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Biomedical subjects

K Rickels

Publications and source records attributed to K Rickels.

At least 163 records · Page 9Linked to original sources
PubMed1985

Six-week trial with diazepam: some clinical observations.

Side effects, improvement, and predictors of response were examined in 295 patients treated for greater than or equal to 1 week with diazepam; 234 of these patients completed 6 weeks of treatment. The greatest improvement occurred during the first week of treatment. Sedation was the predominant side effect. Predictors of improvement included low educational level, lack of previous treatment, presence of precipitating stress, low occupational and/or family adjustment, low levels of trait anxiety, and high levels of state anxiety.

Adult↗
PubMed1985

Evaluating premenstrual symptoms in medical practice.

Essential diagnostic criteria for evaluating premenstrual syndrome (PMS) symptoms are marked change in intensity of symptoms measured on postmenstrual and premenstrual days and documentation of changes for at least two cycles. Four symptom evaluation methods in a PMS treatment program are compared and discussed: physician interview, menstrual symptom questionnaire, daily symptom ratings, and the Hopkins symptom checklist. Data from 241 patients who met the criteria for marked change in symptoms show that premenstrual symptom levels are severe, a subgroup has moderate symptoms continuing in the follicular phase, and that emotional symptoms are predominant. Diagnostic evaluation needs to distinguish menstrually related disorder from undiagnosed physical or psychiatric illness. Further research is needed to identify a classification system of multiple subtypes of menstrual disorders.

Adult↗
PubMed1985

Influence of maternal attitudes on urban, black teens' decisions about abortion v delivery.

Two hundred thirty-one inner city black teenagers, aged 14-17, were followed for two years to assess whether (1) their decision to deliver or abort a pregnancy differed from their perceptions of their mothers' attitudes about having a child or aborting a pregnancy, (2) satisfaction with the decision differed between the abortion and delivery groups, and (3) satisfaction with the decision was affected by who made the decision. Eight-one percent chose the pregnancy outcome that their mothers supported. Those who did decide without their mothers' support (19%) were divided equally between abortion and continuing the pregnancy. The majority in both groups were satisfied with the outcome decision, but initially more deliverers than aborters were satisfied. Satisfaction initially was related to who made the decision, but by the one-year follow-up the difference was no longer significant. Young teens do not seem likely to make a decision about pregnancy outcome that differs from their mothers' views; initial differences in satisfaction with the decision disappear over a one- to two-year period.

Abortion, Induced↗
PubMed1984

Urban black adolescents who obtain contraceptive services before or after their first pregnancy. Psychosocial factors and contraceptive use.

This paper compares three groups of urban black teenagers at their enrollment in a contraceptive program and at a one-year follow-up. The groups comprise 263 never-pregnant, postabortion, and postpartum teens ages less than or equal to 17 years at their initial family planning visit. Self-report questionnaires examined attitudes and information about pregnancy and contraceptive use, sources of contraceptive information, sexual and contraceptive experience, family and partner support for contraceptive use, and demographic background factors. Emotional, personality, and psychosocial factors were assessed with standard measures. Age, partner relationships, and items relating to the mother's communication about contraception and pregnancy were significant variables in the outcome of never-pregnant and delivery of pregnancy. Self-esteem was highest in the never-pregnant group. Personality factors, emotional distress, and social adjustment scores were in the normal ranges and did not differ between the groups. Contraceptive use at follow-up was most consistent in the never-pregnant group. These data suggest the need for earlier family involvement in educating and guiding teens together with access to contraceptive services in preventing unwanted adolescent pregnancies.

Abortion, Induced↗
PubMed1984

Diazepam and desmethyldiazepam plasma concentrations in chronic anxious outpatients.

Within the framework of a large-scale clinical study on the effect of diazepam in chronic anxiety, diazepam (D) and desmethyldiazepam (DD) plasma concentrations were determined frequently. Significant relationships were found between the clinical effect and the plasma concentrations of D and DD, respectively; a curvilinear relationship resulted if the dosage was disregarded, but within the individual dosage groups the relationship was found to be linear. For these computations, the daily diazepam dose was treated as a covariable in a factorial analysis of variance approach. It was found, in addition, that the daily diazepam dose was one of the most significant predictors of the plasma concentration of D or DD, respectively. The steady state plasma concentrations were highest in patients experiencing an exacerbation of their conditions of anxiety if they were returned to placebo after 14 to 22 weeks of diazepam medication. The lowest steady state concentrations were found with those patients who showed withdrawal symptoms under these conditions.

