Biomedical subjects
Publications and source records attributed to M Tansella.
A fatal pancytopenia occurred in a patient with an history of depression with hypomanic rebounds, admitted for a manic episode and treated with levomepromazine, diazepam and lithium carbonate.
The selective use of different neuroleptics in the treatment of schizophrenia by some psychiatrist according to the greater need for a sedative, antidelusional or activating effect is supported only by some uncontrolled clinical observations. Most extensive controlled studies done until now showed no significant differences among neuroloptics in their therapeutic efficacy. The hypothesis that these drugs have specific and selective actions therfore cannot be accepted. In the single patient it seems more rational to choose the right dosage schedule instead of the "right drug". Though the study of the metabolism of these drugs remains the most interesting approach to the problem of the individualization of the therapy., the results of these studies have until now been disappointing e.g. plasma levels of chlorpromazine correlated weakly with clinical improvement. In clinical practice an important element in the process of choosing is still the incidence of side effects and in fact at the moment "the drug of choice" can only be the drug best tolerated by the patient.
Eight normal subjects were tested on a battery of subjective and psychological tests 12 hours after a hypnotic dose of chlordesmethyldiazepam (1 or 2 mg), amylobarbitone sodium (100 mg), and a placebo. The tests included self-ratings of hypnotic effects and alertness; reactiontime, card-sorting, coding and cancellation tasks; arithmetic; and tapping. Before each task, test anxiety and performance expectation was self-rated; and after the task, judgment of performance was self-rated. Residual effects were definitely detectable after the 2-mg dose of benzodiazepine with both behavioral impairment and subjective hangover. Both the 1-mg dose and the barbiturate were almost devoid of such effects. Very few drug effects on test anxiety and performance judgment were discerned. Plasma concentrations of amylobarbitone were related to decreases in test anxiety and of chlordesmethyldiazepam with ratings of sleepiness.
Drug plasma levels of N-desmethyldiazepam (10 and 20 mg/day given at night) and amylobarbitone sodium (200 mg/day given at night) were determined in 45 patients after 1 and 7 days of treatment together with estimates of hypnotic and residual effects. No relationships were found between clinical rati ngs of hypnotic effect and drug plasma levels, while significant correlations were observed between some performance taska and drug plasma concentrations of amylobarbitone sodium, and of the higher dose of N-desmethyldiazepam.
The literature is reviewed on EEG alpha activity in different psychological states, i.e., morbid anxiety, attention and mental relaxation. In the present study, 20 male neurotic inpatients suffering from chronic moderate anxiety were assessed with respect to anxiety level and EEG alpha activity (frequency and per cent time) and fast activity. No significant EEG asymmetry was found. The average alpha per cent time was very low, most of the patients being low-alpha subjects. Anxiety and alpha index were significantly correlated. The patients were then treated with either 80 mg per day of temazepam or placebo for 2 weeks (double-blind). Significant effects were detected in the anxiety state, the drug group showing more improvement, but not in the EEG profile. The measures were expressed at this stage as change scores from the pre-treatment values and correlations between them were computed. The only correlation of significance was a negative correlation between anxiety level and alpha index found after 1 week in the drug group.
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Validity coefficients of the 12-item General Health Questionnaire (GHQ-12) were established against the Clinical Interview Schedule (CIS) in a sample of primary care patients. Comparison between the conventional scoring method, Likert scoring, and the revised scoring procedure proposed by Goodchild and Duncan-Jones (C-GHQ) showed very similar screening properties: sensitivity ranged between 71% and 75%, and specificity ranged between 73% and 76%. The test-retest reliability of the GHQ-12, as expressed by Pearson's r and intraclass correlation coefficient, was satisfactory irrespective of the scoring method used, even though mean scores on the second test tended to be significantly lower than the corresponding mean scores on the first test. The C-GHQ by itself did not result in an improvement of the screening capacity of the GHQ; however, the best results were obtained by combining the conventional scoring and C-GHQ case criteria.
Using two systems which routinely record information about the management of psychiatric disorders in the community (a drug prescription monitoring system and a psychiatric case register), a parallel study was conducted in South Verona on antidepressant prescriptions written by general practitioners (GPs) and on contacts for affective disorders with specialized psychiatric services, in 1983 and 1984. The extent of patient contact for affective disorders was approximately ten times greater at the GP level (in one year about 150 antidepressant prescriptions per 1000 adult inhabitants) than at the out-patient/community psychiatric service level. Similarly, the extent of patient contact at the latter level was approximately ten times greater than at the in-patient level. Patients with a diagnosis of affective disorder accounted for about 20% of the total number of patients contacting the specialized services in one year. The proportions of patients admitted to hospital, among those in contact with these services and assigned a diagnosis of depressive neurosis or a diagnosis of affective psychosis, were 34 and 33% (in 1983 and 1984) and 49 and 50% (in 1983 and 1984), respectively. There was a clear correspondence between monthly fluctuations in the extent of care for affective disorders provided at the two levels in 1984, but not in 1983.
This paper reports the results of a study on seasonal variation in new episodes of affective disorders, conducted using the South-Verona psychiatric case register. We found evidence for a cyclical pattern in the occurrence of affective psychosis, but this was statistically significant only for the males: there was no cyclical variation in depressive neurosis. The advantages are discussed of case register data over hospital admission statistics for the study of seasonal variation. These are particularly marked in case register areas where community psychiatric care is well developed, as in South-Verona.