Psychosomatic aspects of dentistry.
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Biomedical subjects
Publications and source records attributed to F K Judd.
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The DSM-III divides anxiety disorders into two broad categories, Phobic Disorders and Anxiety States. Anxiety states characterised by panic attacks have been separated from generalised anxiety disorders. While this classification may not be generally accepted it is of heuristic value. Delineation of panic disorder as a distinct diagnostic entity has led to renewed efforts to identify a biological cause for the sudden severe somatic and psychological symptoms experienced by these patients. A review of evidence for the involvement of the major neurotransmitter systems is presented. Systematic investigations in DSM-III defined groups of patients are only beginning to be reported. It is difficult as yet to draw any definite conclusions, but some tentative evidence for abnormalities of the noradrenergic system and the GABA-benzodiazepine chloride ionophore receptor complex are emerging. The reliable induction of panic attacks by chemical agents provides the promise of a greater understanding of the possible biological mechanisms involved in this anxiety disorder.
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We report a case of schizophreniform illness, which occurred after the withdrawal of steroid therapy. Despite the withdrawal of steroids, the patient's illness persisted and she required symptomatic treatment with phenothiazines and electroconvulsive therapy. The specific role of steroids in the causation of these illnesses is not clear, and may have implications for the aetiology of schizophrenia. Cases such as this have been reported only rarely in the literature.
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Platelet serotonin uptake was measured in 45 patients (12 males, 33 females) with panic attacks and 21 controls (9 males, 12 females). Higher Vmax values were obtained in the patient group than in the controls (100.2 +/- 11.5 vs. 34.9 +/- 3.8 pmol/10(8) platelets/min; P less than 0.0005) while the affinity constant Km was not significantly different (2.28 +/- 0.3 vs. 1.71 +/- 0.18 microM). A value of Vmax in excess of 60 pmol/10(8) platelets/min was observed in 60% of patients and in only 5% of controls. The results point to a specific abnormality of platelet serotonin uptake in patients with panic attacks.
A kinetic analysis of platelet monoamine oxidase (MAO) was performed in 22 patients with panic disorder and 14 normal controls, using tyramine as a substrate. Patients and controls did not differ significantly for either Km or Vmax, when same sex contrasts were carried out. The results do not support some studies that have shown elevated MAO activity in patients with panic attacks. The reasons for the discrepancies between previous studies and the present one are explored.
Platelet serotonin uptake and 3H-imipramine binding were measured in eight patients with panic disorders and nine controls. The Vmax of serotonin uptake was significantly elevated in patients compared to controls (77 +/- 14 vs. 50 +/- 4 pmol/10(8) platelets/min; P less than 0.05) while Km values were not different (1.46 +/- 0.41 vs. 1.24 +/- 0.20 microM). 3H-Imipramine binding to ruptured platelet membranes was not significantly different between patients and controls for either Bmax (395 +/- 71 vs. 412 +/- 107 fmol/mg protein) or Kd (0.90 +/- 0.18 vs. 1.09 +/- 0.30 nM). The implications for a serotonergic dysfunction in panic disorders are discussed.
Nine patients meeting the DSM-111 criteria for major depressive episode were identified among 84 consecutive admissions to the Spinal Injuries Unit of the Austin Hospital. All were successfully treated with antidepressants. The means of recognition of depression, the differentiation of a depressive illness from grief and the implications for rehabilitation are discussed.