Adult↗
PubMed1984

Withdrawal responses to abrupt discontinuation of desmethyldiazepam.

The authors present the results of a controlled observation of withdrawal reactions accompanying cessation of desmethyldiazepam (clorazepate) therapy. The two subjects studied had had generalized anxiety disorder for several years; both were free from manifestations of other forms of psychopathology or addictive behavior patterns. Both patients maintained stable patterns of clorazepate use at modest doses for extended periods of time. The findings suggest that the long plasma half-life of clorazepate does not offer unique protection from withdrawal reactions associated with long-term therapy. Manifestations of these withdrawal reactions are indistinguishable from reactions associated with other benzodiazepine compounds.

Acute Disease↗
PubMed1984

Symptoms of emotional distress in a family planning service: stability over a four-week period.

The 25-item Hopkins Symptom Checklist ( HSCL -25) was used on two occasions four weeks apart to identify self-reported symptoms of anxiety and depression in patients attending a family planning service. Only 28 per cent of patients classified as anxious to start with remained so four weeks later, but 62 per cent of those with high depression scores and 74 per cent of those with high depression and high anxiety scores maintained significant levels of depression. The implications of these findings for routine screening are discussed.

Adult↗
PubMed1984

Pooling 12 nomifensine studies for efficacy generalizability.

Twelve parallel group, randomized, double-blind studies of nomifensine's safety and efficacy in the treatment of depressed patients were combined into three pools according to common protocols. This approach permitted evaluation of 1) efficacy results for studies with moderate-sized pools of patients, 2) the degree to which efficacy was generalizable to depressed patients in the general population, and 3) the conditions under which pooled active vs. active (imipramine vs. nomifensine) studies could be regarded as pivotal in support of efficacy. Results showed that nomifensine's superiority over placebo was generalizable to patients with a wide range of characteristics, including age 60 years or older. An appropriate statistical profile of more pronounced nomifensine responders would include patients with a duration of present episode less than 4 months who are acutely depressed, exhibit more severe symptoms, and have been previously hospitalized or treated with other psychotropic medications. A comprehensive assessment and power analysis of the pooled active vs. active studies provided strong evidence for comparability of nomifensine and imipramine.

Adolescent↗
PubMed1983

Long-term diazepam therapy and clinical outcome.

This double-blind study involved the continuous (six to 22 weeks) treatment of 180 chronically anxious outpatients with diazepam, 15 to 40 mg/day. Our findings indicate that a significant number of patients benefit from prolonged diazepam treatment and that tolerance to the anxiolytic effect of diazepam does not develop during a 22-week study period. The duration of continual treatment with sedative-benzodiazepines was clearly the most important determinant of withdrawal reactions. Patients treated continuously for less than eight months with sedative-benzodiazepines had an incidence of withdrawal of 5%, whereas 43% of patients treated for eight months or more demonstrated clear withdrawal reactions. While these withdrawal reactions produced considerable distress, they were neither life threatening nor incapacitating and did not include convulsions or psychotic reactions. In all cases, withdrawal reactions could be readily managed by gradually tapering the dose of the benzodiazepine.

Adult↗
PubMed1983

Comparison of alprazolam, imipramine, and placebo in the treatment of depression.

Alprazolam is the first of the triazolobenzodiazepines to be studied in a large population of depressed patients. In a six-week, double-blind multicenter comparison of alprazolam, imipramine hydrochloride, and placebo in the treatment of 723 patients with depression, the two active drugs were statistically more effective than placebo. Alprazolam was at least as effective as imipramine in relieving depressive symptoms, significantly more effective in relieving somatic symptoms, and showed an earlier onset of activity in some measurements. Anticholinergic side effects were reported most often by patients receiving imipramine, while drowsiness was the only side effect reported most often in the alprazolam group. The Feighner Diagnostic Criteria and prestudy and poststudy intercenter conferences with videotaped patient interviews ensured interrater reliability.

Adolescent↗
PubMed1983

A neuroendocrine test battery in bipolar patients and healthy subjects.

Abnormalities of hormonal responses to a number of neuroendocrine challenges have been reported in depressed patients. Most studies have examined responses in a single neuroendocrine axis. We used a series of four neuroendocrine challenges (thyrotropin-releasing hormone test, gonadotropin-releasing hormone test, insulin tolerance test, and dexamethasone suppression test) to examine eight hormonal responses in 22 healthy subjects and 22 patients with bipolar disorder. Variability of hormonal responses in bipolar patients was examined by evaluating the number of abnormal hormonal responses as compared with responses from healthy volunteers. Abnormalities were observed after all four neuroendocrine tests. Nine control subjects (40.9%) and 17 bipolar patients (77.3%) had at least one abnormal response. More strikingly, 12 bipolar patients (54.5%), but no controls, had two or more abnormal responses. These findings suggest that manic-depressive patients show increased variability in hormonal response from multiple neuroendocrine axes.

