Search PubMed⌕ Search

Biomedical subjects

J W Tiller

Publications and source records attributed to J W Tiller.

At least 19 recordsLinked to original sources
PubMed1998

Liability in prescribing choice: the example of the antidepressants.

OBJECTIVE: The aim of this study is to review issues of legal liability in prescribing choice. Prescribing not only occurs in a medical setting, but also in a social and legal context in this era of evidence-based medicine and greater consumer awareness. Prescribers may be unaware of the legal consequences of medical decision-making and prescribing choice. This issue affects all areas of medicine and can be illustrated by antidepressant choice for major depression. METHOD: A review was undertaken of liability issues that may arise in the context of prescribing, with particular reference to prescribing antidepressants. RESULTS: There are legal precedents which illustrate prescribers' potential liability. These impose duties on the prescriber including those of care, to inform, and to respond to patients' wishes. In particular, the duty of care requires that if medicines are of equal efficacy, one should prescribe the best tolerated and least toxic medicine that is most likely to be taken at an effective dose for an adequate duration. While older and newer antidepressants are generally of equal efficacy, the newer agents have higher tolerability, lower toxicity and are less likely to be associated with treatment failure (due to sub-therapeutic dose regimens, or the patient discontinuing medication), disabling psychomotor impairment, dietary interaction or fatal overdose. CONCLUSIONS: There needs to be compelling reasons for prescribing medicines with a greater likelihood of adverse outcomes such as the older antidepressants (e.g. tricyclics) rather than the newer antidepressants such as RIMAs, SSRIs, SNRIs and 5HT2 receptor antagonists. The higher likelihood of an adverse outcome of treatment where an older antidepressant has been prescribed raises the potential for professional negligence claims to be brought against medical practitioners who prescribe such medicines for reasons other than established medical need.

Antidepressive Agents↗
PubMed1998

Perception of natural fluctuations in peak flow in asthma: clinical severity and psychological correlates.

Two methods of defining perception of asthma-related changes in airflow were compared, and relationships to clinical opinions of severity and assessments of psychological functioning were investigated. Perceived breathlessness (VAB) and peak expiratory flow (PEF) were recorded by 100 subjects for 28 days. Perception was defined by correlation of the two values and by the ratio of maximum change in PEF and related change in VAB. The latter method defined 24 poor perceivers (PP) and 13 exaggerated perceivers (EP), in whom presence of a psychological disorder was high (30% of PP, 54% of EP, compared to 8% of the remainder). Clinical severity in EP was assessed as greater than appeared warranted.

Adult↗
PubMed1997

Moclobemide for anxiety disorders: a focus on moclobemide for panic disorder.

Moclobemide is a reversible selective inhibitor of monoamine oxidase A. It has proven efficacy in a wide range of depressive disorders, including agitated anxious depression. In an international, multicentre, double-blind parallel-group study, the tolerability and efficacy of moclobemide were compared with that of the selective serotonin reuptake inhibitor fluoxetine. The target dose of moclobemide was 450 mg/day in the dose range of 300-600 mg/day, while the target dose for fluoxetine was 20 mg/day in the dose range of 10-30 mg/day. There were two consecutive studies. The first was an 8-week short-term study of acute adverse events, tolerability and efficacy. The efficacy data showed no significant difference between moclobemide and fluoxetine. Evaluation of the tolerability in a long-term study of up to 1 year is still in progress. A review of the moclobemide safety database for panic disorder with 624 patients showed a marginal increase in events with moclobemide compared with placebo for insomnia (11.2%), dizziness (4.5%) and dry mouth (3.7%), with rates for headaches and nausea lower for moclobemide than placebo. These data suggest moclobemide is a well tolerated and effective treatment for panic disorder.

Adult↗
PubMed1995

Moclobemide for depression: an Australian psychiatric practice study.

