Biomedical subjects
Publications and source records attributed to J E Miles.
A tension band technique was used in conjunction with a transarticular pin to stabilise 24 sacroiliac separations in 19 cats. The authors suggest that this technique is simpler and safer than the transarticular screw technique, and as effective.
Six volatile compounds, ethylmethylbenzene (1), 1-isopentyl-2,4, 5-trimethylbenzene (2), 2-(hex-3-ene-2-one)phenylmethyl ketone (3), E and Z isomers of 3-butylidene-3H-isobenzofuran-1-one (4 and 5), and 2-penten-1-ylbenzoic acid (6), were isolated from the mosquitocidal hexane extract of Delphinium x cultorum cv. Magic Fountains flowers. In addition, the ethyl acetate extract, which displayed corn earworm antifeedant activity, yielded 4-hydroxybenzoic acid (7) and bis(4-hydroxyphenyl)methanol (8). However, compounds 7 and 8 were not biologically active.
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There is an art to prescribing medications to depressed patients. Both patient and therapist factors are important to a successful outcome with appropriate timing and prescribing of treatment. Two case reports are provided as examples. Specific strategies used by experienced clinicians are presented in the discussion.
Fifty-four patients (34 outpatients, 20 inpatients) fulfilling Research Diagnostic Criteria for Definite Major Depressive Disorder were enrolled in a double-blind study comparing the antidepressant effects of alprazolam versus desipramine. The mean daily dose of alprazolam and desipramine at study termination was 3.78 mg and 208 mg respectively. As there were no significant demographic or clinical differences between outpatients and inpatients, both groups were combined in data analysis. Using the Hamilton Depression Rating Scale (HAM-D) both drug groups showed highly significant improvement beginning with the first week of active drug treatment. HAM-D scores continued to decrease through study termination (six weeks of active drug). There were no significant differences when comparing alprazolam and desipramine (outpatients, inpatients, or both groups combined) on any of the subjective or objective psychometrics used in this study. Clinically, only twelve of thirty-four outpatients (35.3%) were felt to be "markedly or moderately" improved, suggesting that neither the outpatient alprazolam nor desipramine patients did particularly well with drug treatment. In terms of drug safety there was no difference between the alprazolam and desipramine in the number of excessive or serious drug side effects. However, five of twenty-nine alprazolam patients had to discontinue therapy because of excessive drowsiness, and two of the alprazolam outpatients had motor vehicle accidents directly related to this adverse event. Alprazolam appeared as effective as desipramine in the pharmacotherapy of this group of depressed outpatient and inpatients. Alprazolam appeared well-tolerated by most subjects although drowsiness was a common--and at times serious--medication side effect.
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Dealing with patients' sex-related complaints is uncomfortable for many physicians. It can become more comfortable if the physician learns to apply his or her clinical knowledge of sexuality in combination with specific interpersonal interviewing skills. The level of comfort can be increased if the physician accepts his or her professional limitations in providing therapy and knows what other sources of care are available.
Patients with atypical facial pain (AFP) are subject to ineffective dental and surgical procedures for their pain complaints. Twenty-one of fifty-eight patients (36.2 percent) with AFP had sixty-five dental and surgical treatments, with only one patient showing less pain as a result of the treatment. While the majority of patients (69 percent) with AFP suffered from a psychiatric illness, fourteen (24 percent) of the patients referred for AFP had a specific medical or dental disorder that was causal in their pain complaints. There is a trend for the AFP patient with a psychiatric diagnosis to receive more ineffective treatments than those AFP patients for whom a specific medical or dental diagnosis was made. Patients with AFP should receive conservative dental and medical treatment and a psychiatric assessment before dental and surgical procedures are contemplated.
Psychiatric consultation is sometimes a part of the diagnostic evaluation of facial pain. The indications for referral arise out of the history. Several brief questions may indicate whether or not a psychiatric illness is present. Patients may hold beliefs or attitudes about their illness or about psychiatric treatment that make referral difficult. Successful referral depends on the relationship that the dentist establishes with the patient. Recommendations to facilitate the referral are presented.
Atypical facial pain (AFP) patients classically present with a chronic discomfort that is neither anatomic nor dermatomal in distribution. Neuropsychiatric assessment of 68 patients with AFP indicated that 46 (68%) had a specific psychiatric disorder by DSM-III criteria. A wide spectrum of psychiatric disorders was present. The authors emphasize that psychiatric assessment of patients with AFP should be an integral part in early assessments of this disorder, rather than relying on psychiatric opinions after extensive dental and other invasive procedures have been tried in vain and often to the detriment of the patient. Comments on the excellent prognosis in treating the psychiatric syndromes associated with AFP are made.
