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Biomedical subjects

D Healy

Publications and source records attributed to D Healy.

At least 55 records · Page 3Linked to original sources

The meaning and management of neuroleptic medication: a study of patients with a diagnosis of schizophrenia.

The meaning of medication and the way in which people use medicines has been the focus of a number of studies in recent years. However, there has been little attention directed to the meaning and management of neuroleptic medication by people who have received a diagnosis of schizophrenia. This topic is highly relevant to policy because of the central role given to neuroleptics in contemporary mental health and community care services. Using data from in-depth interviews with people with a diagnosis of schizophrenia we explore patients reasons for taking neuroleptics and the ways in which patients self-regulate their medication. The data suggest that the main utility of taking neuroleptic medication is to control specific symptoms and to gain personal control over managing symptoms. The costs of taking medication were side-effects which at times equalised or outweighed the positive gains of the neuroleptic medication. Patient accounts suggest that everyday medication practices are to a significant degree related to a policy context which stresses the need to survey and control the behaviour of people living in the community and the wider meaning and symbolic significance that schizophrenia has for patients in their everyday lives. For this reason, self regulatory action in this group of patients tends to be less evident and the threat of external social control greater than patients taking medication for other chronic conditions. The findings suggest the need to develop a collaborative patient-centred model of medication management for patients diagnosed with schizophrenia.

Adaptation, Psychological↗

The meaning of patient satisfaction: an explanation of high reported levels.

The social policy background to the proliferation of patient satisfaction surveys is a desire for increased patient representation and participation. Within this context, it is assumed that satisfaction surveys embody patients' evaluations of services. However, as most surveys report high satisfaction levels, the interpretation of satisfaction as the outcome of an active evaluation has been called into question. The aim of this study is to identify whether and how service users evaluate services. This was made possible through unstructured in-depth interviews with users of mental health services and through more structured discussion around their responses on a patient satisfaction questionnaire (CSQ 18B) whose psychometric properties has been well documented. Twenty-nine people with current or recent contact with mental health services within the British National Health Service were interviewed. The data revealed that service users frequently described their experiences in positive or negative terms. However, the process by which these experiences were transformed into "evaluations" of the service was complex. Consequently, many expressions of "satisfaction" on the CSQ 18B hid a variety of reported negative experiences. An explanation for this lack of correspondence is outlined.

Bias↗

A casemix cost comparison of 2 treatments for ectopic pregnancy.

In this paper a retrospective cost comparison between laparoscopic treatment of ectopic pregnancy and conventional laparotomy under casemix funding has been performed. The total mean cost of laparoscopic treatment was $2,930 while the total mean cost of laparotomy was $4,259 per patient.

Australia↗

Efficacy of exogenous recombinant murine leptin in lean and obese 10- to 12-mo-old female CD-1 mice.

Leptin efficacy was compared in obese and lean female CD-1 mice. Body weights in these 10- to 12-mo-old mice ranged from 29.7 to 62.0 g, and leptin levels correlated with body weight. Mice from the lean and obese ends of the weight distribution were treated with daily peripheral leptin injections (1-100 mg/kg) for a 33-day period. The half-maximal effective doses for weight loss and fat reduction were shifted 0.5-0.7 log to the right for obese mice. Leptin was less efficacious at low doses (1-3 mg/kg) in obese mice but equal to or more efficacious in obese than lean mice at high doses (30-100 mg/kg). Leptin's initial effects on weight loss could be explained by appetite suppression in both groups, but its effects on fat reduction were greater in leptin-treated than pair-fed mice, particularly in the lean group. Leptin also prevented the elevations in serum corticosterone and ketones found in pair-fed lean mice. These data allow a quantitative comparison of leptin sensitivity in obese vs. lean CD-1 mice and suggest that in mice where obesity is a function of outbreeding and age, leptin sensitivity is moderately reduced. Furthermore, although appetite suppression has a clear role in leptin's effects on body weight, leptin may also have specific effects on lipid metabolism and mobilization that are different from the metabolic compensations that normally occur with food deprivation.

Adipose Tissue↗

Neuroleptic discontinuation syndromes.

