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Biomedical subjects

G B Parker

Publications and source records attributed to G B Parker.

At least 19 recordsLinked to original sources
PubMed2005

Identifying "paradigm failures" contributing to treatment-resistant depression.

BACKGROUND: "Treatment resistant depression" is likely to emerge from a number of factors, including application of the wrong diagnostic and treatment models. METHOD: Current paradigms for managing both depression and treatment resistant depression are considered. We then examine the prevalence of a set of paradigm failures that appeared to contribute to treatment resistant depression in outpatients of a tertiary referral Mood Disorders Unit. RESULTS: Six illustrative paradigm failures are described and their frequencies within the clinical sample reported. Identified paradigm failures were diagnosing and/or managing a non-melancholic condition as if it were melancholic depression, failure to diagnose and manage bipolar disorder, psychotic depression or melancholic depression, misdiagnosing secondary depression and failure to identify organic determinants. CONCLUSION: We suggest that the identification of such "paradigm failures"--and of others that can be assumed to operate--has the potential to enrich the assessment and management of depressed patients, and reduce the prevalence of treatment resistance.

Adolescent↗
PubMed2005

Structural and functional models of depression: from sub-types to substrates.

OBJECTIVE: To present a functional model of depression facilitating research and clinical understanding. METHOD: The authors conducted a systematic literature search and reviewed articles pertaining to the neurochemistry and pathophysiology of depressive disorders, focusing on the contribution made by the principal monoamines to three differing depressive structural sub-types (i.e. psychotic, melancholic and non-melancholic). RESULTS: We suggest that the three structural depressive subtypes appear functionally underpinned by differential contributions of serotonergic, noradrenergic and dopaminergic neurotransmitters, so influencing phenotypic distinction (our structural model) and allowing an aetiological model to be derived with treatment specificity implications. CONCLUSION: The functional model logically iterates with the structural model of depression and provides a useful framework for conceptualizing the depressive disorders. This model provides a logic for distinguishing between principal depressive subtypes, pursuing their functional underpinnings and explaining treatment differential effects across the three sub-types.

Major Depressive Disorder↗
PubMed2005

Treatment-resistant depression: resistant to definition?

OBJECTIVE: To better define treatment-resistant depression (TRD) so as to assist clinical management and refine treatment guidelines. METHOD: In this study, we examine a broad range of clinical variables in depressed patients (n=196) referred to a tertiary referral Mood Disorders Unit (MDU). Information was collected from patients, referrers and assessors over a period of 32 months and included evaluations of treatments, treatment resistance and related variables. Data were analysed across trichotomized 'high', 'low' and 'no' treatment resistance groupings of patients. RESULTS: A significantly greater proportion of patients with melancholia were amongst the high TRD group, and this was consistent across different strategies for evaluating melancholia. CONCLUSION: Melancholia perhaps provides a prototypic TRD subset that perhaps reflects some innate aspects of melancholic depression or factors such as the impact of ageing. Research into TRD is needed to both replicate this finding and perhaps explicate it further.

Adolescent↗
PubMed2003

Attitudes toward psychiatry among students entering medical school.

OBJECTIVE: To survey the attitudes of Australian medical students to determine their views about the relative attractiveness of psychiatry as a career compared with other specialties, and against findings from a North American study. METHOD: We surveyed 655 first-year medical students attending six Australian Universities. RESULTS: Responses indicated that Australian medical students view psychiatry as distinctly less 'attractive' than other career options, as reported in the North American sample. In comparison with other disciplines, psychiatry was regarded as more interesting and intellectually challenging, but also as lacking a scientific foundation, not being enjoyable and failing to draw on training experiences. CONCLUSION: Our findings suggest that psychiatry has an image problem that is widespread, reflecting community perceptions and the specialist interests of medical students on recruitment. If psychiatry is to improve its 'attractiveness' as a career option, identified image problems need to be corrected and medical student selection processes re-considered.

Adult↗
PubMed2001

Rediscovering chronic mania.

OBJECTIVE: This paper presents a case of chronic mania and reviews the diagnosis with respect to its definition and utility. METHOD: A case of chronic mania is described. RESULTS: Unremitting mania poses a diagnostic and management challenge. CONCLUSION: Persistent mania of this duration is rare, but a diagnosis of chronic mania should not be rejected on the basis of chronicity.

Adult↗
PubMed1996

Sociopathy: forever forensic?

We suggest that the criteria for antisocial personality disorder, or "sociopathy", in the Diagnostic and statistical manual of mental disorders (4th edition) are deficient in that they define "failed sociopathy", and fail to include an equally valid group of individuals who, although seen by society as successful, display core features of the antisocial personality disorder.

Antisocial Personality Disorder↗
PubMed1993

On our selection: predictors of medical school success.

OBJECTIVE: To review predictors of academic success in one Australian medical students with predictors rated retrospectively. PREDICTORS: Success and involvement in academic and non-academic pursuits over the final two school years and at university, as well as study and external employment variables. RESULTS: Superior performance over the medical course was predicted by younger age and by being involved in debating in the final school year, immediate entry to the course, having English as a first language, completing school in Australia, having a higher Higher School Certificate (or equivalent) English score, as well as leadership responsibilities in the last year at school, with the first two variables remaining significant in a multiple regression analysis. English and communication skills were two of the five predictors of success for students who did not have English as their first language. For students who had English as their first language, the important predictors were younger age and having debated in the final high school year. CONCLUSIONS: These results, considered with some other recent reports, suggest that academic success in a medical course is predicted to a surprisingly high level by competence in English. Both the importance of communication skills to the practice of medicine, and their assessment in those seeking entry to medical schools, are considered.

