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Biomedical subjects

C P Freeman

Publications and source records attributed to C P Freeman.

At least 19 recordsLinked to original sources
PubMed1992

Edinburgh primary care depression study: treatment outcome, patient satisfaction, and cost after 16 weeks.

OBJECTIVE: To compare the clinical efficacy, patient satisfaction, and cost of three specialist treatments for depressive illness with routine care by general practitioners in primary care. DESIGN: Prospective, randomised allocation to amitriptyline prescribed by a psychiatrist, cognitive behaviour therapy from a clinical psychologist, counselling and case work by a social worker, or routine care by a general practitioner. SUBJECTS AND SETTING: 121 patients aged between 18 and 65 years suffering depressive illness (without psychotic features) meeting the criteria of the Diagnostic and Statistical Manual of Mental Disorders, Third Edition for major depressive episode in 14 primary care practices in southern Edinburgh. MAIN OUTCOME MEASURES: Standard observer rating of depression at outset and after four and 16 weeks. Numbers of patients recovered at four and 16 weeks. Total length and cost of therapist contact. Structured evaluation of treatment by patients at 16 weeks. RESULTS: Marked improvement in depressive symptoms occurred in all treatment groups over 16 weeks. Any clinical advantages of specialist treatments over routine general practitioner care were small, but specialist treatment involved at least four times as much therapist contact and cost at least twice as much as routine general practitioner care. Psychological treatments, especially social work counselling, were most positively evaluated by patients. CONCLUSIONS: The additional costs associated with specialist treatments of new episodes of mild to moderate depressive illness presenting in primary care were not commensurate with their clinical superiority over routine general practitioner care. A proper cost-benefit analysis requires information about the ability of specialist treatment to prevent future episodes of depression.

Adolescent↗
PubMed1991

A practical guide to the treatment of bulimia nervosa.

Bulimia nervosa is a fascinating but challenging disorder to treat. There is no single treatment approach that suits all patients. Some patients make it clear that they would never consider taking drugs, others that group therapy is totally unacceptable and some, however hard they try, just never seem to get the hang of a cognitive behavioural approach. The principles that I have described above relate specifically to bulimic behaviour and attitudes. It is self-evident that other aspects of the patient functioning must not be ignored. Interpersonal, work and social problems may all need to be addressed at some stage during the treatment process and individual therapists will have their own therapeutic style and techniques for tackling these problems. In our experience it is best to tackle the presenting complaint, the bulimic behaviour, as energetically as possible and then to review the other problem areas. Many patients feel that once they have tackled their eating problem they can begin to tackle other problem areas in their life with relatively little outside help. Tackling things in the reverse order, addressing the underlying or background interpersonal difficulties first and paying little or no attention to the presenting behaviour appears to be less acceptable to patients, leads to lengthier and therefore more costly treatment and makes it difficult to distinguish between problems which are causes and those which are effects of the bulimic behaviour. (ABSTRACT TRUNCATED AT 250 WORDS)

Antidepressive Agents↗
PubMed1991

Parotid salivary secretory pattern in bulimia nervosa.

Parotid gland enlargement occurs in about 25% of patients with the binge eating syndrome of bulimia nervosa. The parotid salivary secretory patterns in 28 bulimics were determined in order to investigate the functional abnormality in the glands. Bulimia patients had a reduced resting flow rate. Bulimics who developed sialadenosis (4 patients) had reduced resting and stimulated flow rates. The salivary amylase activity was increased in both the resting and stimulated states in bulimics and the sialadenosis group. The resting total protein levels were greater in the bulimics. The electrolyte and immunoglobulin levels were within normal limits. The possibility of protein and enzymatic secretory disturbances due to autonomic nerve disorders as an explanation for the development of sialadenosis in bulimia nervosa is discussed.

Adult↗
PubMed1990

Evaluation of bioelectrical impedance analysis for body composition measurements in anorexia nervosa.

Many established methods of measuring body composition are time consuming and require complex equipment which is not generally available. Bioelectrical impedance analysis is a technique which utilises the difference in conductivity between fat and lean tissues at radiofrequencies. It uses inexpensive equipment which is simple to use and does not involve the use of ionising radiation. We have evaluated this technique in 44 studies on 38 anorexic females with a wide range of body mass index. Fat free mass was obtained from the mean of three established methods. The initial calibration was derived from 21 studies on 19 anorexics. Fat free mass was regressed against impedance and body habitus parameters to establish the prediction equation with the smallest standard error (1.12 kg). Values of fat free mass derived using this prediction equation were then compared with the other methods in a prospective study. The error of the bioelectrical impedance technique compares favourably with the established methods, even in anorexic patients with very low body mass index.

Adult↗
PubMed1989

Specificity of the salivary cortisol dexamethasone suppression test across psychiatric diagnoses.

