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Biomedical subjects

S R Hirsch

Publications and source records attributed to S R Hirsch.

At least 73 records · Page 4Linked to original sources
PubMed1986

The third biannual winter workshop on schizophrenia. Schladming, Austria, Jan 26-31, 1986.

The following general principles seem to summarize the emphasis that was evident from the several days of multiple presentations and discussions. The need exists to continue to develop improvements in the tools applicable to research in psychiatry, both clinical and biological "instruments" that are both sensitive and specific to the questions asked. New molecular genetic technology has already been used to explore genetic susceptibility hypotheses, as well as novel viral associations. Imaging of brain receptor kinetics in vivo is in progress. Improvements in structured clinical rating scales for quantifying changes in biologically important clusters of symptoms (eg, negative vs positive symptoms) or the defining of prodromal symptoms that lead to relapse are critical to progress in etiological and treatment research. A genetic factor or factors for schizophrenia exist, although whether a "familial" type defines only a subgroup of schizophrenia is controversial. The relative importance of genetic vs environmental variables, and whether there is genetic and environmental heterogeneity, continue to be debated. The most important epidemiological data, the seasonality of birth, and the controversial question of geographical variation in prevalence can be clues to the etiology of schizophrenia and are presently being clarified. The pursuit of new treatments and modifications of present conventional treatments to increase the percentage of patients recovering from psychotic illnesses or lead to more complete recovery states is always of prime importance. An emphasis on clarifying the dopamine hypothesis of schizophrenia with PET continues to be at the forefront of psychiatric research. A focus on patients in a first episode of schizophrenia can clarify major issues.(ABSTRACT TRUNCATED AT 250 WORDS)

Humans↗
PubMed1986

Comparison between the Brief Psychiatric Rating Scale and the Manchester Scale for the rating of schizophrenic symptoms.

A reliability study was carried out to compare the short Manchester Scale (MS) to the longer Brief Psychiatric Rating Scale (BPRS), to see if similar items scored the same aspect of pathology and to find the sources of error. The raters were a psychiatrist and a psychologist cum medical student; they had recently arrived in Britain, came from different cultures and had not used the scale previously. Comparisons between the scales were made by interviewing the patients separately and together using either one or both scales. The items on the MS showed a higher interrater reliability as compared to the BPRS, both with independent and simultaneous ratings. Items based on observation only correlated poorly as compared to items based on verbal report. Lower between-scale correlations for delusions and affect were observed even where the same rater used the two scales, suggesting that the scales have different meanings for these items. The MS is a suitable alternative to the BPRS for quantifying schizophrenic symptoms.

Affect↗
PubMed1986

Does propranolol have an antipsychotic effect? A placebo-controlled study in acute schizophrenia.

Thirty-six acute schizophrenics were randomly assigned to dextro (d)-propranolol or placebo in a double blind trial lasting four weeks. All patients had a fixed dose of haloperidol during the first week, which resulted in an initial improvement in both groups. Thereafter, a deterioration towards base-line was seen. Six patients on placebo, but none on propranolol were treatment failures at the end of three weeks (P less than 0.001). Comparison of change in scores from week 2 to 4 showed significantly greater deterioration in the placebo group; d-propranolol thus had a better effect than placebo in sustaining the initial improvement with haloperidol. The overall magnitude of clinical change from pre-treatment scores is small, the majority of the patients showing little or no overall improvement. It is concluded that d-propranolol has a detectable therapeutic effect, which by inference must have a novel pharmacological basis, but this is not as potent as standard neuroleptics.

Adolescent↗
PubMed1985

Pathway and hemispheric differences in the event-related potential (ERP) to monaural stimulation: a comparison of schizophrenic patients with normal controls.

Previous research has established the stability of the contralateral dominance effect of the auditory temporal N120 peak amplitude. The purpose of this experiment was to examine event-related potential (ERP) asymmetries in schizophrenia, with particular reference to this contralateral dominance phenomenon. Ten unmedicated schizophrenic patients and ten controls heard a series of monaural tones, with no task requirements, while EEG was recorded from Cz, Pz, T3, and T4 referred to linked earlobes. Patients were characterized by smaller N120 amplitudes than controls, an effect that was slightly more pronounced at temporal sites. Patients failed to show the normal N120 contralateral dominance effect. Hemisphere asymmetry ratios revealed that 50% of the patients showed ipsilateral dominance in the auditory pathways. Furthermore, the hemisphere asymmetries (whether ipsilaterally or contralaterally dominant) seen in patients were significantly greater than for controls. These data offer a new level of explanation for schizophrenic performance abnormalities in dichotic listening paradigms and an explanation for for the apparent dichotomy in patient performance between exaggerated right ear advantage (REA) and left ear advantage (LEA).

