Biomedical subjects

I Schweitzer

Publications and source records attributed to I Schweitzer.

72 records · Page 4Linked to original sources

PubMed1989

Is diazepam an antidepressant?

In double-blind sequential study, diazepam was compared with the proven antidepressant moclobemide, in patients with atypical depression. Both agents significantly improved depression ratings over eight weeks of treatment. Diazepam was a significantly better antidepressant than moclobemide at four week, although not at eight weeks. All patients ceased diazepam within one year and none reported withdrawal reactions. These data suggest the need to reconsider that benzodiazepines may be antidepressants and to study their possible antidepressant actions.

Adult↗

PubMed1989

The psychiatric assessment of the patient requesting facial surgery.

Recent years have witnessed an increasing demand for cosmetic or reconstructive facial surgery. This paper addresses the pre-operative psychiatric assessment of the patient requesting facial surgery. Most patients adjust well to surgery and appreciate and accept the outcome. The psychiatrist who helps to screen difficult cases needs specific skills and must understand the body image issues involved. The psychiatrist needs to evaluate the patient's motivations, expectations and understanding of the risks and implications of surgery. Potential problem patients are described, including the minimal defect patient, the patient with secondary gain from the deformity, the older patient, the patient in crisis, the polysurgical patient, the paranoid patient, the schizophrenic patient, and the male patient. Guidelines for evaluating the patient need to be applied flexibly. The psychiatrist must communicate with the surgeon to appreciate clearly the concerns the surgeon has about each patient.

Adult↗

PubMed1989

Treatment of atypical depression with moclobemide: a sequential double controlled study.

A double-blind controlled study of moclobemide and diazepam in patients with atypical depression showed both to be effective antidepressants and anxiolytics. Statistical comparison showed diazepam to be significantly better than moclobemide at week 4. However, by week 8 there was no significant difference between the two drugs for depression scores although diazepam was a significantly better anxiolytic. Side-effects were minimal, and the most common side-effects emerging for both drugs were sleep disturbance and physical tiredness.

Adult↗

PubMed1988

The dexamethasone suppression test: a study in a normal population.

One hundred healthy, non-depressed volunteers were given a standard dexamethasone suppression test (DST) to determine the appropriate criterion values of plasma cortisol to define suppression or nonsuppression. By radioimmunoassay (RIA) of cortisol, the criterion value for 5% nonsuppression was plasma cortisol greater than 187 nmol/l, and for suppression less than 153 nmol/l, with an indeterminate range between these values. Use of the widely accepted pre-determined criterion value of 138 nmol/l gave a significantly greater frequency of nonsuppression. Values of cortisol measured by two RIAs in a subset of 43 volunteers were not equivalent. With the experimentally determined criterion value, no significant differences between nonsuppressors and suppressors were found for any measured physical or psychological parameters. Women taking oral contraceptives had significantly higher plasma cortisol pre-dexamethasone and post-dexamethasone. Their exclusion did not alter the calculated criterion value for the remainder, but their separately estimated criterion value was significantly higher. Caution should be exercised when classifying the DST status of women on oral contraceptives, particularly when values are at the lower end of the nonsuppressor range. Determination of a separate normal range for them may be warranted.

Adrenocorticotropic Hormone↗

PubMed1987

The dexamethasone suppression test: importance of dexamethasone concentrations.

Plasma dexamethasone concentrations and cortisol response to dexamethasone were measured in 29 normal healthy volunteers, 23 depressed patients, and 10 patients with anorexia nervosa at 4:00 PM postdexamethasone. In each of the 3 groups, nonsuppressors had lower dexamethasone concentrations than suppressors. Of the subjects with plasma dexamethasone at or below 0.7 ng/ml, a significantly higher proportion (48%) were nonsuppressors compared to the proportion above 0.7 ng/ml (14%), all of whom were patients. Plasma dexamethasone concentrations in a subgroup of depressed nonsuppressors were high (mean 1.35 ng/ml), whereas the remainder were low (0.42 ng/ml) and were similar to the normal nonsuppressors (0.35 ng/ml), suggesting different mechanisms for nonsuppression in the subgroups. Plasma dexamethasone concentrations were similar in nonendogenous and endogenous depressives, in men and women, and in medicated and drug-free patients. None of the variables of age, weight, history of weight loss, Hamilton depression rating score, predexamethasone cortisol, or postdexamethasone cortisol were significantly correlated with plasma dexamethasone, except for body weight and a history of weight loss in the depressed group only. Mean plasma dexamethasone concentrations increased significantly from week 1 to week 2 in 7 depressed patients, whereas plasma cortisol decreased; however, the relationship between dexamethasone and cortisol varied considerably for individual patients.