The existence of discontinuation syndromes following treatment with neuroleptic (antipsychotic) drugs was first outlined in the mid-1960s but the effects of such syndromes have been neglected since then. We have pursued evidence for the existence and nature of discontinuation syndromes following neuroleptics through reports of difficulties following the use of dopamine blocking anti-emetics, the use of chlorpromazine to treat tuberculosis, the use of antidepressant-neuroleptic combinations in affective disorders, the occurrence of tardive syndromes and studies designed to establish the existence of discontinuation syndromes in schizophrenia. Combined these bodies of data point strongly to the existence of discontinuation syndromes after cessation of treatment with neuroleptics which may involve features other than motor dyskinesias. There is at present little evidence on the relative frequency of such syndromes or predisposing factors. The area needs research input to establish the nature of the syndromes that may result, their frequency, predisposing factors and best methods of treatment.

Antiemetics↗

Reserpine exhumed.

Explore the source record for details and available documents.

Akathisia, Drug-Induced↗

Maternal, umbilical, and amniotic fluid concentrations of tryptophan and kynurenine after labor or cesarean section.

A major route of tryptophan metabolism is via the hepatic and cerebral synthesis of kynurenine, a substance subsequently used by astrocytes in the brain for the production of the neuroactive substances kynurenic acid and quinolinic acid. Both kynurenic and quinolinic acids have been implicated in modulating the activity of excitatory amino acid pathways in the brain, the former as a neuroprotectant because of its antagonist properties, and the latter as an excitotoxin because of its agonist actions, at NMDA receptors. We therefore determined the concentrations of tryptophan and kynurenine in maternal venous and umbilical cord blood, and in amniotic fluid, of infants after labor and vaginal delivery, and after delivery by cesarean section. Concentrations of tryptophan and kynurenine were significantly higher in umbilical vein plasma compared with maternal venous plasma. Tryptophan and kynurenine concentrations in umbilical vein plasma and amniotic fluid were significantly higher after labor, compared with samples obtained from infants of the same gestational age delivered by cesarean section. There was no umbilical vein-to-artery concentration difference for kynurenine in samples obtained after either labor or cesarean section, but there was a significant gradient for tryptophan in samples obtained after vaginal delivery, indicating increased transfer of this amino acid during labor. There was a significant correlation between umbilical vein tryptophan and kynurenine concentrations for both the labor and cesarean section groups, and plasma kynurenine concentrations were also significantly correlated with both umbilical vein cortisol concentrations and the duration of the second stage of labor in the vaginally delivered infants. These results suggest that the placental transfer of tryptophan and the fetal synthesis of kynurenine are increased during labor. These findings have implications for understanding the vulnerability of the infant brain to ischemic/hypoxic damage in the perinatal period. By analogy with the adult brain, the molar ratio of these substances is likely to determine the susceptibility of the brain to seizure and excitotoxic damage.

Adult↗

Analysis of the importance of controllable versus uncontrollable stress on subsequent behavioral and physiological functioning.

Original observations of the effects of stress exposure on behavioral, physiological and pathological indices were documented in the mid 1960s [J.B. Overmier, Interference with avoidance behavior: failure to avoid traumatic shock, J. Exp. Psychol. 78 (1968) 340-343 [12]; J.B. Overmier, M.E.P. Seligman, Effects of inescapable shock upon subsequent escape and avoidance learning, J. Comp. Physiol. Psychol. 63 (1967) 28-33 [13]; M.E.P. Seligman, S.F. Maier, Failure to escape traumatic shock, J. Exp. Psychol. 74 (1967) 1-9 [15]; J.M. Weiss, Effects of coping responses on stress, J. Comp. Physiol. Psychol. 65 (1968) 251-260 [18]]. Studies employing the triadic design (e.g. escapable stress, yoked-inescapable stress and no stress) indicated that the deficits following stress exposure were not caused by stress per se, rather the uncontrollability of the stress was the critical determinant. In this paradigm, the first group (escape) receives exposure to an environmental event that it can "control" by performing a behavioral response. Stress control or coping behavior includes the ability to alter the onset, duration, intensity or pattern of an aversive experience [S.F. Maier, M.E.P. Seligman, Learned helplessness: theory and evidence, J. Exp. Psychol.: Gen. 105 (1976) 3-46 [10]]. The second group is "yoked" to its escape partner and receives the identical physical stressor as its escape counterpart, but there is no behavioral response that the yoked subject can make to alter the outcome. The third group (naive) receives no stress exposure and is either restrained in the experimental apparatus or remains in the home cage until subsequent testing. Researchers using this triadic design should be aware of the concerns of certain investigators [R.M. Church, Systematic effect of random error in the yoked control design, Psychol. Bull. 62 (1964) 122-131 [3]; E.A. Wasserman, Response bias in the yoked control procedure, Behav. Brain Sci. 11 (1988) 477-478 [17]] who have raised important issues about the validity of the yoked control design because of the possibility of systematic biases. For example, individual differences in stress reactivity may result in random error in the yoked control group. This point will be addressed further in Section 5. This procedure allows the investigator to analyze the contributions of the importance of psychological dynamics of stress on a variety of dependent measures including: behavioral, pharmacological, neurochemical and immunological indices.