Achievement↗
PubMed1993

Genetically improved potatoes: protection from damage by Colorado potato beetles.

Russet Burbank potato plants have been genetically improved to resist insect attack and damage by Colorado potato beetles (Leptinotarsa decemlineata (Say)) by the insertion of a cryIIIA gene encoding the insect control protein of Bacillus thuringiensis var. tenebrionis. A modified gene that dramatically improved plant expression of this protein was utilized. Its expression in Russet Burbank potato plants resulted in protection from damage by all insect stages in the laboratory and in dramatic levels of protection at multiple field locations. Analysis of these genetically modified potatoes indicated that they conform to the standards for Russet Burbank potatoes in terms of agronomic and quality characteristics including taste.

Amino Acid Sequence↗
PubMed1992

From nurture to network: examining links between perceptions of parenting received in childhood and social bonds in adulthood.

OBJECTIVE: The authors' goal was to consider the extent to which key characteristics of their parents influence children's later socialization in terms of social networks and intimate relationships and thus to examine whether there is evidence of such continuity. DATA COLLECTION: The authors reviewed the pertinent literature and then examined studies using a measure of key dimensions of the parenting received in childhood (the Parental Bonding Instrument) as well as measures of adult social networks. FINDINGS: The literature review revealed evidence of links (more evident in women) between perceptions of having received uncaring parenting and deficiencies in diffuse social bonds, which could reflect a causal process, a general response bias, or methodological limitations. By contrast, studies using the Parental Bonding Instrument and a specific measure of adult intimate bonds failed to find links between perceptions of parenting received in childhood and the quality of current intimate relationships unless there was extreme deprivation of parental care; in that case, the current intimate relationship was more likely to be rated as uncaring. CONCLUSIONS: These findings refine the view that early socialization experiences shape and dictate interpersonal relationships in adulthood. Any deficiencies in parent-child relationships, except, perhaps, gross parental deprivation, appear capable of modification by a range of experiences (particularly subsequent interpersonal relationships).

Adult↗
PubMed1991

Treatment of bipolar disorder.

OBJECTIVE: To review the current status of the management of bipolar disorder (manic-depressive illness). DATA SOURCES AND STUDY SELECTION: Controlled clinical trials as well as some recent important open studies are examined. DATA EXTRACTION AND SYNTHESIS: Lithium carbonate remains the mainstay of both the acute and prophylactic treatment of this condition. We highlight specific contentious issues in prophylactic management with lithium, that is, indications for initiating long-term treatment, preferred serum concentrations, timing of the dose, duration of treatment and frequency of laboratory monitoring. In recent years, several alternatives to lithium have been demonstrated as effective in both the acute and prophylactic treatment of patients either unable to tolerate or inadequately responsive to this agent. There is now considerable evidence that carbamazepine is of similar efficacy to lithium and more recent studies suggest that valproate may also be as therapeutic. We outline details of the clinical roles of each of these agents, with guidelines concerning monitoring and adverse effects.

Anticonvulsants↗
PubMed1991

Maternal anxiety: a 5-year review of an intervention study.

Primiparous women were divided into groups according to their post-partum trait anxiety scores. Professional or non-professional support for the first 12 months was offered to two subgroups of high trait anxiety subjects. At the 5-year follow-up the high-anxiety mothers (n = 57) manifested more psychological and social pathology than moderate- and low-anxiety mothers (n = 43), and their children also showed signs of poorer adaptation. There was evidence of improved outcome for mothers in the professional intervention group, but not for their children. Child psychopathology was predicted best by maternal psychosocial variables, and to a lesser extent by child temperament variables. The relation of infant attachment and temperament measures to subsequent psychopathology is discussed.

Anxiety↗
PubMed1982

Coping behaviors that mediate between life events and depression.

An attempt was made to identify the repertoires of coping behaviors that may mediate between life events and depressive disorders. Six structural dimensions emerged in a non-clinical group: recklessness, socialization, distraction, problem solving, self-consolation, and passivity. Several age, sex, and social class effects on derived scale scores that assessed behavioral change and the perceived effectiveness of behavioral change were also shown in that nonclinical group. Subsequently, a controlled study revealed behavioral decrement in the reports of nonpsychotic depressives. Further analyses suggested that the decrements could best be explained as a consequence of state levels of depression rather than as indicating ongoing vulnerability characteristics. Such findings have important therapeutic implications for behavioral and cognitive behavioral treatments of depressive disorders.

Adaptation, Psychological↗
PubMed1980

Why does migraine improve during a clinical trial? Further results from a trial of cervical manipulation for migraine.

It is generally accepted that migraine is sensitive to intervention, whether in a treatment situation or in a clinical trial, and a "placebo effect" is often suggested. The influence of a number of non-specific therapeutic ingredients was examined in a recent six-month trial of cervical manipulation for migraine, and results of a 20-month follow-up are reported. During the trial migraine attacks reduced significantly by 28%, and reduced a further 19% up to the follow-up period. The possibility of a trial effect, whereby improvement might stem from circumstances of the trial, was dismissed as an explanation for improvement. There was some evidence to suggest that placebo influences made a slight contribution to improvement, with sex, social class and subjects' optimism about the therapist at the initial treatment being weakly associated with initial improvement. The possibility that improvement levels reflected spontaneous improvement in migraine symptoms is suggested. If this possibility proves valid, clinical trials assessing migraine therapies should be designed so as to consider the natural course of migraine. Degree of improvement at follow-up could be predicted clearly from degree of improvement during the treatment phase and from degree of improvement at the end of the trial. This appears to be important to manipulative therapists who appear to practise without the benefit of valid predictors of response to therapy.

Adolescent↗