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J J Waldron

Publications and source records attributed to J J Waldron.

9 recordsLinked to original sources
PubMed2001

Characteristics of responders and nonresponders to brief-pulse right unilateral ECT in a controlled clinical trial.

In a double-blind, randomized controlled study of electroconvulsive therapy (ECT) in patients with major depression, 7 of the 17 patients allocated to the right unilateral group failed to respond to treatment. The nonresponders were subsequently openly treated with bitemporal treatment, which produced an acceptable outcome in these cases of right unilateral treatment failure. This paper describes the clinical outcome, electrophysiological characteristics (impedence, estimated seizure threshold, and change in threshold), and the degree to which stimuli exceeded threshold in the responder and nonresponder groups. Responders had lower seizure thresholds and longer seizures than nonresponders. In comparison with nonresponders, responders showed trends toward greater impedance and treatment at a somewhat greater degree above threshold during the first few treatments. Threshold change with treatment was found not to be related to clinical outcome. Early identification of patients likely to respond to low-dose right unilateral ECT, together with the avoidance of benzodiazepine prescription during ECT, may permit many patients to receive low-dose right unilateral ECT successfully and with a minimum of cognitive impairment.

Adult↗
PubMed2000

Electrical dose and seizure threshold: relations to clinical outcome and cognitive effects in bifrontal, bitemporal, and right unilateral ECT.

In patients allocated blindly and randomly to receive bitemporal, right unilateral, or bifrontal electroconvulsive therapy, seizure length, electrophysiologic characteristics (dynamic impedance, seizure threshold, and changes in threshold), and the degree of suprathreshold stimulation were recorded. The relations of these variables to clinical outcome and cognitive effects were determined. There were no differences in seizure length between groups, and there were no significant correlations between seizure length and any measure of clinical response. There were substantial differences between the groups in mean charge per treatment, with the right unilateral group receiving lower doses than either bilateral group. Convulsion time was inversely related to applied charge and the rate of increase in charge. There were no significant correlations between impedance, charge, energy, or rate of increase in charge on the one hand, and clinical improvement on the other. The increase in threshold during the course of treatment was not related to clinical change. Cognitive impairment was related to electrical dose only in the bifrontal group, which showed the least degree of treatment-induced intellectual dysfunction. Compared with bitemporal or right unilateral treatment, bifrontal electroconvulsive therapy yields the best ratio of benefits to side effects and should be given at threshold level to minimize cognitive loss.

Cognition Disorders↗
PubMed1995

Are the renal effects of lithium modified by frequency of administration?

It has been claimed that the unwanted effects and toxicity of lithium can be minimized by changes in the dosing schedules. Twenty consecutive psychiatrically stable patients were investigated in a cross-over study to determine whether renal function and other biochemical tests change significantly with changes from once to twice or multiple doses per day or vice versa. There were no significant differences between the 3 study conditions on the mood rating scales or a side effect scale (UKU). Urine volume, test of renal function and other biochemical and hematological indices were similar in all study conditions. We thus conclude that dosing strategy does not consistently affect renal function in lithium-treated patients.

Adult↗
PubMed1993

Therapeutic advantage of bifrontal electrode placement in ECT.

Fifty-nine patients suffering from a major depressive episode, for whom electroconvulsive therapy (ECT) was clinically indicated, were randomly assigned to one of three electrode placement groups for treatment with brief pulse, threshold-level ECT: bitemporal (BT), right unilateral (RU) or bifrontal (BF). Comparison of these groups in terms of number of treatments, duration of treatment, or incidence of treatment failure, showed that the bilateral placements were superior to the unilateral; comparison of Hamilton, Montgomery-Asberg, and visual analogue scale scores showed that the bifrontal placement was superior to both bitemporal and unilateral treatment. Bitemporal treatment showed therapeutic results intermediate between BF and RU. Because BF ECT causes fewer cognitive side effects than either RU or BT, and is independently more effective, it should be considered as the first choice of electrode position in ECT.

Adult↗
PubMed1990

Sleep deprivation in depression: pattern of relapse and characteristics of preceding sleep.

The pattern of relapse following therapeutic response to 40-hr sleep deprivation (SD) was examined in nine depressed patients. On the night ending SD patients were awakened from polygraphically recorded sleep on one or more occasions, in order to assess the clinical state. All subjects were found to demonstrate a precipitous and full relapse over this night, the timing of the relapse varying considerably between individuals. No association was found between deterioration in the clinical state and characteristics of preceding sleep. These results are consistent with the notion that, in predisposed individuals, some process associated with sleep has a depressogenic effect. However, they necessitate revision of theories of SD and depression that emphasize the infrastructure of sleep.

Adult↗
PubMed1990

Electrode placement in ECT: cognitive effects.

Forty patients suffering from a major depressive disorder, for whom electroconvulsive therapy (ECT) was clinically indicated, were assigned to one of three electrode placement groups: bitemporal (BT), right unilateral (RU) or bifrontal (BF). Comparisons of these groups in terms of cognitive status showed that the BF placement, which avoided both temporal regions, spared both verbal and nonverbal functions. These differential effects, which were independent of the degree of clinical depression, were not, however, evident three months after the last ECT.

Adult↗
PubMed1982

The ATP 30-a scale for measuring medical students' attitudes to psychiatry.

The development and validation of a thirty item, Likert-type scale designed to measure medical students' attitudes to psychiatry-the ATP-30 (Attitudes Toward Psychiatry-30 items)-are described. We had hoped to demonstrate that 'attitude to psychiatry' was not a unitary matter but an amalgam of attitudes to a number of things to do with psychiatric practice. This hope was not fulfilled, as a unitary dimension was obtained. A positive change in the attitudes of students toward psychiatry was demonstrated in third and fourth medical year students in relation to exposure to psychiatry. Such a change was not demonstrable in two classes of occupational therapy students exposed to a course in psychiatry. The reasons for this difference between medical students and occupational therapy students are discussed-there possibly being important implications here for psychiatric curriculum planning in medical school. Lastly, we have demonstrated that the positive change in attitudes amongst medical students was transient rather than lasting-a matter which most studies of attitude change do not address. In spite of the apparent impermanence of the positive change in attitudes among medical students, there are a number of possible used to a scale such as the ATP-30, and these are discussed.

Attitude of Health Personnel↗
PubMed1975

A new type of facility in medical education: the Clinical Learning Center.

The two independent forces leading to the development of a new type of facility for medical education were the desire to utilize modern educational concepts (some of which are difficult to employ in traditional hospital settings) and the need to expand students' contact with clinical patients. This special facility, known as the Clinical Learning Center, resembles the ultimate setting of medical practice, that is, the physician's office, and it depends upon volunteer patients who come there primarily to contribute to the educational program while deriving no medical care. Students and instructors have appreciated the opportunity for feedback; the quiet educational environment; the graduated learning experiences; and the use of various resources, especially videotape recording and playback of the clinical encounter. The recruitment of volunteer patients has been highly successful, and the center is proving to be a valuable adjunct to the learning of clinical skills.

Attitude↗