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Biomedical subjects

S Wessely

Publications and source records attributed to S Wessely.

At least 217 records · Page 12Linked to original sources
PubMed1989

Management of chronic (post-viral) fatigue syndrome.

Simple rehabilitative strategies are proposed to help patients with the chronic fatigue syndrome. A model is outlined of an acute illness giving way to a chronic fatigue state in which symptoms are perpetuated by a cycle of inactivity, deterioration in exercise tolerance and further symptoms. This is compounded by the depressive illness that is often part of the syndrome. The result is a self-perpetuating cycle of exercise avoidance. Effective treatment depends upon an understanding of the interaction between physical and psychological factors. Cognitive behavioural therapy is suggested. Cognitive therapy helps the patient understand how genuine symptoms arise from the frequent combination of physical inactivity and depression, rather than continuing infection, while a behavioural approach enables the treatment of avoidance behaviour and a gradual return to normal physical activity.

Cognitive Behavioral Therapy↗
PubMed1988

Postviral fatigue syndrome: time for a new approach.

Controversial views on the postviral fatigue syndrome ("myalgic encephalomyelitis") were critically appraised in their historical context and recent advances in research (virology, immunology, neurophysiology, histopathology, and epidemiology) reviewed. Flaws detected in certain aspects of recent research included in particular failure to define fatigue, inadequate assessment of psychological features, and absent or inappropriate control groups. The findings suggest that the fruitless dichotomy of "organic versus functional" should be replaced by a multifactorial approach. Most important, epidemiological studies with explicit operational case definition are essential before progress can be made in the management of this distressing disorder.

Adult↗
PubMed1988

Response to drugs in schizophrenia: the influence of family history, obstetric complications and ventricular enlargement.

A prospective study of antipsychotic drug treatment showed no difference in response between schizophrenic in-patients with or without a familial predisposition to the illness (N = 53). All patients received at least 600 mg chlorpromazine equivalents antipsychotic medication for 6 weeks. Ventricle brain ratios, ratings of cortical sulcal widening and a history of obstetric complications also failed to account for the variability, but early age of onset was associated with unsatisfactory response.

Adult↗
PubMed1987

Mass hysteria: two syndromes?

On the basis of a literature review it is concluded that mass hysteria can be divided into two syndromes. One form, to be called 'mass anxiety hysteria', consists of episodes of acute anxiety, occurring mainly in schoolchildren. Prior tension is absent and the rapid spread is by visual contact. Treatment consists of separating the participants and the prognosis is good. The second form, to be called 'mass motor hysteria', consists of abnormalities in motor behaviour. It occurs in any age group and prior tension is present. Initial cases can be identified and the spread is gradual. Treatment should be directed towards the underlying stressors but the outbreak may be prolonged. In mass anxiety hysteria the abnormality is confined to group interactions; in mass motor hysteria abnormal personalities and environments are implicated.

Anxiety Disorders↗
PubMedDate not supplied

Dysthymia: clinical picture, extent of overlap with chronic fatigue syndrome, neuropharmacological considerations, and new therapeutic vistas.

Dysthymia, as defined in the American Psychiatric Association and International Classification of Mental Disorders, refers to a prevalent form of subthreshold depressive pathology with gloominess, anhedonia, low drive and energy, low self-esteem and pessimistic outlook. Although comorbidity with panic, social phobic, and alcohol use disorders has been described, the most significant association is with major depressive episodes. Family history is loaded with affective, including bipolar, disorders. The latter finding explains why dysthymia, especially when onset is in childhood, can lead to hypomanic switches, both spontaneously and upon pharmacologic challenge in as many as 30%. Indeed, antidepressants from different classes -tricyclic antidepressants (TCAs), monoamine oxidase inhibitors (MAOIs), reversible inhibitors of monoamine oxidase A (RIMAs), selective serotonin-reuptake inhibitors (SSRIs) and, more recently, amisulpride, and spanning noradrenergic, serotonergic as well as dopaminergic mechanisms of action - have been shown to be effective against dysthymia in an average of 65% of cases. This is a promising development because social and characterologic disturbances so pervasive in dysthymia often, though not always, recede with continued pharmacotherapy beyond acute treatment. Despite symptomatic overlap of dysthymia with chronic fatigue syndrome - especially with respect to the cluster of symptoms consisting of low drive, lethargy, lassitude and poor concentration - neither the psychopathologic status, nor the pharmacologic response profile of the latter syndrome is presently understood. Chronic fatigue today is where dysthymia was two decades ago. We submit that the basic science - clinical paradigm that has proven so successful in dysthymia could, before too long, crack down the conundrum of chronic fatigue as well. At a more practical level, we raise the possibility that a subgroup within the chronic fatigue group represents a variant of dysthymia.

