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Biomedical subjects

P Bech

Publications and source records attributed to P Bech.

At least 127 records · Page 7Linked to original sources
PubMed1990

Plasma ratio tryptophan/neutral amino acids in relation to clinical response to paroxetine and clomipramine in patients with major depression.

The pretreatment plasma ratio of tryptophan (Trp) to other large neutral amino acids (LNAA), thought to reflect brain serotonin formation, was determined in 44 inpatients with major depression, who were subsequently treated double-blind on a fixed-dose schedule for 4 weeks with the selective serotonin uptake inhibitor paroxetine (n = 27) or clomipramine (n = 17). The study took place at four clinical centers. Endogenous and non-endogenous depressives were comparable with respect to the ratio Trp/LNAA and clinical improvement and were therefore analyzed together. The clomipramine group showed a significant inverse correlation between ratio Trp/LNAA and improvement, and patients with a ratio Trp/LNAA below the mean showed a trend towards greater improvement than patients with a higher ratio but with comparable serum drug levels. The improvement in the paroxetine group was significantly inversely correlated with the Trp concentration but not with the ratio Trp/LNAA. The findings accord with previous trials of various antidepressant treatments, in which about 25% of the variance in therapeutic response associates with pretreatment plasma amino acid profiles.

Adult↗
PubMed1990

The development of an observer-scale for measuring social dysfunction and aggression.

Scales for measuring aggressive cognitions and behaviour have mainly been administered by nursing-staff or been self-ratings. During recent years we have made an attempt to construct an observer-scale for aggression analogous to the Hamilton scale for depression. The Social Dysfunction and Aggression Scale (SDAS) consists of 9 items (SDAS-9) covering outward aggression and 2 items (SDAS-2) covering inward aggression. The inter-observer reliability of the SDAS has been found adequate in terms of intra-class coefficients. In a pilot study on 82 inpatients from different centres in Denmark and Sweden the SDAS was compared to three-item scales for outward and inward aggression and to a global scale for outward aggression. The results showed that the SDAS-9 correlated positively with the other outward observer-scales, and the SDAS-2 with the other inward scale. A divergent validity was seen between the outward and inward scales, indicating that it is necessary to measure both dimensions. Preliminary ranks-according-to-frequency scores showed the following order of the nine outward items: irritability, dysphoric mood, social disturbances, nondirected verbal aggressiveness, negativism, directed verbal aggressiveness, physical violence towards staff, physical violence towards things, and physical violence towards persons other than staff.

Aggression↗
PubMed1990

Clomipramine and mianserin in the treatment of chronic tension headache. A double-blind, controlled study.

114 patients with chronic tension headache (more than 10 days per month for at least 6 months) were treated with placebo, clomipramine or mianserin in a double blind parallel group comparison. Eighty-two patients completed the study. Headache pain was scored weekly on visual analogue scales for the 6 weeks of treatment. Observer-rating of headache was made at entry, after 3 weeks and after 6 weeks of treatment. In all groups, headache complaints decreased significantly compared to baseline. With the main parameter the decrease on both clomipramine and mianserin was significant compared to placebo. Although the trend was the same for the other parameters, the changes relative to placebo did not reach statistical significance.

Adolescent↗
PubMed1990

Measurement of psychological distress and well-being.

Psychological distress and well-being are important aspects of quality of life measurements in psychosomatic medicine. The concept of improvement in medicine refers to a clinical distance along which the current state of the patient is compared to the pretreatment position. Quality of life covers, however, more than one distance or dimension in this respect; e.g. well-being, side effects of treatment, and psychosocial stressors. The psychometric aspects of these dimensions are analysed with reference to nomothetic and idiographic methods. The nomothetic approach is the selection of the most unbiased scale tailored to the disorder under investigation. The idiographic approach is the construction of a hermeneutical or meaningful scale for the individual patient. For both methods the clinical improvement index is the most appropriate statistic.

Adaptation, Psychological↗
PubMed1989

Clomipramine and mianserin in chronic idiopathic pain syndrome. A placebo controlled study.

The reduction of pain by two antidepressants, clomipramine and mianserin, was, in this study on 253 patients with chronic idiopathic pain syndrome, found to be not better than a placebo when all patients were compared independently of the classification of pain. The improvement rate was around 40% after 6 weeks of treatment when using a 50% or better reduction in pain level. However, in patients who fulfilled a checklist definition of minor to major depression (30% of the total patient material) clomipramine was superior to mianserin and placebo with an improvement rate of 75% after 6 weeks. Using pain curves over time as outcome measure in the various clinical pain categories it was found that both mianserin and clomipramine seemed superior to placebo in patients with tension headache, but in patients with low back pain syndrome placebo was superior to the two antidepressants. No difference among the three treatments was found in patients with burning mouth syndrome or in patients with abdominal pain. These differences underline the importance of studying specific pain syndromes rather than composite groups of patients with idiopathic pain. The clinical significance of these pain curves needs further placebo controlled investigations.

Adolescent↗
PubMed1989

The use of case vignettes in studies of interrater reliability of psychiatric target syndromes and diagnoses. A comparison of ICD-8, ICD-10 and DSM-III.

This study is part of the ICD-10 field trials in which the use of case vignettes for interrater agreement has been examined. From our electronic database of 880 consecutively admitted inpatients we selected 24 cases that were transcribed to vignettes covering the first 5 ICD-10 target syndrome of dementia, substance use disorders, schizophrenia, mood and anxiety disorders. ICD-10 was compared with ICD-8 and DSM-III. The results showed that all 3 standard classification systems obtained an acceptable interrater agreement. Among the diagnoses, depressive disorders gave rise to most disagreement between the raters. Discrepancies between the methods of measuring interrater agreement were found when intraclass reliability was compared with consensus calculations for the individual patient.

