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Biomedical subjects

P Mitchell

Publications and source records attributed to P Mitchell.

At least 217 records · Page 12Linked to original sources
PubMed1999

Characteristics of depressed patients who report childhood sexual abuse.

OBJECTIVE: Depressed patients who had and had not been exposed to childhood sexual abuse were studied to determine differences in severity of depressed mood, lifetime histories of anxiety and depression, childhood environment, and disordered personality function. METHOD: Data were obtained from 269 inpatients and outpatients with major depression (171 women and 98 men) by means of structured clinical interviews and self-report questionnaires. RESULTS: Forty-six of the 269 patients reported childhood sexual abuse; 40 of these were women. These 40 women were compared with the 131 who did not report childhood sexual abuse. The patients who experienced abuse did not differ from those who had not on psychiatrist-rated mood severity estimates, but they did have higher self-report depression scores. They also evidenced more self-destructive behavior, more personality dysfunction, and more overall adversity in their childhood environment. Childhood sexual abuse status was associated with more borderline personality characteristics independently of other negative aspects of the patients' earlier parenting. Childhood sexual abuse status was linked strongly to adult self-destructiveness, as was early exposure to maternal indifference. CONCLUSIONS: Multivariate analyses suggest that depression is unlikely to be a direct consequence of childhood sexual abuse. Childhood sexual abuse appears to be associated with a greater chance of having experienced a broadly dysfunctional childhood home environment, a greater chance of having a borderline personality style, and, in turn, a greater chance of experiencing depression in adulthood.

Adult↗
PubMed1999

Double-blind controlled investigation of transcranial magnetic stimulation for the treatment of resistant major depression.

OBJECTIVE: The efficacy and safety of left prefrontal repetitive transcranial magnetic stimulation (rTMS) for treating resistant major depression were examined in a double-blind, controlled study. METHOD: Eighteen medication-resistant depressed subjects were randomly assigned to 2 weeks of real or sham rTMS, then permitted up to 4 weeks of real rTMS. Effects on mood, neuropsychological function, EEG, and hearing were assessed. RESULTS: The groups receiving real and sham rTMS improved in mood significantly over the 2-week double-blind period, but there was no significant difference between groups. CONCLUSIONS: Repetitive transcranial magnetic stimulation did not provide significantly greater improvement than did sham treatment. A 4-week course of rTMS, as administered in this study, was safe.

Affect↗
PubMed1999

KRN8602 (MX2-hydrochloride): an active new agent for the treatment of recurrent high-grade glioma.

PURPOSE: To assess the efficacy and toxicity of KRN8602 when administered as an intravenous bolus to patients with recurrent high-grade malignant glioma. PATIENTS AND METHODS: Patients with recurrent or persistent anaplastic astrocytoma or glioblastoma multiforme who had not received recent chemotherapy or radiotherapy and were of good performance status (Eastern Cooperative Oncology Group score < or = 2) were treated with an intravenous bolus of 40 mg/m(2) KRN8602 every 28 days. Tumor responses were assessed radiologically and clinically after every second cycle of therapy. Treatment was continued until documented progression or a total of six cycles. RESULTS: A median of three cycles (range, one to six cycles) of KRN8602 was administered to 55 patients, 49 of whom received at least two cycles and were, therefore, assessable for response. The overall response rate (disease stabilization or better) was 43% (95% confidence interval, 29% to 58%). There were three complete responses, one partial response, seven minor responses, and 10 patients with stable disease. The median time to progression was 2 months (range, 1.5 to 37 months) and overall survival was 11 months (range, 1.5 to 40 months). Neutropenia was the most common toxicity, although it was generally of brief duration, and there were only seven episodes of febrile neutropenia in 176 cycles delivered. Nonhematologic toxicity was mostly gastrointestinal (nausea and vomiting, diarrhea) and events were grade 2 or lower except for a single episode of grade 3 vomiting. CONCLUSION: KRN8602 is an active new agent with minimal toxicity in the treatment of relapsed or refractory high-grade glioma. Further studies with KRN8602 in combination with other cytotoxics and in adjuvant treatment of gliomas are warranted.

Adolescent↗
PubMed1999

An exploration of links between early parenting experiences and personality disorder type and disordered personality functioning.

Reports of early parenting were assessed using two measures, the Parental Bonding Index (PBI) and the Measure of Parenting Style (MOPS), in a sample of 265 patients with DSM-defined major depressive disorder. Psychiatrists then rated the extent to which sample members evidenced the personality "styles" underpinning 15 separate personality disorders, returning personality vignette scores. The extent of disordered functioning was also assessed across "parameters" and "domains" by psychiatrists, referrers, and family members, using a range of measures. Those with higher scores on vignettes measuring borderline, anxious, depressive, and self-defeating personality style rated parents as uncaring, overcontrolling, and abusive. When vignettes were consolidated into scores akin to the DSM clusters, the most consistent links between perceived dysfunctional parenting were with the Cluster C (anxious), and Cluster B (dramatic) styles and were nonsignificant for Cluster A (eccentric) style. Meeting criteria for an increasing number of personality disorder clusters was associated with increasing levels of adverse parenting. Multiple regression analyses indicated that disordered functioning (as assessed by the three independent rater groups) was most distinctly associated with paternal indifference and maternal overcontrol.