Acoustic Stimulation↗
PubMed1985

Long-term depot maintenance of chronic schizophrenic out-patients: the seven year follow-up of the Medical Research Council fluphenazine/placebo trial I. Course of illness, stability of diagnosis, and the role of a special maintenance clinic.

A follow-up study of all patients entering the MRC double-blind trial of fluphenazine decanoate in chronic schizophrenic out-patients achieved a trace rate of 94%. In general, these patients were severely disabled, continued under the care of the maintenance clinic, and their diagnoses remained remarkably consistent; more than one-fifth were found to be in acute schizophrenic relapse and in over a half of these cases, the relapse was not known to the treatment agency. The maintenance clinic attenders were little different from those who no longer used such a facility.

Adult↗
PubMed1985

Long-term depot maintenance of chronic schizophrenic out-patients: the seven year follow-up of the Medical Research Council fluphenazine/placebo trial. II. The incidence of compliance problems, side-effects, neurotic symptoms and depression.

Seven years after the completion of the original trial, over 73% of patients were maintained on depot neuroleptics, and 70% had received such medication for over seven years. About 40% had presented with a problem of compliance at some time, and there was a significant correlation between poor compliance and in-patient admissions and schizophrenic relapses. The prevalence of parkinsonian side-effects, akathisia, and tardive dyskinesia was low. Non-psychotic symptoms were common, even in the absence of acute psychosis. Depression was found in a subgroup of patients; it was frequently reported as an indication for admission during follow-up period, and seemed to be part of the schizophrenic illness rather than a result of antipsychotic drug treatment.

Clinical Trials as Topic↗
PubMed1985

Long-term depot maintenance of chronic schizophrenic out-patients: the seven year follow-up of the Medical Research Council fluphenazine/placebo trial. III. Relapse postponement or relapse prevention? The implications for long-term outcome.

The relapse and admission histories revealed a positive correlation between number of schizophrenic episodes and time on maintenance medication, probably reflecting severity of illness. Relapse rates after drug discontinuation rose to 45% within 13 months. There were no differences of predictive value between those relapsing on or off medication. The relationship between relapse rates, drug treatment, and social outcome is complex; antipsychotic drugs may postpone relapse, and frequent relapses might inhibit improvement in social performance long after florid symptoms have been controlled by medication.

Clinical Trials as Topic↗
PubMed1985

Cytomegalovirus and schizophrenia. A test of a viral hypothesis.

Cerebrospinal fluid (CSF) from 20 chronically hospitalised male schizophrenics and from 12 patients admitted with acute schizophrenia were examined for antibodies against cytomegalovirus. A sensitive and specific enzyme-immunoassay was used to detect IgG or IgM classes of antibodies in the CSF of the schizophrenic patients and of ten orthopaedic patients, who served as controls. No significant amounts of IgM antibody were found in the CSF of either group. A significant titre of IgG was found in only one of the 32 schizophrenics, an acute patient, but in four of the orthopaedic patients. The results do not support an association of cytomegalovirus infection with schizophrenia; if such an association occurs, it must be unusual.

Antibodies, Viral↗
PubMed1984

Schizophrenia and spectral analysis of the visual evoked potential.

Power spectral analysis was performed on the visual evoked potentials (VEPs) recorded in response to flashes of different intensity in both unmedicated schizophrenic and normal subjects. At occipital locations (O1, O2), schizophrenics showed less power than normals in the 10-14 Hz frequency range. In the 18-22 Hz range, schizophrenics showed under-activation in the left hemisphere and over-activation in the right. At temporal locations (T3, T4), schizophrenics showed abnormal (left greater than right) hemisphere patterns of activation in 10-14 Hz and 18-22 Hz ranges. There were no group differences in relationships between power and intensity changes at vertex (Cz). The results suggest abnormal cortical-subcortical interactions during analysis of visual information in schizophrenia.

