Biomedical subjects
Publications and source records attributed to J M Murphy.
We report our experience with 20 patients who developed a rash shortly after the introduction of carbamazepine and were treated with prednisone and an antihistamine. Sixteen patients were successfully continued on carbamazepine while 4 had to discontinue the drug.
Neurochemical and neuropharmacological studies were undertaken to assess the involvement of CNS serotonin (5-HT) and dopamine (DA) pathways in regulating the alcohol intake of rats selectively bred for their high alcohol seeking behavior (P and HAD lines). Neurochemical data indicate that high alcohol seeking behavior (when compared with data from rats with low alcohol seeking characteristics) is associated with (a) lower contents of 5-HT in certain limbic regions, e.g., n. accumbens (Acb), frontal cortex, (b) a lower content of DA in the Acb, and (c) higher densities of 5-HT1A receptors in certain limbic regions, e.g., cerebral cortex. Neurochemical data also suggest that ethanol can activate the DA and 5-HT systems projecting to the Acb. Neuropharmacological studies demonstrated that local microinfusion of a 5-HT agonist into the Acb of the P line of rats enhanced ethanol drinking. Intracranial self-administration studies established that P rats will self-administer ethanol directly into the ventral tegmental area (VTA). Overall the data suggest the involvement of certain VTA DA and dorsal raphe nucleus 5-HT pathways in regulating high alcohol drinking behavior.
The effects of dopamine antagonists microinjected into the nucleus accumbens (Acb) on alcohol-drinking behavior were studied in the selectively bred alcohol-preferring (P) line of rats. P female rats (N = 8) were given access to food and water ad lib, while availability of a 10% (v/v) ethanol solution was limited to 1 hr/day. After implantation of guide cannulas bilaterally into the Acb and recovery from surgery, the rats were microinjected with either the D1 antagonist SCH 23390 (0.1 to 2.0 micrograms/side), the D2 antagonist sulpiride (0.1 to 2.0 micrograms/side) or vehicle, and ethanol intake was monitored. The D1 antagonist SCH 23390 had little effect on alcohol intake although the 0.5 ug/side dose produced a small increase which was not statistically significant. The D2 antagonist sulpiride increased, in a dose dependent manner, the intake of ethanol to as high as 215% of control values (F(4,28) = 39.9; p < 0.001). Additional experiments indicated that the 2.0 micrograms/side dose of sulpiride did not alter the consumption of a 14% glucose nor a 0.25% saccharin solution. These data suggest that D2 receptors in the Acb are important in the regulation of alcohol drinking by the P line of rats.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Depression and anxiety disorders were studied in a longitudinal investigation of a general population. These disorders were identified through responses given in a structured psychiatric interview carried out as part of the Stirling County Study. A 16 year follow-up indicated that depression carried a significantly worse prognosis than anxiety, as measured in terms of mortality risk and the likelihood of becoming a chronic or recurrent illness. When morbidity and mortality information were brought together, it was found that 82% of those who were depressed at the beginning of the study had a poor outcome. This suggests that depressions found in the community, where most of them remain untreated, are similar in seriousness to those seen by psychiatrists in outpatient clinics and mental hospitals. It seems likely that general physicians can play a useful role in caring for such depressions, especially if physicians become alerted to the risks associated with these illnesses.
Explore the source record for details and available documents.
The ability to interview is an essential skill that continues to develop throughout a pediatrician's professional life. Interviewing is a complex procedure that requires in-depth understanding of medical illness, child development, individual and family dynamics, cultural variations, and self-awareness--your personal values and response to crisis, serious illness, and stress. Interviewing is learned by thoughtful reflection of each interview as well as more formally through the use of videotape and attending observation. Each interview is an opportunity to develop a relationship and add a bit of experience that is unique to the patient or parent and potentially useful in understanding more in the future. Although this procedure receives little formal attention, the interview is often the primary vehicle for making the diagnosis, relating to the child and family, and easing emotional suffering and can be a source of satisfaction for the many hours of hard work.
Explore the source record for details and available documents.
The effectiveness of desmopressin (1-desamino-8-D-arginine vasopressin) in reducing intraoperative blood loss during lumbar fusions was investigated in 42 patients (52 operations) and compared with a control group of 55 patients (63 operations). The mean hemoglobin and hematocrit levels on admission and discharge were identical for both groups. Patients receiving desmopressin required less than one-half the number of autologous transfusions than the control group. Desmopressin was effective in reducing blood loss in operations in which intraoperative bleeding was greater than 1,000 milliliters, but it is probably not necessary for anticipated losses less than this amount. It may have a role in operations performed on short notice when autologous blood is usually unavailable.
This chapter brings together evidence indicating the involvement of serotonin (5-HT) in ethanol preference using data mainly obtained from selectively bred alcohol-preferring and alcohol-nonpreferring lines of rodents. Although several laboratories have established rodent lines that will consume large quantities of ethanol daily, only one line thus far has been established that satisfied all the criteria for an animal model of alcoholism and that would be suitable for studying the biological basis of ethanol preference. This is the P line of alcohol-preferring rats that: (1) freely consumes 5-9 g ethanol/kg body wt/day; (2) drinks sufficient alcohol to produce intoxicating blood alcohol concentrations; (3) works to obtain alcohol; (4) self-administers ethanol for its CNS pharmacological effects; and (5) develops chronic tolerance to and dependence on alcohol with free-choice drinking. Relative to the NP line of alcohol-nonpreferring rats, the P rat has lower 5-HT levels in several CNS regions, including some, such as the nucleus accumbens, hypothalamus, and frontal cortex, which are involved in the brain reward circuitry. Furthermore, both acute and chronic ethanol administration have effects on the 5-HT pathway from the dorsal raphe nucleus to the nucleus accumbens in the P rat. Pharmacological studies have demonstrated that fluoxetine, a serotonin uptake inhibitor, reduced the oral consumption or intragastric self-administration of alcohol in the P rats. In addition, administration of a 5-HT1B agonist also attenuated the oral intake of ethanol by P rats. It is hypothesized that the serotonergic pathway from the dorsal raphe nucleus to the nucleus accumbens is involved in the reinforcing actions of alcohol in the P line of rats.
