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Biomedical subjects

M J Irvine

Publications and source records attributed to M J Irvine.

11 recordsLinked to original sources
PubMed1997

Electrocardiographic effects of fluoxetine and doxepin in patients with major depressive disorder.

Cardiovascular adverse effects are amongst the most serious observed with antidepressant drugs and are often due to effects on cardiac conduction and refractoriness. However, such electrophysiologic effects may not be evident when using conventional electrocardiographic measures. Forty patients with major depressive disorder (according to DSM-III-R criteria) were enrolled in a 6-week double-blind parallel group study of fluoxetine (N = 20) or doxepin (N = 20). Cardiac conduction (QRS duration) and repolarization (corrected QT interval, QTc), were measured using signal-averaged electrocardiograms and 12-lead electrocardiogram at baseline and after 2, 4, and 6 weeks of treatment. Patients taking doxepin (mean daily dosage at 6 weeks 169 +/- 42 mg) were similar to those taking fluoxetine (37 +/- 18 mg) for demographic variables and improvement in depression scores but volunteered more side effects (p = 0.011), especially dry mouth (p < 0.001) and dizziness/lightheadedness (p = 0.005). After 6 weeks, doxepin increased heart rate (69 +/- 12 to 81 +/- 13 beats per minute; p = 0.0003) and prolonged QTc (from 417 +/- 36 to 439 +/- 28 msec; p < 0.03); overall QRS duration was not prolonged but was correlated with serum doxepin concentrations (r = 0.78, p < 0.0001). Fluoxetine had no effect on QTc (428 +/- 24 msec at baseline vs. 430 +/- 24 msec at 6 weeks) or QRS duration (97 +/- 12 msec at baseline vs. 94 +/- 12 msec at 6 weeks). The standard 12-lead electrocardiogram showed no significant change in QRS or QTc for either drug. Using a sensitive measure of electrocardiographic effects, doxepin prolongs repolarization and may slow cardiac conduction. Fluoxetine has no measurable electrocardiographic effects, which suggests an increased safety margin for cardiac adverse effects. The ability of the signal-averaged electrocardiogram to resolve small changes in the electrocardiogram is useful in the assessment of drugs with subtle electrophysiologic effects.

Adult↗
PubMed1997

A critical review of research related to family physician-assisted smoking cessation interventions.

A review of family physician-assisted smoking cessation research indicates that the family practice setting affords an excellent opportunity to intervene with a large proportion of smokers, at a time when they are receptive to health promotion messages. Outcome data at 6- and 12-month follow-up intervals indicate the value of combining 3 key strategies in achieving optimal results: physician advice and support, nicotine replacement therapy, and cognitive-behavioural counselling. The authors' review identifies questions that need to be addressed in future research: How can barriers to program delivery be overcome in the family practice setting? What is the best way to ensure optimal integration of the 3 key strategies? Which follow-up intervals are appropriate (e.g., 6 months, 12 months, 18 months) given the finding that relapse is common and that most smokers make several quit attempts before stopping for good?

Follow-Up Studies↗
PubMed1994

Is knowing your cholesterol number harmful?

To examine the potential adverse psychological effects of screening for hypercholesterolemia, 287 men working at a motor-car assembly or steel-making plant who were ultimately diagnosed as having hypercholesterolemia and 236 randomly selected normal cholesterol controls from the same plants completed psychological questionnaires at the initial screen and 1-year later. At baseline and before diagnosis, hypercholesterolemic men scored higher on mental health and lower on negative affect than controls (p values < 0.05). One year later no adverse changes on the psychological measures were found irrespective of the type of follow-up care that they were randomly assigned to receive. Surprisingly only about half of the hypercholesterolemic men believed they had hypercholesterolemia at follow-up despite being told otherwise. Baseline scores of those who did not accept the label (n = 122) [classified as deniers] were higher on measures of positive affect and lower on measures of negative effect than those of hypercholesterolemic men who accepted the disease label (n = 73) (p values < 0.05). Moreover they held more negative attitudes towards dietary change at baseline (p < 0.03), made fewer dietary changes (p values < 0.05), and had a lesser change in total cholesterol. We conclude that a hypercholesterolemia detection and treatment program conducted in a working adult population had no adverse psychological consequences. It did, however, reveal a large subset of hypercholesterolemic men who did not accept the label despite being told they had this problem. Denial was a significant barrier to health behaviour change and may represent a maladaptive coping style for men at risk of cardiovascular disease. High cholesterol appears to be associated with better mental health and those who deny having hypercholesterolemia have the best mental health. The multifarious relationship between cholesterol, mental health, and denial deserves further study.

Adult↗
PubMed1994

Small, blue collar work site hypertension screening: a cost-effectiveness study.

This study determined the cost-effectiveness of one- versus two-stage hypertension screening at small to medium-sized blue collar, multicultural work sites using voluntary health organization and public health unit personnel. Workers with diastolic blood pressure (DBP) > or = 90 mm Hg were randomly allocated to one- or two-stage screening with differing physician referral protocols based on blood pressure level and treatment status. At first screening of 7856 workers, 12.5% had DBP > or = 90 mm Hg or < 90 and on medication with 64% aware of having hypertension, 42% on medication and 30% controlled (DBP < 90 mm Hg). One year later, there were no significant differences in effects or cost-effectiveness between groups. Both had significant DBP decrease (8.5 mm Hg), 54% had seen a physician within the recommended time, and 50% were controlled on medication or any treatment. One-stage screening, being easier to implement, is the preferred option.

