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Biomedical subjects

D Bramble

Publications and source records attributed to D Bramble.

17 recordsLinked to original sources
PubMed2006

Evidence-based guidelines for management of attention-deficit/hyperactivity disorder in adolescents in transition to adult services and in adults: recommendations from the British Association for Psychopharmacology.

Attention-deficit/hyperactivity disorder (ADHD) is an established diagnosis in children, associated with a large body of evidence on the benefits of treatment. Adolescents with ADHD are now leaving children's services often with no readily identifiable adult service to support them, which presents problems as local pharmacy regulations often preclude the prescription of stimulant drugs by general practitioners (GPs). In addition, adults with ADHD symptoms are now starting to present to primary care and psychiatry services requesting assessment and treatment. For these reasons, the British Association for Psychopharmacology (BAP) thought it timely to hold a consensus conference to review the body of evidence on childhood ADHD and the growing literature on ADHD in older age groups. Much of this initial guidance on managing ADHD in adolescents in transition and in adults is based on expert opinion derived from childhood evidence. We hope that, by the time these guidelines are updated, much evidence will be available to address the many directions for future research that are detailed here.

Adolescent↗
PubMed2000

Psychostimulants and psychiatrists: the Trent Adult Psychiatry Psychostimulant Survey.

This study reports upon the results of a postal questionnaire survey of 107 adult psychiatrists which investigated their current use of psychostimulant pharmacotherapy and their attitudes towards the diagnostic status of attention-deficit hyperactivity disorder (ADHD) in adulthood. Of the 88 respondents, only a minority of 11 (12.5%) used psychostimulants in their usual practice, albeit very infrequently (one or two prescriptions per year on average). Methylphenidate hydrochloride ('Ritalin') was the prescribers' most popular agent and 'narcolepsy' was the most frequently cited clinical indication for psychostimulants. ADHD appeared to represent only a very small area of current clinical activity and a minority of clinicians expressed the view that it did not exist in adults. It is concluded that psychostimulant therapy is relatively undeveloped in British adult psychiatry and that the clinical speciality generally appears to be unprepared for the growing numbers of adolescents with ADHD who are currently managed by child psychiatrists and who may require ongoing psychiatric care, including psychostimulant therapy.

Adolescent↗
PubMed1999

Cognitive functioning in children with typical cri du chat (5p-) syndrome.

This study is the first attempt to assess systematically the cognitive functioning in children diagnosed with typical cri du chat syndrome (CDCS) using neuropsychological test measures. Twenty-six children aged between 6 years 4 months and 15 years 5 months (mean 8 years 3 months) completed a battery of tasks measuring IQ level, receptive and expressive language skills, and articulation. Twenty-four children were in the severe learning-disability range with no specific verbal or performance profile. Using more finely tuned measures of cognition, however, a clear discrepancy in the pattern of language functioning was found with better receptive than expressive language skills. One implication of these findings is that parents and professionals should be more optimistic about the capacities of children with CDCS to understand more complex verbal commands than their expressive language skills would suggest.

Adolescent↗
PubMed1997

Case study: Ganser syndrome in children and adolescents.

Six cases of the Ganser syndrome have been previously described in the literature and are reviewed here. They are imperfect representations of the originally described syndrome. This article describes a case of the Ganser syndrome in a 12-year-old boy who, after a mild head injury, presented with three of four of the core symptoms. The nature of the Ganser syndrome remains unclear, but this case study highlights dissociation and abnormal illness behavior as being important in the production of the symptoms. Classically the course is short-lived, although this report raises the possibilities of a much more chronic course.

Adolescent↗
PubMed1997

Rapid-acting treatment for a common sleep problem.

A behavioural modification package incorporating stimulus control, cueing, and rapid-extinction techniques was applied to a group of 15 children with severe learning disability who had chronic sleep disorders. Improvements in their night-settling and night-waking patterns occurred quickly (within a few days) and, in 12 of them, were sustained at medium- and long-term (18 months) follow-up. Additional improvements in the children's daytime behaviour and their mothers' subjective stress indices were observed, though not explicitly addressed. These results compare favourably with those of other studies which have tested behavioural interventions in other cohorts of children with sleep disorders. Wider application of behavioural interventions with these extremely common and potentially handicapping sleep disorders is recommended.

Behavior Therapy↗
PubMed1996

Marked reduction of anemia during pregnancy over a 10-year period in Montserrat.

