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Biomedical subjects

J R Neill

Publications and source records attributed to J R Neill.

At least 19 recordsLinked to original sources
PubMed1996

The cytochrome P450 2D6 (CYP2D6) enzyme polymorphism: screening costs and influence on clinical outcomes in psychiatry.

OBJECTIVES: This study examined factors that affect cost, reliability, and the value of determining the cytochrome P450 2D6 (CYP2D6) polymorphism in clinical practice. STUDY DESIGN: The method of deoxyribonucleic acid isolation, sample preparation, oligonucleotide primers, and polymerase chain reaction procedures were scrutinized for their effect on CYP2D6 genotyping efforts. The determination of the CYP2D6 A, B, D, E, and T alleles was used to identify the deficiency in CYP2D6 expression in 161 individuals phenotyped for CYP2D6 activity with dextromethorphan. The CYP2D6 genotype was assessed in 74 outpatients who had received diagnoses of depression. Eighteen of these patients were screened because of an adverse response to a tricyclic or antidepressant known or suspected to be a CYP2D6 substrate. RESULTS: The CYP2D6 A, B, C, D, E, and T alleles could be detected in 13 hours at a cost of $84 per sample by judicious selection of conditions and procedures. The genotype provided an accurate predictor of CYP2D6 expression in all 134 subjects who expressed the enzyme and in all 27 unrelated individuals phenotyped as deficient in CYP2D6 activity. In the patient group that experienced adverse effects, 44% of all CYP2D6 gene copies contained the A, B, D, E, or T allele(s) associated with inactive CYP2D6 expression. This was more than twice the rate for the occurrence of mutant alleles in the other 56 psychiatric patients (21%) and in 80 random subjects from the general population (20%; p < 0.05). CONCLUSIONS: Screening psychiatric patients for CYP2D6 expression may distinguish metabolic-based therapeutic problems from drug sensitivity caused by other mechanisms.

Antidepressive Agents, Tricyclic↗
PubMed1993

How psychiatric symptoms varied in World War I and II.

Psychiatric syndromes may be differentially expressed according to cultural expectation. An examination of the literature reveals a predominance of conversion symptoms in World War I and a relative decrease among World War II neuropsychiatric casualties. In the latter conflict, by contrast, "combat exhaustion" and psychosomatic disorders comprised the majority of non-psychotic psychiatric casualties. Determinants of this changing "vocabulary of distress" are discussed.

Combat Disorders↗
PubMed1991

'Addiction' phenomenon.

The term "addiction" has become widespread in our society. In this article, I examine the expansion of the medical addiction metaphor to numerous types of behavior. A review of the largely self-help addiction-related literature, selling tens of millions of copies per year, reveals a common path for recovery from these addictions. Understanding the addiction self-help literature can be of help in assisting our patients.

Humans↗
PubMed1989

A social history of psychotropic drug advertisements.

Psychotropic drug advertising for psychiatrists serves many purposes beyond its ostensible function of providing technical information. Medical advertising research has tended almost exclusively to use 'conspiratorial theory'--that is, they embrace the notion that one group (the advertisers) manipulates the other (the physicians). An examination of psychiatric journals from 1955 to 1980 shows the situation to be more complex. Such advertising seems to serve an orienting and therapeutic function for the physician, mirroring and supporting his professional identity or image. Such a view is in conformation with more recent research on nonmedical advertising.

Advertising↗
PubMed1987

When schizophrenia complicates medical care.

Schizophrenia may complicate effective treatment of medical problems. For example, the patient may refuse treatment or may not be competent to give informed consent. When possible, acute psychosis should be treated first; the patient may then cooperate with medical treatment. The patient's ability to give informed consent is important.

Adult↗
PubMed1983

Once more into the breach: doubts about liaison psychiatry.

The author, a consultation/liaison psychiatrist, reviews five important questions about liaison work which are pressing, but remain unanswered. With some trepidation, he seeks to temper the enthusiasm of his colleagues who, by prematurely promising more than can ever be delivered in the name of "holistic" and "biopsychosocial" medicine, may lead our discipline astray.

Humans↗
PubMed1980

Adolf Meyer and American psychiatry today.

After his death in 1950 Adolf Meyer, the "Dean of American Psychiatry," was forgotten by most in the field. As a result, his role in determining the course of psychiatry's current identity crisis remains largely unexplored. Meyer was responsible for enlarging the domain of psychiatry to include involvement in the mental health movement. He fostered a disenchantment with psychiatric diagnosis and with the current ideological pluralism. The authors suggests that there is much in Meyer's thought and work that can be applied to help resolve psychiatry's current crisis.

History, 19th Century↗
PubMed1980

Psychiatry and psychotherapy: past and future.

The place of psychotherapeutics in psychiatry is again in question. In many ways the situation recapitulates that of the late 19th century when psychotherapeutics first came upon the medical scene. The psychiatric hegemony over psychotherapeutics was the outcome of three fierce internecine "battles", (1) the "medicalization" of psychotherapeutics (1870-1910); (2) securing the psychiatric monopoly of psychotherapeutics (1890-1930); and (3) the "medicalization" of psychoanalysis (1920-1940). Three "revolutions" in psychiatry have occurred, since the stable halcyon 1950s, that have loosened the knot which binds psychotherapeutics to psychiatry. The emergence of specific psychopharmacologic therapies, the resurgence of the laboratory tradition (behaviorism) and the community-mental-health movement have diluted the importance of psychotherapeutics in treatment and widened the therapeutic franchise. In addition, there is evidence that the function of psychotherapeutics in society is itself changing. The future of psychotherapeutics in psychiatry is discussed in light of these developments.

Behavior Therapy↗
PubMed1979

Consultation evaluation: I. Psychotropic drug recommendations.

A follow-up chart review was undertaken of 100 consecutive patients seen in psychiatric consultation for whom psychotropic medication was recommended. Significant differences in implementation (P less than 0.01) by class of drugs (neuroleptics, tricyclics, benzodiazepines) were found. Most often no discernible reason for consultee disagreement could be found or inferred. The importance of such follow-up studies for consultation work is stressed.

Anti-Anxiety Agents↗
PubMed1979

The difficult patient: identification and response.

A group of "difficult" psychiatric outpatients in a university hospital system was identified and its distinguishing characteristics compared to a sample of other psychiatric outpatients not so labeled. "Difficult" patients were perceived to be significantly more demanding (p less than or equal to 0.005), dangerous, difficult to empathize with, manipulative and likely to polarize the staff. These patient were perceived differently by physician and nonphysican staff. An analysis revealed that a major source of "difficulty" appeared to be the structure of the treatment system rather than the patient. A corrective strategy was devised to test this hypothesis.

Adult↗
PubMed1978

Marital changes after intestinal bypass surgery.

A retrospective interview study was undertaken of 14 spousal pairs in which one member had undergone the intestinal bypass procedure for massive obesity. Much unanticipated marital discord occurred. Sexual problems were particularly troublesome and affected both members in the spousal pairs. The results point to the role of massive obesity as a selective and stabilizing factor in the marriages of this subset of overweight persons.

Adult↗