PubMed Health⌕ Search

Biomedical subjects

E H Liston

Publications and source records attributed to E H Liston.

At least 19 recordsLinked to original sources
PubMed1994

Lithium sustains the acute antidepressant effects of sleep deprivation: preliminary findings from a controlled study.

Early morning sleep deprivation (patient awake from 0200 to 2200 hours) produces a same-day antidepressant effect in approximately one-half of patients with major depression. Unfortunately, these antidepressant effects are short-lived and patients usually relapse to baseline depression levels within 48 hours. Recent work suggests, however, that the use of lithium with early morning sleep deprivation sustains this rapid antidepressant effect and makes it clinically useful. In a 30-day study, we compared the abilities of four different treatments (lithium plus early morning sleep deprivation, lithium plus a control sleep deprivation procedure, and desipramine with either of the two sleep manipulations) to induce a rapid (next-day) and sustained antidepressant response in 16 depressed patients. Lithium plus early morning sleep deprivation produced a quicker response than lithium with the control sleep deprivation, and the response was sustained for at least 30 days. In this design, however, lithium/early morning sleep deprivation was no faster than either of the two desipramine/sleep deprivation conditions in inducing remission. These results support the results of previous studies and suggest further investigation of this novel sleep/pharmacologic intervention is warranted.

Adult↗
PubMed1990

Proposals for the mechanism of action of convulsive therapy: a synthesis.

The convulsive therapies have been powerful additions to somatic treatment in psychiatry and have enjoyed widespread application for the benefit of many. A number of theories have been advanced in efforts to account for therapeutic efficacy but none has been comprehensive. These theories can be distinguished by whether they posit a central therapeutic role for stimulation, inhibition, psychological effects, or mixed processes induced by treatment. After critically reviewing extant theories, we propose a model for the effects of the convulsive therapies: Convulsive therapy is essentially nonspecific; "nonphysiological" depolarizations are distinctly important for the restoration of aberrant intravesicular transmitter ratios with resultant therapeusis. We present this model as a working hypothesis that may contribute to the guidance of research in the mechanism of action of convulsive treatment and offer several testable hypotheses in this regard.

Brain↗
PubMed1989

Poor interrater reliability of MECTA EEG recordings of ECT seizure duration.

The electroencephalogram (EEG) tracings of seizure durations recorded by the MECTA SR-1 for 24 patients undergoing right unilateral electroconvulsive therapy (ECT) were estimated independently by four psychiatrists and a neurologist. Differences among raters were often large and, overall, were statistically significant. The literature on interrater reliability for the MECTA EEG remains contradictory, and caution in MECTA EEG use appears warranted.

Depressive Disorder↗
PubMed1988

Urinary phenylacetate and response to methylphenidate.

Phenylacetate (PAA) is the metabolic end-product of phenylalanine, a catecholamine precursor, and of phenylethylamine, a centrally active neurochemical substance which has been implicated in the actions of stimulant medications. PAA has been reported to be low in unipolar depression. We measured 24-h urinary PAA in normal controls (N = 21) and in-patients with unipolar depression (N = 33; 12 drug-free) and did subsequent dexamethasome suppression tests (DST). We also gave patients methylphenidate challenges, examining mood response. There were no significant differences between depressed patients and controls in 24-h urinary PAA excretion (P greater than 0.9). However, the variance in PAA excretion was higher in patients than normals and 5 patients had values at or above the 99% confidence limits for the normal control group. There was no association of DST results with PAA excretion (P greater than 0.4). Patients with a worsened mood after taking methylphenidate excreted less PAA than those with an improved mood, however (P less than 0.025). The clinical and theoretical significance of these results is discussed.

Adult↗
PubMed1987

Relatives' descriptions of changes in symptoms of dementia of the Alzheimer type: a comparison of retrospective and concurrent ratings.

