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Biomedical subjects

B K Toone

Publications and source records attributed to B K Toone.

69 records · Page 4Linked to original sources

Psychoses of epilepsy: a radiological evaluation.

Computerized axial tomography (CAT) scanning was carried out on 57 patients who had received a hospital diagnosis of psychoses associated with epilepsy, and 78 epileptic patients with psychiatric illness other than epilepsy. Abnormal scans were reported in approximately half of the cases in both groups. An excess of left hemisphere abnormality was noted in the psychotic group, but this was not significant. These findings failed to provide firm support for the hypothesis that lateralized structural damage to the cerebral hemispheres plays a major part in determining the specific pattern of associated psychotic illness.

Adult↗

The psychoses of epilepsy and the functional psychoses: a clinical and phenomenological comparison.

Sixty-nine patients, each with a combined diagnosis of epilepsy and psychosis, were compared with 53 patients with a diagnosis of functional psychosis. The epileptic affective patients often lacked convincing psychotic features; ECT and lithium were rarely prescribed; only three showed evidence of bipolarity. The epileptic schizophrenic patients were judged to have the better premorbid personality; experienced more paranoid delusions and delusions of reference, and showed less catatonic features than the functional schizophrenic patients. The course of the epileptics' illness was more variable. The concept that the schizophrenia-like psychosis associated with epilepsy is a distinct nosological entity is supported, but not the suggestion of a relationship between affective psychosis and epilepsy.

Adult↗

Electrodermal activity in the affective disorders and schizophrenia.

Electrodermal activity was measured bilaterally at rest and during stimulation in 22 schizophrenic, 11 depressed and 12 anxiety state patients, and in 32 normal volunteers. No group showed a distinctive pattern of lateral asymmetry. The frequency of spontaneous fluctuation in electrodermal activity was greater in the anxiety state and schizophrenic groups and in those patients who reported auditory hallucination during recording. Few schizophrenic subjects failed to respond to visual stimulation but substantial minority failed to habituate. The implications of these findings are discussed.

Adolescent↗

Sex hormone changes in male epileptics.

Mean plasma levels of LH, FSH, PRL, and sex-hormone binding globulin (SHBG) were raised in twenty-seven epileptics on anticonvulsants compared with age matched controls. Sexual activity appeared to be reduced. Anticonvulsant therapy results in raised SHBG levels which may be associated with a lowered free testosterone level as indicated by raised LH levels and lowered sexual activity.

Adult↗

Psychiatrists' models of mental illness and their personal backgrounds.

Seventy-nine junior psychiatrists at the Maudsley Hospital answered 16 biographical questions and a 68-item questionnaire measuring attitudes to the psychoanalytical, biological, social, behavioural, and anti-medical models of mental illness. The psychoanalytical model was the most clearly defined and its adherents the most dogmatic, while those supporting the social model were the most eclectic. Sex, social class, education and political sympathy proved a poor guide to the orientation of the respondent. Individuals who had decided on a career in psychiatry before entering medical school were the most critical of the biological model. Biologically minded psychiatrists were older and, in contrast to Kreitman's findings, there was a shift from a psychoanalytical to a biological preference with increasing psychiatric experience. The importance of scientific attitudes in psychiatry was endorsed by biologically and behaviourally inclined psychiatrists but denigrated by supporters of the analytical approach. Adherents of the psychoanalytical model had as many academic qualifications as the biologically inclined, but had fewer publications and were less active in research. It appears that interest in psychoanalysis is antipathetic to the development of scientific attitudes conducive to research.

Age Factors↗

The effect of temporal lobe surgery on electrodermal activity: implications for an organic hypothesis in the aetiology of schizophrenia.

It has recently been suggested that the bilateral asymmetry of electrodermal activity (EDA) reported in schizophrenia may be related to unilateral temporal lobe dysfunction. To test this hypothesis, 3 aspects of EDA--skin conductance level (SCL), number of spontaneous fluctuations (SF), and skin conductance response (SCR)--were measured bilaterally in 10 patients who had undergone unilateral temporal lobectomy. No differences could be detected between the operated and non-operated sides within the patient group, nor between the patient and control groups. The implications of these findings are discussed.

Adult↗

Salivary secretion in the affective disorders and schizophrenia.

Salivary secretion was measured in 54 psychiatric patients comprising four diagnostic groups: schizophrenia, mania, depression and anxiety state. Detailed psychometric assessment was carried out at the time of measurement. Although salivary flow failed to show an association with either diagnostic category or mental state at the time of examination, it was positively correlated with a subjective rating of appetite. The implications of these findings are discussed.

