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Biomedical subjects

P R Joyce

Publications and source records attributed to P R Joyce.

At least 109 records · Page 6Linked to original sources
PubMed1990

Birth cohort trends in major depression: increasing rates and earlier onset in New Zealand.

In a community sample of 1498 urban adults (18-64 years) interviewed in their homes with the Diagnostic Interview Schedule (DIS), the 6-month and lifetime prevalence of major depression was higher in females than males. However, in the most recent birth cohort young men had a higher 6-month prevalence of depression. Survival analysis of the cumulative lifetime risk for major depression demonstrated a significant trend in both sexes for depression to be increasing in prevalence, and for it to be occurring at an earlier age. Thus New Zealand, like other countries, may be entering an age of melancholy.

Adolescent↗
PubMed1990

The new revolving-door patients: results from a national cohort of first admissions.

A cohort of all first admissions to New Zealand psychiatric hospitals and psychiatric wards of general hospitals in 1980 and 1981 was followed up for 5 years. The cohort consisted of 3875 males and 3965 females aged from 15 to 64 years. Of these subjects, 59.4% had only one admission; 14.6% met our criteria for a revolving-door patient, as they had 4 or more admissions within the 5-year follow-up period. Based on first-admission information, patients who were younger and had a psychotic diagnosis had an increased likelihood of becoming a revolving-door patient. Stepwise logistic regression showed that younger age and psychotic diagnosis independently and in interaction were associated with a high probability of becoming a revolving-door patient. Although patients with a first-admission diagnosis of schizophrenia constitute a large group of the new revolving-door patients for both males and females, for women those with affective disorders and for men those with substance abuse comprise the largest proportion of the new revolving-door patients. This is because affective disorders in women and substance abuse in men are the most common diagnoses on first admission, rather than because the disorders themselves are associated with a high probability of the patients having multiple admissions.

Adolescent↗
PubMed1990

Seasonality of mania in New Zealand.

This paper examines the seasonal variation in manic admissions over a five year period in New Zealand. There is a significant monthly variation in admission rates with a spring/summer peak. Breakdown by sex, age and admission status suggested that there is no particular subgroup responsible, but that young first admissions and older female readmissions do not follow this trend. Examination of the monthly admission rates revealed that this peak is not constant from year to year. Possible mechanisms, which link fluctuating environmental variables with an irregular spring/summer peak for manic admissions, are discussed.

Adult↗
PubMed1989

Factors affecting the use of mental health services in people with alcohol disorders.

In a preliminary analysis of data from a community survey of psychiatric disorders in urban Christchurch, 157 of the 1018 adults interviewed met diagnostic criteria for alcohol abuse and/or dependence. The subjects who met the criteria for alcohol abuse and/or dependence were more likely to have used mental health services than the population at large, although 39% of those with an alcohol disorder had never used any form of mental health service. We examined the impact of severity of alcohol disorder, duration of disorder and gender on the use of services among those with an alcohol disorder. Duration of disorder was not related to use of mental health services. Women are more likely than men to use these services. However, the most important finding was that those with the most severe disorders were most likely to have used mental health services.

Adult↗
PubMed1989

Predictors of drug response in depression.

Although the major classes of antidepressant drugs have been available for over 30 years, clinicians are still unable to predict accurately the response of their depressed patients to medication. This article reviews both clinical and biologic predictors of treatment response and makes recommendations for future studies. The tricyclic antidepressants remain the drugs of choice in major depressive disorders. Lithium has a place in bipolar depressions. Monoamine oxidase inhibitors have a role in depressions accompanied by marked anxiety and/or panic symptoms, in patients who have previously responded to them, and as a second-choice treatment in those depressed patients who have not responded to tricyclic antidepressants. Electroconvulsive therapy or additional antipsychotic drugs are frequently necessary in very severe and delusional depressions. Biologic predictors of response, despite some interesting leads that may in the long term be of considerable importance, are not yet sufficiently established to be of routine clinical usefulness, although either dexamethasone nonsuppression or a shortened rapid eye movement latency may identify depressed patients who require biologic treatment.

Antidepressive Agents↗
PubMed1989

Studies of alpha-2-adrenoceptor function in abstinent alcoholics.

Hormonal, haemodynamic and subjective psychological responses to the intravenous infusion of clonidine were investigated in nine male alcoholics who had been abstinent for 5 weeks, and were compared with those of nine healthy controls. The growth hormone response to clonidine was significantly blunted in the abstinent alcoholics. Both baseline cortisol levels and the clonidine-induced cortisol decrease were significantly greater in the alcoholics than in controls. Blood pressure, pulse rate and psychological responses to clonidine were similar in both groups. These results indicate that some aspects of alpha-2-adrenoceptor sensitivity are persistently abnormal in alcoholics at least 5 weeks into abstinence.

Adult↗
PubMed1989

Christchurch Psychiatric Epidemiology Study, Part I: Methodology and lifetime prevalence for specific psychiatric disorders.

In 1986 the Christchurch Psychiatric Epidemiology Study obtained interviews with a probability sample of 1498 adults aged 18 to 64 years. The Diagnostic Interview Schedule (DIS) was used to enable DSM-III diagnoses to be made. This paper describes the methodology of the study and reports the lifetime prevalence of specific psychiatric disorders. The highest lifetime prevalences found were for generalised anxiety (31%), alcohol abuse/dependence (19%) and major depressive episode (13%). Men had higher rates of substance abuse whereas women had higher rates of affective disorders and most anxiety disorders. Compared with results from the Epidemiologic Catchment Area Program, Puerto Rico and Edmonton, Christchurch has the highest rates for major depression and is among the highest for alcohol abuse/dependence.

