Biomedical subjects
Publications and source records attributed to G D Burrows.
Cigarette smoking was found to have no effect on the steady-state plasma levels of nortriptyline in a group of 22 smokers and 31 nonsmokers. Smokers achieved a mean steady-state nortriptyline concentration of 191.2 +/- 141.3 ng/ml; nonsmokers had a level of 169.3 +/- 92.4 ng/ml. Age, sex, and number of cigarettes smoked had no effect on the plasma concentrations achieved.
In a 5-week study of 22 depressed patients treated with nortriptyline, significant changes in plasma levels, both elevated and reduced, were deliberately produced in the third and fourth weeks of each patient's treatment. Correlation of plasma nortriptyline levels and changes in the severity of depression, as measured by the Hamilton Depression Scale, showed no significant relationships. The implications of the study are discussed.
The aim of this study was to develop a simple method of assessing female sexual response, suitable for use in clinical investigations. Following a review of interview, physiological and psychological methods, a Scale of Sexual Response was developed. Sexually dysfunctional women and women who stated they had no sexual problems completed the Scale. The results demonstrated that 11 of the 15 subscales had concurrent validity. The 4 subscales relating to auto eroticism did not distinguish between groups. Significant changes were demonstrated in 4 subscales following successful therapy of the sexual dysfunction. The scale was shown to be reliable.
Explore the source record for details and available documents.
Vaginismus may be defined as an involuntary spastic contraction of the musculature investing the outer third of the vagina. This spasm is produced by imagined or real attempts at vaginal penetration. Though vaginismus may be suspected from the history, the definitive diagnosis is made on vaginal examination. Preparation and positioning of the patient for this examination are important. Where anxiety of the patient precludes examination, the patient may be first desensitized to penetration using behavioural modification techniques. The patient is then shown how to overcome the spasm using daily digital vaginal examination. When digital vaginal dilatation can be painlessly carried out, intercourse is attempted. In some women, vaginismus appears to be a somatic manifestation of unconsious psychological conflicts. These women may benefit from more intensive psychotherapy.
Oro-facial pain is commonly acute, and of dental origin. There are numerous other less common, but clinically identifiable types of oro-facial pain which can be attributed to an organic cause, and which usually respond to the appropriate treatment. There is a small proportion of oro-facial pain problems, however, which are chronic and which are found to have a psychogenic element of greater or lesser magnitude, and treatment is aimed at psychological or psychiatric therapy. The interim results of an ongoing study of chronic oro-facial pain of psychogenic origin are described in this presentation.
This is a report of a retrospective study of 89 patients who had undergone hysterectomy and oophorectomy. The aims of this study were to identify factors associated with sexual deterioration attributed to the operation. In the sample interviewed, 33 patients (37%) complained of a deterioration of their sexual relationships, which they attributed to the operation. Preoperative expectations of sexual alteration were found to be significantly associated with subsequent sexual dysfunction, and specifically with loss of desire for sexual intercourse. Estrogen administration, while not affecting overall sexual behavior, was specifically associated with less dyspareunia. It was concluded that sexual dysfunction following hysterectomy and oophorectomy was mainly associated with psychologic factors.
Sixty-two patients with moderately severe anxiety symptoms were treated in a double bline 3-week trial with either oxprenolol, diazepam or placebo. The Hamilton Anxiety Scale and a Target symptom improvement score were the main measures of change used. All treatment groups significantly improved in the three weeks of the trial. However in the third week of treatment improvement was greater in the diazepam and oxprenolol groups. Observer preferences significantly favoured the diazepam group. The implications of the study were discussed.
The effects on the heart rate and ECG of anaesthetised guines-pigs of amitriptyline, doxepin, imipramine and nortiptyline infused at 1.0 mg/kg/min until death were observed. In addition an in vitro study on guinea-pig atria was performed on the chronotropic and inotropic effects of these drugs and of desmethylimipramine and protriptyline at a concentration of 10(-5) M. The effect of sodium bicarbonate (3 mEq/kg i.v.) and propranolol (0.01--0.2 mg/kg i.v.) on amitriptyline and doxepin induced ECG changes was also assessed. A difference in the cardiac effects of the in vivo and in vitro model was observed. Guinea-pigs infused with doxepin survived significantly longer than those infused with amitriptyline, imipramine or nortriptyline. No statistically significant difference was found between the tricyclic drugs with respect to onset of widening of the QRS complex, increased PR and QT intervals. In the spontaneously beating atrial preparation doxepin was the most potent cardio-depressant. Sodium bicarbonate had no effect on arrhythmias induced by tricyclics, while propranolol, apart from the bradycardia induced, was without beneficial effect on the ECG. The guinea-pig provides a good model for studying the arrhythmogenic actions of tricyclic antidepressants.
