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Biomedical subjects

Mary V Seeman

Publications and source records attributed to Mary V Seeman.

18 recordsLinked to original sources
PubMed2006

Sex selection bias in schizophrenia antipsychotic trials.

The sex prevalence of schizophrenia is approximately equal, and yet clinical trials of new therapeutic drugs have been conducted, for the most part, with male participants. The authors reviewed the percentage of women in schizophrenia clinical trials of the new "atypical" antipsychotic medications. MEDLINE and Cochrane databases were searched for English-language randomized controlled trials involving risperidone, olanzapine, quetiapine, ziprasidone, and aripiprazole. Studies with a sample size of more than 50 and a subject diagnosis of schizophrenia, schizophrenia spectrum disorder, or broad psychosis were included for review. For each study, the following items were abstracted: source of support, pharmacotherapy, site location, treatment setting, patient phase, psychotic episode number, duration, number of men and women in the total sample, mean age of the sample, and the presence of women-specific inclusion/exclusion criteria. Sixty-seven published studies met criteria. The median percentage of women in the total sample was 33.3%, the minimum was 6.7%, and the maximum was 71.2%. A stepwise linear regression analysis showed that age (younger samples), center location (Unites States and Canada), treatment patient setting (inpatient), and ziprasidone trials were all associated with relatively lower percentages of women. Sex differences in antipsychotic pharmacokinetics and pharmacodynamics that may result in differential effectiveness and susceptibility to adverse effects cannot be ascertained when the percentage of women in clinical trials is as low as it is. The increasing shift toward outpatient rather than inpatient drug trials may help to increase the proportion of women.

Antipsychotic Agents↗
PubMed2006

A group intervention to promote healthy self-concepts and guide recovery in first episode schizophrenia: A pilot study.

The stress associated with managing a first episode of schizophrenia and the secondary psychological sequelae may predispose young people to the phenomenon of illness engulfment, whereby personal identity is lost and replaced with a sense of self defined entirely by the illness. The overall objective of this pilot project was to provide an initial evaluation of the impact of a novel group intervention targeting improvement of self-concept (engulfment) and overall quality of life for young adults recovering from a first episode of schizophrenia. Fifty-two young adults diagnosed with a DSM-IV schizophrenia spectrum disorder were sequentially assigned to either a 12-week group intervention that provided members with opportunities to attain healthy self-concepts or a control group that received high quality treatment as usual. The two groups were compared on pretreatment, post-treatment, and 3-month post-treatment measures of engulfment, quality of life, and psychiatric symptoms. Allowing for dropouts, 26 subjects remained in the treatment group and 14 subjects in the control group after the 3-month follow-up. Participants in the treatment group demonstrated significant improvement in engulfment, quality of life (intrapsychic subscale) and symptoms, while the comparison group did not change. These preliminary results provide support for the benefits of a group intervention designed to enhance self-concept and to minimize the engulfing effects of illness.

Adaptation, Psychological↗
PubMed2005

Psychiatry in the Nazi era.

OBJECTIVES: To update Canadian psychiatrists on recent information from newly discovered Berlin archives about the actions of physicians, especially psychiatrists, during the era of National Socialism in Germany and to encourage introspection about the role of the medical profession, its relationship with government, and its vulnerability to manipulation by ideology and economic pressures. METHOD: This is a selective review of the literature on the collaboration of physicians, especially psychiatrists, in the sterilization, experimentation, and annihilation of patients with mental illness before and during World War II. RESULTS: Directed to value the health of the nation over the care of individual patients and convinced that a hierarchy of worth distinguished one person from another, German psychiatrists were enlisted to commit atrocities during the Nazi period. CONCLUSIONS: The values of care and compassion can be eroded; this knowledge demands constant vigilance.

Adolescent Psychiatry↗
PubMed2005

Parallels between aging and schizophrenia.

As I grow old and struggle to cope with the infirmities of age, I marvel at the resilience of my patients who grapple with and overcome the indignities of schizophrenia. Schizophrenia research is mainly about the deficits, about the many difficulties patients face. It rarely celebrates the accomplishments of patients, their ability, on the whole, to accommodate and adapt to the constraints of their illness. This paper focuses on the gerontology literature, where old age is conceptualized less as defeat, more as a process one can successfully manage. Effective strategies old people use are studied and valued. This is in marked contrast with the psychiatric literature that pathologizes the compensatory strategies used in schizophrenia.

Adaptation, Psychological↗
PubMed2004

Gender differences in the prescribing of antipsychotic drugs.

OBJECTIVE: The aim of this article is to offer recommendations and rationale for gender-specific antipsychotic treatment. METHOD: The author summarizes reviews of recent literature in psychiatric clinical trials, pharmacology, drug safety, toxicology, obstetrics and gynecology, and pediatrics. RESULTS: The pharmacokinetics and pharmacodynamics of antipsychotic drugs differ in women and men and are influenced by gender-specific factors such as body build, diet, smoking, concurrent medication, exercise, substance use, and hormonal transitions. In general, and for some drugs in particular, women require lower doses in order to stay well. Because preliminary drug testing is not done in pregnant women, the issue of effective dosing during pregnancy is unstudied, and safety for fetuses and nursing infants may not become evident until a drug is widely used. Specific adverse effects on issues crucial to women (e.g., parenting) have not been well studied, but some side effects, such as weight gain, passivity, hypotension, and hyperprolactinemia, are reported to be particularly problematic for women. Some serious side effects are more often seen among women than among men. CONCLUSIONS: Optimal maintenance regimens of antipsychotics for women and men are not the same.

Antipsychotic Agents↗
PubMed2003

Eating healthy.

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Diet↗
PubMed2003

Cognitive therapy for schizophrenia: a preliminary randomized controlled trial.