Adult↗

Diagnostic accuracy in presenile dementia.

A follow-up study of patients diagnosed as suffering from presenile dementia has revealed a high incidence of erroneous diagnoses. Of 52 patients discharged from hospital with this diagnosis, information was obtained 5-15 years later on 51. Eighteen were alive and the diagnosis was rejected in 16 (31 per cent). Possible reasons for the mistaken diagnoses are discussed.

Aged↗

Status epilepticus. An uncommon hysterical conversion syndrome.

The distinction between hysterical and organically determined epileptic seizures may be more difficult than is sometimes supposed, and misdiagnosis can have dire consequences. Hysterical seizures may on occasions present as life-threatening crises requiring urgent and intensive treatment. Three such cases, each of which received the diagnosis of status epilepticus, are reported, and their management is discussed.

Adult↗

Psychomotor seizures, arterio-venous malformation and the olfactory reference syndrome. A case report.

A case history is reported of a 44-year-old man with a 6-year history of psychomotor seizures. For the past year he had described persistent olfactory hallucinations of an unpleasant nature which he referred to himself. In many respects these symptoms conform to the pattern observed in the olfactory reference syndrome, a recently described but apparently quite discrete psychiatric disorder; there were, however, certain atypical features. At a later stage unilateral anosmia was noted. Radiological examination then demonstrated an arterio-venous malformation in the right frontal lobe. The relationship between the malformation and the psychomotor seizures, and the implications that each has for the development of an olfactory reference syndrome are fully discussed.

Adult↗

Dichotic listening in psychotic patients.

Patients recently recovered from schizophrenic or manid-depressive psychoses showed larger ear difference scores than normal controls on a dichotic listening test, i.e. when asked to identify dissimilar words fed synchronously to the two ears. The possible significance of the finding is discussed, in relation both to hemispheric organization and to other aspects of cognitive activity which may underlie performance on the task.

Adult↗

Epileptic seizures induced by psychotropic drugs.

On the basis of information abstracted from case histories, 41 patients who had experienced epileptic seizures thought to be due either to treatment with psychiatric drugs or to withdrawal from sedative drugs were compared with a control group of patients. Those who had experienced seizures were more commonly first born and had a history of post-natal brain damage. During the week preceding the seizure there had been a marked increase in drug prescribing. The implications for drug management are discussed.

Adolescent↗

A study of predictive factors in depressive disorders of poor outcome.

A retrospective comparison was made between two groups, each consisting of 30 depressed patients, one in which the outcome following discharge had been good, the other where it had been poor. A previous psychiatric history, earlier admission for psychiatric illness, particularly for affective disorders and a poorer performance on routine intelligence tests were found in the poor prognosis group. In this group the duration of the index admission was longer and the condition of the patient was less improved at the time of discharge. Several symptom variables also discriminated between the groups. These findings are discussed.

Age Factors↗

Antiepileptic therapy, folate deficiency, and psychiatric morbidity: a general practice survey.

The effect of anticonvulsant drugs on folate metabolism and mental symptoms has been investigated extensively in hospital-based studies, but never before in the community or general practice setting. Blood count, serum vitamin B12, red blood cell (RBC), and serum folate were measured in a sample of 82 adult epileptic patients drawn from 5 group practices (14 general practitioners) in southeast London. All patients were receiving antiepileptic medication at the time of examination and were interviewed with a standardized measure of psychopathology. Serum folate values below the lower limit of the normal range (3-15 micrograms/L) were obtained in 9 (10.9%) subjects, and in 50 (60.9%) patients, serum folate concentrations were less than the mean (6.02 micrograms/L) for the whole sample. Macrocytosis was detected in 20 (24.3%) patients. RBC and serum folate levels were significantly correlated with one another, but not with vitamin B12 concentrations. Levels of RBC and serum folate were significantly lower in patients on polytherapy (n = 40) than in those on monotherapy (n = 42); the folate concentrations were also significantly lower in the group with psychiatric morbidity. The association between folate deficiency and affective morbidity was demonstrated for depression but not for anxiety. There was no relationship between serum vitamin B12 and psychiatric disturbance. These findings are discussed in the light of relevant literature regarding the mechanism of action of anticonvulsant drugs in folate depletion and the neuropsychiatric sequelae.

Adolescent↗