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Biomedical subjects

C F Reynolds

Publications and source records attributed to C F Reynolds.

At least 343 records · Page 19Linked to original sources
PubMed1982

The dilemma of denial in the assessment of competency to refuse treatment.

To illustrate the dilemma in evaluating and treating patients who deny their illness, the authors present the case of a woman with paranoia who denied she was ill and refused medication. They focus specifically on the issue of whether a patient who denies his or her illness is truly legally competent to refuse or consent to treatment. They conclude that the assessment of such competency requires a consideration of the accuracy of the patient's "appreciation of the nature of his or her situation" and that safeguards have to be built into a system for evaluating competency along these lines to prevent abuse.

Adult↗
PubMed1981

A clinical and EEG sleep study in the differential diagnosis of pre-pubertal depression: state of the art.

The diagnosis of depression in childhood and adolescence remains problematic. We present an overview of the literature on the diagnosis of childhood and adolescent depression with particular reference to the potential utility of EEG sleep studies. A case of a pre-pubertal boy with depressive symptomatology is presented to illustrate some of the diagnosis difficulties and the application of EEG sleep studies in their resolution. The need for further systematic investigation of EEG sleep correlation of depression in childhood and adolescence is emphasized.

Adolescent↗
PubMed1981

Sleep disorders associated with upper airway obstruction in children.

Improved case identification of children with upper airway obstruction during sleep should result if physicians are aware of such signs and symptoms as excessive daytime sleepiness, loud snoring, restless sleep, recurrent nocturnal enuresis, systemic and pulmonary hypertension, undergrowth or obesity, and cor pulmonale. Furthermore, partial airway obstruction during wakefulness may be a risk factor for the development of sleep apneas or hypopneas. In suspected cases, polysomnography is a useful method for confirming and quantitating the type (central, obstructive, or mixed) and extent of ventilatory disturbance during sleep and its functional significance (such as arterial oxyhemoglobin desaturation or cardiac arrhythmia). Other methods may be employed to yield similar data. There seem to be at least two groups of children reported in the literature, those in whom there is a specific surgically correctable lesion (such as adenotonsillar hypertrophy) versus those who eventually need tracheotomy because of collapse of upper airway musculature during sleep. In the latter group of children, it is necessary to hypothesize an additional defect in the CNS regulation of respiration during sleep. Further research is necessary to define the boundary between normal and abnormal breathing during sleep, and to understand more thoroughly the effects of intermittent hypoventilation on daytime functioning.

Airway Obstruction↗
PubMed1981

Diagnostic classification of sleep disorders: implications for psychiatric practice.

We have applied a diagnostic classification of sleep and arousal disorders (Association of Sleep Disorders Centers - ASDC) to a group of 174 patients in order to assess its usefulness. In our population, there were over twice as many disorders of initiating and maintaining sleep (DIMS) as there were disorders of excessive sleepiness (DOES). We found that 68.1% of diagnoses in DIMS were psychiatric (particularly affective disorders) and that 37.8% of diagnoses in DOES were either sleep apnea or narcolepsycataplexy. Furthermore, drug/alcohol abuse was much more strongly associated with DIMS, while medical disorders were more often found to be associated with DOES. Since only 58% of our sample could be adequately classified with one diagnosis, we expect that the ASDC nosology will need to evolve further. Nevertheless, the nosology should facilitate comparability and pooling of data across centers.

Adolescent↗
PubMed1980

Sleep disturbances in a series of elderly patients: polysomnographic findings.

A group of 27 elderly patients with complaints of either chronic insomnia or excessive daytime sleepiness were studied in the Sleep Evaluation Center of Western Psychiatric Institute and Clinic during the period January 1977-June 1979. On the basis of anamnestic data from patients and bedroom partners, together with polysomnographic findings, sleep disturbances were classified according to the nosology of the Association of Sleep Disorders Centers. Of the 27 patients, 19 had disorders of initiating or maintaining sleep (DIMS), 7 had disorders of excessive somnolence (DOES), and 1 had parasomnia (episodic nocturnal wandering). Of the 19 DIMS patients, two-thirds had either a primary affective disorder (depression) or a persistent psychophysiologic disturbance. Of the 7 DOES patients, 6 had a primary sleep disorder such as a sleep apnea syndrome or narcolepsy-cataplexy. Additional electroencephalographic sleep data are presented on elderly patients with primary nonpsychotic depression. The latency of rapid eye movements (REM) in the depressed patients was shorter (p less than 0.05) than in patients with a persistent psychophysiologic disturbance. The percentage of REM sleep was significantly elevated (p less than 0.05) in the depressed group, and intermittent wakefulness was decreased (p less than 0.01). The causes of sleep disturbance in the elderly are both heterogeneous and complex. The need for accurate differential diagnosis and a multiaxial approach is stressed.

Aged↗
PubMedDate not supplied

Effect of continuation treatment on residual symptoms in late-life depression: how well is "well"?

