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Biomedical subjects

R L Sack

Publications and source records attributed to R L Sack.

At least 55 records · Page 3Linked to original sources
PubMed1987

Antidepressant and circadian phase-shifting effects of light.

Bright light can suppress nighttime melatonin production in humans, but ordinary indoor light does not have this effect. This finding suggested that bright light may have other chronobiologic effects in humans as well. Eight patients who regularly became depressed in the winter (as day length shortens) significantly improved after 1 week of exposure to bright light in the morning (but not after 1 week of bright light in the evening). The antidepressant response to morning light was accompanied by an advance (shift to an earlier time) in the onset of nighttime melatonin production. These results suggest that timing may be critical for the antidepressant effects of bright light.

Circadian Rhythm↗
PubMed1987

Civil commitment by conservatorship: the workings of California's law.

This article summarizes the conservatorship provisions of the California Civil Commitment Statute, the Lanterman-Petris-Short (LPS) Act and reviews the major findings from previous studies. By studying the hospital records of eighty-five gravely disabled patients affected by LPS, the authors address issues raised by these reports. The results indicate that the law's provisions work unevenly. Patients with acute and current disability received conservatorships more frequently than those who had been disabled in the past. There is some evidence that the process is used to confine threatening patients and does not function equally well for all diagnostic groups.

Activities of Daily Living↗
PubMed1986

Flurbiprofen in the treatment of acute gout. A comparison with indomethacin.

The relative efficacy and safety of flurbiprofen (Ansaid, Upjohn) and indomethacin were compared in 29 patients with monoarticular gouty arthritis of less than 48 hours' duration. A loading dose of 400 mg of flurbiprofen or 200 mg of indomethacin was administered for 24 hours, followed by 200 mg of flurbiprofen per day or 100 mg of indomethacin per day for a maximum of five days. Based on global assessment of improvement, at least 50 percent of patients in both treatment groups showed improvement within 24 hours. There were statistically significant improvements in pain, swelling, erythema, and skin temperature in both groups of patients within 48 hours of treatment. By 72 hours, the proportion of patients with improvement in the flurbiprofen group was equal to or greater than the proportion in the indomethacin group for all clinical efficacy parameters. At the end of treatment, eight of 15 patients in the indomethacin group and five of 14 patients in the flurbiprofen group were asymptomatic. There were no statistically significant differences between indomethacin and flurbiprofen in the percentage of asymptomatic patients at the end of treatment. Side effects were mild in both groups. No clinically significant between-treatment differences were noted in vital signs or in the results of laboratory assays.

Acute Disease↗
PubMed1986

Human melatonin production decreases with age.

The purpose of this study was to investigate the effects of time of year and demographic variables on the amplitude of melatonin production in normal human subjects. Melatonin production was estimated by measuring the overnight excretion of its major urinary metabolite, 6-hydroxymelatonin. Urine was collected on three consecutive nights in the summer from a sample of 60 normal subjects balanced for sex and age. The collections were repeated in a subgroup during the winter. Melatonin production clearly declined with age but was not influenced by other demographic variables or by season of the year.

Adult↗
PubMed1986

The use of plasma melatonin levels and light in the assessment and treatment of chronobiologic sleep and mood disorders.

Using the highly accurate and sensitive gas chromatographic-negative chemical ionization mass spectrometric assay for plasma melatonin we have measured plasma melatonin in humans as a biological marker for 24-hour (circadian) and seasonal rhythms and the effects of light on these rhythms. We propose that there are at least three critical parameters for light to be chronobiologically active in humans: intensity, wavelength and timing. With regard to timing, we have found that bright light exposure in the morning advances circadian rhythms (shifts them to an earlier time) and bright light in the evening delays them (shifts them to a later time). We have suggested that chronobiologic sleep and mood disorders be "phase typed" into either the phase advance subtype or the phase delayed subtype and that these disorders can then be treated with either evening light (for phase advanced disorders) or morning light (for phase delayed disorders). Regarding the function of melatonin in humans, we have preliminary evidence that it may participate in the regulation of the circadian rhythm of intraocular pressure.

Biological Clocks↗
PubMed1985

Melatonin, light and chronobiological disorders.

Human plasma melatonin concentrations can be measured accurately and sensitively by gas chromatography-negative chemical ionization mass spectrometry. With this assay, we have shown that: in rats and in humans, plasma melatonin is exclusively derived from the pineal gland; propranolol and clonidine reduce melatonin levels in human; some blind people appear to have free-running melatonin secretory circadian rhythms; bright light can acutely suppress human melatonin production according to a linear fluence-response relationship; manic-depressive patients appear to be supersensitive to light, even when they are well; melatonin levels are greater in manic patients than in depressed patients; in experiments to test the clock-gate model and the hypothesized phase-response curve, two different effects of light appear to present in humans: an acute suppressant effect (mainly in the evening during long photoperiods) and an entrainment effect (particularly during the morning but also in the evening). When blood is sampled for measuring melatonin levels as a marker for circadian phase position, bright light should be avoided after 5 p.m. (the dim light melatonin onset). Bright-light exposure in the morning appears to advance circadian rhythms, whereas bright-light exposure in the evening appears to delay them. Once a patient has been 'phase typed' (phase-advanced vs. phase-delayed), predictions can be made about whether morning or evening light would be more effective in treating the sleep or mood disorder.

Circadian Rhythm↗
PubMed1981

The ethics of human experimentation in psychiatry: toward a more informed consensus.

In recent years, the expansion in medical research has been accompanied by a growing concern for human rights, and a proliferation of government regulations. These concurrent developments have generated a deepening uneasiness about the future of human experimentation in psychiatry. This troubled state of affairs points out the desirability of a moral consensus that will respect the concerns of those involved. Toward that end, we offer a method for assessing the arguments now crowding the literature and propose a set of paradigms of human experimentation--the scientific, authoritarian, market, fiduciary, collegial, and social--which appear to lie behind the clash of perspectives. It is our hope that these paradigms can contribute to a fair and sympathetic examination of the conflicting positions. While this in itself cannot guarantee a moral consensus, it can facilitate a clearer organization and understanding of priorities.

Behavioral Research↗
PubMed1981

Psychopharmacology in medical practice--the benefits and the risks.

Psychopharmacology has become a major approach to treatment in primary medical care. However, combined psychiatric and medical illness can give rise to some challenging diagnostic problems. Furthermore, drug treatment of patients with such illnesses can involve important drug-disease interactions and drug-drug interactions. One should keep in mind the issues that arise when an emotionally troubled patient would benefit from a psychotropic drug but a concurrent medical illness complicates this treatment. An awareness of both the medical and psychiatric issues involved may make successful treatment possible.

Adult↗
PubMed1975

Masochism: a clinical and theoretical overview.

This paper will review some of the theoretical and clinical features of masochism from an eclectic point of view. The topic of masochism has been taken up by authors of many perspectives because it addresses one of the anomalous, absurd, difficult-to-explain aspects of behavior for which no psychological system has an easy answer. Therefore, a wide-ranging literature on the topic of masochism is available. However, few previous reviewers have attempted to draw from a variety of disciplines and theoretical frameworks. In this review the historical development of the term and some of the psychoanalytic conceptualizations will be presented first. Since previous reviews of masochism from a strictly psychoanalytic perspective are adequate (Brenner, 1959; Eisenbud, 1967; Fenichel, 1945; Loewenstein, 1957; Panken, 1967), our discussions of masochism will be developed employing more extensively the interpersonal, social, learning theory, and biological perspectives.

Conflict, Psychological↗