Animals↗

Low intraovarian vascular resistance: a marker for severe ovarian hyperstimulation syndrome.

OBJECTIVE: To assess intraovarian blood flow in relation to the severity of ovarian hyperstimulation syndrome (OHSS) after controlled ovarian hyperstimulation. DESIGN: A prospective study. SETTING: Monash IVF, Clayton, Victoria, Australia. PATIENT(S): Thirty patients with OHSS after embryo or gamete transfer who also had sonographic evidence of ascites. MAIN OUTCOME MEASURE(S): The resistance to blood flow within the ovaries of 11 patients with severe OHSS and 19 patients with mild OHSS was measured by using transabdominal ultrasonography with color flow and pulsed Doppler imaging. RESULT(S): The pulsatility index (PI), resistance index (RI), and the S-D ratio, all measures of downstream vascular impedance, were significantly lower in those patients with severe OHSS. In cases with RI < 0.48, more than two thirds of the patients had a pleural effusion, whereas patients with either PI < 0.75 or S-D < 1.92 had pleural effusion in over one half of the cases. It was notable that blood flow velocity did not differ significantly between the two groups despite the changes in vascular impedance. CONCLUSION(S): There appears to be a close correlation between the severity of OHSS and the resistance to blood flow within the stimulated ovaries. Measurement of intraovarian vascular resistance before gamete transfer or ET in patients undergoing controlled ovarian hyperstimulation may help in predicting those patients at particular risk of developing severe OHSS.

Adult↗

Short-term immobilization-induced cancellous bone loss is limited to regions undergoing high turnover and/or modeling in mature rats.

Estrogen and calcium deficiencies increase both bone resorption and formation, whereas immobilization mainly decreases bone formation. How these functionally different risk factors for bone loss interact in cancellous bone undergoing modeling or remodeling activity is not well understood. Mature (6-month-old) female rats were subjected to sham operation (sham), ovariectomy (ovx), dietary calcium deficiency (LoCa, 0.1% Ca), and sciatic and femoral denervation (IM), ovx+IM, or LoCa+IM for 4 weeks. The primary spongiosa, the region of active modeling within 1 mm of the growth plate, in ovx, LoCa, and IM groups showed a decrease in cancellous bone volume, trabecular number, and connectivity when compared to sham controls. Groups combining two risk factors exhibited additive changes when compared with single risk factor groups. In the secondary spongiosa, an area with little modeling activity, ovx and LoCa groups, as expected, lost bone. In contrast with the primary spongiosa, IM alone did not induce bone loss in the secondary spongiosa, and the groups with a combination of IM and ovx or IM and LoCa showed a greater bone loss than either ovx or LoCa alone. Ovx and LoCa groups showed increases in both bone formation rate and eroded surface in the secondary spongiosa, while IM groups showed a decrease in bone formation rate. Combining IM with either ovx or LoCa resulted in increased eroded surface. The effects on cortical bone were assessed at the tibio-fibular junction. A trend toward decreased percentage of cortical bone area and an increase in marrow cavity area were observed in the combined deficiency groups only. These changes were the result of a statistically significant increase in endosteal eroded surface in IM+ovx and IM+LoCa groups. Our results demonstrate that immobilization-induced bone loss is restricted to the primary spongiosa where most modeling events occur. However, the inhibitory effect of IM on bone formation in the secondary spongiosa is unmasked in remodeling sites when a high turnover state is provided by either estrogen or dietary calcium deficiency. These results suggest that the presence of a risk factor, such as immobilization, which in the short-term causes inhibition of bone formation, does not predispose the skeleton to rapid cancellous bone loss except when accompanied by modeling or high turnover.

