PubMed Health⌕ Search

Biomedical subjects

H A Fox

Publications and source records attributed to H A Fox.

At least 19 recordsLinked to original sources
PubMed2001

Extended continuation and maintenance ECT for long-lasting episodes of major depression.

While most major depressive episodes are relatively short lasting, a substantial minority of patients with severe mood disorders respond poorly to available treatments and remain ill for extended periods of time. The possible role of continuation and maintenance electroconvulsive therapy (ECT) in the management of such patients has not been clearly established. Three patients are reported whose long-lasting, relatively medication refractory episodes of major depression were treated with ECT for both acute and continuation and maintenance purposes. Although relapses occurred despite treatment, the frequency, severity, and duration of relapses were apparently diminished by ECT. Relapses occurred with diminishing frequency over the course of individual episodes, and were typically reversed by three or four closely spaced ECT treatments. No medical complications occurred. While complaints of memory difficulty were common, Mini-Mental Status Examinations 6 weeks after ECT were unimpaired. Continuation and maintenance ECT appears to be a safe and effective treatment modality for long-lasting episodes of major depression. Recommendations for clinical management are proposed.

Aged↗
PubMed1993

Patients' fear of and objection to electroconvulsive therapy.

Patients' fear of and objection to electroconvulsive therapy (ECT) have complicated the administration of this modality since its inception. Despite modifications in technique and pretreatment education over the years, these problems have not disappeared. The author discusses the literature on fear of convulsive therapy and provides three case examples from his clinical experience. The review suggests that some patients gradually develop a pathological fear of ECT over the course of treatment, which creates a significant obstacle to compliance and in some cases leads to refusal of treatment. The author suggests that this clinical phenomenon, described during the 1950s but often underrecognized today, merits further study.

Adult↗
PubMed1989

Are brief pulse and sine wave ECT equally efficient?

The literature reflects that brief pulse electroconvulsive therapy (ECT) uses less energy to elicit seizures and produces less cognitive disturbance than does sine wave ECT. However, the relative effectiveness and efficiency of the two waveforms have not been firmly established. In an effort to clarify these issues, the authors retrospectively compared a diagnostically heterogeneous group of 197 patients who received sine wave ECT with a similar group of 144 patients who received brief pulse ECT. The average number of ECT treatments administered to each group was essentially the same. Among a more homogeneous group of patients with affective disorders treated with either bilateral or mixed electrode placements, the number of treatments required with each waveform did not differ significantly.

Aged↗
PubMed1988

Convalescent phase of bipolar disorder.

The interepisode interval in bipolar disorder has been relatively unstudied, in part because patients are generally considered to be well during that period. The author proposes that a symptomatic convalescent phase follows acute episodes of mania and depression and precedes the return to the entirely well state. A case is presented of a 15-month convalescence that followed a manic episode. The most prominent features of the convalescence were its long duration, its saw-toothed pattern of remitting and recurring symptoms, and the presence of dysphoria. The fluctuation of dysphoric symptoms was at times associated with and at times independent of life events and was independent of lithium levels. Supportive psychotherapy is apparently a critical element in the management of this phase. Questions about the nature and optimal management of the convalescent period are raised.

Bipolar Disorder↗
PubMed1986

Tests of cognition and their relationship to psychiatric diagnosis and demographic variables.

Psychiatric and control subjects were given a test of cognition consisting of orientation, spelling the word "world" backward, serial 7's test, and recalling three words. The interrelationships among test scores, diagnosis, and demographic variables were determined. Dementia was differentiated from nonorganic psychiatric disorder using only orientation and recall of three words. Depressed, schizophrenic, and bipolar patients were significantly different from controls in their ability to recall three words. In nondemented subjects, the serial 7's test was positively correlated with years of education; spelling "world" backward was negatively correlated with age. Sex, marital status, and orientation showed no significant correlation and hence were bias free.

Age Factors↗
PubMed1985

Stimulation in the NICU: is more necessarily better?

Animal studies and studies with human full-term infants suggest that the stimulation present in utero affects postnatal preferences and levels of response. The premature infant does not necessarily benefit from a re-creation of the in utero environment. Each aspect of the in utero environment should be assessed independently as a potential source of added stimulation in the NICU to determine its possible effects on the development of the premature infant. The NICU environment cannot be accurately labeled by global descriptors of "deprivation" or "overstimulation." When compared with the home environments of full-term infants from lower SES homes, different aspects of the NICU environment were recorded more often, less often, or equally as often as in the full-term infants' homes. Baseline levels of stimulation should be recorded in any NICU environment prior to the institution of an intervention program. NICU caregivers tended to respond contingently to their premature patients' behaviors. However, the prematures provided few opportunities for the nurses to respond, when visual and vocal behaviors used by full-term infants were employed as the expected norm. Perhaps both the medical staff and parents should be trained to recognize and respond to the more subtle, different cues described by Als et al. as being prevalent in the behavioral repertoire of the premature infant. Based on ecologic descriptions of NICU's, researchers have suggested that an inappropriate pattern of stimulation may characterize the environment, rather than an inappropriate amount of stimulation. The NICU environment has been characterized as providing little cross-modal stimulation, few temporally patterned stimuli, and little diurnal rhythmicity. In addition, the premature infant may have few opportunities to control the environment, contrary to the full-term infant's experiences. There is evidence of some negative effects of added NICU stimulation. Individual infants should be assessed prior to intervention for their level of behavioral maturation. Interventions should be individualized for the particular needs of each infant, rather than subjecting all infants assigned to a treatment condition with a stimulation "package." The worthy goal of promoting the development of premature infants carries with it the responsibility of ensuring that no harmful effects could befall any one infant.

Acoustic Stimulation↗
PubMed1983

The DSM-III concept of organic brain syndrome.

The shortcomings of the DSM-II classification of organic brain syndrome are described, including the limitation of the concept to the global brain disorders; the idiosyncratic use of the terms acute and chronic; and the unsatisfactory categories psychotic and nonpsychotic. Organic brain syndrome is defined according to DSM-III and the 10 separate brain syndrome categories are outlined. The diagnostic criteria for each category are listed and the general principles underlying the criteria are described. Finally, the goals of the authors' of DSM-III to enhance diagnostic reliability and validity are discussed and the impact of the new nomenclature is assessed.

Delirium↗
PubMed1981

The DSM-III concept of schizophrenia.

The development of DSM-III is traced from the Feighner Criteria through Spitzer's Research Diagnostic Criteria. The specific criteria for the diagnosis of schizophrenia are listed, and the symptoms which contribute to the diagnosis are categorized. Differences from the DSM-II concept are highlighted, and the complicated question of schizoaffective disorder is discussed. The DSM-III resolutions to the major controversies in the study of schizophrenia are outlined. Finally, the major strengths and weaknesses of the DSM-III approach are assessed.

Diagnosis, Differential↗
PubMed1978

Bleuler, Schneider and schizophrenia.

Three important elements in Bleuler's work are described and criticized: the fundamental-accessory dichotomy, the primary-secondary dichotomy, and question of diagnosis. The major influences on Schneider's thinking are outlined and his general approach to psychopathology, criteria for the diagnosis of schizophrenia, and approach to clinical evaluation are described. The work of Mayer-Gross and Langfeldt, whose diagnostic formulations integrate the thinking of Bleuler and Schneider is briefly described. Finally, the contributions of these 4 authors are compared and contrasted, and their respective impact on the current study of schizophrenia is assessed.

Germany↗