Biomedical subjects
Publications and source records attributed to G Beaumont.
Some of the problems inherent in the measurement of mood are considered. Various physician rating and patient self-rating instruments are described which may have practical application in general practitioner trials. The need for continuing research in the area of the measurement of mood disturbance in the setting of general practice is stressed.
Two trials of maprotiline (Ludiomil) were performed in general practice. In the first study depressed patients were given either 75 mg of maprotiline in a single dose or 25 mg three times daily. Assessments of the severity of depression and of side-effects were made initially and following 1, 2 and 4 weeks' treatment. At each assessment measurements of plasma levels of maprotiline were made. A second trial was performed in which some patients receiving 75 mg single dose of maprotiline had whole blood levels of maprotiline assayed. Steady-state levels of maprotiline were achieved after one week but these levels showed considerable individual variability. No clear correlation emerged between clinical response, side-effects and plasma or blood levels. Some of the factors which may be responsible are discussed.
In a large, open, multicentre trial, conducted in general practice, 765 patients suffering from agoraphobia or social phobias were treated with clomipramine (Anafranil, Geigy Pharmaceuticals). Four hundred and eight patients completed a twelve-week course of treatment. Of 285 withdrawals, 139 were due to side-effects. Good results were obtained on all measures of phobias in those patients who completed the study, the improvements being of the order of 70-80%, and over 50% of patients being symptom-free.
Two assessment schemes for assessing obsessional and phobic disorders are described. The schemes were constructed with the phenomenology and epidemiology of the disorders in mind and were designed for use in the setting of general practice.
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Twenty depressed patients seen in general practice were admitted to an open, uncontrolled pilot trial of a new 50 mg formulation of clomipramine. Treatment was administered for four weeks and clinical progress assessed by the General Health Questionnaire, a new depression rating scale and a new design of a visual analogue scale. Two patients dropped out of the study, one because of side-effects and a second because it was necessary to change the dosage. Of the 18 patients remaining 17 showed significant improvement during the four weeks treatment as assessed by the three clinical measures. Plasma levels of clomipramine and desmethylclomipramine were assayed. Steady-state appeared to be achieved between one and two weeks. Between two and four weeks levels of clomipramine varied between 14 and 136 microng/ml with a mean level of 54-6 microng/ml and of desmethylclomipramine, between 3-5 and 344-3 microng/ml with a mean level of 76-7 microng/ml The 50 mg formulation of clomipramine appeared to produced therapeutic levels in 17 of the 18 patients treated. Because so many patients recovered in spite of individually variable plasma levels no correlations between clinical effect and plasma levels were demonstrable. Side-effects were not generally troublesome and were low in incidence. Correlations between plasma level and side-effects were inexplicably negative but rarely significantly so.
Patients treated with four dosage regimes of clomipramine (Anafranil) 10 mg t.d.s., 30 mg o.n., 25 mg t.d.s. and 75 mg o.n. in a clinical trial lasting four weeks were regularly weighed. Due allowance was made for the normality or otherwise of normal weight, appetite and, in women, menstruation. There was no evidence that during the four weeks of this particular study and on these doses of clomipramine patients showed any increase in weight.
An attempt was made to measure the effects of depressive illness and of clomipramine (Anafranil) therapy in doses of 30 mg and 75 mg daily on sexual appetite and performance. A special questionnaire was devised to gather information on sexual habits before illness, during illness and following treatment. It proved difficult to differentiate between the beneficial effects of recovery from depression and the possible adverse drug effects on sexual activity. Two patients dropped out of the study because of supposed sexual side-effects--a male with ejaculatory difficulties and a female with orgasmic impotence. Fifty-four patients completed the sexual questionnaire and a four-week course of clomipramine. There were nineteen males and thirty-five females. Sixty-eight per cent of males and 57% of females had their 'sex life' impaired by depressive illness. Coital rate was decreased and depression interfered with performance and satisfaction. Clomipramine therapy seemed to have advantageous and disadvantageous effects. The advantageous effects were probably associated with improvement in depressive illness. There was evidence that clomipramine had an adverse effect sexually in 26% of males and 14% of females. The effect was dose-related in females.
Many studies have suggested that psychotropic drugs may be valuable in the managment of chronic painful conditions and of the pain due to neoplastic disease. An opiate-sparing effect has been postulated. Most of the studies are, unfortunately, uncontrolled. The question arises as to whether psychotropic drugs, in addition to allaying anxiety and depression, alter pain threshold or the appreciation of pain.
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A brief rating scale for use in assessing patients with phobic and obsessional states is presented. The scale concentrates on the measurements of general anxiety, avoidance, interference and physiological accompaniments in phobias and an anxiety, resistance and interference in obsessions. It also includes a section on other psychiatric symptoms.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.