Adult↗
PubMed1991

Efficacy of a brief group psychoeducational intervention for bulimia nervosa.

This study compared a brief group treatment that was designed to be purely educational (ED) with a longer course of individual cognitive-behavioural (CB) therapy intended to represent more standard clinical care. Participants were 65 women who sought treatment at Toronto General Hospital, met DSM-III criteria for bulimia nervosa at a normal weight and reported vomiting at least twice weekly. Results indicated that the CB treatment, as expected, was generally more effective than the ED intervention, but on several important outcome indices both treatments appeared to be equally effective for the healthiest 25-45% of the sample. The more intensive individual CB treatment was associated with greater improvement in patients who were more severely symptomatic. However, the ED intervention proved significantly more cost-effective and it was suggested that a sequential treatment program might achieve the superior benefits associated with the longer individual CB treatment at a reduced cost.

Adolescent↗
PubMed1986

Relaxation and stress management in the treatment of essential hypertension.

Thirty-two male and female hypertensives, 34 to 65 yr of age, systolic blood pressure (SBP) less than 200 mmHg and diastolic blood pressure (DBP) between 90 and 109 mmHg, were randomly allocated to receive either relaxation and stress management (experimental condition) or mild physical exercise (control condition). Half the participants were taking antihypertensive drugs, which were constant for six months prior to the study and controlled during the study. Outcome measures included various measures of blood pressure in the clinic and at home, cardiovascular responsiveness, moods and 24-hr urinary adrenaline and noradrenaline. The study schedule consisted of 3-months baseline, 10 weeks treatment and 3-months follow-up. Relaxation was superior to the control procedure in reducing blood pressure as assessed by nurses blind to the participants' treatment at post-treatment for DBP and at follow-up for DBP and SBP.

Adult↗
PubMed1986

Integration and sequencing of treatment approaches for eating disorders.

General principles for the management of eating disorders are viewed with particular emphasis on correcting disturbed eating and weight within the current cultural context. A range of different therapeutic options are outlined with indications for the integration and sequencing of these as part of a multidimensional model of treatment.

Anorexia Nervosa↗
PubMedDate not supplied

Personality differences between hypertensive and normotensive individuals: influence of knowledge of hypertension status.

Personality characteristics such as anxiety and anger have long been associated with essential hypertension, but the results of past studies have often been confounded by inadequate diagnosis of hypertension, antihypertensive medications, and use of unvalidated measures of personality. Moreover, little attention has been given to the importance of differential exposure to medical attention and labeling as determinants of personality. To overcome these shortcomings, personality characteristics were measured by self-report using validated questionnaires in untreated male and female hypertensives who were either aware (n = 80) or unaware (n = 82) of their hypertension at the time of assessment. Hypertension diagnosis was based upon repeated blood pressure measurements over 5 months. Hypertensives were compared to age-, sex-, ethnicity-, and occupation-matched normotensives. Results indicated that aware hypertensives scored significantly higher than normotensives and unaware hypertensives on neuroticism, trait and state anxiety, and self-reported Type A behavior. They also scored higher than normotensives on state anger, and there was a similar trend for anger suppression. There were no differences between unaware hypertensives and normotensives. The findings suggest that these personality factors are not a fundamental characteristic of hypertension but reflect the influence of exposure to medical attention or knowledge of hypertension status.

Adult↗
PubMedDate not supplied

Relaxation behavior therapy as sole treatment for mild hypertension.

This study tested the efficacy of relaxation therapy as sole treatment for mild hypertension in 110 men and women recruited from a five-stage worksite blood pressure screening program. Participants were randomized to 12-weeks of relaxation therapy or support therapy. Outcome blood pressure assessments made by assessors who were unaware of group allocation revealed similar decreases in both treatment groups at post-treatment and 6-month follow-up. While body weight did not change, alcohol consumption decreased similarly in both groups, and alcohol consumption was positively correlated with both absolute diastolic blood pressure and change in diastolic blood pressure at outcome. In conclusion, a superior blood pressure effect was not associated with relaxation therapy; however, alcohol consumption decreased in both treatment groups, suggesting that both interventions facilitated changes in health risk behaviors and indirectly on blood pressure level.

Adult↗
PubMedDate not supplied

The control group dilemma in clinical research: applications for psychosocial and behavioral medicine trials.

OBJECTIVE: Clinical research on psychosocial and behavioral medicine interventions has burgeoned in the past two decades, so much so that sole reliance on standard no-treatment control conditions may no longer be appropriate or feasible. We discuss the ethical, theoretical, scientific, and statistical considerations that shape current clinical outcomes research for psychosocial and behavioral medicine interventions. METHOD AND RESULTS: Secondary analysis of a psychosocial randomized trial (N = 127) illustrates some of these points. CONCLUSIONS: A new design for randomized clinical trials is described that does not require a no-treatment control group, and that reveals dose-response relationships between interventions and treatment outcomes.

Behavior Therapy↗