Adolescent↗

PubMed1987

Prediction of outcome in depressed patients by weekly monitoring with the dexamethasone suppression test.

Forty-three depressed patients in hospital were studied with weekly dexamethasone suppression tests (DSTs) and were followed as out-patients for at least three months after discharge. The detection rate of patients with LHPA axis dysfunction increased from 41% with a single DST to 59% with serial DSTs. There was a poor correlation between weekly post-dexamethasone cortisol levels and Hamilton depression rating scores. In patients with evidence of LHPA axis dysfunction, a DST at discharge discriminated effectively between a good and a poor outcome group; persistent non-suppression was strongly linked with a relapse of depression in the first three months after discharge. In general, our results support previous claims that the DST is a state marker for depressive illness.

Depressive Disorder↗

PubMed1986

The effects of weight change on the dexamethasone suppression test in depressed and anorexic patients.

Prior studies on weight change and hypothalamic-pituitary-adrenal (HPA) axis functioning are reviewed. Data on 58 depressed and eight anorexic patients is presented. No significant difference in the frequency of cortisol non-suppression in the dexamethasone suppression test (DST) was found between depressed patients with a history of weight loss and those without, nor between depressed patients who lost weight during their first week in hospital and those who did not. Mean weight loss of suppressors did not significantly differ from that of non-suppressors. Of 12 patients whose DST normalised during their stay in hospital, only four gained weight. Five anorexics who were non-suppressors were less than 70% of their ideal body weight (IBW), while three suppressor anorexics were greater than or equal to 70% IBW. These results indicate that mild to moderate weight change is not a significant influence on DST response in depression.

Anorexia Nervosa↗

PubMed1986

Liaison consultation psychiatry with patients who have replantation surgery to the upper limb.

Thirty-eight patients who had replantation surgery to the upper limb were studied and findings, case vignettes and specific liaison-consultation issues are presented. The assessment of the patient for pre-existing psychopathology, such as drug and alcohol abuse and personality abnormalities, is emphasised; the possibility of the amputation having been a deliberate, self-inflicted act is noted; and the roles of pre-accident stress and emotional conflict are discussed. Data concerning adverse post-operative emotional reactions are presented and body-image changes, including the disruption to body integrity and the reintegration of the bodily part, are described. The psychological aspects of replantation surgery are compared to other forms of surgery, in particular amputation and renal transplantation.

Accident Proneness↗

PubMed1985

Psychological reactions and processes following replantation surgery: a study of 50 patients.

Fifty consecutive patients admitted for replantation surgery received a psychiatric evaluation. In 28 percent of the patients there was evidence of preaccident psychopathology. Fifty-four percent of the patients reported a recent stressful life event predating the accident. Fifty-four percent of the patients were assessed as having an adverse postoperative emotional reaction. The presence of preaccident psychopathology, evidence of family dysfunction, and a history of a recent stressful life event were positively linked with an adverse postoperative emotional reaction. In addition, patients with hand or arm replants were significantly less likely to require a psychiatric intervention than patients with leg replants. The psychological processes pertaining to the replantation journey are described in five stages: the preaccident period, the initial response, the stage of uncertainty, the recognition of loss, and acceptance and reintegration. Finally, the role of a liaison psychiatrist on a replantation unit is outlined and further research is strongly urged.

Adult↗

PubMed1985

Effects of taxol on microtubule organization in mouse splenic lymphocytes and on response to mitogenic stimulation.

We have used immunofluorescence staining with antibodies to tubulin and electron microscopy to examine the effects of microtubule assembly-promoting drug taxol on the organization of microtubules in unstimulated and in mitogen stimulated mouse splenic lymphocytes. A 4-h exposure to 10 microM taxol of unstimulated or stimulated cells results in an extensive reorganization of the microtubule system to form one to a few large bundles of microtubules which extend from the centrosome. Concomitantly, the centrosome is displaced from the normal position near the nucleus to a position near the plasma membrane. The Golgi apparatus is not disrupted by this treatment and also appears to be displaced in association with the centrosome. We then examined the capacity of lymphocytes with taxol-reorganized microtubules to respond to stimulation by the mitogen concanavalin A. The taxol-induced reorganization of microtubules has no effect on the increase in cell size (blastogenesis), the changes in structure of the nucleus and cytoplasm, or on the DNA replication that occurs in response to mitogen. The stimulated cells, however, do not proliferate and appear to accumulate in mitosis with the appearance of multiple asters. We conclude that all of the major events of mitogenic stimulation up to the first mitosis can occur in the presence of a highly reorganized microtubule system. Our results suggest that taxol will be a useful drug in determining those lymphocyte functions that are dependent on the presence of normal microtubule organization.

