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Biomedical subjects

T Howell

Publications and source records attributed to T Howell.

At least 37 records · Page 2Linked to original sources
PubMed1989

Dangerous behavior in a demented patient. Preserving autonomy in a patient with diminished competence.

When a cognitively-impaired elderly man nearly caused a serious fire at home through his inappropriate use of a gas oven, the incident raised questions about his capacity to live alone. Although he clearly wanted to preserve his independence, the health care team felt obligated to assure his safety. The following discussion of dangerous behavior in a demented elderly man elicits and portrays these conflicting values, and highlights the physician's obligations in such ethically and legally complex situations.

Activities of Daily Living↗
PubMed1985

Treatment of depression in cancer patients.

One hundred and fifty-two women undergoing mastectomy were randomly assigned to routine care or routine care plus monitoring by a specialist nurse. The nurse detected and referred 76% of her patients for psychiatric help. Only 15% of the routine care subjects that warranted help were referred. Twelve to eighteen months after surgery, morbid anxiety and depression were less common in the monitored (5% and 5%) than in the control (30% and 50%) group. This difference appeared to be due primarily to psychiatric treatment which included antidepressant medication, anxiolytic drugs, and supportive psychotherapy. Few affective disorders remitted without such treatment. In a further study, the effects of antidepressant medication plus cognitive therapy and cognitive therapy alone were compared. Both treatments alleviated depression in the short term but the improvement was sustained in the long term only in those given combined treatment.

Amitriptyline↗
PubMed1982

Catecholamine metabolites in spinal cord injury.

Previous reports of catecholamine metabolism in spinal cord injury (SCI) have found elevated levels of urinary norepinephrine metabolites. These data have been cited as evidence of a sustained increase in peripheral norepinephrine activity in this population. A study was designed to test this hypothesis and to control for the effect of affective disorders on catecholamine metabolism. Determinations were made of the level of urinary 3-methoxy-4-hydroxyphenylethylglycol (MHPG) and vanillylmandelic acid (VMA) in 30 patients with SCI. Urinary MHPG and VMA were not significantly higher than normal in the total sample. However, in spastic quadriplegia, urinary MHPG was lower than normal, and a calculated VMA:MHPG ratio was higher than normal in complete quadriplegia and spastic quadriplegia. This high ratio was due primarily to decreased MHPG. The authors suggest that these changes are due to decreased norepinephrine turnover in the damaged SC and that a VMA:MHPG ratio is the most useful measure of norepinephrine activity in SCI.

Adolescent↗
PubMed1981

Psychiatric disorders in patients with spinal cord injuries.

Although previous studies have reported that all patients with spinal cord injuries experience depression, they have not distinguished between despondency and depressive disorder. Of 30 patients with spinal cord lesions and depressive disorders diagnosed using the Schedule for Affective Disorders and Schizophrenia and the Research Diagnostic Criteria (RDC). 15 patients had RDC diagnoses before or after their injury. A depressive disorder developed in nine after injury. Eight depressive disorders developed within a month of the injury. Postinjury depressive disorders were more common in patients with complete spinal cord lesions but were divided equally between paraplegics and quadriplegics. Only one patient received antidepressants. The remainder recovered without treatment other than the rehabilitation program. The accident causing the injury seemed related to a psychiatric disorder before injury in six patients (four alcoholics and two hypomanics) and to drinking before the accident in 15 patients.

Accidents↗
PubMed1981

Depression in spinal cord injured patients.

Many regard depression as an inevitable psychological sequela of spinal cord injury. This assumption, if inaccurate, may confound the rehabilitation process. We evaluated 22 patients with recent spinal cord injuries (less than 6 months), using a standardised interview and diagnostic process. Five patients (22 per cent) had diagnosable depressions after their injury. This is higher than the incidence of depression in the general population, but less than anticipated.

Adolescent↗
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↗
PubMed1977

Melanin distribution and sensitivity to group therapy.

Student participants in group therapy were hypothesized to improve on three dimensions of behavior as a result of therapy. It was further hypothesized that improvement would be related to participant eye color, with dark-eyed persons demonstrating greatest improvement and lighter-eyed individuals demonstrating lesser improvement. Differences were also expected from Ss by program. Ss were 35 male and female master's level students in clinical, counseling, and educational psychology programs, ranging in age from 23 to 39 years. Dependent measures were collected before and after therapy with the Vriend and Dyer Scale, an instrument yielding three factors: Self Defeating Behaviors, Fully Functioning Behaviors, and Personal Mastery Index. The design utilized a 3 (eye color) X 2 (program) two-way ANOVA, fixed effects model. Significant main effects were found for Fully Functioning Behaviors: by eye color (p less than .002) and by program (p less than .03). No interactions or other main effects were found.

Adult↗