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Biomedical subjects

G Parker

Publications and source records attributed to G Parker.

At least 235 records · Page 13Linked to original sources
PubMed1991

Age and depression.

The interaction of age and depression was investigated by comparing differences between elderly (greater than or equal to 60 years old) and younger consecutive in- and out-patient referrals to a tertiary referral mood disorders unit. Older patients with unipolar major depressive episode were more likely to be psychotic and agitated regardless of depressive subtype and less likely to have personality inadequacies or a family history of affective disorder. In this sample, elderly depressives' rating of diagnosis, severity, endogeneity and social impairment were similar, irrespective of age of first onset of depression, but a positive family history and personality abnormalities were less likely in late-onset depressives.

Adjustment Disorders↗
PubMed1991

Distinguishing psychotic and non-psychotic melancholia.

To examine the necessary and sufficient status of delusions and hallucinations as clinical features of psychotic (delusional) depression, we studied a consecutive sample of 137 patients meeting DSM-III, RDC and our clinical criteria for endogenous depression/melancholia, of whom 35 had delusions and/or hallucinations, and represented our putative 'psychotic depressives' (PDs). The PDs were contrasted with the remaining 'endogenous depressives' (the EDs), and an age- and sex-matched subsample of the latter, the MEDs. Univariate and multivariate analyses of clinical features established that, in addition to the presence of delusions and/or hallucinations, the PDs could be distinguished in particular by severe psychomotor disturbance, as well as by sustained and unvarying depressive content, the absence of any diurnal mood variation and by constipation. Latent class analyses suggested that overt psychotic features (such as delusions and hallucinations) were sufficient but not necessary for a subject to be assigned to the 'psychotic' latent class, and a subsequent chart review suggested that, in some PDs actual psychotic features may not be able to be elicited because of severe psychomotor change, suggesting that clinical reliance on eliciting delusions or hallucinations may result in a number of 'masked psychotic depressives' escaping valid diagnosis.

Affective Disorders, Psychotic↗
PubMed1991

Growth hormone and other hormonal responses to clonidine in melancholic and nonmelancholic depressed subjects and controls.

To study putative differences in central neurotransmitter function in depressive subtypes, growth hormone, adrenocorticotropic hormone (ACTH), cortisol, and prolactin responses to the alpha 2-noradrenergic receptor agonist clonidine (1.3 micrograms/kg i.v.) were examined in 26 subjects with major depression, 13 of whom had melancholia. The responses of 10 of these endogenous/melancholic subjects were compared with those of 10 controls who were matched to the patients on age, sex, and menopausal status. In 15 of the depressed subjects, prolactin and cortisol responses to the putative serotonergic agonist fenfluramine were also examined to test for associations between these challenges. There were no significant differences in any of the responses between melancholic and nonmelancholic depressive subgroups after controlling for age and sex. With the exception of a greater reduction in ACTH in the endogenous/melancholic subjects, there were also no significant differences in hormonal responses between these patients and controls. There was, however, a significantly greater reduction in systolic blood pressure in the control subjects. There were no significant correlations between the responses to clonidine and fenfluramine. The findings suggest that clonidine at a dosage of 1.3 micrograms/kg is neither able to differentiate reliably between depressive subtypes nor to differentiate reliably between depressed and control subjects.

Adrenocorticotropic Hormone↗
PubMed1991

Psychosocial risk factors distinguishing melancholic and nonmelancholic depression: a comparison of six systems.

We examined six systems or scales designed to distinguish melancholia from residual nonmelancholic depressive disorders in a sample of 305 patients. A count of the number of significant psychosocial risk factors showed that a clinical diagnosis was the most differentiating (19 significant risk factors), followed by the Newcastle index (13), DSM-III (10), and the CORE system (10)--the last essentially assessing psychomotor change; Research Diagnostic Criteria (RDC) (7) and an endogeneity symptom scale (2) were the least differentiating. A subsample of "composite melancholics" was derived, comprising 138 who met "melancholia" criteria for DSM-III, RDC, and CORE, and they were contrasted with residual depressives. The composite melancholics were older, had had a briefer depressive episode, and differed significantly on 12 risk factors, essentially being less likely to report deprivational experiences such as deficient parenting and dysfunctional marital relationships. We suggest that such a risk factor strategy is of potential use in refining the clinical definition of melancholia.

