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Biomedical subjects

D Raft

Publications and source records attributed to D Raft.

At least 19 recordsLinked to original sources
PubMed1991

The detection of depression by patient self-report in women with gynecologic cancer.

We examined the utility of patient self-report forms in identifying those gynecologic oncology patients who would be diagnosed by an experienced consultation-liaison psychiatrist as suffering from major depression. Sixty-five women with gynecologic tumors were evaluated by a consultation-liaison psychiatrist, using standardized (DSM-III) criteria. Each patient also completed a Carroll Rating Scale for Depression (CRS). The CRS demonstrated sensitivity and specificity of 87 percent and 58 percent, respectively. Used as a screening instrument to rule out depression, the CRS yielded a negative predictive value of 94 percent. We identified a priori forty items from the CRS which should not be influenced by the non-psychiatric biologic effects of gynecologic tumors, and compared the performance of this non-cancer related symptoms subscale (NCSG) to that of the CRS. The NCSG did not significantly outperform the CRS; its sensitivity and specificity were 87 percent and 62 percent, respectively. Because our study population was relatively homogeneous (i.e., non-ovarian gynecologic oncology patients without severe debilitation who were not receiving chemotherapy, radiation therapy, or other invasive procedures), the findings should not be generalized to other oncologic populations at this time. Our results suggest that patient self-report forms can be effective screening devices for identifying those non-ovarian, gynecologic oncology patients who should then be carefully evaluated for coexisting clinical depression.

Adult↗
PubMed1987

An outpatient evaluation of phenelzine and imipramine.

Phenelzine and imipramine were evaluated in a 5-week double-blind study of outpatients with major depression. Median daily doses of phenelzine 75 mg and imipramine 150 mg were employed. Of 27 patients 26 completed the 5-week study. Both drugs produced an equal overall effect, as measured by the Hamilton Rating Scale for Depression (HAM-D) and the Beck Depression Inventory (BDI). When patients were grouped on the basis of panic attack symptoms, phenelzine was found to be more effective than imipramine (p less than .05 for all patients on the BDI; p less than .05 for women on both rating scales).

Adult↗
PubMed1986

Selection of imagery in the relief of chronic and acute clinical pain.

This study examined the effects of pleasant imagery and type of pleasant imagery on the relief of acute and chronic pain. Two images were used in alternation, both selected from five images generated by the patient. The first image was the one most preferred by the patient; the second was the one determined by the experimenter to represent the most successful mastery of developmental stages according to the schemata outlined by Erickson (International Encyclopedia of Social Sciences, Vol. 9, McMillan, 1968). It was hypothesized that an image associated with successful phases of life would be less likely to provoke anxiety disruptive of the relaxation procedure and thus be more effective in the relief of pain. Both images were successful in reducing reported pain relief over a three-day period, but as predicted, the developmentally-selected image was more effective. The general effectiveness of these images held only for patients with acute pain.

Acute Disease↗
PubMed1986

An assessment of the Newcastle Anxiety Depression Index.

The Newcastle Anxiety and Depression Diagnostic Index (NADDI) has been reviewed, and its advantages and disadvantages discussed. One hundred eighty-seven patients were examined, and grouped into three categories by means of the NADDI, which produced a unimodal distribution of score. These three groups were studied in respect of the Hamilton Depression and SCL-90 self-rating scales. Significant profile differences were found on both scales. Patients with pure anxiety and pure depression were more distressed than the intermediate group of mixed anxiety-depressed patients. The NADDI scale items were compared in four clinical groups of primary endogenous, primary nonendogenous depression, generalized anxiety, and panic disorder. Most differences were found when panic disorder was compared to the other three groups, and generalized anxiety disorder received minimal validation. Treatment response was also examined.

Adult↗
PubMed1986

Depression in women treated for gynecological cancer: clinical and neuroendocrine assessment.

To determine the prevalence of major depression in cancer patients and assess the usefulness of the dexamethasone suppression test (DST) and the thyrotropin-releasing hormone (TRH) stimulation test for diagnosing major depression in these patients, the authors studied 83 women hospitalized for gynecological cancer. Nineteen (23%) had major depression according to DSM-III criteria. The sensitivity and specificity of the DST were 40% and 88%, respectively. No relationship between DST and TRH test results was found. These findings indicate a high prevalence of depression in cancer patients, but further research on these tests in cancer patients is needed; their routine use with cancer patients is premature at this time.

Adult↗
PubMed1986

Psychotropic prescribing patterns of nonpsychiatric residents in a general hospital in 1973 and 1982.

The findings of a study of the frequency and type of psychotropic drugs that nonpsychiatric residents prescribed for nonpsychiatric patients in a teaching hospital in 1982 were compared with the findings of a similar study in the same hospital nine years earlier. The overall percentage of patients receiving psychotropic drugs remained almost the same, at less than 10 percent. However, in 1982 residents prescribed antidepressants almost four times as often as in 1973, and the use of antianxiety agents decreased. Deficiencies in chart documentation of psychotropic prescribing and the tendency to use conservative dosages remained unchanged from the earlier study.

Anti-Anxiety Agents↗
PubMed1985

Life adaptation after percutaneous transluminal coronary angioplasty and coronary artery bypass grafting.

