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Biomedical subjects

G D Burrows

Publications and source records attributed to G D Burrows.

At least 55 records · Page 3Linked to original sources
PubMed1995

Moclobemide for depression: an Australian psychiatric practice study.

Seven hundred twelve patients meeting DSM-III-R criteria for major depression and recommended for antidepressant treatment were treated with moclobemide as outpatients (88%) or inpatients in ordinary psychiatric practices. These differ from the highly selected patients usually studied in antidepressant research, without comorbidity, or coprescription and treated in special clinics. Sixty-five percent were women, with a mean age of 45 (+/- 13.6) years, and 88% were outpatients. Eighty-eight percent had preexisting depression. Eight percent had prior manic episodes. Previous antidepressant treatment for this episode had been received by 69%, with the most common reasons for change to moclobemide being inadequate response (66%) and poor tolerability (20%). The modal final dose was 450 mg. Regarding tolerability, 52% did not report adverse events. The most common adverse events were insomnia or stimulation (13%), nausea (11%), headache or migraine (11%), dizziness or disorientation (6%), sedation or drowsiness (5%), agitation or nervousness (3%), and diarrhea (3%). Only 10% of adverse events were severe, and 83% lasted less than 2 weeks. There was no difference when moclobemide followed fluoxetine use. Most adverse events did not significantly differ from the frequencies reported in double-blind placebo-controlled studies. Concomitant medications from all major drug groups were taken by 520 patients (73%), with no adverse interactions. Moclobemide overdose resulted in an uneventful recovery, whereas mixed overdoses caused no problems other than those attributable to coprescribed medication. On physician clinical global impression, 65% were moderately improved or better after 8 weeks.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

A risk-benefit assessment of moclobemide in the treatment of depressive disorders.

Moclobemide, a novel benzamide, is a reversible inhibitor of monoamine oxidase-A (RIMA). It has been extensively evaluated in the treatment of a wide spectrum of depressive disorders. Comparative studies have shown that the drug is more effective than placebo and as effective as other antidepressants. In terms of efficacy, moclobemide offers no more benefits than do existing agents. On the other hand, moclobemide is better tolerated than tricyclic antidepressants and, unlike irreversible monoamine oxidase inhibitors, has a much lower propensity to cause a 'cheese reaction' (a potentially fatal syndrome caused by an interaction with tyramine-rich foods). These are significant clinical benefits, particularly in elderly patients. Furthermore, moclobemide lacks significant effects on psychomotor performance and cognitive function, has few clinically important drug interactions and is safe on overdose. The drug has a relatively short plasma elimination half-life, a property that allows a change to an alternative agent within 24 hours in cases of nonresponse. Since it is well tolerated, therapeutic dosages can often be achieved from the onset of treatment. These benefits need to be considered against the potential risks of moclobemide therapy. To date, the most significant hazards of therapy appear to arise from drug interactions with clomipramine or selective serotonin (5-hydroxytryptamine; 5-HT) reuptake inhibitors, where the occurrence of the serotonin syndrome is potentially fatal. Similarly, in preclinical tests moclobemide has been shown to potentiate the effects of pethidine (meperidine) and dextropropoxyphene, so that combined use of moclobemide is a useful addition to the therapeutic agents used for depressive disorders.(ABSTRACT TRUNCATED AT 250 WORDS)

Antidepressive Agents↗
PubMed1994

Youth suicide in Victoria: a retrospective study.

OBJECTIVE: To determine the trends in youth suicide in Victoria and Australia as a whole, and their relation to youth unemployment. DESIGN: We used Australian Bureau of Statistics data to analyse suicide trends between 1907 and 1990 in young people aged 15-24 years and made an in-depth study of youth suicides between 1980 and 1990, for which computerised data are available. RESULTS: There has been a steady increase in youth suicide both in Victoria and Australia as a whole since 1960 in males but not females. There were significant differences in age, sex and area of residence in both the rate and the method of suicide. The increase in youth suicide was not associated with the rise in unemployment. Male (not female) suicide rates were higher in non-metropolitan areas and areas of high youth unemployment. The reasons for the increase in youth suicide remain obscure. CONCLUSIONS: There is a need for a prospective in-depth study to determine factors in the aetiology of youth suicide, with particular reference to possible areas for prevention.

