Biomedical subjects
Publications and source records attributed to G Parker.
Recent advances in medical experimentation have evoked wide-ranging responses from the medical profession and the wider community. This article argues against the medical profession assessing experimentation issues by reference to a narrow utilitarian model and promotes, by way of a behavioural science perspective, an emphasis on process issues.
The mid-life phase, with its component features (e.g., solitude, detachment and self-doubt), its tasks (e.g., the search for self and reattachment) and several outcomes (e.g., rapprochement, chronic depression), is reviewed. A novella by John Fowles, The Ebony Tower, is presented as an allegorical account of the mid-life crisis, and its inherent myths examined. Key clinical issues, including the attributional distorting effect of mood on the protagonist's search for self and induced states of learned helplessness, are explored with reference to literary myths and clinical vignettes.
Low levels of neuroticism have variably been associated with a better outcome of depressive disorders but the interpretation of this phenomenon is clouded by the knowledge that severity of depression may itself confound ratings of neuroticism. To clarify any relationship between neuroticism and outcome, the authors assessed the predictability of neuroticism (as assessed by questionnaire, psychiatrist rating, and subject self-report) in separate groups of psychiatric patients and symptomatic volunteers with nonmelancholic depression. Depressives' judgments of their own neuroticism correlated with neuroticism scores on the Eysenck Personality Inventory (EPI), but neither of these measures predicted improvement at 6 nor 20 weeks. Judgments of neuroticism made by psychiatrists, which did not correlate with EPI neuroticism scores, did predict improvement. The study suggests that differences in defining neuroticism contribute to its variable association with outcome and further suggests the relevance of clinically assessing neuroticism as a personality variable.
Forty-three patients with non-endogenous depressive disorders were assessed shortly after psychiatric referral, and reassessed at six and at 20 weeks. The pattern of improvement appeared to be set shortly after the initial consultation, but could be most clearly predicted by the degree of improvement at the end of the third week. Key baseline factors predicting a more marked improvement at each follow-up were a more severe depression, the break-up of an intimate relationship, and the presence of weight loss. Positive life events occurring after the initial assessment predicted improvement at six and at 20 weeks, while the presence of a neutralising event (which negated an earlier threatening life event) predicted improvement at 20 weeks.
Primiparous women (n = 627) were screened on state and trait anxiety measures in the post-partum period; sub-groups of highly anxious (n = 89), moderately anxious (n = 29), and minimally anxious (n = 29) mothers were derived and subsequently interviewed. The high-anxiety mothers were randomly assigned to a professional intervention, to a non-professional intervention, and to a control group, and their progress was reviewed over the following 12 months. Compliance, both in responding to progressive assessments and in accepting therapeutic intervention, was extremely high. Changes in anxiety levels for mothers not receiving an intervention were minimal over the study. In the high-anxiety sub-groups, there was a 19% reduction in state anxiety levels for those receiving a professional intervention, a 12% reduction for those receiving a non-professional intervention, and a 3% reduction in the controls. A planned contrast analysis determined that only professional intervention had a significant effect, intervention successfully lowering state anxiety levels to a value comparable with the moderately anxious mothers.
Diagnostic patterns for schizophrenia and affective psychosis were examined for all admissions to psychiatric facilities in New South Wales over a ten-year (1967-1977) period, before, during, and after lithium carbonate had been established as an accepted treatment. While the proportion of functional psychoses to total admissions remained relatively constant over the study, there was a relative decrease in schizophrenia, and a relative increase in the affective psychosis group. Analyses of sub-groups suggested, after controlling for the effects of time, that the introduction of lithium has been associated with an increase in diagnoses of mania and a decrease in diagnoses of paranoid schizophrenia, both for first admissions and for readmissions.
A recently published paper by Prioleau and colleagues has questioned whether the benefits of psychotherapy exceed those of placebo in real patients. A critique of that paper is presented drawing attention to key methodological weaknesses, to the subjective interpretation of the meta-analysis data, and to the selective and tendentious presentation of the authors' conclusions. Arguing that psychotherapy is best evaluated in relation to a limited group of conditions, and to disorders in which high efficacy is claimed, controlled studies of psychotherapy for neurotic and reactive depressive disorders are reviewed. The view that psychotherapy may have a key effect in influencing the natural history of these depressive disorders is explored.
A survey of 312 patients attending 13 Sydney general practices suggested that preparedness to accept psychiatric referral by a general practitioner related most clearly to preparedness to consult the general practitioner in the first instance and the perceived likelihood of the general practitioner suggesting a psychological problem, while the sociodemographic characteristics of the patient did not appear of relevance. Data on actual psychiatric referrals by the contributing general practitioners suggested a higher psychiatric referral by practices in lower social class regions of Sydney and a differential referral pattern, with referral to a community psychiatric facility being rare in other than low social class general practices.
