Biomedical subjects
D Waxman
Publications and source records attributed to D Waxman.
Hospital phobia: a rapid desensitization technique.
The less disabling phobias do not normally present a problem in that the stimulus may be avoided. This would also apply to hospital phobia until an acute medical or surgical problem might arise, when avoidance could constitute a direct threat to life. Although phobic illness is a common problem the small number of cases of hospital phobia recorded may represent the tip of the iceberg beneath which could be many phobic patients who deny their symptoms and risk their health because of their irrational fear. A case of hopsital phobia in a pregnant patient with suspected disproportion was treated by a rapid desensitization technique using hypnosis. After five sessions of 30 min each, the patient was symptom free. This simple method of desensitization, if more widely known would considerably minimize the risk caused by concealment of the phobic problem.
The management of phobic disorders using clomipramine (Anafranil).
The problem of phobic anxiety is viewed in the context of the entire area of mental illness and of its epidemiology in the general population. The importance of the diagnosis of depression in phobic patients and its simultaneous treatment is emphasized. Psychotherapeutic and psychopharmacological methods are discussed and some results of recent trials of clomipramine (Anafranil) are reported. The author concludes that for the successful outcome of treatment an eclectic approach must be considered. The combination of behavioural techniques of desensitization along a hierarchy of anxiety-provoking situations, together with psychotherapeutic support and the simultaneous exhibition of the more specific antidepressant and antiphobic preparation clomipramine would offer the best hope of symptom relief.
The treatment of Depression comparing divided and single doses of maprotiline (Ludiomil).
A clinical trial of seventy-five patients suffering from depressive illness and treated with maprotiline (Ludiomil) is reported. Twenty-eight patients were given a single nightly dose of 75 mg and twenty-six patients were treated with 25 mg three times daily. Twenty-one patients withdrew from the trial. It was found that those patients on the nocte regime made greater improvement than those on the divided dosage. Sleep disturbances and mood swings were significantly improved on the nocte dosage. Both regimes were equally well tolerated. Special care was taken in recording any adverse drug effects in order to distinguish these from pre-existing symptoms of the illness.
A clinical trial of clomipramine and diazepam in the treatment of phobic and obsessional illness.
A double-blind comparative study of clomipramine and diazepam was carried out in patients suffering from phobic and obsessional disorders. Nineteen doctors submitted 58 patients. Seventeen patients withdrew from the trial, twelve because of side-effects. Forty-one patients completed the trial and of these 14 were on clomipramine and 27 were taking diazepam. Patients were assessed for phobias, obsessions, general psychiatric symptoms and side-effects and each was rated on a special symptom inventory at 0, 2, 4 and 6 weeks of treatment. A General Health Questionnaire and Burns Questionnaire was completed for each patient at the beginning and end of the study. General level of anxiety for diffuse phobic anxiety and situational anxiety for illness and death fears responded better to clomipramine than to diazepam. Global assessment showed significantly more progress on clomipramine than diazepam between weeks 4 and 6.
Hypnosis in the psychotherapy of neurotic illness.
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An investigation into the use of anafranil in phobic and obsessional disorders.
A multicentre clinical trial of clomipramine in the treatment of obsessional and phobic disorders in general practice is described. All phobias showed an improvement in situational anxiety, interference and autonomic side effects. With the exception of two cases of animal phobia there was also improvement in general anxiety and avoidance. Obsessional cases showed an overall improvement in all symptom areas.