As part of the Stirling County Study (Canada), general physicians were interviewed to identify the psychiatric disorders experienced by a sample of adults selected in 1952. Based on information about vital status gathered 16 years later, we found that those with a psychiatric disorder at the beginning of the study experienced 1.6 times the expected number of deaths. The effect in regard to premature mortality and accidental deaths was particularly strong. Four of six categories of psychiatric diagnoses were significantly associated with mortality. In terms of standardized mortality ratios, depression had the highest and anxiety the lowest risk in this general population. The findings are discussed as providing historical background from the 1950s and 1960s for studying trends.
The present study was undertaken to determine if spiroxatrine, a reported 5-HT1A antagonist, could block the attenuating effects of fluoxetine (a 5-HT uptake inhibitor) on voluntary ethanol intake by the selectively bred alcohol-preferring P line of rats. Fluoxetine (10 mg/kg, IP) significantly reduced the intake of 10% ethanol by P rats approximately 50% during the 4-hour period of alcohol availability. Spiroxatrine (4 mg/kg, IP) was without effect on ethanol intake when given alone. However, when given 5 minutes before fluoxetine (10 mg/kg, IP), this dose of spiroxatrine augmented the reduction of ethanol intake to approximately 15% of control values after 4 hours. Similar experiments conducted with 1 mg/kg (IP) 8-hydroxy-2(di-N-propylamino) tetralin (DPAT) demonstrated that this 5-HT1A agonist also enhanced the attenuating effects of fluoxetine on ethanol intake. Likewise, spiroxatrine augmented the DPAT reduction of alcohol intake. Spiroxatrine enhanced the effect of DPAT and fluoxetine on food intake as it did on ethanol intake. The results suggest that spiroxatrine behaved as a partial agonist and/or modulator and not as an antagonist at 5-HT1A receptors under the present experimental conditions.
Examined the validity of the Pediatric Symptom Checklist (PSC), a brief parent-completed psychosocial screening questionnaire, in a sample of 166 students from a public middle school. Positive screening on the parent PSC was significantly associated with independent ratings by the students' guidance counselor and teachers of the need for regular counseling; any academic failure during the next 2 years; and PSCs competed by the students about themselves. Most students who screened positive on the parent PSC were found to have significant problems in at least one of the above areas. The PSC also identified a group of students whose difficulties were previously unknown to school personnel. For pediatric psychologists, guidance counselors, and pediatricians who need to identify middle-school students with serious psychosocial problems, the PSC appears to be a valid and useful first-stage screening instrument.
Recent medical and surgical advances allow many severely burned patients to survive who formally would have died. Assessment of psychiatric outcomes with these patients may provide ways of measuring effects of acute burn care methods on later quality of life, specify more accurately their emotional needs during rehabilitation, and stimulate further research. Thirty children, aged 7 to 19, with severe burns are compared with 30 nonburned subjects matched for age, sex, SES, and parents' marital status according to DSM-III criteria. The burned children had significantly higher levels of overanxious disorder, phobias, and enuresis, but they had the same rates of present depressive disorders.
The results of a diagnostic outcome study of children and adolescents with severe burns are presented. The positive research findings include evidence of present and lifetime full and partial anxiety and depressive disorders and statistically significant within-sample, burn-related, and demographic differences. The negative findings are less depression and post-traumatic stress disorder by DSM-III criteria than expected, the presence of a subgroup of severely burned children who appeared to be functioning well with only a few or no diagnoses, and absence of significant differences on many variables on within-group comparisons. Based on these data, periodic psychiatric evaluation or reevaluation and specifically targeted followup treatment are indicated for many burned children, adolescents, and their families.
Self-administered screening questionnaires are available to assist primary care physicians in detecting undiagnosed depression and anxiety disorders. This study used receiver operating characteristic (ROC) analysis to evaluate three such tests: the General Health Questionnaire (GHQ), the Mental Health Inventory (MHI), and the Somatic Symptom Inventory (SSI). Stratified by the results of a preliminary GHQ, 364 health maintenance organization (HMO) members were given these tests and a Diagnostic Interview Schedule (DIS), the latter used as a "truth" standard for current psychiatric diagnosis. The MHI performed significantly better than the GHQ in detecting mental disorders generally and anxiety disorders in particular, and somewhat better in detecting affective disorders. The SSI performed best in detecting anxiety disorders and was significantly better than the GHQ. When subjects who had participated in a previous study involving repeated GHQ administration were excluded, sensitivity of all tests improved, especially the GHQ. We conclude that the MHI can be a useful tool for screening primary care patients, and that the SSI has additional predictive value with respect to anxiety disorders.
Explore the source record for details and available documents.