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Biomedical subjects

P Sachdev

Publications and source records attributed to P Sachdev.

At least 73 records · Page 4Linked to original sources
PubMed1994

The abortion battle: the Canadian scene.

In January 1988 the Supreme Court of Canada struck down the country's archaic abortion law on the ground that it imposed arbitrary delays and unfair disparities in access to abortion across the country. Since then, the conservative government of Canada has made a few attempts to introduce a new abortion policy, but it did not get passed in the parliament because the revised bills failed to protect women's right to 'life, liberty, and security of the person' within the meaning of the Canadian Charter. Canada has been without an abortion law for over four years and there has been a wide range of provincial policies and confusion in the country. Despite the legal vacuum, Canadian women are not frenziedly having abortions. However, the militancy of the anti-abortion groups has steadily intensified with continued assault on a woman's right to make reproductive choices. Since no law, short of banning abortions altogether, is going to satisfy abortion opponents, the abortion battle will rage on in Canada.

Abortion, Legal↗
PubMed1993

Tardive and chronically recurrent oculogyric crises.

Six patients with chronically recurrent oculogyric crises (OGC) are reported. Four of these were derived from a study of 100 schizophrenic patients on maintenance neuroleptic medication, thereby giving a prevalence of 4% in such patients. Three of the six had the OGC develop as a tardive side-effect, and in one patient the episodes persisted for some months after the cessation of the offending neuroleptic drug. The episodes of ocular dystonia were associated with other dystonic movements and a number of psychiatric symptoms, with obsessional thoughts and hallucinations being the outstanding features in one patient each. This paper argues for an increased recognition of chronically recurrent and tardive OGC. It also draws attention to the fact that drug-induced OGC may be a multifaceted disorder with disturbances of movement, thought, behavior, and emotion, reminiscent of the OGC described in association with epidemic encephalitis lethargica.

Adolescent↗
PubMed1993

Intravenous benztropine and propranolol challenges in tardive akathisia.

We challenged five patients suffering from tardive akathisia (TA) with intravenous benztropine (2 mg), propranolol (1 mg) and placebo (saline) using a random, double-blind cross-over design to examine the effects of the drugs on the subjective, objective and global manifestations of neuroleptic-induced akathisia. Benztropine produced a marginally significant, and propranolol a significant improvement in the overall manifestations of the disorder. The patients demonstrated a considerable placebo effect and marked variation in their responses to the drugs. The implications of these findings for the pathophysiology of TA in relation to acute akathisia and tardive dyskinesia are discussed.

Adult↗
PubMed1993

Neuroleptic-induced defecation in rats as a model for neuroleptic dysphoria.

Two groups of 32 rats were challenged in a well-habituated environment with haloperidol (0.5 mg/kg), haloperidol (0.1 mg/kg), domperidone (0.1 mg/kg), or saline to study the effect of these drugs on defecation--an index of emotionality--and voluntary movements in the 2 hours after the injection. The haloperidol-treated rats in the high-dose condition had significantly more bolus counts in the 2 hours after the injection than were observed in the groups treated with domperidone (a peripheral dopamine D2 receptor antagonist) or placebo. All movements were greatly reduced in the haloperidol-treated rats and, in this group, the ones with more bolus counts did not differ in their activity levels from those with fewer bolus counts. There was a trend for the rats that were less mobile at 10 minutes after the injection to produce more boli in the 2-hour period. Our study, therefore, replicates the findings of Sanberg (1980) and Russell et al. (1987a, 1987b) that haloperidol increases "emotional" defecation in rats in well-habituated environments, but the same model does not replicate the motor component of neuroleptic-induced akathisia seen in human subjects.

Animals↗
PubMed1993

Intravenous benztropine and propranolol challenges in acute neuroleptic-induced akathisia.

We challenged six patients suffering from acute neuroleptic-induced akathisia (NIA) with intravenous benztropine (2 mg), propranolol (1 mg), and placebo (saline) using a random, double-blind cross-over design to examine the effects of the drugs on the subjective, objective, and global manifestations of NIA. Benztropine produced a significant amelioration of NIA, more apparent in its subjective component. Propranolol failed to produce a significant improvement overall in any of the akathisia measures, with only one patient showing clinical improvement. The patients demonstrated considerable placebo effect and marked variation in their responses to the drugs.

Acute Disease↗
PubMed1993

Treatment of obsessive-compulsive disorder by psychosurgery.

We report a longitudinal study of 26 patients with medically intractable obsessive-compulsive disorder (OCD) who were treated with psychosurgery and had a comprehensive follow-up for a mean 10 years. Seventeen patients had combined orbitomedial and cingulate lesions, 6 cingulate lesions only and 3 orbitomedial lesions only. Eighteen patients were interviewed personally and lesions verified on magnetic resonance imaging scans in fourteen. On a 6-point global rating scale, 10 (38%) patients had obvious improvement, another 6 (23%) showed mild improvement of doubtful clinical value, and the remaining 10 showed either no change (n = 6; 23%) or were judged to be worse (n = 4; 15%). Both obsessive and compulsive symptoms improved, and this change was independent of the changes in anxiety and depression scores. No significant predictors of improvement were identified. Patients with cingulate lesions only fared worse. Eight patients who had a second operation did not show much improvement. A comparison of a subgroup of patients with 10 matched nonsurgical OCD controls supported the contention that the improvement in OCD was attributable to the psychosurgery. Important adverse effects in the stereotactic surgery group (n = 20) were epilepsy (1 patient) and personality change (2 patients). The psychosurgery group performed relatively poorly on the Wisconsin Card Sort Test but did not show any deterioration in Wechsler Intelligence and Memory scores.

