Philosophic perspectives on access to health care: distributive justice in health care.
Explore the source record for details and available documents.
Costs and Cost Analysis↗
Biomedical subjects
A Buchanan
Publications and source records attributed to A Buchanan.
The investigation of acting on delusions as a tool for risk assessment in the mentally disordered.
Explore the source record for details and available documents.
Delusions↗
Light visor treatment for seasonal affective disorder: a multicenter study.
The effectiveness of light therapy in seasonal affective disorder (SAD) was evaluated in 105 subjects across five centers. Three intensities of light (60 lux, 600 lux, and 3500 lux) were used in a 2-week randomized, parallel design. There was no significant difference in antidepressant efficacy of the three intensities of light. All three intensities produced a similar frequency of antidepressant response to each other and to that reported in previous studies. There were site differences in the severity of depression during light treatment, but diagnosis and medication status did not affect antidepressant response. These findings suggest that light therapy has an antidepressant action by a nonspecific effect or that light is biologically active in the treatment of SAD across a wide range of intensities.
Adult↗
Acting on delusion: a review.
The paper reviews the link between delusional beliefs and behaviour. The literature pertaining to the link between normal beliefs and behaviour is briefly examined, emphasizing the predominance of psychological and philosophical contributions to the topic. The psychiatric literature describing actions consequent upon delusional beliefs is then reviewed. In conclusion, those aspects of psychosis, distinct from delusional beliefs themselves, which may affect the likelihood of a given belief being acted upon, are discussed.
Cognition Disorders↗
Side effects of light therapy in seasonal affective disorder.
The authors report the frequency of side effects of light therapy in 105 patients with seasonal affective disorder treated with three intensities of light. Common symptoms to emerge during treatment were headache (19%), eyestrain (17%), and feeling "wired" (14%). There was no relationship between side effects and intensity of light used.
Female↗
Acting on delusions. I: Prevalence.
Associations between delusions and abnormal behaviour were retrospectively assessed in a sample of 83 consecutively admitted deluded subjects. All were interviewed about events in the previous month using a new measure of delusional phenomenology and action. For 59 subjects this information was supplemented by informant interviews. Clinical consensus was reached concerning the probability that actions reported by informants were linked to delusions. Half of the sample reported that they had acted at least once in accordance with their delusions. Violent behaviour in response to delusions was uncommon. Information provided by informants suggested that some aspect of the actions of half of the sample was either probably or definitely congruent with the content of their delusions. However, there was no link between self-reports and informants' reports of such action. A latent class analysis of self-reported delusional action suggested three classes of action, namely aggressive to self or other, defensive action, and either none or single action. Self-reported action was associated with delusions of catastrophe. Informant data suggested that persecutory delusions were the most likely to be acted upon, but in contrast delusions of guilt or catastrophe appeared to decrease the chance of delusional behaviour. Actions associated with abnormal beliefs are more common than has been suggested.
Acting Out↗
Acting on delusions. II: The phenomenological correlates of acting on delusions.
The aim of the study was to identify the phenomenological characteristics of those delusions which are associated with action. The sample consisted of 79 patients admitted to a general psychiatric ward, each of whom described at least one delusional belief. The variables studied included the phenomenology of the delusions, and behaviour. Two behavioural ratings were used, one derived from the subjects' own description of their behaviour and the other from information provided by informants. There was no association between delusional phenomenology and acting on a delusion when the subjects' behaviour was described by informants. When action was described by the subjects themselves, acting was associated with: being aware of evidence which supported the belief and with having actively sought out such evidence; a tendency to reduce the conviction with which a belief was held when that belief was challenged; and with feeling sad, frightened or anxious as a consequence of the delusion.
Acting Out↗
Hypersomnia and morning light therapy for winter depression.
Explore the source record for details and available documents.
Adult↗
The effects of ultraviolet-A wavelengths in light therapy for seasonal depression.
Although light therapy is a recognized effective treatment for seasonal affective disorder (SAD), there has been little research into the critical wavelengths of light that produce the antidepressant effect. Previous studies found conflicting results for the importance of the ultraviolet (UV) spectrum in the therapeutic effect of light therapy. To assess the clinical effects of UV-A wavelengths (315-400 nm), we studied 33 depressed SAD patients diagnosed with structured interviews by DSM-IIIR criteria. Following a baseline week, patients underwent 2 weeks of 2500 lux light therapy for 2 h daily (06:00-08:00). Light therapy consisted of cool-white fluorescent light with the addition of a special UV-A fluorescent tube. Patients were randomized to wear glasses during light therapy that either blocked (UV-blocked condition) or passed (UV-A condition) wavelengths below 400 nm. Both treatments significantly reduced all depression ratings, but no differences were found between the UV-A and UV-blocked conditions. We conclude that the UV-A spectrum does not increase the antidepressant response of light therapy. Given the potential side effects of chronic UV exposure, clinical application of light therapy should use light sources that have the UV spectrum filtered.
Adult↗
Electroretinography in seasonal affective disorder.
