Biomedical subjects
G B Murray
Publications and source records attributed to G B Murray.
On panic attacks and neurologic problems.
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Electroconvulsive therapy for poststroke depression.
Of the 193 patients with stroke and depression treated at Massachusetts General Hospital from 1969 to 1981, 14 had electroconvulsive therapy (ECT) for poststroke depression. Among these 14 patients, depression developed less than 1 year after stroke in 9 and more than 1 year after stroke in 5. Except for 2 of the patients in whom depression developed within a year, all had marked improvement in depression after ECT. A transitory cardiac arrhythmia developed in 1 patient, but none of the patients had an exacerbation of stroke or a worsening of neurologic status. These findings indicate that ECT is safe and effective for poststroke depression.
Psychostimulant treatment of depressive disorders secondary to medical illness.
Hospital charts were reviewed for 66 medical and surgical patients who received dextroamphetamine or methylphenidate to treat a depressive disorder. Approximately three-fourths showed some improvement; in half of the sample, improvement was marked or moderate. Of those who improved, 93% reached their peak response within the first 2 days. Relapse occurred in only 5 patients. Side effects were minimal. Nonsignificant trends suggested that dextroamphetamine was more effective for major depression than adjustment disorder, while methylphenidate tended to be more effective for adjustment disorder. Psychostimulants appear to be a therapeutic option in the medically ill depressed population and may be more rapidly effective with fewer side effects than tricyclic antidepressants.
Complex partial seizures associated with Waldenstrom's macroglobulinemia.
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Clorazepate in the treatment of complex partial seizures with psychic symptomatology.
Clorazepate frequently can control symptoms in complex partial seizure disorders with psychic symptomatology at dosages less than those recommended for its use as an adjunctive anticonvulsant. Four case examples illustrate this use. These beneficial effects may reflect a heightened response by limbic seizure foci to the anticonvulsant effects of nordiazepam, or a potentiation of its anticonvulsant effects through attenuating patient anxiety.
Use of high-dose intravenous haloperidol in the treatment of agitated cardiac patients.
Although previous reports have documented the safe and effective use of intravenous haloperidol in agitated cardiac patients, the dosages advocated have in general been relatively low: 1 to 2 mg every 2 to 4 hours. In this report, the authors demonstrate that such doses may be insufficient to control severe agitation in coronary care unit patients. Four cases are presented in which more than 100 mg/day of intravenous haloperidol were required for safe and effective control of confusion and agitation.
Neuropsychiatric presentation of men with pituitary tumors (the 'four A's').
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Complex partial seizures presenting as a psychiatric illness.
A 36-year-old woman was treated for a wide variety of psychiatric illnesses over a span of two decades before a diagnosis of complex partial seizures was made. Her history included poor impulse control, rage attacks, multiple suicide attempts, rapid mood swings, depression, and psychotic episodes. Bulimia, panic attacks, severe obsessive-compulsive symptoms, and multiple somatic complaints were also present. In retrospect, these symptoms could be attributed to complex partial seizures with cognitive and affective symptomatology, automatisms, and psychosensory symptoms, and were controlled by anticonvulsant medications. Therefore, so-called "purely" psychiatric disorders should not be diagnosed before a diagnosis of limbic epilepsy (however, this might be labeled, e.g., complex partial seizure, psychomotor seizure, psychical seizure, or temporal lobe epilepsy) has been considered.
The theme of death in complex partial seizures.
The theme of death highlighted the depersonalization phenomena of four patients with complex partial seizures. These patients became preoccupied with death in association with psychomotor seizures, visual hallucinations, and altered perception of time and reality. The episodic sense of being dead or of having an appointment with death is a clue to the diagnosis of recurrent complex partial seizures even without overt motor stigmata of seizures. The syndrome differs from fear of death, steroid psychosis, the "near death syndrome," and Cotard's syndrome. Adjustment of antiseizure medication is an important therapeutic maneuver.
Use of psychostimulants in medically ill patients with neurological disease and major depression.
The effective therapeutic response to dextroamphetamine and methylphenidate by five depressed patients with neurological disease is described. In four of these patients tricyclic antidepressants had to be discontinued due to the concomitant deterioration of their cognitive functions, and in one case they were not used due to cardiovascular complications. There was a rapid remission of depressive symptomatology with no adverse side effects, consistent with the findings of other investigators. The possible association of right hemisphere strokes and depression is also discussed. Further evaluation of the therapeutic role of psychostimulants in the treatment of depressed patients with structurally-compromised brain function is recommended.
Epilepsy and psychopathology.
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New technologies media for fund raising are on the way.
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Use of psychostimulants in medically ill depressed patients.
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The use of d-amphetamine in medically ill depressed patients.
A positive therapeutic response to d-amphetamine is described in three medically ill depressed patients in a general hospital. Two patients were either unable to tolerate or responded poorly to tricyclic antidepressants. In one patient, d-amphetamine was chosen because of the combination of postoperative pain and depression. There was a rapid remission of depressive symptomatology with no adverse side effects, consistent with the findings of other investigators. Further evaluation of the therapeutic role of d-amphetamine in the treatment of medically ill depressed patients is recommended.
Hyperventilation as a variant of tardive dyskinesia.
Respiratory dyskinesia, a variant of tardive dyskinesia, may mimic chronic psychogenic hyperventilation syndrome, hence pseudopsychogenic hyperventilation. Respiratory alkalosis and sympathetic discharge may occur in both conditions. Neurological symptoms, dyspnea, chest pain, muscle spasms may also occur. Ventilation increases with stress and disappears with sleep in both conditions. However, respiratory dyskinesia has been seen in association with other choreiform movement disorders. Speech is interrupted by breathing and breathing is interrupted by grunts and groans. Respiratory dyskinesia is under partial voluntary control and is not due to a "psychological problems."
A case report of anorexia nervosa and Gaucher's disease.
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Psychiatric medicine. An annotated bibliography of recent literature.
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