Search PubMed⌕ Search

Biomedical subjects

P Fonagy

Publications and source records attributed to P Fonagy.

At least 73 records · Page 4Linked to original sources
PubMed1988

The natural history of tolerance to the benzodiazepines.

Dependence on benzodiazepines following continued use is by now a well-documented clinical phenomenon. Benzodiazepines differ in their dependence potential. The present studies were aimed at examining the possibility that differential rates of tolerance development might account for differences in dependence risk. Four studies are reported. The first three studies concerned normal subjects. The development of tolerance over a fifteen day period was demonstrated for three different benzodiazepines (ketazolam, lorazepam and triazolam) using two paradigms. Tolerance in terms of a reduction in effectiveness of a repeated given dose was most notable for the benzodiazepine with a medium elimination half-life (lorazepam) for physiological, behavioural and subjective measures. In the case of the drug with the longest elimination half-life (ketazolam) reduction in effectiveness could only be assumed to be occurring if account was taken of the steady increase in plasma concentrations of active metabolites. For this drug it seemed that the physiological measures were those most likely to demonstrate the development of tolerance. Although triazolam showed few significant drug effects on this paradigm (testing being 12 hours after ingestion of this short half-life benzodiazepine), tolerance was seen to develop on some subjective measures. Using an alternative method of testing tolerance, assessing responses to a diazepam challenge dose, a high degree of tolerance on two-thirds of the measures was observed in subjects when pretreated with the benzodiazepine with the most marked accumulation of active metabolites (ketazolam). The other two drugs also led to tolerance development on a range of measures; this was more marked for lorazepam than triazolam. Blunting of the growth hormone response to diazepam was the most sensitive and reliable method of detecting tolerance to the benzodiazepines. Symptoms on discontinuation of the two weeks' intake of the benzodiazepines were marked for all the drugs but unrelated to either the tolerance induced or the elimination half-life of the particular drug. A further clinical study revealed that tolerance persisted in a group of long-term benzodiazepine users for between four months and two years following complete abstinence from the drug. These patients appeared to be less affected by diazepam in terms of its commonly observed subjective effects, regardless of their original medication. These ex-long-term users of benzodiazepines were, however, more likely to manifest two specific types of effects--immediate 'symptom' reduction and exacerbation of 'withdrawal symptoms' over the subsequent week.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed1987

A follow-up study of patients treated for benzodiazepine dependence.

By interviewing and administering questionnaires to 63 patients one to five years after treatment for benzodiazepine dependence the long-term success rate was examined together with factors associated with outcome. Fifty-four per cent of patients had permanently withdrawn from medication at follow-up. Most of those who were successful continued to experience psychiatric symptoms after discharge. Significantly more women than men managed to withdraw from medication. Outcome was not related to previous benzodiazepine regimen, psychiatric history or experiences of withdrawal. It is argued that psychological adjuncts should be included in the treatment of benzodiazepine dependence in order to prevent relapse.

Adult↗
PubMed1987

Psychoanalysis and diabetic control: a single-case study.

The records of the 3 1/2 year, five times weekly psychoanalysis of a diabetic teenager with recurrent diabetic imbalance were examined using non-experimental single-case design methodology. A selected set of analytic themes was operationalized and independently rated for each week of the psychoanalysis. A weekly index of the quality of diabetic balance was also obtained for the same period. Time series analysis was used to examine the relationship between psychoanalytic themes and glycosuria. Two themes of psychic conflict were found to predict short-term changes in diabetic control. In the long term the verbalization of conflict was strongly associated with improved diabetic control. The results are discussed in terms of a psychoanalytic model of adaptation to diabetes.

Adolescent↗
PubMed1987

Psychological adjustment and diabetic control.

Glycosylated haemoglobin concentrations, C peptide secretion, insulin dose, psychiatric state, intellectual functioning, and the extent to which the implementation of the diabetic regimen was shared between parent and child were studied in a cross sectional study of 50 children with diabetes aged 6-16. Indications of psychological disturbance in the children and their parents predicted low glycosylated haemoglobin concentrations in the children, and accounted for 44% of variance in blood glucose control. The child's early and independent participation in the implementation of the diabetic regimen was associated with poor control.

Adaptation, Psychological↗
PubMed1986

The effects of the benzodiazepine antagonist Ro 15-1788 on psychophysiological performance and subjective measures in normal subjects.

Ro 15-1788 is an imidazodiazepine which was initially described as a pure benzodiazepine antagonist lacking in intrinsic actions. Although recent animal work has shown the drug to have differing intrinsic actions depending on the dose, the majority of studies on human subjects conclude that it is a pure antagonist of benzodiazepines. Two oral doses of Ro 15-1788 (30 mg and 100 mg) were compared with 5 mg diazepam and placebo in their intrinsic effects on a range of psychophysiological, performance and subjective measures in 12 healthy adult subjects. At both these doses Ro 15-1788 showed a mixture of agonist (benzodiazepine-like) effects and other non-benzodiazepine-like effects on the variables measured. Although there was no clear-cut dose-response relationship, the results suggested a predominance of benzodiazepine-like effects at the higher dose on physiological measures whilst the lower dose was observed to have greater effects on a number of behavioural and subjective dimensions. The subjective changes were the opposite of those normally found for benzodiazepines.