Animals↗

Probabilistic reasoning in obsessive-compulsive and delusional disorders.

BACKGROUND: Delusional disorder (DD) and obsessive-compulsive disorder (OCD) have been investigated in previous studies using probabilistic reasoning paradigms and abnormalities in each group have been reported. No study to date has compared results between these groups. This study compares patients with these disorders with those who have both phenomena. METHODS: Thirty subjects with DD, 29 with OCD and 16 with obsessive and delusional features were compared with 30 normal controls in a study of probabilistic reasoning using two different computer-based tasks involving a Bayesian paradigm. RESULTS: Deluded subjects showed a 'jump to conclusions' reasoning style, but on a test that added a consequence to their choices did not differ from normals. OCD subjects deviated from Bayesian and control norms to a greater degree than did DD subjects. In subjects with mixed psychopathology, the presence of both phenomena appeared to 'normalize' these probability estimates. CONCLUSIONS: Our findings extend those of others but require cautious interpretation as to the role of probabilistic reasoning in the genesis of delusions or obsessions. Obsessionals in both the OCD and Mixed groups, showed substantial deviation from Bayesian norms, suggesting that obsessionality leads to a reasoning style that is less 'normal' than that of delusionals. Further work is required to investigate clinical correlates of these findings which provide modest support for the proposal that the combination of obsessions and delusions confers greater functional advantages than simply having delusions or obsessions.

Adult↗

Cumulative pregnancy rates in couples with anovulatory infertility compared with unexplained infertility in an ovulation induction programme.

Using a retrospective analysis, we compared cumulative pregnancy rates, early pregnancy failure rates and multiple pregnancy rates in couples with polycystic ovarian syndrome (PCOS) (n = 148), hypogonadotrophic or eugonadotrophic hypogonadism (n = 91) and unexplained infertility (n = 117), who were treated in an ovulation induction clinic between January 1991 and December 1995. The women were treated with either human menopausal gonadotrophin (HMG) or purified follicle stimulating hormone (FSH). The cumulative pregnancy rate (derived from life-table analysis) after four ovulatory treatment cycles was 70% in the PCOS group, 74% in the hypogonadism group and 38% in the unexplained infertility group. The cumulative pregnancy rate in the unexplained infertility group was significantly lower than the other groups (P < 0.001) but there was no significant difference between PCOS and hypogonadism using the log rank test. The early pregnancy failure rate was 25% in the PCOS group, 27% in the hypogonadism group and 26% in the unexplained infertility group (chi(2) = 0.132, not significant). The multiple pregnancy rate was 20% in the PCOS group, 30% in the hypogonadism group and 17% in the unexplained infertility group (chi(2) = 2.105, not significant). Treatment of anovulatory infertility using HMG or FSH is effective irrespective of the cause. Couples with unexplained infertility are less successfully treated using HMG: correction of unexplained infertility may involve more than simple correction of possible subtle ovulatory defects.

Adult↗

The enhancement of social functioning as a therapeutic principle in the management of depression.

It has long been considered that depression is a biochemical disorder resulting from dysfunction of monoamine systems in the brain and that antidepressants act upon these systems as 'magic bullets' to correct the lesion. An alternative hypothesis is that antidepressants act upon intact monoamine systems to produce functional changes that are not necessarily a reversal of the initial cause. If this is the case, one would expect that currently available classes of antidepressants would have overlapping spectra of therapeutic effects and that, while all may be effective in the majority of patients, some will be more useful according to individual needs. To date, the assessment of recovery from depression, using scales such as the Hamilton Rating Scale for Depression, has been physician centred. Such assessments leave open the possibility that patients may not have recovered in terms of their social adaptation and that, accordingly, the patients themselves and their relatives may not perceive them as having recovered. Findings of differences between antidepressants on the Social Adaptation Self-evaluation Scale highlight the importance of patient perception of treatment efficacy. These differences may indicate differences in efficacy not detected by conventional instruments, differences in tolerability, differences in the speed of onset of antidepressant activity, or differences in the behavioural profile produced by different classes of antidepressants.