Seven hundred twelve patients meeting DSM-III-R criteria for major depression and recommended for antidepressant treatment were treated with moclobemide as outpatients (88%) or inpatients in ordinary psychiatric practices. These differ from the highly selected patients usually studied in antidepressant research, without comorbidity, or coprescription and treated in special clinics. Sixty-five percent were women, with a mean age of 45 (+/- 13.6) years, and 88% were outpatients. Eighty-eight percent had preexisting depression. Eight percent had prior manic episodes. Previous antidepressant treatment for this episode had been received by 69%, with the most common reasons for change to moclobemide being inadequate response (66%) and poor tolerability (20%). The modal final dose was 450 mg. Regarding tolerability, 52% did not report adverse events. The most common adverse events were insomnia or stimulation (13%), nausea (11%), headache or migraine (11%), dizziness or disorientation (6%), sedation or drowsiness (5%), agitation or nervousness (3%), and diarrhea (3%). Only 10% of adverse events were severe, and 83% lasted less than 2 weeks. There was no difference when moclobemide followed fluoxetine use. Most adverse events did not significantly differ from the frequencies reported in double-blind placebo-controlled studies. Concomitant medications from all major drug groups were taken by 520 patients (73%), with no adverse interactions. Moclobemide overdose resulted in an uneventful recovery, whereas mixed overdoses caused no problems other than those attributable to coprescribed medication. On physician clinical global impression, 65% were moderately improved or better after 8 weeks.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

Youth suicide in Victoria: a retrospective study.

OBJECTIVE: To determine the trends in youth suicide in Victoria and Australia as a whole, and their relation to youth unemployment. DESIGN: We used Australian Bureau of Statistics data to analyse suicide trends between 1907 and 1990 in young people aged 15-24 years and made an in-depth study of youth suicides between 1980 and 1990, for which computerised data are available. RESULTS: There has been a steady increase in youth suicide both in Victoria and Australia as a whole since 1960 in males but not females. There were significant differences in age, sex and area of residence in both the rate and the method of suicide. The increase in youth suicide was not associated with the rise in unemployment. Male (not female) suicide rates were higher in non-metropolitan areas and areas of high youth unemployment. The reasons for the increase in youth suicide remain obscure. CONCLUSIONS: There is a need for a prospective in-depth study to determine factors in the aetiology of youth suicide, with particular reference to possible areas for prevention.

Adolescent↗
PubMed1993

Clinical overview on moclobemide.

1. Moclobemide is a novel benzamide reversible inhibitor of monoamine oxidase A and has clinical efficacy in a wide spectrum of depressive illness including endogenous and non-endogenous depression, in younger adults and in the elderly. 2. Comparisons have shown similar efficacy to all main classes of antidepressants and much greater tolerability and safety in overdose than tricyclic antidepressants. Clinically, it is neither sedative nor alerting. 3. There is no need for dietary restrictions for patients on moclobemide on a normal diet, and drug interactions are few and usually mild. Specific cautions are noted with pethidine and with selective serotonin re-uptake inhibitor antidepressants. 4. Moclobemide is a useful addition to the range of antidepressants in clinical practice.

Animals↗
PubMed1992

Post-stroke depression.

Depression is present in 25-30% of stroke patients: though associated with physical disability and loss of function, it cannot be explained simply as a response to the disability. The severity of depression correlates with proximity of the lesion to the left anterior frontal pole, while right hemisphere lesions show the reverse trend. Post-stroke depressions may last more than 7-8 months without treatment, and are highly correlated with a failure to resume premorbid social and physical activities. However, this is a group of patients whose recovery could be hastened by appropriate antidepressant treatment, though most antidepressants are of limited value in the treatment of these patients, because of side-effects or possible toxicity. Since moclobemide has few side-effects it may be uniquely well tolerated in this group of patients, having proven efficacy for both endogenous and reactive depressions.

Cerebrovascular Disorders↗
PubMed1991

Plasma cortisol and 11-deoxycortisol activity in depressed patients and normal volunteers.

