Biomedical subjects
Publications and source records attributed to G Masterton.
Admissions to hospital following parasuicide in one city over eighteen years exhibit a cyclical variation apparently synchronized with the lunar quarters. The effect would only account for approximately 0.7 out of the average of 46 parasuicides per 100,000 adults per lunar cycle (95% CI 0.6-0.8), and fails to reach statistical significance.
In a total of 22,169 parasuicides over 19 years, there was evidence for a seasonal cycle in parasuicide admissions among women, with an increase during the summer and a fall over the winter, including a pronounced December nadir. Further analysis of the winter trough suggests a sociological explanation, the focal point being Christmas. There was no evidence for monthly or seasonal variation among men.
Reductions in emergency psychiatric presentations to hospital occurred during and after the finals of the World Cup football competitions, an effect evident in women as well as men, and more marked among the mentally ill than those who were not. Increases in the numbers of schizophrenic and neurotic men presenting before, and alcoholic men during, the competitions can be attributed to the football. The generalised reductions during and after could reflect an indirect effect upon help-seeking, although actual relapse rates of mental illnesses might be affected. These changes could arise from enhancement of national identity and cohesion.
This study investigated the general practice consultations of 46 patients during the year before and 13 weeks after hospital admission for deliberate self-poisoning. These were compared with data for controls matched for age, sex, family structure and area of residence. The frequency of consultations increased as parasuicide approached but this effect was due to large increases in a few patients. The greatest increase in the number of consultations and an increase in subjects consulting for physical problems occurred four to six months before the event. The seriousness of the attempt assessed by suicidal intent was unrelated to consulting pattern either before or after overdose. The rate of default from appointments was less than for controls, although this was not significantly different. Because of the problems in identifying when intentional self-harm will occur and the common presentation being psychosocial distress rather than mental illness, intervention to prevent parasuicide is likely to prove even more difficult than for suicide.
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Two women with insulin-treated diabetes who presented with hyperventilation in the setting of generalized anxiety disorder and panic disorder, respectively, are reported. The symptoms of hyperventilation and hypoglycaemia proved indistinguishable even after successful treatment with a behavioural approach including explanation, breathing retraining, and relaxation. With diabetic patients a cognitive strategy is complicated by conditioning to think in terms of diabetic control and an inability to safely reattribute symptoms to faulty breathing habit because of the risk of ignoring hypoglycaemia.
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Ninety-six per cent of the residents occupying the 11 Local Authority Homes within the catchment area of one Scottish district psychiatric hospital were surveyed to estimate current levels of organic cerebral impairment and behavioural problems in the Homes. Clear evidence of dementia was shown by 27.1% of the residents but the actual prevalence of organic cerebral impairment could be as high as 66.4%. An excessively high level of socially disruptive behaviour was discovered. This study suggests that Local Authority Homes, with their present staffing levels, are having to cope with large numbers of dependent and behaviourally disturbed old people. Four possible solutions are outlined. Irrespective of what is adopted, it is essential that Health and Social Service developments are fully co-ordinated.
Plasma growth hormone (GH), prolactin, and corticosteroid responses to insulin-induced hypoglycaemia were studied in 24 men with progressive alcoholism who had been abstinent for two to seven days. Ten normal healthy subjects (five men, five women) served as controls for comparing GH and prolactin responses, while cortisol responses were studied in a further six male controls. Blood samples were taken at intervals after an injection of soluble insulin (0.1 U/kg body weight). All patients developed adequate hypoglycaemia (blood glucose <2.2 mmol/l (<39.6 mg/100 ml)) and nine had impaired GH responses (peak concentration <10 mU/1). Prolactin concentrations fell or remained unchanged in nine patients, eight of whom also had impaired GH responses. In seven patients corticosteroid concentrations decreased from basal concentrations, and six of these patients had impaired GH responses. All three hormone responses were impaired in several patients, and significant correlations were found between the GH and prolactin responses at 45 and 60 minutes. GH response was not correlated with age, duration of drinking, duration of alcoholism, or admitted alcohol intake. GH responses were significantly lower in patients who had the most severe withdrawal symptoms. Our observations of impaired stress responses in some recently abstinent alcoholics may have important implications for the management of alcohol withdrawal syndrome.
The accepted modern practice is to treat each sexually transmitted disease with the shortest possible course of treatment consistent with success. In candidal vulvovaginitis, six days is the minimum period that has so far been found to be successful, but we report here a further reduction to three days. Patients were given two clotrimazole pessaries nightly for three consecutive nights; the overall success rate was 89-4% one month after treatment. This compares favourably with the 93% cure rate reported with the six-day course of clotrimazole. With both the long and short courses, patients having their first attack of genital candidosis responded better than those with a history of previous infection. Short courses of clotrimazole treatment are particularly valuable in dealing with uncooperative women who stop treatment at the earliest possible moment. Clinical and laboratory diagnostic pitfalls and their possible influence upon the therapeutic outcome are also discussed.
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349 male patients with uncomplicated gonococcal urethritis were treated with a single dose of 300 mg. or 400 mg. minocycline hydrochloride. The lower dose gave a lower failure rate, 3-2 compared with 5-1 per cent., but this difference was not statistically significant. The overall known failure rate of 4-2 per cent. compares most favourably with our previous findings in this area using other drugs of the tetracycline group. The incidence of post-gonococcal urethritis (5-1 per cent.) was also the lowest we have found. The few side-effects reported were comparatively trivial. Because of its high degree of therapeutic efficacy, the relatively lack of side-effects, and the reduced incidence of post-gonococcal urethritis, minocycline hydrochloride should be considered the drug of choice whenever single-dose oral treatment is given in uncomplicated gonorrhoea in men.
In a trial of natamycin, an antifungal antibiotic in a vanishing cream base, assessment was possible in 66 men with genital or anal candidosis. The overall cure rate was 82 percent, In 43 patients with culturally proven candidosis it was 98 percent. but in 23 patients treated solely on clinical impression it was only 52 percent. Symptoms were rapidly relieved in those who responded and there were no side-effects. In our hands, natamycin 2 per cent cream has proved to be a valuable preparation in the treatment of candidal balanitis.
Two hundred and two patients with symptoms, signs and mycological evidence of Candida vaginitis were entered in a single-blind trial comparing 6-day clotrimazole therapy with a control group receiving 6 days' nystatin therapy. Adequate data was collected on 69 clotrimazole and 72 nystatin treated patients for analysis. Judged by both the severity of symptoms and signs and the number of patients with negative mycological findings, 6-day clotrimazole therapy produced statistically significantly better results than obtained in the control group. When reviewed 4 weeks after starting therapy, 93% of the clotrimazole treated patinets had culturally negative results for Candida compared with 74% of the patients treated with nystatin. It is concluded that 6-day clotrimazole therapy is effective in the treatment of Candida vaginitis.