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Biomedical subjects

P H Rack

Publications and source records attributed to P H Rack.

10 recordsLinked to original sources

Psychiatric and social problems among immigrants.

High rates of mental morbidity among migrants are common but not universal. Differences in rates may reflect factors in: (a) the country of origin; (b) the actual move; (c) the country of settlement. About 1.8 million people came to Britain in 1950-1970 from the West Indies and Indian subcontinent. They resembled Gastarbeiters in other European countries, except that as Commonwealth citizens they had the right of permanent residence. With their children (many of whom are now adults) they are 3.5% of Britain's population. Britain does not have a liberal cosmopolitan culture in which newcomers are welcomed, and the situation has deteriorated in response to high unemployment, constrained public expenditure, and widening gulfs between income-groups. Minority groups are scapegoated, and racial prejudice is more apparent than ever. Black people face obstacles in education and employment. Immigration laws which curtail the right to live in Britain have created insecurity, which is aggravated by insensitive policing and irresponsible press reporting. Institutions and authorities have been slow to respond to the different needs of new cultures. Riots receive more publicity than the daily violence which black people experience, which includes implicit contempt expressed as negative stereotypes, and explicit physical harassment. In this situation a high incidence of stress-related disporders might be predicted. There has been insufficient community-based research but one study of Indian and Pakistani samples showed them to have less mental and emotional disorder than indigenous controls.(ABSTRACT TRUNCATED AT 250 WORDS)

Acculturation↗

Mental illness among Polish and Russian refugees in Bradford.

An epidemiological study of first admission to psychiatric hospitals in Bradford revealed that foreign-born people had substantially higher illness rates than native born. Comparing the major World War II refugee groups it was found that morbidity was higher among Poles than Ukrainians. It is suggested that the difference can be partly explained by the lower social cohesion of the former. The resulting marginal identity is insufficient protection against the normal crises and losses of later life.

Adolescent↗

Ethnic differences in depression and its response to treatment.

There are many cultural variations in the presentation of depression and language problems in describing and interpreting symptoms. The somatization of mental disease varies in different ethnic groups, as does the social significance of disease. These are all important factors in treating immigrant patients and present special difficulties in measurement. Cultural differences are very important in the multi-cultural society which exists today in Britain. Doctors have an obligation to understand these in order to provide the right treatment for patients.

Bipolar Disorder↗

Ethnic differences in drug response.

People from different ethnic or environmental backgrounds may respond differently to psychotropic drugs. The underlying psychogenic or biochemical cause of mental illness may vary in different cultures and cause differences in the presenting symptomatology. The psychotropic effect of drugs may then differ or be interpreted differently. Also, the pharmacokinetics of drugs, particularly rates of metabolism, may differ on account of genetic and/or environmental factors. The relevance of such differences to general clinical treatment will depend on the type of drug. If the margin of safety of a particular compound is small, then variation due to ethnic origin may be an important factor. For relatively safe drugs this is not so crucial but, in psychiatry particularly, unpleasant drug-induced side effects are common and it is desirable to find the preparation most acceptable to the individual. Clinical findings should not be extrapolated from one culture to another without examination of the relevant ethnic groups.

Asia↗

Clinical experience in the treatment of obsessional states (2).

There is no adequate classification of obsessive/compulsive phenomena and they frequently co-exist with other psychiatric symptoms, notably depression. Seven years experience in the use of intravenous clomipramine in these conditions is reviewed. Good results have been obtained in the treatment of depression, and obsessive/compulsive/phobic states, and mixed patients. The results in neuroses and personality disorders are poor. It is concluded that clomipramine is the treatment of choice for obsessive/compulsive disorders, with or without accompanying depression.

Clomipramine↗

Some practical problems in providing a psychiatric service for immigrants.

Immigrant minority groups in a multicultural society create certain problems for the psychiatric services, because of language, diagnostic differences, acceptability, treatment expectations and other differences. A clinical team has been established at a Bradford psychiatric hospital where there are many Asian patients, and some of the problems encountered are described.

Asia↗

Side effects of tricyclic antidepressand drugs with particular reference fo dothiepin.

Fifteen patients on dothiepin and 20 on other tricyclic compounds were compared for side effects by self-rating. The high incidence of complaints beforehand and overall reduction during 2 weeks treatment, correlating with clinical improvement, shows that comparison of side effects is unreliable unless pretreatment incidence is recorded.

Adjustment Disorders↗

Changes in obsessive/compulsive patients as measured by the Leyton Inventory before and after treatment with clomipramine.

The Leyton Obsessional Inventory has been found to be a useful measure in assessing patients before and after treatment with clomipramine. Mean scores for symptoms and interference altered significantly during the course of treatment. The Leyton Obsessional Inventory, however, lacks external validation owing to the absence of some valid alternative quantification. In the absence of such external validation it seems justifiable to use the mean Leyton score diagnostically but not as a sole indication of severity or response to treatment.

Clinical Trials as Topic↗