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Biomedical subjects

M Marks

Publications and source records attributed to M Marks.

At least 37 records · Page 2Linked to original sources
PubMed1996

Rhythm and blues: the theory and treatment of seasonal affective disorder.

Seasonal affective disorder (SAD) is a depressive disorder which occurs during the winter and remits in the spring and summer. It differs from non-seasonal depression in its seasonal variation and in the presence of neurovegetative symptoms such as increased appetite and hypersomnia. This review is aimed at clinical practitioners and presents a detailed description of the syndrome before discussing the assessment of SAD and the current treatment of choice of phototherapy. Particular attention is paid to the impotant issue of differential diagnosis during assessment and the practicalities involved in the administration of light therapy during treatment.

Adult↗
PubMed1996

How does marriage protect women with histories of affective disorder from post-partum relapse?

Interviews were carried out at 36 weeks antenatal with 63 married couples, in 36 of which the woman had a history of affective disorder and in 27 the woman had no previous psychiatric history. The men's attitudes to their wives were assessed using expressed emotion methodology. Also assessed were psychiatric history, neuroticism, satisfaction with the marital relationship and attitudes to sex, pregnancy and parenthood in both the woman and her partner. Women with psychiatric histories who did not relapse in the six months following delivery had partners who were more positive about them than partners of high-risk women who remained well and control women. This effect is explored further by examining which characteristics of the man and which of the woman contributed to his critical and positive comment score. Criticism of his wife was associated with each partner reporting less marital satisfaction and also with the man's psychiatric history. No characteristic of the woman contributed to her partner's criticism. In contrast, the men's positive comments about their wives were associated with the woman's satisfaction with key aspects of her femaleness. Positive husbands had wives were pleased to be pregnant, happy with their pregnant bodies and enjoying the sexual aspect of the marital relationship. In women with psychiatric histories the time which had elapsed since her last psychiatric admission also influenced his positive comments.

Case-Control Studies↗
PubMed1996

Cognitive-behavioural treatment of shoplifting in a depressed female.

This paper describes the successful treatment of a depressed shoplifter, using cognitive therapy combined with exposure, an approach not previously described in the literature for this problem. Definitions of shoplifting behaviour are discussed, and other treatment methods examined.

Adult↗
PubMed1996

Nosocomial outbreak of Aspergillus fumigatus infection among patients in a renal unit?

Aspergillus fumigatus is present in the environment worldwide and it is only able to infect debilitated or immunodepressed subjects. Nosocomial outbreaks of A. fumigatus infection have been associated with hospital reconstruction. Spores are released into the environment and are inhaled by immunodepressed patients housed in nearby Medical Units. Specific clinical syndromes are allergic bronchopulmonary aspergillosis and invasive pulmonary aspergillosis with characteristic radiological features. Invasive A. fumigatus infection is commonly fatal, even if promptly diagnosed and treated. Three consecutive cases of A. fumigatus infection occurred in debilitated patients housed in our Renal Unit while building renovation near the Unit was being performed. Two of these patients died and pulmonary and diffuse aspergillosis was found on postmortem examination. The third patient, highly suspected to be infected with Aspergillus, was aggressively and successfully treated with liposomal amphotericin B. Our experience suggests that fungal infections have gained increasing prominence in clinical medicine and they must be considered in chronic debilitated patients including dialysis patients, and that liposomal amphotericin B represents an important advance in the treatment of aspergillosis.

Aged↗
PubMed1995

Clinical survey of a psychiatric mother and baby unit: characteristics of 100 consecutive admissions.