A clinical comparison was made between a butyrophenone drug (haloperidol), and an established antianxiety agent of the benzodiazepine group (diazepam). Both drugs were highly effective in reducing anxiety symptoms, with few and mild side effects of diminishing intensity throughout the trial period.
The effects of tricyclic antidepressants on the heart are reviewed. Statistically significant increases in heart rate and in atrioventricular conduction times were found following the administration of tricyclic drugs to 32 depressed patients. The method of His bundle electrocardiography was used to study atrioventricular conduction in ambulant patients and in patients admitted after an overdose of tricyclic antidepressant drugs. Distal conduction defects were frequently found in patients following tricyclic overdosage, but these were not seen with doxepin overdosage. Impaired distal conduction was also found in occasional patients on therapeutic doses of tricyclic drugs. Some animal experiments giving similar results to the above clinical findings are also described. The clinical implications of these findings are discussed.
Explore the source record for details and available documents.
A double-isotope derivative dilution procedure for measuring plasma levels of Nortriptyline is described. The assay is specific, sensitive, precise and reproducible. Studies on the variation in steady-state plasma levels are described on a fixed oral dosage of nortriptyline. Between individual variations in steady-state plasma levels are large. Between day within individual variation is 15-20%. Dosage regime, time of blood sampling after last oral dose and the method of blood handling are unlikely to affect the steady-state plasma levels. Within an individual, the oral dose, duration of treatment and concomitant drug treatment are all important determinants of the steady-state plasma level.
Fifty-three patients suffering from depressive illness were classified as 'responders' or 'non-responders' on the basis of an "amelioration score" of the Hamilton Rating Scale for depression after six weeks treatment with nortriptyline hydrochloride at 150 mgs. daily. A multivariate analysis of variance was performed on the four psychological rating scale scores used, to determine whether rating scales could predict treatment response to tricyclis antidepressants was found to be at 75% probability.ic anti-depressants was found to be at 757. probability.ic antidepressants. There was a significant difference between the two groups after adjustment for age. Subjects were then classified as 'non-responders' and 'responders' on the basis of their discriminant scores. The prediction of response to tricycl
In considering subject material of "Stress and distress" in a symposium devoted to emotional probelms of middle age, who better to consider than the doctor? What effects does the stress of medical practice have on the mental health of the practitioner and his family?
With the widespread use of tricyclic antidepressant drugs, the relationship between the concentration of the drug in the plasma and the therapeutic response is of considerable interest. We describe a double-isotope derivative dilution procedure for measuring plasma nortriptyline. In the method, [14C]nortriptyline is used for estimating procedural losses and [3H]acetic anhydride for derivative formation. The assay is rapid and adequately specific, sensitive, precies, and reproducible for routine clinical use. We used it to investigate the variation in steady-state drug concentrations in plasma of persons who were on a 150 mg/day dose of nortriptyline. Intra-individual variation from day to day was 10-14%. This variation was not significantly affected by the dosage schedule, the time of sampling after an oral dose, or the storage of the plasma samples. For 19 patients on 150 mg of nortriptyline per day, the mean concentration in plasma was 181 +/- 22 (SE) mug/liter, a value that compares well with our previous findings and those of other groups.
There is no doubt that the relatively recent changes in our society must have effects on the development of the early adult. These include changes in society's attitudes, permissiveness, changing roles, equal employment and wage opportunities, women's liberation, the 'single mother by desire', changing divorce laws, integrated university colleges of residence, to mention but a few factors. The effects of drugs, illegal and legal, alcohol, the motor vehicle, pollution and environmental change must also be remembered as possible sources of anxiety in early adulthood.