Adolescent↗
PubMed1994

Serotonergic function in panic disorder: endocrine responses to D-fenfluramine.

1. Prolactin and cortisol responses to d-fenfluramine were measured in 16 patients with DSM-III-R panic disorder and 14 normal controls. 2. Patients showed a greater mean prolactin response than controls but the difference between groups was not statistically significant (P > 0.05, MANOVA). 3. No consistent differences were observed between patients and controls with respect to cortisol responses (P > 0.05, MANOVA). 4. The results do not support the hypothesis of hypersensitive post-synaptic serotonin receptors in patients with panic disorder. 5. Studies in larger groups are necessary to confirm the trend and to explore receptor subtype sensitivity.

Adult↗
PubMed1994

Neuroendocrine responses to single doses of buspirone in obsessive-compulsive disorder.

Prolactin and cortisol responses to buspirone, a partial serotonin agonist with effects on the 5-HT1A receptor, were measured in 16 patients with DSM-III-R obsessive-compulsive disorder (OCD) and 16 normal controls. No consistent differences were observed between patients and controls with respect to the hormone responses measured. The results suggest that dysfunction of the 5-HT1A receptor is not present in OCD patients. The limitations of buspirone as a specific agonist challenge of the 5-HT1A receptor are discussed. Although data from other studies generally support a serotonin dysfunction in OCD, the question of which specific subtype(s) of receptor remains unanswered.

Adult↗
PubMed1994

Definition and differential diagnosis of treatment-resistant depression.

There are no agreed criteria for treatment-resistant depression, but the failure to respond adequately to two successive courses of monotherapy with pharmacologically different antidepressants, given in an adequate dose for sufficient time is one pragmatic definition. Inherent within this definition are notions of what constitutes an adequate dose of drug, the length of treatment and pharmacological specificity of treatments. When these factors are accounted for, treatment resistance may be encountered in 15-20% of patients. In attempting to treat such patients a number of pharmacological strategies have been adopted and some are briefly reviewed. Psychosurgery may have a role to play in cases of absolute treatment resistance.

Antidepressive Agents↗
PubMed1993

Long-term drug treatment of panic disorder.

Drug treatment of panic disorder with benzodiazepines and antidepressants has been established as efficacious in the short-term (6-8 weeks). The efficacy of medications during long-term (i.e., continuous) treatment has not often been addressed and a review of the evidence is presented. Most data exists for the long-term effectiveness of benzodiazepines. Experience with the triazolobenzodiazepine, alprazolam, is reviewed together with some other high potency drugs, e.g., clonazepam. Tricyclic antidepressants are also effective in the long-term treatment of panic and the relevant studies are presented. Long-term efficacy for monoamine oxidase inhibitors is not as clearly established. The issue of relapse following drug withdrawal is addressed and some strategies for patient management in long-term therapy are discussed.

Anti-Anxiety Agents↗
PubMed1993

Prolactin response to dl-fenfluramine in panic disorder.

The objective of this study was to test the hypothesis that serotonin receptors are hypersensitive in patients with panic disorder. Eleven patients and 12 controls received a single PO dose of 60 mg of dl-fenfluramine at 0900h on a single occasion. Blood samples were collected with an indwelling intravenous catheter at 30-min intervals from 0930h to 1530h and prolactin determined by radioimmunoassay. In both groups, fenfluramine induced a rise in the plasma prolactin concentration from baseline. The patients showed a greater increase in prolactin response than the normal controls. This result is consistent with the hypothesis of increased serotonin receptor function in patients with panic disorder.

Administration, Oral↗
PubMed1993

Relationship between antidepressant response and plasma concentrations of fluoxetine and norfluoxetine.

The relationship between plasma concentration, clinical outcome and side-effects was examined in 23 patients with major depressive disorder (DSM-III-R) treated with fluoxetine. All patients received a fixed dose of 20 mg for 6 weeks. Good response was observed in 57% of patients, while 30% of patients had moderate responses after 6 weeks of treatment. Fluoxetine and norfluoxetine plasma concentrations were not significantly influenced by age and sex. At 6 weeks, plasma fluoxetine concentrations were not significantly different between responders and non-responders to treatment (82.2 +/- 59.6 micrograms/l vs. 84.7 +/- 6.7 micrograms/l) or those with or without side-effects (74.6 +/- 28.7 micrograms/l vs. 87.0 +/- 66.6 micrograms/l). Similarly, norfluoxetine concentrations were not significantly different for responders and non-responders (65.5 +/- 28.9 micrograms/l vs. 66.5 +/- 26.2 micrograms/l) or those with or without side-effects (66.6 +/- 14.4 micrograms/l vs. 61.5 +/- 33.6 micrograms/l). Plasma concentrations and clinical outcome were not related in a simple manner. Further studies are needed to evaluate the role of monitoring plasma fluoxetine/norfluoxetine concentrations as a routine procedure.

