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Biomedical subjects

M R Trimble

Publications and source records attributed to M R Trimble.

At least 127 records · Page 7Linked to original sources
PubMed1986

Obsessions and compulsions in Gilles de la Tourette's syndrome.

The incidence of obsessive-compulsive disorder (OCD) in patients with Gilles de la Tourette's syndrome (GTS) was assessed with a specially designed questionnaire. The Inventory was administered to patients with OCD, patients with GTS, and normal controls. Fifty-one percent of the patients with GTS had significantly elevated Inventory scores. The frequent occurrence of OCD in GTS suggests that the two disorders may share common neurobiologic mechanisms.

Adolescent↗
PubMed1986

Pseudoseizures.

The history of hysteria, with special reference to pseudoseizures, is reviewed. The distinguishing features between nonepileptic and epileptic convulsions are then considered, prior to discussion of management and prognosis. The various psychopathologies associated with the diagnosis are noted, as are psychiatric conditions that may be confused with epilepsy. It is concluded that pseudoseizures represent a complex clinical problem, often requiring multidisciplinary evaluation, that can be rewarding to diagnose and treat.

Anxiety Disorders↗
PubMed1985

The treatment of depression in patients with epilepsy. A double-blind trial.

Forty-two patients with depression and epilepsy were entered into an antidepressant trial of amitriptyline, nomifensine and placebo. The dose of the active drug was 25 mg tid, which was doubled in non-responders on the active drug after 6 weeks. At that point a further 6 week follow-up was carried out. Serum antidepressant and anticonvulsant levels were assessed. The results indicated that at 6 weeks all patients showed a decline in their depression scores but at 12 weeks nomifensine was superior to amitriptyline. The possible reasons for this and the clinical implications of this are discussed.

Adolescent↗
PubMed1985

A study of cerebral blood flow and metabolism in epileptic psychosis using positron emission tomography and oxygen.

Data are presented on four groups using positron tomography and 15 O inhalation. Compared to age-matched volunteer controls, epileptic patients show regions of low blood flow and hypometabolism as found in previous studies. Epileptic psychotic and non-psychotic patients have been compared, and the main differences noted were lower rOER in the psychotic group, especially in frontal, temporal and basal ganglia regions. When a group of psychotic patients receiving neuroleptic drugs was compared to those free of these medications the rOER was higher in the treated sample, and the rCBF fell, significantly in some areas. These data are discussed in the light of other reports of positron tomography in psychosis.

Antipsychotic Agents↗
PubMed1985

Epileptic psychosis: an evaluation of PSE profiles.

Data are presented on 24 patients with epilepsy and psychosis whose clinical presentation was rated using the Present State Examination (PSE). Seventeen had complex partial seizures and a diagnosis of temporal lobe epilepsy, seven had generalised epilepsy. An association between a CATEGO category of nuclear schizophrenia (NS) and a lesion of the left side was noted. No clear link between depressive symptoms and a right-sided focus was discovered. Affective disorders were noted in both groups of epileptic patients, although paranoid psychoses were commoner in the temporal lobe group. There was also a tendency for the latter to have more delusions of persecution, ideas of reference, and special features of depression. The group rated as NS appear less likely to show evidence of intellectual deterioration than the other psychotic patients; in addition, the interval between the onset of their epilepsy and the onset of their psychosis is shorter. Radiological assessment by CAT reveals few differences between groups, but the psychotic samples do show higher than expected values on a number of variables, in particular the bilateral septum-caudate distance and the size of the third and fourth ventricle.

Adult↗
PubMed1985

Biological antagonism and epileptic psychosis.

The controversial literature about the biological antagonism between schizophrenia and epilepsy involves at least two areas of clinical interest. Firstly, it is frequently stated that convulsive treatment was introduced into psychiatry for the management of psychosis because of this antagonism, and secondly, it has a bearing on the topics of 'alternative psychosis' and 'forced normalisation', as reported in the epilepsy literature. In addition to these, the subject is of theoretical interest in its relationship to other biological antagonisms that may be found in nature, but closer examination of the literature suggests that some of the discussions and controversies surrounding this problem are based on assumptions that may be incorrect. One possible reason for this may be the fact that much of the original work was written in German, and we propose therefore to give a brief account of the origins of the theories, as derived from their original sources.

Convulsive Therapy↗
PubMed1985

An investigation of hysteria using the Illness Behaviour Questionnaire.

