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Biomedical subjects

J Ennis

Publications and source records attributed to J Ennis.

At least 37 records · Page 2Linked to original sources
PubMed1988

Suicide attempts and resuscitation dilemmas.

The conventional psychiatric opinion that suicide is a manifestation of psychiatric illness may not apply to circumstances in which suicide or the refusal of life-sustaining medical treatment results from the rational decisions of autonomous individuals. As medical technology advances, questions about the prolongation of life and the discontinuation of medical treatment have become commonplace in the medical setting. In this context, contradictions may exist between the principle of patient autonomy and that of physician responsibility. Dilemmas about treatment decisions that emerge from these conflicting perspectives are highlighted in this article. We report two cases of attempted suicide in the context, respectively, of (1) terminal illness and (2) advanced age. Some of the complex psychiatric, ethical, and legal issues related to the case reports are addressed.

Acquired Immunodeficiency Syndrome↗
PubMed1988

General practice patients on long-term psychotropic drugs. A controlled investigation.

In a health centre, 3.6% of the registered patients were found to have received at least one prescription for psychotropic drugs in each quarter of a year. These patients were mainly elderly and female. Psychiatric interviews were held with randomly selected index patients, and with matched controls. Most index patients reported taking psychotropic drugs for several years, mainly anxiolytics, antidepressants and non-barbiturate hypnotics, and mainly in low dosage. Index patients had much higher levels of psychiatric morbidity, as shown by the Present State Examination, history of specialist psychiatric treatment, and previous drug overdoses. In index patients the main diagnoses were neurotic depression and phobic disorder. Index patients reported more problems with finances and with social isolation.

Adult↗
PubMed1986

Cohort analysis of Ontario suicide rates, 1877-1976.

Birth cohort studies of suicide rates in Alberta, the United States and Australia indicate that within each generation, suicide rates increase with age. Such studies argue that cohort-specific suicidal risk, together with present high suicide rates among young people predict even higher rates as these generations grow older. Ontario data from a 100-year period demonstrate that within birth cohorts suicide rates consistently increase with age, peak between ages 50 and 70, then decline. Gradual increases in mean suicide rates result in every birth cohort having higher suicide rates than the preceding cohort at almost every age level. These trends combine to produce a regular birth cohort effect and a steady shift in cross-sectional data to higher rates of suicide among younger age groups. Abrupt increases in suicide rates occurring during the Great Depression had only transient effects on birth cohort and cross-sectional curves. Results provide weak support for the hypothesis of cohort-specific suicidal risk and clarify the factors which produce birth cohort effects.

Adolescent↗
PubMed1985

Management of the repeatedly suicidal patient.

Although repetitive suicidal behaviour is commonly encountered, a relatively small number of very difficult patients engage in it. These individuals suffer primarily from severe personality disorders, as well as alcoholism and drug abuse. They are at high risk for eventual suicide. Although as a group they receive a great deal of hospital treatment, inpatient management is fraught with difficulties. Extended inpatient treatment is unlikely to be of benefit and may perpetuate the behaviour by leading to regression and excessive dependence on hospitalization. A model of management is described which couples the use of a brief-stay, crisis, inpatient unit and community-based outpatient treatment. Communication between institutions and agencies involved in the patient's care as well as coordination of services is essential. Acceptance by therapists of the risk of suicide and the realistic limitations to meeting these patients' needs can help such patients assume more responsibility and independence.

Adolescent↗
PubMed1985

The dexamethasone suppression test and suicidal patients.

The dexamethasone suppression test (DST) was used in an in-patient crisis unit to determine whether the test could identify suicidal patients who might benefit from tricyclic antidepressants. DST results, DSM-III diagnoses, and measures of symptom levels were obtained for 72 patients admitted for a 3-5 day period; 31 were non-suppressors. Abnormal DST results were not related to DSM-III diagnosis or to scores on measures of depression and symptom levels. Only three patients met DSM-III criteria for major depression with melancholia; 26 patients had a diagnosis of alcohol or substance abuse. The poor specificity of the DST in this patient population suggests that its routine use in such patients could be highly misleading.