Adult↗
PubMed1999

Sensory impairment and driving: the Blue Mountains Eye Study.

OBJECTIVES: This study examined the associations between vision, hearing, loss, and car accidents. METHODS: A cross-sectional survey of 3654 people aged 49 years and older in the Blue Mountains, Australia, was used. Each subject had a detailed eye examination and interview. RESULTS: Self-reported car accident rates in the past year among 2379 current drivers were 5.6% for those aged 49 to 79 years and 9.1% for those 80 years and older. A 2-line difference in visual acuity was associated with increased risk of accidents (adjusted prevalence ratio [PR] = 1.6), as was visual acuity worse than 6/18 in the right eye (PR = 2.0), overall moderate hearing loss (PR = 1.9), and hearing loss in the right ear (PR = 1.8). CONCLUSIONS: Sensory loss in drivers may be an important risk factor for car accidents.

Accidents, Traffic↗
PubMed1999

Possible associations between computed tomography scan and cataract: the Blue Mountains Eye Study.

OBJECTIVES: This study examined possible associations between the presence of cataract and a history of computed tomography (CT) scan of the head in an older population. METHODS: The Blue Mountains Eye Study examined 3654 people aged 49 to 97 years who lived west of Sydney, Australia. As part of a medical history, participants were asked whether they had ever had a head CT scan. Masked grading of lens photographs assessed cortical, nuclear, and posterior subcapsular cataracts. RESULTS: No significant associations were found between history of head CT scan and age- and sex-specific prevalence of any type of cataract. CONCLUSIONS: This study provided no evidence to support an association between routine head CT scans and development of cataract.

Aged↗
PubMed1999

Inhaled corticosteroids and cataract: prevalence, prevention and management.

Oral and topical (ocular) corticosteroids are known to have the potential to cause cataracts, but inhaled corticosteroids have generally been considered to be free of this adverse effect. However, a large epidemiological study has recently found a strong association in adults between use of inhaled corticosteroids and risk of posterior subcapsular cataract, the most serious type of cataract. This is likely to be a causal association as the association was strong (odds ratio of 10 for heavy users of corticosteroids compared with nonusers); in addition, there was a dose-response relationship and the association is biologically plausible. For people with asthma, the benefits of inhaled corticosteroids for management of their respiratory symptoms will be much greater than the risk of cataract. This is particularly true for children, in whom the risk of cataract is extremely low. Nevertheless, the existence of serious adverse effects of inhaled corticosteroids means they should be used for the shortest duration, and in the lowest dose, compatible with effective asthma management.

Administration, Inhalation↗
PubMed1999

Asymmetry in optic disc parameters: the Blue Mountains Eye Study.

PURPOSE: To examine asymmetry in vertical optic disc parameters among subjects classified as normal, as having ocular hypertension (OH), and as having open-angle glaucoma (OAG) in a population-based sample. METHODS: The Blue Mountains Eye Study examined 3654 people aged 49 to 97 years, including 2929 normal subjects, 118 with OH, and 79 with OAG in the groups of interest for the asymmetry study. Optic disc parameters were measured in a masked manner from stereo optic disc photographs. RESULTS: Vertical disc diameter asymmetry (the absolute value of left minus right disc diameters) was similar among normal, OH, and OAG groups (median, 0.07-0.08 mm). Vertical cup- disc ratio asymmetry was higher in patients with OAG (median, 0.11) than in normal subjects (median, 0.06; P < 0.0001) and in those with OH (median, 0.05; P < 0.0001) but was similar between normal subjects and patients with OH (P = 0.17). A cup- disc ratio asymmetry of 0.2 or more was found in 24% of patients with OAG, compared with 1% of patients with OH and 6% of normal subjects. Corresponding rates for cup- disc ratio asymmetry of 0.3 or more in these three groups were 10%, 0%, and 1%, respectively. Using multiple linear regression, cup-disc ratio asymmetry was associated with disc diameter asymmetry and intraocular pressure asymmetry. However, these two factors explained only 3% of the variability of cup- disc ratio asymmetry and 20% of cup diameter asymmetry. CONCLUSIONS: Despite differences between the OAG group and either the OH or normal groups, asymmetry alone was not useful in identifying patients with OAG. At all levels of asymmetry, subjects were more likely to be classified as normal than with OH or OAG.

Aged↗
PubMed1999

Refractive associations with cataract: the Blue Mountains Eye Study.