Although relatives' retrospective reports are often used in characterizing the onset and progression of symptoms in dementia of the Alzheimer type (DAT), little is known about the accuracy of these accounts. The primary purpose of this paper is to summarize preliminary data obtained from relatives in an ongoing family study of DAT. Preliminary findings suggest there is rough reliability to relatives' recall of the progression of symptoms over time. This observation is discussed in relation to literature from other areas (e.g. child development, psychopathology) where the reliability of relatives' retrospection has been more thoroughly examined.

Aged↗
PubMed1986

Prolongation of the antidepressant response to partial sleep deprivation by lithium.

Depressed patients given a loading dose of lithium on the first of 2 successive days of partial sleep deprivation (PSD), and kept at maintenance levels thereafter, showed significantly greater prolongation of the antidepressant effects of PSD than patients treated with PSD and placebo, even though the acute elevation in mood derived from PSD was as great on placebo as on lithium. Depression was assessed 3 days after PSD with an augmented version of the Hamilton Rating Scale for Depression. Patients on lithium alone, without PSD, did not have the acute elevation in mood seen in the two PSD groups and had significantly less improvement in depression than those who received PSD with lithium.

Adult↗
PubMed1984

Medical, judicial, and statutory regulation of ECT in the United States.

The standards for ECT recommended by an APA task force report and those embodied in federal court orders and state statutes and regulations are compared. The authors conclude that there is serious boundary and role confusion owing to progressive intrusion of state authority into areas traditionally held to lie in the domain of medical judgment and clinical care. In spite of comprehensive safeguards promulgated by the psychiatric community, overregulation by legislatures and courts is commonplace, interposing law between physicians and patients and resulting in delays or denials of service while failing to resolve critical legal issues involving competence and consent.

Adolescent↗
PubMed1984

A comparison of national and in-house examinations of psychiatric knowledge.

The search continues for the optimum method of assessing psychiatric residents' knowledge. In 1982, 72% of the U.S. residency programs gave the Psychiatry Resident In-Training Examination ( PRITE ). The authors compared the PRITE with an examination developed by their program. The two tests yielded highly correlated percentages of correct responses and resident rank orders for advanced residents, detected similar areas of weakness, had comparable dollar costs, and elicited similar, moderately high resident satisfaction. Important differences were the amount of information and feedback provided to residents and to the residency program and the time between the test and the feedback.

Clinical Competence↗
PubMed1983

Behavioral responses to amphetamines in identical twins.

Male, monozygotic twins (six pairs) were repeatedly tested before and after d-amphetamine, l-amphetamine, or placebo administration. Drug effects on cognitive, psychomotor, personality, mood, and pain variables were assessed. Members of a twin pair tended to respond similarly on several tests under placebo conditions, indicating genetic determination of the behavioral variables. In addition, cotwins tended to show similar responses to amphetamine as measured by one test of cognitive function, by several mood and personality variables (hostility, autonomic arousal, friendliness, feelings of tension and loss of control), and tended to have similar plasma levels of both amphetamine isomers. Although shared environmental effects cannot be ruled out, the results are consistent with genetic mediation of a variety of behavioral effects of amphetamines.

Adult↗
PubMed1983

Clinical differentiation of primary degenerative and multi-infarct dementia: a critical review of the evidence. Part I: Clinical studies.

For patient care and for research purposes there is an obvious need for a valid and reliable set of clinical criteria to distinguish antemortem between primary degenerative dementia (PDD) and multi-infarct dementia (MID). To this end, specific diagnostic criteria for each have been promulgated in the official nomenclature, and a rating scale devised to differentiate these disorders is in wide use. These efforts suggest a diagnostic capability that is not, however, well supported by the literature. This critical analysis of representative clinical studies and articles published over the past two decades reveals important drawbacks in methodologic approaches and interpretation of data which seriously undermine confidence in making the clinical distinction between PDD and MID.

Alzheimer Disease↗
PubMed1983

Clinical differentiation of primary degenerative and multi-infarct dementia: a critical review of the evidence. Part II: Pathological studies.