One hundred forty-eight psychiatric inpatients, 12 outpatients, and 17 normal controls were given the 1.0-mg overnight Dexamethasone Suppression Test (DST), with salivary cortisol concentrations being measured as the dependent variable. Based on the Structured Clinical Interview for DSM-III, the patients were diagnosed as having major depression with melancholia (n = 21), nonmelancholic major depression (n = 50), mania (n = 15), schizophrenia (n = 32), dementia (n = 6), substance dependence/abuse n = 18), and miscellaneous (n = 18). Neither the melancholic major depressives nor the entire group of major depressives had significantly higher salivary cortisol pre- or postdexamethasone as compared with all the other patients combined, nor did the melancholic patients have significantly higher cortisol than the nonmelancholic depressives. The inpatients as a group had significantly higher pre- and postdexamethasone cortisol values than the normal controls; cortisol values for the outpatients were intermediate between these two groups. Illness severity (in the depressives), length of time in hospital before the DST, and medication regimen were all unrelated to DST outcome. Thus, in this study, the salivary cortisol DST showed little clinical utility in discriminating major depressives with and without melancholia from other patients with a broad range of psychiatric diagnoses. The test did distinguish between hospitalized psychiatric patients and normal control subjects and between depressed inpatients and depressed outpatients, indicating that hospitalization-related variables contributed to DST outcome.

Adult↗
PubMed1988

Controlled trial of psychotherapy for bulimia nervosa.

In a randomised controlled trial of different types of psychotherapy for bulimia 92 women were assigned to receive cognitive-behaviour therapy (n = 32), behaviour therapy (30), or group therapy (30) for 15 weeks and a further 20 (controls) assigned to remain on a waiting list for 15 weeks. Eating behaviour and psychopathology were assessed by standard methods. At the end of the trial the controls had significantly higher scores than the treated groups on all measures of bulimic behaviour. In terms of behavioural change all three treatments were effective, 71 (77%) of the 92 women having stopped bingeing. In addition, scores on eating and depression questionnaires were reduced and self esteem improved. Follow up was continuing, but of 24 women available at one year, 21 were not bingeing and had maintained their improved scores on psychometric scales. Bulimia nervosa is amenable to treatment by once weekly structured psychotherapy in either individual or group form.

Adult↗
PubMed1988

Drug and group treatments for bulimia/bulimia nervosa.

This paper is a review of all published studies using drug or group treatments. Both open uncontrolled and controlled trials are reviewed. There have been six open uncontrolled studies of drug treatment and eight placebo controlled double-blind trials of antidepressants. Four other studies using anticonvulsants or agents such as fenfluramine are also reviewed. Seven uncontrolled reports of group treatment for bulimia are presented and six where group treatment has been compared with other treatments or evaluated against a control group. It is our assessment that neither group nor drug treatments have at present been shown to be as effective as individual psychotherapy, but that both are clearly more efficacious than placebo control and that on balance when weighing cost against efficacy, group treatment of a relatively brief kind with long follow-up is the most effective treatment intervention.

Anticonvulsants↗
PubMed1987

The seat-belt sign.

Explore the source record for details and available documents.

Abdominal Injuries↗
PubMed1987

A self-rating scale for bulimia. The 'BITE'.

A new brief questionnaire, the Bulimic Investigatory Test, Edinburgh (BITE), for the detection and description of binge-eating is described. Data from two separate populations demonstrate satisfactory reliability and validity. The scale has measures of both symptoms and severity. All items in the DSM-III definition of bulimia and Russell's definition of bulimia nervosa are covered but the questionnaire is more than just an operationalised checklist of these diagnostic criteria.

Adolescent↗
PubMed1987

Physical and psychological characteristics of five male bulimics.

The case histories of five men who met DSM-III criteria for bulimia and details of their physical characteristics are given. Various eating disorder questionnaires were administered and the results indicated that most of these instruments would not have identified the men as suffering from an eating disorder. The necessity of caution in asserting the prevalence of bulimia using these measures is emphasised.

Adult↗
PubMed1987

Fluoxetine as a treatment for bulimia nervosa.

The results of a small study using fluoxetine in the treatment of bulimia nervosa are presented. Ten subjects were treated on an open basis with fluoxetine 60-80 mg daily. Seven subjects stopped their bulimic behaviour completely, two improved and one was unchanged. The results indicate that fluoxetine may have a role in the treatment of bulimia and that further investigation is warranted. A brief review of other drug studies on bulimia nervosa is presented.

Adult↗
PubMed1985

Isolated pancreatic damage following seat belt injury.

A case is reported of a 25-year-old male driver who suffered blunt injury to the abdomen by a seat belt at the time of a road traffic accident. The pancreas was the only organ disrupted and this gave rise to traumatic pancreatitis followed by a pseudocyst. The delay in clinical signs is emphasized and the management described.

Accidents, Traffic↗
PubMed1985

Pre- and post-dexamethasone salivary cortisol concentrations in major depression.

Seventy patients fulfilling DSM-III criteria for major depression were given the 1.0 mg overnight dexamethasone suppression test, with salivary cortisol concentrations being measured as the dependent variable. Using both the DSM-III and the Research Diagnostic Criteria, we categorized the patients into four groups based on increasing frequency of endogenous symptomatology. Among these four groups there were no significant differences in salivary cortisol concentrations either before dexamethasone or eight, 16, and 24 h after dexamethasone. Similarly, there were no significant differences among the groups in either the ratios of post- to pre-dexamethasone salivary cortisol or the frequencies of positive tests based on several criterion levels of cortisol for the three post-dexamethasone samples. Multiple regression analyses indicated that the Hamilton depression rating scale item "somatic anxiety" was significantly negatively related to post-dexamethasone cortisol concentrations. We conclude that, for our sample of major depressives, the salivary cortisol dexamethasone suppression test showed no utility as a laboratory correlate of depressive episodes with endogenous features.

Adult↗