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Biomedical subjects

R A Emsley

Publications and source records attributed to R A Emsley.

At least 37 records · Page 2Linked to original sources
PubMed1999

Television as a medium for psycho-education in South Africa: analysis of calls to a mental health information centre after screening of a TV series on psychiatric disorders.

OBJECTIVES: As one of the most powerful media, television may have an important role to play in providing psycho-education in both developed and developing countries. The South African Broadcasting Corporation (SABC) recently screened a TV series that focused on the signs and symptoms of the main psychiatric disorders. The aim of this paper is to describe calls to our Mental Health Information Centre after screening of the series. DESIGN: The TV series "Improve Your Frames of Mind" was developed by an independent producer in collaboration with the Society of Psychiatrists of South Africa, and was screened by the SABC. At the end of each show, the telephone number of our Mental Health Information Centre was given to viewers. All calls to our centre were entered into a database and later analysed. SETTING: A mental Health Information Centre in South Africa. SUBJECTS: Callers to the Mental Health Information Centre. RESULTS: Almost 3,000 calls were taken by three psychiatric nurses working at the Mental Health Information Centre. Calls related to each of the major psychiatric disorders, particularly the mood and anxiety disorders. Callers expressed satisfaction with the information that they received from the Centre. CONCLUSION: A TV series on psychiatric disorders appeared successful in encouraging viewers to seek additional information. Indeed, additional telephone lines would have allowed even more calls to be fielded. Further research is necessary to determine whether it would be useful for TV to portray specific treatment interventions.

Health Education↗
PubMed1999

A double-blind placebo-controlled trial of paroxetine in the management of social phobia (social anxiety disorder) in South Africa.

BACKGROUND: Social phobia, also known as social anxiety disorder, is a highly prevalent disorder with significant morbidity. Patients with social phobia frequently develop co-morbid psychiatric disorders such as depression and substance abuse, and the disorder impacts significantly on social and occupational functioning. It has been suggested that the selective serotonin reuptake inhibitors (SSRIs) are useful in the management of this disorder, but few controlled trials have been undertaken in this regard. There are also few data on the pharmacotherapy of social phobia in South Africa. METHODS: A double-blind randomised placebo-controlled multi-site flexible-dose trial of paroxetine was undertaken over 12 weeks among patients with a primary diagnosis of social phobia. Primary response measures were the Global Improvement item on the Clinical Global Impression scale (CGI) and mean change from baseline in the patient-rated Liebowitz Social Anxiety Scale (LSAS) total score. Ninety-three patients participated at 9 South African sites; their data are reported here. RESULTS: There was a significant drug effect on both the CGI Global Improvement score and the LSAS at 12 weeks. In addition, there was no significant difference in overall rate of adverse experiences between those on paroxetine and those on placebo. CONCLUSIONS: Paroxetine is both effective and safe in the acute treatment of social phobia. The findings here are consistent with those of previous controlled studies of the SSRIs as well as with previous work done in the USA on the use of paroxetine in the treatment of this disorder. Early diagnosis and treatment of social phobia should be encouraged. However, further research on long-term pharmacotherapy of social phobia is needed.

Adult↗
PubMed1999

Partial response to antipsychotic treatment: the patient with enduring symptoms.

While approximately 70% of patients with schizophrenia and other psychotic disorders show a clear-cut reduction of symptoms in clinical trials, there is considerable variation in individual patient outcome, ranging from complete remission to absolute refractoriness. When additional indicators of treatment outcome are considered, such as cognitive and occupational and social functioning, it is clear that the overall outcome for schizophrenia is far from satisfactory. For many schizophrenic patients, treatment with conventional antipsychotic agents is not fully effective, and one approach has been to increase the administered dose. However, raising the dose increases the likelihood of side effects and may significantly compromise patient compliance. The availability of atypical antipsychotic agents represents a significant step forward for those patients who are nonresponsive to conventional antipsychotics, offering proven efficacy, a lower risk of extrapyramidal symptoms, and improved clinical outcomes.

Adult↗
PubMed1997

Psychiatric manifestations and magnetic resonance imaging in HIV-negative neurosyphilis.