BACKGROUND: The aim of the current study was to assess whether patients with a DSM-IV diagnosis of schizophrenia and experiencing persistent positive and negative symptoms improve with the addition of cognitive-behavioural therapy to enriched standard treatment. METHODS: A controlled study was completed with 42 patients randomized to either cognitive-behavioural therapy plus enriched treatment-as-usual (CBT-ETAU) (n = 24) or enriched treatment-as-usual only (ETAU) (n = 18). Enriched treatment-as-usual comprised comprehensive treatment within specialised schizophrenia treatment services. Cognitive-behavioural therapy was conducted on an individual basis for 6 months (20 sessions). Clinical assessments were done at pretreatment, posttreatment and at 6-month follow-up by raters blind to group allocation. RESULTS: Significant clinical effects were observed for positive, negative and overall symptom severity for patients treated in CBT-ETAU, although there were no statistically significant differences between the treatment groups at posttreatment. The most pronounced effect of CBT-ETAU in comparison to ETAU in this study was in the reduction of negative symptoms at follow-up. CONCLUSION: These results show promise for the impact of CBT on negative symptoms when explicitly targeted in treatment.

Adult↗
PubMed2003

Scaling down.

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Aging↗
PubMed2002

The role of sex hormones in psychopathology: focus on schizophrenia.

The example of schizophrenia is used to illustrate how sex hormones affect the presentation of illness and its treatment. Organization and activation effects of hormones are explained, and behavior is shown to result from a complex interplay of hormones, brain mechanisms, and social pressures. Sex differences in schizophrenia (in onset age, symptoms, antipsychotic, and other treatment) are consequences of this interplay and impact on the clinician's ability to diagnose, treat, prognosticate, and prevent the disability and distress of schizophrenia.

Antipsychotic Agents↗
PubMed2002

Elevation of prolactin levels by atypical antipsychotics.

OBJECTIVE: Atypical antipsychotics are thought not to elevate prolactin levels. The authors examined data suggesting that atypical antipsychotics do elevate prolactin levels but more transiently than typical antipsychotics. METHOD: Prolactin levels in 18 male patients with schizophrenia who were receiving atypical antipsychotics were monitored over the 24-hour period following administration of their daily oral dose of risperidone, olanzapine, or clozapine. RESULTS: The baseline prolactin levels in patients receiving risperidone (mean=27 ng/ml, SD=14) were abnormally high, but baseline prolactin levels in patients receiving olanzapine (mean=9 ng/ml, SD=5) and clozapine (mean=9 ng/ml, SD=5) were not high. All three atypical antipsychotics caused a doubling of prolactin levels over baseline levels 6 hours after medication administration. CONCLUSIONS: These data suggest that these atypical antipsychotics raise prolactin levels, although the increases with olanzapine did not reach statistical significance. This suggests that the differences in the effects on prolactin levels of atypical and typical antipsychotics are not categorical but lie in the degree and duration of dose-induced prolactin elevation, attributable to the differential binding properties of each drug on pituitary dopamine D(2) receptors.

Adult↗
PubMed2002

The role of estrogen in schizophrenia: implications for schizophrenia practice guidelines for women.

OBJECTIVE: The objective of this paper is to integrate what is known about estrogen effects on symptoms and treatment response into a global understanding of schizophrenia. The aim is to expand Canadian schizophrenia guidelines to include the specific needs of women. METHOD: We searched the Medline database; keywords included estrogen, estrogen replacement therapy, schizophrenia, psychosis, treatment, tardive dyskinesia (TD), and women. We examined reference lists from relevant articles to ensure that our review was complete. We review the evidence for the effects of estrogen in schizophrenia and we make recommendations for the next revision of official practice guidelines. RESULTS: The epidemiologic evidence suggests that, relative to men, women show an initial delay in onset age of schizophrenia, with a second onset peak after age 44 years. This points to a protective effect of estrogen, confirming animal research that has documented both neurotrophic and neuromodulatory effects. Clinical research results indicate that symptoms in women frequently vary with the menstrual cycle, worsening during low estrogen phases. Pregnancy is often, though not always, a less symptomatic time for women, but relapses are frequent postpartum. Some work suggests that in the younger age groups women require lower antipsychotic dosages than men but that following menopause they require higher dosages. Estrogen has been used effectively as an adjunctive treatment in women with schizophrenia. Estrogen may also play a preventive role in TD. CONCLUSIONS: Symptom evaluation and diagnosis in women needs to take hormonal status into account. Consideration should be given to cycle-modulated neuroleptic dosing and to careful titration during pregnancy, postpartum, and at menopause. We recommend that discretionary use of newer neuroleptic medication and adjuvant estrogen therapy be considered.

Adult↗
PubMedDate not supplied

Single-sex psychiatric services to protect women.

BACKGROUND: Most psychiatric services (eg, inpatient units, day therapy centers, outpatient clinics, and community clinics) are not currently segregated by sex, but recent developments--such as increasing psychiatric acuity and increasing numbers of comorbidities--have raised the level of violence and perceived threat in psychiatric facilities and have made a proportion of the more vulnerable patients feel unsafe. AIM: The purpose of this review is to examine the concept of vulnerability as it applies to female psychiatric patients and to review the literature on the determinants of violence in psychiatric facilities and on preferences among psychiatric patients with respect to same-sex vs mixed-sex psychiatric services. RESULTS: Literature from Great Britain and from disability organizations supports same-sex facilities as options for women who feel unsafe in mixed-sex facilities. Outcomes with respect to violent incidents have not been evaluated. CONCLUSIONS: Same-sex psychiatric facilities need to be implemented in a variety of communities and careful research conducted to examine potential benefits in specific populations.

Female↗