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Biomedical subjects

D Quinlan

Publications and source records attributed to D Quinlan.

7 recordsLinked to original sources

The current status of placebo in hospital practice.

Despite a voluminous literature on the topic of placebo, there has been little documentation of either actual clinical practice of prescribing placebo or the attitudes that surround it. Through a questionnaire survey of all head nurses of clinical units in one health services area of Connecticut, data were obtained on current practices regarding placebo use in the natural hospital setting. Multiple reasons for placebo use in the natural hospital setting. Multiple reasons for placebo use were given, and it was noted that patients receiving placebo tended to be viewed in certain ways. The effectiveness of placebo in symptom relief was reported as nearly double that reported in the experimental literature. Methodologic issues of the study and of placebo investigation, in general, are discussed. Because common clinical problems appear to generate most instances of placebo use, several issues pertinent to medical education are raised. Some future directions for placebo research are proposed.

Adolescent

Indicators of E.C.T. response and non-response in the treatment of depression.

Two matched groups of depressed patients, one ECT responsive and one ECT non-responsive, were compared for clinical, historical and treatment variables. Three factors predicted good response: (1) duration of illness less than one year; (2) presence of a precipitating event; (3) presence of delusions. A trend suggested that concurrent physical debilitation was a negative indicator. Possible explanations for these findings were proposed.

Acute Disease

Is disordered thinking unique to schizophrenia?

To provide data on several issues related to disordered thinking in schizophrenia, 200 acutely ill psychiatric patients (including 55 schizophrenics) were evaluated on four instruments to assess thought pathology (the Object Sorting Test, the Rorschach Test, a social comprehension test, and a proverbs test). Patients were assessed at two phases of their disorders (the acute phase and the phase of partial recovery). The results suggest (1) disordered thinking is not unique to schizophrenia; (2) distinctions between mild and severe levels of thought pathology are important; and (3) disordered thinking is influenced by acute psychopathology and acute upset. Inferential evidence suggests (4) disordered thinking fits along a continuum with normal thinking; (5) "thought disorders" are not a discrete, separate entity, standing apart from other aspects of thinking; and (6) older concepts about primary symptoms in schizophrenia need reexamination.

Acute Disease

The function and activity of certain membrane enzymes when localized on- and off- the membrane.

A group of enzymes known to be involved in group translocation-type transport mechanisms for the uptake of a variety of nucleotide precursors are enzymatically active both in their natural membrane milieu and in aqueous solution. The activity in aqueous solution markedly differ, however, from the enzymatic activity when the enzyme is membrane localized. The adenine phosphoribosyltransferase (PRT) of E. coli (Hochstadt-Ozer and Stadtman, 71a) is capable of carrying out an exchange reaction between the base moieties of adenine and AMP without requiring P-ribose-PP as an intermediate; the enzyme in aqueous solution requires P-ribose-PP, indicating a different reaction mechanism in the two environments. Like the adenine PRT of E. coli, the hypoxanthine PRT of Salmonella typhimurium (Jackman and Hochstadt, '76) also carried out an exchange reaction on the membrane only and also is more sensitive to a number of inhibitors in aqueous solution relative to the sensitivity when embedded in the membrane. In addition, however, the hypoxanthine PRT, while restricted to hypoxanthine as a substrate in the membrane, also accepts guanine as substrate in its soluble form. The membrane capacities reas determined in a guanine PRT deletion strain (Jackman and Hochstadt, '76). Finally, in mammalian cell lines purine nucleoside phosphorylase, which translocates the ribose moiety of inosine across the plasma membrane of mouse fibroblasts undergoes a 30-fold increase in substrate turnover number upon liberation from the membrane. These data raise two important caveats with respect to study of membrane enzymes and transport. Firstly, an enzyme once solubilized and found to differ kinetically from substrate transport in situ cannot be excluded from participating in translocations in the membrane on the basis of its activity in aqueous solution. Secondly, an enzyme which "appears" largely soluble upon cell rupture cannot be assumed to be a cycloplasmic enzyme because of majority of the solubilized activity may represent only a small fraction of the enzyme molecules highly activated concomitant to their solubilization. In this latter case the ability to activate enzyme still residing on the membrane (e.g., with detergents) would be necessary in order to estimate total membrane associated activity after cell rupture.

Adenine

Primitive drive-dominated thinking: relationship to acute schizophrenia and sociopathy.

To investigate primitive drive-dominated thinking in schizophrenic disorders and sociopathic behavior, responses on the Rorschach and other personality tests of 171 acute psychiatric patients were assessed using Holt's system. Results suggested that: (a) Acute schizophrenics were high on primitive drive content, but this was also characteristic of some nonschizophrenics, and other types of disturbed thinking were even more prominent in schizophrenics. (b) There were no significant differences between process and reactive schizophrenics in expression of primitive drive content. (c) Males showed more drive-dominated thinking than females (p less than .10), although sex was not a powerful variable. (d) Depressives showed less drived-dominated thinking than nondepressive (p less than .05). (e) Patients high on sociopathic or rule-breaking behavior tended to show more primitive drive-dominated thinking (p less than .01).

Acute Disease

Looseness of associations in acute schizophrenia.

To study looseness of associations and other theoretically relevant variables of speech pathology, 51 acute psychiatric patients, including 26 schizophrenics, were studied at the acute phase of their disorder by means of a free verbalization interview. The results on these 51 patients during the acute period were: 1. There were clear differences between the schizophrenic patient group and the control patient group, the overall index of deviant verbalizations being significant at the .001 level. 2. Many types of looseness were found in non-schizophrenic patients as well as in schizophrenics. Except at the very mildest levels, however, the variants of overt looseness were strikingly more frequent in occurrence and severe in degree in the schizophrenic group (p smaller than .01). 3. Gaps in communication, vagueness of ideas and blocking, though present to some degree in our control group, were much more common in the schizophrenic sample (p smaller than .001). 4. In the control group of patients, private meanings (including neologisms), repetition and perseveration were extremely rare, and current delusional thinking virtually non-existent. Private meanings and current delusional thinking were conspicuously present in the schizophrenic sample; repetition and perseveration were present to a mild degree in this acute schizophrenic sample. 5. Schizophrenic patients tend to show more looseness of associations when faced with a request to talk about topics not related to their illness.

Adult