Neurosyphilis can mimic virtually any psychiatric disorder. Since there are no studies measuring the relationship between its psychiatric manifestations and neuroradiological findings, we performed magnetic resonance imaging (MRI) on 20 newly diagnosed patients with neurosyphilis and 20 healthy volunteers. MRI abnormalities occurred in 13 neurosyphilis patients. These included foci of increased signal intensity of T2-weighted images, and generalized cerebral atrophy. Two control subjects showed minor focal changes. In the neurosyphilis patients, frontal lesions showed statistically significant associations with the overall degree of psychiatric morbidity as measured by the brief psychiatric rating scale (p < 0.05). Temporo-parietal lesions showed a near significant association with cognitive impairment as measured by the Mini mental-state examination (p = 0.06). Atrophy measures correlated significantly with cognitive impairment. The results suggest that the site of brain lesions may be important in determining the nature of the psychiatric symptoms in neurosyphilis.

Adult↗
PubMed1997

Risperidone augmentation of serotonin reuptake inhibitors in obsessive-compulsive and related disorders.

BACKGROUND: While serotonin is the neurotransmitter most commonly implicated in obsessive-compulsive and related disorders, there is also evidence for dopaminergic mediation of these conditions. Indeed, augmentation of serotonin reuptake inhibitors with the atypical neuroleptic risperidone has been suggested to be useful in obsessive-compulsive disorder (OCD). METHOD: Charts of all patients treated in our OCD clinic with the combination of a serotonin reuptake inhibitor and risperidone were reviewed. Demographic details of patients and clinical response to this pharmacotherapeutic strategy were tabulated. RESULTS: A series of patients with OCD (N = 8), trichotillomania (N = 5), and Tourette's syndrome (N = 3) who were refractory to treatment with serotonin reuptake inhibitors had received risperidone augmentation. In a number of cases, this strategy proved clinically effective. However, a minority of patients experienced significant adverse effects. CONCLUSION: Patients with OCD and related disorders are not infrequently refractory to treatment with serotonin reuptake inhibitors. Controlled trials of risperidone augmentation in such patients seem warranted. In particular, it is necessary to determine an appropriate dose range to minimize adverse effects.

Adult↗
PubMed1997

A new model for the pathophysiology of Alzheimer's disease. Aluminium toxicity is exacerbated by hydrogen peroxide and attenuated by an amyloid protein fragment and melatonin.

OBJECTIVES: Although Alzheimer's disease (AD) is the leading cause of dementia in developed countries, there is an as yet unexplained lower prevalence of the disease in parts of Africa. AD is characterised by a catastrophic loss of neurons; free radicals (oxidative toxins) have been implicated in the destruction of the cells through the process of lipid peroxidative damage of cell membranes. Previously aluminium (Al) and a fragment of beta amyloid (A beta 25-35) were shown to exacerbate free-radical damage, while melatonin reduced this effect. The aim of the present study was: (i) to investigate the conditions determining the toxicity of Al and A beta 25-35; and (ii) to assess whether melatonin could attenuate the damage done by both aluminium and the amyloid fragment, thus suggesting a pathway for the aetiology of AD. DESIGN: An in vitro model system was used in which free radicals were generated, causing lipid peroxidation of platelet membranes, thus simulating the disease process found in the brain. RESULTS: 1. Al and A beta 25-35 caused lipid peroxidation in the presence of the iron (II) ion (Pe2+), Al being more toxic than A beta 25-35. 2. A beta 25-35 attenuated the lipid peroxidation promoted by Al. 3. Hydrogen peroxide (H2O2) greatly exacerbated the toxicity of Al and A beta 25-35. 4. Melatonin prevented lipid peroxidation by Al and A beta 25-35 in the absence of H2O2, but only reduced the process when H2O2 was present. CONCLUSIONS: In the light of the results obtained from the present study, the following hypotheses are formulated. 1. In AD, excessive quantities of Al are taken up into the brain, where the Al exacerbates iron-induced lipid peroxidation in the lysosomes. 2. In response, the normal synthetic pathway of amyloid protein is altered to produce A beta fragments which attenuate the toxicity of Al. In the process of sequestering the Al and iron, immature plaques are formed in the brain. 3. Microglia are activated, in an attempt to destroy the plaques by secreting reactive oxygen species such as H2O2. At this point in the disease process, lipid peroxidation causes a catastrophic loss of brain cells. 4. Melatonin, together with other free radical scavengers in the brain, reduces the free-radical damage caused by Al and A beta, except in the latter stages of the disease process. Since melatonin is produced by the pineal gland only in the dark, the excess of electric light in developed countries may help explain why AD is more prevalent in these countries than in rural Africa.

Aluminum↗
PubMed1997

Zinc and platelet membrane microviscosity in Alzheimer's disease. The in vivo effect of zinc on platelet membranes and cognition.