Adult↗
PubMed1983

Visual evoked potentials in schizophrenia. Intensity effects and hemispheric asymmetry.

Visual evoked potentials (VEP) to different flash intensities were recorded at a central site (Cz) plus at homologous temporal and occipital locations in normal and unmedicated schizophrenic subjects. Schizophrenic patients showed an hemisphere asymmetry of the P100-N120 peak-trough amplitude with smaller left but larger right hemisphere amplitudes than normal. Further, two subgroups of patients were found with abnormalities lateralized to the left hemisphere. One group was found to have abnormal P100 amplitude-intensity patterns at the left temporal site while the other group showed deviant N120 amplitude-intensity patterns at the left occipital location. The clinical significance of these results can be seen in the higher nuclear schizophrenia (PSE-CATEGO) scores in the left temporal subgroup and the higher hypomania and situational anxiety scores in the left occipital group. Patients also showed slower than normal P100 and N120 peak latencies.

Adult↗
PubMed1982

Parasuicide. A review of treatment interventions.

From review of studies of treatment intervention in parasuicide it is concluded that: (1) Suicide prevention centres do not lower the incidence of suicide. (2) Retrospective follow-up studies of patients self-selected for treatment or no treatment find that patients who attend for treatment have a lower repeat rate of parasuicide. This may have nothing to do with treatment. (3) Intensive domicillary follow-up for 3-6 months after inpatient treatment in a specialised unit for parasuicide is no better at preventing further parasuicides than conventional follow-up in outpatient department or via the GP. (4) A multidisciplinary outreach programme was effective in one study but not three others. (5) Behaviour therapy was no better than insight oriented psychotherapies when administered intensely over 10 days for inpatients with a previous history of overdose. (6) Medication in the form of depot flupenthixol, 20 mg every 4 weeks was significantly better than placebo for chronic repeaters (3 or more attempts) but Mianserin 30 mg/d was not. (7) There was no relationship between improved symptoms, improved social circumstances or the repeat rate for parasuicide. In a controlled trial conducted by the authors in parasuicides, Mianserin 60 mg/d reduced depressive symptoms significantly more rapidly than Nomifensine or placebo but there was no difference by 6 weeks and the risk of repeat was not affected.

Adolescent↗
PubMed1982

Low risk of contrast media-induced acute renal failure in nonazotemic type 2 diabetes mellitus.

The risk of developing contrast media-induced acute renal failure was studied in 49 randomly selected nonazotemic type 2 adult diabetic patients subjected to IVU. There were 19 men and 30 women in the group whose mean age was 62 +/- 10 years (range, 38 to 82 years). In preparation for IVU, patients were neither dehydrated nor given a laxative. The IVU was performed in the morning, using sodium diatrizoate and meglumine diatrizoate. Serum creatinine levels were measured pre-IVU and on days 1, 3, and 6 after the IVU. A total of three patients (6%) had an elevation of serum creatinine greater than 25% above the baseline by post-IVU day 3. One patient developed oliguria (less than 400 ml/24 hr) that lasted 2 days. Creatinine clearances of the three patients showing contrast media toxicity were 74, 60, and 105 ml/min pre-IVU. In each of the three patients, a return to pre-IVU serum creatinine concentration was noted within 2 weeks. It is concluded that the risk of acute renal failure post-IVU is small in hydrated nonazotemic type 2 diabetic patients.

Acute Kidney Injury↗
PubMed1982

(Des-Tyr)gamma-endorphin for schizophrenia. A critical review.

(Des-Tyr)-gamma-endorphin is a naturally-occurring neuropeptide. It has no opiate-like activity, and animal research suggests that it shares with haloperidol certain effects on animal behaviour. The compound was given to schizophrenics, and initial claims of 'a reduction or total disappearance of symptoms in schizophrenics partly or completely resistant to conventional neuroleptics and suffering from long-lasting psychoses' were made. Several investigators have attempted to replicate these findings without success. This paper reviews the shortcomings in methodology and interpretation of results of the investigations carried out so far and emphasises that the fundamental question of whether (Des-Tyr)-gamma-endorphin has any clinical antipsychotic effect has not been answered by any study to date.

Antipsychotic Agents↗