PURPOSE: To assess the relationship between myopia and age-related cataract in a defined older population. METHODS: A cross-sectional study of 3654 people aged 49 to 97 years was conducted in the Blue Mountains near Sydney, Australia, from 1992 through 1994. General medical, eye, and refractive history and information about confounders were collected by questionnaire. Participants had a detailed determination of refraction, and the spherical equivalent refraction of each eye was calculated. The Wisconsin Cataract Grading System was used in masked grading of slit lamp and retroillumination lens photographs, to assess presence and severity of nuclear, cortical, and posterior subcapsular (PSC) cataract. Data from both eyes were analyzed by the generalized estimating equation method, adjusting for cataract risk factors. RESULTS: Included in the analysis were 7308 eyes. A history of wearing distance glasses, excluding eyes with current hyperopic refraction, was used as a proxy for myopia. Subjects who had worn distance glasses were more likely to have nuclear cataract (odds ratio [OR] 1.3; confidence interval [CI] 1.0-2.1). After stratification by age at first wearing distance glasses, this relationship remained only for people who first wore distance glasses after age 40 years (OR 1.3; CI 1.0-1.8), which suggested a myopic refractive shift from developing nuclear opacity and was supported by the weak association found between current myopic refraction and nuclear cataract (OR 1.3; CI 1.0-1.6). Eyes with onset of myopia before age 20 years had the greatest PSC cataract risk (OR 3.9; CI 2.0-7.9). This was supported by the finding of an association between current myopic refraction and PSC cataract (OR 2.5; CI 1.6-4.1). PSC cataract was inversely associated with hyperopia (OR 0.6; CI 0.4-0.9). Refraction-related increasing odds were found between PSC cataract and myopia: low myopia (OR 2.1; CI 1.4-3.5), moderate myopia (OR 3.1; CI 1.6-5.7), and high myopia (OR 5.5; CI 2.8-10.9). High myopia was associated with PSC, cortical, and late nuclear cataract. CONCLUSIONS: Early-onset myopia (before age 20 years) may be a strong and independent risk factor for PSC cataract. The findings suggest the possibility of a dose response between levels of myopia and PSC cataract. Nuclear cataract was associated with presumed acquired myopia, whereas high myopia was associated with all three types of cataract.

Age Factors↗
PubMed1999

Are individuals with autism and Asperger's syndrome susceptible to visual illusions?

A recent finding that individuals with autism are not susceptible to illusions has been explained by Happé (1996) as a sign of "weak central coherence" at lower levels of processing. We investigated the phenomenon with a more sophisticated measure. In Experiment 1, individuals with autism, Asperger's syndrome, moderate learning difficulties, and typical development adjusted certain comparison lines and circles to make them appear to be the same size in four visual illusions. With a minor exception, the participants with autism and Asperger's syndrome evinced a systematic bias in their judgements in the illusion condition. The extent of this was no different from control participants. In a second experiment, a similar finding was obtained in a task where participants made verbal judgements about the stimuli. The results suggest that lower-level coherence in visual processing in autism is intact.

Adolescent↗
PubMed1999

Malignant transformation in pleomorphic xanthoastrocytoma--a report of two cases.

Pleomorphic xanthoastrocytomas (PXA) with malignant transformation are reported in two adult men with a long history of seizures, recent onset of neurological symptoms and superficially located, temporal lobe lesions. Although PXA is generally described as having relatively benign behaviour, this report adds two further cases of malignant transformation to the literature.

Adult↗
PubMed1999

Impact of visual impairment on use of community support services by elderly persons: the Blue Mountains Eye Study.

PURPOSE: To estimate the impact of visual impairment in older Australians on the use of community support services. METHODS: In the Blue Mountains Eye Study, 3654 people aged 49 or older were examined- 82.4% of eligible residents in an area west of Sydney, Australia. Presenting and best-corrected visual acuities were measured using a LogMAR chart. Subjects were categorized as having visual impairment if their better eye read 40 or fewer letters (20/40 or worse). Interview data included marital and other socioeconomic status measures, living status (alone or with spouse or other person), use of community support services, reliance on regular help from nonspouse family members or friends, and perceived ability to go out alone. RESULTS: After adjusting for age, gender, education, living status, walking disability, and health-related factors, for each one-line (five-letter) decrease in best-corrected visual acuity, there was a corresponding increase in reliance on community support services (odds ratio [OR], 1.17; 95% confidence interval, [CI] 1.07-1.28) or combined community and family support (OR 1.22; 95% CI, 1.12-1.32). Visually impaired persons were three times as likely to use regular support services provided by the municipality (OR 3.1; 95% CI, 1.8-5.1). A similar increased reliance on regular help from community, nonspouse family members, or friends was found. Visually impaired persons were also much more likely to state that they thought they were unable to go out alone (OR 6.2; 95% CI, 2.6-14.3). The findings were similar when presenting visual acuity was used to define visual impairment or after subjects with walking disabilities were excluded. Visual impairment seemed to have a greater effect on use of community support services in women than in men. CONCLUSIONS: After adjustment was made for confounding factors, visual impairment was found to affect significantly and negatively the independence of elderly people, particularly older women. Presenting visual acuity closely approximated best-corrected visual acuity in its impact on the use of community support services.

Activities of Daily Living↗