Adult↗
PubMed1993

Measuring medical students' empathy skills.

Empathy is an important skill for the medical practitioner or medical students to develop when interviewing patients. It helps the interviewer establish effective communication, which is important for accurate diagnosis and patient management. Two facets of medical education limit students' development of accurate empathy: the traditional format of interviewing training and the social ethos of medical training and medical practice, which stress clinical detachment. A number of researchers and educators have developed consulting skills training programmes, designed to enhance students' empathic skills and ability. One difficulty for researchers has been the conceptual complexity of the term 'empathy' and greater difficulty in measuring the dimension. This paper reviews the range of approaches to the measurement of empathy and reports on a research study designed to evaluate a two-stage measurement technique, involving a pencil-and-paper test of empathy and independent observer ratings of medical students' actual interview behaviours. Results lead to the conclusion that pencil-and-paper tests of empathy cannot incorporate the range of complex cognitive, emotional and behavioural components of the empathy construct. On the other hand, trained observers have been able to use items on a specially developed History-taking Rating Scale to discriminate between the empathic behaviours of a group of students trained in consulting skills with those of a group of control students who each carried out videotaped history-taking interviews with hospitalized patients.

Adult↗
PubMed1993

Human immunodeficiency virus infection, dementia and the older patient.

Australian statistics have shown that 10.9% of AIDS cases have occurred in the 50 years and over age group. To date little attention has been given to the many issues surrounding HIV infection in the older population, for example, the failure to consider HIV as an aetiological factor in the older person presenting with neuropsychiatric disorder and the potential for misdiagnosis of AIDS dementia complex as dementia of the Alzheimer type. This paper includes a discussion of the clinical features of the AIDS dementia complex, its resemblance to the syndrome of "subcortical dementia", and review of the literature reporting dementia as the presenting feature of HIV infection in older individuals.

AIDS Dementia Complex↗
PubMed1993

A multicentre double blind trial of fluoxetine versus amitriptyline in the treatment of depressive illness.

The antidepressant efficacy and side effect profile of a fixed dose of 20 mg/day of fluoxetine, a specific serotonin reuptake inhibitor, were compared to those of amitriptyline. Fifty-eight patients with DSM-III-R depression were randomly assigned to receive either fluoxetine or amitriptyline. Fifty-six patients (fluoxetine N = 23, amitriptyline N = 23) completed the 6 week study. Comparable antidepressant efficacy was demonstrated for the two drugs. Patients taking fluoxetine reported less side-effects than those taking amitriptyline.

Adult↗
PubMed1993

Alterations to plasma melatonin and cortisol after evening alprazolam administration in humans.

Six healthy volunteers were given a 2-mg dose of alprazolam at 21:00 h and hourly blood samples were collected until 08:00 h the following morning. A control night of hourly blood sampling was undertaken 7 days before Plasma was analyzed for melatonin, cortisol, and alprazolam concentrations. Melatonin concentrations were significantly suppressed by alprazolam at 23:00, midnight, 01:00, 06:00, and 07:00 h. A trend toward suppression was evident from 02:00 to 05:00 h. Cortisol concentrations were also suppressed by alprazolam at several times throughout the night (01:00-04:00 h). Plasma alprazolam levels showed a peak at 3 h and remained relatively high 19-20 h after the dose. The significance of melatonin suppression by alprazolam is discussed in terms of benzodiazepine binding sites and GABA minergic transmission in the human pineal gland, suprachiasmatic nuclei, and retina. Plasma cortisol suppression has been reported for other benzodiazepine drugs, but conflicting data exist for alprazolam. The present results do not support the proposed inhibitory effect of melatonin on the hypothalamic-pituitary-adrenal (HPA)-axis. It is suggested that there is no simple direct relationship between melatonin and the HPA axis in humans.

Adult↗