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Biomedical subjects

A J Frances

Publications and source records attributed to A J Frances.

44 records · Page 3Linked to original sources
PubMed1984

Studies of selective and reversible monoamine oxidase inhibitors.

Several selective and reversible monoamine oxidase inhibitors (MAOIs) have recently become available. Preliminary studies suggest that these compounds have antidepressant effects and may offer significant safety and side effect advantages over classical MAOIs. Pilot studies with 1-deprenyl, a selective MAO-B inhibitor, indicate that it may be most effective for patients with nonendogenous depression and for those (endogenous or nonendogenous) who present with certain reverse vegetative signs. The drug appears ineffective in depressed patients with associated panic attacks and phobic symptoms. An alternative approach in the development of safer, effective MAOIs is the use of rapidly reversible MAO-A inhibitors, such as moclobemide, that carry less risk of a hypertensive reaction and yet appear to be effective antidepressants. As selective MAO-A and MAO-B inhibition may be effective in different depressive subtypes and may have different side effects, these drugs are valuable pharmacologic probes for studying the biochemical bases of depressive disorders.

Animals↗
PubMed1982

Reliability and rationality in the prediction of suicide.

The reliability and validity of psychiatrists' predictions of a patient's potential for suicide are increasingly being questioned, both by mental health professionals and by the courts. The authors describe a study conducted in 1978 to measure the reliability with which a team of mental health professionals assessed suicidal risk in a group of 16 patients seen in videotaped interviews. They found that the highest reliability was on an item that assessed the seriousness of the patient's past suicide attempts; the lowest reliability came in assessing the patient's risk of death from accidents, homicide, or neglect of self. Over-all, the authors say, the clinicians made their judgments based on rational and consistent evaluation of the data.

Adult↗
PubMed1979

Selection criteria for family therapy.

The patient selection criteria for most modalities of psychotherapy have not yet been clearly articulated. This paper presents a decision-tree model outlining the factors that incline a clinician to perform a family evaluation, then to decide upon family treatment instead of another form of therapy, and finally to settle upon the particular duration and intensity of family treatment. We have compiled screening criteria, based on research and clinical opinion, to be applied in the utilization review of the decisions made at each of these steps. This method can be used to evaluate the appropriateness of care and render decision-making explicit and accountable; it may also have considerable value in training and research.

Crisis Intervention↗
PubMedDate not supplied

Is neuroleptic dysphoria a healthy response?

We examined the relationship between neuroleptic-induced extrapyramidal effects, subjective neuroleptic dysphoria, and clinical outcome in acutely psychotic inpatients. Thirteen of 50 consecutively admitted patients experienced severe neuroleptic dysphoria. Dysphoric patients were less likely to comply with neuroleptic, but nine did complete neuroleptic trials. The compliant dysphoric inpatients received significantly lower neuroleptic doses compared with nondysphoric patients, and yet had equivalent overall improvement of psychotic symptoms and less severe extrapyramidal effects. Despite having fewer physical signs of akinesia, dysphoric patients were significantly more distressed from akinesia than nondysphoric. We conclude that while some neuroleptic dysphoric patients become noncompliant, others benefit from dysphoria by negotiating for lower, less toxic, and yet effective neuroleptic dosages.

Adult↗
PubMedDate not supplied

Increased tardive dyskinesia in alcohol-abusing schizophrenic patients.

Many schizophrenics have a diagnosis of substance abuse or dependence. We evaluated whether drug or alcohol abuse is an independent risk factor for tardive dyskinesia (TD) in schizophrenia. In a consecutive admission, clinical study of 75 hospitalized schizophrenics, drug or alcohol abusers had significantly higher TD scores than nonabusers. The association of alcohol abuse or dependence with TD seemed independent from other risk factors for TD.

Adult↗
PubMedDate not supplied

Crisis intervention response and long-term outcome: a pilot study.

We investigated whether process variables (therapeutic alliance and insight) measured at the termination of crisis intervention predict long-term treatment compliance and 2-year outcome. Thirty-seven consecutive depressed psychiatric patients assigned to outpatient crisis intervention (CCI) were assessed with both questionnaires and standardized instruments at intake, 1 week, and CCI termination (mean, 6 weeks). Thirty-one subjects (84%) were also evaluated at 1-year and 2-year follow-up. We found that working alliance and development of insight predicted positive global change and symptom improvement at 1 and 2 years' follow-up. Furthermore, the observed correlation between process measures and 2-year outcome was found to be independent of age, sex, symptoms severity at intake, improvement of symptoms at CCI termination, premorbid adjustment, DSM-III-R axis I/axis II diagnosis, and therapeutic alliance at intake.

Adult↗
PubMedDate not supplied

Prediction of response of chronic depression to imipramine.

We had previously reported that imipramine was superior to placebo for the treatment of chronic depression. As a part of that study, we subsequently investigated clinical and demographic variables which might be associated with favorable or poor outcome for treatment with imipramine or placebo. Results are reported herein. Eight-six patients were entered and 53 completed an 8-week protocol. Outcome was assessed based on a 6-week, double-blind treatment phase, which followed a 2-week, single-blind placebo phase. Outcome was not found to significantly relate to demographic variables, severity or course of depression, diagnostic subtype, symptom profile, or DST results. Some modest associations were found between 'neurotic' personality traits and poor outcome. Results are discussed and compared with prior studies of prediction of tricyclic antidepressant response in both acute and chronic depressions.

Adult↗