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Biomedical subjects

M W Carney

Publications and source records attributed to M W Carney.

At least 19 recordsLinked to original sources

Folate deficiency, biopterin and monoamine metabolism in depression.

Seven (21%) of 34 patients with a severe DSM-III diagnosis of major depression had red-cell folate levels below 150 ng/ml. This subgroup with folate deficiency had significantly lower CSF 5-hydroxyindoleacetic acid (5HIAA) compared to neurological controls. For all depressed patients red-cell folate was significantly correlated with CSF 5HIAA and homovanillic acid (HVA). CSF tetrahydrobiopterin (BH4) was significantly correlated with CSF 5HIAA and HVA and red-cell folate. Our observations provide further evidence of the links between folate, biopterin and monoamine metabolism in depression.

Adult

Thiamine and pyridoxine lack newly-admitted psychiatric patients.

One hundred and fifty four patients admitted to a general hospital psychiatric unit with a history of poor diet were examined. Serum pyruvate was estimated in all, red cell transketolase in 74 and red cell aspartate transaminase in 66. Significantly more of the 58 abnormally low thiamine patients than of the normal thiamine group showed clinical signs of malnutrition or were diagnosed as chronic alcoholics, drug addicts, schizophrenics or endogenous depressives. Significantly more endogenous depressives than other patients had a raised aspartate transaminase activity coefficient (pyridoxine lack.) While most low thiamine findings are probably manifestations of malnutrition pyridoxine lack may have some aetiological significance in endogenous depression.

Adolescent

Self-inflicted bleeding and bruising.

Of 8 psychiatrically referred patients with bruises and bleeding, self-injury was admitted in 2 cases and the means of self-injury were discovered in 6. All the patients were fairly young, single or unhappily married females, with unresolved emotional problems, most commonly sexual. 22 of 43 female haematology outpatients showed no haemostatic abnormality and were though to be seeking attention.

Adolescent

Mechanism of the antipsychotic effect in the treatment of acute schizophrenia.

In a double-blind trial in which 45 patients with acute schizophrenia took part the alpha-isomer of flupenthixol (which blocks the dopamine receptor) was found to be significantly more effective than both beta-flupenthixol (which does not) and placebo. The drug effect was confined to the "positive" symptoms--delusions, hallucinations, and though disorder--and appeared only in the 3rd and 4th weeks of the trial. It was as great in patients with evidence of deterioration (Feighner-positive patients) as in patients without deterioration and was less in patients who had affective disturbance in addition to schizophrenia symptoms. The findings are consistent with the hypothesis that dopamine-receptor blockade is the only requirement for antipsychotic activity and suggest that the antipsychotic effect occurs in patients with typically schizophrenic illnesses but may be limited to positive symptoms.

Acute Disease

Area security unit in a psychiatric hospital.

Since 1974 a psychiatric hospital security unit, designed to serve the whole catchment area, has cared for mentally ill (mostly psychotic) patients with disturbed behaviour that cannot be managed in open wards. There are a few long-term dangerous patients but most stay only briefly. The admission of women to the unit was not followed by the expected reduction in violence. The unit has facilities for occupational therapy, physical recreation, work, and study, which are particularly important for those who are too dangerous to leave it. The unit's calming influence depends as much on the supportive effect of the high staff ratio as on the use of tranquillisers. This type of unit is not suitable for patients with personality disturbances who "act out" or for mentally abnormal offenders; but it functions well as a crisis centre for the disturbed mentally ill, and there is an increasing demand for its services.

Adult

Serum folic acid and B12 in 272 psychiatric in-patients.

Serum folate and B12 estimations were carried out on 272 admissions to a psychiatric unit during 1972 and 1973. 21.3% had serum folate below 2 ng/ml and 26.1% serum B12 below 150 pg/ml. The organic psychosis patients had a significantly lower mean B12 than the others, and were over-represented among the low B12 group. Low B12 status was also associated with low RBC and WBC. Low folate status was linked with depression, malnutrition, physical illness and low Hb, RBC and WBC. There were more chronic alcoholics than others with serum folate greater than 4-9 ng/ml, low RBC and macrocytosis. The presence of one or more haematological abnormalities (macrocytosis, low Hb, low RBC or low WBC) predicted low folate in 76%, and low B12 in 79%, but these were also found in 40% of the normal folate and 41% of the normal B12 patients. Macrocytosis may prove to be a reliable sign of alcoholic abuse.

Adult

Unilateral ECT.

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Electroconvulsive Therapy

Crohn's disease: a psychosomatic illness?

We investigated the psychological status of Crohn's disease patients because 10 such patients had been referred to our psychiatric out-patient department over a period of six years, whereas if there were no association between the disease and psychiatric morbidity, the expected referral rate would be one case in 20 to 100 years. We found an association between episodes of psychiatric and physical symptoms in the case histories. We administered the Eysenck Personality Inventory and the Manifest Anxiety Scale to 28 out-patients with Crohn's disease (8 psychiatrically and 20 non-psychiatrically referred), 17 with chronic non-psychosomatic medical diseases, 43 with psychosomatic diseases and 100 with neurosis. Crohn's disease patients were significantly more anxious, neurotic and introverted than both the test norms and the non-psychosomatic medical out-patients and did not differ appreciably from the psychosomatic patients in these respect.

Adjustment Disorders

Comparison of antipsychotic depot injections in the maintenance treatment of schizophrenia.

122 Schizophrenic patients treated with injections of fluphenazine ethanate, 97 with fluphenazine decanoate and 199 with flupenthixol decanoate were followed up for mean times of 41, 33 and 21 months respectively. Their progress was compared by examining reasons for discontinuing injections and outcome in three separate groups defined according to first preparation given; relating the events causing patients to discontinue injections or be readmitted to patient-months spent on each drug; and analysing reasons for inter-drug transfers 43 per cent, 24 per cent and 23 per cent respectively of these three groups of patients discontinued the injections. Severe extrapyramidal effects were most frequent with fluphenazine ethanate, intermediate with fluphenazine decanote, and least frequent frequent with flupenthixol. Lack of cooperation was rather more frequent with flupenthixol than with the other drugs. Severe depression occurred with all three. More patients on fluphenazine injections were transferred for any reason to flupenthixol than vice-versa. A case of 'irreversible' movement disorder was seen with each preparation. It is suggested that current maintenance doses of flupenthixol decanoate are too low.

Adolescent