Antidepressive Agents↗

Delusional phenomenology--dimensions of change.

Although the application of cognitive techniques to both the measurement and modification of delusional beliefs has recently been developed in more theoretical detail (e.g. Chadwick & Lowe, 1994, Behaviour Research and Therapy, 32, 355-367) there has not been an effort to examine the variability of delusional phenomenology across time. In the present study we report on the treatment of 6 individuals who fulfilled DSM-III-R (American Psychiatric Association, 1987) criteria for Delusional Disorder and who received cognitive therapy targeted specifically on the single symptom of their delusional belief(s). Single-case time-series methodology was used to examine the associations between different aspects of delusional phenomenology through baseline and intervention study phases. Belief maintenance factors were found to be significantly associated with conviction in all 3 individuals who responded to the intervention. Negative behaviours, affect associated with the belief, preparedness to talk to others about the belief and insight were associated with conviction in some individuals but not others. Preoccupation and acting on the belief were aspects of delusional phenomenology that were found to systematically vary independent of belief conviction. The results support a multidimensional view of delusional phenomenology and the process of change during cognitive intervention.

Adult↗

Double-blind placebo controlled study: human biosynthetic growth hormone for assisted reproductive technology.

OBJECTIVE: To study whether the effect of cotreatment with human biosynthetic GH improves the outcome of poor IVF responders. DESIGN: A double-blind placebo-controlled study using a GnRH agonist (GnRH-a) and gonadotropin in a "boost" flare-up protocol for ovarian stimulation together with either placebo, 4, or 12 IU of human GH followed by oocyte retrieval and IVF-ET. PATIENTS: Twenty-two patients with previously demonstrated poor responses in at least two assisted reproductive technology cycles were recruited. INTERVENTIONS: Pretreatment and post-treatment blood samples and daily morning blood samples during ovarian stimulation were collected after an overnight fast. Human GH or placebo and GnRH-a were administered SC; gonadotropin was administered IM. Oocytes were collected by ultrasound-guided transvaginal aspiration of follicles. Embryos were cultured in vitro and transferred transcervically. MAIN OUTCOME MEASURES: Serum E2, FSH, GH, insulin-like growth factor-I (IGF-1), IGF binding protein 1 (IGFBP-1), and IGFBP-3 concentrations. Number of FSH ampules, follicles, oocytes, embryos, and pregnancies. RESULTS: No improvement in cycle outcome was demonstrated with daily adjuvant human GH administration with either 4 or 12 IU. Serum IGF-I levels were highest in the 12 IU human GH group and lowest in the placebo group. Serum IGFBP-3 levels increased 2 days after IGF-I levels in the 12 IU human GH group only. Serum IGFBP-1 levels were unchanged in all groups. CONCLUSION: Poor IVF responders do not benefit from cotreatment with human GH during their ovarian stimulation.

Adult↗

Interpersonal sensitivity predicts depressive symptom response to the circadian rhythm disruption of nightwork.

This paper reports the results of a study designed to explore the validity of a shiftwork model of affective disorders. Fifty-five student nurses doing nightwork for the first time were recruited to a study designed both to replicate an earlier study of the effects of nightwork on cognitive, emotional and neurovegetative measures and to assess the effects of nightwork on personality measures and the role of personality factors and nightwork induced disturbances in predicting accommodation to nightwork. As in the earlier study, concentration, interest, energy, sleep and appetite were significantly disturbed by nightwork and there was an increased perception of recent criticism from other. The findings from both studies were, therefore, aggregated to explore further possible relations between outcomes and the pre-nightwork level of affective symptoms and sensitivity to interpersonal criticism. These predicted poor response. In contrast, measures of cognitive style and symptom interpretation did not predict outcome. The findings are not inconsistent with proposals that disturbance of circadian rhythms consequent on psychosocial disruptions may play a part in the genesis of or maintenance of depression. They also support a proposal that nightwork induced changes may be a suitable human model for investigation of aspects of the affective disorders.

Adult↗