Biomedical subjects
G Andrews
Publications and source records attributed to G Andrews.
Onset sequencing of selected lip muscles in stutterers and nonstutterers.
The present study examined lip muscle activity during the speech production of stutterers and fluent speakers to provide information about the nature of stuttering blocks. Depressor Anguli Oris (DAO) and Depressor Labii Inferioris (DLI) were recorded, using hooked-wire electromyography (EMG), in 3 stutterers and 3 nonstutterers during productions of the words "peek", "puck", and "pack." EMG records indicated that nonstutterers activated DAO prior to DLI for production of the initial/p/. Stutterers frequently reversed this sequence of onset, particularly when they stuttered. Results are discussed in terms of mistiming versus anticipatory hypertension hypotheses about stuttering.
Anxiety disorders and neuroticism: are there genetic factors specific to panic?
Data from 2,903 adult same-sex twin pairs were analysed to investigate whether the genetic determinants of symptoms of panic are different from those underlying the neuroticism personality trait. Our results suggest that much of the genetic variation influencing the physical symptoms associated with panic is of the nonadditive type, perhaps due to dominance or epistasis. In both sexes these nonadditive genetic effects on physical symptoms influence the reporting of "feelings of panic". In males they also account for as much as half the genetic variance in neuroticism. The remainder is additive and also accounts for the balance of genetic variation in "feelings of panic". In females genetic variance in neuroticism is entirely additive but is not an important source of covariation with either panic symptom. Thus, symptoms of panic seem to be shaped in part by unique genetic influences which do not affect other anxiety symptoms. That a substantial part of the genetic variance in neuroticism in males may be due to the nonadditive effects on physical symptoms of panic may help to explain the rather low correlation between the genetic influences found to affect neuroticism in males and their counterparts in females.
Prediction of outcome after treatment for stuttering.
Predicting who will relapse after behavioural or dynamic psychotherapy is important. A search for variables likely to predict individuals at risk of relapse was conducted in two groups of successfully treated stutterers. The most powerful predictors were the attainment of three goals by the last day of treatment; namely, skill mastery as evidenced by no stuttering, normal attitudes to communication, and an internalisation of the locus of control. Of the subjects who achieved these three goals, 97% maintained their improved speech in the long term. No subject who failed to achieve any of these goals remained fluent, while those who achieved one or two goals had intermediate outcomes. No single goal was necessary and none alone was sufficient to maintain improvement. Both actual and perceived mastery over stuttering appear to be important if the long-term outcome is to be satisfactory.
The long-term outcome of depressive illness.
One hundred and forty-five patients with primary depressive illness admitted to a university hospital between 1966 and 1970 were followed up an average of 15 years later. Adequate data were obtained on 133 (92%) of the 145. During the follow-up period, 7% of the 133 had suicided, 12% had remained incapacitated by illness and only 20% had remained continuously well. Patients for whom the index admission was not their first were especially likely to be readmitted during the follow-up period. Patients with endogenous depression, none of whom developed schizophrenia during the follow-up period, were more likely to need readmission than patients with an index diagnosis of neurotic depression. In all other respects the prognosis for the two types of depression was the same, with considerable morbidity evident in both.
Cushing's syndrome in a woman with a left perihilar mass.
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The work of Australian psychiatrists, circa 1986.
A random sample of psychiatrists was asked to supply details about their last 20 patients. Sixty percent responded. The median patient in treatment was aged 36 and saw a psychiatrist in office practice once a month over a three year period. Forty-one percent of the patient case load suffered from a psychotic disorder, 39% from a neurosis, and 6% from a personality disorder. Marital problems, problems in living and drug or alcohol dependence were infrequent reasons for consultation. Two positive conclusions were drawn: that the case load reflected the morbidity in the community, and that the prognosis for patients with personality disorders was better than usually expected. There were two areas of concern that may need attention: that insight and group psychotherapy require substantial numbers of treatment hours, and that behavioural psychotherapy is rarely used for patients with neurotic conditions.
Behavior therapy and tricyclic medication in the treatment of obsessive-compulsive disorder: a quantitative review.
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Views of practicing psychiatrists on the treatment of anxiety and somatoform disorders.
Psychiatrists in Australia were asked to recommend treatments for several anxiety and somatoform disorders. In previous surveys they had agreed about the preferred treatments for schizophrenia and major affective disorder but not about treatments for "neurotic depression" or agoraphobia. In the present survey, no treatment was regarded as critical by a majority of psychiatrists for any of the five anxiety and somatoform disorders studied. The authors conclude that because neurotic disorders form an important part of the workload of psychiatrists, consensus procedures should be used to develop guidelines for treatment until the research literature can provide more adequate guidance.
Elderly patients after they leave hospital.