Adaptation, Psychological↗
PubMed1991

Perceived interpersonal risk factors of non-endogenous depression.

In a case-control study, two potential interpersonal risk factors of non-endogenous depression, namely a patient's perception of their current intimate partner as dysfunctional and a patient's recall of exposure to previous deprivational parenting, were quantified. The interpersonal characteristics of the partner were assessed principally by a brief self-report questionnaire, the Intimate Bond Measure (IBM). By cross-sectional and longitudinal comparison of this instrument with other interview-derived and self-report measures, the convergent, discriminant and predictive validity of the IBM in depressed patients was established. Further, little evidence of any distorting effect of depressed mood or neuroticism was detected. The perception of the current intimate partner as dysfunctional imparted a risk to non-endogenous depression of at least five times, while reported exposure to parental 'affectionless control' was quantified as a four times' risk. Importantly, IBM care scores predicted the course of the depressive disorder over a six-month period.

Adaptation, Psychological↗
PubMed1991

Psychotic depression: a review and clinical experience.

We review research literature on psychotic (delusional) depression, including demographic, illness pattern, clinical, biological marker and treatment issues. Secondly, we report a study of a consecutive sample of 137 patients meeting criteria for DSM-III melancholia, RDC definite endogenous depression and our "clinical" criteria for endogenous depression, of whom there were 35 "psychotic depressives" (PDs). The PDs were contrasted with the remaining 76 depressives (EDs) and with an age and sex-matched subset (MEDs). The PDs were distinctly older than the EDs at assessment and at initial onset of any affective disorder. Compared to the MEDs, they tended to have longer illnesses, were more likely to be hospitalised (and to have longer stays), to receive (in the past and for the current episode) combination antipsychotic/antidepressant medication and/or ECT, and to have a poorer course over the following year. They were no more likely to have a bipolar pattern, a family history of depressive disorder, schizophrenia or alcoholism, or vegetative depressive features. Developmental psychosocial stressors and antecedent life event stressors were not over-represented. Most of the PDs had delusions, one-fifth reported hallucinations and psychomotor disturbance was marked. Other differential clinical findings were sustained mood disturbance, constipation, and the absence of a diurnal variation in mood and energy.

Adult↗
PubMed1991

Attitudes of general practitioners to occupational health services.

To assess the attitude of General Practitioners towards Occupational Health Services in the NHS and industry, a questionnaire was sent to 63 GPs with a response rate of 83 per cent. The majority of GPs felt that Occupational Health Departments acted in the best interests of their patients; but felt that occupational physicians sometimes meddle in primary care. The views of GPs on the acceptability of occupational health involvement in health screening, education and specific vaccinations was varied, with enthusiasm for health education and very limited screening, but little enthusiasm for vaccinations. The overall view of occupational health was positive, but specific areas of communication and overlap of function need to be explored in more depth. The new GP contract places specific requirements on GPs to undertake health screening and to reach targets for vaccination and cervical cytology. If the quality of the interface between occupational health services and primary care can be improved, both specialties would benefit.

Attitude of Health Personnel↗
PubMed1991

Effect of physiotherapy on sickness absence in industry: a comparative study.

A cross-sectional comparative study was carried out in two chemical manufacturing plants in order to ascertain the effect of an occupational physiotherapy service on absence attributed to sickness. There was no overall effect on total sickness absence rates in this study, but a possible reduction in short-term sickness absence was noted. Changes in management attitudes to absence attributed to sickness at the comparison site caused a significant reduction in short-term absences. It is concluded that physiotherapy in an occupational setting has little effect on sickness absence compared to management attitudes, but the unquantifiable benefits, such as increased employee mobility, better industrial relations and employee morale may be significant benefits, worthy of further study.

