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Biomedical subjects

L G Kiloh

Publications and source records attributed to L G Kiloh.

At least 19 recordsLinked to original sources
PubMed1990

Diagnosis, personality and the long-term outcome of depression.

Patients diagnosed in the late 1960s as suffering from either endogenous or neurotic depression, or as presenting with depression but discharged with another neurotic diagnosis, were followed for 15 years. Diagnosis at index admission did not predict overall outcome, but patients with endogenous depression, an apparently stable diagnosis, had longer index admissions, were readmitted sooner, but spent less time ill than patients in either of the neurosis groups. Personality abnormality accounted for 20% of the variance in outcome in the neurotic groups and only 2% of the variance in the endogenous group. Thus there is evidence that endogenous and neurotic depression are two illnesses and that, in the neuroses particularly, prognosis will depend on the extent to which these personality abnormalities are modified by treatment.

Depressive Disorder↗
PubMed1988

The long-term outcome of depressive illness.

One hundred and forty-five patients with primary depressive illness admitted to a university hospital between 1966 and 1970 were followed up an average of 15 years later. Adequate data were obtained on 133 (92%) of the 145. During the follow-up period, 7% of the 133 had suicided, 12% had remained incapacitated by illness and only 20% had remained continuously well. Patients for whom the index admission was not their first were especially likely to be readmitted during the follow-up period. Patients with endogenous depression, none of whom developed schizophrenia during the follow-up period, were more likely to need readmission than patients with an index diagnosis of neurotic depression. In all other respects the prognosis for the two types of depression was the same, with considerable morbidity evident in both.

Adult↗
PubMed1986

The epilepsy of Dostoevsky.

The evidence in favour of a diagnosis of limbic epilepsy in the case of Dostoevsky is reviewed. Independent records from numerous biographical sources support the widely held view that Dostoevsky had frequent convulsive episodes, that the episodes began in childhood and continued throughout his life and that Dostoevsky himself was able accurately to record the premonitory aura and sequelae of such episodes. In addition the increasing memory impairment he suffered both for recent and remote events from the age of 40 supports the presence of progressive brain damage. This information renders implausible the analytic interpretations of Freud and his followers, that Dostoevsky's epilepsy was hysterical in origin, where epileptiform somatization was presumed to dispose of excessive psychic excitation, and that this process had its roots in Dostoevsky's unconscious hatred of his father and latent homosexuality. Nevertheless, Dostoevsky's neuroticism is clearly supported by his life-long hypochondriasis, obsessionality, paranoid traits, tendency to reactive depressions, and experience of quasi-hallucinatory episodes which were probably not epileptic in origin. Neither his epilepsy nor his neuroticism can explain or detract from the profundity and wisdom of the literary monuments which clearly attest Dostoevsky's ample genius.

Epilepsies, Partial↗
PubMed1985

The trials of ECT.

Since its introduction in 1934, electroconvulsive therapy has been subjected to a large number of clinical trials of varying methodological sophistication. Although doubts continue to be expressed about the efficacy of ECT, there is a remarkable degree of unanimity in the findings of trials published over a period of 50 years: improvement rates in depression of 70-80 per cent, compared with 20-30 per cent in untreated controls. The principal caveat is that ECT is not a ubiquitous treatment, even in the field of depression, and only patients with endogenous illnesses, whether unipolar or bipolar, can be expected to respond. Even among these, ECT cannot be expected to prevent the relapses in an illness whose underlying course is episodic. The published studies leave little doubt that ECT is statistically more effective than any of the antidepressant drugs, although the relative difference in outcome between the 2 forms of therapy is small, and drugs are to be preferred in mild or moderate cases. However, ECT is an effective and rapidly acting treatment for severe depressive illness, and the rapidity of the response makes its early use desirable in patients at risk of suicide, and those showing marked retardation, agitation and weight loss.

Adjustment Disorders↗
PubMed1979

Six month evaluation of thiopropazate hydrochloride in tardive dyskinesia.

Using a blind evaluation of cinematographic films of patients suffering from tardive dyskinesia we found that thiopropazate hydrochloride in a dosage up to 30 mg daily was effective in reducing the severity of the dyskinesia in most patients. The overall improvement in the group of patients studied was not significant after one or three months of therapy but was significant after six months of treatment. The administration of thiopropazate hydrochloride over a six month period did not appear to aggravate the underlying pathophysiology so that the drug could be considered likely to be safe for long-term use. The anticholinergic antiparkinsonism agent benztropine mesylate aggravated the dyskinesia to a significant degree.

Clinical Trials as Topic↗
PubMed1978

The neural basis of aggression and its treatment by psychosurgery.

The limbic system and its connections provide the neural basis for aggressive behaviour. Violent individuals may differ quantitively or qualitively from normal. Many of the latter suffer from epilepsy. In some the epileptiform discharges from the amygdala can only be recorded using depth electrodes. It can be taken that the control of abnormal degrees of violent behaviour is now possible. Should such operations be used? If so who should have them? What preacutions need to be taken that such operations are not abused? How can informed consent be obtained? The development of new surgical techniques make these questions pertinent if not urgent.