Demographic, obstetric, clinical features and clinical outcome of 100 consecutive admissions to a psychiatric mother and baby unit are presented. Referral patterns by health services involved are also examined. 56% of admissions occurred within 2 weeks of delivery and the mean duration of admission was 2 months. Patients were categorized as having schizophrenia (n = 20), affective psychosis (n = 56) or non-psychotic disorders (n = 24) and these three groups were compared. There were few demographic and obstetric differences between diagnostic categories. The affective psychosis group were more likely to have acute illnesses with an onset and admission occurring within 2 weeks of delivery. Women with non-psychotic disorders were also most likely to become ill within 2 weeks of delivery but tended to be admitted later. Only 7% of the affective psychotic and non-psychotic women were discharged separated from their infants. Women with schizophrenia were less likely to have acute admissions and required greater input of nursing and service resources than mothers with other illnesses but 50% were discharged without their infants. More research is needed into matching models of care to the needs of mothers with different kinds of chronic, recurrent and new episodes of mental illness that present after childbirth. There are few guidelines to aid clinical staff in assessing the risk, current or future, of significant harm to an infant as a consequence of maternal mental illness, particularly of schizophrenia.

Adult↗
PubMed1995

[The influence of information and communication in the orthodontic consultation and treatment visit. II. The communication style and compliance].

The establishment of a good rapport between dentist and patient is together with providing information a basic prerequisite for successfully motivating the patient to comply with the guidance the dentist provides. Both the style adopted in verbally communicating with the patient and also nonverbal communication play a decisive role in the establishment and maintenance of such a relationship. In the pilot study presented here, which draws on psychological interaction analysis of video recordings taken of the initial consultation with 27 patients and of 28 routine treatment sessions with different patients, the typical interaction patterns between the orthodontist and the patient are objectively assessed and compared. The most important findings of the study were: (1) The mean duration of the chairside sessions was lowest during routine encounters with cooperative patients. (2) During consultations approximately 2/3 of the time was taken up talking to each other. On the other hand, in treatment sessions with uncooperative patients only 1/4 of the time was devoted to verbal communication. (3) The orthodontist dominated the conversation in all groups and especially in conversing with the uncooperative patients. (4) In the consultation sessions the dentist and the patient related relatively strongly to each other. (5) Providing mere information significantly predominated over any discussion of the professional aspects of the treatment. (6) During the consultations eye contact was maintained over almost all of the sessions.(ABSTRACT TRUNCATED AT 250 WORDS)

Communication↗
PubMed1995

Acute pancreatitis in HIV-seropositive patients: a case control study of 44 patients.

PURPOSE: To analyze whether pancreatitis presents differently in HIV-seropositive patients compared to the general population, and to evaluate the accuracy of classic predictors of pancreatitis severity in patients with HIV infection. METHODS: A multiyear, multicenter, retrospective study of 44 consecutive patients with acute pancreatitis and HIV and 44 consecutive control patients with acute pancreatitis without HIV. RESULTS: Of 939 hospitalized patients with HIV, 44 (4.7%) had acute pancreatitis, 27 of whom had AIDS. Pancreatitis presented with similar clinical findings in HIV patients and controls except that HIV patients had greater anemia, hypoalbuminemia, and leukopenia (Student's t-test P < 0.0001, < 0.0002, < 0.0001, respectively), and a higher incidence of fever, diarrhea, and hepatomegaly. These differences probably stem from HIV-related immunosuppression and malnourishment rather than pancreatitis. Patients with HIV had a higher frequency of medication-associated pancreatitis due to pancreatoxic medications used in HIV patients (18 versus 2 cases; odds ratio [OR] 14.54; Student's t-test P < 0.0001). They had a lower frequency of gallstone pancreatitis (2 versus 22 cases; OR 0.05; P < 0.0001). Patients with HIV had a higher frequency of a severe hospital course, defined as prolonged hospitalization or death in hospital (22 versus 12 cases; chi-square P < 0.05). The presence of AIDS or leukopenia in patients with HIV was strongly associated with a severe hospital course. The Ranson and modified Glasgow scales were poor predictors of disease severity in HIV patients (eg, Ranson scale sensitivity 41%; positive predictive value 53%; negative predictive value 52%). These scales' lack of markers of immunosuppression impeded their performance. The APACHE II scale, which contains markers of immunosuppression, was a moderately robust predictor of disease severity in HIV patients (sensitivity 73%; specificity 68%; positive predictive value 70%; negative predictive value 71%). All three scales predicted the disease severity in control patients well. CONCLUSIONS: Pancreatitis presents similarly in HIV patients as in the general population with the following significant differences: a high frequency of medication-associated pancreatitis, a low frequency of gallstone pancreatitis, a high frequency of HIV-related causes (most commonly from HIV-related drugs), additional symptoms and signs due to underlying immunosuppression, and a more severe hospital course. The APACHE II system can be used to predict whether a patient with HIV and pancreatitis is at risk for prolonged hospitalization or death in hospital.