Plasma cortisol and 11-deoxycortisol were measured in 30 depressed patients and 110 normal volunteers before and after a 1.0 mg dexamethasone suppression test (DST). Post-dexamethasone plasma cortisol, 11-deoxycortisol and the cortisol/11-deoxycortisol ratio were significantly higher in the depressives compared to the controls, even when age and sex were taken into account. Pre-dexamethasone plasma cortisol, post-dexamethasone cortisol, 11-deoxycortisol and their ratio were significantly higher in the cortisol nonsuppressors than in the suppressors. The measurement of post-dexamethasone 11-deoxycortisol and the ratio did not differentiate between endogenous and reactive depression. Using the normative data, we explored several methods for determining a criterion value to define abnormal post-dexamethasone plasma 11-deoxycortisol and the cortisol/11-deoxycortisol ratio in depressed patients. All showed poor sensitivity and a low positive predictive value for depression. The measurement of 11-deoxycortisol thus does not enhance the clinical utility of the DST.

Adult↗
PubMed1991

Obtaining outpatient referrals for clinical research.

Two methods of recruiting patients with generalised anxiety disorder (GAD) were compared. One hundred general practitioners in the immediate neighbourhood of a major urban hospital were approached for referrals, and an article on generalised anxiety asking for volunteers was placed in the evening newspaper. The former resulted in ten doctor-initiated referrals, two of whom fulfilled DSM-III criteria for GAD. The latter resulted in over 500 volunteers. In a random selection of 136 volunteers who secured their doctors' approval, 56 fulfilled GAD criteria. The majority of the remainder had a depressive illness. The newspaper article was more economical of researchers' time and more successful in finding suitable subjects than directly approaching general practitioners.

Adult↗
PubMed1990

Dexamethasone kinetics in depressed patients before and after clinical response.

Dexamethasone pharmacokinetics were measured in 19 depressed patients, 10 dexamethasone suppression test (DST) nonsuppressors and nine suppressors, following a 1 mg oral dose in tablet form at 2300 h. Median dexamethasone concentrations were significantly lower in the nonsuppressors from 3-16 hr post-administration. Nonsuppressors had a significantly lower area under the curve than suppressors, and plasma clearance was significantly faster in the nonsuppressors than in the suppressors. Eleven patients, six nonsuppressors and five suppressors, agreed to a repeat DST after clinical improvement when all six nonsuppressors had normal DST responses. There were no significant differences between the median dexamethasone concentrations, or any of the pharmacokinetic parameters measured, of the "normalising" nonsuppressors and the suppressors. Dexamethasone kinetics were altered in depressed nonsuppressors but became normal with remission of depressive symptoms and normalisation of the DST response.

Adult↗
PubMed1990

Reactions of first-year medical students to their initial encounter with a cadaver in the dissecting room.

This study reports the results of a 1986 questionnaire survey of 100 first-year medical students regarding their preparation for and reactions to their first encounter with a human cadaver in the dissecting room. The students were aware of psychological and physical reactions to this experience, and although they felt adequately prepared prior to the class, expressed a desire for greater preparation afterwards, particularly through more discussion of the experience with the anatomy staff. A surprising number of the students (62) had had prior exposure to a dead human body, which was a significant influence upon their reactions. The results of this study suggest a need for improving both the preparation for coping with dissection and the follow-up opportunities for dealing with professional and emotional issues raised during human dissection.

Adaptation, Psychological↗
PubMed1990

Antidepressants, alcohol and psychomotor performance.

The acute psychomotor effects of moclobemide, a reversible inhibitor of MAO-A antidepressant (100 and 300 mg) compared with amitriptyline (25 and 75 mg) showed that moclobemide caused no significant impairment in contrast with amitriptyline, which caused significant impairment at both doses. Two other studies are reviewed. One study reported the acute effects of moclobemide (100 and 300 mg), trazodone (100 mg), placebo, and alcohol (0.5 g/kg) or placebo in an elderly group: moclobemide caused little impairment or alcohol potentiation and may reverse some alcohol impairment, whereas trazodone caused substantial impairment and alcohol potentiation. Another study of the acute and chronic effects of moclobemide (200 mg 3 times daily) or clomipramine (25 mg twice daily) and their interactions with alcohol (blood alcohol concentration 0.6 g/l) showed that alcohol caused significant impairment, whereas clomipramine tended to enhance and moclobemide to reduce some impairment. Moclobemide appears to be an antidepressant with few psychomotor effects and minimal alcohol potentiation and may reduce some alcohol impairment.

Antidepressive Agents↗