Adult↗
PubMed1983

Tricyclic plasma levels in depressed outpatients treated with amitriptyline.

Seventy-four patients were treated with 150 mg/day amitriptyline (AT) to determine possible correlations between clinical improvement, demographic variables, and AT and nortriptyline (NT) plasma levels. Plasma level determinations after 2 and 6 weeks of treatment revealed that moderately significant correlations existed between AT plasma levels and clinical improvement, dosage intake, age, weight, sex, and coffee intake. Some of these findings were more pronounced after 2, and some after 6 weeks of treatment.

Amitriptyline↗
PubMed1983

The dexamethasone suppression test as a predictor of antidepressant response.

There is some evidence to suggest that dexamethasone suppression test (DST) results obtained prior to treatment for depression might aid in selecting the proper type of antidepressant medication. Forty endogenously depressed outpatients were evaluated with the DST and 12 (30%) were identified as nonsuppressors. All patients were then treated with desipramine (150-350 mg/day). Plasma concentrations of desipramine were monitored to assure that therapeutic levels were achieved. At 5 weeks of treatment, patients were characterized as treatment responders or nonresponders on the basis of change in Hamilton Depression Scale scores.

Adolescent↗
PubMed1983

Behavioral and emotional factors: comparisons of anovulatory infertile women with fertile and other infertile women.

This controlled study compared behavioral and emotional factors in a group of anovulatory infertile women requesting treatment to achieve pregnancy. The sample comprised 49 women with secondary amenorrhea or oligomenorrhea in the treatment group, 141 women in the fertile comparison group, and 104 women with diagnoses other than anovulation in an infertile comparison group. Scores on the Hopkins Symptom Checklist (HSCL-90), the Eysenck Personality Inventory, the Langner Screening Scale, a Mood Analog Scale, and the Minnesota Multiphasic Personality Inventory (MMPI) were in the normal range and did not differ significantly between the groups. On other measures, the treatment group rated itself significantly less potent than to partner, mother, or father and reported more inhibited sexual attitudes than the comparison groups. Conclusions were that neurotic personality structure or psychopathology were not significantly greater in the treatment group than in the comparison groups. Whether the lower self-esteem and inhibited sexual attitudes of the treatment group resulted from or preceded infertility could not be determined.

Anovulation↗
PubMed1983

Evaluating a household survey measure of psychic distress.

This paper describes a study to assess the validity of a brief household survey measure of psychic distress (PSYDIS). The measure classifies persons according to their pattern of scores on four dimensions, including anxiety and depression. Study subjects were interviewed first as respondents from the general population in a cross-sectional household survey. Then, according to their ratings on PSYDIS, subsamples were selected for psychiatric evaluation in a clinic a few weeks later. The survey ratings of 287 persons were compared with evaluations of the same persons by experienced psychiatrists. Overall levels of concordance ranged from 76% to 80%, depending on the psychiatric criterion used. Concordance was very high for women; it was lower for men and for persons classified as High on PSYDIS. We than applied two analytic strategies for increasing agreement between the clinical judgements and the clinical ratings. Strategy number I augmented the symptom checklist data with additional survey data on the subject's history of episodes of distress. Strategy II revised procedures for constructing the PSYDIS typology by (1) using more rigorous cutting point scores on the component scales, and (2) using a non-typological method of classification. The first strategy improved agreement between the clinic and survey measures; the second did not. The paper also compares PSYDIS with other brief symptom checklist measures.

Anxiety↗
PubMed1983

Physician prognosis in relationship to drug and placebo response in anxious and depressed psychiatric outpatients.

The relationship between treating physician's prognosis and treatment response to active drug or placebo in samples of 517 anxious and 569 depressed outpatients who had participated in 4-week double-blind drug trials was examined. Log-linear analyses employing diagnosis, prognosis, treatment (active drug or placebo), and treatment response were conducted. Anxious patients had been treated with either chlordiazepoxide or placebo, and depressed patients had received either amitriptyline or placebo. Significant differences were found, suggesting that physician prognosis is related to pharmacologically induced symptom relief in anxious but not in depressed patients. In the depressed patient sample, prognosis and improvement were found to be significantly related in placebo but not drug-treated patients.

Adult↗