OBJECTIVES: To investigate the effects of oral zinc supplementation on: (i) plasma zinc concentrations; (ii) platelet membrane microviscosity in vivo; and (iii) cognitive function of Alzheimer's disease (AD) patients. DESIGN: An open-labelled pilot study. SETTING: University of Stellenbosch Medical School and Stikland Hospital. SUBJECTS: Six volunteer AD patients. OUTCOME MEASURES: Plasma zinc levels, platelet membrane microviscosity and cognition (MMSE and ADAS-cog tests). RESULTS: Oral zinc supplementation (30 mg/day) did not increase plasma zinc levels significantly, but significantly increased platelet membrane microviscosity (P = 0.02; 6 patients). Four patients, who underwent 12 months of evaluation, showed modest cognitive improvement on psychometric testing (Mini-Mental State Examination and the cognitive portion of the Alzheimer's Disease Assessment scale scores). CONCLUSIONS: While earlier literature promoted the use of zinc in AD patients, a recent study has contradicted this and implicated zinc in the aetiology of Alzheimer's disease. On the basis of the above results, it may be premature to single out zinc as a causal agent in AD.

Aged↗
PubMed1997

The Mental Health Information Centre of South Africa: a report of the first 500 calls.

BACKGROUND: Despite significant advances in the understanding and treatment of psychiatric disorders in recent years, there remains a good deal of stigma and ignorance in the community. In order to increase awareness of psychiatric disorders in South Africa, we initiated a Mental Health Information Centre at the University of Stellenbosch. In this report, the first 500 calls to the centre are described. METHODS: A routine component of the service delivered by the Mental Health Information Centre is the gathering of data from callers. Data gathered from callers was collated and analysed. RESULTS: Callers from all areas of South Africa made use of the centre, asking for information about depression, obsessive-compulsive disorder and other mental health issues. Interventions included the mailing of pamphlets, referrals to general practitioners and mental health care professionals, and other forms of help. Most callers experienced significant satisfaction with the service. CONCLUSION: Psycho-education is an increasingly important component of psychiatric care. A mental health information centre may be a relatively inexpensive way of providing psycho-education to a large section of the community. Further research is necessary to determine the efficacy of such interventions.

Adult↗
PubMed1996

Serotonergic agents in the treatment of hypothalamic obesity syndrome: a case report.

The hypothalamic obesity syndrome is characterized by hyperphagia and excessive weight gain in the presence of demonstrable hypothalamic injury. There have been no previous reports describing the use of serotonergic agents in this condition. We report on a patient with severe hyperphagia and obesity secondary to a hypothalamic lesion, who was treated with consecutive courses of fluoxetine and fenfluramine. Neither treatment resulted in a reduction in food intake or weight. Treatment of hypothalamic obesity with serotonergic agents appears to be of little value, probably because they exert their effect via intact serotonergic-sensitive hypothalamic nuclei.

Adult↗
PubMed1995

Cognitive change after treatment for neurosyphilis. Correlation with CSF laboratory measures.

The decision to re-treat a patient with neurosyphilis is usually based on the clinical response, cerebrospinal fluid (CSF), cell count, and CSF protein concentration. The value of the CSF Venereal Disease Research Laboratory (VDRL) test on its own as a marker for treatment response in neurosyphilis has not been established. To assess the usefulness of CSF markers for continuing infection, 12 patients with neurosyphilis were reevaluated 1 year after treatment. Change in cognitive functioning, as assessed by the Mini-mental State Examination (MMSE), was correlated with the CSF cell count, protein content, IgG index, and VDRL test titer at follow-up. A significant negative correlation was obtained between 1 year improvement in MMSE score and CSF VDRL titers at both the 6- and the 12-month follow-up examinations, and with the 6-month CSF protein concentration. These findings suggest that the CSF VDRL titer may be an indicator of continued Treponema pallidum activity in patients without obvious clinical deterioration.

Adult↗
PubMed1995

Vasopressin secretion and memory impairment in alcoholic Korsakoff's syndrome.

The response of arginine vasopressin (AVP) to an intravenous hypertonic saline infusion was investigated in 19 patients with alcoholic Korsakoff's syndrome, 17 non-amnesic alcoholics and 21 non-alcoholic controls. Compared with non-alcoholic controls the Korsakoff patients had elevated basal AVP levels and showed erratic fluctuation of AVP secretion, not related to changes in serum sodium levels. The non-amnesic alcoholics had a similar, but less severe derangement. Neuropsychological tests revealed significant correlations between basal AVP levels and memory performance in the non-amnesic alcoholics, raising the possibility of a common lesion--most likely in the diencephalon--for memory impairment and AVP dysregulation in chronic alcoholics.