Adult↗
PubMed1986

The effect of emotional arousal on spontaneous swallowing rates.

The effect of two experimental tasks aimed at inducing emotional arousal on spontaneous swallowing rates was investigated. An anxiety-inducing cognitive task and a Velten-type depression-inducing manipulation were both found to increase spontaneous swallowing rates in normal subjects. This confirmed previous anecdotal reports of elevated swallowing rates associated with emotional arousal. The implication of this finding for a possible pathway between emotional factors and gastrointestinal disorders is discussed.

Adult↗
PubMed1986

Patients' attitudes to student doctors.

The attitudes of 92 patients to student doctors in a maternity unit were assessed by questionnaire. A total of 76% of attitude statements by patients were favourable to the presence of student doctors. There was a significant trend for patients from lower social class groups to have more positive attitudes to student doctors (0.01 less than P less than 0.05). There was a slight tendency for male students to elicit more favourable attitudes than female students (0.05 less than P less than 0.05).

Attitude to Health↗
PubMed1985

Life events, depression and hypothalamic-pituitary-adrenal axis function.

The relationship between antecedent life events, clinical profile, and hypothalamic-pituitary-adrenal function was examined in 72 depressed patients. Antecedent life events were associated with first episodes of depression and with greater severity of illness, but their presence did not distinguish between patients diagnosed as endogenous or neurotic, and status on the dexamethasone suppression test was not associated with a greater or lesser likelihood of antecedent events. However, urinary free cortisol levels were higher in those patients with life events and difficulties.

Adult↗
PubMed1984

Endocrine changes and clinical profiles in depression: I. The dexamethasone suppression test.

Hypothalamic-pituitary-adrenal axis function was investigated in 72 patients with primary depression. Forty-four per cent of the patients demonstrated abnormal suppression of their cortisol levels after a 1 mg overnight dexamethasone suppression test. Patients with abnormal suppression ('non-suppressors') were not clearly distinguished from 'suppressors' by the commonly used diagnostic classifications. They did not appear to be more severely depressed, but they were more likely than the 'suppressors' to be in-patients. Multivariate analysis of the data suggested that two clinical features were independently associated with non-suppression: the PSE syndromes of Slowness and General Anxiety. However, the association of these syndromes with non-suppression was relatively weak, indicating that the clinical significance of the dexamethasone suppression test is, as yet, unclear. The results raise doubts about the validity of using the dexamethasone suppression test as a diagnostic marker for a specific depressive syndrome.

Adult↗
PubMed1984

Endocrine changes and clinical profiles in depression: II. The thyrotropin-releasing hormone test.

Thirty-one (43%) of 68 patients with primary depression were found to have a blunted thyroid-stimulating hormone (TSH) response to thyrotropin-releasing hormone (TRH). Increased thyroid activity, as measured by the free thyroxine index (FTI), was present in 16 (24%) of the patients. Patients with blunted responses had a higher mean FTI level than those with normal responses. Patients with blunted responses were significantly more likely to exhibit the symptoms of depersonalization, derealization and agitation. There was no clear association between blunting and any particular diagnostic category of depression. Patients with blunted responses and high FTI values were more likely to report significant long-term environmental difficulties than patients with blunted responses and normal FTI values. It is suggested that there may be more than one mechanism responsible for blunting of the TSH response in depressed patients. In some patients blunting may be due to negative feedback from increased output of thyroid hormones, possibly released as part of a stress response. In other patients blunting may be due to a different mechanism, possibly involving pituitary gland dysfunction. These mechanisms would not necessarily be mutually exclusive in any one patient.

Adult↗
PubMed1983

Behavioural techniques in the management of aerophagia in patients with hiatus hernia.

Aerophagia has been shown to occur in association with hiatus hernia, and it has been suggested that it may have an aetiological role. Two behavioural methods are described, which are designed to reduce the rate of swallowing. They were applied to a group of 12 patients with hiatus hernia, in whom aerophagia had been demonstrated. Patients were on the whole successful in reducing their rate of spontaneous swallowing. An association was observed between symptomatic improvement and successful reduction of swallowing rate. This was still apparent on follow-up at nine months. Symptomatic improvement, however, on the whole appeared to be short-lived. The possible clinical significance of aerophagia in hiatus hernia is discussed.

Aerophagy↗
PubMed1983

Autonomic arousal in eating disorders: further evidence for the clinical subdivision of anorexia nervosa.

Autonomic arousal, measured by skin conductance level and response, was examined in 36 female patients with eating disorders (anorexia nervosa and bulimia nervosa) and 32 control subjects. No differences were found between the control group and anorexics who lost weight solely through dieting (restricting anorexics). Patients with a diagnosis of bulimia nervosa and anorexics with bulimic features, however, showed fewer spontaneous skin conductance responses and were faster to habituate to 85 dB tones than either controls or restricting anorexic patients. The pattern of findings supports recent views concerning the clinical subdivision of anorexia nervosa.

Adolescent↗