Absenteeism↗
PubMed1991

The Life Skills Profile: psychometric properties of a measure assessing function and disability in schizophrenia.

The Life Skills Profile (LSP) was developed as a measure of function and disability in schizophrenia. We now report a number of studies assessing its psychometric properties, principally when completed by case workers, residential carers and parents. We demonstrate high test-retest reliability for all 3 rater groups. High interrater reliability was demonstrated between raters of the same background (such as parent vs parent) and when co-ratings by caseworkers and residential carers were examined. By contrast, parents rated differently to case workers and residential carers, a finding that could reflect different raters "knowing" subjects in different ways, or the effects of response biases. To pursue the latter possibility, the influences of rater "burden of care" and "optimism" were examined. A concurrent validity study is reported, offering additional support for the validity of the measure.

Activities of Daily Living↗
PubMed1991

Personality as a vulnerability factor to depression.

One hundred and forty non-depressed primiparous women in a stable relationship completed two personality measures (the EPI and the IPSM) antenatally, and were then assessed for depression at several times post-natally. The risk of depression at six months was increased up to tenfold by high interpersonal sensitivity and threefold by high neuroticism. When previously depressed women were excluded from analyses, high interpersonal sensitivity and, to a lesser extent, high neuroticism were still associated with an increased risk of being depressed. Interpersonal sensitivity, as measured, is suggested as a refined personality risk factor to both the onset and recurrence of depression.

Depressive Disorder↗
PubMed1991

Parental representations of patients with panic disorder and generalised anxiety disorder.

Previous studies using the Parental Bonding Instrument have shown a general trend for neurotic subjects to score their parents as less caring and more protective. Such a finding was broadly replicated in a study of 80 clinically anxious subjects and age- and sex-matched controls. Although direct comparisons of PBI scores failed to reveal clear-cut differences between generalised anxiety (GA) and panic disorder (PD) subgroups, logistic regression analyses revealed higher odds ratios for parental assignment to aberrant categories in the GA group, with PD patients reporting a more limited pattern of overprotective parenting only. Our findings suggest that adverse parental behaviour may be relevant to the pathogenesis of GA, while parental 'affectionate constraint' may be a parental response to early manifestations of PD.

Adult↗
PubMed1991

Depression sub-typing: unitary, binary or arbitrary?

The strongest statistical support for the binary view of depression has been provided by factor (principal components) analytic studies which delineate a bipolar factor with features interpreted as reflecting "endogenous depression" and "neurotic depression" at opposing poles. We review the seminal studies to suggest instead that the bipolar factor has generally polarised depression and anxiety, and that no such entity or symptom complex of "neurotic depression" has been isolated. Instead "neurotic depression" has been defined principally by features of anxiety and personality style. We argue that the suggested entity is, in fact, a pseudo-entity, being no more than a residual group of non-depressive features without any significant intrinsic depressive characteristics. We support our interpretation by showing comparable solutions in published studies of depressives alone, contrasted with separate analyses of anxious and depressed patients. We also report two studies in which the "neurotic depressive" pole is made to appear and disappear by the inclusion and exclusion of anxiety items. As factor analytic studies have defined the "residual" pole so variably, we argue that some features held to distinguish neurotic depression are of no utility and that such a diagnosis is meaningless. We suggest that the clinician should not proceed (after excluding endogenous depression) to conclude that the default option is necessarily an entity "neurotic depression" and that instead a heterogeneous group of options (e.g. anxiety, personality disorder) require review. If the "neurotic depressive" type of the multivariate analytic studies is a pseudo-entity, then a modified unitary view of depression may be valid.

Adult↗
PubMed1991

Carbamazepine for treatment-resistant melancholia.