AIDS-Related Opportunistic Infections↗
PubMed1995

Social sensitivity: a shared feature of all phobias.

The prominence of a variety of social fears among types of phobia was examined. Responses of 80 agoraphobics, 25 social phobics and 35 specific phobics to Wolpe's (1983) Fear Survey Schedule were factor-analysed. Factors of social sensitivity (accounting for 24 out of 50 per cent of the variance), agoraphobia (7 per cent), blood injuries (5 per cent) and five other small specific phobic factors were extracted. On social sensitivity, agora- and social phobics overlapped; specific phobics were significantly lower than social phobics. On agoraphobia scores, agoraphobics scored significantly higher than social and specific phobics. A regression analysis was performed to assess the relative contribution of the diagnostic groups to each factor. Social sensitivity may be a normal evolved mechanism that is protective in social interactions.

Adult↗
PubMed1995

The role of the father in parental postnatal mental health.

Contrary to idealized images of parenthood, the months immediately following childbirth are characterized by enhanced rates of parental mental illness and filicide. In this paper we consider fathers and their role in the postnatal well-being of the parturient couple. The process of becoming a father is influenced by not only the man's internal and external experiences of 'father', but also the woman's, since the new infant's relationship with father is mediated by mother and her conjugal relationship with father. When a couple's prenatal relationship is based on a system of shared parental constructs involving a denigrated father and overvalued mother and a concomitant intolerance of the idea of a creative (Oedipal) couple, they will experience particular difficulties in adjusting to the new family configuration. In working with individuals or couples who have experienced post-partum psychological difficulties it is important to remember that not only maternal imagos but also paternal and conjugal ones need to be addressed.

Adult↗
PubMed1995

Post-traumatic stress disorder in airplane cabin crew attendants.

Six cabin crew attendants who survived an airplane crash in which 47 passengers were killed were assessed for post-traumatic stress disorder and other psychological problems. Each was interviewed 8 months after the crash and completed questionnaires measuring intrusive thoughts, avoidance, depressed mood, anxiety, and fear. Questionnaires were repeated 10 months later. All six met DSM-III-R criteria for post-traumatic stress disorder, reported a wide range of symptoms, and developed a fear of flying 8 months after the crash. Depression scores were normal 18 months after the crash, but all other measures remained unchanged, showing a continued high level of traumatic stress. Results point to the potential for crash survivors to develop chronic psychological problems. The highest levels of distress were reported by the three most senior members of staff with the most responsibility on board, who had also suffered the most severe physical injury. Clinical implications of the results are discussed, and the need for predisaster training of cabin crew and postdisaster treatment is emphasized.

Accidents, Aviation↗
PubMed1994

The 'match/mismatch' model of fear: empirical status and clinical implications.

This paper reviews empirical evidence for the 'match/mismatch' model of fear and defines what is currently known about the prediction of fear. It also outlines several gaps in the literature on this topic and problems with the methodology used to study this phenomenon. Some of these gaps are filled by studies on the prediction of pain and where relevant these are discussed. Important areas for future research are identified, the clinical implications of the model are outlined and specific suggestions for treatment are made.

Fear↗
PubMed1994

Use of plasma for arterial blood gas analysis in leukemia.