Alkaloids↗

PubMed1984

Postrhytidectomy psychosis: a rare complication.

This is the case of a middle-aged woman who had a rhytidectomy procedure that was complicated by a postoperative psychotic illness with delusional ideas. Our data suggest that this patient's peculiar vulnerability to rhytidectomy resulted from a specific disturbance of body image.

Affective Disorders, Psychotic↗

PubMed1984

Changes in organization and microtubule assembly activity of the centrosome during lymphocyte stimulation.

Changes in the organization of centrosomes in mouse splenic T lymphocytes stimulated by concanavalin A (con A) were examined by electron microscopy of serial sections. In both resting and stimulated lymphocytes the single centrosome consists of a pair of centrioles, satellite bodies, and pericentriolar material. In resting cell centrosomes the satellite bodies are preferentially associated with, and appear to be attached by short stalks to, one of the centrioles. The satellite bodies are the primary sites of microtubule termination in the resting cell centrosome. During stimulation by con A there is a several-fold increase in microtubule content. This is correlated with an overall increase in centrosome size, an apparent increase in the size and in the number of satellite bodies, and a redistribution of satellite bodies to occupy a position between the two centrioles. Increased numbers of microtubules are detected terminating on the satellite bodies and in the pericentriolar material of the stimulated cell centrosome. Microtubule assembly from centrosomes in vitro was assessed by electron microscopy using detergent-permeabilized lymphocytes that had been pretreated to remove endogenous microtubules and supplied with purified bovine brain tubulin. These studies indicate that satellite bodies are major sites of microtubule assembly in both resting and stimulated cell centrosomes and show that the centrosomes of stimulated cells assemble more microtubules in vitro than resting cell centrosomes. This parallels the increase in microtubule content in intact lymphocytes stimulated by con A and suggests that the changes in centrosome organization and microtubule assembly capacity that occur during stimulation are causally related.

Animals↗

PubMed1983

Freeze fracture through the cytoskeleton, nucleus and nuclear matrix of lymphocytes studied by scanning electron microscopy.

The technique of delaying fixation until after freeze-fracture and thawing, described in an earlier paper (Haggis & Bond, 1979), has been developed further for study of cells in culture, principally mouse lymphocytes stimulated by concanavalin A. Using a thin layer of cells, a cryoprotectant concentration of either 10% glycerol or dimethylsulphoxide, is sufficient to give good structural preservation after rapid freezing and thawing. Nuclear matrices and Triton-permeabilized cells have been prepared from stimulated lymphocytes for comparative study. Polylysine-coated fibrin support films have been found to provide a convenient means of handling cells and subcellular preparations during freeze fracture, critical point drying and mounting for high-resolution scanning electron microscopy.

Cell Nucleus↗

PubMed1982

Psychiatric aspects of replantation surgery.

The surgical literature on replant patients was reviewed and reports of psychiatric complications were noted. Data for this study were obtained from semistructured psychiatric interviews administered to 30 replant patients within a few days of admission. In addition, 24 of the patients received two or more follow-up interviews. Thirty-three percent of the patients showed evidence of preaccident psychopathology; 20% suffered from a substance use disorder. Fifty percent of the patients reported a stressful life event within the year antedating the accident. Sixty percent of the patients were assessed as warranting psychiatric intervention. The presence of preaccident psychopathology, family or marital dysfunction, previous psychiatric history, and a stressful life event were all positively associated with the occurrence of an adverse postoperative emotional reaction. Case material is presented to illustrate specific psychological issues of replantation surgery, such as those concerning body image and the disruption to body integrity. Suggestions for further research are given.

Accident Proneness↗

PubMedDate not supplied

A sequential double-blind controlled study of moclobemide and diazepam in patients with atypical depression.