A critical examination of representative pathological studies published over the past four decades reveals that this literature fails to provide sufficient support for the antemortem differentiation of primary degenerative dementia (PDD) from multi-infarct dementia (MID) on the basis of clinical criteria. Similar conclusions with respect to clinical studies and articles are presented in Part I of this overview. Among the difficulties commonly encountered in the literature are sampling bias, retrospective design, nonblind assessments, inadequate sample size, failure to consider overlap (i.e., mixed cases), absence of pathological verification in the clinical studies and post hoc reasoning. The necessity to assure that one is dealing with a case of PDD as opposed to some other dementing process is self-evident. However, these reviews show that this capability has not been adequately established with respect to the differential diagnosis of PDD and MID; the evidence to date indicates that the clinical diagnosis of MID, in particular, should be made with caution until more conclusive methods become available.

Aged↗
PubMed1981

Morphine, experimental pain, and psychological reactions.

This study examines the effects of morphine (10 mg/70 kg body weight) versus placebo (isotonic saline) on experimentally induced cold pressor pain threshold and tolerance, on self-reports of psychological states and drug effects, observer ratings of psychological states, and performance on timed cognitive-motor tasks in 20 non-drug using, normal male volunteers (21-28 years of age). Morphine increased both threshold and tolerance for cold pressor pain, and also increased "euphoric" and decreased "clear thinking" responses on the respective scales. Morphine, in contrast to placebo, increased scores on depression, fatigue, and cognitive loss-dysfunction scales and decreased scores on carefree and "friendliness" scales. Three sets of psychological variables were observed to covary significantly: Measures of anxiety and hostility; reports of fatigue and cognitive dysfunction; and reports of carefree feelings and perceptions of clear thinking. While measures of hostility, fatigue, and cognitive dysfunction covaried positively, reports of carefree feelings and perception of clear thinking covaried negatively with increased pain threshold and tolerance. Anxiety, contrary to reports in the literature, also covaried positively with the pain measures. The results were interpreted as supporting a relationship between increased arousal of the nervous system and decreased pain sensitivity in conjunction with the known analgesic effects of morphine.

Adult↗
PubMed1981

Assessment of psychotherapy skills: the problem of interrater agreement.

Thirteen experienced supervising psychiatrists independently rated the psychotherapy interviews of six residents, using a detailed assessment instrument. Although interrater agreement was significantly greater than would be expected by chance, the extent of agreement was uniformly low. Agreement was significantly poorer for judgments about technique skills than about communication skills and for second-year than for first-year residents. Other factors, such as the faculty rank and training of the rater, did not covary significantly with observed ratings. The findings suggest that rating methods which purport to assess psychotherapy skills should undergo careful methodological evaluation and testing before they are accepted as valid assessment techniques.

Clinical Competence↗
PubMed1981

Diagnosis and treatment of dementia in the aged.

Dementia affects an estimated 5 percent of the population 65 years of age and older, with 20 percent being affected at 75 years or older. Although the most common forms, primary degenerative and multi-infarct dementia, currently lack specific treatments, it is estimated that a thorough diagnostic evaluation will uncover a treatable cause in 10 percent to 20 percent. The differential diagnosis includes benign senescent forgetfulness, depression, adjustment disorder, paranoid states, amnestic syndrome, delirium, drug effects, systemic illnesses and intracranial conditions. The approach to each patient involves a history, physical examination, mental status evaluation and laboratory tests that focus on identifying treatable conditions. When no specific treatments are available, however, symptomatic treatments, including pharmacotherapy, environmental management, family supports and psychotherapy, can offer relief for both patients and their families and improve the daily functioning of the elderly patient with dementia.

Aged↗
PubMed1980

Hospital treatment of elderly neuropsychiatric patients. II. Statistical profile of the first 122 patients in a new teaching ward.

Data are presented on the first 122 patients admitted to a geropsychiatric teaching ward in a university hospital. A high incidence of medical problems are reflected by abnormal laboratory findings complicated the management of these patients, most of whom had dementia or depression. In all diagnostic categories, the patients appeared to benefit from the intensive inpatient treatment. Difficulties in the areas of diagnosis, treatment, length of hospital stay, discharge placement and program evaluation are discussed.

Aftercare↗