Adult↗
PubMed1995

The thyrotropin releasing hormone stimulation test in alcoholism.

The mechanism for a blunted thyroid stimulating hormone (TSH) response to thyrotropin releasing hormone (TRH) in alcoholics is not known. We performed a combined TRH and gonadoliberin stimulation test on three well-defined groups of nondepressed alcoholic men. Group A comprised patients with acute withdrawal symptoms (n = 28), group B patients abstinent for 5-8 weeks (n = 29) and group C patients who had been abstinent for > 2 years (n = 16). Twenty-two healthy male volunteers were used for comparison. A blunted TSH response to TRH (delta TSH < 5 microU/l) occurred only in groups A (39%) and B (17%). In group A delta TSH showed a significant negative correlation with the severity of withdrawal symptoms and a significant positive correlation with serum magnesium levels. In group B, patients with a family history of alcoholism had significantly lower delta TSH levels than those without such a family history. Groups did not differ with respect to basal and delta prolactin, and TSH responses were not significantly associated with vitamin deficiency, cortisol levels or free thyroid hormone levels. We conclude that TRH stimulation test blunting appears to be related to factors operating in the withdrawal state and improves with continued abstinence. A possible role of genetic factors and serum magnesium needs to be further explored.

Adult↗
PubMed1994

The usefulness of cerebrospinal fluid tests for neurosyphilis.

To determine the usefulness of cerebrospinal fluid (CSF) tests for syphilis at a large academic hospital, clinical and laboratory data on 644 patients in whom such testing was requested over a 12-month period were analysed. In 198 cases (31%) the Treponema pallidum haemagglutination (TPHA) screening test could not be performed because of insufficient fluid. Thirty-eight of the remaining patients were diagnosed as having active neurosyphilis. Examination of 22 files of patients who had a positive TPHA and fluorescent treponemal antibody absorption (FTA-Abs) test together with a negative CSF Venereal Disease Research Laboratory (VDRL) test revealed that other CSF measures indicating disease activity (CSF protein, cells or IgG index) were not utilised optimally. In 10 (45%) of these patients neurosyphilis was not diagnosed despite either abnormal or incomplete CSF biochemical analysis, indicating that if the CSF VDRL is used as the sole marker for disease activity, some cases of neurosyphilis are likely to be missed.

Adult↗
PubMed1994

Endocrine function in alcoholic Korsakoff's syndrome.

Hypothalamic-pituitary function was studied by means of several dynamic endocrine tests in 19 patients with alcoholic Korsakoff's syndrome, 17 non-amnesic alcoholics and 21 non-alcoholic controls. The responses of thyroid stimulating hormone, prolactin, follicle stimulating hormone, and luteinizing hormone to a combined thyrotropin releasing hormone and gonadoliberin stimulation test did not differ significantly. For the dexamethasone suppression test, the Korsakoff patients had significantly higher basal serum cortisol and 08:00 hr post-dexamethasone cortisol levels than non-alcoholic controls. These findings raise the possibility that chronically elevated cortisol levels may contribute to cognitive impairment in alcoholic Korsakoff's syndrome.

Adult↗
PubMed1993

Disordered water homeostasis and cognitive impairment in schizophrenia.

To investigate a possible association between disordered water homeostasis and cognitive impairment in schizophrenia, neuropsychological tests were applied to 16 schizophrenic patients with severely deranged water homeostasis and to 16 matched schizophrenic controls. The patients with disordered water homeostasis tended to obtain poorer scores than the controls throughout, the differences being statistically significant for two of the tests (Wechsler Memory Scale Visual Reproduction and Trial Marking Test part A). These results were not ascribable to differences in the duration of the illness, premorbid IQ, medication, or electroconvulsive therapy received, or prominence of any particular symptoms. The results suggest the co-existence of disordered water homeostasis and cognitive impairment in a subset of schizophrenic patients.

Adult↗
PubMed1992

Psychiatric manifestations of neurosyphilis.

To investigate referral patterns, initial diagnoses and clinical features of patients with neurosyphilis who present with psychiatric manifestations, records were kept of 21 such patients admitted to an acute psychiatric ward. In none of the 12 cases referred from primary care workers was the possibility of neurosyphilis considered. In only 3 cases was this diagnosis considered on admission to the psychiatric ward before serum serological test results were known. Commonest presenting symptoms were personality change (16 patients) and memory impairment (13 patients). Neurological signs or symptoms were also common, particularly absent pupillary reaction to light (5 patients) and buccolingual masticatory movements (5 patients). A positive serological test remains the single most important factor in identifying patients with neurosyphilis.

Adult↗