Adolescent↗
PubMed1989

Christchurch Psychiatric Epidemiology Study, Part II: Six month and other period prevalences of specific psychiatric disorders.

The Christchurch Psychiatric Epidemiology Study determined the occurrence (over 2 weeks, 1 month, 6 months, 12 months and life-time) of a number of specific DIS/DSM-III psychiatric diagnoses in the Christchurch urban area. Data were collected on 1498 randomly selected adults, aged between 18 and 64 years. The Diagnostic Interview Schedule (DIS) was used to collect information to make a DSM-III diagnosis. The six month prevalence rates of disorder are presented and compared with available results from the NIMH Epidemiological Catchment Area Program, Puerto Rico and Edmonton. Other period prevalences for the total sample are also presented. Christchurch is shown to have higher six month prevalence rates for major depression and alcohol abuse/dependence than other sites which have utilised the DIS in community surveys.

Adolescent↗
PubMed1988

Plasma 11-deoxycortisol and cortisol following dexamethasone in psychiatric patients.

As it has been suggested that calculating the ratio of cortisol to its biosynthetic precursor, 11-deoxycortisol, may enhance the sensitivity of the dexamethasone suppression test (DST) for depression, cortisol and 11-deoxycortisol were measured in 90 subjects undergoing this test. Among these subjects, post-dexamethasone cortisol and 11-deoxycortisol levels were significantly correlated (r = 0.65, P less than 0.001) and evaluating the ratio of cortisol to 11-deoxycortisol decreased rather than enhanced sensitivity of the DST.

17-Hydroxycorticosteroids↗
PubMed1988

Carbamazepine in rapid cycling bipolar affective disorder.

Eighteen patients with rapid cycling bipolar affective disorder were recruited for an open trial of carbamazepine. Of these patients all but 2 had been resistant to lithium prophylaxis. Twelve of the patients were able to complete at least 6 months on carbamazepine. Of these 12 patients, 2 had a complete remission of their affective disorders on carbamazepine alone, 2 completely responded to combined lithium and carbamazepine treatment, 3 had a slight beneficial effect from the drug, and for the other 5 patients carbamazepine was of no therapeutic benefit. This suggests that, while carbamazepine is effective for some rapid cycling patients, for the majority alternative treatment strategies are still required.

Adult↗
PubMed1987

The dexamethasone suppression test in psychiatry.

The dexamethasone suppression test (DST) for depression (melancholia) has been the focus of considerable recent interest because of claims that it may be a sensitive and specific biological marker for melancholia. When the data from four separate studies were combined, 52% of our patients with major depression were DST nonsuppressors. However, nonsuppression was also observed in 11% of manic patients, 20% of schizophrenic patients and 15% of nondepressed abstinent alcoholics. These results, in conjunction with other reports, suggest that the specificity of the test is not sufficiently high to make it a satisfactory general diagnostic test.

Alcoholism↗
PubMed1987

Changing trends in first admissions and readmissions for mania and schizophrenia in New Zealand, 1974 to 1984.

From 1974 to 1984 in New Zealand there was a significant decline in first psychiatric admissions for the functional psychoses. This decline is due to decreasing first admission rates for schizophrenia and depressive psychoses, despite an increasing first admission rate for mania. Although a small part of the declining first admission rate for schizophrenia may be due to the increasing diagnosis of mania, this is insufficient to explain all the decline and suggests an actual decline in the incidence of schizophrenia. Over this same period readmissions for functional psychoses increased, with the most marked increase being in manic readmissions. Although a variety of factors influence readmission rates, the marked rise in manic readmissions suggests broadening diagnostic criteria for mania.

Adult↗
PubMed1986

Endocrine and behavioral responses to methylphenidate in normal subjects.

Methylphenidate (0.3 mg/kg) was administered intravenously to 20 normal subjects. Behavioral responses varied considerably among individuals. Both cortisol and growth hormone showed significant increases (p less than 0.001). The adrenocorticotrophic hormone (ACTH) response seemed insufficient to explain the increase in cortisol. For men only, the increase in cortisol correlated positively with the increase in epinephrine (r = 0.77, p less than 0.05) and correlated negatively with baseline cortisol (r = -0.70, p less than 0.05), with increase in growth hormone (r = -0.70, p less than 0.05), and with the increase in "energy" (r = -0.83, p less than 0.01). The growth hormone response varied between the sexes, and for men, the growth hormone correlated with both an increase in "energy" (r = 0.70, p less than 0.05) and "friendliness" (r = 0.68, p less than 0.05). For all subjects, baseline heart rate correlated with the increase in "energy" (r = -0.69, p less than 0.002). In a separate study, six male subjects received, on different occasions, saline and a lower dose of methylphenidate. Together, these studies show that the increases in cortisol, growth hormone, and epinephrine, and the decrease in prolactin are dose-dependent.

Adult↗
PubMed1986

Physostigmine reduces the plasma cortisol response to methylphenidate in normal subjects.

Six healthy male subjects were studied to determine whether the reduced plasma cortisol response to methylphenidate observed in depressed patients could be reproduced in normal subjects by pretreatment with physostigmine. Indeed, physostigmine was found to mimic this effect. The finding raises the possibility that increased cholinergic rather than decreased adrenergic activity could explain the blunted cortisol response to stimulants reported in depressed patients. Physostigmine also enhanced the growth hormone rise and prolactin decline, and limited the increase in heart rate following methylphenidate administration.

Adult↗