Life adaptation of 32 patients who had undergone percutaneous transluminal coronary angioplasty (PTCA) for coronary stenosis was compared with that of 15 patients who had coronary artery bypass grafting (CABG). Patients were matched for psychosocial, anatomic and cardiac functions. Life adaptation was measured at 6 and 15 months after PTCA or CABG by the Psychosocial Adjustment to Illness Scale (PAIS), a multidimensional instrument that evaluates change in 7 primary life domains. The overall PAIS scores for patients who had undergone PTCA were significantly better (p less than 0.04) than the scores for those who had undergone CABG after 6 months, and this superior functioning continued after 15 months (p less than 0.05). After 6 months patients who had undergone PTCA functioned better at work (p less than 0.005), in sexual performance (p less than 0.0001) and with their families (p less than 0.002). The improvement in work functioning continued at 15 months (p less than 0.04), but the differences in sexual and family domains became nonsignificant.

Adaptation, Psychological↗
PubMed1984

Use of phenelzine in continuation therapy.

In 18 depressed patients, phenelzine had proved to be a beneficial drug during treatment of the acute illness. Following 4 weeks' remission induced by either 45 or 60 mg/day, patients were assigned to take part in a double-blind study in which the dose either remained fixed at the original dose, or was decreased by 15 mg/month and eventually replaced by placebo. 15 patients completed the study. Patients who remained at the same dose did significantly better on measures of anxiety and depression. The dropout rate ('relapse' rate) also differed significantly between the two dose groups. It is concluded that in this group of patients, maintenance of the full dose of phenelzine is recommended for at least 6 months.

Depressive Disorder↗
PubMed1981

MAO inhibition and control of anxiety following amitriptyline therapy. A pilot study.

In a pilot study, 32 patients with mixed states of anxiety, depression, somatization and panic received amitriptyline for 4 weeks, the dose ranging from 50 to 300 mg/day. Steady-state plasma levels of the drug and activity of platelet monoamine oxidase were measured after 4 weeks. Clinical change was rated, using the SCL-90. Amitriptyline produced a small but significant inhibition of platelet monoamine oxidase activity (range 1.4--82%). A significant positive correlation was noted between MAO inhibition and improvement on somatization, and psychological and panic-phobic components of anxiety, but not for depression. No significant correlations were observed between improvement and combined or separate ami- + nortriptyline plasma levels.

Adult↗
PubMed1981

Relationship between response to phenelzine and MAO inhibition in a clinical trial of phenelzine, amitriptyline and placebo.

This report examines the hypothesis that for phenelzine to be more effective than placebo it is necessary to achieve at least 80% inhibition of platelet MAO activity. This hypothesis was examined in the context of a double-blind comparison of phenelzine, amitriptyline and placebo in depressed patients. When phenelzine became significantly more effective than placebo at 4 weeks, the average MAO inhibition was 85%. By the 5th week, with MAO inhibition greater than 90%, phenelzine was significantly more effective than amitriptyline. A highly significant correlation was noted between improvement and MAO inhibition within the phenelzine group.

Amitriptyline↗
PubMed1980

Psychosocial outcome after coronary artery surgery.

To describe psychosocial adaptation after coronary artery surgery and to identify preoperative factors associated with good outcome, the authors interviewed 30 patients before and 1--2 years after surgery. Despite good physiologic outcome (as measured by treadmill and cardiac function) this sample was found to be functioning poorly. Eighty-three percent were unemployed, and 57% were sexually impaired. A preoperative duration of symptoms of eight months or more was associated with significantly worse postoperative overall adaptation. Most patients who had suffered angina eight months or longer evidenced a damaged self-concept, which was reinforced rather than repaired by the experience of surgery.

Angina Pectoris↗
PubMed1979

Single case study. Complementary effects of phenelzine and psychotherapy in long term treatment of depression.

A case report is described wherein the monoamine oxidase inhibitor phenelzine was administered for 10 months at different doses. Drug treatment in the initial part of the study was double blind. Weekly psychotherapy was instituted at the point of symptomatic recovery. At a reduced dose, in month 3, the patient experienced a relapse in depression. While platelet monoamine oxidase inhibition was greater than 80 per cent the patient was well, but at the point of relapse, inhibition was 14 per cent. Clinical ratings at relapse (Beck and SCL-90 scales) revealed greater readiness by the patient to report psychological discomfort compared with the original interview. The combined effects of psychotherapy and pharmacotherapy were felt to be responsible for this change. However, psychotherapy in this form and duration did not prevent relapse, which depended upon maintaining an adequate dose of phenelzine.

Adult↗
PubMed1979

Behavior modification and haloperidol in chronic facial pain.

Neuralgiform pain and migrainous pain, both of which are amenable to drug therapy, comprise a relatively small percentage of the group of patients with facial pain who come to the practitioner's office. The largest group of facial pain patients are those with myofascial connective tissue disorders. A second group includes patients with neuropathic pain due to trauma such as oral surgery. A third group is made up of those without any identifiable focus of pain in the extracranial tissue. In these three nonneuralgiform and nonmigrainous groups, it is thought that personality factors affecting psychophysiologic mechanisms are of great importance. These patients are generally difficult to treat. A variety of modalities of therapy, such as behavior modification, hypnosis, and biofeedback, has been reported as helpful in some of these patients. In this report we focus on 12 subjects who failed with all these forms of therapy. We found that they responded to relaxation therapy (after Jacobson) along with haloperidol. We describe further characteristics of these patients and details of our method of treatment.

Chronic Disease↗