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Biomedical subjects

R Caplan

Publications and source records attributed to R Caplan.

At least 37 records · Page 2Linked to original sources
PubMed1996

Conversational repair in schizophrenic and normal children.

OBJECTIVE: Children acquire the skills to monitor the adequacy of their spoken message and to self-initiate repair strategies that modify the message during early, middle, and late childhood. To characterize further the communication deficits of childhood-onset schizophrenia, this study compared self-initiated repair strategies in schizophrenic and normal children and their relationship with formal thought disorder, discourse deficits, and distractibility. METHOD: Measures of self-initiated repair, formal thought disorder, and cohesion were coded in 32 schizophrenic and 47 normal children, aged 5.6 to 12.4 years, from speech samples elicited with the Story Game. RESULTS: The schizophrenic children used some repair strategies (false starts, fillers, referential revision) more infrequently than the normal children. Within the schizophrenic group, the children who were receiving neuroleptic medication underutilized repair and had more discourse deficits than the unmedicated patients. Loose associations and distractibility were associated with increased use of false starts but not fillers. CONCLUSIONS: In addition to formal thought disorder and discourse deficits, schizophrenic children underutilize self-initiated repair when presenting their thoughts to the listener, particularly if they are being treated with neuroleptics, a potential sign of increased clinical morbidity. Impoverished communication skills might reflect negative signs in childhood-onset schizophrenia.

Attention↗
PubMed1996

Obsessive-compulsive disorder, tattooing and bizarre sexual practices.

BACKGROUND: A case is presented describing an association between obsessive-compulsive disorder, tattooing and unusual sexual practices. METHOD: A single case report. CONCLUSIONS: Tattooing and unusual sexual practices are compulsive behaviours associated with the subject's obsessive-compulsive disorder. Such associations have not previously been described in the literature.

Adult↗
PubMed1996

A controlled trial of dothiepin and placebo in treating benzodiazepine withdrawal symptoms.

BACKGROUND: The possibility that treatment with tricyclic antidepressants, in the form of dothiepin, might attenuate benzodiazepine withdrawal symptoms was investigated in a double-blind trial. METHOD: Eighty-seven non-depressed psychiatric out-patients with putative normal dose benzodiazepine dependence had their benzodiazepines reduced in stepwise amounts of 20% of the original dose for eight weeks. The patients were randomised to receive dothiepin (with dosage increasing to 150 mg/day) or placebo as an aid to withdrawal before benzodiazepine reduction and these drugs were taken for four further weeks before being stopped. RESULTS: Fewer patients entered and completed the study than expected and a Type II error was possible in the results. Although there was some evidence of withdrawal symptoms being less marked in those patients allocated to dothiepin this was independent of any antidepressant effect as depression scores were lower in the placebo group in the early phase of withdrawal (P < 0.01). Of those completing the study, greater satisfaction (P = 0.03) was recorded by those who had received dothiepin; no other differences reached statistical significance. CONCLUSIONS: Dothiepin (and by implication other tricyclic antidepressants) might have some value in reducing benzodiazepine withdrawal symptoms but does not aid drug withdrawal.

Ambulatory Care↗
PubMed1996

Neoadjuvant combined modality program with selective organ preservation for invasive bladder cancer: results of Radiation Therapy Oncology Group phase II trial 8802.