A 63-year-old patient with chronic lymphocytic leukemia presented with severe hypoxemia. However, the patient's hemoglobin saturation, measured by an ear oximeter, was normal. Although his WBC count was approximately 1,000,000/microliters, hypoxemia could not be explained by the consumption of oxygen by leukocytes. Therefore, arterial blood gas values were analyzed in both plasma as well as in whole blood. The PaO2 in the plasma was much higher than in whole blood and corresponded with the hemoglobin saturation measured by the ear oximeter. These findings suggest that very high leukocyte counts may interfere with the measurement of oxygen tension and that plasma may be used for blood gas analysis in this situation.

Blood Gas Analysis↗
PubMed1993

Massive hemobilia and acalculous cholecystitis due to benign gallbladder polyp.

A 37-year-old male with metachromatic leukodystrophy, a congenital cerebroside storage disease strongly associated with benign gallbladder polyps, presented with hemobilia and acalculous cholecystitis due to a long, slender, benign gallbladder polyp. This case report extends the clinical spectrum of gallbladder polyps and demonstrates a novel cause of hemobilia. The unusually long, slender polyp shape may have promoted hemorrhage due to the potential for torsion around a slender stalk. The mechanism of cholecystitis may have been cystic duct obstruction from blood clots or possibly from prolapse by the long, slender polyp into the cystic duct.

Adult↗
PubMed1993

Neuroendocrine and psychosocial mechanisms in post-partum psychosis.

(1) Results from a study investigating psychosocial and neuroendocrine influences on post-partum psychosis are presented. Subjects were 43 pregnant women with histories of affective disorder (bipolar or schizoaffective disorder, n = 26; major depressive disorder, n = 17), together with 45 pregnant women without any psychiatric history. (2) At 36 weeks antenatal assessments were carried out of the women's psychiatric histories, current psychiatric state and also the occurrence of life events in the preceding year. They were then monitored for 6 months after delivery during which time psychiatric state and any further life events were recorded. Illness was defined according to Research Diagnostic Criteria (RDC); 22 high risk women and 3 control women were categorised as RDC 'cases' during the post-partum follow-up period. Fifteen of the bipolar/schizoaffective women (8 of whom subsequently became ill within 3 months of delivery) and 15 controls (all of whom remained well) also participated in a neuroendocrine test at 4 days post-partum when their growth hormone response to a challenge dose of the dopamine agonist, apomorphine, was measured. (3) The results showed that women with histories of depression and control women who became ill after delivery were three times more likely to have had a life event in the year preceding onset of illness than women from these subgroups who remained well. In contrast, for women with histories of bipolar or schizoaffective disorder, life events appeared to be unimportant. Instead bipolar/schizoaffective women who became ill showed an enhanced growth hormone response to the apomorphine challenge test compared to those who remained well and controls.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

Melatonin rhythms in seasonal affective disorder.

We examined 24-hour melatonin rhythms from 20 patients with seasonal affective disorder (SAD) and 20 healthy volunteers. Patients and controls were individually matched for age, sex, and month of study. Plasma samples were taken at hourly intervals, and were assayed for melatonin by radio-immunoassay. The 24-hourly melatonin estimations for each individual were fitted to a cosine curve, and the significance of the curve fits was calculated. Two analyses were performed. In analysis 1 the following were calculated: (a) cosine fit, (b) significance of fits, (c) mean amplitude and acrophase (peak) and (d) mean melatonin levels. The curve fits were highly significant for all but three subjects (two patients, one control), but there were no significant differences in any measure between the two groups. In analysis 2 the comparisons were repeated and restricted to the 18 patients and 19 controls in whom there was a significantly significant melatonin rhythm. Again there were no significant differences between groups. These results suggest that the circadian rhythm of melatonin is not abnormal in SAD, and that the therapeutic effect of light in SAD is not mediated by phase shifts in melatonin secretion.

Adult↗
PubMed1992

Palliative care [continuing education credit].

Care of the dying patient provides one of the most challenging areas of nursing practice. An understanding of the skills, principles and range of palliative care can enable practitioners to maximise the quality of life of those with advanced cancer and other progressive illnesses.

Attitude to Death↗