mistakes and his biographer would do him a greater service by admitting a decent human frailty rather than always carefully preparing a way to get him off the hook.One can excuse petty slips in definition of the Black Belt and the Delta, but even the most confirmed southern patriot is bound to gag with repeated allusions to Virginia and southern gentlemen, blue bloods, bluestockings, thoroughbreds (human), and the "gilded youth of the aristocracy" -who graciously volunteered along with the hillbillies -to the exclusion of the yeomen who, after all, fought the war. The author cannot deny his obsession with the First Lady as an "instinctive hostess" with a "woman's vision," with Joe Brown's "self righteous twang," or with (the good) Johnston's countenance illuminated by "good qualities of heart and mind." Though irritating, these imperfections are indeed minor, except for their frequency. The basic trouble with both volumes is that the reader must take so much on faith ; he is forced to rely on Mr. Strode's sense of calm reason.
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