A double-blind controlled trial comparing a standard antidepressant drug, amitriptyline, with a new compound, bupropion, was conducted at six centers. There was a placebo washout, after which patients were assigned in a randomized fashion to one of the two treatments. No significant difference was found in therapeutic response to the two drugs after 4 weeks of treatment. Anticholinergic and cardiovascular side effects were less common in the bupropion-treated patients.
The physiology of saliva flow and hyposalivation is discussed. Drug-induced hyposalivation results in a higher incidence of dental caries, causes discomfort for denture wearers, and increases the risk of oral infections. Guidelines for preventing and treating drug-induced xerostomia are offered.
1. Thirty adult outpatients diagnosed with depressive illness were treated with either bupropion HCL or amitriptyline HCL. 2. Weekly ratings of efficacy and safety were undertaken using the Hamilton Depression, Hamilton Anxiety, Clinical Global Improvement, and Treatment Emergent Symptom Scales. Periodic physical investigations were also performed. 3. After 4 weeks of active treatment patients in both drug groups showed significant improvement on all rating scales. 4. The side effect profile of each drug was clinically different from one another with a notable absence of anticholinergic side effects characteristic of the bupropion group. 5. No significant laboratory or physical changes were found although slight changes in weight were noted with bupropion patients having a slight weight loss and amitriptyline patients a slight weight gain. There were no withdrawal effects from discontinuing either drug.
A longitudinal study of 35 full term breast fed (20 males and 15 females; mean birthweight = 3540 g) and 25 full term bottle fed infants (14 males and 11 females; mean birthweight = 3466 g) was carried out to compare the effect of method of feeding on hair zinc and copper concentrations. Hair samples were collected at 30 +/- 2, 90 +/- 4 and 180 +/- 4 days of age and analysed for zinc and copper by instrumental neutron activation procedures. Mean daily zinc and copper intakes were calculated at monthly intervals using three day diet records and test weigh data for the breast fed group. Only the male bottle fed infants showed a significant decline in hair zinc concentration (p less than 0.01) during the six-month study period. These results support the suggestion that male infants have a higher requirement for zinc than females in early infancy. No comparable systematic decline in hair zinc levels was evident in the female bottle fed infants or the male and female breast fed infants. The absence of any fall in hair zinc concentrations in the breast fed infants, despite their significantly lower (p less than 0.01) dietary zinc intakes compared to the bottle fed group, is attributed to the superior bioavailability of zinc from breast milk. Hair copper levels rose during the first three months in both groups, subsequently declining between 3-6 months. These changes were not significantly related to sex or method of milk feeding, but are associated with the redistribution of copper which occurs during early infancy.
Similarities between anorexia nervosa and obsessive-compulsive disorder have been described by a number of authors but few empirical investigations have been reported. In the current study, 15 female anorexics were compared with 14 age-matched female obsessives on a variety of psychometric tests, psychiatrist's ratings and self-rating scales. Obsessives and anorexics obtained similarly high obsessive symptom and trait scores on the Leyton Obsessional Inventory LOI). Both groups were rated by the psychiatrist as similarly obsessive, and there were no significant group differences in self-ratings of obsessive symptoms. Both groups were characterized by high levels of neuroticism and anxiety and low levels of extraversion. In the anorexic group the 6 abstainers had higher resistance scores on the LOI and higher extraversion scores on th MPI than the 9 bulimics. Findings are discussed with reference to the "sorcerer's apprentice" syndrome which appears to characterize both the obsessive and the anorexic.
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The authors review from a psychiatric perspective some of the electroencephalographic techniques that may assist the clinician in diagnosing complex partial seizures (temporal lobe epilepsy). Routine scalp electroencephalograms may not detect temporal lobe EEG abnormalities, leading to the false impression of pseudo or hysterical seizures. Knowledge of the advantages of a sleep recording, specialized EEG electrodes (nasopharyngeal, sphenoidal), and natural or pharmacological activation techniques will increase one's diagnostic acumen. The authors discuss the appropriate use of these methods and their relevance to psychiatry.
In conjoint therapy the motivation of each partner is a central issue, and is a curiously neglected area. While one or both spouses may have "low" motivation for working towards a more functional marriage, they may have very powerful other motivations for seeking conjoint therapy. This paper, derived from a review of 100 couples seen in conjoint therapy, outlines the seven most common alternative motivations encountered, and offers some diagnostic clues and management techniques.