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Biomedical subjects

M V Lambert

Publications and source records attributed to M V Lambert.

11 recordsLinked to original sources
PubMed2002

Separating depersonalisation and derealisation: the relevance of the "lesion method".

OBJECTIVES: Depersonalisation (DP) and derealisation (DR) are often met with in patients with a wide range of localisable neurological conditions. This suggests that the "lesion method" might be a valid approach to study the neurobiology of DP/DR. However, the fact that anxiety can trigger DP/DR makes it difficult to establish whether the presence of DP/DR in neurological patients is mainly determined by coexisting anxiety or by lesion location. To overcome this difficulty, we suggest the study of neurological phenomena, which although not considered as DP/DR, bear enough phenomenological resemblance with them as to warrant their use as models. METHODS: One patient with "visual hypoemotionality" and another with "hemiasomatognosia" are described in detail together with a selective literature review. RESULTS: Complaints of patients with visual hypoemotionality are indistinguishable from those of patients with "visual derealisation". There is also a phenomenological overlap between "asomatognosia" and the symptom of "body alienation", which is a central feature of depersonalisation. CONCLUSIONS: Phenomenological similarities between visual hypoemotionality and DR suggest that a disruption of the process by means of which perception becomes emotionally coloured may be an underlying mechanism in both conditions. Likewise, phenomenological overlaps with asomatognosia suggest that DP might result from parietal mechanisms disrupting the experience of body ownership and agency. These findings give validity to the notion that DP and DR may have distinct neurobiological mechanisms.

Adult↗
PubMed2001

Basal activity of the hypothalamic-pituitary-adrenal axis in patients with depersonalization disorder.

Depersonalisation disorder may occur during severe anxiety or following a traumatic event, suggesting a possible role of stress hormones. This study investigated basal activity of the hypothalamic-pituitary-adrenal (HPA) axis in patients with depersonalisation disorder. Salivary cortisol levels were measured at four time points over 12 h in patients with depersonalisation disorder (N=13), major depressive disorder (MDD, N=14) and healthy controls (N=13). Beck Depression Inventory scores were significantly higher in depersonalised subjects than controls, while MDD subjects demonstrated higher scores than both groups. Basal cortisol levels of depersonalised subjects were significantly lower than those of MDD subjects but not healthy controls. These results point to reduced basal activity of the HPA axis in depersonalisation disorder. This pilot study supports the distinction between depersonalisation disorder and major depressive disorder which should be examined in a larger sample.

Adult↗
PubMed2001

Primary and secondary depersonalisation disorder: a psychometric study.

INTRODUCTION: Depersonalisation may be part of a symptom-complex, a primary or a secondary disorder. Optimal methods of measurement and diagnosis have not been established. METHODS: We assessed 42 patients with primary or secondary depersonalisation, plus psychiatric and non-psychiatric controls using a variety of self-report questionnaire scales including the Beck depression and anxiety Inventories, and one developed by the authors (the Fewtrell Depersonalisation Scale (FDS)). The correlations between the scales and measures of anxiety and depression were calculated, as were sensitivity and specificity against an operational case definition. RESULTS: All the scales were highly correlated. All could distinguish depersonalisation cases from the rest but none could distinguish between primary and secondary depersonalisation disorder. Anxiety and especially depression were correlated with depersonalisation symptoms. The FDS had high sensitivity (85.7%) and specificity (92.3%) which compared favourably with other instruments. Patients with both derealisation and depersonalisation scored the highest on the FDS. DISCUSSION: Depersonalisation disorder comprises a measurable cluster of symptoms which may be quantified with the help of self-report scales. Primary and secondary forms overlap, with depressed mood a frequent feature.

Adolescent↗
PubMed2001

Seizures, hormones and sexuality.

Sexual disorders (both hyposexuality and sexual dysfunction) are common in people with epilepsy, occurring in up to two-thirds of patients. However, characteristically, patients do not spontaneously report these problems. Nocturnal penile tumescence testing suggests that the erectile dysfunction has a neurophysiological component. The aetiology remains uncertain but is likely to be multifactorial, involving neurological, endocrine, iatrogenic, cognitive, psychiatric and psychosocial factors. Epilepsy-related factors include the age of onset/duration of epilepsy along with the seizure type and focus. In addition, seizure frequency might be relevant as successful epilepsy surgery can result in an improvement in sexual functioning despite remaining on anticonvulsant medication. Endocrine changes (raised sex hormone binding globulin and reduced free testosterone) have been reported in men with epilepsy, especially when treated with hepatic-enzyme inducing antiepileptic drugs. Studies have not been performed evaluating anticonvulsants that do not induce hepatic enzymes such as lamotrigine. The association between these endocrine changes and hyposexuality is not known. The relationship between seizures, hormones and anticonvulsant medication in women is explored, focusing on issues such as catamenial epilepsy, the menopause, hormone replacement therapy and the polycystic ovarian syndrome. Suggestions for future research and treatment issues are discussed.