A double-blind controlled study comparing moclobemide and diazepam in patients with atypical depression was carried out. Statistical comparison of the 14 pairs completing 4 weeks showed that significant reductions in depressive symptomatology as measured by the Hamilton and Carroll depression rating scales occurred in both drug groups, and that diazepam was significantly better than moclobemide. A separate analysis of the 10 pairs completing 8 weeks treatment showed that significant decreases in depression ratings occurred in both drug groups but that by week 8 there was no significant difference between the two drugs for depression scores. Side-effects were minimal, and the most common side-effects emerging for both drugs were sleep disturbance and physical tiredness.

Adult↗

PubMedDate not supplied

Risperidone versus haloperidol: I. Meta-analysis of efficacy and safety.

Haloperidol is widely considered a reference standard in antipsychotic therapy and is commonly used in comparative studies of the efficacy and safety of antipsychotic medication. Comparative clinical trials have shown that the novel antipsychotic agent risperidone tends to have greater efficacy (i.e., clinical response defined as a > or = 20% reduction in total scores on the Positive and Negative Syndrome Scale) than haloperidol in patients with chronic schizophrenia and poses less risk of extrapyramidal symptoms (EPS). We used DerSimonian and Laird's random-effects model to analyze pooled patient data from available randomized, double-masked, comparative trials of risperidone and haloperidol in patients with schizophrenia treated for at least 4 weeks at recommended doses. The purpose of the analysis was to determine whether there are significant overall differences in the rates of patient clinical response, prescription of anticholinergic agents, and treatment dropout. Six of the nine trials revealed in a literature search met all criteria for inclusion in the meta-analysis. The meta-analysis showed that in patients with chronic schizophrenia, risperidone therapy is associated with significantly higher response rates, significantly less prescribing of anticholinergic medication, and significantly lower treatment dropout rates than haloperidol. These results demonstrate the greater treatment efficacy associated with risperidone compared with haloperidol and suggest both a lower incidence of EPS and improved treatment compliance.

Antipsychotic Agents↗

PubMedDate not supplied

Risperidone versus haloperidol: II. Cost-effectiveness.

Australia and Canada are currently the only Western nations with government guidelines for analyzing the cost-effectiveness of drugs. We used guidelines issued by the Australian Pharmaceutical Benefits Advisory Committee to construct a model for comparing the cost-effectiveness of risperidone and haloperidol over a 2-year period in patients with chronic schizophrenia. Use of clozapine was also included in the analysis as an alternative treatment given to patients who proved unresponsive to therapy with haloperidol or risperidone. Results are expressed in Australian dollars. Cost-effectiveness was determined by using decision-analytic modeling to compare clinical outcomes and costs. The analytic model contained a decision tree for each of the compared agents that tracked the distribution of patients between treatment outcome pathways (i.e., scenarios). Distributions were based on probabilities derived from our meta-analysis results reported elsewhere and from other sources. Each scenario had an associated monetary cost that included all significant direct costs (i.e., hospital costs; outpatient costs; and the cost of drugs, the services of health care professionals, and government-subsidized hostel accommodation). The cost for a given outcome was the sum of costs for all scenarios leading to that outcome. Cost-effectiveness was expressed as the total cost per favorable outcome. The definition of a favorable outcome was one in which the patient was in a response phase at the end of the 2-year period. The probability of a patient experiencing a favorable outcome at the end of 2 years was 78.9% for risperidone versus 58.9% for haloperidol. The total cost of treatment for 2 years was $15,549.00 for risperidone versus $18,332.00 for haloperidol. The expected cost per favorable outcome was $19,709.00 for risperidone and $31,104.00 for haloperidol. Risperidone was more cost-effective than haloperidol and therefore was "dominant" in pharmacoeconomic terms because it produced a higher proportion of favorable outcomes at lower cost. Sensitivity analysis showed that the difference in clinical response rate was a key determinant of cost-effectiveness.

Antipsychotic Agents↗

PubMedDate not supplied

The provision of public health nursing follow-up services for postnatal clients in Ontario: a cross-sectional survey.

We did a cross-sectional survey of official health agencies in Ontario in 1990 to assess methods of providing postnatal services. The response rate was 78.6%. We found that diverse methods of postnatal follow-up are offered although home visits remain a primary mode of service delivery. There are significant differences in the timing of home and telephone visits and postnatal group sessions.

Cross-Sectional Studies↗