BACKGROUND: There have only been a few studies of the role of carbamazepine in the management of treatment-resistant depression. METHOD: The response to carbamazepine of 16 melancholic patients, who had been depressed for an extended period despite a number of standard treatments, was studied retrospectively. RESULTS: Seven patients (44%) had a moderate or marked improvement. The responders included both psychotic and nonpsychotic depressives, and patients with concurrent organic brain disease. There was, however, a high rate of complications, with 5 of these 7 responders (71%) having to discontinue carbamazepine because of adverse effects. This high rate of complications may have reflected the older age of our sample. CONCLUSION: These findings suggest the efficacy of carbamazepine in melancholic patients who have not responded to conventional treatments, but indicate that the high rate of significant side effects may limit its long-term usefulness.

Adult↗
PubMed1990

Long-term jugular vein catheterization in horses.

The use of soft catheter materials in large-bore veins has allowed safe long-term venous access in human patients. Similar principles were applied to groups of horses; the jugular vein was catheterized for 14 days (group 1) and for 30 days (group 2). Three catheter materials were compared, and the clinical and histologic findings indicated that the least reaction was associated with silastic, followed by polyurethane; polytetraflouroethylene caused marked reaction. Our results suggest that by using catheters made of materials (especially silastic) that are less stiff or rigid, the duration of catheterization can be increased to 14 days or longer with minimal complications.

Animals↗
PubMed1990

Perceived dysfunctional intimate relationships: a specific association with the non-melancholic depressive subtype.

Associations between perceptions of dysfunctional current intimate relationships and subtypes of depressive disorders were quantified in a sample of 136 patients, using the Intimate Bond Measure (IBM). Deficient care was two to three times more likely to be reported by patients with non-melancholic disorders than by matched subjects, but was no more likely to be reported by patients with melancholic disorders, suggesting a risk factor selective for depressive type. Patients who reported markedly deficient care in childhood were more likely to report very poor current intimate relationships. For the remaining patients, however, no evidence of continuity between a dysfunctional parental relationship and a current dysfunctional intimate relationship was found.

Adult↗
PubMed1990

Expressed emotion as a predictor of schizophrenic relapse: an analysis of aggregated data.

We examine published data from 12 studies assessing the capacity of Expressed Emotion (EE) status to predict schizophrenic relapse. Analysis of aggregated data, for 908 subjects, established a 3.7 times greater likelihood of relapse in those categorized as high EE, and a somewhat waning predictive strength EE over the publication interval, 1962-88.

Data Interpretation, Statistical↗
PubMed1990

Perceptions of general and specific therapist behaviors.

In the process of developing a two-part therapist rating scale, we obtained questionnaire responses from a large sample of subjects who had undergone one of a variety of psychotherapies. Our data support the importance of perceived therapist care as a strong correlate of patient satisfaction, and patients seemed able to discriminate clearly between psychodynamic and cognitive-behavioral therapies. In the first (nonspecific) questionnaire, we derived five dimensions (Care-Concern, Directive-Control, Critical-Confronting, Understanding, and Charisma) from principal-components analyses, with the first two dimensions being relatively independent of each other. A multiple-regression analysis revealed that combined scale scores accounted for 50% of the variance of patient satisfaction ratings, with the Care dimension accounting for most of this effect. In the second questionnaire, data were analyzed from respondents who had undergone therapy with known cognitive-behavioral or psychodynamic therapists; but, in a minority of subjects who were recruited through the media, we depended on detailed descriptive vignettes to allocate them to one or another of these "specific" types of psychotherapy. Six scales emerged, three characterizing cognitive-behavioral therapies (Behavioral Task Orientation, Organization, and Cognitive Focus) and three representing psychodynamic therapies (Transference, Inner Conflict, and Relationship). Subjects' ratings on all scales strongly discriminated between the two broad modalities of therapy, suggesting that patient reports may provide valid measures of therapist styles. We conclude that questionnaires such as the one we are developing may provide economical measures for assessing therapist consistency when comparing different modalities of psychotherapy.

Adult↗