Anemia during pregnancy is associated with adverse outcomes including maternal and perinatal mortality. However, health education and other public health strategies seeking to reduce its prevalence have usually met with only limited success. The study reported here surveyed anemia of pregnancy on the island of Montserrat in 1980, 1985, and 1990. This involved examination of clinic and hospital records for over 90% of all women giving birth on Montserrat in 1980 and 1985, as well as 80% of those giving birth in 1990. This examination showed a dramatic reduction in the prevalence of anemia at the time of the first prenatal visit (a drop from 82% of the study women in 1980 to 23% in 1985 and 19% in 1990) and also a marked drop at three days postpartum (from 91% in 1980 to 41% in 1985 and 39% in 1990). Logistic regression analyses indicated that after controlling for three possible confounding factors (maternal age, parity, and weeks of gestation at first prenatal visit) the difference between the risk of developing anemia during pregnancy in 1980 as compared to 1985 or 1990 was still highly significant. The reasons for the observed drop in anemia's prevalence during the survey period are not entirely clear, partly because of the retrospective nature of the study. However, better nutrition resulting from improvement in the standard of living on Montserrat during the survey period could have been important, as could changes in health education and food supplementation activities.

Adolescent↗
PubMed1996

Consumer opinion concerning the treatment of a common sleep problem.

In an uncontrolled, open, pilot study, 15 severely learning disabled children suffering from severe and lifelong night-settling and night-waking (NS/NW) problems were treated with a brief behavioural modification approach based upon the behavioural therapy principles of rapid extinction, cueing and stimulus control. Following the treatment positive changes in these problems occurred quickly (within a few days) and these were sustained at both the 4- and 18-month follow-up stages in the majority of the children. Despite the misgivings of previous commentators concerning rapid extinction techniques, the children's parents found this treatment approach to be safe, helpful and acceptable. This study explores their views about this form of treatment and also about previous help they had received.

Behavior Therapy↗
PubMed1995

Two cases of severe head-banging parasomnias in peripubertal males resulting from otitis media in toddlerhood.

The author presents two case reports of peripubertal boys with severe and chronic head-banging parasomnias, or rhythmic movement disorders (RMDs), which started de novo whilst they were suffering from recurrent and severe otitis media in toddlerhood. Treatment consisting of straightforward behaviour modification techniques and advice concerning healthy sleeping habits proved highly successful. It is proposed that these late-onset or 'acquired' forms of RMD might be distinct from those which continue from infancy which have a stronger developmental aetiology.

Behavior Therapy↗
PubMed1994

Polydipsia amongst adults with a learning disability in an institution.

A hospital-based adult learning disabled population (n = 371) was screened for polydipsia with the help of a purpose-designed questionnaire. Polydipsia was defined as excessive drinking of more than 3 l of non-alcoholic fluid over a 24-h period. Altogether, 23 (6.2%) subjects were found to have polydipsia. The polydipsic group was compared with the whole hospital population on variables such as age and IQ distribution. A matched group of 23 individuals without a history of polydipsia was drawn from the same hospital population. The polydipsic and the matched group were compared using various biochemical and psychological measures. Thirty-five per cent of polydipsic patients, compared to 13% of the matched group, showed evidence of compensated hyponatraemia. This difference was not significant. There was no significant difference between the polydipsic and the matched group in the frequency of psychiatric illness, behavioural problems or autism. There also was no significant difference in the IQ levels of the polydipsic patients and the total hospital population. Polydipsia in this population is largely seen as part of an abnormal behavioural repertoire without any evidence of possible organic cause, except unidentified diabetes mellitus. Klein Levin syndrome and pica were represented in the polydipsic group, but not amongst the matched group.

Adult↗
PubMed1994

Childhood sexual experiences with adults: adult male psychiatric patients and general practice attenders.

BACKGROUND: Sexual abuse of male children is now believed to be common, and there may be links to adult psychiatric disorders. METHOD: Recollections of sexual experiences with adults in childhood were studied systematically in 115 men attending general practice surgeries and 100 male psychiatric patients. RESULTS: The latter reported more frequent and more serious events before the age of 13 than the general practice attenders. No significant difference was detected for events between the ages of 13 and 15. CONCLUSIONS: Childhood sexual abuse before the age of 13 may be associated with later psychiatric disorders, although the nature of the association remains uncertain. The possible significance of such experiences should be considered when assessing men with mental disorders.

Adolescent↗