Adult↗
PubMed1978

Asthenic personality, myth or reality.

One hundred and seventy five subjects admitted to hospital for neurotic conditions were assessed as to their personality types. Forty seven percent were judged as having personality traits consistent with the diagnosis of asthenic personality disorder. Thirteen of the 138 symptom, life history and psychological test items examined were found to be associated with the asthenic traits. Condensation of these thirteen items by factor analysis showed that two features--anxiety proneness and inability to cope with stress--together defined the disorder.

Anxiety↗
PubMed1977

Depressed lymphocyte function after bereavement.

During 1975 twenty-six bereaved spouses took part in a detailed prospective investigation of the effects of severe stress on the immune system. T and B cell numbers and function, and hormone concentrations were studied approximately 2 weeks after bereavement and 6 weeks thereafter. The response to phytohaemagglutinin was significantly depressed in the bereaved group on the second occasion, as was the response to concanavalin A at 6 weeks. There was no difference in T and B cell numbers, protein concentrations, the presence of autoantibodies and delayed hypersensitivity, and in cortisol, prolactin, growth hormone, and thyroid hormone assays between the bereaved group and the controls. This is the first time severe psychological stress has been shown to produce a measurable abnormality in immune function which is not obviously caused by hormonal changes.

Adult↗
PubMed1977

Depression: a multivariate study of Sir Aubrey Lewis's data on melancholia.

Principal component analyses were carried out on 51 items abstracted from Lewis's 1934 and 1936 papers. The first component was bipolar, differentiating between endogenous items and those that were mainly neurotic. The distributions of the first component scores by cluster indicated that there were two separate clusters of patients, one mainly endogenous, the other neurotic. It was concluded that Lewis's data indicate that there are at least two qualitatively different depressive illnesses. Further component analyses were carried out using the 25 endogenous items. The first component was a general one of endogenous depression. The distributions of its scores were bimodal, indicating that there were two groups of patients, those who suffered from endogenous depression and those who did not. These analyses indicated that endogenous depression is a categorical illness.

Adjustment Disorders↗
PubMed1976

The investigation of dementia: the results in 100 consecutive admissions.

One hundred patients admitted consecutively to the Neuropsychiatric Institute, each with the provisional diagnosis of dementia, were investigated. The diagnosis was confirmed in 81 patients. Amongst these, a potentially reversible cause was found in eight patients. Eleven patients were found to have potentially treatable pseudodementing illnesses and eight patients were found to have a chronic organic brain syndrome not characterized by intellectual deterioration. It is recommended that all patients with provisional diagnoses of dementia be investigated early in the course of their illnesses, in the anticipation of finding a reversible dementia or a treatable pseudodementing illness. The investigations can be conducted more efficiently in specialist units, staffed with neurologists and psychiatrists, and having easy access to pathology, neuroradiology, nuclear medicine and computerized axial tomography facilities.

Adult↗
PubMed1976

A prospective evaluation of open prefrontal leucotomy.

Forty-three patients received an open prefrontal leucotomy for severe and intractable psychiatric illnesses. As a result of the operation three patients died, three developed personality changes and one had repeated grand-mal seizures. Of the 40 patients followed up for six months, 57-5% showed marked improvement in their clinical state and 30-0% mild to moderate degrees of improvement whilst no patient's condition was considered to be worse. Significant improvement was obtained after operation in the mean scores on the Hamilton Anxiety Scale, the Hamilton Depression Scale, the Beck Depression Scale and the Neuroticism Scale of the Eysenck Personality Inventory. Extroversion, as measured by the Eysenck Personality Inventory, was significantly increased after operation. It is recommended that open prefrontal leucotomy procedures be replaced by the safer stereotactic or electrode implantation techniques and that all psychosurgery be confined to specialist units.

Adult↗
PubMed1976

A double-blind comparative trial of loxapine and trifluoperazine in acute and chronic schizophrenic patients.

A double-blind comparative trial of loxapine and trifluoperazine was carried out in 57 acute and chronic schizophrenic patients. In both groups of patients loxapine proved to be equivalent in its effects to trifluoperazine and there were suggestions it might be rather more effective in chronic patients. Side-effects were similar with the two drugs but anticholinergic effects, excitement, dizziness and faintness occurred rather more commonly with loxapine. Laboratory tests, urine analysis, cardiovascular and ophthalmological investigations showed no significant abnormalities.

Acute Disease↗
PubMed1974

Stereotactic amygdaloidotomy for aggressive behaviour.

Amygdaloidotomy was performed bilaterally on 15 and unilaterally on three patients exhibiting severe aggressive or self-mutilating behaviour. Nine subjects (50%) were improved a year after operation; improvement was maintained in seven (39%) for periods ranging from 27 months to nearly six years. Four non-epileptic cases had convulsions during the period of review; one of them has a persistent mild hemiparesis dating from the postoperative period. There was a tendency for epileptics to respond better than non-epileptics and for mentally retarded patients to respond poorly, but none of the differences was statistically significant.

Adolescent↗