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Biomedical subjects

J M Ellison

Publications and source records attributed to J M Ellison.

At least 19 recordsLinked to original sources
PubMed2000

Treatment-resistant depression and the collaborative treatment relationship.

Many depressed patients experience only limited improvement despite provision of appropriate therapies within a collaborative treatment arrangement (the integrated provision of psychotherapy and pharmacotherapy). In the interest of enhancing these patients' partial responses, it is valuable to examine the treatments provided and also the collaborative framework in which they are offered. The authors use vignettes to illustrate how each of several factors-the adequacy of treatment with each modality, behavioral impediments to response, compliance with treatments, recognition and appropriate matching of treatments to relevant concurrent diagnoses, and appropriate communication between collaborating clinicians-may affect treatment outcome. Recommendations are offered for clinicians engaging in a collaborative relationship, including attending carefully to the patients' comments about a complementary modality of treatment and the clinician delivering it, communicating useful information to the collaborating therapist, and being receptive to information that is offered by the collaborating therapist.

Behavior Therapy↗
PubMed1996

Description of antipanic therapy in a prospective longitudinal study.

The authors present a summary scale for assessing the percentage of patients in a large longitudinal study of panic disorder who received proven effective psychopharmacologic treatment. Such a scale provides a means for assessing and comparing somatic treatments of panic disorder across medication classes. The antipanic therapy levels were applied to data on medication treatment received by 492 patients participating in a naturalistic study and reflect psychopharmacologic treatment prescribed in 11 academic centers. Results show that among patients treated by psychiatrists at major teaching hospitals only 54% of the most symptomatic groups received optimal pharmacologic treatment. Among less symptomatic patients, who nonetheless met full criteria for panic disorder with or without agoraphobia, only 43% received maximal therapy.

Adult↗
PubMed1995

Schizophrenia and the life cycle.

We reframe the longitudinal treatment of persons with schizophrenia from the perspective of phases in adult development. This approach articulates the need for different interventions of varying intensities over the person's lifetime. The paper discusses the implications of an adult developmental perspective in managing pharmacologic treatment and psychosocial interventions, and in reallocating financial resources for improved long-term outcomes. This perspective is especially useful in the context of a comprehensive community mental health program permitting access to a continuum of services throughout the lifecycle.

Adolescent↗
PubMed1993

The case for a services-based approach to payment for mental illness under national health care reform.

In this position paper drafted by the committee on psychopathology of the Group for the Advancement of Psychiatry, the authors discuss merits and disadvantages of three different approaches to equitable coverage of mental illness: coverage for selected psychiatric diagnoses, coverage based on severity of impairment, and coverage of services. They believe that coverage of selected disorders has political appeal but is discriminatory and arbitrary; it is also impractical because clinicians may overdiagnose conditions covered by insurance and underdiagnose excluded conditions. Coverage based on severity of impairment, or disability, has similar limitations. The authors believe services should be the principal basis for coverage, as under general medical insurance. The approach is nondiscriminatory, and costs can be controlled through such means as managed care, changes in the payment system, or benefit design.

Community Mental Health Services↗
PubMed1993

SSRI-associated nocturnal bruxism in four patients.

BACKGROUND: Nocturnal bruxism (tooth clenching and/or grinding during sleep) affects a significant proportion of the population. Its etiology remains uncertain, and no entirely satisfactory treatment is available. METHOD: This is an observational report of four depressed individuals selected from one psychiatrist's practice within an urban hospital's psychopharmacology clinic. Psychiatric diagnoses were made according to DSM-III-R criteria. Nocturnal bruxism was determined on the basis of dental examination and/or self-reported nocturnal tooth clenching and/or grinding. RESULTS: Four patients developed nocturnal bruxism within 2 to 4 weeks after initiation of treatment with fluoxetine or sertraline. Bruxism remitted in all patients after a decrease in antidepressant dosage (N = 1) or addition of buspirone (N = 3). CONCLUSION: These observations, which should be confirmed by a controlled study, suggest an association between serotonin selective reuptake inhibitor (SSRI) treatment and the onset or exacerbation of nocturnal bruxism. In addition, they suggest that a decrease in SSRI dosage or the addition of buspirone may relieve SSRI-associated nocturnal bruxism.

1-Naphthylamine↗
PubMed1992

Pharmacotherapy observed in a large prospective longitudinal study on anxiety disorders.

Data concerning 331 subjects participating in a longitudinal study on anxiety disorders were collected over the first 6 months of the study. Preliminary analyses of somatic treatment according to diagnoses and study site were conducted. The comorbidity of one anxiety disorder with other DSM-III-R diagnoses and other types of anxiety disorders was extensive. Patients with panic disorder received significantly more treatment with a benzodiazepine than patients without panic disorder. Fewer than five percent of the sample were treated with a monoamine oxidase inhibitor. Comorbid depression increased the likelihood of treatment with a newer non-MAOI (non-monoamine oxidase inhibitor), nontricyclic antidepressant. Results suggest a strong effect of treatment site on the pharmacotherapy offered.

Adolescent↗
PubMed1990

Fluoxetine-induced bradycardia and syncope in two patients.

Fluoxetine appears to cause a low incidence of adverse cardiac effects. An uncommon but potentially hazardous effect of fluoxetine therapy, however, is bradycardia accompanied by faintness or syncope. The authors report two cases in which this adverse effect occurred. They hypothesize that the mechanism of bradycardia in these cases represents a direct central nervous system effect of increased serotonin on medullary cardiovascular regulation.

Adult↗