Adult↗
PubMed1993

Risk factors for tardive dystonia: a case-control comparison with tardive dyskinesia.

The objective of this study was to determine the putative risk factors for the development of tardive dystonia (TDt) in contrast with tardive dyskinesia (TD). Fifteen TDt patients seen in the Movement Disorders Clinic were compared with 2 groups of 15 TD controls each. The first control group was drawn from the Clinic and matched with the TDt cases for severity, using degree of dysfunction as the matching variable. The second control group comprised mild TD cases drawn from a separate study of drug-induced movement disorders in chronic schizophrenia and were matched for age and sex with the TDt cases. A number of demographic, treatment-related, diagnosis-related and historical variables suggested in the literature were examined. Most risk factors for TDt that have been suggested by previous studies were not supported. The first control group was significantly older than the TDt cases. The TDt patients had a more frequent past history of acute drug-induced dystonia and of postural tremor prior to the onset of the mental illness, although only the former reached statistical significance. The results suggested that TDt and TD do not differ in most putative risk factors, although the small sample size increases the likelihood of a type II error. It is inconclusive on the role of young age and male sex as risk factors. TDt cases may, however, be individuals vulnerable to the development of dystonia, with neuroleptics probably bringing out such a vulnerability. This finding needs to be examined in larger studies.

Adult↗
PubMed1993

Clinical characteristics of 15 patients with tardive dystonia.

Clinical characteristics of 15 consecutively referred patients with tardive dystonia are reported. The onset of tardive dystonia occurred in all age groups and in both sexes, with some preponderance in men. There was considerable overlap with tardive dyskinesia and tardive akathisia. Six subjects reported past acute dystonia, and four had histories of essential tremor, suggesting a vulnerability to the development of dystonia.

Adult↗
PubMed1993

The neuropsychiatry of brain iron.

In the last two decades, many biological functions of iron have been identified, in particular its role in many enzymatic processes, its effect on dopamine D2 receptor function, its interaction with other neurotransmitters (gamma-aminobutyric acid, serotonin, opiate-peptides), and its catalytic role in the nonenzymatic mechanisms for oxidation, hydroxylation, and peroxidation reactions. The role of iron in Parkinson's disease, Alzheimer's disease, brain injury due to exogenous causes, neuroleptic-induced movement disorders, schizophrenia, and other neuropsychiatric disorders is currently being explored. This study summarizes current understanding of the anatomy and physiology of brain iron with special reference to these disorders.

Alzheimer Disease↗
PubMed1993

Low-dose apomorphine challenge in tardive akathisia.

We challenged seven tardive akathisia patients with low-dose apomorphine (0.01 mg/kg) SC and placebo in a double-blind, random design. Apomorphine caused a significantly greater reduction in the objective (movement) but not the subjective (distress) component of akathisia.

Adult↗
PubMed1992

Golfers' cramp: clinical characteristics and evidence against it being an anxiety disorder.

The clinical characteristics of 20 golfers suffering from golfers' cramp or the "yips" are described. The typical description is that of a middle-aged golfer who has played competitive golf since his teens and develops the problem during a tournament in the form of a jerk, spasm, or freezing of movement while putting or chipping, with the rest of the game being relatively unaffected. The problem generally takes a chronic fluctuating course, and a number of 'trick' strategies are partially or fully successful. In this study, the subjects were compared with a matched group of 20 unaffected golfers on a number of indices of psychopathology; no significant differences emerged. The more severely affected golfers also did not differ significantly from the mildly affected ones, except on the subjective report of anxiety. These data support the argument that golfers' cramp is not an anxiety disorder or a neurosis. The important role of anxiety and arousal in its manifestation is, nevertheless, recognized and its pathophysiology speculated upon.

Adult↗
PubMed1992

Neuroleptic-induced movement disorders and body iron status.

1. The distribution of iron in the human brain, what is known about its biological functions, and the interaction of neuroleptics with iron suggest that this trace metal may play an important role in the pathogenesis of neuroleptic-induced movement disorders (NIMD). 2. The availability of magnetic resonance imaging has made some of the hypotheses testable in human subjects. 3. This article is a brief overview of the current literature on the association between NIMD and brain iron.

Antipsychotic Agents↗
PubMed1992

Iron and akathisia.

Explore the source record for details and available documents.

Akathisia, Drug-Induced↗
PubMed1992

Psychotic symptoms preceding ocular deviation in a patient with tardive oculogyric crises.

This report describes a patient with schizophrenia who developed episodes of ocular dystonia as a delayed side effect of neuroleptic medication. Each episode was preceded and accompanied by marked agitation, stereotypic behaviour and exacerbation of hallucinations. Both the psychotic and dystonic symptoms responded to anticholinergic medication. The theoretical and practical implications of this observation are discussed.

Adult↗