PURPOSE: This phase II study was designed to evaluate effectiveness and toxicity of a combined chemoradiotherapy program with selective bladder preservation in the management of patients with invasive bladder cancer. PATIENTS AND METHODS: Ninety-one eligible patients with invasive bladder cancer stages T2M0 to T4AM0 suitable for radical cystectomy received two courses of methotrexate, cisplatin, and vinblastine (MCV regimen) followed by radiotherapy with 39.6 Gy and concurrent cisplatin. After complete urologic evaluation, operable patients who achieved complete response were selected for bladder preservation and treated with consolidation cisplatin-radiotherapy. RESULTS: Of 91 eligible patients, 85 underwent complete urologic evaluation and 68 (75%; 95% confidence interval [CI], 59% to 84%) had documented complete responses. Fourteen operable patients with residual tumor underwent immediate cystectomy. Of 70 patients treated with consolidation cisplatin-radiotherapy, 36 subsequently developed bladder recurrences, 23 of which were invasive. Patients with invasive recurrence (n = 16), extensive noninvasive recurrence (n = 6), or severe treatment complications (n = 1) underwent salvage cystectomy. Thus, a total of 37 of 91 patients (40%) required cystectomy. The 4-year cumulative risk of invasive local failure (which includes induction failures) was 43% (95% CI, 33% to 53%). The 4-year actuarial risk of distant metastasis was 22% (95% CI, 13% to 31%). The 4-year actuarial survival rate of the entire group was 62% (95% CI, 52% to 72%). The 4-year actuarial rate of survival with bladder intact was 44% (95% CI, 34% to 54%). CONCLUSION: Initial results of this combined chemoradiotherapy program show that bladder preservation can be achieved in the majority of patients, and that overall survival is similar to that reported with aggressive surgical approaches. Long-term survival and quality-of-life assessments require longer follow-up study.

Aged↗
PubMed1995

Adults with a history of child sexual abuse: evaluation of a pilot therapy service.

OBJECTIVE: To evaluate a pilot service offering therapy specifically to adults with a history of child sexual abuse. DESIGN: Questionnaire survey. SETTING: Specialised therapy unit, Breakfree, which offers care, therapy, and support. SUBJECTS: 116 clients presenting to the service who were offered therapy. MAIN OUTCOME MEASURES: Scores from three psychological questionnaires--the social activities and distress scale, the general health questionnaire, and the delusions, symptoms, and states inventory--and from questionnaires about the clients' abuse, previous use of health services, and opinion of the Breakfree service. RESULTS: Clients had received previous help from health services and other agencies without apparent effect; they were highly distressed according to their psychological scores; and they were very frequent users of the health services. The clients showed significant improvement in their psychological scores (Wilcoxon's matched pairs signed ranks test): social activities and distress scale, z = -3.3, P = 0.001; general health questionnaire, z = -5.8, P < 0.00001; delusions, symptoms, and states inventory, z = -4.8, P < 0.00001). This was most pronounced for those who had completed therapy by the end of the study. Whereas 82/88 clients had a score for the general health questionnaire that indicated clinical distress at the start, only 28/58 did so at the end of the study (only 17/35 among those who had finished therapy). CONCLUSIONS: This group of adults with a history of child sexual abuse were highly disturbed and previous high users of the health service. The specialist service Breakfree was effective in the short term and, if the benefits are sustained, would yield a net cost saving to the health service.

Adult↗
PubMed1995

Epilepsy in early development: the lesson from surgery for early intractable seizures.

This report examines the impact on development and the problems involved in assessing development in very young children with early-onset intractable seizures, particularly infantile spasms. A review of studies on medically and surgically treated children with infantile spasms underscores the relationship between seizure control and developmental outcome. About 50% of children with markedly intractable infantile spasms attained seizure control and significant improvement in the use of nonverbal communication, a developmental measure that has been used in other populations of developmentally delayed children. With the exception of duration of illness, clinical measures of age of onset of infantile spasms, type of surgery, and side of surgery did not appear to be related to the postoperative change in nonverbal communication. The neuropathology findings of surgically treated children with infantile spasms suggest that the underlying pathology occurs early in brain development. In conclusion, the cumulative effect of uncontrolled seizures and the underlying pathology might impact the early development of children with intractable infantile spasms.

Age of Onset↗
PubMed1995

What's in a name?

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Attitude to Health↗
PubMed1995

Inflict kindness.

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Education, Medical↗
PubMed1994

Impact of a multileaf collimator on treatment morbidity in localized carcinoma of the prostate.