Animals↗
PubMed2001

The assessment and management of adult patients with epilepsy--the role of general practitioners and the specialist services.

Recommendations have been made that all patients developing seizures should be referred to specialist services for full investigation and assessment and re-referred for issues such as inadequate seizure control, consideration of drug withdrawal and for pre-conceptual counselling. Bristol area general practitioners (GPs) were sent a questionnaire to determine their referral practices for adult patients with epilepsy. Details of their current management of these patients and their requirements from the specialist services were also obtained. Questionnaires were completed and returned by 67.8% of the GPs. Most referred their patients to the neurological or neuropsychiatric services. More than 70% wanted their new patients to be assessed within 4 weeks. Approximately, half at least sometimes treated their patients before this assessment of which a third never or only rarely sought advice as to the most suitable anticonvulsant. Most (71.5%) believed they had consultations with their patients with epilepsy at least yearly; however, only 34.3% had a recall system for non-attendees. Two-thirds either currently audited their practices or were willing to consider doing so, and 64.4% recognized a need for regular seminars on epilepsy. Few welcomed the introduction of joint clinics but two thirds believed co-operation cards could be useful. GPs in practices with an epilepsy nurse specialist were more supportive of the use of co-operation cards and were more likely to be involved in audit. Recommendations to improve the care provided by the Primary Health Care teams and aid communications with the specialist epilepsy services are made.

Adult↗
PubMed2000

Depersonalization in cyberspace.

We explored the possibility of carrying out clinical research on the Internet. To do so, we compared psychometric and demographic variables between two groups of sufferers of depersonalization disorder, one recruited via the Internet, the other from outpatients attending the Depersonalization Research Unit. No differences were found in demographics or features of depersonalization. Those seen in the clinic were, however, significantly more depressed. We then explored the answers to several questions posted on a depersonalization bulletin board by a second group of Internet users. Useful information on symptoms, precipitants, and treatment was gained. It is concluded that the Internet could become a valuable tool in clinical psychiatric research.

Adult↗
PubMed1999

Depression in epilepsy: etiology, phenomenology, and treatment.

A history of depression or depressive symptomatology has been reported in up to two-thirds of patients with medically intractable epilepsy, whereas community studies have demonstrated affective disorder only in a quarter of these patients. Depression has been reported peri- and interictally. However, differentiation may be difficult in patients with frequent seizures. Most authors have found no correlation between depression and epilepsy variables. However, complex partial seizures, especially of temporal lobe origin, appear to be etiologic factors, particularly in men with left-sided foci. Depression is also more common in patients treated with polytherapy especially with barbiturates, phenytoin, and vigabatrin. Depression has also been described de novo after temporal lobectomy. Psychosocial factors also play a part, but underlying risk factors (e.g., genetic, endocrine and metabolic) may explain the increased rates of depression in people with epilepsy compared to those with other neurologic and chronic medical conditions. The depression appears to be endogenous. Patients tend to exhibit fewer neurotic traits and more psychotic symptoms such as paranoia, delusions, and persecutory auditory hallucinations. Treatment approaches include psychotherapy, rationalization of antiepileptic drug medication, antidepressant treatment, and ECT. The tricyclic and related antidepressants appear to be epileptogenic, especially in people at high risk (personal or family history of seizures, abnormal pretreatment EEG, brain damage, alcohol or substance abuse/withdrawal and concurrent use of CNS-active medication). Seizures tend to occur early in treatment or after dose increments, especially if rapidly titrated. There is little evidence that the newer antidepressants, e.g., selective serotonin reuptake inhibitors, moclobemide, venlafaxine, or nefazodone are more epileptogenic than placebo.

Adult↗
PubMed1997

Obstructive sleep apnoea following rapid weight gain secondary to treatment with vigabatrin (Sabril).

A case of a patient with medically intractable epilepsy, who developed obstructive sleep apnoea (OSA), and an increase in seizure frequency, as a consequence of weight gain following treatment with vigabatrin is described. The relationship between exacerbation of epilepsy and sleep disruption secondary to OSA is discussed. Recommendations regarding the choice of anticonvulsants in patients at risk of developing OSA are made.

Adult↗
PubMedDate not supplied

Visual imagery and depersonalisation.

Twenty-eight people diagnosed with depersonalisation disorder (DD) were assessed using self-report measures of imagery ability in relation to a range of symptoms and in comparison with age- and sex-matched controls. It was found that symptoms of depersonalisation as well as other dissociative symptoms and depressed mood correlated with impaired ability to generate visual images. This was particularly evident with images pertaining to the self and other people as opposed to objects. A subgroup of 10 patients was tested on a neuropsychological battery of visual perception tests and found to be unimpaired compared with normal controls and patients with obsessive compulsive disorder, despite subjective impairments in imagery and high symptom scores. The findings add further weight to the distinctions made between imagery and perceptual processes.

Adult↗