Humans↗
PubMed1989

The Brief Psychiatric Rating Scale. Dimension of schizophrenia--reliability and construct validity.

This study has focussed on a 10-item Brief Psychiatric Rating Scale (BPRS) subscale for the quantification of schizophrenic states. Seven psychiatrists interviewed jointly patients who all fulfilled the DSM-III criteria of schizophrenia, and in a subsequent pencil-and-paper procedure a judgment analysis was performed. The reliability analysis showed that less experienced BPRS raters made less consistent judgments implying the cautionary statement that the proper use of a scale for schizophrenia requires specialized training with the scale. The validity analysis showed that the BPRS items had an additive relationship implying that the sum of these items is a sufficient statistic for the measurement of severity of schizophrenic states. Finally, the results seem to indicate, that the underlying dimension defined by the 10-items BPRS subscale includes hierarchically the negative and positive symptoms of schizophrenia.

Adult↗
PubMed1989

Methods of evaluation of psychoactive drugs.

The classification of psychoactive drugs into minor tranquilizers (i.e. antianxiety drugs) and major tranquilizers (i.e. antidepressants, antimaniacs and antipsychotics) is based on clinical symptom rating scales. The group of symptoms in these scales of anxiety, depression, mania and schizophrenia has a shared phenomenology in the sense that the symptoms can be ordered from less to more severe. The inter-observer agreement when using these scales is adequate as agreement is of 80% or higher. By use of rating scales it has been found in controlled clinical trials that minor psychiatric disorders such as anxiety states without depression have a good outcome of placebo in 60 to 65%. In depressive disorders placebo has a good outcome in 20-45%, but in the elderly depressed patient the placebo effect is poorest (25%). Antidepressants have a good outcome in 60-75%, but in the elderly depressed patients only in 50%. In other words the drug-placebo difference is around 25%. In the major psychiatric disorders such as mania and schizophrenia the drug-placebo difference is around 50%. The use of clinical symptom scales in evaluating side-effects of psychoactive drugs is increasing. However, also non-clinical or laboratory tests have an important role in measuring side-effects, especially in motor skills related to car driving. The use of mentally healthy volunteers in measuring side-effects of major tranquilizers seems inadequate. As yet no biological methods to measure clinical effects of the tranquilizers have been developed for practical use.

Drug Evaluation↗
PubMed1988

Platelet 3H-imipramine binding in psychogenic pain patients.

High-affinity binding of 3H-imipramine was analyzed in platelet membranes from patients with chronic psychogenic pain. The patients who in addition to the pain also showed affective symptoms such as depression and anxiety had lower binding than the pain patients without these symptoms.

Adolescent↗
PubMed1988

Rating scales for mood disorders: applicability, consistency and construct validity.

Rating scales for mood disorders have been reviewed with special reference to their consistency, applicability, and validity. Diagnostic scales with a biometric reference to antidepressants have been developed on the basis of the Newcastle Scales. This Diagnostic Melancholia Scale (DMS) includes two dimensions, one measuring endogenous depression, and one measuring reactive depression. These dimensions were found not to be mutually exclusive as 30% of the depressed patients scored high on both dimensions. Scales measuring outcomes of treatment were subdivided into (a) scales measuring disability of clinical depression (melancholia), anxiety, and mania, (b) scales measuring distress as a construct of side-effects during treatment, and (c) scales measuring discomfort or quality of life. Disability, distress and discomfort should be separately validated as they reflect different aspects of outcome of treatment. Self-rating scales have their main applicability in the measurement of discomfort.

Anxiety Disorders↗
PubMed1987

Neuroleptic profile of cipazoxapine (Savoxepine), a new tetracyclic dopamine antagonist: clinical validation of the hippocampus versus striatum ratio model of dopamine receptors in animals. A preliminary report.

Cipazoxapine is a new tetracyclic dopamine antagonist which we tested to validate an animal model for neuroleptics. This model was based on drug affinity to dopamine receptors in hippocampus versus striatum. For haloperidol the ratio was 0.67, for cipazoxapine 0.06. In this preliminary trial on eight schizophrenic patients we found that cipazoxapine in doses between 0.40 and 2 mg had an antipsychotic effect (measured by the BPRS) without extrapyramidal side-effects (measured by the Simpson-Angus-Scale). Our preliminary results thus support the animal findings.

Adolescent↗
PubMed1987

An integration of the DSM-III and ICD-8 by global severity assessments for measuring multidimensional outcomes in general hospital psychiatry.

A multiaxial classification system has been developed in which three ICD-8 derived axes of psychiatric syndromes, personality disorders and somatic syndromes, and two DSM-III axes of psychosocial stressors and social functioning have been included. Global assessment scales were annexed the three ICD-8 axes. This DSM-III/ICD-8 system was used for registration of 880 consequetively admitted psychiatric patients in a general hospital setting. The results showed that six psychiatric syndromes (substance use disorders, schizophrenia, manic-depressive psychosis, reactive psychosis, neurosis, and adjustment reactions) were responsible for 80% of the diagnostic variance. Of these syndromes, manic-depressive psychosis had the highest improvement rate both concerning symptoms and social functioning. Manic-depressive psychosis had also the lowest coefficient of variation in the stay in hospital indicating a high degree of homogeneity in accordance to the diagnose-related group system. However, patients within the categories of reactive psychosis and neurosis who received antidepressants also had a low coefficient of variation, although the neurotics were significantly more depressed than the manic-depressives at discharge from hospital.

Adolescent↗