PURPOSE: To evaluate the effectiveness of variable multileaf collimation, three-dimensional treatment planning, and computer-controlled conformal radiation therapy of prostate cancer. METHODS AND MATERIALS: Two hundred and forty-five patients with locally advanced prostate cancer have completed treatment over a 9-year time span using a multileaf collimator and conformal treatment techniques on the University of Washington cyclotron. All patients had three-dimensional treatment planning with computed tomography scans in the treatment position, and had treatment fields individually shaped to the target volume with a continuously variable multileaf collimator. Treatment was delivered under computer control with network transfer of the multileaf collimator settings from the treatment planning computer to the cyclotron control system. RESULTS: The multileaf collimator combined with three-dimensional treatment planning results in elegant dose distributions. These neuron dose distributions resulted in a reduced local/regional tumor failure rate with no increase in complications when compared to control treatment with photons in a randomized trial. Neutron treatment delivered at other institutions without conformal beam shaping resulted in the same improvement in local-regional tumor control rates, but was associated with a significantly higher normal tissue complication rate than seen with conformal neutron beam delivery techniques (grade 3 and 4 cumulative late normal tissue toxicity rates of 39% vs. 10%, p = 0.0007). CONCLUSIONS: Conformal treatment of prostate cancer using a multileaf collimated neutron beam results in increased local/regional tumor control rates with low normal tissue toxicities. This experience is directly applicable to the conformal treatment of prostate cancer with photons.

Humans↗
PubMed1994

Blink rate in childhood schizophrenia spectrum disorder.

Spontaneous blink rate, a putative measure of dopamine function, was measured in schizophrenic, schizotypal, and normal children, aged 5.6-13.2 years during three different cognitive tasks. Unlike that of schizophrenic adults, the blink rate of the schizophrenic children who were not on neuroleptics was significantly lower than that of the normal children. There were no statistically significant differences, however, in the blink rates of the neuroleptic-treated schizophrenic children and the normal children. The schizophrenic and schizotypal children had similar spontaneous blink rates. Within each diagnostic group, the blink rate was lowest for listening, intermediate for conversation, and highest for verbal recall. These findings highlight the need to examine the relationship between age, blink rate, and dopamine function in childhood-onset schizophrenia spectrum disorder.

Adolescent↗
PubMed1994

Communication deficits in childhood schizophrenia spectrum disorders.

This article examines the effects of age, cognition, and discourse skills on the clinical manifestations of formal thought disorder in 31 children with schizophrenia, 14 with schizotypal personality disorder (SPD), and 70 who were normal. The communication deficits of the 31 children with schizophrenia have three characteristics: illogical thinking, loose associations, and impaired discourse skills. Loose associations and illogical thinking reflect different aspects of impaired attention/information processing in children with schizophrenia. Only certain aspects of the discourse deficits of the children with schizophrenia are associated with the cognitive measures used in this study. The children with SPD have similar illogical thinking and loose associations scores but a narrower range of discourse deficits than the children with schizophrenia. Implications of the interaction between the clinical, cognitive, and discourse manifestations of the communication deficits of children with schizophrenia are discussed. The possible relationship between these manifestations and positive and negative symptoms of schizophrenia are also reviewed.

Attention↗
PubMed1994

Thought disorder in childhood.

OBJECTIVE: This paper delineates the evolution of the concept of thought disorder and presents a developmental/neurobehavioral theory of the main components of formal thought disorder in childhood-onset schizophrenia. METHOD: A review of past and recent clinical, cognitive, and linguistic studies of thought disorder in childhood-onset schizophrenia presents the main features and changes in the thought disorder concept. RESULTS: The review emphasizes that, in the past, this term was used to describe a variety of clinical manifestations in a heterogenous group of children because of the lack of distinction between childhood schizophrenia and infantile autism. The studies that have been conducted during the past 15 years, however, have demonstrated well-defined clinical components of thought disorder and their cognitive/information processing, linguistic/pragmatic, and biological correlates. CONCLUSIONS: A functional conceptualization of formal thought disorder in childhood-onset schizophrenia is presented in light of the theoretical and clinical implications of the reviewed studies.

Adolescent↗
PubMed1994

An Osler year.

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England↗