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Biomedical subjects

M E McNamara

Publications and source records attributed to M E McNamara.

At least 19 recordsLinked to original sources

The effects of music on cardiac patients on bed rest.

Hospitalizations that require invasive cardiac procedures or support with an intra-aortic balloon pump can be unsettling. This study was undertaken to measure the effect of a music intervention on physiologic and psychological responses of patients on bed rest due to procedural sheaths or an intra-aortic balloon pump. A randomized, two-group, pretest/post-test design was utilized to measure the effect of a 30-minute music intervention on heart rate, blood pressure, respiratory rate, skin temperature, pain perception, and mood states. One hundred forty subjects participated, 65 in the control group and 75 in the treatment group. There were no significant differences between the groups in demographic, clinical, or baseline variables, except for respiratory rate. After the music intervention, there were reductions in blood pressure, respiratory rate, and psychological distress, as measured by the Profile of Mood States (p < 0.05). Music appeared to affect selected physiologic responses and reduce psychological distress in patients on bed rest.

Affect↗

Absence seizures associated with panic attacks initially misdiagnosed as temporal lobe epilepsy: the importance of prolonged EEG monitoring in diagnosis.

While temporal lobe epilepsy is often considered in the differential diagnosis of patients with anxiety or panic disorders, other types of epilepsy can confound the presentation or treatment of adults with panic disorders. The cases of two patients are presented who were initially thought to have temporal lobe epilepsy producing panic attacks, but who were subsequently found to have primary generalized seizures. The clinical implications are discussed.

Adult↗

Psychological factors affecting neurological conditions. Depression and stroke, multiple sclerosis, Parkinson's disease, and epilepsy.

As a contribution to the proposed revision of the DSM-III-R category "Psychological Factors Affecting Physical Condition" for DSM-IV, this article reviews the history of how the relationship of psychiatric illness to neurological illness has been understood with respect to depression. Since both psychiatric and neurological illness are aspects of brain functioning, any statement of the relationship of these categories entails certain epistemological assumptions, some of which have undergone considerable change and rapid evolution in the course of the last century.

Cerebrovascular Disorders↗

Anticonvulsant-responsive panic attacks with temporal lobe EEG abnormalities.

The phenomenology of panic attacks and of complex partial seizures overlap, and at times distinguishing between the two entities is difficult. The authors report five patients with recurrent panic attacks and temporal lobe EEG abnormalities whose symptoms did not warrant a clinical diagnosis of partial seizures but who responded well to anticonvulsant therapy. The cases suggest that focal cortical discharges may trigger panic attacks in some patients in whom an unequivocal diagnosis of epilepsy cannot be made. Electroencephalography and anticonvulsant trials may be appropriate in patients with panic attacks refractory to conventional treatment.

Adolescent↗

Depression as a manifestation of obstructive sleep apnea: reversal with nasal continuous positive airway pressure.

Fifty-five patients with obstructive sleep apnea each completed a Zung Self-Rating Depression Scale (SDS), Twenty-five patients (45%) had SDS scores greater than or equal to 50, consistent with depression. The SDS scores did not correlate with age, the number of respiratory events per hour sleep, antihypertensive medication, or the oxygen saturation baseline or nadir. The group with SDS scores of 50 or greater, however, had 68.0 +/- 8.8 respiratory events per hour compared with 47.9 +/- 4.7 in the group with SDS scores under 50 (p less than .05). Nineteen patients who were treated with nasal continuous positive airway pressure completed a follow-up SDS Inventory. After treatment, the SDS scores fell from 60.5 +/- 1.9 to 44.4 +/- 2.6 (p less than .001) in the 11 patients with baseline elevated scores. The authors conclude that obstructive sleep apnea can produce prominent symptoms of depression that appear to be related to the severity of the underlying apnea; furthermore, treatment of obstructive sleep apnea may result in alleviation of these symptoms in certain patients.

Adult↗

Sleep apnea and hypothyroidism presenting as depression in two patients.

Two patients are described who presented with depression and were later found to have both obstructive sleep apnea and hypothyroidism. Both patients had normal thyroxine (T4) levels but elevated thyroid-stimulating hormone (TSH) levels. Thyroid replacement led to resolution of both apnea and depression. The possibility of hypothyroidism as a cause of sleep apnea and depression is discussed.

Aged↗

Depression in borderline patients: a prospective EEG sleep study.

The relationship between borderline personality disorder and primary major depression was studied prospectively using Schedule for Affective Disorders and Schizophrenia-Lifetime Version (SADS-L) interviews and electroencephalographic (EEG) sleep studies. Ten consecutively admitted borderline patients (a prospective sample), defined by Gunderson's Diagnostic Interview for Borderlines (DIB), underwent EEG sleep studies on two consecutive nights and were compared to previously reported samples of nonborderline depressed patients (defined by Research Diagnostic Criteria; RDC), normal controls, and DIB-defined borderline patients who had been referred "to rule out major depression" (a retrospective sample). EEG sleep data were analyzed visually and by automated techniques. Rapid eye movement (REM) latency values were similar in depressed and both borderline groups but significantly different from controls. Eighty-five percent of REM latency values in RDC major depressives were less than or equal to 65 minutes, compared to similar rates of 75% in the prospective sample of borderline patients and 65% in the retrospective sample, versus 35% for controls (chi 2 = 10.7, p less than 0.005). The REM latency in borderline patients did not vary with the severity of depression as measured by the Hamilton Rating Scale for Depression. In the prospective borderline sample, the major SADS-L diagnoses were chronic intermittent depression (five), current major depression (four) (two unipolar, two bipolar II), and labile personality (one). A convergence of nosologic and EEG sleep data is suggested, and supports the concept of a close relationship between criteria-defined borderline personality disorder and affective illness.

Adolescent↗

Epidemiology of peptic ulcer in Australia. A study based on government statistics in four states.

A study of Pharmaceutical Benefits Scheme cimetidine prescriptions, hospital admissions, and deaths due to peptic ulcer in 13 million Australians in 1981 indicated that the annual ulcer incidence per 1000 population was 3.8 for duodenal ulcer and 0.7 for gastric ulcer. Approximately 70 000 Australians appear to receive initial treatment for a peptic ulcer each year. Two-thirds of patients were managed outside hospital. Patients with gastric ulcers were more likely to be admitted to hospital or to die from their ulcer than were patients with duodenal ulcers. Significant regional differences in ulcer frequency were found; in particular, the risk of gastric ulcer in NSW was four times that in Victoria. Gastric and duodenal ulcers were more common in New South Wales than in Victoria, Queensland or Western Australia. These differences, and other regional variations, indicate appropriate localities for further studies of the aetiology of peptic ulcer.

Adolescent↗