Seventy-nine patients with a diagnosis of hysteria were compared, on a number of variables, with a control group of neurological patients without psychiatric morbidity, and with psychiatric patients free from somatic complaints. Demographic information was obtained, and rating scales for the assessment of personality and mood, were administered, as well as Pilowsky's illness Behaviour Questionnaire. The data confirm the high incidence of affective disturbance in particular, depression and anxiety in patients with hysteria. There was no link between hysteria and early hospitalisation, although associations were found with sexual disturbances, a past history of vague or undiagnosed illness, affective inhibition, and denial. Relationships between personality and illness behaviour reveal links between personality dimensions and the reporting of illness.

Adolescent↗
PubMed1985

Adverse neuropsychiatric effects of anticonvulsant drugs.

Clinical and electrical evidence of peripheral neuropathy may result from long term treatment with phenytoin or barbiturates, especially in combination, or after repeated exposure to toxic blood concentrations of either drug. Prolonged acute toxicity with phenytoin may rarely lead to permanent residual ataxia. Reversible dystonia may occasionally be precipitated by phenytoin or carbamazepine; asterixis by phenytoin, barbiturates or carbamazepine; and, more commonly, tremor by valproate. All the major anticonvulsant drugs, especially in combination, can produce occasional subacute cognitive or behavioural syndromes. In varying degrees, the drugs also impair attention, concentration, memory, mental speed or processing, or motor speed. Possible mechanisms of impaired mental function include neuronal damage, or disturbance of folic acid, monoamine or hormonal metabolism. The relative influence on neurological or psychological function is an important factor in the choice of anticonvulsant drug for the treatment of epilepsy.

Animals↗
PubMed1984

Sodium valproate and cognitive function.

The literature concerning the effects of sodium valproate on cognitive function was reviewed, including both volunteer and patient studies. Two were reported from the National Hospital--one a double-blind crossover investigation against placebo in volunteers, and the other in patients on monotherapy. It was concluded that sodium valproate has minimal adverse effects, although those that are seen are probably dose related. It has less of an effect on cognitive function than some of the other commonly used anticonvulsants.

Adolescent↗
PubMed1984

A clinical study of Gilles de la Tourette syndrome in the United Kingdom.

The clinical features of 53 British-born patients with Gilles de la Tourette syndrome are described. The mean age at onset of body tics was seven years and for vocalisations 11 years. Coprolalia was present in 39%, copropraxia in 21%, echolalia in 46% and echopraxia in 21%. Complicated antics and mannerisms were also common, often involving the compulsive touching of objects or self-injurious behaviour. Forty-six per cent of cases had a family history of tics in a single close relative and in two individuals a further member of the family had Gilles de la Tourette syndrome. Focal dystonia was present in four patients who had never received neuroleptics drugs and chorea was seen in two other untreated patients. In three patients acoustic startle consistently induced brief eye blink followed by a whole body jerk or jump. Rapid repetitive movements of the hands increased the frequency and severity of tics in 13 patients, but the performance of mental arithmetic under time pressure had a much more unpredictable effect. Electroencephalographic abnormalities occurred in eight (13%) but no definite CT brain scan abnormalities were detected. The incidence of left handedness did not differ from that in the general population and no evidence to suggest organic impairment was found on neuropsychological testing. This study provides no support for the notion that Gilles de la Tourette syndrome is a degenerative disorder of the central nervous system but provides some evidence for heterogeneity.

Adolescent↗
PubMed1984

Deficient learning and memory in early and middle phases of multiple sclerosis.

Forty-three patients with multiple sclerosis showed disturbances in short-term memory, learning, and delayed recall which were associated with years of active disease (average was 4.5 years), age, presence of flareup, but not steroid/ACTH treatment. Unrecognised memory loss might be prevalent early in the natural history of multiple sclerosis and deserves neuropsychological assessment.

Adrenocorticotropic Hormone↗
PubMed1984

Epilepsy, antidepressants, and the role of nomifensine.

The clinical and animal literature on the relationship between antidepressant drugs and the precipitation of seizures or lowering of the seizure threshold is reviewed. All tricyclic antidepressants have the potential to provoke seizures, particularly in patients with a preexisting lowered seizure threshold. A pilot investigation and a double-blind trial comparing the nontricyclic nomifensine with amitriptyline and placebo in epileptic patients are described. Results of these and other studies suggest that nomifensine--almost alone among the antidepressant drugs--has minimal seizure-provoking effects and therefore may be valuable in the management of patients with epilepsy or other neurologic diseases associated with lowered seizure threshold.

Adult↗