Retinal mechanisms have been hypothesized in the pathophysiology of seasonal affective disorder (SAD). Electroretinography (ERG) is a noninvasive electrophysiologic test that provides an objective measure of photoreceptor and retinal function. We conducted dark-adapted ERG examinations with a bright white light stimulus in a group of depressed, drug-free patients with seasonal affective disorder (6 men, 18 women) diagnosed by DSM-III-R criteria, and a group of sex- and age-matched control subjects (6 men, 16 women) during the winter. A significant difference was found between SAD patients and controls, but female SAD patients had lower ERG b-wave amplitudes than female controls, while male SAD patients had higher amplitudes than the matched controls. The ERG b-wave implicit times (times from onset of stimulus to peak of b-wave) were significantly longer in the left eyes of the male control subjects. These data may indicate subtle retinal changes in patients with SAD, but the results must be considered preliminary because of the small number of subjects studied and the large intersubject variability in the ERG procedure.
Adult↗
A two-year prospective study of treatment compliance in patients with schizophrenia.
The study is a prospective investigation of the factors associated with treatment compliance in 61 patients discharged from hospital with a ward diagnosis of schizophrenia. All cases were classified using reliable diagnostic criteria and all were followed up for two years. Compliance was assessed by inspection of records and by analysis of urine. Sociodemographic factors and illness variables were unrelated to compliance. Some aspects of a patient's insight and attitude, namely, a belief that medication had helped during the admission, a stated willingness to take treatment after discharge and a generally optimistic outlook, were associated with improved compliance. Other variables which showed such an association were the absence of the drug side-effect akinesia, good previous compliance and voluntary, as opposed to compulsory, admission to hospital.
Adolescent↗
Attitude of the medical profession to psychiatry.
The attitude of the medical profession to psychiatry carries important implications for the quality of personnel attracted into the specialty and for the treatment, in a general medical setting, of patients with mental disorders. This article examines the components of doctors' attitudes and reviews the literature with regard to their attitudes to psychiatrists themselves, psychiatric patients and psychiatry as a vocation. The implications of these findings for psychiatrists are discussed.
Attitude of Health Personnel↗
Sleepwalking and indecent exposure.
Explore the source record for details and available documents.
Exhibitionism↗
The assessment of insight in psychosis.
An assessment schedule was used to determine the nature of insight in 91 mixed psychotic patients, and to examine its distribution and associations. While all the components of the schedule intercorrelated significantly, scores for compliance were only weakly related to those for ability to label psychotic phenomena as abnormal. Compliance and illness recognition were related to IQ. Total insight score was inversely correlated, moderately, with a global measure of psychopathology derived from the PSE, and was less in patients involuntarily committed. Age, sex, diagnosis, and the number of previous hospital admissions had little effect. The results support the notion that insight is not a unitary concept.
Adult↗
Strategic planning for tomorrow's success.
The changes that have occurred in the home care industry in the last few years have been immense. To be competitive agencies now must consider activities as broad ranging as forming mission statements and expanding services. Pharmacy services might be a first step to individual agency change.
Day Care, Medical↗
The 'longlong' population of Ialibu District, Southern Highlands Province, Papua New Guinea: contact with health services and care in the village.
The aim of the study was to describe the general behaviour, living arrangements and level of health services contact of the mentally ill population of a health district in Papua New Guinea. The immediate relatives of 31 'longlong' people living in Ialibu District were interviewed. About half of the mentally ill subjects were able to cook and look after a garden. Just over half had engaged in physical violence or stolen and one-fifth had been physically restrained. Almost all were living in their own village although not all were living with their own families. Just over half had had contact with health services and this contact had usually been brief and, in the relatives' eyes, unsatisfactory.
Activities of Daily Living↗
Low electrooculographic ratios in patients with seasonal affective disorder.
OBJECTIVE: Changes in retinal sensitivity to light have been hypothesized as etiological in seasonal affective disorder. This study was undertaken to investigate sensitivity to light in seasonal affective disorder using electrooculography (EOG), an objective measure of retinal light response. METHOD: In a mood disorders clinic, 19 depressed, drug-free patients with seasonal affective disorder, diagnosed by DSM-III-R criteria, were compared with 19 age- and sex-matched normal comparison subjects. All subjects had identical EOG testing performed during the winter. EOG (Arden) ratios were calculated from the EOG data. RESULTS According to multivariate analysis of variance, the EOG ratios in the patients with seasonal affective disorder were significantly lower than those of the normal comparison subjects, although there was considerable overlap in EOG ratios between patients and comparison subjects. CONCLUSIONS: These results suggest that seasonal affective disorder is associated with subtle retinal abnormalities at the level of the photoreceptor/retinal pigment epithelium complex, consistent with subsensitivity to light. A limitation of this study is that the retinal origins of the EOG response are nonspecific and still not completely elucidated.
Adult↗
Sleepwalking and indecent exposure.
The case is described of a naked sleepwalker who was convicted of indecent exposure. The literature relating to sleepwalking and indecent exposure is briefly reviewed and the legal position discussed. Sleepwalkers are seldom convicted of crimes which they commit while asleep. In recent years a successful defence has usually been mounted on the basis that sleepwalking is, in legal terms, an automatism. Occasionally, however, sleepwalkers are convicted and this report illustrates one such case.
Adult↗