The cytotoxic chemotherapeutic agent doxorubicin was found to acutely decrease platelet survival times in beagle dogs as determined using platelets labeled with [111In]oxine. Recovery was rapid, with platelet survival times returning to normal within 3 wk of cessation of treatment. Doxorubicin (1.5 mg/kg i.v. every 3 wk for a total of four doses) also delayed the return of platelet survival times to normal when given to beagle dogs following placement of thoracoabdominal aortic Dacron grafts. It is not known whether or not this may have clinical significance.
The nature and course of depressive disorders in a group of general practice patients were assessed by screening 564 subjects who attended representative practices in Sydney by means of a self-report depression inventory. Of these, 25% of women and 17% of men reported significant depressive symptoms. An interview was sought with these "potential depressives" to determine, in particular, the extent to which they might be considered to have a psychiatric disorder, using the PSE case-finding procedure. Of those interviewed, 83% scored as psychiatric "cases", while the mean duration of their depression was nine months. A longitudinal component to the study suggested that the mental condition of the sample had improved minimally at six weeks' and at 20 weeks' follow-up assessments.
Of 6052 adult patients who consulted their doctors in six Oxfordshire general practices between October 1980 and February 1981, 2110 (35%) were smokers. The smokers were allocated to one of four study groups--a control (non-intervention) group; a group that received verbal and written antismoking advice from the general practitioner; a group that received this advice and also a demonstration of exhaled carbon monoxide; and a group that received the advice plus the offer of further help from a health visitor. After one year 72% of smokers replied to a postal follow up questionnaire: 11% of the control group claimed to have stopped smoking compared with 15% in the group that received advice alone, 17% in the exhaled carbon monoxide group, and 13% in the health visitor group. Validation of these findings by assays of urinary concentrations of cotinine showed that between 24% and 40% of subjects may have misreported their smoking habits, but there was no indication that the rate of misreporting was higher in the intervention groups than in the control group. Giving advice routinely against smoking has a useful effect, and showing an immediate, personal, and potentially harmful consequence of smoking using a CO-oximeter may improve this, particularly in lower socioeconomic groups.
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A sample of 79 young women whose mothers had died in the subjects' childhood, and whose fathers had remarried, was studied to determine any effects on state and trait depression associated with modification of high and low risk parental style. Lack of care from fathers and lack of care from step-mothers were the parental variables most strongly associated with high trait depression, and almost all subjects scoring both these parents as uncaring affirmed a distinct life-time episode of depression. In a married sub-group of 63 subjects, low marital affection and low stepmother care accounted for 33% of the variance in trait depression scores, while low paternal care was no longer a significant predictor. Data for the married sub-group suggested that an affectionate husband largely corrected any diathesis to greater depression exerted by uncaring parenting, while the protective effects of caring parenting on adult depressive experience were largely undone by marriage to an unaffectionate husband.
A consecutive series of 45 women admitted to an obstetric unit were given the dexamethasone suppression test (DST) on days three to five post-partum, 82% being abnormal. The likelihood of an abnormal DST on one or both occasions increased linearly across the days of testing. Subjects completed the Beck self-report depression measure and the General Health Questionnaire at baseline and at six weeks. Baseline cortisol levels were not associated with baseline morbidity as assessed on the questionnaires and were not predictive of morbidity assessed at the six-week follow-up. It is concluded that the immediate post-partum period be included as a false-positive influence on the DST.
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Equivalent forms of Weissman's Dysfunctional Attitude Scale were assessed in 251 Australian patients routinely attending their general practitioner. Normative scores were strikingly similar to those reported in North America. The influences of demographic variables on scale scores were examined, and factor analyses suggested four key attributional constructs. In a second study of 43 clinically depressed patients we assessed the degree to which higher Dysfunctional Attitude scores might be an antecedent to, or a consequence of, greater depressive severity and found support favouring the latter explanation.
Cimetidine 200 mg three times daily and 400 mg at night was given to 10 subjects for four weeks. Apparent liver blood flow was measured by indocyanine green clearance and microsomal enzyme activity by antipyrine clearance, before and after cimetidine. There was no reduction in indocyanine green clearance but antipyrine clearance, as expected, was significantly reduced by 15% at four weeks. Chronic cimetidine treatment does not reduce apparent liver blood flow and is therefore unlikely to be of use in the treatment of portal hypertension. The cimetidine associated hepatic enzyme inhibition appears to persist with prolonged treatment. Therefore patients on chronic cimetidine remain vulnerable to certain drug interactions.
The extratemporal portion of the facial nerve is often severed by various forms of surgical and non-surgical trauma. A commonly accepted method of repair is with monofilament nylon suture, using microsurgical techniques to approximate the epineurium. A study was designed to compare the clinical and histologic success of repair using microfibrillar collagen hemostat (Avitene) with that of suture repair of the epineurium. Although the success rates of these two methods of repair of peripheral facial nerves in rabbits appear to be functionally equivalent, the histologic results show the suture repair to be superior.