Antidepressive Agents↗
PubMedDate not supplied

Iatrogenic factors and chronic pain.

OBJECTIVE: Although it is accepted that the etiology of chronic pain is multifactorial, little attention has been given to the possible role of iatrogenesis. The aim of the present study is to identify possible iatrogenic factors in chronic pain patients. METHODS: We report a cross-sectional study of 125 patients attending specialist pain clinics in South London. Data were collected using semistructured checklists. Patients were interviewed with a structured psychiatric interview and were given a questionnaire booklet to complete. RESULTS: We found that possible iatrogenic factors, such as over-investigation, inappropriate information and advice given to patients as well as misdiagnosis, over-treatment, and inappropriate prescription of medication were common in this sample. CONCLUSIONS: We suggest that future studies should take account of the role of the doctors, as well as that of the patients, in the etiology, and hence prevention of chronic pain.

Adult↗
PubMedDate not supplied

Psychosocial and developmental antecedents of chest pain in young adults.

OBJECTIVE: The objective of this study was to assess the relationships among chest pain, psychiatric disorder, and early experience of ill health. METHODS: The Medical Research Council National Survey of Health and Development is a population-based birth cohort study established in 1946 (N = 5362). During childhood, several informants (parents, teachers, and school physicians) were interviewed or completed questionnaires. Data were available on the subjects' health, the health of their parents, and subjects' personalities. At the age of 36 years, subjects were asked about chest pain using the Rose Angina Questionnaire and completed the Present State Examination, a semistructured psychiatric interview. Subjects were followed for another 7 years (to age 43 years) to determine the outcome of those with chest pain. RESULTS: Chest pain was reported in 17.2% (95% CI = 15.9-18.5%) of respondents at 36 years. The prevalence of exertional chest pain was 1.0% (95% CI = 0.7-1.3%). There was little evidence of coronary heart disease in those with exertional pain at age 36 years when followed for 7 years. However, there was a powerful cross-sectional relationship between psychiatric disorder and chest pain (OR for psychiatric disorder and all chest pain = 3.55, 95% CI = 2.34-5.37; OR for psychiatric disorder and exertional chest pain = 29.08, 95% CI = 6.65-127.15). Childhood risk factors, including poor health reported in parents at age 15 years and fatigue during childhood, were also associated with chest pain. CONCLUSIONS: Chest pain (especially exertional chest pain) is strongly associated with psychiatric disorders in young adults. Childhood experiences, including illness in parents, are associated with subsequent chest pain.

Adolescent↗
PubMedDate not supplied

Symptoms of low blood pressure: a population study.

OBJECTIVE: To establish whether an association exists between blood pressures in the "low normal" range and common symptoms such as tiredness, dizziness, headache, and palpitation, as suggested by French and German medical practice but not English or American medical practice. DESIGN: Cross sectional population based survey (the health and lifestyle survey) of blood pressure measurements and self reported common symptoms. Results were analysed by combined stratification and logistic regression. SUBJECTS: 7383 (82%) Adults aged 18 and over chosen from the electoral register in England, Wales, and Scotland for the health and lifestyle survey, in whom satisfactory physiological measurements were taken, from 9003 in the interviewed sample. MAIN OUTCOME MEASURES: Body mass index, smoking, social class, exercise, self declared physical illnesses, hours slept, use of drugs, and psychological illness as determined with the general health questionnaire assessed as potential confounders. RESULTS: True confounders were sex, age, taking of drugs, physical illness, exercise, and body mass index. A negative association was found between systolic blood pressure and self reported tiredness and feeling faint, which persisted after adjustment for the confounders. The association was strongest in women aged under 50. A negative association between systolic blood pressure and headache and a positive association between systolic blood pressure and palpitation were explained by confounding by age. CONCLUSIONS: Systemic hypotension is associated with persistent tiredness but treatment is not suggested as either possible or necessary. Instead, low blood pressures may be associated with opposite effects on mortality contrasted with morbidity.

Adolescent↗
PubMedDate not supplied

Pride.

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Humans↗