Adolescent↗
PubMed1984

The effects of non-prescribing of anxiolytics in general practice. I. Controlled evaluation of psychiatric and social outcome.

Ninety one patients with new episodes of minor affective disorder were selected by their general practitioners as suitable for anxiolytic medication. Half the patients were allocated randomly to a drug-group (anxiolytic medication), and half to a non-drug group (brief counselling without anxiolytics). Psychiatric and social assessments were made (i) at initial consultation when treatment was started; (ii) one month later; (iii) seven months later. Before treatment the two groups were similar on all main variables. On the General Health Questionnaire, 85 per cent of patients were psychiatric cases before treatment, 40 per cent at one month and 30 per cent at seven months. Similar improvements were found with other measures of psychiatric state (Profile of Mood States; Present State Examination) and social functioning (SAS-M). Improvements were similar and parallel in the two groups. Neither group of patients increased their consumption of alcohol, tobacco or non-prescribed drugs. The non-drug group did not make increased demands on the doctors' time.

Adult↗
PubMed1983

Self-harm: 2. Deliberate nonfatal self-harm.

The incidence of deliberate acts of self-harm, such as drug overdoses, has greatly increased in the past two decades. The term "suicide attempt" is really a misnomer. For most people who harm themselves the primary motivation is rarely to die. As well, there are many differences between self-harm patients and patients who have committed suicide. The former tend to be characterologically disturbed and socially disadvantaged. Intervention narrowly focused on suicide prevention will lead to lengthy hospital stays in high-risk cases and ineffective treatment for most self-harm patients, who tend not to comply with outpatient treatment. Crisis-oriented intervention with a brief hospital stay in all cases of self-harm may provide more effective assessment and management.

Canada↗
PubMed1983

Self-harm: 1. Suicide.

Although suicide rates have remained relatively stable, the risk of suicide has increased among 25- to 35-year-old men. Attempts to understand suicide fall into three major frameworks: sociologic theories, psychologic theories and the relation of suicide to psychiatric illness. The risk of suicide can be assessed by means of a relatively simple clinical interview. Since most suicide victims consult their family doctors within the month before their death, physicians are in a unique position to prevent suicide. Routine assessment of the risk of suicide among patients who appear depressed or are undergoing an emotional crisis can lead to accurate diagnosis and effective intervention. Similarly, the appropriate use of psychotropic medication can lead to effective treatment while minimizing the risk of a lethal overdose.

Age Factors↗
PubMed1981

Stopping life-sustaining medical treatment: psychiatric considerations in the termination of renal dialysis.

Data are presented regarding the decision by medical staff and by patients to discontinue renal dialysis. Some relevant issues regarding the patients are discussed, including their mental competence, underlying motivation and psychiatric state. Also some of the medical factors involved in the decision to stop treatment are considered. Emphasis is placed on the importance of the patients's sense of active participation and involvement in his treatment. Mention is made of the importance of interventions to decrease the psychological morbidity in survivors of patients who stop dialysis.

Anxiety↗
PubMed1980

Interstitial 3p deletion in a child due to paternal paracentric inserted inversion.

An infant with multiple anomalies and developmental delay during his first year was found to have an intersitital deletion of band p14 from the proximal short arm of chromosome 3. Examination of the father's chromosomes indicates an "inserted paracentric inversion" in chromosome 3 as the probable origin of the deletion in the child.

Abnormalities, Multiple↗
PubMed1978

The value of flexor hinge hand splints.

Functional hand splints have been in use in a number of spinal injury units in the USA since the early 1950s. The splints are designed to provide a pinch-grip either by harnessing wrist dorsiflexion or by external power. Such devices are little used in the United Kingdom. This paper describes the results of late provision of 62 such splints in a Disabled Living Unit. A proportion of tetraplegic patients found such splints of considerable functional value. It is estimated that some 30--60 patients each year would benefit from them if appropriate facilities for early fitting were available.

Adolescent↗