A follow-up survey was conducted of 125 patients, aged 75 years and over, who had been discharged from a general teaching hospital in western Sydney. Assessments were made of the patients' functional status, living arrangements, reliance on family care and use of health and community services in the three-month period after discharge. Results indicate that immediately after leaving hospital more patients were living with family or friends than were prior to hospitalization and there was a slight increase in the number of patients who were living in nursing homes. However, by three months after discharge, the living arrangements resembled the pattern of arrangements before the hospital admission. At three months after discharge from hospital, 66% of patients were fully independent with regard to basic activities of daily living such as bathing, dressing and eating, but only 34% of men and 17% of women were fully independent in broader activities such as shopping and meal preparation. By this stage, 88% of patients were in daily contact with family carers who were providing for many of their elderly relatives' needs. A consideration of the needs of carers upon admission to hospital of elderly patients and the provision of support services for carers after discharge should become high priorities in comprehensive geriatric care.
Does non-clinical decompression stress lead to brain damage in abalone divers?
Abalone divers are subject to considerable decompression stresses and could be at risk of progressive cognitive impairment. A sample of abalone divers was compared with a sample of fishermen, by means of a battery of neuropsychological tests. No evidence of cognitive impairment was found in the divers, in spite of evidence of their exposure to decompression stress. The implications for other professional divers and for recreational underwater divers who follow standard decompression protocols are reassuring.
The role of psychological intervention in the management of patients after myocardial infarction.
A review of the literature suggests that it is neither appropriate nor cost-effective to involve as a routine all patients who have suffered a myocardial infarction in a traditional outpatient rehabilitation programme where physical conditioning is the principal (or only) ingredient. However, there is evidence to show that psychological intervention programmes that provide short-term psychological support, health education and intervention in coronary risk behaviour influence favourably both physical and psychosocial outcome. The case is put forward for intervention, during the first few days of the patient's admission to hospital, with a treatment package that comprises health education and relaxation therapy. The need for further interventions such as counselling, behavioural therapy, and physical conditioning may be assessed, depending on the patient's response to the initial programme.
A survey of practising psychiatrists' views on the treatment of schizophrenia.
Practicing psychiatrists' views about the treatment of schizophrenia were investigated as part of a Quality Assurance Project. A questionnaire which asked for treatment recommendations for each of four case descriptions of patients with schizophrenia was mailed to a one-in-six random sample of Australian psychiatrists; 90% responded. Psychiatrists almost uniformly advocated the use of antipsychotic drugs and usually recommended concurrent supportive psychotherapy or family/social intervention procedures. The recommendations varied systematically, according to the initial history obtained and to the initial response to treatment.
A survey of practising psychiatrists' views on treatment of the depressions.
The views of practising psychiatrists on treatment of the depressions were investigated as part of a Quality Assurance Project. A one in six random sample of all Australian psychiatrists was mailed a questionnaire. This asked for treatment recommendations for each of five case descriptions of patients with depression. Respondents were asked to code their treatment plans from a glossary listing possible treatments for depression: 85% of the sample responded. Tricyclic antidepressants were the treatment of choice for two cases of endogenous depression, electroconvulsive therapy (ECT) being recommended when psychotic features were present or when drug therapy had failed. Psychotherapies were the treatment of choice for cases with neurotic features, drugs being recommended when improvement with psychotherapy did not occur.
The people seen by Sydney psychiatrists.
A one-in-six sample of psychiatrists practising in Sydney was asked to provide details of patients seen in the previous five working days. The averaged workload of the 49 psychiatrists showed that they spent a third of their time with patients with psychotic illnesses, a third with patients with neurotic conditions and most of the remainder on patients troubled by personality disorders. Sixty-one per cent of the patients were female and the median age of the patients was 39 years. Psychotherapy was the most commonly used primary treatment for the neuroses and personality disorders, but drugs were used most frequently for the psychoses.
Comparison of weight reduction with metoprolol in treatment of hypertension in young overweight patients.
Weight reduction was compared with metoprolol (200 mg daily) in a randomised placebo-controlled trial of first-line treatment of mild hypertension (diastolic blood pressure 90-109 mm Hg) in 56 overweight patients aged under 55 years. After 21 weeks of follow up the weight-reduction group had lost an average of 7.4 kg. The fall in their systolic pressure of 13 mm Hg was significantly greater than that in the placebo group (7 mm Hg) but not different from that in the metoprolol group (10 mm Hg). Their fall in diastolic pressure (10 mm Hg) was greater than that in both the metoprolol (6 mm Hg) and placebo (3 mm Hg) groups. At the end of the follow-up period 50% of patients in the weight-reduction group had a diastolic pressure of less than 90 mm Hg. In the metoprolol group there was a decrease in high density lipoprotein (HDL)-cholesterol and an increase in the ratio of total to HDL-cholesterol; in the weight-reduction group there was a decrease both in total cholesterol and in the ratio of total to HDL-cholesterol. Thus in this study population weight reduction produced significant and clinically important reductions in blood pressure but not the adverse effects on plasma lipids commonly associated with antihypertensive drug therapy.