UNLABELLED: The objectives of this report were (1) to describe residual depressive symptoms in elderly patients during continuation therapy with combined nortriptyline and interpersonal psychotherapy; (2) to determine which symptoms were persistent; (3) to determine the clinical correlates of residual depressive symptoms; and (4) to document distinct response pattern clusters during combined continuation therapy. METHOD: Box plot analyses of Hamilton depression scores and Global Assessment Scale scores, repeated twice monthly over 4 months, were conducted using data from 105 elderly depressives. Temporal trends in the data were examined via random regression analysis. Individual trajectories for each of the 105 patients were examined for patterns of response during continuation therapy. RESULTS: We observed a low mean Hamilton rating of 7 (SD = 2.3) at the start of continuation therapy and 5 (SD = 3.0) at the end. Both Hamilton and GAS scores showed modest but significant improvement over time. Hamilton variability was most apparent in symptoms of mood lowering, apathy, anxiety (psychological and somatic), feelings of guilt, anergia, insomnia, and loss of libido; other symptoms (retardation, agitation, hypochondriasis, loss of appetite, loss of weight, suicidal ideation, and loss of insight) showed clear resolution. A diagnosis of RDC situational depression was associated with higher levels of residual symptoms, while level of chronic medical burden, personality dysfunction, and social support were not. Examination of response patterns showed that a quarter of patients experienced one or more brief symptomatic exacerbations. CONCLUSION: On average, an excellent level of symptom resolution was achieved for most patients with Hamilton scores comparable to those seen in healthy elderly controls. These data support a position of therapeutic optimism in late-life depression and underscore full remission as an achievable therapeutic goal.

Aged↗
PubMedDate not supplied

Electroencephalographic sleep in schizophrenia: a critical review.

Several polysomnographic abnormalities seem to occur consistently in schizophrenic patients: impaired sleep continuity and reduced total sleep, reduced amounts of slow wave sleep, and reduced rapid eye movement (REM) sleep latency and defective REM rebound following REM deprivation. None of these findings is specific for schizophrenia, and only a subgroup of schizophrenic patients seem to have these abnormalities. It appears that reduced slow wave sleep may be related to a neurodevelopmental disorder related to the defect state in schizophrenia. The pathophysiological significance of the defective REM rebound and the REM sleep abnormalities in schizophrenia remain uncertain. Carefully designed studies are needed to further characterize the sleep disturbance in schizophrenia and to study them in relation to other, known pathophysiological changes in this disorder.

Cerebral Cortex↗
PubMedDate not supplied

Childbearing in women with and without a history of affective disorder. I. Psychiatric symptomatology.

Psychiatric symptoms and morbidity were examined prospectively in 34 obstetrically healthy volunteers recruited early in pregnancy. All women were free of current psychiatric disorder. Fourteen women had a history of affective disorder, and 20 had no lifetime history of any psychiatric disorder. Symptoms were assessed using both clinician- and self-administered ratings at specified points from 12 weeks of gestation through 8 months' postpartum. All women reported mild symptom elevation during pregnancy and the early puerperium, regardless of psychiatric history. The most frequently endorsed symptoms in both groups were somatic. However, women with a history of affective disorder reported more psychic and somatic distress than women with no psychiatric history. Onset of a psychiatric disorder did not occur during pregnancy in this sample, and only one woman, with both a personal and family history of affective disorder, met criteria for a new episode postpartum. Brief periods of symptom elevation occurred postpartum for 14.7% of the sample (five women, two with and three without a personal history of affective disorder) in the context of additional life stressors combining with the stress of new motherhood. These findings suggest that the impact of childbearing alone on psychiatric symptoms and morbidity is modest among women who are psychiatrically healthy at pregnancy onset and have sound social support networks.

Adult↗
PubMedDate not supplied

Childbearing in women with and without a history of affective disorder. II. Electroencephalographic sleep.

Electroencephalographic (EEG) sleep was examined longitudinally in 34 obstetrically healthy volunteers recruited early in pregnancy. All women were free of current psychiatric disorder. Fourteen women had a personal history of affective disorder, and 20 had no history of any psychiatric disorder. EEG sleep was recorded in subjects' homes at specified points from 12 weeks' gestation through 8 months' postpartum to examine the impact of childbearing on sleep and psychiatric symptoms in women with a history of affective disorder. EEG sleep measurements, as well as clinical ratings of sleep, indicated that sleep disturbances were most pronounced over the first 2 to 3 months' postpartum and were characterized primarily by interrupted sleep. The obstetrical course of these women was uneventful, and the outcome with respect to affective disturbances was highly favorable. Nevertheless, childbearing was associated with greater changes in total sleep time and with rapid eye movement (REM) latency reduction in women with a history of affective disorder, even in the absence of clinically significant mood changes. Findings suggest that the sleep system of women with a history of affective disorder may be more sensitive to the psychobiological changes associated with childbearing, as evidenced by earlier onset of sleep disruption over the childbearing course and a reduction in REM latency in the final trimester that persisted throughout the eighth postpartum month.

Adult↗